Abstract

The 2000 Namibia Demographic and Health Survey (NDHS) was implemented to assess the progress made in the health sector since the 1992 NDHS. It therefore focused on measuring achievements related to the same indicators as in 1992, but also included new aspects, e.g. HIV/AIDS. Furthermore, the 2000 NDHS was designed to obtain reliable data for all 13 administrative regions, which had not been established at the time of the 1992 NDHS. In addition, data for the four MOHSS Regional Directorates are included, which provide comparison to the 1992 NDHS results at the sub-national level.

A nationally representative sample of 6,755 women age 15-49 and a sub-sample of about 2,954 men age 15-59 were interviewed in the 2000 NDHS. Twenty mobile teams conducted the interviews from late September to mid-December 2000.

The primary objective of the 2000 NDHS was to provide up-to-date information on fertility and mortality, family planning, fertility preferences, maternal and child health, and knowledge and behaviour regarding HIV/AIDS. The 2000 NDHS was patterned after the 1992 NDHS so as to maximise the ability to measure trends on similar indicators between 1992 and 2000. The ultimate intent is to use this information to evaluate existing programmes and design new strategies in order to ensure delivery of health and social welfare services to the population in a cost effective and efficient manner.

MAIN RESULTS

• Household Characteristics : As part of the 2000 NDHS, households were assessed as to the availability of various amenities. The survey found that 79 percent of households have access to safe drinking water, compared to only 68 percent in 1992.Nationally, 45 percent of households have sanitary means of excreta disposal, compared to 40 percent in 1992. There are large disparities by residence, with 85 percent of households in urban areas having sanitary toilets, compared to only 19 percent of rural households. Overall, some 63 percent of households consume adequately iodised salt. The disparity between urban and rural areas is small at 68 percent and 60 percent, respectively.

• Fertility : The total fertility rate (TFR) for the three-year period before the survey is 4.2 births per woman. This represents a sharp decline from 5.4 births per woman for the 3-year period prior to 1992, a net reduction of 1.2 children or a 22 percent decline over the past eight years.

• Family planning : Some knowledge of family planning is nearly universal among Namibian women, 97 percent of whom have heard of at least one method. Knowledge of methods is only slightly higher among married women than all women.

• Fertility Preferences : Overall, close to half (48 percent) of all women age 15-49 either do not want any more children or have already been sterilised. Forty-five percent of women would like to have a child in the future; however, half of these women (22 percent) would like to wait two or more years before having another child.

• Maternal Health : Survey results show that the vast majority of pregnant women in Namibia (93 percent) receive antenatal care. More than 9 in 10 women receive antenatal care from a medical professional (91 percent), mostly from nurses and midwives (78 percent). Doctors provide 13 percent of antenatal care services, while traditional birth attendants provide only 2 percent of antenatal care.

• Child Health : According to the health passport and mothers' reports, 65 percent of children 12-23 month have received all the recommended vaccinations, and only 5 percent have not received any vaccinations. When compared to the 1992 NDHS, the percentage of children aged 12-23 months who had received all vaccinations has improved, from 58 percent in 1992 to 65 percent in 2000.

• HIV/AIDS : Awareness of AIDS is almost universal in Namibia, with 98 percent of women and over 99 percent of men saying they had heard of AIDS. It is very encouraging to note that large majorities of both women (81 percent) and men (87 percent) spontaneously mention condoms as a means of avoiding HIV.

In conclusion, the 2000 NDHS provides a valuable source of data on a wide variety of indicators, which permit the assessment of progress achieved over the past 8 years. In general, considerable improvements have occurred in the health sector. However, many challenges remain to further improve the health of the Namibian nation.

Geographic coverage

The 2000 NDHS sample was designed to produce reliable estimates of most of the major survey variables for the country as whole; for urban and rural areas separately; and for each of the 13 regions.

Analysis unit

• Household
• Women age 15-49
• Men age 15-59
• Children under five

Universe

The population covered by the 2000 NDHS is defined as the universe of all women age 15-49 in Namibia and all men age 15-54 living in the household.

Kind of data

Sample survey data

Sampling procedure

The 2000 NDHS sample was designed to produce reliable estimates of most of the major survey variables for the country as whole; for urban and rural areas separately; and for each of the 13 regions. The design called for a nationally representative probability sample of 6,500 women age 15-49 and a subsample of about 3,000 men age 15-59.

The 2000 NDHS sample was largely based on the Central Bureau of Statistics' master sample, drawn from the list of enumeration areas (EAs) created for the 1991 census. In 1997, new EAs were demarcated in Walvis Bay, which was not part of Namibia at the time of the 1991 census. The new EAs were incorporated into the 1991 census frame and the number of primary sampling units (PSUs) in the master sample was increased. A PSU corresponds to an entire EA or a group of EAs.

