The 1992 Namibia Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Ministry of Health and Social Services, assisted by the Central Statistical Office, with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal mortality, maternal and child health and nutrition. Interviewers collected information on the reproductive histories of 5,421 women 15-49 years and on the health of 3,562 children under the age of five years.
The Namibia Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on mortality and fertility, socioeconomic characteristics, marriage patterns, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of women and children. More specifically, the objectives of NDHS are:
- To collect data at the national level which will allow the calculation of demographic rates, particularly fertility rates and child mortality rates, and maternal mortality rates; To analyse the direct and indirect factors which determine levels and trends in fertility and childhood mortality, Indicators of fertility and mortality are important in planning for social and economic development;
- To measure the level of contraceptive knowledge and practice by method, region, and urban/rural residence;
- To collect reliable data on family health: immunisations, prevalence and treatment of diarrhoea and other diseases among children under five, antenatal visits, assistance at delivery and breastfeeding;
- To measure the nutritional status of children under five and of their mothers using anthropometric measurements (principally height and weight).
According to the NDHS, fertility is high in Namibia; at current fertility levels, Namibian women will have an average of 5.4 children by the end of their reproductive years. This is lower than most countries in sub-Saharan Africa, but similar to results from DHS surveys in Botswana (4.9 children per woman) and Zimbabwe (5.4 children per woman). Fertility in the South and Central regions is considerably lower (4.1 children per woman) than in the Northeast (6.0) and Northwest regions (6.7).
About one in four women uses a contraceptive method: 29 percent of married women currently use a method (26 percent use a modem method), and 23 percent of all women are current users. The pill, injection and female sterilisation are the most popular methods among married couples: each is used by about 7 to 8 percent of currently married women. Knowledge of contraception is high, with almost 90 percent of all women age 15-49 knowing of any modem method.
Certain groups of women are much more likely to use contraception than others. For example, urban women are almost four times more likely to be using a modem contraceptive method (47 percent) than rural women (13 percent). Women in the South and Central regions, those with more education, and those living closer to family planning services are also more likely to be using contraception.
Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size (5.0 children) is only slightly lower than the total fertility rate (5.4 children). Thus, the vast majority of births are wanted.
On average, Namibian women have their first child when they are about 21 years of age. The median age at first marriage is, however, 25 years. This indicates that many women give birth before marriage. In fact, married women are a minority in Namibia: 51 percent of women 15-49 were not married, 27 percent were currently married, 15 percent were currently living with a man (informal union), and 7 percent were widowed, divorced or separated. Therefore, a large proportion of children in Namibia are born out of wedlock.
The NDHS also provides inlbrmation about maternal and child health. The data indicate that 1 in 12 children dies before the fifth birthday. However, infant and child mortality have been declining over the past decade. Infant mortality has fallen from 67 deaths per 1,000 live births for the period 1983-87 to 57 per 1,000 live births for the period 1988-92, a decline of about 15 percent. Mortality is higher in the Northeast region than elsewhere in Namibia.
The leading causes of death are diarrhoea, undemutrition, acute respiratory infection (pneumonia) and malaria: each of these conditions was associated with about one-fifth of under-five deaths. Among neonatal deaths low birth weight and birth problems were the leading causes of death. Neonatal tetanus and measles were not lbund to be major causes of death.
Maternal mortality was estimated from reports on the survival status of sisters of the respondent. Maternal mortality was 225 per 100,000 live births for the decade prior to the survey. NDHS data also show considerable excess male mortality at ages 15-49, which may in part be related to the war of independence
during the 1980s.
Utilisation of maternal and child health services is high. Almost 90 percent of mothers received antenatal care, and two-thirds of children were bom in health facilities. Traditional birth attendants assisted only 6 percent of births in the five years preceding the survey. Child vaccination coverage has increased rapidly since independence. Ninety-five percent of children age 12-23 months have received at least one vaccination, while 76 percent have received a measles vaccination, and 70 percent three doses of DPT and polio vaccines.
Children with symptoms of possible acute respiratory infection (cough and rapid breathing) may have pneumonia and need to be seen by a health worker. Among children with such symptoms in the two weeks preceding the survey two-thirds were taken to a health facility. Only children of mothers who lived more than 30 km from a health facility were less likely to be taken to a facility.
About one in five children had diarrhoea in the two weeks prior to the survey. Diarrhoea prevalence was very high in the Northeast region, where almost half of children reportedly had diarrhoea. The dysentery epidemic contributed to this high figure: diarrhoea with blood was reported for 17 percent of children under five in the Northeast region. Among children with diarrhoea in the last two weeks 68 percent were taken to a health facility, and 64 percent received a solution prepared from ORS packets. NDHS data indicate that more emphasis needs to put on increasing fluids during diarrhoea, since only I 1 percent mothers of children with diarrhoea said they increased the amount of fluids given during the episode.
Nearly all babies are breastfed (95 percent), but only 52 percent are put on the breast immediately. Exclusive breastfeeding is practiced for a short period, but not for the recommended 4-6 months. Most babies are given water, formula, or other supplements within the first four months of life, which both jeopardises their nutritional status and increases the risk of infection. On average, children are breastfed for about 17 months, but large differences exist by region. In the South region children are breastfed lor less than a year, in the Northwest region for about one and a half years and in the Northeast region for almost two years.
Most babies are weighed at birth, but the actual birth weight could be recalled for only 44 percent of births. Using these data and data on reported size of the newborn, for all births in the last five years, it was estimated that the mean birth weight in Namibia is 3048 grams, and that 16 percent of babies were low birth weight (less than 2500 grams).
Stunting, an indication of chronic undemutrition, was observed for 28 percent of children under five. Stunting was more common in the Northeast region (42 percent) than elsewhere in Namibia. Almost 9 percent of children were wasted, which is an indication of acute undemutrition. Wasting is higher than expected for Namibia and may have been caused by the drought conditions during 1992.
Matemal height is an indicator of nutritional status over generations. Women in Namibia have an average height of 160 cm and there is little variation by region. The Body Mass Index (BM1), defined as weight divided by squared height, is a measure of current nutritional status and was lower among women in the Northwest and the Northeast regions than among women in the South and Central regions.
On average, women had a health facility available within 40 minutes travel time. Women in the Northwest region, however, had to travel more than one hour to reach the nearest health facility. At a distance of less than 10 km, 56 percent of women had access to antenatal services, 48 percent to maternity services, 72 percent to immunisation services, and 49 percent to family planning services. Within one hour of travel time, fifty-two percent of women had antenatal services, 48 percent delivery services, 64 percent immunisation services and 49 percent family planning services. Distance and travel time were greatest in the Northwest region.