| Author(s) |
National Institute of Statistics of Rwanda, Kigali, Rwanda Ministry of Finance and Economic Planning, Kigali, Rwanda Ministry of Health, Kigali, Rwanda The DHS Program, ICF International, Rockville, Maryland, USA |
| Table of contents |
TABLES AND FIGURES ..........................................................................................................................................ix
FOREWORD ............................................................................................................................................................ xix
ACKNOWLEDGMENTS ........................................................................................................................................ xxi
MAP OF RWANDA ............................................................................................................................................... xxii
1 INTRODUCTION ......................................................................................................................................... 1
1.1 Country Profile .................................................................................................................................. 1
1.1.1 Geography .......................................................................................................................... 1
1.1.2 Economy ............................................................................................................................. 2
1.1.3 Population ........................................................................................................................... 3
1.1.4 Population Policy ................................................................................................................ 4
1.1.5 Health Policy ...................................................................................................................... 4
1.2 Objectives and Methodology of the Survey ...................................................................................... 5
1.2.1 Objectives of the Survey ..................................................................................................... 6
1.2.2 Questionnaires .................................................................................................................... 7
1.2.3 Sample Design .................................................................................................................... 7
1.2.4 Sample Coverage ................................................................................................................ 8
1.2.5 Anthropometry Measurements, Anemia, Malaria, and HIV Testing .................................. 9
1.3 Pretest .............................................................................................................................................. 11
1.4 Training of Field Staff ..................................................................................................................... 11
1.5 Fieldwork ........................................................................................................................................ 12
1.6 Data Processing ............................................................................................................................... 12
2 HOUSEHOLD CHARACTERISTICS ..................................................................................................... 13
2.1 Household Population by Age and Sex ........................................................................................... 13
2.2 Household Composition .................................................................................................................. 15
2.3 Educational Attainment ................................................................................................................... 16
2.4 School Attendance .......................................................................................................................... 18
2.5 Household Conditions ..................................................................................................................... 20
2.5.1 Household Drinking Water ............................................................................................... 20
2.5.2 Household Sanitation Facilities ........................................................................................ 21
2.5.3 Household Hand Washing Places ..................................................................................... 22
2.5.4 Household Characteristics ................................................................................................ 23
2.5.5 Household Possession of Durable Goods ......................................................................... 25
2.5.6 Household Wealth ............................................................................................................ 26
2.6 Birth Registration ............................................................................................................................ 27
2.7 Children’s Living Arrangements and Orphanhood ......................................................................... 28
2.8 School Attendance by Survivorship of Parents ............................................................................... 29
2.9 Health Insurance Coverage and Bank Accounts ............................................................................. 30
3 RESPONDENT CHARACTERISTICS .................................................................................................... 35
3.1 Background Characteristics of Respondents ................................................................................... 35
3.2 Educational Attainment ................................................................................................................... 37
3.3 Literacy ........................................................................................................................................... 38
3.4 Exposure to Mass Media ................................................................................................................. 40
3.5 Employment .................................................................................................................................... 43
3.6 Use of Tobacco ............................................................................................................................... 48
4 PROXIMATE DETERMINANTS OF FERTILITY ............................................................................... 51
4.1 Marital Status .................................................................................................................................. 51
4.2 Polygamy ........................................................................................................................................ 52
4.3 Age at First Union ........................................................................................................................... 54
4.4 Age at First Sexual Intercourse ....................................................................................................... 56
4.5 Recent Sexual Activity .................................................................................................................... 58
5 FERTILITY ................................................................................................................................................. 61
5.1 Fertility Levels and Differentials .................................................................................................... 62
5.2 Fertility Trends ................................................................................................................................ 65
5.3 Children Ever Born and Living ....................................................................................................... 67
