Albania Demographic and Health Survey 2008-09 - The DHS Program

483 Pages·2010·2.96 MB·English

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REPUBLIC OF ALBANIA

Albania
Demographic and Health Survey
2008-09

Institute of Statistics
Institute of Public Health
Tirana, Albania

ICF Macro
Calverton, Maryland, USA

March 2010

Ministria e Shëndetësisë
This report summarizes the findings of the 2008-09 Albania Demographic and Health Survey (2008-09 ADHS),
which was conducted by the Institute of Statistics (INSTAT) and the Institute of Public Health (IPH). ICF Macro, an
ICF International Company, provided technical assistance to the project through funding from UNICEF and
MEASURE DHS, a USAID-funded project providing support and technical assistance in the implementation of
population and health surveys in countries worldwide. Funding for the 2008-09 ADHS was provided by USAID,
UNICEF, UNFPA, the Swiss Cooperation Office in Albania (SCO-A), the World Health Organization (WHO), and
the Spanish Agency for International Development Cooperation (AECID). The opinions expressed herein are those
of the authors and do not necessarily reflect the views of USAID, UNICEF, UNFPA, SCO-A, WHO, or the
Government of Albania.

Additional information about the 2008-09 ADHS may be obtained from either:

The Institute of Statistics
Lantona Sado, ADHS Coordinator
Street address: Blvd ‘Gergj Fishta’ #3, Tirana, Albania.
Telephone: [phone], Fax: [phone], Email: [email protected]

or

The Institute of Public Health
Elizana Petrela, ADHS Coordinator
Street address: ‘Aleksander Moisiu’ # 80, Tirana, Albania.
Telephone: [phone], Fax: [phone], Email: [email protected]

Additional information about the MEASURE DHS project may be obtained from ICF Macro, MEASURE DHS,
11785 Beltsville Drive, Suite 300, Calverton, MD 20705 USA; Telephone: [phone], Fax: [phone], E-
mail: [email protected], Internet: http://www.measuredhs.com.

Recommended citation:

Institute of Statistics, Institute of Public Health [Albania] and ICF Macro. 2010. Albania Demographic and Health
Survey 2008-09. Tirana, Albania: Institute of Statistics, Institute of Public Health and ICF Macro.
INTRODUCTION

In the early-mid 1990s, Albania entered a new phase of major changes, moving from a
totalitarian to a democratic system and shifting gradually to the free market economy. This process
led, naturally, to changes in various demographic and health characteristics of the Albanian society.

The 2008-09 Albania Demographic and Health Survey (ADHS) is a nationally representative
study aimed at collecting and providing information on population, demographic, and health
characteristics of the country. Population-based studies of this magnitude are a major undertaking that
provide information on important indicators which measure the progress of a country.

The ADHS results help provide the necessary information to assess, measure, and evaluate
the existing programs in the country. They also provide crucial information to policy-makers when
drafting new policies and strategies related to the health sector and health services in Albania.

The information collected in the 2008-09 Albania Demographic and Health Survey will be
used not only by local decision-makers and programme managers, but also by partners and foreign
donors involved in various development areas in Albania, as well as by academic institutions to do
further analysis with the collected data.

The 2008-09 ADHS is the result of hard and good quality work of many Albanian institutions
as well as national and international organizations, which have shown a high level of professionalism
and dedication to good quality data in the field of health and demographics in Albania.

Petrit VASILI

Minister of Health
Introduction | iii

CONTENTS

Page

INTRODUCTION.........................................................................................................iii
TABLES AND FIGURES...........................................................................................................xi
PREFACE ................................................................................................................................xix
ACKNOWLEDGMENTS........................................................................................................xxi
LIST OF CONTRIBUTORS.................................................................................................xxiii
SUMMARY OF FINDINGS..................................................................................................xxv
MILLENNIUM DEVELOPMENT GOAL INDICATORS................................................xxxi
MAP OF ALBANIA...............................................................................................................xxxii

CHAPTER 1 INTRODUCTION

1.1 Geography and Population...............................................................................1
1.2 History.............................................................................................................1
1.2.1 The Albanian Language.........................................................................3
1.2.2 The Albanian Flag.................................................................................3

1.3 Economy..........................................................................................................3
1.4 Characteristics of the Health System.................................................................4
1.4.1 Health Care System..............................................................................4
1.4.2 Primary Health Care.............................................................................5
1.4.3 Country Epidemiological Profile............................................................6
1.4.4 Hospital Services..................................................................................7
1.4.5 Pharmaceutical Services........................................................................7
1.4.6 Health Insurance Institute.....................................................................7
1.4.7 Human Resources................................................................................8
1.4.8 Sources of Public Financing for Health..................................................8

1.5 Objectives and Organization of the Survey.......................................................9
1.5.1 Sample Design and Implementation...................................................10
1.5.2 Questionnaires...................................................................................10
1.5.3 Biomarkers.........................................................................................12
1.5.4 Field Staff and Fieldwork....................................................................13
1.5.5 Data Processing..................................................................................14
1.5.6 Response Rates...................................................................................14

CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS

2.1 Household Population by Age and Sex...........................................................18
2.2 Household Composition................................................................................19
2.3 Children’s Living Arrangements......................................................................20
2.4 Educational Attainment of Household Members.............................................21
2.5 Preschool Attendance and Primary School Participation.................................26
2.6 Housing Characteristics..................................................................................28
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2.6.1 Drinking Water...................................................................................30
2.6.2 Sanitation Facilities.............................................................................32
2.6.3 Household Possessions.......................................................................32
2.7 Wealth Quintiles............................................................................................34
2.8 Birth Registration............................................................................................34

CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS

3.1 Background Characteristics of Respondents....................................................37
3.2 Educational Level of Respondents..................................................................39
3.3 Literacy..........................................................................................................41
3.4 Exposure to Mass Media ................................................................................42
3.5 Employment ..................................................................................................44
3.6 Occupation....................................................................................................47
3.7 Employment Characteristics...........................................................................50

CHAPTER 4 FERTILITY

4.1 Current Fertility Level.....................................................................................53
4.2 Fertility Differentials by Background Characteristics........................................55
4.3 Fertility Trends...............................................................................................56
4.4 Children Ever Born and Living........................................................................57
4.5 Birth Intervals.................................................................................................58
4.6 Age at First Birth.............................................................................................60
4.7 Teenage Pregnancy and Motherhood.............................................................61

CHAPTER 5 FAMILY PLANNING

5.1 Knowledge of Contraceptive Methods............................................................63
5.2 Ever Use of Contraception.............................................................................66
5.3 Current Use of Contraceptive Methods..........................................................68
5.4 Trends in Contraceptive Use..........................................................................71
5.5 Differentials in Contraceptive Use by Background Characteristics...................71
5.6 Other Forms of Fertility Regulation.................................................................73
5.7 Number of Children at First Use of Contraception..........................................73
5.8 Knowledge of the Fertile Period.....................................................................74
5.9 Source of Contraception................................................................................75
5.10 Cost of Contraception....................................................................................79
5.11 Informed Choice............................................................................................79
5.12 Contraceptive Discontinuation.......................................................................81
5.13 Future Use of Contraception..........................................................................81
5.14 Reasons for Not Intending to Use Contraception............................................82
5.15 Preferred Method for Future Use...................................................................83
5.16 Exposure to Family Planning Messages...........................................................83
5.17 Contact of Non-users with Family Planning Providers.....................................84
5.18 Attitudes of Respondents Towards Family Planning........................................85

CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY

6.1 Introduction...................................................................................................87
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6.2 Marital Status.................................................................................................87
6.3 Age at First Marriage......................................................................................88
6.4 Age at First Sexual Intercourse........................................................................93
6.5 Recent Sexual Activity....................................................................................96
6.6 Post-partum Amenorrhoea, Abstinence, and Insusceptibility...........................98
6.7 Termination of Exposure to Pregnancy........................................................100

CHAPTER 7 FERTILITY PREFERENCES

7.1 Desire for More Children............................................................................101
7.2 Need for Family Planning Services...............................................................104
7.3 Ideal Number of Children...........................................................................107
7.4 Wanted and Unwanted Fertility..................................................................110
7.4.1 Planning Status of Births...................................................................110
7.4.2 Wanted Fertility...............................................................................111

CHAPTER 8 INFANT AND CHILD MORTALITY

8.1 Definitions and Methodology......................................................................113
8.2 Assessment of Data Quality.........................................................................114
8.3 Levels and Trends in Infant and Child Mortality...........................................115
8.4 Socio-economic Differentials in Childhood Mortality...................................117
8.5 Demographic Differentials in Childhood Mortality......................................118
8.6 Perinatal Mortality.......................................................................................119
8.7 High-risk Fertility Behaviour........................................................................119

CHAPTER 9 MATERNAL HEALTH

9.1 Antenatal Care............................................................................................124
9.1.1 Antenatal Care Provider...................................................................124
9.1.2 Number and Timing of Antenatal Care Visits....................................126
9.1.3 Components of Antenatal Care.........................................................126
9.1.4 Tetanus Toxoid Immunization..........................................................128

9.2 Delivery Care..............................................................................................129
9.2.1 Place of Delivery..............................................................................130
9.2.2 Assistance during Delivery................................................................131

9.3 Postnatal Care.............................................................................................132

CHAPTER 10 CHILD HEALTH

10.1 Child’s Weight and Size at Birth..................................................................135
10.2 Vaccination Coverage.................................................................................137
10.3 Acute Respiratory Infections And Fever.......................................................140
10.4 Diarrhoea...................................................................................................142
10.5 Disposal of Stools........................................................................................146
10.6 Family Support for Learning........................................................................148
10.7 Children Left Alone.....................................................................................150
10.8 Child Discipline..........................................................................................151
Contents | vii
CHAPTER 11 NUTRITION

