Abstract

The 2006 Uganda Demographic and Health Survey (UDHS) is a nationally representative survey of 8,531 women age 15-49 and 2,503 men age 15-54. The UDHS is the fourth comprehensive survey conducted in Uganda as part of the worldwide Demographic and Health Surveys (DHS) project. The primary purpose of the UDHS is to furnish policymakers and planners with detailed information on fertility; family planning; infant, child, adult, and maternal mortality; maternal and child health; nutrition; and knowledge of HIV/AIDS and other sexually transmitted infections. In addition, in one in three households selected for the survey, women age 15-49, men age 15-54, and children under age 5 years were weighed and their height was measured. Women, men, and children age 6-59 months in this subset of households were tested for anaemia, and women and children were tested for vitamin A deficiency. The 2006 UDHS is the first DHS survey in Uganda to cover the entire country.

The 2006 Uganda Demographic and Health Survey (UDHS) was designed to provide information on demographic, health, and family planning status and trends in the country. Specifically, the UDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, and breastfeeding practices. In addition, data were collected on the nutritional status of mothers and young children; infant, child, adult, and maternal mortality; maternal and child health; awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections; and levels of anaemia and vitamin A deficiency.

The 2006 UDHS is a follow-up to the 1988-1989, 1995, and 2000-2001 UDHS surveys, which were also implemented by the Uganda Bureau of Statistics (UBOS). The specific objectives of the 2006 UDHS are as follows:

• To collect data at the national level that will allow the calculation of demographic rates, particularly the fertility and infant mortality rates
• To analyse the direct and indirect factors that determine the level and trends in fertility and mortality
• To measure the level of contraceptive knowledge and practice of women and men by method, by urban-rural residence, and by region
• To collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS, and to evaluate patterns of recent behaviour regarding condom use
• To assess the nutritional status of children under age five and women by means of anthropometric measurements (weight and height), and to assess child feeding practices
• To collect data on family health, including immunizations, prevalence and treatment of diarrhoea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding
• To measure vitamin A deficiency in women and children, and to measure anaemia in women, men, and children
• To measure key education indicators including school attendance ratios and primary school grade repetition and dropout rates
• To collect information on the extent of disability
• To collect information on the extent of gender-based violence.

MAIN RESULTS

• Fertility : Survey results indicate that the total fertility rate (TFR) for the country is 6.7 births per woman. The TFR in urban areas is much lower than in the rural areas (4.4 and 7.1 children, respectively). Kampala, whose TFR is 3.7, has the lowest fertility. Fertility rates in Central 1, Central 2, and Southwest regions are also lower than the national level. Removing four districts from the 2006 data that were not covered in the 20002001 UDHS, the 2006 TFR is 6.5 births per woman, compared with 6.9 from the 2000-2001 UDHS. Education and wealth have a marked effect on fertility, with uneducated mothers having about three more children on average than women with at least some secondary education and women in the lowest wealth quintile having almost twice as many children as women in the highest wealth quintile.

• Family planning : Overall, knowledge of family planning has remained consistently high in Uganda over the past five years, with 97 percent of all women and 98 percent of all men age 15-49 having heard of at least one method of contraception. Pills, injectables, and condoms are the most widely known modern methods among both women and men.

• Maternal health : Ninety-four percent of women who had a live birth in the five years preceding the survey received antenatal care from a skilled health professional for their last birth. These results are comparable to the 2000-2001 UDHS. Only 47 percent of women make four or more antenatal care visits during their entire pregnancy, an improvement from 42 percent in the 2000-2001 UDHS. The median duration of pregnancy for the first antenatal visit is 5.5 months, indicating that Ugandan women start antenatal care at a relatively late stage in pregnancy.

