Albania Demographic and Health Survey 2017-18

484 Pages·2017·7.17 MB·English

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REPUBLIC OF ALBANIA

Albania
Demographic and Health Survey
2017-18

Institute of Statistics
Institute of Public Health
Tirana, Albania

The DHS Program
ICF
Rockville, Maryland, USA

October 2018
This report presents the findings of the 2017-18 Albania Demographic and Health Survey (2017-18 ADHS), which
was conducted by the Institute of Public Health (IPH) and the Institute of Statistics (INSTAT). ICF provided
partial technical assistance to the project. Funding for the 2017-18 ADHS was provided by the Swiss Agency for
Development and Cooperation (SDC), the United Nations Population Fund (UNFPA), the United Nations
Children’s Fund (UNICEF) and United Nations Entity for Gender Equality and the Empowerment of Women
(UN Women). The opinions expressed herein are those of the authors and do not necessarily reflect the views of
SDC, UNFPA, UNICEF, and UN Women, or the Government of Albania.
Additional information about the ADHS may be obtained from:
Institute of Statistics
Rr. Vllazën Huta, #35, Tirana, Albania
Tel: [phone], Fax: [phone], Email: [email protected]
Or
Institute of Public Health
Blvd Alexander Moisiu # 80, Tirana, Albania
Tel.: [phone], Fax [phone], Email: [email protected]
Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD
20850, USA; Telephone: [phone]; Fax: [phone]; Email: [email protected];
Internet: www.DHSprogram.com.
Recommended citation:
Institute of Statistics, Institute of Public Health, and ICF. 2018. Albania Demographic and Health Survey
2017-18. Tirana, Albania: Institute of Statistics, Institute of Public Health, and ICF.
CONTENTS
TABLES AND FIGURES .................................................................................................................................. vii
PREFACE ........................................................................................................................................................... xv
ACKNOWLEDGMENTS ................................................................................................................................ xvii
FOREWORD ..................................................................................................................................................... xix
CONTRIBUTORS TO THE REPORT ........................................................................................................... xxi
ABBREVIATIONS .......................................................................................................................................... xxiii
READING AND UNDERSTANDING TABLES FROM THE 2017-18 ADHS .......................................... xxv
MAP OF ALBANIA ........................................................................................................................................ xxiv
1 INTRODUCTION AND SURVEY METHODOLOGY ..................................................................... 1
1.1 History, Geography, and Population .......................................................................................... 1
1.2 Health Care ................................................................................................................................ 2
1.3 Survey Objectives ...................................................................................................................... 2
1.4 Sample Design and Sample Updating ........................................................................................ 2
1.5 Questionnaires and Forms .......................................................................................................... 3
1.6 Anthropometry, Anemia Testing, and Blood Pressure Measurement ........................................ 4
1.7 Pretest ......................................................................................................................................... 4
1.8 Training of Field Staff for the Main Fieldwork ......................................................................... 5
1.9 Fieldwork ................................................................................................................................... 5
1.10 Data Processing .......................................................................................................................... 5
1.11 Response Rates .......................................................................................................................... 6
2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION ....................................... 7
2.1 Drinking Water Sources and Treatment ..................................................................................... 7
2.2 Sanitation ................................................................................................................................... 8
2.3 Household Wealth ...................................................................................................................... 8
2.4 Household Population and Composition .................................................................................. 10
2.5 Children’s Living Arrangements and Parental Survival .......................................................... 11
2.6 Birth Registration ..................................................................................................................... 12
2.7 Education ................................................................................................................................. 12
2.7.1 Educational Attainment of Women ........................................................................... 12
2.7.2 Educational Attainment of Men ................................................................................. 13
2.7.3 School Attendance ..................................................................................................... 13
3 CHARACTERISTICS OF RESPONDENTS .................................................................................... 27
3.1 Basic Characteristics of Survey Respondents .......................................................................... 27
3.2 Education and Literacy ............................................................................................................ 28
3.3 Early Education and Support in Learning ................................................................................ 29
3.4 Mass Media Exposure .............................................................................................................. 31
3.5 Employment ............................................................................................................................. 32
3.6 Occupation ............................................................................................................................... 33
3.7 Health Insurance Coverage ...................................................................................................... 35
4 MARRIAGE AND SEXUAL ACTIVITY .......................................................................................... 55
4.1 Marital Status ........................................................................................................................... 55
4.2 Age at First Marriage ............................................................................................................... 56
4.3 Early Marriage ......................................................................................................................... 56
4.4 Age at First Sexual Intercourse ................................................................................................ 57
4.5 Recent Sexual Activity ............................................................................................................. 58
5 FERTILITY .......................................................................................................................................... 67
5.1 Current Fertility ....................................................................................................................... 67
5.2 Children Ever Born and Living ................................................................................................ 69
5.3 Non-Live Pregnancy Outcomes ............................................................................................... 69
5.4 Birth Intervals .......................................................................................................................... 69
Contents • iii
5.5 Insusceptibility to Pregnancy ................................................................................................... 71
5.6 Age at First Birth ..................................................................................................................... 72
5.7 Teenage Childbearing .............................................................................................................. 72
6 FERTILITY PREFERENCES ............................................................................................................ 83
6.1 Desire for Children................................................................................................................... 83
6.2 Ideal Family Size ..................................................................................................................... 84
6.3 Fertility Planning Status ........................................................................................................... 85
6.4 Wanted Fertility Rates ............................................................................................................. 86
7 FAMILY PLANNING ......................................................................................................................... 93
7.1 Contraceptive Knowledge and Use .......................................................................................... 94
7.2 Source of Modern Contraceptive Methods .............................................................................. 95
7.3 Discontinuation of Contraceptives ........................................................................................... 96
7.4 Demand for Family Planning ................................................................................................... 96
7.5 Decision-making about Family Planning ................................................................................. 98
7.6 Exposure to Family Planning Messages in the Media.............................................................. 98
7.7 Contact of Nonusers with Family Planning Providers ............................................................. 98
8 MATERNAL HEALTH CARE ........................................................................................................ 111
8.1 Antenatal Care Coverage and Content ................................................................................... 112
8.1.1 Skilled Providers ...................................................................................................... 112
8.1.2 Timing and Number of ANC Visits ......................................................................... 112
8.2 Components of ANC Visits ................................................................................................... 113