5.4 Birth Intervals ................................................................................................................................. 68
5.5 Exposure to the Risk of Pregnancy ................................................................................................. 70
5.6 Menopause ...................................................................................................................................... 71
5.7 Age at First Birth ............................................................................................................................ 72
5.8 Teenage Fertility ............................................................................................................................. 73
6 FERTILITY PREFERENCES ................................................................................................................... 75
6.1 Desire for Children.......................................................................................................................... 75
6.2 Ideal Number of Children ............................................................................................................... 78
6.3 Fertility Planning Status .................................................................................................................. 80
7 FAMILY PLANNING ................................................................................................................................ 83
7.1 Knowledge of Contraceptive Methods ............................................................................................ 83
7.2 Current Use of Contraceptive Methods ........................................................................................... 85
7.2.1 Current Use of Contraception by Age .............................................................................. 85
7.2.2 Current Use of Contraception by Background Characteristics ......................................... 87
7.2.3 Trends in Current Use of Family Planning ....................................................................... 89
7.3 Timing of Sterilization .................................................................................................................... 89
7.4 Source of Supply ............................................................................................................................. 89
7.5 Use of Social Marketing Brands of Pills and Condoms .................................................................. 90
7.6 Informed Choice ............................................................................................................................. 91
7.7 Contraceptive Discontinuation ........................................................................................................ 92
7.8 Reasons for Discontinuation of Contraceptive Use ........................................................................ 93
7.9 Knowledge of Fertile Period ........................................................................................................... 94
7.10 Need and Demand for Family Planning Services ........................................................................... 95
7.10.1 Need and Demand for Family Planning among Currently Married Women .................... 95
7.10.2 Need and Demand for Family Planning among All Women and Women Who Are Not Currently Married .... 97
7.11 Future Use of Contraception ........................................................................................................... 98
7.12 Exposure to Family Planning Messages .......................................................................................... 99
7.13 Contact of Nonusers with Family Planning Providers .................................................................. 100
8 INFANT AND CHILD MORTALITY .................................................................................................... 103
8.1 Assessment of Data Quality .......................................................................................................... 104
8.2 Levels and Trends in Childhood Mortality ................................................................................... 105
8.3 Socioeconomic Differentials in Childhood Mortality ................................................................... 106
8.4 Demographic Differentials in Mortality ........................................................................................ 107
8.5 Perinatal Mortality ........................................................................................................................ 108
8.6 High-Risk Fertility Behavior......................................................................................................... 110
9 MATERNAL HEALTH ............................................................................................................................ 113
9.1 Antenatal Care .............................................................................................................................. 113
9.1.1 Components of Antenatal Care ....................................................................................... 115
9.1.2 Tetanus Vaccinations ...................................................................................................... 117
9.2 Delivery Care ................................................................................................................................ 118
9.2.1 Place of Delivery ............................................................................................................ 118
9.2.2 Assistance during Delivery ............................................................................................. 120
9.3 Postnatal Care ............................................................................................................................... 122
9.3.1 Maternal Postnatal Care .................................................................................................. 122
9.3.2 Newborn Postnatal Care ................................................................................................. 124
9.4 Problems in Accessing Health Care .............................................................................................. 126
10 CHILD HEALTH ...................................................................................................................................... 129
10.1 Child’s Size at Birth ...................................................................................................................... 130
10.2 Vaccination of Children ................................................................................................................ 131
10.3 Trends in Vaccination Coverage ................................................................................................... 133
10.4 Childhood Illnesses ....................................................................................................................... 134
10.4.1 Acute Respiratory Infections .......................................................................................... 134
10.4.2 Fever ............................................................................................................................... 135
10.5 Diarrheal Disease .......................................................................................................................... 137
10.5.1 Prevalence of Diarrhea.................................................................................................... 137
10.5.2 Treatment of Diarrhea ..................................................................................................... 138
10.5.3 Feeding Practices during Diarrhea .................................................................................. 140
10.6 Knowledge of ORS Packets .......................................................................................................... 142