• Child health : Forty-six percent of children age 12-23 months have been fully vaccinated. Over nine in ten (91 percent) have received the BCG vaccination, and 68 percent have been vaccinated against measles. The coverage for the first doses of DPT and polio is relatively high (90 percent for each). However, only 64 percent go on to receive the third dose of DPT, and only 59 percent receive their third dose of polio vaccine. There are notable improvements in vaccination coverage since the 2000-2001 UDHS. The percentage of children age 12-23 months fully vaccinated at the time of the survey increased from 37 percent in 2000-2001 to 44 percent in 2006. The percentage who had received none of the six basic vaccinations decreased from 13 percent in 2000-2001 to 8 percent in 2006.

• Malaria : The 2006 UDHS gathered information on the use of mosquito nets, both treated and untreated. The data show that only 34 percent of households in Uganda own a mosquito net, with 16 percent of households owning an insecticide-treated net (ITN). Only 22 percent of children under five slept under a mosquito net on the night before the interview, while a mere 10 percent slept under an ITN.

• Breastfeeding and nutrition : In Uganda, almost all children are breastfed at some point. However, only six in ten children under the age of 6 months are exclusively breast-fed.

• HIV/AIDS AND stis : Knowledge of AIDS is very high and widespread in Uganda. In terms of HIV prevention strategies, women and men are most aware that the chances of getting the AIDS virus can be reduced by limiting sex to one uninfected partner who has no other partners (89 percent of women and 95 percent of men) or by abstaining from sexual intercourse (86 percent of women and 93 percent of men). Knowledge of condoms and the role they can play in preventing transmission of the AIDS virus is not quite as high (70 percent of women and 84 percent of men).

• Orphanhood and vulnerability : Almost one in seven children under age 18 is orphaned (15 percent), that is, one or both parents are dead. Only 3 percent of children under the age of 18 have lost both biological parents.

• Women's status and gender violence : Data for the 2006 UDHS show that women in Uganda are generally less educated than men. Although the gender gap has narrowed in recent years, 19 percent of women age 15-49 have never been to school, compared with only 5 percent of men in the same age group.

• Mortality : At current mortality levels, one in every 13 Ugandan children dies before reaching age one, while one in every seven does not survive to the fifth birthday. After removing districts not covered in the 2000-2001 UDHS from the 2006 data, findings show that infant mortality has declined from 89 deaths per 1,000 live births in the 2000-2001 UDHS to 75 in the 2006 UDHS. Under-five mortality has declined from 158 deaths per 1,000 live births to 137.

Geographic coverage

The sample of the 2006 UDHS was designed to allow separate estimates at the national level and for urban and rural areas of the country. The sample design also allowed for specific indicators, such as contraceptive use, to be calculated for each of nine sub-national regions. Portions of the northern region were oversampled in order to provide estimates for two special areas of interest: Karamoja and internally displaced persons (IDP) camps. At the time of the survey there were 56 districts. This number later increased to 80. The following shows the 80 districts divided into the regional sampling strata:

• Central 1: Kalangala, Masaka, Mpigi, Rakai, Lyantonde, Sembabule, and Wakiso
• Central 2: Kayunga, Kiboga, Luwero, Nakaseke, Mubende, Mityana, Mukono, and Nakasongola
• Kampala: Kampala
• East Central: Bugiri, Busia, Iganga, Namutumba, Jinja, Kamuli, Kaliro, and Mayuge
• Eastern: Kaberamaido, Kapchorwa, Bukwa, Katakwi, Amuria, Kumi, Bukedea, Mbale, Bududa, Manafwa, Pallisa, Budaka, Sironko, Soroti, Tororo, and Butaleja
• North: Apac, Oyam, Gulu, Amuru, Kitgum, Lira, Amolatar, Dokolo, Pader, Kotido, Abim, Kaabong, Moroto, and Nakapiripirit (Estimates for this region include both settled and IDP populations.) Karamoja area: Kotido, Abim, Kaabong, Moroto, and Nakapiripirit IDP: IDP camps in Apac, Oyam, Gulu, Amuru, Kitgum, Lira, Amolatar, Dokolo and Pader districts
• West Nile: Adjumani, Arua, Koboko, Nyadri, Nebbi, and Yumbe
• Western: Bundibugyo, Hoima, Kabarole, Kamwenge, Kasese, Kibaale, Kyenjojo, Masindi, and Buliisa
• Southwest: Bushenyi, Kabale, Kanungu, Kisoro, Mbarara, Ibanda, Isingiro, Kiruhura, Ntungamo, and Rukungiri

