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MEASURE DHS+ assists countries worldwide in the collection and use of 

data to monitor and evaluate population, health, and nutrition programs. 

Funded by the U.S. Agency for International Development (USAID), 

MEASURE DHS+ is implemented by ORC Macro in Calverton, 

Maryland. The opinions expressed herein are those of the authors and do 

not necessarily reflect the views of the U.S. Agency for International 

Development. 

The main objectives of the MEASURE DHS+ project are: 

1) to provide decisionmakers in survey countries with information useful for informed policy choices, 

2) to expand the international population and health database, 

3) to advance survey methodology, and 

4) to develop in participating countries the skills and resources necessary to conduct high-quality demographic and health surveys. 

 

Information about the MEASURE DHS+ project or the status of MEASURE DHS+ surveys is available 

on the Internet at http://www.measuredhs.com or by contacting: 

ORC Macro 

11785 Beltsville Drive, 

Suite 300 

Calverton, MD 20705 USA 

Telephone: 301-572-0200 

Fax: 301-572-0999 

E-mail: reports@orcmacro.com 

DHS Comparative Reports No. 8 

Child Morbidity 

and Treatment Patterns 

Rebecca Y. Stallings 

ORC Macro 

Calverton, Maryland, USA 

December 2004 
This publication was made possible through support provided by the U.S. Agency for International Development under the terms of Contract No. HRN-C-00-97-00019-00. The opinions 

expressed herein are those of the authors and do not necessarily reflect the views of the U.S. 

Agency for International Development. 

Recommended citation: 

Stallings, Rebecca Y. 2004. Child Morbidity and Treatment Patterns. DHS Comparative Reports 

No. 8. Calverton, Maryland: ORC Macro. 
Contents iii

Contents 

Tables and Figures v

Preface xiii

Dedication xv

Acknowledgments xvii

Executive Summary xix 

1 Introduction 1 

2 Data and Methods 5 

2.1 Diarrhea Prevalence and Treatment 7 

2.1.1 Prevalence of Diarrhea 7 

2.1.2 Use of Oral Rehydration Solutions and Other Treatments 8 

2.1.3 Use of Appropriate Health Care Providers 8 

2.2 Fever and Treatment 8 

2.2.1 Prevalence of Fever 8 

2.2.2 Use of Antimalarials for Treatment of Fever 9 

2.3 Acute Lower Respiratory Infection and Treatment 9 

2.3.1 Prevalence of ALRI Symptoms 9 

2.3.2 Use of Appropriate Health Care Providers 9 

2.4 Cofactors of Child Morbidity 10 

2.4.1 Socioeconomic Characteristics 10 

2.4.2 Child's Characteristics 10 

2.4.3 Environmental Factors 11 

3 Diarrhea 13 

3.1 Prevalence Levels and Differentials 13 

3.1.1 Residence 13 

3.1.2 Child's Age 16 

3.1.3 Socioeconomic Characteristics 16 

3.1.4 Demographic Characteristics 22 

3.1.5 Nutritional Factors 25 

3.1.6 Measles Immunization Status 34 

3.1.7 Environmental Factors 37 

3.2 Diarrhea Treatment and Careseeking Behaviors 45 

3.2.1 Diarrhea Treatment by Careseeking Behavior 46 

3.2.2. Diarrhea Treatment by Residence and Maternal Education 

 54 

3.2.3 Diarrhea Treatment by Demographic Characteristics 61 

4 Acute Lower Respiratory Infection 67 
iv Contents

4.1 Prevalence Levels and Differentials of ALRI Symptoms 67 

4.1.1 Residence 67 

4.1.2 Child's Age 70 

4.1.3 Socioeconomic Characteristics 70 

4.1.4 Demographic Characteristics 74 

4.1.5 Nutritional Status 76 

4.1.6 Immunization Status 78 

4.1.7 Environmental Factors 81 

5 Fever 87 

5.1 Prevalence Levels and Differentials 87 

5.1.1 Residence 87 

5.1.2 Child's Age 90 

5.1.3 Socioeconomic Characteristics 90 

5.1.4 Demographic Characteristics 95 

5.1.5 Nutritional Status 97 

5.1.6 Immunization Status 100 

5.2 Treatment of Fever 102 

5.3 Seeking Care for Symptoms of ALRI and/or Fever 103 

5.3.1 Residence 104 

5.3.2 Residence and Wealth Index 104 

5.3.3 Residence and Mother's Education 107 

5.3.4 Demographic Characteristics 112 

6 Summary and Conclusions 115 

6.1 Prevalence of Diarrhea 116 

6.2 Careseeking and Treatment for Diarrhea 118 

6.3 Prevalence of ALRI Symptoms 120 

6.4 Prevalence of Fever 121 

6.5 Use of Antimalarials 122 

6.6 Careseeking for ALRI Symptoms and/or Fever 122 

6.7 Special Comments about Central Asia 123 

References 125 

Appendix 127 
Tables and Figures v

Tables and Figures 

Table 2.1 Summary of DHS surveys included in this report, 1996-2002 6 

Table 3.1 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey, Demographic and Health Surveys 1996-2002 14 

Table 3.2 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey, by residence and wealth index, 

Demographic and Health Surveys 1996-2002 18 

Table 3.3 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey by residence and mother’s 

education, Demographic and Health Surveys 1996-2002 21 

Table 3.4 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey, by child’s sex, birth order, birth 

interval, and mother’s age, Demographic and Health Surveys 

1996-2002 24

Table 3.5 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey by nutritional status indices, 

Demographic and Health Surveys, 1996-2002 26

Table 3.6 Percentage of infants age 0-5 months and 6-11 months with 

diarrhea in the two weeks preceding the survey by breastfeeding 

status, Demographic and Health Surveys 1996-2002 29

Table 3.7 Percentage of infants age 0-5 months and 6-11 months with 

diarrhea in the two weeks preceding the survey, by receipt of 

plain water and use of bottle with nipple in the past 24 hours, 

Demographic and Health Surveys 1996-2002 32

Table 3.8 Percentage of children age 12-23 months and 24-35 months 

with diarrhea in the two weeks preceding the survey, by measles 

immunization status, Demographic and Health Surveys 

1996-2004 36

Table 3.9.1 Percentage of urban children under age three years with diarrhea 

in the two weeks preceding the survey, by housing 

characteristics, Demographic and Health Surveys 1996-2002 39

Table 3.9.2 Percentage of rural children under age three years with diarrhea 

in the two weeks preceding the survey, by housing 

characteristics, Demographic and Health Surveys 1996-2002 40

Table 3.10.1 Among children under age three years with diarrhea in the two 

weeks preceding the survey who were taken to a health provider, 

percentage receiving treatment by type of treatment, 

Demographic and Health Surveys 1996-2002 48
vi Tables and Figures

Table 3.10.2 Among children under age three years with diarrhea in the two 

weeks preceding the survey who were not taken to a health 

provider, percentage receiving treatment by type of treatment, 

Demographic and Health Surveys 1996-2002 49

Table 3.11 Percentage of children under age three with diarrhea in the two 

weeks preceding the survey who received oral rehydration 

solutions (ORS or RHF), by residence and mother’s education, 

Demographic and Health Surveys 1996-2002 56

Table 3.12 Percentage of children under age three with diarrhea in the two 

weeks preceding the survey who received both increased fluids 

and continued feeding, by residence and mother's education, 

Demographic and Health Surveys 1996-2002 59

Table 3.13 Percentage of children under age three with diarrhea in the two 

weeks preceding the survey who received oral rehydration 

solutions (ORS or RHF), by child's sex, age, birth order, and 

mother’s age, Demographic and Health Surveys 1996-2002 62

Table 3.14 Percentage of children under age three with diarrhea in the two 

weeks preceding the survey who received both increased fluids 

and continued feeding, by child’s sex, age, birth order, and 

mother’s age, Demographic and Health Surveys 1996-2002 65

Table 4.1 Children under age three with symptoms of acute lower 

respiratory infection (ALRI) in the two weeks preceding the 

survey, by residence and age, Demographic and Health Surveys 

1996-2002 68

Table 4.2 Percentage of children under age three with symptoms of acute 

lower respiratory infection (ALRI) in the two weeks preceding 

the survey, by residence and wealth index, Demographic and 

Health Surveys 1996-2002 71

Table 4.3 Percentage of children under age three with symptoms of acute 

lower respiratory infection (ALRI) in the two weeks preceding 

the survey, by residence and mother’s education, Demographic 

and Health Surveys 1996-2002 73

Table 4.4 Percentage of children under age three with symptoms of acute 

lower respiratory infection (ALRI) in the two weeks preceding 

the survey, by child's sex, birth order, birth interval, and mother’s 

age, Demographic and Health Surveys 1996-2002 75

Table 4.5 Percentage of children under age three with symptoms of acute 

lower respiratory infection (ALRI) in the two weeks preceding 

the survey, by nutritional status indices, Demographic and 

Health Surveys 1996-2002 77
Tables and Figures vii

Table 4.6 Percentage of children age 12-23 months and 24-35 months 

with symptoms of acute lower respiratory infection (ALRI) in 

the two weeks preceding the survey, by immunization status, 

Demographic and Health Surveys 1996-2002 80

Table 4.7.1 Percentage of urban children under age three with symptoms of 

acute lower respiratory infection (ALRI) in the two weeks 

preceding the survey, by potential environmental risk factors, 

Demographic and Health Surveys 1996-2002 82

Table 4.7.2 Percentage of rural children under age three with symptoms of 

acute lower respiratory infection (ALRI) in the two weeks 

preceding the survey, by potential environmental risk factors, 

Demographic and Health Surveys 1996-2002 83

Table 5.1 Percentage of children under age three with a fever in the two 

weeks preceding the survey, by residence and age, Demographic 

and Health Surveys 1996-2002 88

Table 5.2 Percentage of children under age three with a fever in the two 

weeks preceding the survey, by residence and wealth index, 

Demographic and Health Surveys 1996-2002 91

Table 5.3 Percentage of children under age three with a fever in the two 

weeks preceding the survey, by residence and mother's education, 

Demographic and Health Surveys 1996-2002 94

Table 5.4 Percentage of children under age three with a fever in the two 

weeks preceding the survey, by child's sex, birth order, birth 

interval, and mother's age, Demographic and Health Surveys 

1996-2002 96

Table 5.5 Percentage of children under age three with a fever in the two 

weeks preceding the survey, by nutritional status indices, 

Demographic and Health Surveys 1996-2002 98

Table 5.6 Percentage of children age 12 to 23 months and 24-35 months 

with fever in the two weeks preceding the survey, by 

immunization status, Demographic and Health Surveys 

1996-2002 101

Table 5.7 Percent distribution of children under age three with fever in the 

two weeks preceding the survey, by residence and medication 

received, Demographic and Health Surveys 1999-2002 102

Table 5.8 Among children under age three with symptoms of acute lower 

respiratory infection (ALRI) and/or fever in the two weeks 

preceding the survey, percentage taken to an appropriate health 

care provider, by residence and wealth index, Demographic and 

Health Surveys 1996-2002 106
viii Tables and Figures

Table 5.9 Among children under age three with symptoms of acute lower 

respiratory infection (ALRI) and/or fever in the two weeks 

preceding the survey, percentage taken to an appropriate health 

care provider, by residence and mother's education, 

Demographic and Health Surveys 1996-2002 109

Table 5.10 Percentage of children under age three with symptoms of acute 

lower respiratory infection (ALRI) and/or fever in the two weeks 

preceding the survey who were taken to an appropriate health 

provider, by child's sex, age in months, birth order, birth interval, 

and mother's age, Demographic and Health Surveys 1996-2002 113

Table A.1 Percentage of children age 12-23 months immunized at any time 

before the survey, by residence, Demographic and Health 

Surveys 1996-2002 129
Tables and Figures ix

Figure 1.1 Model of the operation of proximate determinants 2

Figure 3.1 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey, by residence 15

Figure 3.2 Mean percentage of children under age three years with diarrhea 

in the two weeks preceding the survey, by age in months 16

Figure 3.3.1 Percentage of urban children under age three years with diarrhea 

in the two weeks preceding the survey, by wealth index and 

region 19

Figure 3.3.2 Percentage of rural children under age three years with diarrhea 

in the two weeks preceding the survey, by wealth index and 

region 19

Figure 3.4 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey, by mother’s age and region 23

Figure 3.5 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey, by low weight-for-age status 

and region 27

Figure 3.6.1 Percentage of infants age 0-5 months with diarrhea in the two 

weeks preceding the survey, by breastfeeding status and region 30

Figure 3.6.2 Percentage of infants age 0-5 months with diarrhea in the two 

weeks preceding the survey, by plain water intake in the past 24 

hours and region 33

Figure 3.6.3 Percentage of infants age 0-5 months with diarrhea in the two 

weeks preceding the survey, by use of bottle with nipple in the 

past 24 hours and region 33

Figure 3.7.1 Percentage of urban children under age three years with diarrhea 

in the two weeks preceding the survey, by access to safe drinking 

water and region 38

Figure 3.7.2 Percentage of urban children under age three years with diarrhea 

in the two weeks preceding the survey, by presence of household 

means of sanitary excreta disposal and region 41

Figure 3.8.1 Percentage of rural children under age three years with diarrhea 

in the two weeks preceding the survey, by access to safe drinking 

water and region 43

Figure 3.8.2 Percentage of rural children under age three years with diarrhea 

in the two weeks preceding the survey, by presence of household 

means of sanitary excreta disposal and region 44

Figure 3.9 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey for whom advice or treatment 

was sought from an appropriate health care provider 47
x Tables and Figures

Figure 3.10.1 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey who received oral rehydration 

solutions (ORS or RHF), by contact with health care provider 

and region 51

Figure 3.10.2 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey who received increased fluids, by 

contact with health care provider and region 52

Figure 3.10.3 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey who received enough food, by 

contact with health care provider and region 53

Figure 3.10.4 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey who received medication (pills, 

syrups, injections, or IV fluids), by contact with health care 

provider and region 54

Figure 3.11.1 Percentage of urban children under age three years with diarrhea 

in the two weeks preceding the survey who received oral 

rehydration solutions (ORS or RHF), by mother’s education and 

region 57

Figure 3.11.2 Percentage of rural children under age three years with diarrhea 

in the two weeks preceding the survey who received oral 

rehydration solutions (ORS or RHF), by mother’s education and 

region 57

Figure 3.12.1 Percentage of urban children under age three years with diarrhea 

in the two weeks preceding the survey who received increased 

fluids and continued feeding, by mother’s education and region 60

Figure 3.12.2 Percentage of rural children under age three years with diarrhea 

in the two weeks preceding the survey who received increased 

fluids and continued feeding, by mother’s education and region 60

Figure 3.13 Percentage of children under age three years with diarrhea in the 

two weeks preceding the survey who received oral rehydration 

solutions, by age in months and region 63

Figure 4.1 Percentage of children under age three years with symptoms of 

ALRI in the two weeks preceding the survey, by residence 69

Figure 4.2 Mean percentage of children under age three years with 

symptoms of ALRI in the two weeks preceding the survey, by 

age in months 70

Figure 4.3 Percentage of children under age three years with ALRI 

symptoms in the two weeks preceding the survey, by low weightfor-tage status and region 78

Figure 5.1 Percentage of children under age three years with fever in the 

two weeks preceding the survey, by residence 89

Figure 5.2 Mean percentage of children under age three years with fever in 

the two weeks preceding the survey, by age in months 90
Tables and Figures xi

Figure 5.3.1 Percentage of urban children under age three years with fever in 

the two weeks preceding the survey, by wealth index and region 93

Figure 5.3.2 Percentage of rural children under age three years with fever in 

the two weeks preceding the survey, by wealth index and region 93

Figure 5.4 Percentage of children under age three years with fever in the 

two weeks preceding the survey, by low weight-for-age status 

and region 99

Figure 5.5 Percentage of children under age three years with fever in the 

two weeks preceding the survey who received an antimalarial 

drug, by residence 103

Figure 5.6 Among children under age three years with symptoms of ALRI 

and/or fever in the two weeks preceding the survey, percentage 

for whom advice or treatment was sought from an appropriate 

health care provider 105

Figure 5.7.1 Percentage of urban children under age three years with 

symptoms of ALRI and/or fever in the two weeks preceding the 

survey, who were taken to an appropriate health care provider, by 

wealth index and region 108

Figure 5.7.2 Percentage of rural children under age three years with 

symptoms of ALRI and/or fever in the two weeks preceding the 

survey, who were taken to an appropriate health care provider, by 

wealth index and region 108

Figure 5.8.1 Percentage of urban children under age three years with 

symptoms of ALRI and/or fever in the two weeks preceding the 

survey, who were taken to an appropriate health care provider, by 

mother’s education and region 111

Figure 5.8.2 Percentage of rural children under age three years with 

symptoms of ALRI and/or fever in the two weeks preceding the 

survey, who were taken to an appropriate health care provider, by 

mother’s education and region 111

Figure A.1 Percentage of children age 12-23 months immunized against 

measles at any time before the survey, by residence 130

Figure A.2 Percentage of children age 12-23 months fully immunized at any 

time before the survey by residence 131

Figure A.3 Percentage of households with access to safe drinking water, by 

residence 132

Figure A.4 Percentage of households with sanitary means of excreta 

disposal, by residence 133

Figure A.5 Undernutrition/infection cycle 134

Preface xiii

Preface 

One of the most significant contributions of the MEASURE DHS+ program is the 

creation of an internationally comparable body of data on the demographic and 

health characteristics of populations in developing countries. The DHS Comparative 

Reports series examines these data across countries in a comparative framework. The 

DHS Analytical Studies series focuses on specific topics. The principal objectives of 

both series are to provide information for policy formulation at the international level 

and to examine individual country results in an international context. Whereas Comparative Reports are primarily descriptive, Analytical Studies take a more analytical approach. 

The Comparative Reports series covers a variable number of countries, depending 

on the availability of data sets. Where possible, data from previous DHS surveys are 

used to evaluate trends over time. Each report provides detailed tables and graphs 

organized by region. Survey-related issues such as questionnaire comparability, survey 

procedures, data quality, and methodological approaches are addressed as needed. 

The topics covered in Comparative Reports are selected by MEASURE DHS+ staff 

in conjunction with the MEASURE DHS+ Scientific Advisory Committee and 

USAID. Some reports are updates and expansions of reports published previously. 

It is anticipated that the availability of comparable information for a large number 

of developing countries will enhance the understanding of important issues in the 

fields of international population and health by analysts and policymakers. 

Martin Vaessen 

Project Director 

Dedication xv

Dedication 

This report is dedicated to Dr. Kenneth H. Brown and Dr. Christopher L. Kjolhede, 

with whom the author had the privilege of working on community-based research in 

the areas of early childhood diarrhea, respiratory illness, and nutrition in developing 

countries. 

Acknowledgments xvii

Acknowledgments 

The author is very grateful to Alex Izmukhambetov of data processing for his hard 

work and willing spirit over the course of many table revisions. The author also 

thanks Dr. Alfredo Fort for his careful review of the manuscript, Dr. Michel Pacque 

for his comments, Katherine Senzee, Justine Faulkenburg, and Kaye Mitchell for 

production support, and Dr. Sidney Moore for editing. 

Executive Summary xix

Executive Summary 

This third comparative report on childhood morbidity and treatment patterns focuses 

on the symptoms associated with three of the leading causes of death in early childhood (diarrhea, cough accompanied by short, rapid breathing, and fever) and treatment responses to these symptoms. The analysis is based on data collected on children under age three in 52 developing countries. The surveys were conducted 

between 1996 and 2002 under the DHS-III and MEASURE DHS+ programs. 

The data presented in this report show wide variation both within and between 

world regions in the prevalence of diarrhea, fever, and the symptoms of acute lower 

respiratory infection (ALRI) in young children. There are also substantial differentials in maternal careseeking and other treatment responses to early childhood illness. 

The symptoms of diarrhea, fever, and ALRI all peak between 6 to 17 months of 

age. 

Overall, urban residence, higher household wealth, higher maternal education, and 

older maternal age are associated with a lower diarrhea prevalence, as are better child 

nutritional status and full breastfeeding (among infants). A household’s lack of adequate sanitary facilities and finished floors in the home, and the provision of plain 

water or a bottle with a nipple to younger infants (under age 6 months) are associated 

with a higher diarrhea prevalence. Vaccination against measles is associated with a 

lower diarrhea prevalence throughout the second and third years of life. 

Children with diarrhea living in urban areas are more likely than their rural 

counterparts to be taken to a health care provider. Children with diarrhea who are 

taken for advice or treatment to an appropriate health care provider are more likely 

than those not taken for care to be given oral rehydration solutions, 

nonrecommended treatments (including antibiotics), and to be offered more fluids 

and the same amount of food or more than usual, compared with children who are 

not taken for care. Younger infants (under age 6 months) are less likely than older 

children to be given oral rehydration solutions, and younger mothers (under age 20 

years) are more likely than older mothers to have offered more fluids and continued 

feeding their child with diarrhea. 

Rural children are slightly more likely than urban children to have had recent 

ALRI symptoms. Higher household wealth is associated with a lower prevalence of 

ALRI symptoms, in general, except for West/Middle Africa. Higher maternal education is associated with lower ALRI symptom prevalence in urban than in rural areas. 

Better nourished children are less likely to have had recent ALRI symptoms, outside 

of Central Asia. Children in households with natural floors, urban children in households where cooking is mainly done with biomass fuels, and children in households 

with 5 or more persons per sleeping room, are more likely to have had recent ALRI 

symptoms. 

Fever is more prevalent among rural than urban children. Greater household 

wealth and higher maternal education are associated with lower prevalence of fever. 

Children born after a short birth interval (less than 24 months) and high birth order 

children (six or higher) are more likely than first-born children to have had fever recently, outside of Central Asia. Better nutritional status is associated with a lower 

prevalence of fever, except in Central Asia. Children age 12 to 23 months who have 
xx Executive Summary

received all recommended infant vaccinations are less likely to have had fever recently. 

Information on the use of antimalarials for the treatment of fever was collected in 

17 of the surveys. Overall, use of antimalarials among children reported to have had 

fever in the past two weeks is higher in urban than rural areas. 

Urban residence, greater household wealth, and higher level of mother’s education 

are all associated with a greater probability of seeking advice or treatment from a 

health care provider for a child with symptoms of ALRI and/or fever. When examined by age group, older infants (6 to 11 months) with these symptoms are most 

likely to be taken for care. Younger mothers (under age 20) are also somewhat more 

likely to seek care for these symptoms. Children born after a short birth interval (less 

than 24 months) are less likely than children born after a long interval (36 or more 

months) and high birth order children (six or higher) are less likely than first-born 

children to be taken for care when experiencing symptoms of ALRI and/or fever. 

Child’s sex is not associated with differential use of care except in South/Southeast 

Asia where, on average, boys are more likely than girls to be taken for care. 

It is anticipated that data discussed in this report will inform and guide national 

and international efforts to reduce the burden of childhood morbidity by highlighting 

those countries and/or subgroups to whom health care resources and interventions 

would most beneficially be directed. 

Introduction 1

 1

Introduction 

n 1990, the mortality rate for children under age five was 100 or more deaths per 

1,000 live births in 55 countries. By the end of the decade, 50 of those countries 

failed to meet the target of reducing the under-five mortality rate to less than 70 

deaths per 1,000 live births, a goal established at the 1990 World Summit for Children. Consequently, a new goal was set to reduce under-five mortality by two-thirds 

(compared with 1990) by the year 2015 as one of the United Nations Millennium 

Development Goals (United Nations, 2001). 

In the first of five papers published as a series on child survival by the Lancet in 

2003, Black and colleagues used a prediction model to estimate the distribution of 

cause of death in the 42 countries accounting for 90 percent of all deaths among children under age five in the year 2000 (Black et al., 2003). The leading causes were, in 

order, neonatal conditions (33 percent), diarrhea (22 percent), pneumonia (21 percent), malaria (9 percent), AIDS (3 percent), and measles (1 percent). In the 42 

countries, the proportions of deaths due to diarrhea and pneumonia were found to be 

fairly consistent; variability across countries was found to be largely explained by differences in deaths caused by malaria and AIDS. They concluded that the extent of 

variation found between major causes of death in commonly used regional groupings 

“highlights the need for disaggregation at regional and global levels to allow public 

health intervention efforts to be focused appropriately.” 