10.7 Stool Disposal ............................................................................................................................... 142
11 NUTRITION OF CHILDREN AND ADULTS ...................................................................................... 145
11.1 Nutritional Status of Children ....................................................................................................... 146
11.1.1 Measurement of Nutritional Status among Young Children ........................................... 146
11.1.2 Measures of Child Nutritional Status .............................................................................. 147
11.1.3 Trends in Children’s Nutritional Status .......................................................................... 150
11.2 Initiation of Breastfeeding ............................................................................................................ 151
11.3 Breastfeeding Status by Age ......................................................................................................... 152
11.4 Duration of Breastfeeding ............................................................................................................. 154
11.5 Types of Complementary Foods ................................................................................................... 156
11.6 Infant and Young Child Feeding (IYCF) Practices ....................................................................... 157
11.7 Prevalence of Anemia in Children ................................................................................................ 160
11.8 Micronutrient Intake among Children ........................................................................................... 162
11.9 Iodization of Household Salt ......................................................................................................... 165
11.10 Nutritional Status of Women ........................................................................................................ 165
11.11 Prevalence of Anemia in Women ................................................................................................. 167
11.12 Micronutrient Intake among Mothers ........................................................................................... 169
11.13 Nutritional Status of Men .............................................................................................................. 170
12 MALARIA ................................................................................................................................................. 173
12.1 Mosquito Nets ............................................................................................................................... 175
12.1.1 Ownership of Mosquito Nets .......................................................................................... 175
12.1.2 Use of Mosquito Nets by Persons in the Household ....................................................... 177
12.1.3 Use of Mosquito Nets by Children under Age 5 ............................................................. 178
12.1.4 Use of Mosquito Nets by Pregnant Women .................................................................... 179
12.2 Prevalence and Prompt Treatment of Fever .................................................................................. 180
12.3 Prevalence of Anemia and Malaria in Children and Women ........................................................ 182
13 HIV- AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR ............................. 189
13.1 Knowledge of HIV and AIDS and of Transmission and Prevention Methods .............................. 190
13.1.1 Awareness of AIDS ........................................................................................................ 190
13.1.2 HIV Prevention Methods ................................................................................................ 190
13.1.3 Knowledge about Transmission ...................................................................................... 192
13.1.4 Knowledge of Prevention of Mother-to-Child Transmission of HIV ............................. 195
13.2 Stigma Associated with AIDS and Attitudes Related to HIV and AIDS ...................................... 196
13.3 Attitudes toward Negotiating Safer Sex ........................................................................................ 198
13.4 Attitudes toward Condom Education for Youth ............................................................................ 200
13.5 Multiple and Concurrent Partnerships and Paying for Sex ........................................................... 201
13.5.1 Multiple Sexual Partnerships .......................................................................................... 201
13.5.2 Concurrent Sexual Partners ............................................................................................ 204
13.5.3 Payment for Sex .............................................................................................................. 206
13.6 Prior Testing for HIV .................................................................................................................... 207
13.7 HIV Testing during Antenatal Care .............................................................................................. 209
13.8 Reports of Recent Sexually Transmitted Infections ...................................................................... 211
13.9 Needle and Syringe Injection ........................................................................................................ 213
13.10 HIV- and AIDS-related Knowledge and Behavior among Youth ................................................. 214
13.10.1 Knowledge about HIV and AIDS and Sources for Condoms ......................................... 215
13.10.2 Age at First Sex and Condom Use at First Sexual Intercourse ....................................... 216
13.10.3 Premarital Sexual Activity .............................................................................................. 217
13.10.4 Multiple Sexual Partnerships .......................................................................................... 218
13.10.5 Age-mixing in Sexual Relationships .............................................................................. 218
13.10.6 Recent HIV Testing among Youth ................................................................................. 219
13.11 Male Circumcision ........................................................................................................................ 220
14 HIV PREVALENCE ................................................................................................................................. 225
14.1 Coverage Rates for HIV Testing among Adults ........................................................................... 226
14.2 HIV Prevalence among Adults ...................................................................................................... 228
14.2.1 HIV Prevalence by Age and Sex .................................................................................... 228
14.2.2 Trends in HIV Prevalence ............................................................................................... 229
14.2.3 HIV Prevalence by Socioeconomic Characteristics ........................................................ 230
14.2.4 HIV Prevalence by Demographic Characteristics........................................................... 231
14.2.5 HIV Prevalence by Sexual Risk Behavior ...................................................................... 233
14.3 HIV Prevalence among Youth ...................................................................................................... 234
14.3.1 Overall HIV Prevalence among Youth ........................................................................... 234