Due to considerable rural-urban migration, extensive peripheral development and intensive development of previously rural areas has taken place since 1991, particularly in Windhoek. At the time of the 2000 NDHS sample design, new EAs were being demarcated for the upcoming population census. A list of the new EAs in the urban areas of Caprivi, Hardap, Kunene, Omaheke, Oshana, and Otjozondjupa Regions was made available for the sample selection. Finally, in Khomas Region, a quick count of dwellings both in the old EAs within Windhoek and in the newly demarcated EAs in the informal settlement zones on the outskirts of Windhoek was implemented in order to get an up-to-date measure of size for the capital city.

The sampling frame for the 2000 NDHS was obtained by supplementing the master sample with the list of the new EAs in urban areas in selected regions and the updated EAs in Khomas Region. It should also be noted that the urban-rural classification of EAs was changed in the master sample so as to reflect the recent proclamation of municipalities, towns and villages. Some of the EAs were also shifted from one region to another following changes in regional boundaries.

The 2000 NDHS sample was selected in two stages. In the first stage, 260 PSUs (106 urban and 154 rural) were selected with probability proportional to the number of households within the PSU. Each selected PSU was divided into segments, one of which was retained in the sample. All households residing in the selected segment were included in the sample and all women age 15-49 listed in these households were eligible for individual interview. In one-half of the households, all men age 15-59 were also eligible.

Mode of data collection

Face-to-face

Research instrument

The 2000 NDHS involved three questionnaires: a) a household questionnaire, b) a questionnaire for individual women 15-49, and c) a questionnaire for individual men 15-59. These instruments were based on the model questionnaires developed for the international DHS program, as well as on the questionnaires used in the 1992 NDHS.

The questionnaires were developed in English and translated into six local languages-Afrikaans, Damara/Nama, Herero, Kwangali, Lozi, and Oshiwambo. People other than the initial translators did back translations into English with the goal of verifying the accuracy of the translations.

a) The household questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the household questionnaire was to identify women and men eligible for individual interview and children under five who were to be weighed and measured. In addition, information was collected about the dwelling itself, such as the source of water, type of toilet facilities, materials used to construct the house, ownership of various consumer goods, use of iodised salt, and household expenditures on health care.

b) The Woman's Questionnaire was used to collect information from all women aged 15-49 and covered the following topics: - Background characteristics (age, education, religion, etc.); - Reproductive history; - Knowledge and use of contraceptive methods; - Antenatal, delivery, and postnatal care (including tetanus toxoid testing); - Breastfeeding and weaning practices; - Child health and immunisation; - Marriage and recent sexual activity; - Fertility preferences; - Knowledge of HIV/AIDS (condom use, number of partners, etc.); - Maternal mortality; - Husband's background and respondent's work.

c) In every second household, in addition to the women, all men age 15-59 were eligible to be interviewed with the Man's Questionnaire, which covered: - Background characteristics (age, education, religion, etc.); - Knowledge and use of contraceptive methods; - Marriage and

It is presumed that the first humans migrated from Siberia to North America approximately twelve thousand years ago, where they then moved southwards to warmer lands. It was not until many centuries later that humans returned to the north and began to settle regions that are now part of Canada. Despite a few short-lived Viking settlements on Newfoundland around the turn of the first millennium CE, the Italian explorer Giovanni Caboto (John Cabot), became the first European to explore the coast of North America in the late 1400s. The French and British crowns both made claims to areas of Canada throughout the sixteenth century, but real colonization and settlement did not begin until the early seventeenth century. Over the next 150 years, France and Britain competed to take control of the booming fur and fishing trade, and to expand their overseas empires. In the Seven Year's War, Britain eventually defeated the French colonists in North America, through superior numbers and a stronger agriculture resources in the southern colonies, and the outcome of the war saw France cede practically all of it's colonies in North America to the British.