8.3 Delivery Services ................................................................................................................... 114
8.3.1 Institutional Deliveries ............................................................................................. 114
8.3.2 Assistance during Delivery ...................................................................................... 115
8.3.3 Delivery by Caesarean ............................................................................................. 115
8.4 Postnatal Care ........................................................................................................................ 116
8.4.1 Postnatal Health Check for Mothers ........................................................................ 116
8.4.2 Postnatal Health Check for Newborns ..................................................................... 117
8.5 Problems in Accessing Health Care ....................................................................................... 118
9 CHILD HEALTH ............................................................................................................................... 131
9.1 Birth Weight ........................................................................................................................... 131
9.2 Vaccination of Children ......................................................................................................... 132
9.3 Symptoms of Acute Respiratory Infection ............................................................................. 133
9.4 Fever ...................................................................................................................................... 134
9.5 Diarrheal Disease ................................................................................................................... 134
9.5.1 Prevalence of Diarrhea............................................................................................. 134
9.5.2 Feeding Practices ..................................................................................................... 135
9.5.3 Treatment of Diarrhea .............................................................................................. 135
9.6 Disposal of Children’s Stools................................................................................................. 136
9.7 Child Discipline ..................................................................................................................... 136
9.8 Inadequate Care ..................................................................................................................... 138
10 NUTRITION OF CHILDREN AND ADULTS ............................................................................... 155
10.1 Nutritional Status of Children ................................................................................................ 155
10.1.1 Measurement of Nutritional Status among Young Children .................................... 155
10.1.2 Data Collection ........................................................................................................ 157
10.1.3 Levels of Child Malnutrition ................................................................................... 157
10.2 Infant and Young Child Feeding Practices ............................................................................ 158
10.2.1 Breastfeeding ........................................................................................................... 158
10.2.2 Exclusive Breastfeeding .......................................................................................... 159
10.2.3 Median Duration of Breastfeeding ........................................................................... 159
10.2.4 Complementary Feeding .......................................................................................... 160
10.2.5 Minimum Acceptable Diet ....................................................................................... 160
10.3 Anemia Prevalence in Children ............................................................................................. 162
10.4 Presence of Iodized Salt in Households ................................................................................. 163
10.5 Micronutrient Intake and Supplementation among Children ................................................. 163
10.6 Adults’ Nutritional Status ...................................................................................................... 164
iv • Contents
10.6.1 Nutritional Status of Women ................................................................................... 164
10.6.2 Nutritional Status of Men ........................................................................................ 165
10.7 Anemia Prevalence in Adults ................................................................................................. 165
10.8 Micronutrient Intake among Mothers .................................................................................... 166
11 LIFESTYLE HEALTH RISK FACTORS ....................................................................................... 183
11.1 Tobacco Smoking .................................................................................................................. 183
11.2 Alcohol Consumption ............................................................................................................ 184
11.3 Consumption of Sugary Sodas and Juices .............................................................................. 185
11.4 Consumption of Oils and Fat ................................................................................................. 186
11.5 Consumption of Fruits and Vegetables .................................................................................. 187
11.6 Physical Activity .................................................................................................................... 188
12 NON-COMMUNICABLE DISEASES ............................................................................................. 207
12.1 Hypertension .......................................................................................................................... 207
12.2 Self-reported Prevalence of Noncommunicable Diseases ...................................................... 209
12.3 Self-reported Prevalence of Chronic Disabilities ................................................................... 210
12.4 Recent Injuries and Ailments ................................................................................................. 211
12.5 Assessment of One’s Own Health Evolution ......................................................................... 211
12.6 Awareness of Cancer-screening Tests .................................................................................... 212
12.7 Depression.............................................................................................................................. 213
13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR ................................ 227
13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods........................................... 227
13.2 Knowledge about Mother-to-Child Transmission (MTCT) ................................................... 229
13.3 Discriminatory Attitudes toward People Living with HIV .................................................... 229
13.4 Multiple Sexual Partners ........................................................................................................ 230
13.5 Paid Sex ................................................................................................................................. 230
13.6 Coverage of HIV Testing Services ........................................................................................ 231
13.6.1 Awareness of HIV Testing Services and Experience with HIV Testing ................. 231
13.6.2 HIV Testing of Pregnant Women ............................................................................ 232
13.7 Male Circumcision ................................................................................................................. 232
13.8 Self-reporting of Sexually Transmitted Infections ................................................................. 232
13.9 HIV/AIDS-Related Knowledge and Behavior among Young People .................................... 233
13.9.1 Knowledge ............................................................................................................... 233
13.9.2 Age at First Sex ....................................................................................................... 233
13.9.3 Premarital Sex .......................................................................................................... 234
13.9.4 Multiple Sexual Partners .......................................................................................... 234
13.9.5 Coverage of HIV Testing Services .......................................................................... 234
14 WOMEN’S EMPOWERMENT........................................................................................................ 253
14.1 Employment and Cash Earnings ............................................................................................ 254
14.2 Control over Women’s Earnings ............................................................................................ 255
14.3 Control over Men’s Earnings ................................................................................................. 256
14.4 Ownership of Assets .............................................................................................................. 257
14.5 Bank Accounts and Mobile Phones ....................................................................................... 258
14.6 Participation in Decision Making ........................................................................................... 258
14.6 Attitudes toward Wife-Beating .............................................................................................. 259
14.7 Experience of Intimate Partner Violence ............................................................................... 260
14.8 Negotiating Sexual Relations ................................................................................................. 260
15 REFERENCES ................................................................................................................................... 283
APPENDIX A SAMPLE DESIGN ............................................................................................................... 285
A.1 Introduction ............................................................................................................................ 285
A.2 Sampling Frame ..................................................................................................................... 285
A.3 Sample Design and Selection ................................................................................................. 286
A.4 Sampling Weights .................................................................................................................. 287