This document, the third comparative report1

 on childhood morbidity and treatment patterns produced under the DHS program, focuses on symptoms associated 

with three of the leading causes of death in early childhood: diarrhea; cough with 

short, rapid breathing (proxy for pneumonia and other acute lower respiratory infections); and fever (proxy for malaria and other acute illnesses warranting medical 

treatment). This report also examines treatment responses to these symptoms using 

data collected in nationally representative household surveys conducted from 1996 to 

2002 in 52 developing countries. 

In a seminal paper, published in 1984, Mosley and Chen proposed a new analytical framework for the study of child survival in developing countries, which they referred to as a proximate determinant model (Mosley and Chen, 1984). One of the 

five premises upon which the framework is based is that social and economic determinants “must operate through more basic proximate determinants that in turn influence the risk of disease and the outcome of disease processes.” Another premise is 

that “specific diseases and nutrient deficiencies observed in a surviving population 

may be viewed as biological indicators of the operations of the proximate determinants.” A third premise is that “growth faltering and ultimately mortality in chil-

 

1

 Previous reports in 1991 and 1998 were published in a series called Comparative Studies 

rather than Comparative Reports.

I 

One of the United Nations 

Millennium Development 

Goals was to reduce underfive mortality by two-thirds 

(compared with 1990) by 

the year 2015. 
2 Introduction

dren...are the cumulative consequences of multiple disease processes, including their 

biosocial interactions.” 

Mosley and Chen identified a set of proximate determinants that they proceeded 

to group into five categories: maternal factors, environmental contamination, nutrient 

deficiency, injury, and personal illness control. Figure 1.1 illustrates the operation of 

these proximate determinants. The first four categories influence the rate at which 

healthy persons shift toward illness, while the fifth category, personal illness control, 

influences both the rate of illness, via the use of preventive measures like immunization, and the rate of recovery, via the use of appropriate treatments for manifest illnesses. 

Figure 1.1 

Model of the operation of proximate determinants 

Mosley and Chen further described the socioeconomic determinants as including 

community-, household-, and individual-level characteristics. Residence (urbanrural) is a broad, nonspecific community characteristic that is often highly correlated 

with the physical infrastructure, including resources for clean water and adequate 

sanitation (environmental contamination), the availability of health care facilities 

and/or providers (personal illness control), and the availability and stability of the 
Introduction 3

food supply (nutrient deficiency). Also at the community level are ecological characteristics, such as season, temperature, and rainfall, which impact food production, the 

water supply and sanitation, proliferation of bacteria, and transmission of vectorborne diseases. 

Socioeconomic determinants at the household level are highly correlated with income or wealth. The availability and nutrient adequacy of food (nutrient deficiency), 

quality and quantity of water, adequacy of food storage and sanitation facilities, housing quality (such as ventilation, crowding, cleanable floors), adequacy of fuel supply 

to ensure proper cooking and cleaning and for warmth (environmental contamination), and the ability to access (transportation) and pay for both preventive and curative care (personal illness control) are all largely determined by income or wealth. 

At the individual level are characteristics of the parents or other caretakers that operate on proximate determinants to influence the child’s health and well-being. 

These include productivity and adherence to traditions, norms, and attitudes or 

beliefs. Productivity incorporates skills (commonly measured by educational attainment), demands on time for both child/family care and income generation, and 

personal health. Cultural traditions and societal norms can result in intrahousehold 

food distribution and use of resources to obtain preventive and curative health care 

that may be discriminatory, such as being based on a child’s gender or age. Beliefs 

about the causes of disease or about feeding practices can result, for instance, in a 

reluctance to obtain recommended immunizations or to continue feeding a child 

who has diarrhea. 

Since the late 1990s, recommended strategies for the treatment of diarrhea, 

acute respiratory infection (ARI), and fever in young children in developing countries have been combined by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF) under the umbrella of the Integrated Management 

of Childhood Illness (IMCI) program (Gove, 1997). A set of indicators for monitoring the effectiveness of the program at both the health facility and household levels 

was developed and has periodically been revised. These indicators are among those 

used to monitor progress toward the World Summit for Children (WSC) goals and 

the Millennium Development (MD) goals. 

Under the IMCI program, mothers are taught to recognize the general danger 

signs warranting urgent medical attention, including the inability to drink or breastfeed, vomiting, convulsions, lethargy, and loss of consciousness. 

With regard to diarrhea, danger signs include blood in the stool, signs of severe 

dehydration, and persistent diarrhea for 14 or more days. Two indicators are available 

from the Demographic and Health Surveys (DHS) to monitor WSC goal 23: reduction by 50 percent in the deaths due to diarrhea in children under the age of five years and 

25 percent reduction in the diarrhea incidence rate. These two indicators are 1) proportion of children who had diarrhea in the past two weeks and were treated with oral 

rehydration salts or an appropriate homemade solution and 2) proportion of children 

who had diarrhea in the past two weeks and received increased fluids and continued 

feeding during the episode.2

 

2

 Recent research studies have concluded that the volume of liquids, rather than the 

composition, is more important in the treatment of watery diarrhea. Hence, at a recent 

meeting to review child survival indicators, UNICEF, WHO, and collaborators decided to 

combine the two indicators for the appropriate home-based treatment of nonsevere watery 

Since the late 1990s, 

recommended strategies 

for the treatment of 

diarrhea, acute 

respiratory infection, and 

fever in young children 

have been combined 

under the umbrella of the 

Integrated Management 

of Childhood Illness 

(IMCI) program. 
4 Introduction

For ARI, IMCI guidelines recommend that children with a cough and rapid or 

difficult breathing should be taken to a health care provider for assessment. Children 

observed to have rapid breathing, chest indrawing, stridor, or any general danger sign 

should then be given a first dose of an appropriate antibiotic. If the child is not hospitalized, the mother should be instructed as to the importance of administering a full 

course of the antibiotic to the child at home. One indicator is available from DHS to 

monitor WSC goal 24, reduction by one-third in the deaths due to acute respiratory infections in children under five years. That indicator is the proportion of children who had 

ARI in the past two weeks and were taken to an appropriate health provider, where 

ARI is defined as a cough with short, rapid breaths.3

 

For fever, the IMCI recommendations differ between areas that are or are not in 

malaria-endemic zones. In high-transmission malaria-endemic areas, all children under five should be presumptively treated with antimalarials (Nicoll, 2000), whether at 

home or in a health facility. Children with a stiff neck, any general sign of danger, a 

persistent fever lasting more than seven days, or a recent episode of measles in the last 

three months warrant medical evaluation for severe febrile disease or severe complications of measles. One indicator is available from DHS in certain malaria-endemic 

countries to monitor MD goal 6, target 8: (to) have halted by 2015 and begun to reverse 

the incidence of (malaria). That indicator is the proportion of children who were ill 

with fever in the past two weeks and received antimalarial drugs. 

It should be borne in mind that all of these morbidities fluctuate seasonally and 

that the DHS surveys are not conducted with seasonal comparability as a parameter. 

For the tables in this report, the 52 countries are organized into six regions as defined by the U.S. Agency for International Development (USAID): West/Middle 

Africa; South/East Africa; North Africa/West Asia/Europe; Central Asia; 

South/Southeast Asia; and Latin America/Caribbean. Regional averages are presented in addition to national estimates of the prevalence of diarrhea, acute lower 

respiratory infection (ALRI), and fever and treatment responses to those illness episodes. Data in the tables are further disaggregated by various distal and proximal determinants. 

Special emphasis has been given to residence in this report for three reasons. First, 

many important risk factors for diarrhea, ALRI, and fever tend to be more common 

in rural areas, such as less well developed water and sanitation systems, lower housing 

quality, and exposure to biomass fuels. Second, access to and availability of health 

care facilities or providers tend to be more limited in rural areas. And third, planning 

for health care programs and campaigns often requires different strategies for rural 

communities than for urban communities. 

It is anticipated that data presented in this report will inform national and international efforts to reduce the burden of childhood morbidity in developing countries, by 

highlighting those countries and/or subgroups to whom health care resources and 

interventions would most beneficially be directed. 

 

diarrhea to become continue feeding and provide either oral rehydration therapy (oral 

rehydration salts or appropriate homemade solutions) or increase fluids (UNICEF, 2004). 

3

 In an effort to be more precise, UNICEF is now advocating the use of the phrase suspected 

pneumonia (UNICEF, 2004) in lieu of ARI. This report uses the acronym ALRI in lieu of 

ARI to emphasize lower respiratory tract involvement.

Data presented in this 

report will inform 

national and 

international efforts to 

reduce the burden of 

childhood morbidity in 

developing countries. 
Data and Methods 5

 2

Data and Methods 

he data presented in this report are taken from the most recent DHS surveys 

conducted in 52 countries between 1996 and 2002, and for which a standard recode file was available by January 2004. These surveys are designed to provide nationally representative samples of households, and they normally cover the entire country. 

DHS samples may be self-weighting, in which case each household has an equal 

overall probability of selection. However, in most surveys, stakeholders are interested 

in obtaining estimates with good precision for subgroups that may constitute only a 

small proportion of the population. In these situations, small domains are oversampled, and standardized sample weights are assigned. 

Information regarding household composition and characteristics is obtained by 

interviewing an adult member of the household, while information about children 

under three years of age is obtained from their mothers. In most surveys, all women 

age 15-49 who are either usual members of the household or who stayed in the house 

the night before the interview (de facto members) are eligible to be interviewed unless 

they are physically or mentally incapacitated. In a few countries, eligibility is restricted to usual household members or to married women. 

During the period when the 52 surveys were conducted, revisions were made to 

the standard Household and Women’s questionnaires as the DHS program entered 

its fourth phase, MEASURE DHS+. Thus, questionnaires for 31 of the surveys, from 

1996-2000, are based on the format used in phase three (DHS-III), while the remaining 21, from 1999 to 2002, are based on the revised phase four format. In addition, each country is allowed some flexibility in the insertion or deletion of standard 

questions and in the wording of questions or response codes. While an effort was 

made to reconcile these discrepancies by creation of the standard recode files, a few 

household and individual items included in the tables in this report were not available 

for every country. Table 2.1 summarizes basic characteristics of the 52 surveys. 

T

In most surveys, all 

women age 15-49 who 

are either usual members 

of the household or who 

stayed in the house the 

night before the 

interview are eligible to 

be interviewed. 
6 Data and Methods

Table 2.1 

Summary of DHS surveys included in this report, 1996-2002

Fieldwork 

Survey 

DHS

phase Start End 

Female 

respondents Age Number 

Number of 

children 

under 3 

years 

West/Middle Africa 

Benin 2001 4 Aug-01 Oct-01 AW 15-49 6,219 2,912 

Burkina Faso 1998-99 3 Dec-98 Mar-99 AW 15-49 6,445 3,219 

Cameroon 1998 3 Feb-98 Jun-98 AW 15-49 5,501 2,260 

Chad 1996-97 3 Dec-96 Jul-97 AW 15-49 7,454 3,938 

Côte d’Ivoire 1998-99 3 Sep-98 Mar-99 AW 15-49 3,040 1,221 

Gabon 2000 3 Oct-00 Dec-00 AW 15-49 6,183 2,324 

Ghana 1998 3 Nov-98 Feb-99 AW 15-49 4,843 1,802 

Guinea 1999 3 May-99 Jun-99 AW 15-49 6,753 3,005 

Mali 2001 4 Jan-01 May-01 AW 15-49 12,817 6,973 

Mauritania 2000-01 3 Oct-00 Apr-01 AW 15-49 7,728 2,796 

Niger 1998 3 Mar-98 Jul-98 AW 15-49 7,577 4,403 

Nigeria 1999 3 Mar-99 May-99 AW 10-49 9,810 3,208 

Senegal 1997 3 Jan-97 Apr-97 AW 15-49 8,593 3,868 

Togo 1998 3 Feb-98 May-98 AW 15-49 8,569 3,693 

South/East Africa 

Comoros 1996 3 Mar-96 May-96 AW 15-49 3,050 1,056 

Eritrea 2002 4 Jan-02 Jul-02 AW 15-49 8,754 3,281 

Ethiopia 2000 4 Feb-00 Apr-00 AW 15-49 15,367 6,412 

Kenya 1998 3 Feb-98 Jul-98 AW 15-49 7,881 3,205 

Madagascar 1997 3 Sep-97 Dec-97 AW 15-49 7,060 3,537 

Malawi 2000 4 Jul-00 Nov-00 AW 15-49 13,220 6,862 

Mozambique 1997 3 Mar-97 Jun-97 AW 15-49 8,779 3,803 

Namibia 2000 4 Sep-00 Dec-00 AW 15-49 6,755 2,346 

Rwanda 2000 4 Jun-00 Aug-00 AW 15-49 10,421 4,293 

South Africa 1998 3 Feb-98 Sep-98 AW 15-49 11,735 2,912 

Tanzania 1999 3 Sep-99 Nov-99 AW 15-49 4,029 1,817 

Uganda 2000-01 4 Sep-00 Feb-01 AW 15-49 7,246 4,245 

Zambia 2001-02 4 Jan-02 May-02 AW 15-49 7,658 3,681 

Zimbabwe 1999 4 Sep-99 Dec-99 AW 15-49 5,907 2,029 

North Africa/West Asia/Europe 

Armenia 2000 4 Oct-00 Dec-00 AW 15-49 6,430 880 

Egypt 2000 4 Mar-00 May-00 EMW 15-49 15,573 6,741 

Jordan 2002 4 Jul-02 Sep-02 EMW 15-49 6,006 3,454 

Turkey 1998 3 Aug-98 Nov-98 EMW 15-49 8,576 2,013 

Yemen 1997 3 Oct-97 Dec-97 EMW 15-49 10,414 7,056 

Central Asia 

Kazakhstan 1999 3 Jul-99 Sep-99 AW 15-49 4,800 788 

Kyrgyz Rep. 1997 3 Aug-97 Nov-97 AW 15-49 3,848 1,104 

Turkmenistan 2000 4 Jul-00 Oct-00 AW 15-49 7,919 1,968 

Uzbekistan 1996 3 Jun-96 Oct-96 AW 15-49 4,415 1,325 

South/Southeast Asia 

Bangladesh 1999-00 3 Oct-99 Mar-00 EMW 10-49 10,544 3,927 

Cambodia 2000 4 Feb-00 Jun-00 AW 15-49 15,351 4,232 

India 1998-99 3 Nov-98 Jul-00 EMW 15-49 90,303 30,668 

Indonesia 1997 3 Sep-97 Dec-97 EMW 15-49 28,810 9,322 

Nepal 2001 4 Jan-01 Jun-01 EMW 15-49 8,726 3,840 

Philippines 1998 3 Feb-98 Apr-98 AW 15-49 13,983 4,415 

Vietnam 1997 3 Jul-97 Oct-97 AW 15-49 5,664 1,769 

Latin America/Caribbean 

Bolivia 1998 3 Mar-98 Sep-98 AW 15-49 11,187 3,826 

Brazil 1996 3 Mar-96 Jun-96 AW 15-49 12,612 2,757 

Colombia 2000 4 Mar-00 Jul-00 AW 15-49 11,585 2,725 

Dominican Rep. 2002 4 Jul-02 Oct-02 AW 15-49 28,000 6,395 

Guatemala 1998-99 3 Nov-98 Apr-99 AW 15-49 6,021 2,618 

Haiti 2000 4 Mar-00 Jul-00 AW 15-49 10,159 3,645 

Nicaragua 2001 4 Sep-01 Dec-01 AW 15-49 11,328 3,807 

Peru 2000 4 Aug-00 Nov-00 AW 15-49 27,843 6,790 

Note: Tanzania 1999 and Guatemala 1998/99 were interim surveys 

AW = All women; EMW = Ever-married women 

In addition to minor differences in the survey questions, there are differences in 

the periods for which mothers were asked to respond to questions about illness episodes, treatment, and preventive care for individual children. While most of the surveys used under five years as the age criteria, others used under three years. For simplicity of presentation and because child morbidity rates associated with diarrhea, ALRI, 
Data and Methods 7

and fever are higher for children under age three than for those age three and older, 

the data presented in this report are restricted to children under three years of age. 

In each table, countries are listed alphabetically within one of six regions. The 

number of surveys available in each region varies from 4 to 14. Both the median and 

the mean of each column of percentages by region were computed to represent the 

average regional value because, in those regions with few surveys available, either a 

very large or a very small percentage will exert undue influence on the average regional value. It is important to understand that these average regional values are not 

estimates of the true median and mean values, because surveys are not available from 

all countries within each region. They are simply rough estimates that can be used to 

make broad comparisons across regions. 

Another statistic used to aid interpretation of the data presented in the tables is 

the intracountry differential, which is simply the difference between the percentages 

taken from two categories of a tabulated variable. For example, the two-week period 

prevalence of diarrhea in children under age three in Eritrea is 19.3 percent for males 

and 14.7 percent for females, yielding a positive differential by sex of 4.6. In Kazakhstan, diarrhea prevalence is 16.2 for males and 21.3 for females, yielding a negative 

differential by sex of 5.1. A mean regional differential can be computed, but again, it 

is a rough estimate because all countries are not represented. 

In all tables, the percentages shown are based on weighted sample data. In individual table cells, the denominator for the percentage shown may be based on a small 

actual (unweighted) number of individuals. When the denominator is based on 25 to 

49 individuals, the figure in the table cell is enclosed in parentheses. When the denominator is based on fewer than 25 individuals, an asterisk indicates that the figure 

has been suppressed. 

It should be borne in mind that the use of the term ‘significant,’ when used to describe patters shown in tables or figures, is not meant to imply statistical significance 

in this report. 

2.1 Diarrhea Prevalence and Treatment 

2.1.1 Prevalence of Diarrhea 

In both the DHS-III and MEASURE DHS+ individual questionnaires, mothers 

were asked the following: 

“Has (NAME) had diarrhea in the last 2 weeks?” 

In the MEASURE DHS+ questionnaire, mothers were not asked about blood in 

stools or number of bowel movements on the worst day of the most recent episode of 

diarrhea. Thus, diarrhea prevalence based on this single question may be underestimated or overestimated. 

Increased Fluids and Continued Feeding 

When a positive response was given, mothers were next asked about fluids and 

foods offered to the child during the diarrhea episode. In the DHS-III questionnaire, 

these questions were worded as follows: 

“Was he/she given the same amount to drink as before the diarrhea, or more, or less? 

In all tables, the 

percentages shown are 

based on weighted 

sample data. 
8 Data and Methods

“Was he/she given the same amount of food to eat as before the diarrhea, or more, or less? 

In the MEASURE DHS+ questionnaire, these questions were worded as follows: 

“Now I would like to know how much (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than 

usual to drink?” 

“When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same 

amount, more than usual, or nothing to eat?” 

Mothers who gave a response of “less” were probed further. In this report, the response codes much less, somewhat less, stopped food, and never gave food have all been 

collapsed into a single category of “less.” 

2.1.2 Use of Oral Rehydration Solutions and Other Treatments 

Mothers were next asked about their use of oral rehydration salts (ORS) and local 

recommended home fluids (RHF) for rehydration during the diarrhea episode, either 

of which is an appropriate treatment. In addition, they were asked whether anything 

else was given as a treatment. These responses, which most frequently included pills 

or syrups, injections, intravenous fluids, home remedies and herbal medicines, are 

generally considered to be inappropriate treatments by WHO. 

Use of intravenous fluids administered by a health care provider is appropriate 

treatment for severe dehydration, and use of antibiotics (pills, syrups, or injections) is 

appropriate treatment for dysentery and cholera. Because additional questions about 

the presence of blood in the stool or the occurrence of watery stools were not included in the MEASURE DHS+ questionnaire, it was not possible to distinguish the 

cases for which intravenous fluids, pills, syrups, or injections may have been appropriate treatment. Hence, the prevalence of inappropriate treatment for diarrhea episodes from the DHS surveys may be overestimated. 

2.1.3 Use of Appropriate Health Care Providers 

Mothers were asked whether or not they sought advice or treatment for the diarrhea and, if so, where. Any public or private health care facility, doctor, or community health worker is considered an appropriate source of advice or treatment, 

whereas pharmacies, shops, and traditional practitioners are considered to be inappropriate sources. 

2.2 Fever and Treatment 

2.2.1 Prevalence of Fever 

Mothers were asked— 

“Has (NAME) been ill with a fever at any time in the last 2 weeks?” 

Fever is a nonspecific symptom associated with many different diseases that may 

or may not require medical attention or medications. High or prolonged fevers are 

Because additional 

questions about the 

presence of blood in the 

stool or the occurrence of 

watery stools were not 

included in the MEASURE 

DHS+ questionnaire, it 

was not possible to 

distinguish the cases for 

which intravenous fluids, 

pills, syrups, or injections 

may have been 

appropriate treatment. 
Data and Methods 9

more likely to be indicative of serious illness than are mild or short-term fevers. In a 

cross-sectional survey like the DHS survey, it is difficult to obtain accurate recall of 

the severity of recent fever episodes. In addition, children who are undernourished 

may also have immune suppression and, consequently, may not develop a fever in 

response to an infectious agent. For countries where malaria is not endemic, prevalence of fever based on this single question should be interpreted as a general indicator of morbidity in the young child population. For malaria-endemic countries, it 

should be borne in mind that malaria prevalence increases in rainy seasons and that 

the timing of fieldwork for the surveys is not comparable across countries. 

2.2.2 Use of Antimalarials for Treatment of Fever 

In the MEASURE DHS+ questionnaire, the following questions were added for 

optional use in malaria-endemic countries when a mother reported a recent episode 

of fever in her child: 

“Did (NAME) take any drugs for the fever?” 

“What drugs did (NAME) take?” 

Each country that included these medication questions used a country-specific list 

of antimalarial drugs. 

2.3 Acute Lower Respiratory Infection and Treatment 

2.3.1 Prevalence of ALRI Symptoms 

Mothers were asked— 

“Has (NAME) had an illness with a cough at any time in the last 2 weeks?” 

Mothers who provided a positive response were next asked— 

“When (NAME) had an illness with a cough, did he/she breathe faster than usual with 

short, rapid breaths?” 

For purposes of estimating ALRI prevalence in DHS surveys, children whose 

mothers reported a recent episode of cough with rapid breathing are presumed to 

have experienced an episode of acute lower respiratory infection (ALRI)1

. Technically, the diagnosis of an ALRI episode that warrants urgent medical attention, primarily pneumonia, requires observing the child for chest indrawing or stridor (highpitched, noisy respirations) and counting the number of breaths per minute (more 

than 50 for infants under 12 months of age and more than 40 for children 12 months 

of age or older). Hence, ALRI prevalence based on mothers’ responses to these two 

questions (i.e., cough and short, rapid breaths) may underestimate or overestimate 

serious respiratory illness. 

 

1

 This report uses the acronym ALRI in lieu of ARI (used in DHS surveys) to emphasize 

lower respiratory tract involvement. 

In a cross-sectional survey 

like the DHS survey, it is 

difficult to obtain accurate 

recall of the severity of 

recent fever episodes. 
10 Data and Methods

2.3.2 Use of Appropriate Health Care Providers 

In the DHS-III questionnaire, mothers who reported a recent episode of cough 

were next asked whether or not they sought advice or treatment for the cough and, if 

so, where. Any public or private health care facility, doctor, or community health 

worker is considered an appropriate source of advice or treatment, whereas pharmacies, shops, and traditional practitioners are considered to be inappropriate sources. 

In the MEASURE DHS+ surveys, mothers who reported a recent episode of either 

cough or fever were asked these same questions. Since a child might have experienced 

two separate illness episodes in the past two weeks, one with a cough and rapid 

breathing (ALRI) and one with a fever, it is not possible to determine for children 

with both conditions reported whether care was sought for the ALRI. However, fever occurs at some point in the majority of cases of pneumonia. Hence, in this report, 

prevalence of careseeking is based on a denominator of children with symptoms of 

ALRI and/or fever. 