Increased migration and declining native populations

The early 1800s saw a large influx of migrants into Canada, with the Irish Potato Famine bringing the first wave of mass-migration to the country, with further migration coming from Scandinavia and Northern Europe. It is estimated that the region received just shy of one million migrants from the British Isles alone, between 1815 and 1850, which helped the population grow to 2.5 million in the mid-1800s and 5.5 million in 1900. It is also estimated that infectious diseases killed around 25 to 33 percent of all Europeans who migrated to Canada before 1891, and around a third of the Canadian population is estimated to have emigrated southwards to the United States in the 1871-1896 period. From the time of European colonization until the mid-nineteenth century, the native population of Canada dropped from roughly 500,000 (some estimates put it as high as two million) to just over 100,000; this was due to a mixture of disease, starvation and warfare, instigated by European migration to the region. The native population was generally segregated and oppressed until the second half of the 1900s; Native Canadians were given the vote in 1960, and, despite their complicated and difficult history, the Canadian government has made significant progress in trying to include indigenous cultures in the country's national identity in recent years. As of 2020, Indigenous Canadians make up more than five percent of the total Canadian population, and a higher birth rate means that this share of the population is expected to grow in the coming decades.

Independence and modern Canada

Canadian independence was finally acknowledged in 1931 by the Statute of Westminster, putting it on equal terms with the United Kingdom within the Commonwealth; virtually granting independence and sovereignty until the Canada Act of 1982 formalized it. Over the past century, Canada has had a relatively stable political system and economy (although it was hit particularly badly by the Wall Street Crash of 1929). Canada entered the First World War with Britain, and as an independent Allied Power in the Second World War; Canadian forces played pivotal roles in a number of campaigns, notably Canada's Hundred Days in WWI, and the country lost more than 100,000 men across both conflicts. The economy boomed in the aftermath of the Second World War, and a stream of socially democratic programs such as universal health care and the Canadian pension plan were introduced, which contributed to a rise in the standard of living. The post war period also saw various territories deciding to join Canada, with Newfoundland joining in 1949, and Nunavut in 1999. Today Canada is among the most highly ranked in countries in terms of civil liberties, quality of life and economic growth. It promotes and welcomes immigrants from all over the world and, as a result, it has one of the most ethnically diverse and multicultural populations of any country in the world. As of 2020, Canada's population stands at around 38 million people, and continues to grow due to high migration levels and life expectancy, and a steady birth rate.

Abstract

The 1992 Zambia Demographic and Health Survey (ZDHS) was a nationally representative sample survey of women age 15-49. The survey was designed to provide information onlevels and trends of fertility, infant and child mortality, family planning knowledge and use, and maternal and child health. The ZDHS was carried out by the University of Zambia in collaboration with Central Statistical Office and the Ministry of Health. Fieldwork was conducted from mid-January to mid-May 1992, during which time, over 6000 households and 7000 women were interviewed.

The primary objectives of the ZDHS are: - To collect up-to-date information on fertility, infant and child mortality and family planning; - To collect information on health-related matters such as breastfeeding, antenatal care, children's immunizations and childhood diseases; - To assess the nutritional status of mothers and children; - To support dissemination and utilisation of the results in planning, managing and improving family planning and health services in the country; and - To enhance the survey capabilities of the institutions Involved in order to facilitate the implementation of surveys of this type in the future.

MAIN RESULTS

• Results imply that fertility in Zambia has been declining over the past decade or so; at current levels, Zambian women will give birth to an average of 6.5 children during their reproductive years.

• Contraceptive knowledge is nearly universal in Zambia; over 90 percent of married women reported knowing about at least one modern contraceptive method.Over half of women using modern methods obtained them from government sources.

• Women in Zambia am marrying somewhat later than they did previously. The median age at marriage has increased from 17 years or under among women now in their 30s and 40s to 18 years or older among women in their 20s. Women with secondary education marry three years later (19.9) than women with no education (16.7).

• Over one-fifth (22 percent) of currently married women do not want to have any more children.

• One of the most striking findings from the ZDHS is the high level of child mortality and its apparent increase in recent years.

• Information on various aspects of maternal and child healtlr--antenatal care, vaccinations, bmastfeeding and food supplementation, and illness---was collected in the ZDHS on births in the five years preceding the survey.

• ZDHS data indic ate that haft of the births in Zambia are delivered at home and half in health facilities.

• Based on information obtained from health cards and mothers' reports, 95 percent of children age 12- 23 months are vaccinated against tuberculosis, 94 percent have received at least one dose of DPT and polio vaccines, and 77 percent have been vaccinated against measles. Sixty-seven percent of children age 12-23 months have been fully immunised and only 4 percent have not received any immuhisations.

• Almost all children in Zambia (98 percent) are breastfed. The median duration of breasffeeding is relatively long (19 months), but supplemental liquids and foods are introduced at an early age. By age 2-3 months, half of all children are being given supplementary food or liquid.

• ZDHS data indicate that undemutrition is an obstacle to improving child health; 40 percent of children under age five are stunted or short for their age, compared to an international reference population. Five percent of children are wasted or thin for their height and 25 percent are underweight for their age.

