Demographic and Health Survey 1999 - Zimbabwe

Abstract
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The Central Statistical Office (CSO) conducted the third Zimbabwe Demographic and Health Survey (ZDHS) between August and November 1999. The 1999 Zimbabwe Demographic and Health Survey (ZDHS) is a nationally represen­tative survey that was implemented by the Central Statistical Office (CSO) from August to November 1999. Although significantly ex­panded in content, the 1999 ZDHS is a follow-on to the 1988 and 1994 ZDHS surveys and provides updated estimates of the basic demo­graphic and health indicators covered in the earlier surveys. The 1999 ZDHS was conducted in all of the ten provinces of Zimbabwe.

The 1999 Zimbabwe Demographic and Health Survey (ZDHS) is one of a series of surveys undertaken by the Central Statistical Office (CSO) as part of the Zimbabwe National Household Survey Capability Programme (ZNHSCP) and the worldwide MEASURE DHS+ programme. The Zimbabwe National Family Planning Council (ZNFPC), the Department of Population Studies of the University of Zimbabwe (UZ), the National AIDS Coordinating Programme (NACP), and the Ministry of Health and Child Welfare (MOH&CW) contributed significantly to the design, implementation, and analysis of the ZDHS results. The U.S. Agency for International Development (USAID) provided funds for the implementation of the 1999 ZDHS. Macro International Inc. provided technical assistance through its contract with USAID. UNICEF/Zimbabwe supported the survey by providing additional funds for fieldwork transportation.

The primary objectives of the 1999 ZDHS were to provide up-to-date information on fertility levels, nuptiality, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of mothers and young children, early childhood mortality and maternal mortality, maternal and child health, and awareness and behaviour regarding AIDS and other sexually transmitted diseases.

The 1999 ZDHS is a follow-up of the 1988 and 1994 ZDHS surveys, also implemented by CSO. The 1999 ZDHS is significantly expanded in scope and provides updated estimates of basic demographic and health indicators covered in the earlier surveys.

KEY RESULTS

Like the 1988 ZDHS and the 1994 ZDHS, the 1999 ZDHS was designed to provide information on levels and trends in fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. Specific questions were also asked about the respondent's knowledge, attitude, and practice regarding the HIV/AIDS virus and other sexu­ally transmitted diseases. Like the1994 ZDHS, the 1999 ZDHS also collected data on mortality related to pregnancy and childbearing (i.e., maternal mortality). The ZDHS data are in­tended for use by programme managers and policymakers to evaluate and improve family planning and health programmes in Zimbabwe.

- Fertility. The 1988, 1994, and 1999 ZDHS results show that Zimbabwe continues to experience a fairly rapid decline in fertility.
- Marriage. The median age at first marriage in Zimbabwe has risen slowly over the past 30 years. Women age 20-24 marry about one year later than women 40-49 (19.7 years and 18.8 years, respectively). The proportion of women married by age 15 declined from 9 percent among those age 45-49 to 2 percent among women age 15-19 years.
- Polygyny. One in six women in Zimbabwe reported being in a polygynous union.
- Fertility Preferences. More than half (53 percent) of the married women in Zimbabwe would like to have another child.
- Family Planning. Since 1994, knowl­edge of family planning in Zimbabwe has been universal and has not varied across subgroups of the population. The pill, condoms, and injectables are the most widely known methods.
- Antenatal Care. Utilisation of antenatal services is high in Zimbabwe; in the five years before the survey, mothers received antenatal care from a trained medical professional for 93 percent of their most recent births; 13 percent from a doctor and 80 percent from a trained nurse or a midwife.
- Delivery Characteristics. In 1999, the percentage of births delivered in health facilities (72 percent) was slightly higher than the percentage recorded in the 1994 ZDHS (69 per­cent).
- Childhood Vaccination. Three in four children 12-23 months have been vaccinated against six diseases (tuberculosis, diphtheria, pertussis, tetanus, polio, and measles). Two in three children completed the vaccination sched­ule by the time they turned one year.
- Childhood Diseases. In the 1999 ZDHS, mothers were asked whether their children under the age of five years had been ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey.
- Childhood Mortality. Data from sur­veys since 1988 indicate that early childhood mortality in Zimbabwe declined until the late 1980s, after which there was stagnation and an upward trend in the past five years.
- Adult and Maternal Mortality. As in 1994, the 1999 ZDHS collected information that allows estimation of adult and maternal mortality.
- Perceived Problems in Accessing Women's Health Care. Women are sometimes perceived to have problems in seeking health care services for themselves.
- Nutrition. Breastfeeding is nearly universal in Zimbabwe; 98 percent of the children born in the past five years were breastfed at some time.
- AIDS-related Knowledge and Behav­iour. Although practically all Zimbabwean women and men have heard of AIDS, the quality of that knowledge is sometimes poor; 17 percent of women and 7 percent of men could not cite a single means to avoid getting HIV/AIDS.