Analysis unit

• Household
• Women age 15-49
• Men age 15-54
• Children under five

Universe

The population covered by the 2006 UDHS is defined as the universe of alll women age 15-49 who were either permanent residents of the households in the 2006 UDHS sample or visitors present in the household on the night

Abstract

The 2011 Uganda Demographic and Health Survey (UDHS) was designed to provide information on demographic, health, and family planning status and trends in the country. Specifically, the UDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, breastfeeding practices, and awareness and use of family planning methods. In addition, data were collected on the nutritional status of mothers and young children; infant, child, adult, and maternal mortality; maternal and child health; awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections; and levels of anaemia and vitamin A deficiency.

The 2011 UDHS is a follow-up to the 1988-1989, 1995, 2000-2001, and 2006 UDHS surveys, which were implemented by the Statistics Department of Ministry of Finance and Planning, and later by the Uganda Bureau of Statistics (UBOS). The specific objectives of the 2011 UDHS were as follows: - To provide data at the national and subnational level that would allow the calculation of demographic rates, particularly fertility and infant mortality rates - To analyse the direct and indirect factors that determine the level of and trends in fertility and mortality - To measure the level of contraceptive knowledge and practice of women and men by method, by urban-rural residence, and by region - To collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS, and to evaluate patterns of recent behaviour regarding condom use - To assess the nutritional status of children under age 5 and women by means of anthropometric measurements (weight and height), and to assess child feeding practices - To collect data on family health, including antenatal visits, assistance at delivery, breastfeeding, immunizations, and prevalence and treatment of diarrhoea and other diseases among children under age 5 - To measure vitamin A deficiency in women and children, and to measure anaemia in women, men, and children - To measure key education indicators, including school attendance ratios and primary school grade repetition and dropout rates - To collect information on the extent of disability - To collect information on the extent of gender-based violence

This information is essential for informed policy-making and planning, monitoring, and evaluation of health programmes in general and reproductive health programmes in particular, at both the national and regional levels. A long-term objective of the survey was to strengthen the technical capacity of the National Statistics Office to plan, conduct, process, and analyse data from complex national population and health surveys.

The 2011 UDHS provides national and regional estimates on population and health that are comparable to data collected in Uganda’s four previous DHS surveys and similar surveys in other developing countries. Data collected in the 2011 UDHS add to the large and growing international database of demographic and health indicators.

Geographic coverage

National

Analysis unit

• Household
• Women age 15-49
• Men age 15-54
• Children under five

Kind of data

Sample survey data

Sampling procedure

Sample Frame The sampling frame used for the 2011 UDHS is the 2002 Population Census provided by the Uganda Bureau of Statistics (UBOS). The UBOS has an electronic file consisting of 48,715 Enumeration Areas (EAs) created for the 2002 Population and Housing Census. An EA is a geographic area consisting of a convenient number of dwelling units that serve as counting units for the census.

Sample Design The sample for the 2011 UDHS was designed to provide population and health indicator estimates for the country as a whole and for urban and rural areas separately. A representative sample of 10,086 households was selected for the 2011 UDHS. The sample was selected in two stages. In the first stage, 404 enumeration areas (EAs) were selected from among a list of clusters sampled for the 2009/10 Uganda National Household Survey (2010 UNHS). This matching of samples was done to allow linking of the 2011 UDHS health indicators to poverty data from the 2010 UNHS. The clusters in the UNHS were selected from the 2002 Population Census sample frame.