Contents • v
APPENDIX B ESTIMATES OF SAMPLING ERRORS .......................................................................... 293
APPENDIX C DATA QUALITY TABLES ................................................................................................ 311
APPENDIX D PERSONS INVOLVED IN THE 2017-18 ALBANIA DHS ............................................. 315
APPENDIX E QUESTIONNAIRES ........................................................................................................... 319

vi • Contents
TABLES AND FIGURES

1 INTRODUCTION AND SURVEY METHODOLOGY ..................................................................... 1
Table 1.1 Results of the household and individual interviews ..................................................... 6
2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION ........................................ 7
Table 2.1 Household drinking water .......................................................................................... 16
Table 2.2 Household sanitation facilities ................................................................................... 17
Table 2.3 Household characteristics .......................................................................................... 18
Table 2.4 Household possessions .............................................................................................. 19
Table 2.5 Wealth quintiles ......................................................................................................... 19
Table 2.6 Household population by age, sex, and residence ..................................................... 20
Table 2.7 Household composition ............................................................................................. 21
Table 2.8 Children’s living arrangements and orphanhood ....................................................... 22
Table 2.9 Birth registration of children under age 5 .................................................................. 23
Table 2.10.1 Educational attainment of the female household population ..................................... 24
Table 2.10.2 Educational attainment of the male household population ........................................ 25
Table 2.11 School attendance ratios ............................................................................................ 26