Geographic coverage
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The 1999 Zimbabwe Demographic and Health Survey (ZDHS) is a nationally represen­tative survey that was implemented by the Central Statistical Office (CSO) from August to November 1999. The survey was conducted in all of the ten provinces of Zimbabwe.

Analysis unit
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- Household
- Women age 15-49
- Men age 15-54
- Children under five years

Universe
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The population covered by the 1994 ZDHS is defined as the universe of all women age 15­-49 in Zimbabwe and all men age 15-54 living in the household.

Kind of data
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Sample survey data

Sampling procedure
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The sampling frame used for the 1999 ZDHS was the 1992 Zimbabwe Master Sample (ZMS92) developed by the CSO after the 1992 Population Census. The same enumeration areas (EAs) of the 1994 ZDHS were used in the 1999 ZDHS. The ZMS92 included 395 enumeration areas stratified by province and land use sector. For purposes of the ZDHS, 18 sampling strata were identified: urban and rural strata for each of the eight provinces, and Harare (including Chitungwiza) and Bulawayo provinces, which are exclusively urban strata.

The sample for the 1999 ZDHS was selected in two stages. In the first stage, 230 EAs were selected with equal probability. Then, within each of these 230 EAs, a complete household listing and mapping exercise was conducted in May 1999, forming the basis for the second-stage sampling. For the listing exercise, permanent CSO enumerators were trained in listing and cartographic methods. All private households were listed. The list excluded people living in institutional households (army barracks, hospitals, police camps, etc.).

Households to be included in the ZDHS were selected from the EA household lists, with the sample being proportional to the total number of households in the EA. All women age 15-49 years in those households were eligible to be interviewed in the ZDHS. Furthermore, a 50 percent systematic subsample of these households was selected, within which interviews with all males age 15-54 years were to be conducted as well.

Since the objective of the survey was to produce estimates of specific demographic and health indicators for each of the 10 provinces, the sample design allowed for an oversample of smaller strata. The overall target sample was 6,208 women and 2,970 men. The ZDHS sample is not self-weighting at the national level (i.e., weights are required to estimate national-level indicators).

Mode of data collection
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Face-to-face

Research instrument
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Four types of questionnaires were used for the ZDHS: the Household Questionnaire, the Women's Questionnaire, the Men's Questionnaire, and the Cluster Location form. The contents of these questionnaires were based on the DHS Model “A” Questionnaire, which is designed for use in countries with moderate to high levels of contraceptive use.

a) The Household Questionnaire was used to list all the usual members and visitors of selected households. Some basic information was collected on 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 who were eligible for the individual interview. The Household Questionnaire also collected information on characteristics of the household's dwelling units, such as the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various consumer and durable goods.

b) The Women's Questionnaire was used to collect information on women age 15-49 years. These women were asked questions on the following topics:
Background characteristics (education, residential history, etc.) Reproductive history Knowledge and use of family planning methods Fertility preferences Antenatal and delivery care Breastfeeding and weaning practices Vaccinations and health of children under age five Marriage and sexual activity Woman's status and husband's occupation Awareness and behaviour regarding AIDS and other sexually transmitted diseases Adult mortality including maternal mortality.
As in the 1994 ZDHS, a “calendar” was used in the 1999 ZDHS to collect information on the respondent's history since January 1994 concerning reproduction, contraceptive use, reasons for discontinuation of contraception, marriage, and migration. In addition, interviewing teams measured the height and weight of all children under the age of five years and of all women age 15­-49.

c) The Men's Questionnaire was administered to all men age 15-54 living in every second household in the ZDHS sample (i.e., a 50 percent sample). The Men's Questionnaire collected much of the same information found in the Women's Questionnaire, but was shorter because it did not contain questions on reproductive history and maternal and child health.

d) CSO Provincial Supervisors administered the Cluster Location Form. This exercise was carried out in January 2000. Global Positioning System (GPS) receivers were used to calculate the position (in terms of latitude and longitude) of each of the 230 clusters in the ZDHS. These positions can be used to link other data about Zimbabwe (e.g., average rainfall) to the information collected during the 1999 ZDHS.

