Global Forum on Gender Statistics,Manila, Philippines, 11-13 October, 2010

Integrating gender into tools for the production and Analysis of

Health Statistics

Mrs.Hang LinaDeputy Director General, NIS

CAMBODIAESA/STAT/AC.219/25

Introduction• The National Institute of Statistics (NIS) has been closely

working with a number of concerning line ministries (MOWA, MOH, MOE, MOA) and development partners (UNFPA, SIDA, and JICA) to promote gender equality and gender statistics in Cambodia.

• A Gender Mainstreaming Action Group (GMAG) was formed in July 2006, supporting by UNFPA. A Gender Mainstreaming Action Plan (GMAP) had been produced for 2008-2010 and now is updating for 2009-2013. Training courses on Gender Mainstreaming into Statistics and Planning had been conducted for the senior officers of the Ministry of Planning and by provinces.

Introduction

• A Gender Statistics Working Group was established in February, 2007. A Gender booklet “Women and Men” in Cambodia (1st edition) had been published for 2008 and now is updating for 2010 (2nd edition) with the support from SIDA. Another publication namely “Gender in Cambodia” is an in-depth analysis based on 2008 Population Census results with the support from UNFPA.

Introduction• The National Institute of Statistics has conducted two

Censuses and several Surveys which serve as major sources of gender statistics for Cambodia. They are:– The Population Census (every ten years ,1998 and 2008)– The Socio-Economic Survey (every year from 1996)– The Demographic and Health Survey (every five

years,2000,2005 and 2010).The Population census does not cover much on health

though it provides mortality and cause of death indicators as well as population figures up to the village level disaggregated by sex, age group etc that are useful in estimating health indicators. The other two surveys,however, do provide health statistics.

Introduction

• NIS incorporate with MOH conduct Demographics and Health survey (DHS) since 2000, 2005. Then 2010 is on the way of collection data.

Key Gender issues in Cambodia

• Economic empowerment of women;• Enhancing women’s and girls’ education;• Legal protection of women and girls;• Promotion of health of women and girls;• Promotion of women in decision-making; and• Gender mainstreaming in national policies and

programs

Promotion of health of women

• Women continue to report problems in accessing health care:– Women and men are accessing treatment for illness or injury,

but women continue to report problem in accessing health care. No information is available on the problems faced by men in accessing health services. As of 2005, 91.5 percent of people who were ill sought at least one treatment, an increase over 88.6 percent reported in 2000.

– While no data is available on the proportion of males reporting problems in accessing health services, the proportion of women reporting at least one problem in accessing health care decreased from 93 percent in 2000 to 88.5 percent in 2005.

Promotion of health of women

– However, the overall number of women reporting problem remains very high. Getting money for treatment remains the main problem (88.1 percent in 2000 and 74.1 percent in 2005), followed by concern that no provider or drugs are available, and not wanting to go to health services alone.

– There are significant differences in utilization of public sector health services, 70 percent of health center and 58 percent of referral hospital clients are female. This gender bias is more pronounced in urban than in rural areas, and during reproductive years (15-49).

Maternal Health

• Antenatal Care: DHS 2005– 69 percent of women received ANC from trained

personnel (doctors, nurses, and midwives) at least once.– 61 percent of women received care during pregnancy from

midwives;– 6 percent of women received care from a doctor, and – 2 percent of women went to a nurse.– 28 percent of women received no antenatal care for birth

in the preceding five years against 55 percent in year 2000.

Maternal Health (cont.)

• Child Birth and Delivery:– A large majority of births (78 %) in the five years before

the survey were delivered at home;– Only 22 percent being delivered in a health facility;– 50 % of children born in urban areas were delivered in a

health facility. It was three time (17 %) of children born in rural areas.

– The proportion of births delivered in a health facility is only 10 % for uneducated mothers, compared with 48 % for mothers with secondary and higher education.

Maternal Health (cont.)

• Assistance at Delivery:– In 2005 44 % of births are delivered with the

assistance of a trained health professional (doctor, nurse, or midwife). Increase from 32% in 2000.

– 55% of births are delivered with assistance of a traditional birth attendant

Maternal Health (cont.)

