| Author(s) |
Ministry of Health, Ramshah Path, Kathmandu, Nepal New ERA, Kathmandu, Nepal The DHS Program, ICF, Rockville, Maryland, USA |
| Date |
2017-11-01 |
| Country |
Nepal |
| Language |
English |
| Table of contents |
FOREWORD ............................................................................................................................................ xix
ACKNOWLEDGEMENTS ..................................................................................................................... xxi
2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY TECHNICAL ADVISORY COMMITTEE .......... xxiii
2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY TECHNICAL WORKING
GROUP ...................................................................................................................................... xxiv
CONTRIBUTORS TO THE REPORT .................................................................................................. xxv
ACRONYMS AND ABBREVIATIONS .............................................................................................. xxvii
READING AND UNDERSTANDING TABLES FROM THE 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY (NDHS) ... xxxi
SUSTAINABLE DEVELOPMENT GOAL INDICATORS ............................................................ xxxvii
MAP OF NEPAL ...................................................................................................................................... xlii
1 INTRODUCTION AND SURVEY METHODOLOGY .............................................................. 1
1.1 Survey Objectives ..............................................................................................1
1.2 Sample Design ...................................................................................................1
1.3 Questionnaires....................................................................................................3
1.4 Anthropometry, Hemoglobin Testing, and Blood Pressure Measurement ........4
1.5 Pretest .................................................................................................................5
1.6 Training of Field Staff .......................................................................................5
1.7 Fieldwork ...........................................................................................................6
1.8 Data Processing ..................................................................................................7
1.9 Response Rates ..................................................................................................7
2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION ............................... 9
2.1 Drinking Water Sources and Treatment ............................................................9
2.2 Sanitation .........................................................................................................10
2.3 Exposure to Smoke inside the Home and Other Household Characteristics ....11
2.3.1 Exposure to Smoke Inside the Home ................................................11
2.3.2 Other Housing Characteristics ..........................................................11
2.3.3 Household Durable Goods ................................................................11
2.3.4 Access to Government Health Facilities ...........................................11
2.4 Household Wealth ............................................................................................11
2.5 Hand Washing ..................................................................................................12
2.6 Household Population and Composition .........................................................13
2.7 Migration..........................................................................................................14
2.8 Birth Registration .............................................................................................14
2.9 Children’s Living Arrangements and Parental Survival ..................................15
2.10 Education .........................................................................................................15
2.10.1 Educational Attainment ....................................................................15
2.10.2 School Attendance ............................................................................16
2.10.3 Other Measures of School Attendance .............................................17
2.11 Possession of Mosquito Nets ...........................................................................17
2.12 Knowledge of Lymphatic Filariasis .................................................................17
2.13 Food Security ...................................................................................................18
3 CHARACTERISTICS OF RESPONDENTS ............................................................................. 43
3.1 Basic Characteristics of Survey Respondents ..................................................43
3.2 Spousal Separation ...........................................................................................44
3.3 Education and Literacy ....................................................................................44
3.4 Mass Media Exposure and Internet Usage.......................................................45
3.5 Employment .....................................................................................................46
3.6 Occupation .......................................................................................................47
3.7 Tobacco Use.....................................................................................................47
3.8 Knowledge and Attitudes Regarding Tuberculosis .........................................48
4 MARRIAGE AND SEXUAL ACTIVITY .................................................................................. 75
4.1 Marital Status ...................................................................................................75
4.2 Polygyny ..........................................................................................................76
4.3 Age at First Marriage .......................................................................................77
4.4 Age at First Sexual Intercourse ........................................................................77
4.5 Recent Sexual Activity ....................................................................................78
5 FERTILITY ................................................................................................................................... 89
5.1 Current Fertility ...............................................................................................89
5.2 Children Ever Born and Living........................................................................91
5.3 Birth Intervals ..................................................................................................91
5.4 Insusceptibility to Pregnancy ...........................................................................92
5.5 Age at First Birth .............................................................................................93
5.6 Teenage Childbearing and Sexual and Reproductive Behaviors before Age 15 .... 93
5.6.1 Teenage Childbearing .......................................................................93
5.6.2 Sexual and Reproductive Behaviors before Age 15 .........................94
6 FERTILITY PREFERENCES ................................................................................................... 103
6.1 Desire for Another Child ...............................................................................103
6.2 Ideal Family Size ...........................................................................................104
6.3 Fertility Planning Status .................................................................................105
