Abstract
The 2000-2001 Uganda Demographic and Health Survey (UDHS) is a nationally representative survey of 7,246 women age 15-49 and 1,962 men age 15-54. The main purpose of the 2000-2001 UDHS is to provide policy-makers and programme managers with detailed information on fertility; family planning; childhood and adult mortality; maternal and child health and nutrition; and knowledge of, attitudes about, and practices related to HIV/AIDS. The 2000-2001 UDHS is the third national sample survey of its kind to be undertaken in Uganda. The first survey was implemented in 1988-1989 and was followed by the 1995 UDHS. Caution needs to be exercised when analysing trends using the three UDHS data sets because of some differences in geographic coverage.
The 2000-2001 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 haemoglobin and vitamin A in the blood.
The 2000-2001 UDHS is a follow-up to the 1988-1989 and 1995 UDHS surveys, which were also implemented by the Uganda Bureau of Statistics (UBOS, previously the Department of Statistics). The 2000-2001 UDHS is significantly expanded in scope but also provides updated estimates of basic demographic and health indicators covered in the earlier surveys.
The specific objectives of the 2000-2001 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 immunisations, prevalence and treatment of diarrhoea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding
- To measure levels of haemoglobin and vitamin A in the blood of women and children
- To collect information on the extent of child labour.
MAIN FINDINGS
- Constant Fertility: The UDHS results show that fertility in Uganda has remained stationary in recent years. The total fertility rate (TFR) declined from 7.3 births per woman recorded in the 1988 survey to 6.9 births for the 1995 UDHS. Since then, the TFR has remained at the same level. The crude birth rate (CBR) from the 2000-2001 survey is 47 births per 1,000 population, essentially the same as that recorded in 1995 (48 births per 1,000 population).
- Unplanned Fertility: Despite increasing use of contraception, the survey data show that unplanned pregnancies are still common in Uganda. One in four births in the five years prior to the survey were mistimed (wanted later), and 15 percent were not wanted at all. If unwanted births could be prevented, the total fertility rate in Uganda would be 5.3 births per woman instead of the actual level of 6.9.
- Fertility regulation: Increasing Use of Contraception. Contraceptive use among currently married women in Uganda has increased from 15 percent in 1995 to 23 percent in 2000-2001. Most of the increase is due to greater use of modern methods (8 percent in 1995 compared with 18 percent in 2000-2001). The most widely used methods in 2000-2001 were injectables (6 percent), the lactational amenorrhoea method (4 percent), and the pill (3 percent). There has been a shift in method mix since 1995, when periodic abstinence, the pill, and injectables were the most widely used methods. Condom use has also increased from 1 percent in 1995 to 2 percent in 2000-2001.
- Maternal and child health: Antenatal Care. Survey data show that antenatal coverage is very high in Uganda. Women receive at least some antenatal care for more than nine in ten births. In most cases, antenatal care is provided by a nurse or a midwife (83 percent). Doctors provide antenatal care to 9 percent of pregnant women, while the role of traditional birth attendants is insignificant. Only 42 percent of pregnant women make four or more antenatal care visits, while another 42 percent make only two or three visits. Moreover, very few women receive antenatal care during the first trimester of pregnancy. The majority of women (70 percent) receive tetanus toxoid vaccination during pregnancy, with 42 percent of the women receiving two or more doses of vaccine.
- Nutritional Status of Children: Survey data show that there has been little improvement since 1995 in children's nutritional status. Overall, 39 percent of Ugandan children under five years are classified as stunted (low height-for-age), 4 percent of children under five years are wasted (low weight-for-height), and 23 percent are underweight.
- Nutritional Status of Women: The mean height for Ugandan women is 158 centimetres (cm), which is similar to the mean height obtained in the 1995 UDHS. The cutoff point below which women are identified as short in stature is in the range of 140 to 150 cm. Two percent of women are less than 145 cm tall. Another measure of women's nutritional status is the body mass index (BMI), which is derived by dividing the weight in kilograms by the height in metres squared (kg/m2). A cutoff point of 18.5 has been recommended for defining chronic undernutrition. In the 2000-2001 UDHS, the mean BMI for women was 21.9, which falls within normal limits.
- Knowledge of HIV/AIDS: In Uganda, HIV/AIDS has been termed a “household disease”, because nine in ten respondents of either sex knew personally of someone with HIV or who had died of AIDS. Although knowledge of AIDS in Uganda is universal, the level of awareness about the disease is not matched by the knowledge of ways to avoid contracting the virus. The most commonly cited ways are using condoms (54 percent of women and 72 percent of men), abstaining from sexual relations (50 percent of women and 65 percent of men), and having only one sexual partner (49 percent of women and 43 percent of men).
- Mortality : knowledge is uneven. Overall, 58 percent of women know that HIV can be transmitted during pregnancy, 69 percent know about transmission during delivery, and 46 percent know about transmission during breastfeeding. Levels of knowledge among men are similar.
- Knowledge of Symptoms of Sexually Transmitted Infections (STIs): STIs have been identified as cofactors in HIV/AIDS transmission. Almost half of women and one in four men either have no knowledge of STIs at all or are unable to recognise any symptoms of STIs in a man. Sixty-four percent of women know of some symptoms of STIs in women and 53 percent know of some symptoms in men. Knowledge of symptoms of STIs among men is generally higher than among women.
- HIV/AIDS testing: Eight percent of women and 12 percent of men report that they have been tested for HIV. Women in their twenties and men age 25-39 are the most likely to have had the test. This test is much more common among respondents living in urban areas, in the Central Region, and in Kampala district and among those who have secondary education.