11.1 Breastfeeding and Supplementation............................................................154
11.1.1 Initiation of Breastfeeding.............................................................154
11.1.2 Breastfeeding Status by Age..........................................................156
11.1.3 Duration and Frequency of Breastfeeding.....................................158
11.1.4 Types of Complementary Foods....................................................159
11.1.5 Food and Liquids Consumed by Women......................................162

11.2 Salt Iodization.............................................................................................163
11.3 Micronutrient Intake among Young Children...............................................164
11.4 Micronutrient Intake among Mothers..........................................................167
11.5 Prevalence of Anaemia................................................................................169
11.5.1 Prevalence of Anaemia in Children...............................................169
11.5.2 Prevalence of Anaemia in Women and Men.................................170

11.6 Nutritional Status of Children......................................................................173
11.7 Trends in Child Nutrition............................................................................176
11.8 Nutritional Status of Women and Men........................................................177

CHAPTER 12 HIV AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR

12.1 Knowledge of HIV/AIDS..............................................................................182
12.2 Knowledge of Ways to Reduce AIDS Transmission......................................183
12.3 Comprehensive Knowledge about HIV/AIDS...............................................185
12.4 Knowledge about Mother-to-Child Transmission.........................................188
12.5 Accepting Attitudes Towards People Living with HIV/AIDS..........................190
12.6 Attitudes Towards Negotiating Safer Sex......................................................192
12.7 Adult Support of Education About Condom Use to Prevent AIDS................194
12.8 Multiple Sexual Partners and Higher-Risk Sex..............................................195
12.9 Testing for HIV............................................................................................200
12.10 Male Circumcision......................................................................................202
12.11 Reports of Recent Sexually Transmitted Infections.......................................203
12.12 Comprehensive HIV/AIDS Knowledge and Source of Condoms
among Youth..............................................................................................205
12.13 Age at First Sexual Intercourse.....................................................................207
12.14 Condom Use at First Sexual Intercourse......................................................209
12.15 Premarital Sex and Condom Use among Young Women and Men..............210
12.16 Higher-Risk Sex and Condom Use among Young Adults..............................211
12.17 Age-Mixing in Sexual Relationships............................................................213
12.18 Drunkenness during Sexual Intercourse among Youth.................................214
12.19 Recent HIV Testing among Youth................................................................215

CHAPTER 13 ADULT HEALTH

13.1 Current Health Status..................................................................................217
13.2 Chronic and Acute Illnesses.........................................................................220
13.3 Knowledge of Cancer Screening..................................................................221
13.4 Use of Tobacco...........................................................................................223
13.5 Alcohol Consumption.................................................................................227
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13.6 Hypertension..............................................................................................229
13.6.1 Prevalence of Hypertension..........................................................229
13.6.2 Awareness of Hypertension and Treatment Status.........................233

13.7 Problems in Accessing Health Care.............................................................234
13.8 Utilization and Quality of Health Services...................................................236
13.9 Health Insurance.........................................................................................238
13.10 Payments for Health Care...........................................................................241

CHAPTER 14 MIGRATION

14.1 Households With at Least One Former Member Who Has Migrated...........247
14.2 Characteristics of Migrants’ Former Households..........................................249
14.3 Migrant Population.....................................................................................252
14.4 Background Characteristics of Migrants.......................................................254
14.5 Reasons For Migration.................................................................................256
14.6 Trends in Migration.....................................................................................257
14.7 Destination of Migrants...............................................................................258
14.8 Children of Migrants Left Behind.................................................................264
14.9 Money or Goods Sent to Households by Migrants.......................................267
14.10 Short-term Emigration.................................................................................270

CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND
HEALTH OUTCOMES

15.1 Employment and Cash Earnings...................................................................271
15.2 Use of Earnings...........................................................................................272
15.3 Household Decision-making.......................................................................275
15.4 Men’s Attitudes about Household Decision-making....................................276
15.5 Attitudes toward Wife Beating.....................................................................279
15.6 Attitudes towards Refusing Sexual Relations................................................282
15.7 Indicators of Women’s Empowerment........................................................287
15.8 Current Use of Contraception by Women’s Status.......................................288
15.9 Women’s Status and Ideal Family Size and Unmet Need............................289
15.10 Women’s Status and Reproductive Health Care..........................................290

REFERENCES........................................................................................................................299

APPENDIX A SAMPLE IMPLEMENTATION........................................................................

A.1 Introduction...............................................................................................299
A.2 Sampling Frame..........................................................................................299
A.3 Sample Allocation.......................................................................................300
A.4 Sampling Procedure and Updating of the Sampling Frame..........................301
A.5 Men’s Sub-sample......................................................................................302
A.6 Sampling Probabilities................................................................................303
A.7 Weighting And Representativeness.............................................................303
A.8 Special Concerns........................................................................................305

APPENDIX B ESTIMATES OF SAMPLING ERRORS....................................................309
Contents | ix