6.4 Wanted Fertility Rates ...................................................................................106
7 FAMILY PLANNING ................................................................................................................ 115
7.1 Contraceptive Knowledge and Use ................................................................115
7.2 Source of Modern Contraceptive Methods ....................................................118
7.3 Informed Choice ............................................................................................118
7.4 Discontinuation of Contraceptives .................................................................119
7.5 Demand for Family Planning .........................................................................119
7.6 Decision Making about Family Planning ......................................................121
7.7 Future Use of Contraception ..........................................................................121
7.8 Exposure to Family Planning Messages in the Media ...................................121
7.9 Contact of Nonusers with Family Planning Providers ...................................121
8 INFANT AND CHILD MORTALITY ...................................................................................... 141
8.1 Infant and Child Mortality .............................................................................142
8.2 Biodemographic and Sociodemographic Risk Factors ..................................143
8.3 Perinatal Mortality .........................................................................................144
8.4 High-risk Fertility Behavior ...........................................................................145
9 MATERNAL AND NEWBORN HEALTH CARE.................................................................. 151
9.1 Antenatal Care Coverage ...............................................................................152
9.1.1 Skilled Providers .............................................................................152
9.1.2 Timing and Number of ANC Visits ................................................152
9.2 Components of ANC Visits ...........................................................................153
9.3 Protection against Neonatal Tetanus ..............................................................154
9.4 Delivery Services ...........................................................................................154
9.4.1 Institutional Deliveries ....................................................................154
9.4.2 Skilled Assistance during Delivery .................................................155
9.4.3 Delivery by Cesarean ......................................................................156
9.4.4 Care and Support during Delivery ..................................................157
9.5 Postnatal Care ................................................................................................158
9.5.1 Postnatal Health Check for Mothers ...............................................158
9.5.2 Postnatal Health Check for Newborns ............................................159
9.5.3 Newborn Care Practices ..................................................................160
9.6 Abortion .........................................................................................................161
9.6.1 Knowledge that Abortion Is Legal ..................................................161
9.6.2 Pregnancy Outcomes ......................................................................162
9.6.3 Abortion Status among Women ......................................................162
9.7 Problems in Accessing Health Care ...............................................................163
10 CHILD HEALTH ........................................................................................................................ 201
10.1 Birth Weight...................................................................................................201
10.2 Vaccination of Children .................................................................................202
10.3 Symptoms of Acute Respiratory Infection ....................................................204
10.4 Fever ..............................................................................................................205
10.5 Diarrheal Disease ...........................................................................................205
10.5.1 Prevalence of Diarrhea ....................................................................205
10.5.2 Treatment or Advice Seeking during Diarrhea ...............................206
10.5.3 Feeding Practices ............................................................................207
10.5.4 Treatment of Diarrhea .....................................................................208
10.6 Disposal of Children’s Stools ........................................................................209
11 NUTRITION OF CHILDREN AND ADULTS ........................................................................ 223
11.1 Nutritional Status of Children ........................................................................223
11.1.1 Measurement of Nutritional Status among Young Children ..........224
11.1.2 Data Collection ...............................................................................225
11.1.3 Levels of Child Malnutrition ..........................................................225
11.2 Infant and Young Child Feeding Practices ....................................................226
11.2.1 Initiation of Breastfeeding ..............................................................226
11.2.2 Exclusive Breastfeeding..................................................................227
11.2.3 Median Duration of Breastfeeding..................................................227
11.2.4 Infant and Young Child Feeding (IYCF) Indicators and Breastfeeding Status ....228
11.2.5 Complementary Feeding .................................................................228
11.2.6 Minimum Acceptable Diet ..............................................................229
11.3 Anemia Prevalence in Children .....................................................................230
11.4 Presence of Iodized Salt in Households .........................................................232
11.5 Micronutrient Intake and Supplementation among Children.........................232
11.6 Adult Nutritional Status .................................................................................233
11.6.1 Nutritional Status of Women ..........................................................233
11.6.2 Nutritional Status of Men................................................................234
11.7 Anemia Prevalence in Women .......................................................................235
11.8 Micronutrient Intake and Food Consumed among Mothers ..........................236
11.8.1 Micronutrient Intake among Mothers .............................................236
11.8.2 Food Consumed by Mothers ...........................................................237
11.9 Counseling on Maternal, Infant, and Young Child Nutrition ........................237
11.10 Growth Monitoring and Promotion and Counseling at the Monitoring and Promotion Session ......238
12 ADULT AND MATERNAL MORTALITY ............................................................................. 259
12.1 Data ................................................................................................................259
12.2 Direct Estimates of Adult Mortality ..............................................................260
12.3 Direct Estimates of Maternal Mortality .........................................................261
12.4 Trends in Pregnancy-Related Mortality .........................................................262