2.4 Cofactors of Child Morbidity 

2.4.1 Socioeconomic Characteristics 

Wealth Index 

Information collected in DHS surveys about household composition, assets, and 

amenities is obtained from an adult age 18 or older who is a member of the household and who is often but not always the head of the household. 

In collaboration with the World Bank, ORC Macro has devised an index of 

wealth based on both a standard list of household assets and amenities and some additional country-specific items that are collected by the DHS Household Questionnaire. The DHS wealth index is used in a statistical analysis that divides the population into wealth quintiles. A quintile is assigned to each household as a measure of its 

relative socioeconomic level (Rutstein and Johnson, 2004). 

Mother’s Characteristics 

Information about the mother, including age in years and highest level of formal 

education completed, is taken from the Women’s Questionnaire. 

2.4.2 Child’s Characteristics 

The child’s sex, age in months, birth order, and birth interval are derived from the 

complete birth history collected by the Women’s Questionnaire for all live births. 

Nutritional Status 

In the DHS-III questionnaire, height and weight measurements of children under 

the age of three years born to eligible interviewed women were collected in most 

countries. Beginning with the MEASURE DHS+ questionnaire, all children in the 

household under the age of six years are eligible for height and weight measurement. 

Height is measured lying down for children under two years and standing up for 

those two years and above. Shorr portable measuring boards are used to collect the 

measurements. Weight is obtained to the nearest 0.1 kilogram using UNISCALE 

digital scales from UNICEF. Date of birth is also ascertained. Weight-for-age, 

height-for-age, and weight-for-height indices are computed and expressed as stanAny public or private 

health care facility, 

doctor, or community 

health worker is 

considered an appropriate 

source of advice or 

treatment, whereas 

pharmacies, shops, and 

traditional practitioners 

are considered to be 

inappropriate sources. 
Data and Methods 11

dardized deviation units (Z-scores) from the median of an international reference 

population developed by the U.S. National Center for Health Statistics (NCHS) and 

endorsed by WHO and the U.S. Centers for Disease Control and Prevention 

(CDC). 

Breastfeeding Status 

Children are classified into one of three categories based on breastfeeding status: 

full, partial, and none. This classification is derived from the mother’s responses to 

questions about the number of times during the preceding day or night that the child 

was breastfed or was given anything on a list of liquids or solids. Full breastfeeding is 

defined in this report as the receipt of breast milk alone or in addition to plain water, 

water-based liquids, and/or fruit juices only during the preceding day or night. This 

definition combines exclusive and predominant breastfeeding as defined in the 

WHO Global Databank on Breastfeeding (WHO, 1996).2 Partial breastfeeding is 

defined as the receipt of breast milk in addition to other milk, infant formula, or solids. Children who received no breast milk during the preceding day or night are classified as none. 

Receipt of Recommended Vaccines 

In keeping with the recommendations of the WHO Expanded Programme on 

Immunization (WHO, 2002), children in developing countries should receive one 

BCG vaccination, three or four polio vaccinations, three DPT vaccinations, and one 

measles vaccination by the age of 12 months. 

In DHS surveys, information is gathered from mothers to ascertain the immunization status of their young children. The preferred source of information is an individual vaccination card filled out by a health worker and kept in the household. When 

mothers are able to produce such an immunization record, the DHS interviewer records the dates of each vaccination. In addition, mothers are asked to report any vaccinations that were not recorded on the card, although no date is obtained. Mothers 

who cannot produce a vaccination card are probed to recall whether or not the child 

ever received the recommended number of doses of each vaccine. 

When vaccination dates are missing, children cannot be classified according to 

vaccines received by the age of 12 months. However, they can be classified according 

to vaccines received prior to the interview. Thus, these data can be used to approximate a set of indicators for World Summit for Children goal 22, the proportions of 

children age 12 months immunized against diphtheria, pertussis, and tetanus (DPT), 

poliomyelitis, tuberculosis, and measles. 

2.4.3 Environmental Factors 

Source of Drinking Water 

The household respondent is asked— 

 

2 In 2001, WHO issued recommendations on the optimal duration of breastfeeding, calling 

for exclusive breastfeeding for the first six months of life (WHO, 2001). In this report, the 

introduction of solid and semisolid foods during weaning is of more interest as a vehicle for 

ingesting diarrheal pathogens than the introduction of nonmilk/nonformula liquids; hence, 

the use of full, partial, and none. Receipt of plain water in the past 24 hours in relation to the 

prevalence of recent diarrhea is examined separately. 

Children are classified 

into one of three 

categories based on 

breastfeeding status: full, 

partial, and none. 

In keeping with the 

recommendations of the 

WHO Expanded Programme 

on Immunization, children 

in developing countries 

should receive one BCG 

vaccination, three or four 

polio vaccinations, three 

DPT vaccinations, and one 

measles vaccination by the 

age of 12 months. 
12 Data and Methods

“What is the main source of drinking water for members of your household?” 

While locally specific response codes may be included, the standard broad categories of response codes in DHS surveys include piped water, well water, surface water, 

rainwater, tanker truck, and bottled water. Safe drinking water is defined by 

UNICEF for monitoring WSC goal 4 as “water piped into the dwelling or yard, a 

public tap, a tubewell or borehole with pump, a protected well or spring, or rainwater” (UNICEF, 2000). In this report, response codes have been collapsed to fit the 

UNICEF definition. 

Sanitary Means of Excreta Disposal 

The household respondent is asked the following: 

“What kind of toilet facilities does your household have?” 

While locally specific response codes may be included, the standard broad categories of response codes in DHS surveys include flush toilet, pit toilet or latrine, and no 

facility or bush or field. Sanitary means of excreta disposal is defined by UNICEF as 

“flush toilet connected to a sewage system or septic tank, a pour flush latrine, improved pit latrine, or traditional pit latrine” (UNICEF, 2000) for monitoring WSC 

goal 5. In this report, response codes have been collapsed to fit the UNICEF definition. 

Flooring Materials 

The DHS interviewer makes the determination about the type of floor material in 

the dwelling. The standard broad categories for response codes in DHS surveys are 

natural, rudimentary, and finished floor. In this report, responses are classified as 

natural (including earth, sand, or dung) and improved. 

Cooking Fuels 

The household respondent is asked— 

“What type of fuel does your household mainly use for cooking?” 

In this report, responses have been collapsed into smoke- or fume-producing fuels 

(including charcoal, wood, straw, and dung) and clean burning fuels (including electricity, gas, and kerosene). 

Crowding 

Three measures of crowding are computed from information collected in the 

Household Questionnaire. The number of usual household members and the number 

of children in the household under age five years are determined from the household 

schedule. In addition, in the DHS-III questionnaire, a question was included to ascertain the number of rooms used for sleeping. Where asked, the average number of 

persons per sleeping room can then be computed. 

The DHS interviewer 

makes the determination 

about the type of floor 

material in the dwelling. 

In this report, responses 

are classified as natural 

(including earth, sand, or 

dung) and improved. 
Data and Methods 13
Diarrhea 13

 3

Diarrhea 

3.1 Prevalence Levels and Differentials 

3.1.1 Residence 

esidence is a multidimensional factor with respect to diarrhea risk. Sources of 

drinking water and sanitation facilities in rural communities are often more rudimentary than those in urban communities, although urban slum areas often lack 

improved amenities as well. Young children in rural areas are more likely to be 

around animals and their feces than are urban children. Also, health care facilities 

and providers may be less available and/or accessible in rural areas to treat a sick child 

(Legrand and Lalou, 1997). 

The percentage of children under three years of age whose mothers reported that 

the child had diarrhea at any time in the two weeks preceding the day of interview is 

shown for all children and by place of residence in Table 3.1. In four regions, the total mean prevalence is around 20 percent, but is lower in Central Asia and 

South/Southeast Asia. Total diarrhea prevalence is less than 10 percent in only five 

countries (Egypt, Turkmenistan, Uzbekistan, Bangladesh, and the Philippines) and is 

more than 30 percent in six countries (Niger, Togo, Ethiopia, Turkey, Yemen, and 

Haiti). 

As shown in Figure 3.1, diarrhea prevalence is higher for rural children than urban 

children in most countries. The countries with a negative differential (urban minus 

rural) of five or more percentage points are Côte d’Ivoire, Mali, Niger, Togo, Ethiopia, Rwanda, South Africa, Turkey, Vietnam, Nicaragua, and Peru. Countries for 

which the diarrhea prevalence is higher for urban versus rural children by five or more 

percentage points are Mauritania, Comoros, and Mozambique. 

R

Diarrhea 

prevalence is 

higher for rural 

children than 

urban children in 

most countries. 
14 Diarrhea

Table 3.1 

Percentage of children under age three years with diarrhea in the two weeks preceding the 

survey, Demographic and Health Surveys 1996-2002 

 Residence Age in months 

Survey Urban Rural 0-5 6-11 12-17 18-23 24-29 30-35 Total 

Number of 

children 

West/Middle Africa 

Benin 2001 13.9 17.2 6.9 21.3 22.2 19.6 13.9 13.2 16.1 2,912 

Burkina Faso 1998-99 24.4 25.1 14.4 28.8 32.4 29.8 24.6 21.9 25.0 3,219 

Cameroon 1998 17.0 19.7 10.8 20.9 27.4 25.3 17.7 11.2 18.9 2,260 

Chad 1996-97 26.3 25.6 17.6 28.7 31.3 25.9 30.5 20.3 25.7 3,938 

Côte d’Ivoire 1998-99 20.6 28.9 10.3 30.3 34.8 34.3 20.4 21.8 26.1 1,221 

Gabon 2000 22.5 17.8 11.0 28.4 29.6 26.3 16.6 13.9 21.2 2,324 

Ghana 1998 19.5 22.4 13.6 25.4 25.0 28.0 19.5 17.0 21.7 1,802 

Guinea 1999 22.6 27.5 15.7 32.2 35.2 29.9 23.9 23.9 26.2 3,005 

Mali 2001 16.9 24.7 13.9 28.7 28.5 24.1 22.3 20.1 22.8 6,974 

Mauritania 2000-01 26.9 20.7 17.4 29.3 28.5 28.2 19.5 14.5 23.3 2,796 

Niger 1998 31.6 39.0 30.0 50.3 42.4 38.1 36.6 27.4 37.8 4,403 

Nigeria 1999 13.9 15.8 8.1 18.8 18.7 17.7 15.1 11.9 15.3 3,208 

Senegal 1997 18.7 20.6 15.8 25.4 23.0 24.0 18.5 13.4 19.9 3,868 

Togo 1998 27.0 32.3 19.0 36.7 41.0 35.0 29.4 26.3 31.1 3,693 

Median 21.6 23.6 14.2 28.7 29.1 27.2 20.0 18.6 23.1 

Mean 21.6 24.1 14.6 28.9 30.0 27.6 22.0 18.3 23.7 

South/East Africa 

Comoros 1996 27.5 21.7 22.6 37.0 23.4 20.1 18.8 12.9 23.1 1,056 

Eritrea 2002 14.8 18.1 7.1 20.4 21.3 24.0 17.5 14.4 17.0 3,281 

Ethiopia 2000 23.1 30.9 15.3 38.6 36.2 37.9 26.8 25.4 30.1 6,412 

Kenya 1998 17.1 17.1 11.9 22.4 26.1 16.8 16.9 6.6 17.1 3,205 

Madagascar 1997 30.0 26.3 15.3 32.9 35.3 29.4 27.5 21.4 27.1 3,537 

Malawi 2000 19.2 24.1 13.0 35.9 37.3 25.6 16.2 11.3 23.5 6,862 

Mozambique 1997 30.6 18.0 10.2 22.2 33.6 16.8 20.8 20.4 20.7 3,803 

Namibia 2000 17.1 15.9 9.1 22.8 21.4 19.1 13.3 10.9 16.3 2,346 

Rwanda 2000 17.0 23.7 13.5 28.5 32.2 23.9 16.3 17.5 22.6 4,293 

South Africa 1998 14.5 20.2 11.1 22.1 26.8 21.2 13.8 9.0 17.4 2,912 

Tanzania 1999 13.9 18.2 10.1 30.3 26.1 14.5 13.9 9.0 17.3 1,817 

Uganda 2000-01 21.3 26.2 17.8 38.1 30.0 28.9 20.0 15.1 25.6 4,245 

Zambia 2001-02 28.0 27.5 9.9 38.5 38.9 33.1 27.4 17.3 27.6 3,681 

Zimbabwe 1999 16.6 19.2 6.1 27.7 29.0 20.6 16.5 10.4 18.4 2,029 

Median 18.2 21.0 11.5 29.4 29.5 22.6 17.2 13.7 21.7 

Mean 20.8 21.9 12.4 29.8 29.8 23.7 19.0 14.4 21.7 

North Africa/West Asia/Europe 

Armenia 2000 8.3 11.7 9.9 14.1 12.5 8.5 7.7 6.4 10.0 880 

Egypt 2000 7.9 10.2 8.6 14.5 12.6 7.5 7.7 4.8 9.3 6,741 

Jordan 2002 19.7 22.5 18.1 26.2 29.8 19.8 12.7 14.5 20.4 3,454 

Turkey 1998 32.8 43.4 26.3 44.1 46.1 40.6 34.8 27.2 36.8 2,013 

Yemen 1997 29.8 34.2 26.6 38.9 38.8 36.4 31.2 27.3 33.2 7,056 

Median 19.7 22.5 18.1 26.2 29.8 19.8 12.7 14.5 20.4 

Mean 19.7 24.4 17.9 27.6 28.0 22.6 18.8 16.0 21.9 

Central Asia 

Kazakhstan 1999 20.0 17.8 13.0 24.3 27.1 18.1 13.5 15.8 18.7 788 

Kyrgyz Rep. 1997 15.1 18.3 11.8 21.4 25.1 24.5 11.3 11.3 17.6 1,104 

Turkmenistan 2000 6.5 2.4 1.5 6.5 7.0 5.4 2.9 0.6 4.0 1,968 

Uzbekistan 1996 8.5 3.7 4.7 6.0 6.3 8.3 2.9 2.4 5.2 1,325 

Median 11.8 10.8 8.3 14.0 16.1 13.2 7.1 6.9 11.4 

Mean 12.5 10.6 7.8 14.6 16.4 14.1 7.7 7.5 11.4 

South/Southeast Asia 

Bangladesh 1999-00 9.5 7.8 3.4 11.9 13.5 9.5 7.1 3.5 8.1 3,927 

Cambodia 2000 19.9 23.9 16.1 29.7 28.7 26.1 22.0 18.2 23.3 4,232 

India 1998-99 19.3 18.8 15.9 25.0 22.9 19.3 16.2 13.9 18.9 30,668 

Indonesia 1997 12.0 13.6 7.6 16.9 14.0 15.4 13.6 11.2 13.1 9,322 

Nepal 2000 22.2 25.7 18.7 34.5 33.0 26.2 23.0 17.3 25.5 3,840 

Philippines 1998 8.7 10.8 6.2 13.9 15.8 10.8 7.3 4.3 9.8 4,415 

Vietnam 1997 5.8 10.8 8.1 16.8 15.7 7.9 5.3 7.1 10.1 1,769 

Median 12.0 13.6 8.1 16.9 15.8 15.4 13.6 11.2 13.1 

Mean 13.9 15.9 10.9 21.2 20.5 16.5 13.5 10.8 15.5 

Latin America/Caribbean 

Bolivia 1998 23.1 27.2 14.6 25.4 35.0 31.6 25.3 16.0 24.8 3,826 

Brazil 1996 15.5 18.0 11.2 22.0 19.3 18.3 14.6 10.8 16.1 2,757 

Colombia 2000 16.9 19.1 10.7 22.7 23.9 18.2 15.8 13.5 17.6 2,725 

Dominican Rep. 2002 17.6 19.4 12.7 25.8 25.7 20.7 14.3 9.6 18.2 6,395 

Guatemala 1998-99 16.5 17.8 8.4 21.7 28.1 22.9 11.3 12.3 17.3 2,618 

Haiti 2000 30.9 33.7 27.9 43.4 45.6 36.5 26.6 16.1 32.8 3,645 

Nicaragua 2001 13.9 19.4 13.1 19.6 20.6 17.7 15.4 13.0 16.6 3,807 

Peru 2000 17.4 22.6 11.8 22.7 25.7 25.4 17.7 14.1 19.7 6,790 

Median 17.2 19.4 12.3 22.7 25.7 21.8 15.6 13.3 17.9 

Mean 19.0 22.2 13.8 25.4 28.0 23.9 17.6 13.2 20.4 
Diarrhea 15

Figure 3.1 

Percentage of Children under age three years with diarrhea in the two weeks preceding the survey, 

by residence 
16 Diarrhea

3.1.2 Child’s Age 

Newborn infants benefit from maternal antibodies acquired in-utero and through 

breast milk. By age 6-9 months, when complementary foods are recommended to be 

introduced, passively acquired immunity diminishes greatly. At the same time, the 

infant is increasingly exposed to disease-causing pathogens through contaminated 

foods and liquids, feeding utensils, and the indoor and outdoor environments. As the 

child ages, his/her own immune system matures and he/she is increasingly less vulnerable to common infectious agents. 

This age-related susceptibility is clearly demonstrated in Figure 3.2, a line graph 

showing the mean diarrhea prevalence for each region by six-month age groups. The 

patterns are similar across regions, with the average prevalence peaking at age 6-17 

months followed by a decline to levels near those for age 0-5 months by the end of 

the third year of life. 

Figure 3.2 

Mean percentage of children under age three years with diarrhea in the two 

weeks preceding the survey, by age in months 

0

5

10

15

20

25

30

35

0-5 6-11 12-17 18-23 24-29 30-35

Percentage of children with diarrhea

West/Middle Africa South/East Africa North Africa/West Asia/Europe

Central Asia South/Southeast Asia Latin America/Caribbean

3.1.3 Socioeconomic Characteristics 

Residence and Household Wealth Index 

The household wealth index used in this report is largely asset based, but it does 

incorporate the source of drinking water and type of sanitation facilities used by the 

household, as well as the type of flooring. It can reasonably be assumed that in general, wealthier households may be able to maintain a higher overall level of hygiene 

during food preparation and eating and for general cleanliness of the home and clothing. 

The average prevalence 

of diarrhea peaks at age 

6-17 months followed by 

a decline to levels near 

those for age 0-5 months 

by the end of the third 

year of life. 
Diarrhea 17

In Table 3.2, diarrhea prevalence in the past two weeks is shown by household 

residence and three categories of household wealth, as measured by ranking in the 

country-specific wealth index score distribution. Figures 3.3.1 and 3.3.2 show the 

range, mean, and median values of the national prevalence estimates for the countries 

in each region by urban-rural residence and three broad wealth index categories. 

Overall, these data support an association between low relative household wealth 

and an increased probability of recent diarrhea for both urban and rural children. For 

urban children, the average prevalence of diarrhea is consistently lower among those 

in the most affluent households compared with children from the least affluent 

households in each region, with the exception of Central Asia. 

Data are sparse for rural children in households in the highest wealth category in 

Central Asia and Latin America/Caribbean. In other regions, the average diarrhea 

prevalence for rural children is again consistently lower among children in the most 

affluent versus the least affluent households, and it decreases across the three wealth 

categories. 

The difference in diarrhea prevalence among children in households in the lowest 

wealth category and the highest wealth category was computed for each country for 

which the numbers were sufficiently large. In both urban and rural areas, the differentials are generally positive. In eight countries (Benin, Kenya, Malawi, Mozambique, Uganda, Turkey, Brazil, and Peru), diarrhea prevalence among urban children 

in households in the lowest 40 percent of their country-specific wealth index score 

distribution is ten or more percentage points higher than the prevalence among urban 

children in households in the highest 20 percent. 

Similarly, there are seven countries in which the diarrhea prevalence among rural 

children in the least affluent households is at least ten percentage points greater than 

the prevalence among rural children in the most affluent households: Cameroon, 

Mauritania, Togo, Mozambique, Uganda, Yemen, and the Kyrgyz Republic. There 

are no negative differentials of similar magnitude. 

Overall, the data support 

an association between 

low relative household 

wealth and an increased 

probability of recent 

diarrhea for both urban 

and rural children. 
18 Diarrhea

Table 3.2 

Percentage of children under age three years with diarrhea in the two weeks preceding the survey, by 

residence and wealth index, Demographic and Health Surveys 1996-2002 

Urban Rural 

Household wealth index Household wealth index 

Survey 

Lowest 

40% 

Middle 

40% 

Highest 

20% Total 

Number of 

children 

Lowest 

40% 

Middle 

40% 

Highest 

20% Total 

Number of 

children 

West/Middle Africa Benin 2001 22.8 13.1 10.4 13.9 931 17.5 16.7 16.5 17.2 1,981 

Burkina Faso 1998-99 * (31.7) 24.3 24.4 346 23.0 26.8 31.0 25.1 2,872 

Cameroon 1998 (12.9) 19.0 15.5 17.0 622 23.9 13.7 9.4 19.7 1,639 

Chad 1996-97 19.7 32.5 24.6 26.3 865 24.4 27.1 26.9 25.6 3,073 

Côte d’Ivoire 1998-99 * 19.8 19.5 19.5 362 31.3 23.0 * 28.9 729 

Gabon 2000 23.6 22.1 22.0 22.5 1,697 17.9 15.6 * 17.8 627 

Ghana 1988 * 25.6 11.5 19.5 459 24.8 18.6 (19.6) 22.4 1,343 

Guinea 1999 * 21.4 23.8 22.6 795 27.6 27.5 (28.0) 27.5 2,210 

Mali 2001 26.7 14.9 16.9 16.9 1,706 24.9 24.8 21.5 24.7 5,265 

Mauritania 2000-01 32.3 26.5 26.4 26.9 1,189 21.5 20.8 (0.0) 20.7 1,606 

Niger 1998 * 39.9 29.9 31.6 733 37.0 41.4 41.8 39.0 3,671 

Senegal 1997 14.0 19.6 18.2 18.7 1,296 21.3 18.9 23.9 20.6 2,572 

Togo 1998 26.9 33.9 22.1 27.0 865 32.8 32.6 16.3 32.3 2,828 

Median 23.2 22.1 22.0 22.5 24.4 23.0 21.5 24.7 

Mean 22.4 24.6 20.4 22.1 25.2 23.7 21.4 24.7 

South/East Africa 

Comoros 1996 28.2 27.5 26.7 27.5 255 24.6 18.6 19.4 21.7 801 

Eritrea 2002 (21.1) 17.8 11.4 14.8 1,097 17.3 19.5 * 18.1 2,184 

Ethiopia 2000 * 25.9 22.9 23.1 649 30.9 31.0 30.4 30.9 5,762 

Kenya 1998 (23.4) 23.9 12.7 17.1 600 19.0 15.2 13.8 17.1 2,606 

Madagascar 1997 35.1 28.3 28.3 30.0 704 25.0 28.7 21.2 26.3 2,833 

Malawi 2000 29.1 27.9 16.0 19.2 890 23.9 24.8 22.1 24.1 5,967 

Mozambique 1997 37.0 36.7 25.8 30.6 806 22.3 15.7 5.1 18.0 2,996 

Namibia 2000 17.6 19.9 13.8 17.1 810 17.2 14.2 10.7 15.9 1,536 

Rwanda 2000 (21.9) 26.7 14.6 17.0 690 24.0 23.3 24.3 23.7 3,604 

South Africa 1998 21.2 13.3 11.9 14.5 1,422 20.2 20.9 (16.5) 20.2 1,490 

Tanzania 1999 (15.3) 21.2 11.0 13.9 354 17.2 20.2 11.6 18.2 1,463 

Uganda 2000-01 (34.6) 26.4 19.9 21.3 486 30.4 22.5 18.8 26.2 3,759 

Zambia 2001-02 * 33.1 21.0 28.0 1,124 28.4 25.8 29.0 27.5 2,556 

Zimbabwe 1999 * 18.0 15.6 16.6 668 17.9 21.0 * 19.2 1,361 

Median 23.4 26.2 15.8 18.2 23.1 21.0 19.1 21.0 

Mean 25.9 24.8 18.0 20.8 22.7 21.5 18.6 21.9 

North Africa/West Asia/Europe 

Armenia 2000 11.9 8.3 7.1 8.3 453 11.9 12.6 * 11.7 427 

Egypt 2000 7.0 9.0 7.0 7.9 2,625 10.7 10.0 5.5 10.2 4,116 

Jordan 2002 19.2 21.3 17.3 19.7 2,680 21.6 24.9 19.4 22.5 774 

Turkey 1998 38.3 34.9 22.2 32.8 1,260 44.9 40.7 * 43.4 753 

Yemen 1997 (32.5) 34.1 26.9 29.8 1,631 37.5 31.8 22.7 34.2 5,425 

Median 19.2 21.3 17.3 19.7 21.6 24.9 19.4 22.5 

Mean 21.8 21.5 16.1 19.7 25.3 24.0 15.9 24.4 

Central Asia Kazakhstan 1999 * 21.5 15.6 20.0 326 18.7 15.2 * 17.8 462 

Kyrgyz Rep. 1997 (19.4) 14.3 14.7 15.1 253 20.3 16.4 (10.1) 18.3 851 

Turkmenistan 2000 6.8 5.5 7.0 6.3 769 2.9 1.6 * 2.4 1,192 

Uzbekistan 1996 6.4 8.0 9.9 8.5 414 3.4 4.4 (2.2) 3.7 911 

Median 6.8 11.2 12.3 11.8 11.1 9.8 6.2 10.8 

Mean 10.9 12.3 11.8 12.5 11.3 9.4 6.2 10.6 

South/Southeast Asia Bangladesh 1999-00 9.6 7.2 10.8 9.5 644 8.4 7.6 5.3 7.8 3,283 