In the second stage of sampling, households in each cluster were selected from a complete listing of households, which was updated prior to the survey. Households were purposively selected from those listed. All households in the 2010 UNHS that were in the 404 EAs were included in the UDHS sample.

All women age 15-49 who were either permanent residents of the households or visitors who slept in the households the night before the survey were eligible to be interviewed. In addition, in a subsample of one-third of households selected for the survey, all men age 15-54 were eligible to be interviewed if they were either permanent residents or visitors who slept in the household on the night before the survey. An additional sample was selected for administration of the Maternal Mortality Module.

Note: See Appendix A (in final survey report) for the details of the sample design.

Mode of data collection

Face-to-face

Research instrument

Four types of questionnaires were used in the 2011 UDHS: the Household Questionnaire, the Woman’s Questionnaire, the Maternal Mortality Questionnaire, and the Man’s Questionnaire. These questionnaires were adapted from model survey instruments developed by ICF for the MEASURE DHS project and by UNICEF for the Multiple Indicator Cluster Survey (MICS) project. The intent was to reflect the population and health issues relevant to Uganda. Questionnaires were discussed at a series of meetings with various stakeholders, ranging from government ministries and agencies to nongovernmental organizations (NGOs) and development partners. The questionnaires were translated into seven major languages: Ateso, Ngakarimojong, Luganda, Lugbara, Luo, Runyankole-Rukiga, and Runyoro-Rutoro.

The Household Questionnaire was used to list all the usual members and visitors who spent the previous night in the selected households. Basic information was collected on the characteristics of each person listed, including his or her age, sex, education, relationship to the head of the household, and disability status. For children under age 18, survival status of the parents was determined. Data on the age and sex of household members were used to identify women and men eligible for an individual interview. In addition, the Household Questionnaire collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and ownership and use of mosquito bednets.

The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. The eligible women were asked questions on the following topics: - Background characteristics (age, education, media exposure, etc.) - Birth history and childhood mortality - Knowledge and use of family planning methods - Fertility preferences - Antenatal, delivery, and postnatal care - Breastfeeding and infant feeding practices - Vaccinations and childhood illnesses - Marriage and sexual activity - Woman’s work and husband’s background characteristics - Awareness and behaviour regarding AIDS and other sexually transmitted infections (STIs) - Adult mortality, including maternal mortality - Knowledge of tuberculosis and other health issues - Gender-based violence

The Maternal Mortality Questionnaire was administered to all eligible women age 15-49 in 35 additional households in 394 out of 404 EAs. It collected data on maternal mortality using the Sibling Survival Module (commonly referred to as the ‘Maternal Mortality Module’).

The Man’s Questionnaire was administered to all eligible men age 15-54 years in every third household in the 2011 UDHS sample. The Man’s Questionnaire collected information similar to that in the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health.

Cleaning operations

Questionnaire data were entered in the field by the field editors on each team and the files were periodically sent to the UBOS office by internet. All the paper questionnaires were also returned to UBOS headquarters in Kampala for data processing, which consisted of office editing, coding of open-ended questions, a second data entry, and finally, editing computer-identified errors. The data were processed by a team of eight data entry operators, two office editors, and one data entry supervisor. Data entry and editing were accomplished using CSPro software. The processing of data was initiated in August 2011 and completed in January 2012.

Response rate

A total of 10,086 households were selected for the sample, of which 9,480 were found to be occupied during data collection. Of these, 9,033 households were successfully interviewed, giving a household response rate of 95 percent.

Of the 9,247 eligible women identified in the selected households, interviews were completed with 8,674 women, yielding a response rate of 94 percent for women.

Of the 2,573 eligible men identified in the selected subsample of households for men, 2,295 were successfully interviewed, yielding a response rate of 89 percent for men.

Response rates were higher in rural than in urban areas, with the rural-urban difference being more pronounced among men (92 and 82 percent, respectively) than among women (95 and 91 percent, respectively).

Note: See summarized response rates by residence