13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR ......................... 265
13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods ..................266
13.2 Knowledge about Mother-to-Child Transmission .........................................267
13.3 Discriminatory Attitudes towards People Living with HIV ..........................267
13.4 Multiple Sexual Partners ................................................................................268
13.5 Paid Sex .........................................................................................................268
13.6 Coverage of HIV Testing Services ................................................................269
13.6.1 Awareness of HIV Testing Services and Experience with HIV Testing ...269
13.6.2 HIV Testing of Pregnant Women ...................................................270
13.7 Knowledge on Treatment for HIV .................................................................270
13.8 Self-reporting of Sexually Transmitted Infections ........................................270
13.9 HIV/AIDS-Related Knowledge and Behavior among Young People ...........271
13.9.1 Knowledge ......................................................................................271
13.9.2 First Sex ..........................................................................................271
13.9.3 Premarital Sex .................................................................................272
13.9.4 Multiple Sexual Partners .................................................................272
13.9.5 Coverage of HIV Testing Services .................................................273
14 BLOOD PRESSURE .................................................................................................................. 289
14.1 History of High Blood Pressure .....................................................................289
14.2 Blood Pressure status ....................................................................................290
15 WOMEN’S EMPOWERMENT ................................................................................................ 301
15.1 Married Women’s and Men’s Employment ..................................................301
15.2 Control over Women’s Earnings ...................................................................302
15.2.1 Control over Men’s Earnings ..........................................................303
15.3 Women’s Control over Their Own Earnings and over Those of Their Husbands ....303
15.4 Women’s and Men’s Ownership of Assets ....................................................304
15.5 Ownership of Title or Deed for House and Land ..........................................304
15.6 Knowledge About the Household Property ...................................................305
15.7 Ownership and Use of Bank Accounts and Mobile Phones ..........................305
15.8 Women’s Participation in Decision Making ..................................................306
15.9 Attitudes towards Wife Beating .....................................................................307
15.10 Attitude towards Negotiating Safer Sexual Relations with Husband ............307
15.11 Ability to Negotiate Sexual Relations with Husband ....................................308
15.12 Women’s Empowerment Indicators ..............................................................308
15.13 Current Use of Contraception by Women’s Empowerment ..........................309
15.14 Ideal Number of Children and Unmet Need for Family Planning by Women’s Empowerment ......309
15.15 Reproductive Health Care by Women’s Empowerment ................................309
15.16 Early Childhood Mortality and Women’s Empowerment .............................309
16 DOMESTIC VIOLENCE ........................................................................................................... 337
16.1 Measurement of Violence ..............................................................................338
16.2 Women’s Experience of Physical Violence ...................................................339
16.2.1 Perpetrators of Physical Violence ..................................................................340
16.3 Experience of Sexual Violence ......................................................................340
16.3.1 Prevalence of Sexual Violence .......................................................340
16.3.2 Perpetrators of Sexual Violence......................................................340
16.4 Experience of Different Forms of Violence...................................................340
16.5 Marital Control by Husband ..........................................................................341
16.6 Forms of Spousal Violence ............................................................................341
16.6.1 Prevalence of Spousal Violence......................................................342
16.6.2 Onset of Spousal Violence ..............................................................344
16.7 Injuries to Women due to Spousal Violence..................................................344
16.8 Violence Initiated by Women against Husbands ...........................................345
16.9 Forms of Emotional Violence in the household ...........................................346
16.10 Help-Seeking among Women Who Have Experienced Violence ..346
16.10.1 Sources for Help .............................................................................347
17 CAUSE OF DEATH IN NEONATES ....................................................................................... 365
17.1 The Verbal Autopsy Instrument.....................................................................365
17.2 Data Collection Methods ...............................................................................366
17.3 Quality Assurance ..........................................................................................366
17.4 Cause of Death Certification and coding .......................................................366
17.5 Characteristics of Neonatal Deaths and Stillbirths ........................................367
17.6 Cause of Neonatal Deaths ..............................................................................368
17.7 Cause of Stillbirths .........................................................................................369
17.8 Health Services related to Neonatal Deaths and Stillbirths ...........................369
REFERENCES.......................................................................................................................................... 375
APPENDIX A SAMPLE DESIGN ....................................................................................................... 379
A.1 Introduction ....................................................................................................379
A.2 Sample Frame ................................................................................................379
A.3 Sample Design and Implementation ..............................................................380
A.4 Sample Probabilities and Sampling Weights .................................................383
APPENDIX B ESTIMATES OF SAMPLING ERRORS .................................................................. 385
APPENDIX C DATA QUALITY TABLES ........................................................................................ 399
APPENDIX D MORTALITY CLASSIFICATION AND WHO INTERNATIONAL
CLASSIFICATION OF DISEASE (ICD) CODES .................................................... 405
APPENDIX E PERSONS INVOLVED IN THE 2016 NEPAL DEMOGRAPHIC AND
HEALTH SURVEY ...................................................................................................... 407
APPENDIX F QUESTIONNAIRES .................................................................................................... 411 |
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