Cambodia 2000 21.4 17.0 21.2 19.9 552 25.1 23.3 18.7 23.9 3,680 

India 1998-99 21.2 21.9 16.5 19.3 6,928 19.5 18.2 16.3 18.8 23,741 

Indonesia 1997 15.5 13.7 9.4 12.0 2,624 14.6 13.1 8.5 13.6 6,698 

Nepal 2000 (19.3) 35.0 19.9 22.2 237 27.3 25.2 19.7 25.7 3,603 

Philippines 1998 10.6 8.6 6.8 8.7 2,049 11.1 11.0 4.7 10.8 2,366 

Vietnam 1997 12.2 3.4 6.1 5.8 255 10.6 11.8 6.4 10.8 1,513 

Median 15.5 13.7 10.8 12.0 14.6 13.1 8.5 13.6 

Mean 15.7 15.3 13.0 13.9 16.7 15.7 11.4 15.9 

Latin America/Caribbean Bolivia 1998 25.9 24.3 16.6 23.1 2,219 27.3 26.5 * 27.2 1,606 

Brazil 1996 21.1 13.2 9.0 15.5 2,104 18.9 11.6 * 18.0 653 

Colombia 2000 22.4 15.3 13.5 16.9 1,863 19.6 12.7 * 19.1 862 

Guatemala 1998-99 16.4 16.1 17.1 16.5 991 19.2 15.8 (11.1) 17.8 1,627 

Haiti 2000 32.2 36.4 24.1 30.9 1,203 31.5 37.9 (36.6) 33.7 2,442 

Nicaragua 2001 17.9 15.4 9.3 13.9 1,931 20.5 14.9 * 19.4 1,875 

Peru 2000 24.2 18.2 10.1 17.4 3,744 23.1 18.0 * 22.6 3,046 

Median 22.4 16.1 13.5 16.9 20.5 15.8 23.8 19.4 

Mean 22.9 19.8 14.2 19.2 22.9 19.6 23.8 22.5 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and 

has been suppressed. 
Diarrhea 19

Figure 3.3.1 

Percentage of urban children under age three years with diarrhea in the two 

weeks preceding the survey, by wealth index and region 

Figure 3.3.2 

Percentage of rural children under age three years with diarrhea in the two 

weeks preceding the survey, by wealth index and region 

u = Unknown (insufficient data) 
20 Diarrhea

Residence and Mother’s Education 

Mother’s education has frequently been used as a proxy indicator of socioeconomic 

status in international surveys and studies. In this report, the wealth index serves this 

purpose. However, mother’s education is also thought to be associated with hygiene, 

careseeking, and treatment of illness behaviors pertaining to early childhood morbidities. 

The two-week period prevalence of diarrhea among children under three years of 

age is shown in Table 3.3 by residence and mother’s education (highest level of formal education completed). In most regions, the average diarrhea prevalence in both 

urban and rural areas decreases with increasing level of mother’s education. It should 

be noted that state-supported education is compulsory for grades one through nine in 

the four Central Asian countries included here and, hence, nearly all of the mothers 

in those countries fall into the highest education category. 

For each country, the difference in diarrhea prevalence between children whose 

mothers have no completed years of formal education and those whose mothers completed at least one year of secondary school was computed by urban-rural residence.1

In urban areas, the regions of North Africa/West Asia/Europe and Latin America/Caribbean have the largest mean differences in diarrhea prevalence by mother’s 

education (ten and eight percentage points, respectively). In ten countries, diarrhea 

prevalence is higher by ten percentage points or more among urban children whose 

mothers have the least versus the most education. These countries are Cameroon, 

Ghana, Comoros, Rwanda, Zambia, Jordan, Turkey, Brazil, Colombia, and Nicaragua. A negative difference of the same magnitude was observed in only one country, 

Gabon. 

 

1

 Table entries marked with an asterisk indicate percentages based upon less than 25 

observations. In such cases, a differential is not computed. 

In most regions, the 

average diarrhea 

prevalence in both 

urban and rural areas 

decreases with 

increasing level of 

mother’s education. 
Diarrhea 21

Table 3.3 

Percentage of children under age three years with diarrhea in the two weeks preceding the survey by 

residence and mother’s education, Demographic and Health Surveys 1996-2002 

 Urban Rural 

 Highest level of education Highest level of education 

 Survey None Primary Secondary+ Total 

Number of 

children None Primary Secondary+ Total

Number of 

children 

West/Middle Africa Benin 2001 17.1 10.7 9.5 13.9 931 17.2 17.1 15.3 17.2 1,981 

Burkina Faso 1998-99 24.2 28.0 21.7 24.4 346 25.0 27.8 * 25.1 2,872 

Cameroon 1998 25.8 16.2 13.3 17.0 622 25.5 16.2 16.4 19.7 1,639 

Chad 1996-97 24.3 28.6 29.9 26.3 865 23.9 33.9 * 25.6 3,073 

Côte d’Ivoire 1998-99 19.0 22.4 22.3 20.6 412 30.0 25.0 * 28.9 809 

Gabon 2000 12.2 23.9 22.9 22.5 1,697 (19.8) 18.7 15.7 17.8 627 

Ghana 1988 26.6 22.2 15.9 19.5 459 25.0 27.5 16.7 22.4 1,343 

Guinea 1999 21.5 28.8 20.2 22.6 795 27.0 38.8 (23.7) 27.5 2,210 

Mali 2001 16.7 15.4 19.3 16.9 1,706 24.2 28.5 31.9 24.7 5,267 

Mauritania 2000-01 30.1 24.3 25.0 26.9 1,189 21.2 17.8 (22.3) 20.7 1,606 

Niger 1998 33.1 31.3 25.0 31.6 733 39.3 36.7 (27.8) 39.0 3,671 

Nigeria 1999 18.1 13.3 11.3 13.9 896 18.0 14.0 12.5 15.8 2,312 

Senegal 1997 17.9 20.3 17.7 18.7 1,296 20.4 22.6 20.6 20.6 2,572 

Togo 1998 29.3 27.3 23.0 27.0 865 33.3 31.4 23.5 32.3 2,828 

Median 22.9 23.2 21.0 21.6 24.6 26.3 20.6 23.6 

Mean 22.6 22.3 19.8 21.6 25.0 25.4 20.6 24.1 

South/East Africa Comoros 1996 33.1 20.4 22.5 27.5 255 23.0 19.8 17.9 21.7 801 

Eritrea 2002 15.2 15.5 13.8 14.8 1,097 17.9 19.4 (14.4) 18.1 2,184 

Ethiopia 2000 23.9 26.3 20.4 23.1 649 31.2 29.8 24.6 30.9 5,762 

Kenya 1998 (11.6) 24.7 9.0 17.1 600 20.7 18.1 12.3 17.1 2,606 

Madagascar 1997 20.8 33.1 29.9 30.0 704 25.0 26.7 27.0 26.3 2,833 

Malawi 2000 18.7 20.1 17.6 19.2 891 24.2 24.4 18.3 24.1 5,972 

Mozambique 1997 20.1 33.5 27.0 30.6 806 17.8 18.8 (3.3) 18.0 2,996 

Namibia 2000 24.4 16.6 16.5 17.1 810 22.6 16.3 12.7 15.9 1,536 

Rwanda 2000 32.6 18.5 10.8 17.0 690 22.6 24.5 22.2 23.7 3,604 

South Africa 1998 (16.7) 18.3 13.4 14.5 1,422 18.6 20.7 20.4 20.2 1,490 

Tanzania 1999 4.4 16.6 7.0 13.9 354 13.3 20.5 13.7 18.2 1,463 

Uganda 2000-01 27.1 22.7 18.6 21.3 486 27.6 26.6 19.1 26.2 3,758 

Zambia 2001-02 (41.7) 28.7 26.1 28.0 1,124 29.9 27.5 23.9 27.5 2,556 

Zimbabwe 1999 * 30.3 12.5 16.6 668 22.2 18.8 19.1 19.2 1,361 

Median 20.8 21.6 17.1 18.2 22.6 20.6 18.7 21.0 Mean 22.3 23.2 17.5 20.8 22.6 22.3 17.8 21.9 

North Africa/West Asia/Europe Armenia 2000 * * 8.3 8.3 453 * * 11.4 11.7 427 

Egypt 2000 9.0 8.6 7.4 7.9 2,625 10.7 10.1 9.7 10.2 4,116 

Jordan 2002 31.9 18.5 19.6 19.7 2,680 11.5 27.0 23.1 22.5 774 

Turkey 1998 42.0 34.2 24.8 32.8 1,260 45.9 43.0 39.0 43.4 753 

Yemen 1997 32.2 28.6 24.5 29.8 1,631 34.4 33.8 31.0 34.2 5,425 

Median 32.1 23.6 19.6 19.7 23.0 30.4 23.1 22.5 Mean 28.8 22.5 16.9 19.7 25.6 28.5 22.8 24.4 

Central Asia Kazakhstan 1999 * * 20.1 20.0 327 * * 17.6 17.8 462 

Kyrgyz Rep. 1997 * * 15.1 15.1 253 * * 18.3 18.3 851 

Turkmenistan 2000 * * 6.4 6.5 775 * * 2.4 2.4 1,192 

Uzbekistan 1996 * * 8.5 8.5 414 * * 3.7 3.7 911 

Median u u 11.8 11.8 u u 10.7 10.8 Mean u u 12.5 12.5 u u 10.5 10.6 

South/Southeast Asia Bangladesh 1999-00 7.5 13.3 8.8 9.5 644 8.8 7.0 7.0 7.8 3,283 

Cambodia 2000 24.1 17.5 20.5 19.9 552 23.6 25.2 18.9 23.9 3,680 

India 1998-99 21.0 21.9 17.6 19.3 6,925 19.6 20.0 16.0 18.8 23,733 

Indonesia 1997 16.2 14.4 10.2 12.0 2,624 10.2 15.4 10.6 13.6 6,698 

Nepal 2000 25.7 14.8 22.0 22.2 237 26.8 25.6 18.6 25.7 3,603 

Philippines 1998 * 10.5 8.3 8.7 2,049 5.1 12.0 10.1 10.8 2,366 

Vietnam 1997 * 9.7 4.8 5.8 255 13.4 11.8 9.9 10.8 1,513 

Median 21.0 14.4 10.2 12.0 13.4 15.4 10.6 13.6 

Mean 18.9 14.6 13.2 13.9 15.4 16.7 13.0 15.9 

Latin America/Caribbean 

Bolivia 1998 22.1 27.7 20.6 23.1 2,219 22.3 28.3 29.0 27.2 1,606 

Brazil 1996 34.5 17.0 13.7 15.5 2,104 29.0 17.3 13.3 18.0 653 

Colombia 2000 (39.7) 21.7 14.5 16.9 1,863 29.8 19.2 16.2 19.1 862 

Dominican Rep. 2002 17.2 21.0 14.6 17.6 4,192 21.8 22.0 14.4 19.4 2,204 

Guatemala 1998-99 12.4 17.5 17.6 16.5 991 18.4 18.2 9.7 17.8 1,627 

Haiti 2000 33.2 33.4 26.0 30.9 1,203 34.5 33.8 27.4 33.7 2,442 

Nicaragua 2001 22.1 17.5 10.8 13.9 1,931 20.4 19.6 16.1 19.4 1,875 

Peru 2000 17.0 24.1 15.8 17.4 3,744 19.2 24.0 20.8 22.6 3,046 

Median 22.1 21.4 15.2 17.2 22.1 20.8 16.2 19.4 Mean 24.8 22.5 16.7 19.0 24.4 22.8 18.4 22.1

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases 

and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
22 Diarrhea

In rural areas, the largest regional mean difference in diarrhea prevalence by 

mother’s education is seen in Latin America/Caribbean (six percentage points), because of the large positive differentials found in Brazil and Colombia (16 and 14 percentage points, respectively). A positive differential in prevalence among rural children whose mothers have the least versus the most education exceeds ten percentage 

points in just two other countries: Niger and Mozambique. Rural Jordan is a notable 

exception, with a negative differential of 12 percentage points 

3.1.4 Demographic Characteristics 

While boys and girls are equally susceptible to common pathogens, gender inequities may occur with regard to expenditures of money and time to obtain care for a 

sick child. Inequities in careseeking may also be found between firstborn and laterborn children, as financial and time resources become more constrained with additional children. A short birth interval has also been linked to a higher frequency of 

illness, presumably because of maternal nutrient depletion during pregnancy or simply increased competition for household resources (Bohler and Bergstrom, 1995). 

Older mothers generally are more experienced in child care, including care during 

illnesses. However, older mothers may also be less inclined than younger mothers to 

adopt changes in recommendations for illness treatment, preferring to maintain past 

practices. 

Table 3.4 shows the two-week period prevalence of diarrhea by sex, birth order, 

birth interval, and mother’s age. Differentials in diarrhea prevalence by sex are negligible in most countries. A difference of plus or minus five percentage points is observed in only one country, Kazakhstan, where male children fared better than female 

children (16 and 21 percent, respectively). 

Differentials in diarrhea prevalence by birth order do not follow a consistent pattern. Among those countries for which a differential of at least five percentage points 

in diarrhea prevalence is observed between firstborn children and children of order six 

and higher, three are positive (that is, the prevalence for firstborn children is higher 

than for children of order six and higher), namely, Gabon, Zambia, and Jordan, while 

three are negative, namely, Ghana, Nepal, and Colombia. 

The regional average values for diarrhea prevalence are slightly higher for children 

born after a shorter birth interval (less than 24 months) compared with children born 

after a longer interval (36 or more months). However, differences in prevalence between these two categories are negligible in the majority of countries. In seven countries (Benin, Ghana, Comoros, Mozambique, South Africa, Turkey, and the Dominican Republic), diarrhea prevalence for children born after shorter intervals 

exceeds that for children born after longer intervals by more than five percentage 

points, and is lower by that amount in only one country, Tanzania. 

Regional average values 

for diarrhea prevalence 

are slightly higher for 

children born after a 

shorter birth interval 

(less than 24 months) 

compared with children 

born after a longer 

interval (36 or 

more months). 
Diarrhea 23

Figure 3.4 shows the range, mean, and median diarrhea prevalence of the countries 

included for each region by mother’s age. Generally, mother’s age is not associated 

with diarrhea prevalence in the West/Middle Africa and South/East Africa regions. 

However, in six countries in these two regions, the differential in diarrhea prevalence 

between children of mothers age 15-19 and those of mothers age 35 or older is five 

percentage points or more (Gabon, Togo, Comoros, Namibia, Rwanda, and Zambia). In Tanzania, there is an equally large negative differential. 

Figure 3.4 

Percentage of children under age three years with diarrhea in the two weeks 

preceding the survey, by mother’s age and region 

The strongest association between diarrhea prevalence and mother’s age is found 

in North Africa/West Asia/Europe. Four of the five countries (excluding Yemen) 

have significant positive differentials (range of 7 to 23 percentage points), yielding a 

regional mean differential of 13 percentage points between the prevalence of diarrhea 

in children of younger mothers (age 15-19) compared with older mothers (age 35 or 

older). The second largest regional mean differential is found in Latin America/Caribbean (seven percentage points), followed by Central Asia (six percentage 

points). Additional countries with positive differentials exceeding five percentage 

points (range of 5 to 15) include Kazakhstan, the Kyrgyz Republic, Turkmenistan, 

Indonesia, Nepal, Vietnam, Brazil, the Dominican Republic, and Haiti. There is an 

equally large negative differential in Nepal. 

The strongest association 

between diarrhea 

prevalence and mother’s 

age is found in North 

Africa/West Asia/Europe. 
24 Diarrhea

Table 3.4 

Percentage of children under age three years with diarrhea in the two weeks preceding the survey, by 

child’s sex, birth order, birth interval, and mother’s age, Demographic and Health Surveys 1996-2002 

Child sex Birth order Birth interval (months) Mother’s age 

Survey Male Female 1 2-3 4-5 6+ First <24 24-35 36+ <20 20-34 35+ Total 

Number of 

children 

West/Middle Africa 

Benin 2001 16.1 16.1 16.5 15.3 15.9 17.1 16.6 22.0 16.0 14.4 17.8 16.1 15.7 16.1 2,912 

Burkina Faso1998-99 24.8 25.3 23.7 26.9 22.7 25.8 23.8 28.7 26.3 23.8 23.6 25.7 23.7 25.0 3,219 

Cameroon 1998 19.6 18.3 20.3 17.9 17.6 20.3 20.1 15.5 19.6 18.9 24.0 17.9 19.6 18.9 2,260 

Chad 1996-97 27.3 24.3 26.2 25.3 26.2 25.5 26.3 23.3 26.8 25.6 25.6 25.8 25.5 25.7 3,938 

Côte d’Ivoire 1998-99 25.3 26.9 27.8 24.8 26.5 25.9 27.8 25.9 26.1 25.1 26.8 26.7 23.6 26.1 1,221 

Gabon 2000 21.0 21.4 24.1 21.3 19.8 18.5 24.5 20.2 20.1 19.9 26.0 21.0 16.7 21.2 2,324 

Ghana 1998 23.1 20.3 22.0 17.7 23.2 27.1 22.1 28.8 20.4 20.8 21.9 21.2 23.1 21.7 1,802 

Guinea 1999 26.2 26.2 27.3 24.5 27.4 26.3 27.4 27.3 26.4 25.4 25.5 26.9 24.3 26.2 3,005 

Mali 2001 23.7 21.8 25.0 22.2 21.2 23.4 25.0 23.1 22.6 21.9 22.8 22.9 22.4 22.8 6,973 

Mauritania 2000-01 23.1 23.6 26.3 22.2 21.1 24.4 26.3 22.4 22.2 22.9 20.8 23.3 24.3 23.3 2,796 

Niger 1998 38.7 36.7 35.0 37.3 37.8 39.5 34.8 41.4 36.2 39.3 36.0 37.2 40.8 37.8 4,403 

Nigeria 1999 15.1 15.5 14.8 14.6 16.7 15.1 14.8 14.2 16.8 14.9 16.3 15.1 15.6 15.3 3,208 

Senegal 1997 19.4 20.5 21.2 18.1 21.8 19.5 21.2 20.8 20.3 18.7 21.7 20.1 19.0 19.9 3,868 

Togo 1998 31.0 31.1 30.8 30.9 32.3 30.3 30.5 33.7 33.3 29.4 35.8 30.8 30.6 31.1 3,693 

Median 23.4 22.7 24.6 22.2 22.3 25.0 24.8 23.2 22.4 22.4 23.8 23.1 23.4 23.1 

Mean 23.9 23.4 24.4 22.8 23.6 24.2 24.4 24.8 23.8 22.9 24.6 23.6 23.2 23.7 

South/East Africa 

Comoros 1996 22.9 23.3 22.1 21.8 23.8 24.5 22.2 25.9 24.4 20.3 31.3 23.0 21.2 23.1 1,056 

Eritrea 2002 19.3 14.7 17.2 16.8 15.0 19.0 17.0 17.0 18.6 15.8 17.6 17.0 16.9 17.0 3,281 

Ethiopia 2000 31.7 28.5 28.6 31.8 28.9 30.3 28.7 30.8 30.0 30.6 32.1 30.0 30.0 30.1 6,412 

Kenya 1998 17.8 16.4 18.0 15.8 14.4 20.9 17.8 15.2 17.1 17.5 15.4 17.4 16.8 17.1 3,205 

Madagascar 1997 27.9 26.2 27.9 26.2 28.1 26.5 28.0 25.8 26.8 27.4 24.5 28.4 23.9 27.1 3,537 

Malawi 2000 24.1 22.8 22.5 22.9 23.8 25.1 22.3 24.6 26.1 21.8 26.0 23.5 22.0 23.5 6,862 

Mozambique 1997 21.6 19.8 17.8 19.0 25.0 21.8 17.8 31.5 23.5 17.6 20.4 20.6 21.3 20.7 3,803 

Namibia 2000 16.4 16.1 17.4 14.1 19.2 16.4 17.6 17.2 14.8 16.0 21.0 16.2 14.5 16.3 2,346 

Rwanda 2000 22.8 22.4 24.0 23.3 23.0 20.1 23.9 21.8 22.0 22.9 26.9 23.7 19.5 22.6 4,293 

South Africa 1998 18.0 16.9 17.5 16.1 18.1 21.8 17.7 23.6 15.6 16.7 21.1 17.1 16.8 17.4 2,912 

Tanzania 1999 19.1 15.5 17.7 16.2 18.1 18.0 17.7 12.8 17.8 18.1 15.9 16.6 21.3 17.3 1,817 

Uganda 2000-01 27.2 24.1 24.7 27.1 24.2 25.7 24.6 26.5 24.7 26.9 27.5 25.5 25.3 25.6 4,245 

Zambia 2001-02 28.5 26.8 30.9 26.7 29.1 24.5 30.9 28.9 27.6 25.1 34.6 27.4 23.6 27.6 3,681 

Zimbabwe 1999 18.4 18.3 15.7 20.7 18.1 18.5 15.8 15.5 20.5 20.0 17.0 18.4 19.1 18.4 2,029 

Median 22.2 21.1 20.1 21.3 23.4 21.8 20.0 24.1 22.8 20.2 22.8 21.8 21.3 21.7 

Mean 22.6 20.8 21.6 21.3 22.1 22.4 21.6 22.7 22.1 21.2 23.7 21.8 20.9 21.7 

North Africa/West Asia/ 

Europe 

Armenia 2000 10.8 8.9 11.9 8.4 10.0 * 11.8 10.1 8.8 7.4 20.3 9.5 6.5 10.0 880 

Egypt 2000 9.6 9.1 9.6 8.3 10.8 10.1 9.6 8.3 9.4 9.6 16.0 9.0 9.2 9.3 6,741 

Jordan 2002 20.0 20.8 22.6 20.3 21.0 17.3 22.3 20.8 18.3 20.1 32.8 21.3 15.4 20.4 3,454 

Turkey 1998 38.6 34.7 36.9 34.3 44.2 38.2 36.5 43.3 40.6 32.9 54.6 36.0 31.4 36.8 2,013 

Yemen 1997 34.5 32.0 32.3 33.6 32.7 33.6 32.4 34.3 33.0 32.8 34.9 33.0 33.2 33.2 7,056 

Median 20.0 20.8 22.6 20.3 21.0 25.5 22.3 20.8 18.3 20.1 32.8 21.3 15.4 20.4 

Mean 22.7 21.1 22.7 21.0 23.7 24.8 22.5 23.4 22.0 20.6 31.7 21.8 19.1 21.9 

Central Asia 

Kazakhstan 1999 16.2 21.3 23.3 18.3 10.8 * 23.3 18.0 16.8 14.9 (20.6) 19.7 11.8 18.7 788 