Cleaning operations
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All questionnaires for the 1999 ZDHS were returned to the CSO for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing computer identified errors. The data were processed on five microcomputers. Data entry and editing were accomplished using the computer programme Integrated System for Survey Analysis (ISSA). Data processing commenced on 15 September 1999 and was completed on 21 January 2000.

Response rate
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A total of 7,010 households were selected in the sample, of which 6,512 were currently occupied. The shortfall was largely due to some households no longer existing in the sampled clusters at the time of the interview. Of the 6,512 existing households, 6,369 were interviewed, yielding a household response rate of 97.8 percent.

In the interviewed households, 6,208 eligible women were identified and of these, 5,907 were interviewed, yielding a response rate of 95.2 percent. In a 50 percent subsample of households, 2,970 eligible men were identified, of which 2,609 were successfully interviewed (87.8 percent response). The principal reason for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the household. The lower response rate among men than among women was due to the more frequent and longer absences of men.

Sampling error estimates
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Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the 1999 ZDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results.

A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design.

If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 1999 ZDHS sample is the result of a two-stage stratified design, and consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the 1999 ZDHS is the ISSA Sampling Error Module (ISSAS). This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates.

Sampling errors for the 1999 ZDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table

In general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions.

The confidence interval (e.g., as calculated for Children ever born to women age 15-49) can be interpreted as follows: the overall average from the national sample is 2.3 and its standard error is .04. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 2.3±.04. There is a high probability (95 percent) that the true average number of children ever born to all women age 15 to 49 is between 2.2 and 2.4.

Data appraisal
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Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 1999 ZDHS to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically.

摘要
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中部统计局（CSO）于1999年8月至11月进行了第三次津巴布韦人口与健康调查（ZDHS）。1999年津巴布韦人口与健康调查（ZDHS）是一项全国性代表性调查，由中部统计局（CSO）于1999年8月至11月实施。尽管在内容上有所扩展，但1999年ZDHS是对1988年和1994年ZDHS调查的延续，并提供了涵盖先前调查的基本人口与健康指标的更新估计。1999年ZDHS在津巴布韦的所有十个省份进行。

1999年津巴布韦人口与健康调查（ZDHS）是中部统计局（CSO）作为津巴布韦国家家庭调查能力项目（ZNHSCP）和全球MEASURE DHS+项目的一部分所进行的一系列调查之一。津巴布韦国家计划生育委员会（ZNFPC）、津巴布韦大学人口研究系（UZ）、国家艾滋病协调计划（NACP）和卫生部及儿童福利部（MOH&CW）在ZDHS的设计、实施和分析方面做出了重大贡献。美国国际开发署（USAID）为1999年ZDHS的实施提供了资金。Macro International Inc.通过其与USAID的合同提供了技术援助。联合国儿童基金会/津巴布韦通过为实地工作提供额外资金来支持调查。

1999年ZDHS的主要目标是提供有关生育水平、婚姻状况、性行为、生育偏好、计划生育方法的认知和使用、母乳喂养实践、母亲和婴幼儿的营养状况、婴幼儿死亡和孕产妇死亡、母亲和儿童健康以及关于艾滋病和其他性传播疾病的认知和行为的最新信息。

1999年ZDHS是对1988年和1994年ZDHS调查的延续，后者也由CSO实施。1999年ZDHS在范围上有所扩展，并提供了涵盖先前调查的基本人口与健康指标的更新估计。

关键结果

与1988年ZDHS和1994年ZDHS一样，1999年ZDHS旨在提供有关生育水平、家庭规划知识和使用、婴儿和儿童死亡率以及母亲和儿童健康的水平和趋势信息。还就受访者对HIV/AIDS病毒和其他性传播疾病的认知、态度和实践进行了具体提问。与1994年ZDHS一样，1999年ZDHS还收集了与怀孕和生育相关的死亡（即孕产妇死亡）数据。ZDHS数据旨在供项目管理人员和政策制定者使用，以评估和改进津巴布韦的家庭规划和卫生计划。