Figure 2.1 Household drinking water by residence ....................................................................... 8
Figure 2.2 Household toilet facilities by residence ..................................................................... 10
Figure 2.3 Household wealth by residence ................................................................................. 11
Figure 2.4 Population pyramid .................................................................................................... 15
3 CHARACTERISTICS OF RESPONDENTS .................................................................................... 27
Table 3.1 Background characteristics of respondents ................................................................ 36
Table 3.2.1 Educational attainment: Women ................................................................................ 37
Table 3.2.2 Educational attainment: Men ..................................................................................... 38
Table 3.3.1 Literacy: Women ....................................................................................................... 39
Table 3.3.2 Literacy: Men............................................................................................................. 40
Table 3.4 Early education .......................................................................................................... 41
Table 3.5 Support in learning .................................................................................................... 42
Table 3.6.1 Exposure to mass media: Women .............................................................................. 43
Table 3.6.2 Exposure to mass media: Men ................................................................................... 44
Table 3.7.1 Internet usage: Women .............................................................................................. 45
Table 3.7.2 Internet usage: Men ................................................................................................... 46
Table 3.8.1 Employment status: Women ...................................................................................... 47
Table 3.8.2 Employment status: Men ........................................................................................... 48
Table 3.9.1 Occupation: Women .................................................................................................. 49
Table 3.9.2 Occupation: Men ....................................................................................................... 50
Table 3.10 Type of employment .................................................................................................. 51
Table 3.11.1 Health insurance coverage: Women .......................................................................... 52
Table 3.11.2 Health insurance coverage: Men ................................................................................ 53

Figure 3.1 Education of survey respondents ............................................................................... 28
Figure 3.2 More than secondary education ................................................................................. 28
Figure 3.3 More than secondary education by prefecture ........................................................... 29
Figure 3.4 Exposure to mass media ............................................................................................ 31
Figure 3.5 Employment status by education ............................................................................... 33
Figure 3.6 Occupation ................................................................................................................. 34
Figure 3.7 Type of employment, women .................................................................................... 34

Tables and Figures • vii
4 MARRIAGE AND SEXUAL ACTIVITY .......................................................................................... 55
Table 4.1 Current marital status ................................................................................................. 59
Table 4.2 Age at first marriage .................................................................................................. 59
Table 4.3 Median age at first marriage by background characteristics ...................................... 60
Table 4.4 Early marriage by background characteristics ........................................................... 61
Table 4.5 Age at first sexual intercourse ................................................................................... 62
Table 4.6 Median age at first sexual intercourse by background characteristics ....................... 63
Table 4.7.1 Recent sexual activity: Women ................................................................................. 64
Table 4.7.2 Recent sexual activity: Men ....................................................................................... 65

Figure 4.1 Marital status ............................................................................................................. 55
Figure 4.2 Women’s and men’s median age at first marriage and first sexual intercourse by
residence .................................................................................................................... 56
Figure 4.3 Women’s and men’s median age at first marriage and first sexual intercourse by
wealth......................................................................................................................... 58
5 FERTILITY .......................................................................................................................................... 67
Table 5.1 Current fertility .......................................................................................................... 74
Table 5.2 Fertility by background characteristics ...................................................................... 74
Table 5.3 Trends in age-specific fertility rates .......................................................................... 75
Table 5.4 Children ever born and living .................................................................................... 75
Table 5.5 Non-live pregnancy outcomes ................................................................................... 76
Table 5.6 Birth intervals ............................................................................................................ 77
Table 5.7 Postpartum amenorrhea, abstinence and insusceptibility ........................................... 78
Table 5.8 Median duration of amenorrhea, postpartum abstinence, and postpartum
insusceptibility ........................................................................................................... 78
Table 5.9 Menopause ................................................................................................................. 79
Table 5.10 Age at first birth ......................................................................................................... 79
Table 5.11 Median age at first birth ............................................................................................. 80
Table 5.12 Teenage pregnancy and motherhood ......................................................................... 81

Figure 5.1 Trends in fertility by residence .................................................................................. 68
Figure 5.2 Trends in age-specific fertility ................................................................................... 68
Figure 5.3 Fertility by prefecture ............................................................................................... 68
Figure 5.4 Fertility by household wealth .................................................................................... 69
Figure 5.5 Non-live pregnancy outcome ..................................................................................... 69
Figure 5.6 Birth intervals ............................................................................................................ 70
Figure 5.7 Median age at first birth by education ....................................................................... 72
Figure 5.8 Teenage pregnancy and motherhood by prefecture ................................................... 73
Figure 5.9 Teenage pregnancy and motherhood by household wealth ....................................... 73
6 FERTILITY PREFERENCES ............................................................................................................ 83
Table 6.1 Fertility preferences by number of living children .................................................... 87
Table 6.2.1 Desire to limit childbearing: Women ......................................................................... 87
Table 6.2.2 Desire to limit childbearing: Men .............................................................................. 88
Table 6.3 Ideal number of children by number of living children ............................................. 89
Table 6.4 Mean ideal number of children .................................................................................. 90
Table 6.5 Fertility planning status ............................................................................................. 90
Table 6.6 Wanted fertility rates ................................................................................................. 91

Figure 6.1 Trends in desire to limit childbearing by number of living children.......................... 84
Figure 6.2 Desire to limit childbearing by number of living children ......................................... 84
Figure 6.3 Ideal family size by education ................................................................................... 85
Figure 6.4 Fertility planning status ............................................................................................. 85

viii • Tables and Figures