Kyrgyz Rep. 1997 19.5 15.6 18.6 17.1 16.0 19.9 18.6 18.6 15.9 17.2 (26.7) 16.6 21.4 17.6 1,104 

Turkmenistan 2000 4.1 3.9 5.0 4.1 1.9 2.1 5.0 5.0 2.9 2.6 (8.4) 4.3 1.2 4.0 1,968 

Uzbekistan 1996 4.7 5.7 6.2 4.3 5.7 5.5 6.1 4.1 4.2 5.7 6.1 5.4 2.8 5.2 1,325 

Median 10.5 10.7 12.4 10.7 8.3 5.5 12.4 11.5 10.1 10.3 14.5 11.0 7.3 11.4 

Mean 13.3 13.6 15.6 13.2 9.6 11.0 15.6 13.9 11.9 11.6 15.4 13.5 11.5 11.4 

South/Southeast Asia 

Bangladesh 1999-00 8.4 7.8 8.4 7.6 8.6 8.8 8.4 5.8 9.7 7.8 7.4 8.4 7.7 8.1 3,927 

Cambodia 2000 24.2 22.4 22.2 23.2 24.7 23.1 22.4 24.6 25.1 22.3 23.1 23.5 23.1 23.3 4,232 

India 1998-99 19.2 18.6 18.2 18.6 20.3 20.1 18.2 18.7 19.9 19.0 21.8 18.6 17.5 18.9 30,668 

Indonesia 1997 14.4 11.8 13.0 12.8 13.3 15.0 13.0 12.8 14.7 12.8 19.6 12.7 12.8 13.1 9,322 

Nepal 2000 26.1 25.0 21.4 26.4 26.6 28.2 21.3 25.9 27.6 26.6 23.1 25.3 28.9 25.5 3,840 

Philippines 1998 10.0 9.6 9.6 9.6 8.9 11.6 9.6 9.3 10.8 9.7 12.6 9.8 9.5 9.8 4,415 

Vietnam 1997 11.7 8.4 10.1 10.3 10.9 5.8 10.0 12.4 8.9 9.9 (19.0) 10.4 5.8 10.1 1,769 

Median 14.4 11.8 13.0 12.8 13.3 15.0 13.0 12.8 14.7 12.8 19.6 12.7 12.8 13.1 

Mean 16.3 14.8 14.7 15.5 16.2 16.1 14.7 15.6 16.7 15.4 18.1 15.5 15.0 15.5 

Latin America/Caribbean 

Bolivia 1998 24.9 24.7 23.8 23.2 26.6 27.2 23.7 25.7 26.6 23.6 26.4 24.8 24.3 24.8 3,826 

Brazil 1996 16.0 16.2 16.3 14.3 21.7 16.6 16.4 16.3 20.6 13.9 21.0 15.9 12.8 16.1 2,757 

Colombia 2000 19.1 15.9 15.9 17.6 20.2 23.1 15.8 19.1 21.0 17.5 18.3 18.1 14.4 17.6 2,725 

Dominican Rep. 2002 19.1 17.2 19.4 17.9 16.1 18.1 19.5 21.8 18.8 14.5 28.3 16.9 13.2 18.2 6,395 

Guatemala 1998-99 18.7 15.9 17.5 16.3 17.9 17.9 17.5 16.8 18.3 16.3 17.8 17.7 15.3 17.3 2,618 

Haiti 2000 34.3 31.2 33.8 31.6 33.2 32.8 33.9 32.3 33.5 31.4 46.8 31.4 31.8 32.8 3,645 

Nicaragua 2001 17.0 16.3 15.0 17.1 17.6 18.2 14.9 17.3 18.2 17.2 20.4 15.7 16.9 16.6 3,807 

Peru 2000 21.0 18.4 18.1 19.1 23.2 21.7 18.1 20.0 23.4 19.3 24.5 19.6 18.2 19.7 6,790 

Median 19.1 16.8 17.8 17.8 21.0 20.0 17.8 19.6 20.8 17.4 22.8 17.9 16.1 17.9 

Mean 21.3 19.5 20.0 19.6 22.1 22.0 20.0 21.2 22.5 19.2 25.4 20.0 18.4 20.4 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and 

has been suppressed. 
Diarrhea 25

3.1.5 Nutritional Factors 

Nutritional Status 

As shown in Figure A.5 in Appendix A, undernutrition and infection, including 

diarrheal diseases, have a cyclical relationship (Tomkins and Watson, 1989). Inadequate dietary intake can lead to growth faltering and low nutritional reserves. Immunity is then lowered, and protein-energy and vitamin A deficiencies in particular can 

damage the mucosa. With the lowered immunity and damaged mucosa, exposure to 

pathogens can result in increased incidence, severity, and duration of diseases. The 

disease process exacerbates the loss of nutrients through alterations in metabolism 

and malabsorption. Loss of appetite, which often accompanies illness, is then reflected by an inadequate dietary intake. 

Because of this cyclical relationship and the cross-sectional design of DHS surveys, it is not possible to ascertain directionality. A child with a recent severe episode 

of diarrhea may have experienced rapid weight loss, reflected by a low weight-forheight measurement (wasting) on the day of interview. A child with frequent or persistent diarrheal episodes may have experienced a chronic loss of essential nutrients 

for growth, reflected by a low height-for-age measurement (stunting). Conversely, 

for the reasons described above, undernourished children may have an enhanced susceptibility to infectious agents, including enteropathogens, and thus have been more 

likely than better nourished children to have had diarrhea in the past two weeks. 

In Table 3.5, the two-week period prevalence of diarrhea is shown by three indices 

of nutritional status: weight-for-age, height-for-age, and weight-for-height. The indices, based on Z-scores derived from anthropometric measurements, are presented 

for severely undernourished (less than -3 SD), moderately undernourished (greater 

than or equal to -3 SD and less than -2 SD), or better nourished (greater than or 

equal to -2 SD) children. 

Overall, these data show a strong and consistent negative association between the 

three measures of nutritional status and diarrhea prevalence, particularly weight-forage and weight-for-height. 

Overall, these data show 

a strong and consistent 

negative association 

between the three 

measures of nutritional 

status and diarrhea 

prevalence, particularly 

weight-for-age and 

weight-for-height. 
26 Diarrhea

Table 3.5 

Percentage of children under age three years with diarrhea in the two weeks preceding the survey by nutritional status indices, Demographic and Health Surveys, 1996-2002 

Weight-for-age Z-score Height-for-age z-score Weight-for-height z-score 

Survey ≤-3.0 -3.0 to -2.01 ≥ -2.0 ≤-3.0 -3.0 to -2.01 ≥ -2.0 ≤-3.0 -3.0 to -2.01 ≥ -2.0 Total 

Number of 

Children 

West/Middle Africa Benin 2001 20.4 19.1 14.5 17.0 19.4 14.6 25.3 20.0 15.1 15.7 2,610 

Burkina Faso 1998-99 38.2 27.7 22.6 34.6 24.5 24.4 35.1 33.1 24.2 25.9 2,530 

Cameroon 1998 40.9 27.9 17.4 23.5 27.1 18.1 * 35.8 19.4 20.4 1,923 

Chad 1996-97 33.0 29.5 23.3 28.9 26.1 25.6 42.3 31.8 24.6 26.3 3,541 

Côte d’Ivoire 1998-99 (46.0) 40.8 23.2 33.4 29.2 26.2 * 39.7 25.5 27.2 1,099 

Gabon 2000 37.1 32.2 20.2 30.0 26.8 20.4 * 30.8 21.6 21.9 2,013 

Ghana 1998 28.1 28.4 19.5 21.2 27.9 20.6 (40.0) 24.4 20.9 21.7 1,638 

Guinea 1999 39.4 33.5 23.1 29.2 30.4 25.0 40.2 37.4 24.5 26.1 2,067 

Mali 2001 30.8 29.0 19.8 27.1 29.4 20.6 35.3 29.9 22.0 23.1 6,120 

Mauritania 2000-01 27.0 25.8 23.5 20.9 28.2 24.0 19.0 34.3 23.3 24.3 2,227 

Niger 1998 49.5 41.5 32.9 45.2 39.0 36.5 54.1 49.0 35.9 38.8 4,022 

Nigeria 1999 25.0 16.9 13.1 18.3 15.6 13.3 25.1 18.4 14.2 15.0 1,473 

Togo 1998 44.1 37.8 28.4 41.0 38.7 28.9 36.8 36.9 30.4 31.2 3,260 

Median 34.0 29.0 22.6 28.9 27.9 24.0 36.1 33.1 23.3 24.3 

Mean 35.3 30.0 21.7 28.5 27.9 22.9 35.3 32.4 23.2 24.4 

South/East Africa Comoros 1996 30.1 23.6 22.1 23.6 24.5 22.5 * 31.0 22.5 23.0 921 

Eritrea 2002 19.4 21.9 15.2 16.7 21.3 16.5 26.4 20.3 16.8 17.5 2,996 

Ethiopia 2000 42.2 35.9 25.3 35.1 33.4 28.5 48.9 44.7 29.0 31.0 6,011 

Kenya 1998 29.7 22.5 16.5 25.9 20.7 16.2 (8.9) 24.9 18.0 18.2 2,821 

Madagascar 1997 36.7 33.1 24.5 34.1 31.2 24.6 (56.6) 34.7 27.7 28.4 3,080 

Malawi 2000 34.7 28.5 21.8 26.8 25.0 22.6 20.8 32.9 23.6 24.1 6,177 

Mozambique 1997 41.0 26.8 19.5 30.6 21.8 21.0 (28.3) 43.0 21.2 22.7 2,837 

Namibia 2000 25.2 23.9 14.6 24.2 22.1 15.1 (24.6) 20.6 16.0 16.5 2,188 

Rwanda 2000 38.9 28.7 20.6 28.2 27.5 20.6 34.6 28.5 22.5 23.2 3,915 

Tanzania 1999 18.5 21.5 17.1 14.7 23.4 17.0 * 18.0 18.3 18.2 1,674 

Uganda 2000-01 34.6 32.7 24.0 28.9 30.2 24.4 * 37.1 25.7 26.2 3,740 

Zambia 2001-02 43.9 36.4 24.0 33.9 31.4 24.9 (41.5) 39.0 27.5 28.2 3,432 

Zimbabwe 1999 (20.1) 29.1 17.6 22.9 24.9 17.2 (23.2) 13.5 19.2 18.9 1,684 

Median 34.6 28.5 20.6 26.8 24.9 21.0 27.4 31.0 22.5 23.0 

Mean 31.9 28.0 20.2 26.6 26.0 20.9 31.4 29.9 22.2 22.8 

North Africa/West 

Asia/Europe Armenia 2000 * * 9.8 * 10.1 9.8 * * 9.7 9.8 805 

Egypt 2000 (16.5) 13.0 9.0 11.2 9.2 9.0 (9.9) 10.2 9.2 9.2 6,264 

Jordan 2002 * 15.7 21.7 18.9 20.1 21.6 * 14.5 21.7 21.5 2,845 

Turkey 1998 (49.9) 53.4 36.8 45.5 49.9 36.6 * (38.6) 37.8 38.0 1,610 

Yemen 1997 40.9 36.1 29.4 36.8 34.9 30.7 31.3 43.3 31.7 33.1 4,966 

Median 40.9 25.9 21.7 27.9 20.1 21.6 20.6 26.6 21.7 21.5 

Mean 35.8 29.5 21.3 28.1 24.8 21.5 20.6 26.6 22.0 22.3 

Central Asia Kazakhstan 1999 * * 16.7 * (29.3) 16.6 * * 17.1 17.8 354 

Kyrgyz Rep. 1997 * 26.1 16.7 11.7 22.9 17.2 * 22.6 17.8 18.0 1,015 

Turkmenistan 2000 (0.0) 5.0 3.8 1.8 5.1 3.9 * 2.3 4.0 3.9 1,745 

Uzbekistan 1996 (3.0) 6.7 5.3 3.7 6.3 5.5 * 5.4 5.3 5.4 989 

Median 1.5 6.7 11.0 3.7 14.6 11.1 u 5.4 11.2 11.6 

Mean 1.5 12.6 10.6 5.7 15.9 10.8 u 10.1 11.1 11.3 

South/Southeast Asia Bangladesh 1999-00 10.8 10.2 6.8 11.0 9.3 7.4 (20.6) 11.2 7.9 8.4 3,306 

Cambodia 2000 34.1 26.6 22.3 26.3 30.2 22.5 32.7 24.3 23.3 23.5 4,006 

India 1998-99 23.5 20.9 17.8 21.3 21.0 18.4 21.9 22.8 19.0 19.5 27,094 

Nepal 2000 33.3 25.9 23.6 27.9 26.7 24.6 35.5 31.0 24.9 25.7 3,707 

Median 28.4 23.4 20.1 23.8 23.9 20.5 27.3 23.6 21.2 21.5 

Mean 25.4 20.9 17.6 21.6 21.8 18.2 27.7 22.3 18.8 19.3 

Latin America/Caribbean Bolivia 1998 40.0 32.9 23.8 31.4 27.6 23.4 * 31.1 24.6 24.7 3,451 

Brazil 1996 * 22.2 16.1 28.4 19.5 15.9 * 22.1 16.3 16.5 2,306 

Colombia 2000 (34.2) 30.8 17.4 26.8 23.8 17.5 * (22.0) 18.3 18.4 2,498 

Dominican Rep. 2002 (22.5) 25.1 17.6 36.2 23.2 17.2 * 11.7 18.0 18.0 5,612 

Guatemala 1998-99 19.2 21.9 17.6 20.3 21.0 16.8 * 28.1 18.2 18.5 2,149 

Haiti 2000 53.7 38.3 31.6 44.9 38.9 31.5 (64.7) 40.7 32.6 33.2 3,532 

Nicaragua 2001 28.8 23.5 15.7 19.1 23.5 15.5 * 18.7 16.4 16.5 3,443 

Peru 2000 25.7 28.3 19.6 27.9 23.8 18.9 * 22.2 20.2 20.2 6,070 

Median 28.8 26.7 17.6 28.2 23.7 17.4 u 22.2 18.3 18.5 

Mean 32.0 27.9 19.9 29.4 25.2 19.6 u 24.6 20.6 20.8 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has 

been suppressed. 

u = Unknown (too few cases to calculate estimate) 
Diarrhea 27

Figure 3.5 shows the range, mean, and median diarrhea prevalence for the countries included in each region by weight-for-age. Apart from Central Asia, there is a 

strong and consistent decrease in the average prevalence of diarrhea with improved 

nutritional status as measured by weight-for-age. Data from the countries in North 

Africa/West Asia/Europe and Central Asia are sparse for severely underweight 

(weight-for-age) children. 

Figure 3.5 

Percentage of children under age three years with diarrhea in the two weeks 

preceding the survey, by low weight-for-age status and region 

u = Unknown (insufficient data) 

The difference in diarrhea prevalence between the lowest and highest categories of 

weight-for-age was calculated for each country. In four countries (Cameroon, Côte 

d’Ivoire, Mozambique, and Haiti), these differentials exceed 20 percentage points. In 

25 of the 42 countries with calculable differences, diarrhea prevalence among severely 

underweight children exceeds that of better nourished, nonunderweight children by 

ten or more percentage points. 

In most regions, the average prevalence of diarrhea decreases with improved nutritional status as measured by height-for-age. The most dramatic decrease is found in 

the Latin America/Caribbean region. In three of those eight countries, the differential in diarrhea prevalence among children in the lowest versus the highest heightfor-age category exceeds 10 percentage points (range of 12 to 19 percentage points). 

A positive differential of this size is found in only two other countries: Burkina Faso 

and Togo. In South/Southeast Asia, the difference in diarrhea prevalence between 

severely stunted and mild/nonstunted children is small. In Central Asia, the pattern 

across categories is irregular. 

In regard to weight-for-height, most of the countries have very low levels of severe 

wasting and, hence, sparse data for severely wasted children. Data are especially 

sparse in this category for the regions of North Africa/West Asia/Europe, Central 

Asia, and Latin America/Caribbean. In the other three regions, the average prevaIn most regions, the 

average prevalence of 

diarrhea decreases with 

improved nutritional 

status as measured by 

height-for-age. 
28 Diarrhea

lence of diarrhea decreases consistently with improved nutritional status as measured 

by weight-for-height. 

Differentials in diarrhea prevalence between the lowest and highest categories of 

weight-for-height were calculated for all countries where data allow. The largest differentials are found in Madagascar and Haiti, where the prevalence of diarrhea 

among severely wasted children is about 30 percentage points higher than that of better nourished, nonwasted children.2

 Of 27 calculable country differentials, an additional 13 are between 10 and 20 percentage points (Benin, Burkina Faso, Chad, 

Ghana, Guinea, Mali, Niger, Nigeria, Ethiopia, Rwanda, Zambia, Bangladesh, and 

Nepal). 

Breastfeeding Status 

Over the course of the first year of life, most infants in developing countries transition from full or predominant breastfeeding to partial or no breastfeeding. Human 

milk contains a variety of antimicrobial factors common to mucosal sites that principally protect the digestive tract and respiratory system of the breastfeeding infant. 

Most of these factors are secreted throughout lactation, including two key proteins, 

lactoferrin and lysozyme, and a key antibody, secretory IgA. The passive transfer of 

secretory antibodies from the mother is especially beneficial, since the child’s secretory immune system matures over the course of the first several months after birth 

(Institute of Medicine, 1991). 

The weaning process introduces increased opportunities for exposure to infectious 

agents through the ingestion of contaminated foods and liquids or eating and drinking utensils. Therefore, illness episodes due to enteric agents are expected to increase 

in frequency as breast milk intake decreases, especially in settings with an inadequate 

supply of safe water and poor sanitation and hygiene conditions. 

The two-week period prevalence of diarrhea is shown in Table 3.6 by two categories of age in months (0-5 months and 6-11 months) and by breastfeeding status. In 

both age groups, fully breastfed infants in a majority of countries have a lower prevalence of diarrhea than their same-age counterparts who are partially breastfed. 

 

2

 In Madagascar and Haiti, the number of children in the severely wasted category is less than 

50. 

The weaning process 

introduces increased 

opportunities for 

exposure to infectious 

agents through the 

ingestion of 

contaminated foods and 

liquids or eating and 

drinking utensils. 
Diarrhea 29

Table 3.6 

Percentage of infants age 0-5 months and 6-11 months with diarrhea in the two 

weeks preceding the survey by breastfeeding status, Demographic and Health 

Surveys 1996-2002 

 

Breastfeeding status of 

infants age 0-5 months 

Breastfeeding status of 

infants age 6-11 months Survey Full Partial None Full Partial None Total 

Number of 

infants 

West/Middle Africa Benin 2001 7.0 7.0 * 25.1 20.7 * 14.1 1,064 

Burkina Faso 1998-99 12.7 15.4 * 21.4 30.8 * 21.0 1,189 

Cameroon 1998 7.4 13.8 * (18.8) 21.3 * 15.6 817 

Chad 1996-97 13.4 22.7 * 15.9 31.0 * 22.6 1,508 

Côte d’Ivoire 1998-99 6.4 13.0 * (8.1) 33.7 * 21.7 411 

Gabon 2000 8.0 11.7 (14.4) (35.0) 28.5 26.8 19.5 795 

Ghana 1988 10.0 20.9 * 28.9 25.5 * 19.7 610 

Guinea 1999 13.1 21.0 * 26.6 35.7 * 22.1 1,099 

Mali 2001 13.2 18.8 * 27.5 30.3 * 20.7 2,750 

Mauritania 2000-01 14.3 21.6 * 18.8 31.1 (41.9) 23.4 1,024 

Niger 1998 23.9 37.0 * 42.0 51.3 * 39.6 1,647 

Nigeria 1999 5.7 12.2 (0.0) 22.3 17.4 (24.1) 13.3 1,109 

Senegal 1997 14.2 19.9 * 24.0 27.1 * 19.9 1,368 

Togo 1998 12.0 23.3 * (42.3) 36.2 * 28.1 1,368 

Median 12.4 19.3 7.2 24.6 30.6 26.8 20.9 

Mean 11.5 18.5 7.2 25.5 30.0 30.9 21.5 

South/East Africa Comoros 1996 (17.0) 24.8 * * 37.6 * 29.8 382 

Eritrea 2002 5.7 13.3 * 15.9 22.7 * 13.6 1,281 

Ethiopia 2000 11.9 23.1 * 32.5 40.3 * 27.1 2,186 

Kenya 1998 7.9 13.0 * * 22.6 (5.9) 17.3 1,087 

Madagascar 1997 10.3 21.7 * (30.1) 32.5 * 23.7 1,280 

Malawi 2000 5.9 22.3 * 36.0 36.1 * 24.3 2,517 

Mozambique 1997 6.1 16.9 * 26.1 21.2 (38.0) 15.8 1,440 

Namibia 2000 7.4 11.0 * * 23.1 16.6 15.8 817 

Rwanda 2000 13.3 14.4 * 30.9 28.4 * 21.7 1,731 

South Africa 1998 5.0 11.1 16.1 * 23.0 21.0 16.6 1,005 

Tanzania 1999 9.2 11.5 * * 30.5 * 19.9 636 

Uganda 2000-01 16.2 21.2 * 39.1 38.5 (28.4) 28.3 1,485 

Zambia 2001-02 8.4 13.3 * 46.6 37.7 * 23.9 1,238 

Zimbabwe 1999 1.6 11.3 * * 26.3 * 16.2 661 

Median 8.1 13.9 u 31.7 29.5 21.0 20.8 

Mean 9.0 16.4 u 32.2 30.0 22.0 21.0 

North Africa/West Asia/ Europe Armenia 2000 8.3 12.0 * * 17.2 12.2 12.1 299 

Egypt 2000 6.9 11.6 (10.2) 16.8 13.3 19.6 11.5 2,362 

Jordan 2002 14.8 19.8 (24.7) * 27.0 25.6 22.8 1,166 

Turkey 1998 26.1 26.2 (27.0) * 45.2 43.4 35.0 712 

Yemen 1997 22.9 28.1 38.7 41.5 38.1 41.6 32.9 2,544 

Median 14.8 19.8 25.9 29.2 27.0 25.6 22.8 

Mean 15.8 19.5 24.9 29.2 28.2 28.5 22.9 

Central Asia Kazakhstan 1999 3.7 (23.0) * * 27.8 (13.4) 19.0 244 

Kyrgyz Rep. 1997 8.5 14.4 * * 21.6 (22.2) 16.4 366 

Turkmenistan 2000 1.8 1.5 * * 6.2 (10.4) 3.9 692 

Uzbekistan 1996 (2.1) 3.9 * * 3.8 (18.7) 5.5 416 

Median 2.9 9.1 u u 13.9 16.0 11.0 

Mean 4.0 10.7 u u 14.9 16.2 11.2 

South/Southeast Asia Bangladesh 1999-00 2.4 4.9 * 10.2 12.6 * 6.9 1,312 

Cambodia 2000 15.3 18.3 * 25.9 30.3 (34.8) 22.8 1,600 

India 1998-99 15.1 17.5 22.4 25.0 25.1 23.8 20.2 10,544 

Indonesia 1997 5.0 10.0 5.6 11.4 18.3 6.7 12.3 3,213 

Nepal 2000 17.6 22.7 * 39.4 33.8 * 26.5 1,282 

Philippines 1998 4.9 4.9 10.5 * 12.3 17.0 10.1 1,494 

Vietnam 1997 1.7 12.6 * * 17.3 * 12.8 529 

Median 5.0 12.6 10.5 25.0 18.3 20.4 12.8 

Mean 8.9 13.0 12.8 22.4 21.4 20.6 15.9 

Latin America/Caribbean 

Bolivia 1998 15.0 14.2 * 15.5 26.9 21.6 20.4 13,16 

Brazil 1996 5.5 11.9 17.9 (12.1) 21.9 23.8 16.8 905 

Colombia 2000 13.0 9.2 (10.7) * 21.7 24.3 17.2 942 

Dominican Rep. 2002 10.1 12.4 16.3 (32.0) 25.8 25.6 19.5 2,011 

Guatemala 1998-99 5.2 10.9 * 25.1 23.4 (5.3) 14.8 901 

Haiti 2000 23.4 30.2 * 39.1 44.9 (32.1) 36.4 1,195 

Nicaragua 2001 13.2 13.4 (10.2) (27.4) 18.6 20.6 16.5 1,140 

Peru 2000 12.2 10.9 * 22.9 23.5 15.4 17.4 2,111 

Median 12.6 12.1 13.5 25.1 23.5 22.7 17.3 

Mean 12.2 14.1 13.8 24.9 25.8 21.1 19.9 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on 

fewer than 25 unweighted cases and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
30 Diarrhea

Figure 3.6.1 shows the range, mean and median diarrhea prevalence estimates for 

those countries included in each region by breastfeeding status for infants under six 

months of age. The regional average percentage of fully breastfed infants age 0-5 

months with recent diarrhea is distinctly lower than the comparable statistic for partially breastfed infants in each region, with the exception of Latin America/Caribbean. At the country level, the differential in diarrhea prevalence among 

fully breastfed versus partially breastfed infants age 0-5 months is negative by five or 

more percentage points in three-fifths (32 of 52) of the countries, including 11 in 

which diarrhea prevalence is lower by more than ten percentage points for fully 

breastfed infants compared with partially breastfed infants. 

