Survey ID Number
Demographic and Health Survey 2000-2001, Uganda
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.
- 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.
The sample was drawn through a two-stage design. The first-stage sample frame for this survey is the list of enumeration areas (EAs) compiled from the 1991 Population Census. In this frame, the EAs are grouped by parish within a subcounty, by subcounty within a county, and by county within a district. A total of 298 EAs (102 in urban areas and 196 in rural areas) were selected. Urban areas and districts included in the Delivery of Improved Services for Health (DISH) project and the Community Reproductive Health Project (CREHP) were oversampled in order to produce estimates for these segments of the population.
Within each selected EA, a complete household listing was done to provide the basis for the second-stage sampling. The number of households to be selected in each sampled EA was allocated proportionally to the number of households in the EA.
It was not possible to cover all districts in the country because of security problems in a few areas. The survey was hence limited to 41 out of the then 45 districts in the country,1 excluding the districts of Kasese and Bundibugyo in the Western Region and Gulu and Kitgum in the Northern Region. These districts cover approximately 5 percent of the total population.
The sample for the 2000-2001 UDHS was aimed at providing reliable estimates of important indicators for the population of Uganda at the national level (less the excluded districts), for urban and rural areas, and for each of the four regions in Uganda defined as:
- Central: Kalangala, Kampala, Kiboga, Luwero, Masaka, Mpigi, Mubende, Mukono, Sembabule, Nakasongola, and Rakai
- Eastern: Bugiri, Busia, Iganga, Jinja, Kamuli, Kapchorwa, Katakwi, Kumi, Mbale, Pallisa, Soroti, and Tororo
- Northern: Adjumani, Apac, Arua, Kotido, Lira, Moyo, Moroto, and Nebbi
- Western: Bushenyi, Hoima, Kabale, Kabarole, Kibaale, Kisoro, Masindi, Mbarara, Ntungamo, and Rukungiri.
The sample was also designed to generate estimates of contraceptive prevalence rates for the districts in the DISH project funded by the United States Agency for International Development (USAID) and districts in the CREHP project. These districts are grouped in six subdomains, namely, the following:
- Group I: Mbarara and Ntungamo
- Group II: Masaka, Rakai, and Sembabule
- Group III: Luwero, Masindi, and Nakasongola
- Group IV: Jinja and Kamuli
- Group V: Kampala
DISH districts: Kabale, Kisoro, and Rukungiri.
In each group, a minimum of 500 completed interviews with women was targeted to allow for separate estimates. Consequently, data for Kampala District can be presented separately because it has more than the specified minimum number of completed interviews.
The 2000-2001 UDHS covered the same EAs as were covered by the 1995 UDHS. However, a new list of households within the EA was compiled and the sample households were not necessarily the same as those selected in 1995. In the case of the CREHP districts (Kabale, Kisoro and Rukungiri), five extra EAs were selected to generate a sample size sufficient to allow independent estimates. Because the 1995 and 2000-2001 UDHS did not cover the same geographical areas, the two surveys are not exactly comparable.
Details of the UDHS sample design are provided in Appendix A and estimations of sampling errors are included in Appendix B of the Final report.
The questionnaire for each DHS can be found as an appendix in the final report for each study.
Three questionnaires were used for the 2000-2001 UDHS, namely, a) the Household Questionnaire, b) the Women's Questionnaire, and c) the Men's Questionnaire. The contents of these questionnaires were based on the MEASURE DHS+ Model “B” Questionnaire, which was developed for use in countries with a low level of contraceptive use. In consultation with technical institutions and local organisations, UBOS modified these questionnaires to reflect relevant issues in population, family planning, and other health issues in Uganda. The revised questionnaires were translated from English into six major languages, namely, Ateso, Luganda, Lugbara, Luo, Runyankole/Rukiga, and Runyoro/Rutoro.
The questionnaires were pretested prior to their finalisation. The pretest training took place from June 14 to July 8, 2000. For this exercise, seven women and seven men were trained to be interviewers, forming seven teams of one woman and one man each. Each team was assigned to test the questionnaires in one of the seven language groups (including English) into which the questionnaires had been translated. Three nurses were recruited to participate in the anemia testing exercise as health technicians. The pretest fieldwork was conducted during a one-week period (July 10-16, 2000).
a) The Household Questionnaire was used to list all the usual members and visitors in selected households. Some basic information was collected on the characteristics of each person listed, including his or 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. 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, and ownership of various durable goods. It also included questions that were designed to assess the extent of child labour and that were used to record the height and weight and the hemoglobin level of women 15-49 and children under the age of five. In households selected for the male survey, the hemoglobin level of men eligible for the individual interview was also recorded.
b) The Women's Questionnaire was used to collect information from all women age 15-49. These women were asked questions on topics related to their background, childbearing experience and preferences, marriage and sexual activity, employment, maternal and child care, and awareness and behaviour regarding AIDS and other sexually transmitted infections (STIs). Information necessary for the calculation of adult mortality including maternal mortality was also included in the Women's Questionnaire.
c) The Men's Questionnaire was administered to all men age 15-54 living in every third household in the UDHS 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, maternal and child health, nutrition, and maternal mortality.
The decision to include vitamin A testing was made rather late in the survey design process. As a result, ORC Macro and UBOS staff organized a special pretest of the vitamin A testing procedures shortly before the main training for the survey. Although there were some concerns about response rates, the pretest indicated that it was feasible to incorporate vitamin A testing into the UDHS. Therefore, ORC Macro staff and UBOS staff and consultants proceeded to develop a special set of training materials for the vitamin A testing.