• Postnatal Care and Practices:– 30 % of women received no postnatal care;– 64 % of mothers received postnatal care within the first

two days of delivery; – 32 % receiving care within four hours of delivery.– Urban women are more likely to receive postnatal care(74

%) than rural women during the first two days after delivery (62 %);

– 37 % of women did not deliver in a health facility and did not receive a postnatal check-up.

Child Health

• Child’s size at birth :Birth weight is a major determinant of infant and child health

and mortality. Children whose birth weight is less than 2.5 kg, or children reported to be “very small” or “smaller than average” are considered to have a higher than average risk of early childhood death. According to DHS 2005;

– 85 % of births were considered by their mothers to be of average or larger than average size;

– 11 % were perceived as smaller than average;– 4 % were considered very small.

Child Health (cont.)

• Immunization of Children :– 60 % of children age 12-23 months were fully vaccinated

by 12 months of age;– 91 % of children had received BCG vaccination;– 70 % had been vaccinated against measles;– 90 % received the first doses of DPT and of polio and

three- fourths received the third doses.

Child Health (cont.)• Acute respiratory infection: ARI– 9 % of children under five years of age showed symptoms

of ARI at some time in the two weeks preceding the survey(2005)

– 11 % of children age 6-11 and 12-23 months had experienced the symptom of ARI in higher proportions than other age group.

• Fever :– 35 % of children under five of age had a fever at some

time in the two weeks preceding the survey– Children age 6-11 and 12-23 months are more commonly

sick with fever (46 and 42 percent, respectively) then other children.

Child Health (cont.)• Diarrhea :– 20 % of all children under five had diarrhea while 3

percent had diarrhea with blood;– As with ARI and fever, young children age 6-11 and 12-23

months are more prone to diarrhea than children in the other age group (32 % and 28 %, respectively)

– Diarrhea is slightly more common among rural children (20 %) than urban children (16 %)

Nutrition of children and women

• Nutrition status of children :– 37 % of children under five are stunted;– 13 % are severely stunted;– 7 % are wasted; and– 36 % are underweight.

More rural children are stunted (38 %) than urban children (31 % ).

Nutrition of children and women (cont.)

• Initiation of breastfeeding :– Breastfeeding is nearly universal in Cambodia, with 97% of

children born in the five years preceding the survey having been breastfed at some time.

– About one in three children is breastfed within one hour of birth (35 percent) and 68 percent within one day of birth. 56 percent of children were given a pre-lacteal feed, that is something other than breast milk during the first three days of life.

– Contrary to WHO’s recommendations less than half of Cambodian children age 4-5 months is exclusively breastfed.

Nutrition of children and women (cont.)

• Prevalence of anemia in children :– Anemia is a critical public health problem in Cambodia,

where more than half (62 percent) of Cambodian children 6-59 months old are anemic, with 29 percent mildly anemic, 32 percent moderately anemic, and 1 percent severely anemic.

Nutrition of children and women (cont.)

• Nutritional Status of Women :– Two indicators of nutritional status for women (age 15-49)

are height and body mass index BMI;– The data analysis on BMI is based on 7,799 women, while

the height analysis is based on 8,370 women age 15-49.– Overall, 8 percent of women are shorter than 145 cm.– 20 percent of women were found to be underweight (BMI

less than 18.5), while 10 percent were overweight or obese.

Nutrition of children and women (cont.)

• Foods consumed by mother:– The staple diet of mothers of young children in Cambodia

consists of foods made from grains (99 percent), and meat, fish, shellfish, poultry, and eggs (94 percent).

– Three out of four women consume fruits and vegetables rich in vitamin A.

– Smaller proportion of mothers consume milk or other milk products (6 percent) and foods made from beans, peas, or nuts (10 percent).

– 31 percent of mothers consume foods made with oil, fat or butter or sugary foods.

Nutrition of children and women (cont.)

• Prevalence of Anemia in women :– 47 percent of women age 15-49 are having anemia.

Among them, 35 percent mildly anemic, 10 percent moderately anemic and just 1 percent severely anemic.