Figure 3.6.1 

Percentage of infants age 0-5 months with diarrhea in the two weeks preceding 

the survey, by breastfeeding status and region 

u = Unknown (insufficient data) 

Data for infants under six months of age who are receiving no breast milk are 

sparse in most regions. On the basis of those countries with adequate denominators 

(25 or more), the average regional prevalence of diarrhea is higher among children 

receiving no breast milk compared with partially breastfed children in the region of 

North Africa/West Asia/Europe, but is the same in South/Southeast Asia and Latin 

America/Caribbean (Figure 3.6.1). 

At age 6-11 months, fully breastfed infants continue to have a lower diarrhea 

prevalence than their partially breastfed counterparts in most of the West/Middle 

African countries shown. The largest differentials, ranging from negative 10 to negative 26, are found in Chad, Côte d’Ivoire, Mauritania, Bolivia, and Brazil. 

The number of infants who are receiving no breast milk remains small at age 6-11 

months in most sub-Saharan African countries and in some countries in 

South/Southeast Asia. On the basis of those countries with adequate denominators 

(25 or more), the regional average prevalence of diarrhea is about the same or lower 

among children receiving no breast milk compared with partially breastfed children. 

 
Diarrhea 31

Other Weaning Factors 

Giving water to infants is not recommended in developing countries, primarily for 

two reasons. First, the water may be contaminated and thus expose the child to infectious agents, resulting in a higher likelihood of diarrhea. Second, an infant who is 

consuming a significant amount of water, which has no nutritional value, may in turn 

consume less of other, nutritious liquids because he/she feels full. Breast milk production, which is influenced by the frequency and duration of suckling, may also decrease 

if the infant feels full. Giving a bottle with a nipple to a child at any age is also not 

recommended in developing countries because of the risk of contamination of the 

nipple. 

In Table 3.7, the percentage of infants age 0-5 months and 6-11 months with diarrhea in the past two weeks is shown by receipt/nonreceipt of plain water and 

use/nonuse of a bottle with a nipple during the preceding 24 hours. For each country, 

the difference in diarrhea period prevalence between recipients and nonrecipients and 

between users and nonusers was calculated. 

Overall, the provision of plain water appears to be the most detrimental factor 

with regard to recent diarrhea among infants age 0-5 months. Figure 3.6.2 shows the 

range, mean, and median diarrhea period prevalence estimates for those countries in 

each region by receipt/nonreceipt of plain water during the preceding 24 hours for 

infants age 0-5 months. The regional average prevalence of diarrhea among younger 

infants who were given plain water is consistently higher than that of infants who 

were not given plain water. 

For infants age 0-5 months, the differential in diarrhea period prevalence between 

recipients and nonrecipients of plain water is positive by more than ten percentage 

points in six countries (Ghana, Malawi, Uganda, Jordan, Kazakhstan, and Haiti) and 

by more than five percentage points in one-third of countries (16 of 47). No negative 

differentials are of this magnitude. 

For infants age 6-11 months, differentials in diarrhea period prevalence between 

recipients and nonrecipients of plain water are more inconsistent in direction. Out of 

37 differentials, just 1 is positive by ten or more percentage points (Mali), and 3 are 

negative by the same amount (Kenya, Kazakhstan, and Cambodia). 

Overall, the provision 

of plain water appears 

to be the most 

detrimental factor with 

regard to recent 

diarrhea among infants 

age 0-5 months. 
32 Diarrhea

Table 3.7 

Percentage of infants age 0-5 months and 6-11 months with diarrhea in the two weeks 

preceding the survey, by receipt of plain water and use of bottle with nipple in the past 

24 hours, Demographic and Health Surveys 1996-2002 

 Infants age 0-5 months Infants age 6-11 months 

 

Plain water 

in past 24 

hours 

Bottle with 

nipple in 

past 24 hours 

Plain water 

in past 24 

hours 

Bottle with 

nipple in 

past 24 hours 

Survey Yes No Yes No Yes No Yes No Total

Number 

of infants 

West/Middle Africa 

Benin 2001 7.8 6.3 (1.6) 7.5 21.3 21.5 * 21.6 14.1 1,064 

Burkina Faso 1998-99 14.0 16.8 * 14.6 29.4 (22.1) * 28.6 21.0 1,189 

Cameroon 1998 11.6 7.0 11.7 10.5 20.6 * 21.8 20.8 15.6 817 

Chad 1996-97 17.5 (20.1) 20.3 17.5 28.7 * (29.7) 28.6 22.6 1,508 

Côte d’Ivoire 1998-99 11.2 * * 10.5 30.4 * * 31.5 21.7 411 

Gabon 2000 11.8 6.9 13.8 8.8 28.9 (24.2) 27.8 28.7 19.5 795 

Ghana 1998 18.7 4.4 20.8 11.5 26.8 * 21.8 26.3 19.7 610 

Guinea 1999 16.4 11.7 19.4 15.5 33.2 (20.9) (39.8) 31.6 22.1 1,099 

Mali 2001 15.2 10.5 8.6 14.1 29.2 26.1 22.0 29.0 20.7 2,751 

Mauritania 2000-01 19.4 12.4 20.5 17.1 29.1 31.0 (43.2) 28.1 23.4 1,024 

Niger 1998 30.1 * (43.6) 29.4 50.3 * (46.5) 50.5 39.6 1,647 

Nigeria 1999 9.2 5.0 6.2 9.1 18.1 22.5 16.0 19.0 13.3 1,109 

Senegal 1997 * 15.8 * 15.7 * 25.4 * 25.2 19.9 1,368 

Togo 1998 19.6 16.3 (19.9) 19.0 36.7 * (40.6) 36.4 28.1 1,368 

Median 15.2 11.1 19.4 14.4 29.1 23.4 28.8 28.6 20.9 

Mean 15.6 11.1 16.9 14.3 29.4 24.2 30.9 29.0 21.5 

South/East Africa 

Comoros 1996 24.7 * (21.7) 22.9 37.4 * (33.3) 38.1 29.8 382 

Eritrea 2002 9.6 5.3 (5.2) 7.2 20.6 19.4 33.2 19.2 13.6 1,281 

Ethiopia 2000 20.5 13.4 19.9 14.4 40.8 33.7 27.2 40.6 27.1 2,184 

Kenya 1998 10.2 14.7 10.0 12.6 20.2 30.0 19.0 23.3 17.3 1,087 

Madagascar 1997 15.7 15.1 (11.1) 15.4 33.2 31.5 (33.3) 32.7 23.7 1,280 

Malawi 2000 20.1 7.1 (13.9) 13.0 36.1 33.6 (24.9) 36.3 24.3 2,517 

Mozambique 1997 12.0 7.1 * * 22.9 17.7 * * 15.8 1,440 

Namibia 2000 11.7 4.5 9.6 8.8 23.2 (18.8) 21.0 24.2 15.8 817 

Rwanda 2000 (11.5) 13.6 16.6 13.4 27.4 29.0 31.6 28.1 21.7 1,731 

South Africa 1998 9.1 14.6 11.4 10.5 21.5 24.1 23.0 21.2 16.6 1,005 

Tanzania 1999 9.5 10.8 19.5 9.1 31.8 * (27.7) 30.5 19.9 636 

Uganda 2000-01 33.3 15.1 (13.6) 18.0 39.8 35.0 28.1 38.7 28.3 1,485 

Zambia 2001-02 14.1 5.4 * 10.1 37.8 45.2 (30.8) 38.9 23.9 1,238 

Zimbabwe 1999 9.2 0.5 * 5.9 27.9 (24.8) (19.6) 28.8 16.2 661 

Median 11.9 10.8 13.6 12.6 29.8 29.5 27.7 30.5 20.8 

Mean 15.1 9.8 13.9 12.4 30.0 28.6 27.1 30.8 21.0 

North Africa/West Asia/ 

Europe 

Armenia 2000 11.2 7.8 10.5 9.5 14.1 * 9.2 18.1 12.1 299 

Egypt 2000 10.5 8.0 12.7 7.6 14.7 12.9 15.8 14.1 11.5 2,362 

Jordan 2002 22.4 11.8 19.1 17.5 26.3 * 28.5 24.3 22.8 1,166 

Turkey 1998 27.8 18.5 28.3 24.6 44.2 * 45.6 42.3 35.0 712 

Yemen 1997 27.4 24.7 31.8 23.1 38.6 42.5 39.4 38.3 32.9 2,544 

Median 22.4 11.8 19.1 17.5 26.3 27.7 28.5 24.3 22.8 Mean 19.9 14.2 20.5 16.5 27.6 27.7 27.7 27.4 22.9 

Central Asia 

Kazakhstan 1999 18.2 (7.0) (24.3) 7.8 21.6 (32.0) 27.4 21.0 19.0 244 

Kyrgyz Rep. 1997 11.8 11.7 6.9 13.7 22.1 20.3 23.8 20.4 16.4 366 

Turkmenistan 2000 1.9 0.0 2.3 1.1 6.2 * 12.2 4.4 3.9 692 

Uzbekistan 1996 5.5 * 6.5 3.6 6.1 * 11.3 3.6 5.5 416 

Median 8.6 7.0 6.7 5.7 13.9 26.1 18.0 12.4 10.9 

Mean 9.4 6.2 10.0 6.6 14.0 26.1 18.7 12.4 11.2 

South/Southeast Asia 

Bangladesh 1999-00 6.1 2.3 7.7 2.4 11.6 13.6 10.4 12.2 6.9 1,312 

Cambodia 2000 16.3 14.6 23.6 15.0 29.4 (39.2) 33.0 29.0 22.8 1,600 

India 1998-99 17.6 14.7 18.6 15.5 25.2 24.2 24.2 25.2 20.2 10,544 

Indonesia 1997 10.9 5.9 11.3 6.9 17.0 16.4 14.1 17.4 12.3 3,213 

Nepal 2000 21.5 17.8 * 18.5 34.9 32.6 * 35.6 26.5 1,282 

Philippines 1998 7.8 4.3 7.1 5.5 14.2 (8.4) 13.4 14.7 10.1 1,494 

Vietnam 1997 9.3 (3.3) (12.5) 7.3 15.2 * 15.9 16.9 12.8 529 

Median 10.9 5.9 11.9 7.3 17.0 20.3 15.0 17.4 12.8 Mean 12.8 9.0 13.5 10.2 21.1 22.4 18.5 21.6 15.9 

Latin America/Caribbean 

Bolivia 1998 12.8 15.1 10.0 16.8 28.3 21.4 23.6 26.6 20.4 1,316 

Brazil 1996 14.8 6.9 13.3 8.4 23.2 15.5 23.6 18.0 16.8 905 

Colombia 2000 10.3 11.1 8.7 13.0 20.5 26.1 22.2 23.1 17.2 942 

Dominican Rep. 2002 14.6 8.4 14.3 7.1 26.3 19.2 24.5 33.3 19.5 2,011 

Guatemala 1998-99 7.1 8.9 11.5 6.3 17.6 25.8 18.7 24.0 14.8 901 

Haiti 2000 31.8 19.6 26.2 28.7 43.5 42.2 36.9 45.7 36.4 1,195 

Nicaragua 2001 14.9 11.3 12.4 13.8 19.6 19.0 16.5 24.7 16.5 1,140 

Peru 2000 8.8 12.1 8.6 12.8 22.1 23.1 18.6 25.3 17.4 2,111 

Median 13.7 11.2 11.9 12.9 22.7 22.3 22.9 25.0 17.3 

Mean 14.4 11.7 13.1 13.4 25.1 24.0 23.1 27.6 19.9 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer 

than 25 unweighted cases and has been suppressed. 
Diarrhea 33

Figure 3.6.2 

Percentage of infants age 0-5 months with diarrhea in the two weeks preceding 

the survey, by plain water intake in the past 24 hours and region 

Figure 3.6.3 

Percentage of infants age 0-5 months with diarrhea in the two weeks preceding 

the survey, by use of bottle with nipple in the past 24 hours and region 

In general, the use of a bottle with a nipple is strongly associated with higher recent occurrence of diarrhea in younger (under six months) but not older infants. 

The range, mean, and median diarrhea period prevalence estimates for those countries included in each region by use/nonuse of a bottle with a nipple during the preceding 24 hours for infants under six months of age is shown in Figure 3.6.3. The 

regional average prevalence of diarrhea for bottle users in this age group is higher 

than that for nonusers in every region except Latin America/Caribbean. 

The use of a bottle with a 

nipple is strongly associated 

with higher recent occurrence 

of diarrhea in younger (under 

six months) infants. 
34 Diarrhea

The difference in diarrhea period prevalence between users and nonusers of a bottle with a nipple among infants age 0-5 months was computed for each country. Out 

of 45 differentials, 14 are positive by five or more percentage points. The largest positive differentials in percentage points are found in Niger (14), Tanzania (10), and 

Kazakhstan (16). While 14 differentials are negative, only 4 are greater than five percentage points. 

For infants age 6-11 months, differentials in diarrhea period prevalence between 

users and nonusers of a bottle with a nipple are more likely to be negative than positive (27 of 46). Large negative differentials, in excess of ten percentage points, are 

found in Ethiopia, Malawi, and Uganda, while positive differentials of the same 

magnitude are seen in Mauritania and Eritrea. 

3.1.6 Measles Immunization Status 

Diarrhea is a frequent complication of other infectious illnesses, including measles, in 

developing countries. A byproduct of measles vaccination, which is recommended in 

most countries to be administered to infants at nine months of age, is a potential reduction in diarrhea incidence and related mortality. 

Measles Immunization Coverage 

Figure A.1 in Appendix A shows by country and residence the percentage of children 

age 12-23 months3

 who received a measles vaccination at any time preceding the interview, according to the vaccination card or mother’s report. The data in Figure A.1 

are derived from Table A.1, also included in Appendix A. 

The WSC goal 22 for the end of the decade (year 2000) was the maintenance of a 

high level of measles immunization coverage, specifically, greater than 90 percent of 

infants by 12 months of age. (In this report, completion of recommended vaccinations is based on the date of interview rather than on the first birthday). Only Jordan 

and Egypt met this goal in the year of each country’s last full survey (2002 and 2000, 

respectively) for both urban and rural children. Ninety percent coverage was achieved 

in urban areas in nine additional countries (Rwanda 2000, Tanzania 1999, Malawi 

2000, Kenya 1998, Mozambique 1997, Eritrea 2002, the Dominican Republic 2002, 

Nicaragua 2001, and Brazil 1996) and in rural areas in two additional countries 

(Turkmenistan 2000 and Uzbekistan 1996). On the basis of regional averages, 

West/Midd le Africa had the lowest percentages of both urban and rural children age 

12-23 months who were immunized against measles, according to the last available 

surveys. 

Urban-rural differentials in the percentage of children age 12-23 months immunized against measles were computed for each country. Three-fourths (38 of 51) of 

these differentials are in excess of positive 5 percentage points; 13 exceed positive 20 

percentage points. In West/Middle Africa, the regional mean urban-rural differential 

is the highest, at 23 percentage points. The largest urban-rural differentials are found 

in Burkina Faso, Niger, Ethiopia, Mozambique, and Yemen, ranging from 33 to 46 

percentage points. 

 

3

 For Peru and Nicaragua, this age range is 18 to 29 months because the recommended age for 

measles vaccination in those countries is 15 rather than 9 months. 

A byproduct of 

measles vaccination is 

a potential reduction 

in diarrhea incidence 

and related mortality. 
Diarrhea 35

Diarrhea and Measles Immunization 

The percentage of children age 12-23 and 24-35 months1 experiencing a diarrhea 

episode in the past two weeks is shown by measles immunization status in Table 3.8. 

These data support a strong and consistent negative association between immunization against measles and diarrhea prevalence. 

On the basis of regional average prevalence, vaccinated children are less likely to 

have had a recent diarrhea episode than their unvaccinated counterparts in both their 

second and third years of life. 

For each country, the difference in prevalence among vaccinated versus unvaccinated children was calculated. The regional mean differentials by age group are all 

negative, consistent with the regional average prevalence pattern observed. For children age 12-23 months, negative differentials exceeding 5 percentage points are 

found in 13 countries, with the largest in Togo (11 percentage points) and Kenya (17 

percentage points). For children age 24-35 months, negative differentials exceed 5 

percentage points in 10 countries, with the largest found in Ghana (12 percentage 

points) and Turkey (11 percentage points). In only two instances are comparably 

large positive differences observed (Côte d’Ivoire, at 12 to 23 months, and Jordan at 

24 to 35 months). 

 

1

 For Peru and Nicaragua, the age groups are 18 to 29 and 30 to 35 months because the 

recommended age for measles vaccination in those countries is 15 rather than 9 months. 

On the basis of regional 

average prevalence, 

vaccinated children are less 

likely to have had a recent 

diarrhea episode than their 

unvaccinated counterparts 

in both their second and 

third years of life. 
36 Diarrhea

Table 3.8 

Percentage of children age 12-23 months and 24-35 months with diarrhea in the two weeks preceding the survey, by measles immunization status, Demographic and Health Surveys 1996-2004 

 

 

Children age 12-23 months 

vaccinated against measles 

Children age 24-35 months 

vaccinated against measles 

Survey Yes No Yes No Total 

Number of 

children 

West/Middle Africa Benin 2001 18.2 26.8 12.5 16.0 17.3 1,848 

Burkina Faso 1998-99 31.9 30.7 22.2 25.0 27.4 2,030 

Cameroon 1998 25.0 28.2 13.4 17.2 20.8 1,443 

Chad 1996-97 33.7 28.0 29.9 24.7 27.7 2,431 

Côte d’Ivoire 1998-99 38.2 27.4 19.9 23.9 28.3 810 

Gabon 2000 27.3 29.2 16.8 12.8 22.1 1,529 

Ghana 1988 24.4 31.9 16.0 27.5 22.7 1,193 

Guinea 1999 33.4 33.9 22.2 26.1 28.6 1,906 

Mali 2001 25.7 27.9 19.6 23.2 24.1 4,223 

Mauritania 2000-01 26.6 31.1 17.4 17.5 23.3 1,771 

Niger 1998 39.4 41.1 30.5 34.0 36.7 2,757 

Nigeria 1999 17.0 19.3 12.5 15.1 16.3 2,099 

Togo 1998 31.8 42.6 24.1 31.9 32.8 2,324 

Median 27.3 29.2 19.6 23.9 24.1 

Mean 28.7 30.6 19.8 22.7 25.2 

South/East Africa 

Comoros 1996 22.2 21.5 16.0 16.3 19.3 674 

Eritrea 2002 22.5 22.8 15.9 17.4 19.2 2,000 

Ethiopia 2000 37.9 36.8 25.5 26.5 31.7 4,226 

Kenya 1998 18.0 35.1 11.2 16.8 17.0 2,118 

Madagascar 1997 33.4 32.0 24.6 25.0 29.0 2,257 

Malawi 2000 30.5 36.4 14.0 12.8 22.9 4,345 

Mozambique 1997 27.9 24.4 17.0 26.2 23.7 2,362 

Namibia 2000 20.1 21.2 12.5 10.8 16.5 1,529 

Rwanda 2000 28.0 36.3 16.4 21.8 23.2 2,562 

South Africa 1998 24.9 19.6 11.8 9.9 17.9 1,906 

Tanzania 1999 22.5 13.1 12.7 6.0 15.9 1,181 

Uganda 2000-01 28.1 31.2 16.2 22.1 24.2 2,760 

Zambia 2001-02 36.1 35.6 21.4 27.9 29.6 2,442 

Zimbabwe 1999 24.8 25.8 13.4 14.1 19.4 1,368 

Median 26.4 28.5 16.0 17.1 21.2 

Mean 26.9 28.0 16.3 18.1 22.1 

North Africa/West Asia/Europe 

Armenia 2000 11.3 8.5 6.3 (13.0) 8.9 581 

Egypt 2000 10.0 12.9 6.2 10.3 8.2 4,379 

Jordan 2002 24.8 24.5 13.8 (3.1) 19.1 2,289 

Turkey 1998 41.8 50.6 28.9 39.8 37.8 1,301 

Yemen 1997 33.6 40.8 27.0 31.4 33.4 4,512 

Median 24.8 24.5 13.8 13.0 19.1 

Mean 24.3 27.5 16.4 19.5 21.5 

Central Asia 

Kazakhstan 1999 21.9 25.9 14.6 (14.3) 18.6 545 

Kyrgyz Rep. 1997 25.7 20.2 11.2 (13.9) 18.2 738 

Turkmenistan 2000 5.5 11.4 1.5 4.9 4.1 1,275 

Uzbekistan 1996 7.5 (4.9) 2.6 * 5.0 909 

Median 14.7 15.8 6.9 13.9 11.6 

Mean 15.1 15.6 7.5 11.0 11.5 

South/Southeast Asia 

Bangladesh 1999-00 10.0 16.1 5.2 7.0 8.7 2,615 

Cambodia 2000 28.9 25.8 18.9 21.9 23.7 2,632 

India 1998-99 19.5 23.2 14.0 16.5 18.3 20,125 

Indonesia 1997 14.4 15.4 11.9 14.1 13.6 6,109 

Nepal 2000 27.2 35.2 19.3 22.9 25.0 2,558 

Philippines 1998 12.5 16.9 5.8 6.1 9.7 2,921 

Vietnam 1997 9.9 16.5 6.4 5.3 8.9 1,240 

Median 14.4 16.9 11.9 14.1 13.6 

Mean 17.5 21.3 11.6 13.4 15.4 

Latin America/Caribbean 

Bolivia 1998 31.9 34.8 20.2 21.8 27.1 2,510 

Brazil 1996 17.9 24.8 13.0 9.3 15.8 1,853 

Colombia 2000 20.2 23.0 14.4 15.3 17.8 1,784 

Dominican Rep. 2002 22.5 27.5 11.9 13.7 17.6 4,384 

Guatemala 1998-99 26.3 22.6 11.4 13.7 18.6 1,716 

Haiti 2000 40.2 41.5 22.4 18.9 31.0 2,450 

Nicaragua 2001 16.5 17.1 12.4 17.9 15.4 2,012 

Peru 2000 20.3 28.6 14.3 12.9 19.2 3,500 

Median 21.4 26.2 13.7 14.5 18.2 

Mean 24.5 27.5 15.0 15.4 20.3 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted 

cases and has been suppressed. 
Diarrhea 37

3.1.7 Environmental Factors 

Regardless of the etiologic agent—bacterial, viral, or parasitic—diarrheal diseases are 

almost always transmitted “by direct contact with feces or by contact with water, 

food, utensils, fingers, flies, or soil that has been contaminated with feces” (Black and 

Lanata, 1995). A safe supply of drinking water and an adequately hygienic means of 

excreta disposal are key determinants of the risk of diarrheal diseases. 

Unfinished floors (earth, sand, or dung) in the main areas of a dwelling pose a risk, 

particularly to crawling infants and young toddlers, who are more likely than older 

children to put contaminated objects found on the floor or dirty hands into their 

mouths. Crowding has also been shown to be associated with an increased risk of 

diarrheal diseases (Stanton and Clemens, 1987). 