• The ZDHS included several questions about knowledge of AIDS. Almost all respondents (99 percent) had heard of AIDS and the vast majority (90 percent) knew that AIDS is transmitted through sexual intercourse.

The implementation of all these aspects of the PHC programmes requires multi-sectoral action and close collaboration among the various govemment institutions. The Govemment has therefore set up multi- sectoral PHC committees as an integral part of the PHC basic supportive manpower and inter-sectoral collaboration with other ministries has been given prominence.

Geographic coverage

The 1992 Zambia Demographic and Health Survey (ZDHS) is a nationally representative sample survey, also representative at the level of the nine provinces.

Analysis unit

• Household
• women age 15-49
• Children under five years

Universe

All women of reproductive age, age 15-49 in the total sample of households.

Kind of data

Sample survey data

Sampling procedure

Zambia is divided administratively into 9 provinces and 57 districts. In preparation for the 1990 Census of Population, Housing and Agriculture, the entire country was demarcated into Census Supervisory Areas (CSAs). Each CSA was in turn divided into Standard Enumeration Areas (SEAs) of roughly equal size. The measure of size used for selecting the ZDHS sample was the number of households obtained during a quick count operation carried out in 1987. The frame of 4240 CSAs was stratified into urban anti rural areas within each province, with the districts ordered geographically within provinces, thus providing further implicit stratification.

The ZDHS sample was selected from this frame in three stages. First, 262 CSAs (149 in urban areas and 113 in rural areas) were selected from this frame with probability proportional to size (the number of households from the quick count). One SEA was then selected from within each sampled CSA, again with probability proportion to size. The Central Statistical Office (CSO) then organised a household listing operation, in which all structures in the selected SEAs were numbered (on doors), the names of the heads of households were listed and the households were marked by number on sketch maps of the SEAs. These household lists were used to select a systematic sample of households for the third and final stage of sampling. Initially, the objective of the ZDHS sample design was to be able to produce estimates at the national level, for urban and rural areas separately, and for the larger provinces. Since Zambia's population is almost equally divided by urban and rural residence, a self weighting sample was originally designed. Later, it was decided that it would be desirable to be able to produce separate estimates for all nine provinces. To achieve this objective, additional rural CSAs (and SEAs) were selected inLuapula, North- eastern and Western Provinces and the sample take (number of households) in each rural SEA in these provinces was reduced from 42 to 35 in order to minimise the total sample size increase (the sample take was 20 households in urban areas). As a result of this oversampling in Luapula, North-Western and Western Provinces, the ZDHS sample is not self-weighting at the national level.

Mode of data collection

Face-to-face

Research instrument

Two types of questionnaires were used for the ZDHS: (a) the Household Questionnaire and (b) the Individual Questionnaire.

The contents of these questionnaires were based on the DHS Model B Questionnaire, which is designed for use in countries with low levels of contraceptive use. Additions and modifications to the model questionnaires were made after consultation with members of the Department of Social Development Studies of the University of Zambia, the Central Statistical Office (CSO), the Ministry of Health, the Planned Parenthood Association of Zambia (PPAZ), and the National Commission for Development Planning. The questionnaires were developed in English and then translated into and printed in seven of the most widely spoken languages (Bemba, Kaonde, Lozi, Lunda, Luvale, Nyanja and Tonga).

a) The Household Questionnaire was used to list all the usual members and visitors of a selected household. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women who were eligible for the individual interview. In addition, information was collected on the household itself, such as the source of water, type of toilet facilities, material used for the floor of the house, and ownership of various consumer goods.

b) The Individual Questionnaire was used to collect information from women age 15-49 about the following topics: Background characteristics (education, religion, etc.); Reproductive history; Knowledge and use of family planning methods; Antenatal and delivery care; Breastfeeding and weaning practices; Vaccinations and health of children under age five; Marriage; Fertility preferences; Husband's background and respondent's work; and Awareness of AIDS.

In addition, interviewing teams measured the height and weight of all children under age five and their mothers.

Cleaning operations

All questionnaires for the ZDHS were returned to the University of Zambia for data processing. The processing operation consisted of office editing, coding of open-ended questions, data entry, and editing errors found by the computer programs. Two programmers (one from the CSO and one from the University), one questionnaire administrator, two office editors, and three data entry operators were responsible for the data processing operation. The data were processed on four microcomputers owned by the Department of Social Development Studies at the University of Zambia. The ZDHS data entry and editing programs were written in ISSA (Integrated System for Survey Analysis) and followed the standard DHS consistency checks and editing procedures. Simple range and skip errors were corrected at the data entry stage. Secondary machine editing of the