- 生育。1988年、1994年和1999年ZDHS的结果表明，津巴布韦的生育率持续较快下降。
- 婚姻。过去30年中，津巴布韦首次结婚的平均年龄缓慢上升。20-24岁的女性比40-49岁的女性晚结婚约一年（分别为19.7岁和18.8岁）。到15-19岁的女性中，到15岁时已婚的比例从45-49岁的9%下降到2%。
- 一妻多夫制。津巴布韦有六分之一的女性报告说她们处于一妻多夫制婚姻中。
- 生育偏好。超过一半（53%）的已婚女性希望再要一个孩子。
- 家庭规划。自1994年以来，津巴布韦对家庭规划的了解已普及，并且在人口各子群体之间没有变化。避孕药、避孕套和注射剂是最为人所知的避孕方法。
- 产前护理。在津巴布韦，产前服务利用率很高；在调查前的五年中，母亲在最近一次分娩中从受过培训的医务人员那里接受了93%的产前护理；13%来自医生，80%来自受过培训的护士或助产士。
- 分娩特征。1999年，在医疗机构分娩的出生率（72%）略高于1994年ZDHS记录的百分比（69%）。
- 儿童疫苗接种。12-23个月大的四分之三的儿童接种了六种疾病（结核病、白喉、百日咳、破伤风、脊髓灰质炎和麻疹）的疫苗。三分之二的孩子在满一岁时完成了疫苗接种计划。
- 儿童疾病。在1999年ZDHS中，母亲被问及她们的5岁以下儿童在调查前两周是否患过伴随短促、快速呼吸的咳嗽。
- 儿童死亡率。自1988年以来的调查数据显示，津巴布韦的婴幼儿死亡率在20世纪80年代末下降，此后出现了停滞和过去五年内的上升趋势。
- 成人和孕产妇死亡率。与1994年一样，1999年ZDHS收集了可用于估计成人和孕产妇死亡的信息。
- 认知到的女性健康护理获取问题。有时人们认为女性在寻求自身健康护理服务时存在困难。
- 营养。在津巴布韦，母乳喂养几乎是普遍的；在过去五年中出生的98%的儿童在某个时候都接受过母乳喂养。
- 艾滋病相关知识和行为。尽管几乎所有津巴布韦的男性和女性都听说过艾滋病，但那种知识的质量有时很差；17%的女性和7%的男性无法列举出避免感染HIV/AIDS的任何一种方法。
地理覆盖范围
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1999年津巴布韦人口与健康调查（ZDHS）是一项全国性代表性调查，由中部统计局（CSO）于1999年8月至11月实施。调查在津巴布韦的所有十个省份进行。

分析单位
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- 家庭
- 15-49岁女性
- 15-54岁男性
- 5岁以下儿童

总体
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1994年ZDHS所覆盖的人口被定义为津巴布韦所有15-49岁女性和所有15-54岁居住在户中的男性的总体。

数据类型
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样本调查数据

抽样程序
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1999年ZDHS使用的抽样框架是中部统计局（CSO）在1992年人口普查后开发的1992年津巴布韦主样本（ZMS92）。1999年ZDHS使用了与1994年ZDHS相同的枚举区域（EA）。ZMS92包括395个按省份和土地利用部门划分的枚举区域。为了ZDHS的目的，确定了18个抽样层：每个省份的城市和农村层，以及哈拉雷（包括奇通韦扎）和布隆迪省，这些省份完全是城市层。

1999年ZDHS的样本在两个阶段进行选择。在第一阶段，随机选择了230个EA。然后，在1999年5月对每个这些230个EA进行了完整的家庭清单和制图练习，这构成了第二阶段抽样的基础。对于清单练习，对永久性CSO人口普查员进行了清单和制图方法的培训。所有私人家庭都被列入清单。清单排除了居住在机构家庭（军营、医院、警察营地等）的人。

要包括在ZDHS中的家庭是从EA家庭清单中选择的，样本与EA中家庭总数成比例。这些家庭中所有15-49岁的女性都有资格在ZDHS中进行访谈。此外，从这些家庭中选择了50%的系统子样本，其中对所有15-54岁的男性进行访谈。