3.1.7.1 Household Access to Safe Drinking Water 

Figure A.3 in Appendix A shows the percentage of urban and rural households in 

each country with access to safe drinking water. In only three countries (Chad, Bangladesh, and Indonesia) do less than half of urban households have access to safe 

drinking water, ranging from 25 percent in Chad to 100 percent in Jordan. In contrast, less than half of rural households have access to safe drinking water in 22 of the 

50 countries shown, ranging from 4 percent in Bangladesh to 99 percent in Jordan. 

Within countries, the differential in percentage of urban versus rural households 

with a safe water supply was computed. The following countries have disparities exceeding 50 percentage points between urban and rural households: Burkina Faso, 

Mauritania, Niger, Senegal, Zambia, Zimbabwe, Kazakhstan, Turkmenistan, and 

Brazil. Rural households have higher access than urban households to a safe water 

supply in just three countries: Turkey, Nepal, and Guatemala. 

3.1.7.2 Household Means of Excreta Disposal 

Figure A.4 in Appendix A shows the percentage of households in each country with 

sanitary means of excreta disposal by residence. More than half of urban households 

have adequate sanitation facilities in all countries, exceeding 90 percent in 33 of the 

50 countries shown. In comparison, in 20 of the 50 countries, less than half of rural 

households have adequate sanitation facilities, falling as low as 4 percent in rural Eritrea. 

Because of the wide disparities in water, sanitation, and housing between urban 

and rural areas observed in these surveys, separate tables (Tables 3.9.1 and 3.9.2, respectively) are presented to show diarrhea prevalence in each area by four householdlevel environmental factors: access to safe drinking water; sanitary means of excreta 

disposal; natural flooring materials; and the number of children under the age of five 

years living in the household. 

A safe supply of drinking 

water and an adequately 

hygienic means of excreta 

disposal are key 

determinants of the risk 

of diarrheal diseases. 
38 Diarrhea

3.1.7.3 Diarrhea and Environmental Factors in Urban Households 

Access to Safe Drinking Water 

Overall, lack of access to a safe supply of drinking water is not consistently associated 

with a higher probability of recent diarrhea among young children in urban areas on 

the basis of these data, although some substantial and moderate differentials are observed in some countries, particularly those in sub-Saharan Africa. 

However, the regional average diarrhea prevalence among children under age three 

years in urban households lacking a source of safe drinking water is higher than 

among children in urban households with safe drinking water (Figure 3.7.1), apart 

from West/Middle Africa. 

Figure 3.7.1 

Percentage of urban children under age three years with diarrhea in the two 

weeks preceding the survey, by access to safe drinking water and region 

For each country, the difference in diarrhea prevalence among children with and 

without a source of safe drinking water was calculated. In three countries (Ethiopia, 

Kenya, and Malawi), all in South/East Africa, the diarrhea prevalence among children from urban households without a source of safe drinking water is more than ten 

percentage points higher, and is higher by more than five percentage points in an additional six countries. However, differentials in most countries are small. In four 

countries, Côte d’Ivoire, Madagascar, Turkey, and the Dominican Republic, the opposite association is observed: the prevalence is higher by five or more percentage 

points among urban children with a safe water supply, compared with those without 

(range 7 to 24). 

Lack of access to a safe 

supply of drinking water 

is not consistently 

associated with a higher 

probability of recent 

diarrhea among young 

children in urban areas. 
Diarrhea 39

Table 3.9.1 

Percentage of urban children under age three years with diarrhea in the two weeks preceding the survey, by 

housing characteristics, Demographic and Health Surveys 1996-2002 

Safe drinking 

water 

Sanitary excreta 

disposal Natural floor 

Number of children under 

age 5 living in household 

Survey Yes No Yes No Yes No 1 2 3+ Total 

Number of 

children 

West/Middle Africa Benin 2001 11.1 18.7 10.9 17.6 19.9 12.3 14.1 9.6 22.1 13.9 931 

Burkina Faso 1998-99 24.8 23.5 24.3 24.8 (19.4) 24.9 25.7 23.2 22.6 24.4 346 

Cameroon 1998 17.3 15.1 17.1 * 19.8 16.3 13.5 19.0 19.7 17.0 622 

Chad 1996-97 24.8 26.9 26.0 27.5 27.6 20.3 27.0 27.1 24.3 26.3 865 

Côte d’Ivoire 1998-99 22.5 15.0 20.1 * * 20.3 18.7 21.7 22.8 20.6 412 

Gabon 2000 22.5 20.3 22.5 (20.7) 20.9 22.7 19.5 25.4 23.0 22.5 1,697 

Ghana 1998 19.3 (21.5) 18.9 (24.9) * 19.5 22.3 18.6 (2.9) 19.5 459 

Guinea 1999 22.1 23.3 23.2 21.8 15.6 23.3 22.0 25.1 19.8 22.6 795 

Mali 2001 16.6 17.6 16.7 (27.0) 18.2 16.0 20.8 15.4 13.2 16.9 1,706 

Mauritania 2000-01 26.9 27.0 25.9 29.9 28.0 26.0 30.1 23.2 27.8 26.9 1,189 

Niger 1998 30.7 40.1 29.8 39.0 40.2 28.1 33.1 30.2 31.3 31.6 733 

Nigeria 1999 13.2 14.8 14.6 9.3 16.4 13.5 10.9 13.9 22.8 13.9 896 

Senegal 1997 19.3 15.8 19.0 14.1 8.6 19.4 17.6 21.4 17.1 18.7 1,296 

Togo 1998 26.0 30.4 25.6 29.9 33.7 26.5 29.1 25.1 21.7 27.0 865 

Median 22.3 20.9 21.3 24.8 19.9 20.3 21.4 22.5 22.4 21.6 

Mean 21.2 22.1 21.0 23.9 22.4 20.6 21.7 21.4 20.8 21.6 

South/East Africa Comoros 1996 28.3 24.0 26.7 * 30.8 25.2 26.4 26.2 (34.2) 27.5 255 

Eritrea 2002 12.6 19.5 13.9 16.3 16.9 13.8 16.0 15.7 4.1 14.8 1,097 

Ethiopia 2000 21.7 34.8 23.6 22.2 25.6 17.5 22.2 24.7 21.3 23.1 649 

Kenya 1998 15.7 26.9 16.0 (42.9) 28.3 13.8 17.3 17.5 14.8 17.1 600 

Madagascar 1997 35.2 11.2 29.8 30.4 29.1 30.2 29.8 26.4 43.3 30.0 704 

Malawi 2000 18.4 32.2 19.1 (22.1) 23.6 17.0 19.2 18.0 24.5 19.2 891 

Mozambique 1997 29.3 34.3 29.9 32.3 33.6 28.7 31.2 27.8 36.1 30.6 806 

Namibia 2000 17.0 (19.4) 17.1 16.9 16.0 17.3 13.6 28.3 14.2 17.1 810 

Rwanda 2000 17.2 16.3 17.1 * 24.6 12.6 20.1 15.6 14.3 17.0 690 

South Africa 1998 14.5 (17.0) 14.3 (20.9) 24.6 14.0 14.2 14.9 15.9 14.5 1,422 

Tanzania 1999 13.7 14.7 13.8 * 17.1 11.9 13.8 12.4 (23.7) 13.9 354 

Uganda 2000-01 21.4 20.5 21.0 (33.9) 23.6 20.6 21.4 20.7 23.0 21.3 486 

Zambia 2001-02 27.1 35.3 27.3 (44.5) 38.0 25.9 27.0 28.7 29.6 28.0 1,124 

Zimbabwe 1999 16.4 * 16.7 * * 16.5 16.8 15.9 (19.0) 16.6 668 

Median 17.8 20.5 18.1 26.3 24.6 17.2 19.7 19.4 22.2 18.2 

Mean 20.6 23.5 20.5 28.2 25.5 18.9 20.6 20.9 22.7 20.8 

North Africa/West Asia/ 

Europe Armenia 2000 8.1 * 8.3 * * 8.3 8.6 9.4 (0.0) 8.3 453 

Egypt 2000 7.9 (5.5) 7.9 * 12.5 7.7 8.8 7.2 5.8 7.9 2,625 

Jordan 2002 19.7 (23.6) 19.7 * * 19.8 19.3 20.4 19.1 19.7 2,680 

Turkey 1998 34.6 26.9 32.8 (32.7) 49.0 32.2 31.6 35.4 33.4 32.8 1,260 

Yemen 1997 30.1 28.7 29.8 (31.1) 38.6 28.1 26.9 31.6 29.9 29.8 1,631 

Median 19.7 25.2 19.7 31.9 38.6 19.8 19.3 20.4 19.1 19.7 

Mean 20.1 21.2 19.7 31.9 33.4 19.2 19.0 20.8 17.6 19.7 

Central Asia 

Kazakhstan 1999 19.4 (23.8) 20.0 * * 19.8 19.6 24.2 * 20.0 327 

Kyrgyz Rep. 1997 15.5 * 15.1 * * 15.2 16.4 9.2 * 15.1 253 

Turkmenistan 2000 5.8 10.4 6.4 * * 6.2 7.3 5.8 3.9 6.5 775 

Uzbekistan 1996 8.2 (11.5) 8.5 * * 8.4 10.4 8.8 3.3 8.5 414 

Median 11.9 11.5 11.8 u u 11.8 13.4 9.0 3.6 11.8 

Mean 12.2 15.2 12.5 u u 12.4 13.4 12.0 3.6 12.5 

South/Southeast Asia Bangladesh 1999-00 8.3 10.0 9.4 (13.2) 7.4 11.6 8.9 11.2 8.5 9.5 644 

Cambodia 2000 18.0 21.6 21.5 18.7 (17.1) 20.2 18.9 20.3 25.1 19.9 552 

India 1998-99 20.0 17.6 18.1 23.3 17.0 23.0 18.7 20.2 19.2 19.3 6,928 

Indonesia 1997 9.9 13.4 11.5 15.1 15.1 11.9 13.5 9.0 8.6 12.0 2,624 

Nepal 2000 21.9 24.2 22.2 22.3 25.1 20.2 23.8 19.5 (23.8) 22.2 237 

Philippines 1998 8.3 9.7 8.2 14.7 17.5 8.3 9.4 8.1 8.3 8.7 2,049 

Vietnam 1997 5.1 7.3 4.9 (13.3) (8.3) 5.5 5.9 6.5 * 5.8 255 

Median 9.9 13.4 11.5 15.1 17.0 11.9 13.5 11.2 13.9 12.0 Mean 13.1 14.8 13.7 17.2 15.4 14.4 14.2 13.5 15.6 13.9 

Latin America/Caribbean Bolivia 1998 22.9 25.7 22.3 26.0 24.1 22.9 20.5 26.7 22.3 23.1 2,219 

Brazil 1996 14.7 19.8 14.4 26.8 26.4 14.9 14.6 14.6 24.5 15.5 2,104 

Colombia 2000 16.8 (20.4) 16.8 18.1 29.5 16.3 14.2 18.7 26.9 16.9 1,863 

Dominican Rep. 2002 22.6 15.2 17.4 21.4 18.8 17.5 16.5 17.1 26.4 17.6 4,192 

Guatemala 1998-99 14.4 21.0 16.9 (6.7) 18.9 15.5 19.9 13.9 14.5 16.5 991 

Haiti 2000 31.1 29.2 28.9 44.4 30.0 31.0 32.6 27.4 36.6 30.9 1,203 

Nicaragua 2001 14.0 (12.2) 13.3 25.9 15.7 13.1 13.0 12.0 23.1 13.9 1,931 

Peru 2000 17.0 19.9 17.1 20.2 22.9 15.1 16.5 18.2 23.4 17.4 3,744 

Median 16.9 20.2 17.0 23.7 23.5 15.9 16.5 17.7 24.0 17.2 Mean 19.2 20.4 18.4 23.7 23.3 18.3 18.5 18.6 24.7 19.0 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases 

and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
40 Diarrhea

Table 3.9.2 

Percentage of rural children under age three years with diarrhea in the two weeks preceding the survey, 

by housing characteristics, Demographic and Health Surveys 1996-2002 

Safe drinking 

water 

Sanitary excreta 

disposal Natural floor 

Number of children under 

age 5 living in household 

Survey Yes No Yes No Yes No 1 2 3+ Total 

Number of 

children 

West/Middle Africa Benin 2001 14.6 18.7 11.6 18.1 16.8 17.6 18.0 15.9 17.8 17.2 1,981 

Burkina Faso 1998-99 29.4 24.8 32.1 24.2 25.0 25.8 24.2 25.2 25.7 25.1 2,872 

Cameroon 1998 18.7 21.2 18.3 27.6 22.6 11.0 20.6 20.4 18.0 19.7 1,639 

Chad 1996-97 24.0 26.0 25.8 25.5 25.4 * 26.1 24.3 27.2 25.6 3,073 

Côte d’Ivoire 1998-99 34.7 24.4 24.9 32.1 28.4 29.2 31.6 28.3 27.2 28.9 809 

Gabon 2000 17.3 19.5 16.9 (40.3) 20.4 14.5 16.0 17.1 20.3 17.8 627 

Ghana 1998 22.9 21.9 19.3 29.2 27.0 21.1 24.8 19.3 23.5 22.4 1,343 

Guinea 1999 28.4 26.7 27.7 27.5 27.5 27.8 28.9 24.2 29.9 27.5 2,210 

Mali 2001 21.1 26.4 23.6 27.6 24.9 21.3 25.9 24.1 23.9 24.7 5,267 

Mauritania 2000-01 17.2 22.2 21.7 20.3 22.0 16.2 20.0 20.5 22.6 20.7 1,606 

Niger 1998 39.3 39.0 37.4 39.1 39.0 38.2 40.2 37.2 40.1 39.0 3,671 

Nigeria 1999 15.0 16.5 16.7 14.1 16.3 15.3 16.1 15.5 16.0 15.8 2,312 

Senegal 1997 22.3 20.0 21.3 19.9 21.5 19.0 20.6 18.5 21.6 20.6 2,572 

Togo 1998 31.7 33.0 30.0 32.7 33.0 31.9 31.7 34.5 30.5 32.3 2,828 

Median 22.6 23.3 22.7 27.6 25.0 21.1 24.5 22.3 23.7 23.6 Mean 24.0 24.3 23.4 27.0 25.0 22.2 24.6 23.2 24.6 24.1 

South/East Africa Comoros 1996 25.9 17.4 21.9 * 24.3 17.6 19.1 23.1 22.8 21.7 801 

Eritrea 2002 15.5 20.1 17.6 18.1 17.6 22.2 16.7 19.5 16.7 18.1 2,184 

Ethiopia 2000 32.5 29.8 32.2 30.8 30.7 41.9 32.6 30.0 26.6 30.9 5,762 

Kenya 1998 17.4 16.3 16.2 20.3 17.7 14.7 16.1 18.4 16.2 17.1 2,606 

Madagascar 1997 27.6 22.1 30.6 24.6 24.7 26.5 28.1 27.1 19.0 26.3 2,833 

Malawi 2000 23.2 25.4 23.9 24.8 24.6 19.9 23.9 23.7 27.2 24.1 5,972 

Mozambique 1997 20.7 15.4 11.2 21.3 20.2 7.3 19.9 16.7 14.7 18.0 2,996 

South Africa 1998 20.8 15.2 20.9 18.7 19.6 20.6 19.0 21.0 23.0 20.2 1,490 

Namibia 2000 14.6 18.5 14.6 16.2 15.6 17.2 17.2 14.9 15.2 15.9 1,536 

Rwanda 2000 22.4 24.3 23.6 26.5 23.7 22.5 26.1 23.5 12.6 23.7 3,604 

Tanzania 1999 16.8 19.6 19.3 13.7 18.3 16.0 20.1 17.8 15.8 18.2 1,463 

Uganda 2000-01 26.5 25.9 24.1 34.9 26.7 21.0 28.4 26.7 21.4 26.2 3,759 

Zambia 2001-02 27.6 27.4 26.0 29.5 27.6 26.6 29.1 25.6 29.2 27.5 2,556 

Zimbabwe 1999 20.9 18.6 20.3 17.8 19.2 19.2 18.3 20.5 19.7 19.2 1,361 

Median 21.7 19.9 21.4 21.3 22.0 20.3 20.0 22.1 19.4 21.0 Mean 22.3 21.1 21.6 22.9 22.2 20.9 22.5 22.0 20.0 21.9 

North Africa/West Asia/Europe Armenia 2000 12.4 8.4 11.7 * * 12.0 14.1 8.8 13.4 11.7 427 

Egypt 2000 10.3 9.6 10.1 13.1 12.6 8.9 10.6 9.9 10.3 10.2 4,116 

Jordan 2002 22.1 (31.7) 22.5 * * 22.5 26.8 20.8 19.3 22.5 774 

Turkey 1998 43.7 41.1 42.2 (61.3) 51.3 41.6 42.3 42.9 47.5 43.4 753 

Yemen 1997 33.4 35.0 32.8 36.5 35.2 33.3 36.4 35.7 30.6 34.2 5,425 

Median 22.1 31.7 22.5 36.5 35.2 22.5 26.8 20.8 19.3 22.5 

Mean 24.4 25.2 23.9 37.0 33.0 23.7 26.0 23.6 24.2 24.4 

Central Asia 

Kazakhstan 1999 17.8 17.8 17.4 * * 17.7 17.7 19.1 * 17.8 462 

Kyrgyz Rep.1997 18.5 16.8 18.4 * 21.1 18.0 17.4 17.2 25.0 18.3 851 

Turkmenistan 2000 1.6 2.9 2.5 * (0.0) 2.5 2.4 2.1 3.7 2.4 1,192 

Uzbekistan 1996 3.5 4.2 3.7 * 3.9 3.6 4.1 3.3 4.0 3.7 911 

Median 10.7 10.5 10.6 u 3.9 10.7 10.8 10.3 4.0 10.8 Mean 10.4 10.4 10.5 u 8.3 10.4 10.4 10.4 10.9 10.6 

South/Southeast Asia Bangladesh 1999-00 6.3 7.9 7.5 8.9 8.0 4.7 7.7 8.0 8.7 7.8 3,283 

Cambodia 2000 23.7 23.9 24.3 23.8 25.9 23.6 23.9 23.9 23.4 23.9 3,680 

India 1998-99 18.6 18.9 16.1 19.4 16.1 19.4 18.1 19.4 19.4 18.8 23,741 

Indonesia 1997 14.3 13.2 12.3 15.1 12.9 13.9 13.5 14.2 10.6 13.6 6,698 

Nepal 2000 27.1 21.9 20.6 26.9 26.2 17.5 25.3 26.7 23.7 25.7 3,603 

Philippines 1998 10.6 10.9 10.2 12.6 10.5 10.9 11.4 11.2 8.7 10.8 2,366 

Vietnam 1997 9.7 11.1 9.6 13.3 10.2 11.3 11.1 10.0 12.0 10.8 1,513 

Median 14.3 13.2 12.3 15.1 12.9 13.9 13.5 14.2 12.0 13.6 Mean 15.8 15.4 14.4 17.1 15.7 14.5 15.9 16.2 15.2 15.9 

Latin America/Caribbean Bolivia 1998 28.5 23.3 27.4 27.1 28.2 24.6 31.3 25.2 24.3 27.2 1,606 

Brazil 1996 19.6 17.5 16.8 19.5 18.7 17.8 17.9 16.5 22.1 18.0 653 

Colombia 2000 18.2 20.2 20.5 16.2 20.5 18.5 19.1 16.4 26.2 19.1 862 

Dominican Rep. 2002 19.5 19.3 18.0 28.2 27.8 18.0 17.9 21.2 19.1 19.4 2,204 

Guatemala 1998-99 16.4 21.4 16.4 21.8 18.2 16.9 15.5 20.9 14.6 17.8 1,627 

Haiti 2000 32.0 35.1 35.3 32.7 31.7 38.1 31.5 35.7 33.2 33.7 2,442 

Nicaragua 2001 19.1 20.0 17.4 22.5 19.4 19.5 18.8 18.8 22.1 19.4 1,875 

Peru 2000 22.1 22.9 24.3 21.0 22.3 23.8 22.9 23.5 18.0 22.6 3,046 

Median 19.6 20.8 19.3 22.2 21.4 19.0 19.0 21.1 22.1 19.4 Mean 21.9 22.5 22.0 23.6 23.4 22.1 21.9 22.3 22.5 22.1 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases 

and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
Diarrhea 41

Sanitary Means of Excreta Disposal 

Poor sanitation, in general, is associated with a higher probability of recent diarrhea 

among young urban children on the basis of these data. Substantial differentials are 

observed in some South/East African and Latin American/Caribbean countries. 

In two regions, North Africa/West Asia/Europe and Central Asia, data for urban children under age three years living in households without adequate sanitation 

are very sparse. Elsewhere, the regional average diarrhea prevalence is consistently 

higher among children in urban households lacking a sanitary means of excreta disposal than among children in urban households with adequate sanitation (Figure 

3.7.2). 

Figure 3.7.2 

Percentage of urban children under age three years with diarrhea in the two 

weeks preceding the survey, by presence of household means of sanitary excreta disposal and region 

u = Unknown (insufficient data) 

For each country with sufficient data, the difference in diarrhea prevalence among 

urban children with and without a sanitary means of excreta disposal was calculated. 

There are seven countries with large negative differentials exceeding ten percentage 

points: Mali, Kenya, Uganda, Zambia, Brazil, Haiti, and Nicaragua. In only one 

country, Guatemala, is an equally large positive differential found. The largest mean 

differentials by region are found in South/East Africa (seven percentage points) and 

Latin America/Caribbean (five percentage points). 

Poor sanitation is 

associated with a higher 

probability of recent 

diarrhea among young 

urban children. 
42 Diarrhea

Main Flooring Material 

Overall, these data support a strong association between unimproved floors in urban 

homes and an increased probability of recent diarrhea among young children. 

In Central Asia, there are too few children in urban households with natural floors 

(earth, sand, or dung) to provide valid prevalence estimates in that category. Elsewhere, the regional average diarrhea prevalence is higher among children in urban 

households with floors of mainly natural materials than among children in urban 

households with mainly finished floors. 

The difference in diarrhea prevalence among urban children in households with 

and without a natural floor was calculated for each country with sufficient data. In 

most countries, the differential is positive. The mean differential is five or more percentage points in three regions: South/East Africa, North Africa/West Asia/Europe, 

and Latin America/Caribbean. The diarrhea prevalence among urban children from 

households with a natural floor is higher by more than ten percentage points in ten 

countries (Niger, Kenya, Rwanda, South Africa, Zambia, Turkey, Yemen, Brazil, and 

Colombia) and by more than five percentage points in eight more. In contrast, only 

four differentials are negative by this amount (Burkina Faso, Guinea, Senegal, and 

India). 

Number of Children under Age Five 

The last environmental indicator examined in Table 3.9.1 is the number of children 

under the age of five years living in the household, including the index child, who is 

under the age of three years. While a consistent association between more young urban children and a higher probability of recent diarrhea is not observed, there are 

substantial differentials in a number of countries in both directions. 

The regional average diarrhea prevalence among index children in urban households with three or more children under five years of age is not consistently higher 

than among index children in urban households in which the index child is the only 

child under five years of age. 

For each country, the difference in diarrhea prevalence among urban index children in households with no additional children under age five versus three or more 

children under age five was calculated. In four countries (Nigeria, Madagascar, Colombia, and Nicaragua), the diarrhea prevalence is lower by more than ten percentage 

points among urban index children in households with no additional children under 

five, but is higher by the same amount in two countries, Ghana and Eritrea. The 

largest mean differential by region is that of Latin America/Caribbean, at negative six 

percentage points, wherein seven of the eight differentials computed are negative. 

These data support a 

strong association 

between unimproved 

floors in urban homes and 

an increased probability 

of recent diarrhea among 

young children. 
Diarrhea 43

3.1.7.4 Diarrhea and Environmental Factors in Rural Households 

The four household-level environmental indicators are repeated in Table 3.9.2 for 

rural children under age three years. 

Access to Safe Drinking Water 

A consistent association between unsafe drinking water and an increased probability of recent diarrhea is not indicated for young rural children by these data. 