14.3.2 HIV Prevalence among Youth by Condom Use at Last Sex ........................................... 235
14.4 HIV Prevalence by Other Characteristics ..................................................................................... 236
14.4.1 HIV Prevalence and STIs ............................................................................................... 236
14.4.2 HIV Prevalence by Male Circumcision .......................................................................... 237
14.4.3 Prior HIV Testing by Current HIV Status ...................................................................... 238
14.5 HIV Prevalence among Cohabiting Couples ................................................................................ 239
14.6 HIV Prevalence among Children .................................................................................................. 241
15 WOMEN’S STATUS AND DEMOGRAPHIC AND HEALTH OUTCOMES ................................... 243
15.1 Women’s and Men’s Employment ................................................................................................ 243
15.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s Earnings ..... 244
15.3 Women’s and Men’s Ownership of Selected Assets ..................................................................... 248
15.4 Women’s Participation in Decision-making ................................................................................. 250
15.5 Attitudes toward Wife Beating ...................................................................................................... 253
15.6 Women’s Empowerment Indicators .............................................................................................. 256
15.7 Current Use of Contraception by Women’s Empowerment Status ............................................... 256
15.8 Ideal Family Size and Unmet Need by Women’s Status .............................................................. 257
15.9 Women’s Status and Reproductive Health Care ........................................................................... 258
16 ADULT AND MATERNAL MORTALITY ........................................................................................... 261
16.1 Data Quality Issues ....................................................................................................................... 261
16.2 Adult Mortality ............................................................................................................................. 263
16.3 Maternal Mortality ........................................................................................................................ 263
17 DOMESTIC VIOLENCE ......................................................................................................................... 267
17.1 Measurement of Violence ............................................................................................................. 267
17.1.1 Use of Valid Measures of Violence ................................................................................ 267
17.1.2 Ethical Considerations in the 2014-15 RDHS ................................................................ 269
17.1.3 Subsample for the Violence Module ............................................................................... 269
17.2 Experience of Physical Violence .................................................................................................. 269
17.3 Perpetrators of Physical Violence ................................................................................................. 272
17.4 Experience of Sexual Violence ..................................................................................................... 273
17.5 Perpetrators of Sexual Violence .................................................................................................... 275
17.6 Age at First Experience of Sexual Violence ................................................................................. 275
17.7 Experience of Different Forms of Violence .................................................................................. 276
17.8 Violence during Pregnancy ........................................................................................................... 277
17.9 Marital Control by Spouse ............................................................................................................ 278
17.10 Forms of Spousal Violence ........................................................................................................... 281
17.11 Spousal Violence by Background Characteristics ......................................................................... 284
17.12 Violence by Spousal Characteristics and Empowerment Indicators ............................................. 286
17.13 Recent Spousal Violence .............................................................................................................. 289
17.14 Onset of Spousal Violence ............................................................................................................ 291
17.15 Physical Consequences of Spousal Violence ................................................................................ 291
17.16 Violence by Women and Men against Their Spouse .................................................................... 293
17.17 Help-seeking Behavior by Those Who Experience Violence ....................................................... 297
18 EARLY CHILDHOOD EDUCATION AND DEVELOPMENT .......................................................... 301
18.1 Prevalence of Early Childhood Education .................................................................................... 301
18.2 Adult Involvement in Early Learning Activities ........................................................................... 302
18.3 Children’s Books and Playthings .................................................................................................. 304
18.4 Adequate Care for Young Children .............................................................................................. 305
18.5 Early Childhood Development ...................................................................................................... 306
REFERENCES ........................................................................................................................................................ 309
APPENDIX A SAMPLE IMPLEMENTATION ............................................................................................... 313
A.1 Introduction .................................................................................................................... 313
A.2 Sampling Frame .............................................................................................................. 313
A.3 Structure of the Sample and the Sampling Procedure ..................................................... 316
A.4 Selection Probability and Sampling Weight ................................................................... 318
A.5 Survey Results ................................................................................................................ 320
APPENDIX B ESTIMATES OF SAMPLING ERRORS ................................................................................. 327
APPENDIX C DATA QUALITY TABLES ....................................................................................................... 349
APPENDIX D DISTRICT TABLES................................................................................................................... 365
APPENDIX E SURVEY PERSONNEL ............................................................................................................. 471
APPENDIX F QUESTIONNAIRES .................................................................................................................. 477 |