– Women with high parity, with little or no education, are pregnant, and living in poor households have higher prevalence of anemia.

– Anemia is also higher among rural than urban women.

Maternal Mortality

• Maternal death is defined as any death that occurred during pregnancy, childbirth, or within two months after the birth or termination of a pregnancy.– DHS 2005: Maternal Mortality Ratio ( MMR) was 472 per

100,000 live births– Population Census 2008: MMR was 461 per 100,000 live

birth.

Infant and Child Mortality

• Infant mortality: the probability of dying between birth and the first birthday;

• Child mortality: the probability of dying between the first and fifth birthday;

• Under-five mortality: the probability of dying between birth and the fifth birthday; DHS 2005 Census 2008- IMR 66 per 1,000 live births 60 per 1,000 live births- Under- five MR 83 per 1,000 live births

Causes of death among infants and children

• The most commonly reported causes of death are: – Baby being premature;– Fever;– Illness of the respiratory system;– Dengue hemorrhagic fever;– Accidents; and– Tetanus type convulsions

Cause of death among males age-groups 5-59 and 60+, Cambodia 2008 Census

Males aged 5-59 years Males aged 60 years and more

Cause of death Per cent of deaths Cause of death Per cent of deaths

All causes 100.0 All causes 100.0

Accidents 24.6 Other illness 41.7

Dengue fever and malaria 18.6 Heart disease 17.8

Other illness 15.0 Tuberculosis 13.9

Fever 12.6 Fever 7.7

Heart disease 7.7 Accidents 6.2

Tuberculosis 6.0 Not Known 5.4

Tetanus 4.8 Dengue fever and malaria 3.1

Not Known 4.5 Diarrhoea 2.5

Diarrhoea 3.7 Tetanus 1.6

HIV/AIDS 2.5 HIV/AIDS 0.2

Cause of death among females age-groups 5-59, and 60+ and 15-49, Cambodia 2008 Census

Females aged 5-59 years Females aged 60 years and more Females aged 15-49 years

Cause of death Per cent of deaths

Cause of death Per cent of deaths

Cause of death Per cent of deaths

All causes 100.0 All causes 100.0 All causes 100.0

Dengue fever and malaria 18.3 Other illness 48.9 Other illness 20.8

Other illness 16.6 Heart disease 14.6 Dengue fever and malaria 17.4

Fever 15.6 Tuberculosis 12.7 Heart disease 13.4

Accidents 12.3 Fever 6.9 Accidents 11.8

Heart disease 9.7 Accidents 6.5 Fever 10.8

Tuberculosis 7.2 Not Known 4.4 Tuberculosis 9.8

Tetanus 4.7 Diarrhoea 3.1 Delivery complications 6.4

Delivery complications 4.1Dengue fever and malaria 1.5 Not Known 4.1

Diarrhoea 3.7 Tetanus 1.0 Tetanus 3.9

Not Known 3.6Pregnancy complications 0.3 HIV/AIDS 3.5

HIV/AIDS 2.6 Delivery complications 0.1 Pregnancy complications 2.6

Pregnancy complications 1.7 HIV/AIDS 0.0 Diarrhoea 2.5

Disability

• The five types of disability identified for the 2008 census purpose are as follows:1. In Seeing2. In Speech3. In Hearing4. In moving5. Mental

Disability (cont.)

• According to 2008 Population census, there are 192,538 disabled persons in Cambodia (or 1.44 percent of country’s population), of which;– 56.3 percent are males and– 43.7 percent are females

• Among the disabled in the country only 61,151 (31.76 percent) persons are congenitally disabled.

Distribution of Disabled Population by type of Disability, Cambodia 2008

CONCLUSIONS

• Decennial population and housing censuses and periodic surveys which are serving as major tools for the production and analysis of health statistics in Cambodia do integrate gender to a great extent.

• However there is a need for a satisfactory civil registration system in the country which would provide on a continuous basis, statistics on births, deaths, causes of death, health, marriage divorce etc . This would go a long way in monitoring public health with particular reference to gender

• More hospitals or public health centers especially in the rural areas for women and children is yet another area that requires attention. .

Thank you for your attention