Unlike that for same-age children from urban households, the regional average diarrhea prevalence among children from rural households without a source of safe 

drinking water is not consistently higher than the corresponding average prevalence 

among children from other rural households with safe drinking water (Figure 3.8.1). 

For each country, the difference in diarrhea prevalence among children with and 

without a source of safe drinking water was calculated. Most of the differentials are 

small (less than five percentage points). The three largest differentials include two 

positive, Côte d’Ivoire (ten percentage points) and Comoros (eight percentage 

points), and one negative, Jordan (ten percentage points). 

Figure 3.8.1 

Percentage of rural children under age three years with diarrhea in the two 

weeks preceding the survey, by access to safe drinking water and region 

Sanitary Means of Excreta Disposal 

These data reveal a largely consistent and significant association between poor sanitation and a higher probability of recent diarrhea for young rural children. 

With respect to a sanitary means of excreta disposal, the number of children from 

rural households without sanitary disposal available in these surveys in Central Asian 

countries is too small to provide valid prevalence estimates in that category. Elsewhere, the regional average diarrhea prevalence is consistently higher among children 

from rural households without a sanitary means of excreta disposal than the correA consistent association 

between unsafe drinking 

water and an increased 

probability of recent 

diarrhea is not indicated 

for young rural children. 

There is a consistent 

association between 

poor sanitation and a 

higher probability of 

recent diarrhea for young 

rural children. 
44 Diarrhea

sponding average prevalence among children from other rural households with adequate sanitation (Figure 3.8.2), most notably in North Africa/West Asia/Europe. 

For each country with sufficient data, the difference in diarrhea prevalence among 

rural children with and without a sanitary means of excreta disposal was calculated. A 

majority of the differentials are negative (29 of 45), and in five countries (Gabon, 

Mozambique, Uganda, Turkey, and the Dominican Republic), the diarrhea prevalence among rural children from households without sanitary disposal is more than 

ten percentage points higher than for children with sanitary disposal facilities. 

Figure 3.8.2 

Percentage of rural children under age three years with diarrhea in the two 

weeks preceding the survey, by presence of household means of sanitary excreta disposal and region 

u = Unknown (insufficient data 

Main Flooring Material 

A largely consistent association between natural flooring materials and an increased probability of recent diarrhea is observed for young rural children. 

As shown in Table 3.9.2, apart from Central Asia, the regional average diarrhea 

prevalence is higher among children from rural households with a floor of mainly 

natural materials than the corresponding average prevalence among children from 

other rural households. 

The difference in diarrhea prevalence among rural children from households with 

and without a natural floor was calculated for each country with sufficient data. In 

most countries, the differential is positive (30 of 48), with the 4 largest found in 

Cameroon (12 percentage points), Mozambique (13 percentage points), Turkey (10 

percentage points), and the Dominican Republic (10 percentage points). There is just 

one equally large negative differential, found in Ethiopia (11 percentage points). 

A largely consistent 

association between 

natural flooring materials 

and an increased 

probability of recent 

diarrhea is observed for 

young rural children. 
Diarrhea 45

Number of Children under Age Five 

The fourth environmental indicator examined is the number of children under the 

age of five years living in the household, including the index child, who is under 

three. Overall, rural children living in households with multiple (three or more) 

young children under age five years do not appear to have an increased likelihood of 

recent diarrhea, as compared with rural children from households with just one or 

two young children, although there are some significant exceptions, particularly in 

South/East Africa. 

With the exception of the region of Latin America/Caribbean, the regional average diarrhea prevalence among index children from rural households with three or 

more children under five years of age is the same or lower than the corresponding 

average prevalence among index children from rural households with no additional 

children under five years of age. 

For each country, the difference in diarrhea prevalence among index children from 

rural households with no additional children under age five versus three or more children under age five was calculated. Most of the differentials are small, but eight are 

positive by more than five percentage points, including for five countries in 

South/East Africa. The largest positive differential is found in Rwanda, where diarrhea prevalence is higher by 14 percentage points among index children from rural 

households with no additional children under five compared with households with 

three or more children under five. 

3.2 Diarrhea Treatment and Careseeking Behaviors 

This section examines the ways by which diarrhea is treated, including feeding practices during illness, and the seeking of care from a health provider in response to a 

child’s recent episode of diarrhea. 

Most diarrhea episodes are not severe and are self-limiting and can be successfully 

managed by the mother or caretaker at home by following the WHO/UNICEF 

(2004) recommendations: administer an oral rehydration salts solution, if on hand, or 

appropriate fluids available in the home early on to prevent dehydration; continue 

feeding or increase breastfeeding during the episode; and increase all feeding following the episode.2

 In cases where the child becomes severely dehydrated, cholera is 

suspected, blood is present in the stool, the diarrheal episode is persistent, or if general danger signs develop, it is appropriate for the mother/caretaker to seek advice 

from a health care provider. 

When a child with diarrhea is seen by a health care provider, he/she should be assessed for dehydration, the possibility of cholera or dysentery, and danger signs indicating the need for urgent referral to a hospital. If the child is severely dehydrated, it 

is recommended that the child be given a rehydration solution intravenously or with a 

naso-gastric tube, if possible. In cases of dysentery, which is estimated to occur in 

about 10 percent of diarrhea episodes among children under age five (USAID, 2004), 

endemic cholera, or certain other serious illnesses with a bacterial etiology, it is recommended to initiate antibiotic treatment. Otherwise, in the majority of cases, the 

 

2

 This recently published joint statement also encourages families to maintain a supply of zinc 

syrup or tablets at home for ready use. 

When a child with diarrhea 

is seen by a health care 

provider, he/she should be 

assessed for dehydration, 

the possibility of cholera or 

dysentery, and danger signs 

indicating the need for 

urgent referral to a hospital. 
46 Diarrhea

provider should initiate the use of an oral rehydration salts solution in the office and 

instruct the mother to continue at home. In addition, the provider should counsel the 

mother to treat this and future non-severe diarrheal episodes as described above.3

 

3.2.1 Diarrhea Treatment by Careseeking Behavior 

Figure 3.9 shows the estimated percentage of children in each country for whom 

advice or treatment for a recent diarrheal episode was sought from an appropriate 

health care provider by urban-rural residence and region. Careseeking for diarrhea 

varies widely within regions. The regions with the widest ranges of careseeking estimates are South/East Africa (from 15 percent in urban and rural Rwanda to 59 percent and over in urban and rural South African and Tanzania) and South/Southeast 

Asia (from 27 and 22 percent in urban and rural Nepal to 77 and 62 percent in urban 

and rural India, respectively). In most countries, urban children with diarrhea are 

more likely to be taken for care than their rural counterparts. Two notable exceptions 

are Kazakhstan and Turkmenistan in Central Asia, although the relevant estimated 

percentages are based on small denominators. 

Tables 3.10.1 and 3.10.2 show the percentage of children under the age of three 

years with diarrhea in the past 2 weeks by use of oral rehydration solutions,4

 feeding 

practices, and the use of non-recommended treatments for children for whom advice 

or treatment was or was not sought from an appropriate health care provider (i.e., 

excludes pharmacies, shops, and traditional practitioners).5

 

Treatment of Children with Diarrhea Taken to a Health Provider 

Turning first to Table 3.10.1, for children with diarrhea in the past two weeks for 

whom treatment was sought at any time during that episode, the regional mean likelihood of use of an oral rehydration salts (ORS) packet ranges from 49 (North Africa/West Asia/Europe) to 68 (Central Asia) percent, but there is a fair amount of 

variability within regions. The countries with the lowest prevalence of ORS use are 

Jordan and Turkey, at about 30 percent, while four countries in South/East Africa 

have the highest prevalence of ORS use, over 80 percent: Malawi, Mozambique, 

Namibia, and Zambia. 

 

3

 The recently published joint statement also recommends that the health care provider supply 

the mother/caretaker with a 10 to 14 day supply of zinc supplements. 4

 In this report, the term oral rehydration solutions refers to a fluid made from oral rehydration 

salts or a government-recommended homemade fluid. We have chosen not to use the term

oral rehydration therapy in order to clearly distinguish the act of providing these solutions from 

that of increasing fluids. 

5

 It should be borne in mind that treatments reported for those children who were taken to a 

health care provider were not necessarily administered by or prescribed by the practitioner. 

The mother may have acted independently to initiate those treatments. 

The countries with the 

lowest prevalence of ORS 

use are Jordan and 

Turkey, at about 30 

percent, while four 

countries in South/East 

Africa have the highest 

prevalence of ORS use, 

over 80 percent: Malawi, 

Mozambique, Namibia, 

and Zambia. 
Diarrhea 47

Figure 3.9 

Percentage of children under age three years with diarrhea in the two weeks preceding the survey for 

whom advice or treatment was sought from an appropriate health care provider 

Note: the percentage for urban children in Vietnam is not shown because the denomination was too small. 
48 Diarrhea

Table 3.10.1 

Among children under age three years with diarrhea in the two weeks preceding the survey who were 

taken to a health provider, percentage receiving treatment by type of treatment, Demographic and 

Health Surveys 1996-2002 

Oral rehydration therapy 

 Diarrhea-specific 

feeding practices 

Nonrecommended 

treatments 

 Survey 

ORS 

packet 

Recommended 

home 

fluid 

(RHF) 

Either 

ORS or 

RHF 

Increased 

fluids 

ORS, 

RHF, or 

increased

fluids 

Continued

feeding 

Increased 

fluids and 

continued 

feeding 

Pills or 

syrups/ 

injections/ 

IV fluids 

Home 

remedies 

or herbal 

medicines 

No 

treatment 

Number 

of 

children 

West/Middle Africa Benin 2001 59.3 15.4 67.4 52.5 82.6 42.0 23.1 61.3 8.9 2.3 120 

Burkina Faso 1998-99 58.0 19.0 64.0 47.6 82.2 - - 2.2 7.6 15.6 159 

Cameroon 1998 52.5 30.8 64.9 61.6 84.7 38.5 24.6 66.8 17.2 0.7 121 

Chad 1996-97 63.9 17.7 70.1 69.4 87.6 33.0 20.0 76.0 29.0 2.1 208 

Côte d’Ivoire 1998-99 47.3 24.7 57.2 55.3 80.0 45.9 17.6 58.5 22.0 9.2 103 

Gabon 2000 47.4 26.8 61.3 70.4 85.3 53.8 37.5 53.6 2.6 4.0 164 

Ghana 1998 55.1 3.5 55.6 62.1 77.9 38.3 24.0 54.2 3.2 3.2 111 

Guinea 1999 65.7 17.1 69.9 59.1 86.8 40.5 20.4 79.5 13.8 0.7 290 

Mali 2001 43.2 35.4 60.6 57.6 80.7 39.4 23.3 64.6 20.3 1.4 277 

Mauritania 2000-01 53.2 22.7 61.3 19.2 68.4 59.7 19.2 1.4 15.2 26.7 177 

Niger 1998 61.5 34.0 72.0 62.7 89.6 40.3 25.1 48.4 9.8 2.7 291 

Nigeria 1999 60.0 58.9 81.5 61.6 90.5 45.2 31.2 75.2 6.0 2.6 183 

Senegal 1997 37.3 46.1 67.8 62.5 84.4 - - 24.8 8.0 9.4 262 

Togo 1998 43.0 21.1 52.4 69.1 81.1 43.1 31.9 68.9 24.8 0.6 212 

Median 54.2 23.7 64.5 61.6 83.5 41.3 23.7 59.9 11.8 2.7 

Mean 53.4 26.7 64.7 57.9 83.0 43.3 24.8 52.5 13.5 5.8 

South/East Africa Comoros 1996 60.0 4.0 60.0 84.0 86.7 25.3 17.3 58.7 20.0 4.0 75 

Eritrea 2002 76.0 34.2 79.9 42.7 83.5 23.8 12.5 36.5 1.5 9.8 255 

Ethiopia 2000 63.0 10.8 64.5 37.1 74.6 5.3 1.7 57.6 4.1 6.1 274 

Kenya 1998 61.1 63.8 83.6 52.4 91.9 48.7 28.0 66.9 7.6 0.9 243 

Madagascar 1997 46.3 1.1 46.6 78.0 82.8 24.0 19.3 69.5 5.9 2.4 378 

Malawi 2000 84.3 - 84.3 43.7 89.8 60.4 30.9 48.2 6.5 2.1 462 

Mozambique 1997 80.6 16.7 83.6 51.5 89.2 46.8 31.6 63.0 10.1 2.0 271 

Namibia 2000 87.4 - 87.4 20.9 90.3 39.9 9.4 28.6 13.1 6.5 196 

Rwanda 2000 55.8 24.1 64.0 30.0 70.2 42.9 9.3 53.1 9.6 6.7 141 

South Africa 1998 62.8 76.9 91.4 57.7 95.8 41.0 20.4 37.9 4.7 1.5 308 

Tanzania 1999 71.7 - 71.7 34.6 82.9 48.5 20.6 - - 17.1 195 

Uganda 2000-01 53.8 15.9 61.2 35.9 70.6 29.2 11.4 77.3 5.0 2.4 511 

Zambia 2001-02 82.8 - 82.8 49.9 87.7 43.1 19.6 25.9 9.5 7.2 453 

Zimbabwe 1999 - 84.9 84.9 57.2 90.9 29.9 21.8 51.8 2.8 4.6 114 

Median 63.0 20.4 81.4 46.8 87.2 40.5 19.5 53.1 6.5 4.3 Mean 68.1 33.2 74.7 48.3 84.8 36.3 18.1 51.9 7.7 5.2 

North Africa/West Asia/Europe Armenia 2000 (74.7) - (74.7) (73.6) (91.0) (36.8) (24.9) (27.6) (19.3) (8.1) 28 

Egypt 2000 48.3 5.1 49.9 17.8 55.9 24.4 4.1 49.9 7.4 16.5 312 

Jordan 2002 29.7 8.6 35.4 55.4 71.3 25.7 11.7 76.6 9.4 9.1 383 

Turkey 1998 28.8 17.2 41.2 64.8 78.4 26.6 15.4 69.2 0.5 9.0 295 

Yemen 1997 63.7 12.3 66.6 51.4 82.7 28.2 12.2 94.5 5.2 1.0 678 

Median 48.3 10.5 49.9 55.4 78.4 26.6 12.2 69.2 7.4 9.0 

Mean 49.0 10.8 53.6 52.6 75.9 28.3 13.7 63.6 8.4 8.7 

Central Asia Kazakhstan 1999 (54.7) - (54.7) (62.8) (74.5) (24.1) (14.7) (62.2) (7.9) (7.8) 42 

Kyrgyz Rep. 1997 73.7 17.6 78.0 77.2 95.0 16.2 8.4 73.2 9.8 1.9 72 

Turkmenistan 2000 (76.8) - (76.8) (67.3) (86.8) (33.0) (21.6) (93.8) (6.3) (0.0) 34 

Uzbekistan 1996 (63.6) (8.2) (63.6) (81.4) (93.5) (22.2) (14.1) (67.4) (20.2) (0.0) 23 

Median 68.6 12.9 70.2 72.2 90.2 19.2 14.4 70.3 8.8 1.0 

Mean 67.2 12.9 68.3 72.2 87.4 23.9 14.7 74.2 11.1 2.4 

South/Southeast Asia Bangladesh 1999-00 76.3 26.3 85.6 56.8 89.0 48.2 29.3 78.5 5.1 0.7 87 

Cambodia 2000 36.4 4.2 39.8 59.1 74.1 29.0 12.6 72.3 5.3 6.6 241 

India 1998-99 36.1 3.6 38.3 23.7 50.9 50.2 13.8 73.1 2.5 11.1 3,782 

Indonesia 1997 65.4 - 65.4 59.1 83.9 45.8 27.9 - - 16.1 662 

Nepal 2000 64.4 - 64.4 40.1 76.8 35.3 17.8 73.8 4.7 1.1 215 

Philippines 1998 70.8 15.3 73.0 66.7 91.4 50.6 29.4 43.9 11.9 2.3 188 

Vietnam 1997 52.8 21.1 62.3 54.4 78.5 47.3 16.6 52.2 14.5 9.6 90 

Median 64.4 15.3 64.4 56.8 78.5 47.3 17.8 72.7 5.2 6.6 

Mean 57.5 14.1 61.3 51.4 77.8 43.8 21.1 65.6 7.3 6.8 

Latin America/Caribbean Bolivia 1998 55.1 33.9 70.6 72.6 89.5 40.6 28.2 65.5 5.9 3.0 344 

Brazil 1996 62.9 14.8 67.4 67.1 87.2 38.5 17.6 24.6 11.9 6.7 154 

Colombia 2000 35.3 18.5 42.9 44.2 64.8 39.9 14.9 26.9 19.0 19.5 149 

Dominican Rep. 2002 52.8 8.8 57.8 41.0 75.3 40.2 17.4 42.6 13.3 12.3 431 

Guatemala 1998-99 62.3 8.4 64.0 41.3 77.6 36.0 10.1 81.6 1.8 1.2 162 

Haiti 2000 77.6 5.9 79.0 39.3 84.7 20.2 6.7 51.9 6.0 2.3 193 

Nicaragua 2001 72.4 14.4 76.0 41.0 82.7 39.9 19.0 55.6 6.2 6.1 297 

Peru 2000 38.8 29.6 55.0 58.3 80.3 26.7 14.4 35.8 19.1 11.0 540 

Median 58.7 14.6 65.7 42.8 81.5 39.2 16.2 47.3 9.1 6.4

Mean 57.2 16.8 64.1 50.6 80.3 35.3 16.0 48.1 10.4 7.8

Note: Figures in parentheses are based on 25-49 unweighted cases. A dash indicates that information was not collected about this treatment. 
Diarrhea 49

Table 3.10.2 

Among children under age three years with diarrhea in the two weeks preceding the survey who 

were not taken to a health provider, percentage receiving treatment by type of treatment, Demographic and Health Surveys 1996-2002 

Oral rehydration therapy 

 Feeding practices 

Nonrecommended 

treatments 

Survey 

ORS 

packet 

Recommended 

home 

fluid 

(RHF) 

Either 

ORS 

or 

RHF 

Increased 

fluids 

ORS, 

RHF,or 

increased 

fluids 

Continued 

feeding 

Increased 

fluids and 

continued 

feeding 

Pills or 

syrups/ 

injections/ 

IV fluids 

Home 

remedies 

or herbal 

medicines 

No 

treatment 

Number 

of 

children 

West/Middle Africa Benin 2001 13.0 11.6 22.5 32.6 45.9 45.1 14.5 19.7 26.8 28.7 349 

Burkina Faso 1998-99 4.6 4.0 7.3 34.1 38.1 - - 1.6 40.9 34.9 647 

Cameroon 1998 9.8 14.2 21.6 64.9 68.5 40.9 26.9 33.8 18.1 17.2 307 

Chad 1996-97 12.9 7.2 17.8 54.9 61.3 40.9 17.8 33.4 24.9 20.7 806 

Côte d’Ivoire 1998-99 10.9 7.3 15.4 53.3 57.4 47.2 24.7 20.0 30.7 23.8 216 

Gabon 2000 15.1 14.9 25.9 60.5 67.9 66.0 41.5 27.9 11.5 19.3 329 

Ghana 1998 21.2 3.0 23.4 53.7 62.5 39.6 19.9 46.7 15.7 11.8 280 

Guinea 1999 18.0 9.7 23.9 48.7 58.8 49.2 20.8 40.0 20.1 20.5 498 

Mali 2001 6.4 19.7 23.8 52.3 61.9 39.1 20.2 18.9 31.5 22.9 1,312 

Mauritania 2000-01 12.2 18.9 26.2 21.8 37.8 66.7 21.8 0.0 20.1 51.0 475 

Niger 1998 10.7 10.1 17.3 54.5 62.2 43.9 20.7 24.3 15.1 25.4 1,372 

Nigeria 1999 18.8 25.9 33.0 48.7 63.9 40.7 19.3 31.5 12.6 23.9 307 

Senegal 1997 3.7 12.6 14.7 48.1 54.3 - - 8.8 14.6 37.9 510 

Togo 1998 11.2 7.8 16.1 59.5 63.5 34.6 20.9 44.6 29.0 12.5 935 

Median 11.7 10.9 22.1 52.8 61.6 42.4 20.8 26.1 20.1 23.4 Mean 12.0 11.9 20.6 49.1 57.4 46.2 22.4 25.1 22.3 25.0 

South/East Africa Comoros 1996 15.4 4.7 18.9 67.5 72.2 39.6 25.4 6.5 24.9 20.7 169 

Eritrea 2002 22.0 19.7 34.6 34.2 52.8 26.6 12.3 8.2 1.8 44.0 303 

Ethiopia 2000 5.8 7.3 11.6 32.2 38.4 13.0 3.5 23.0 9.6 44.3 1,658 

Kenya 1998 17.8 50.7 56.9 56.0 74.2 55.2 31.3 19.2 12.4 17.8 306 

Madagascar 1997 8.0 0.8 8.3 52.3 54.6 35.1 16.6 32.1 14.4 25.6 579 

Malawi 2000 34.5 - 34.5 32.3 51.5 58.2 23.8 20.0 15.4 33.2 1,148 

Mozambique 1997 21.5 13.7 30.2 36.5 47.6 52.0 23.9 16.9 21.4 29.8 516 

Namibia 2000 32.8 - 32.8 9.4 39.6 56.7 5.3 5.1 8.8 51.3 186 

Rwanda 2000 7.7 6.8 12.7 15.7 24.8 49.6 7.8 7.9 30.4 47.2 829 

South Africa 1998 37.1 60.8 70.4 54.9 81.6 51.5 24.4 14.5 3.5 15.7 200 

Tanzania 1999 29.9 - 29.9 28.3 48.4 56.5 19.2 - - 51.6 120 

Uganda 2000-01 16.9 15.1 27.7 19.0 37.6 35.7 7.8 27.3 18.5 35.5 578 

Zambia 2001-02 31.9 - 31.9 35.1 51.8 47.4 15.2 8.7 21.6 33.2 565 

Zimbabwe 1999 - 60.5 60.5 48.1 73.8 47.3 20.0 5.7 3.4 23.0 258 

Median 21.5 14.4 31.1 34.7 51.7 48.5 17.9 14.5 14.4 33.2 Mean 21.6 24.0 32.9 37.3 53.5 44.6 16.9 15.0 14.3 33.8 

North Africa/West Asia/Europe Armenia 2000 25.3 - 25.3 37.7 43.5 44.5 15.5 23.8 7.4 37.8 59 

Egypt 2000 21.0 4.8 25.5 15.1 37.6 30.5 4.8 23.9 5.8 44.2 318 

Jordan 2002 4.6 2.3 6.6 52.2 55.6 43.9 20.5 16.9 5.5 35.4 320 

Turkey 1998 7.4 14.2 20.6 57.5 65.0 38.3 18.1 22.6 0.3 27.3 446 

Yemen 1997 21.2 6.1 24.4 45.0 57.7 30.3 10.7 27.7 2.7 33.5 1,665 

Median 21.0 5.5 24.4 45.0 55.6 38.3 15.5 23.8 5.5 35.4 Mean 15.9 6.8 20.5 41.5 51.9 37.5 13.9 23.0 4.3 35.6 

Central Asia Kazakhstan 1999 21.6 - 21.6 57.6 59.3 54.3 22.2 39.9 10.1 29.1 106 

Kyrgyz Rep. 1997 20.8 7.7 23.8 56.5 60.8 44.6 16.3 56.5 11.6 16.7 122 

Turkmenistan 2000 (36.4) - (36.4) (51.0) (66.2) (36.4) (14.8) (54.2) (1.1) (18.8) 45 

Uzbekistan 1996 (14.7) (8.7) (23.4) (74.9) (83.3) (32.1) (20.6) (40.3) (23.8) (9.1) 45 

Median 21.2 8.2 23.6 57.0 63.5 40.5 18.4 47.2 10.8 17.8 Mean 23.4 8.2 26.3 60.0 67.4 41.8 18.5 47.7 11.6 18.4 

South/Southeast Asia Bangladesh 1999-00 55.5 21.1 67.7 46.8 77.3 42.3 19.5 35.8 6.0 15.7 232 

Cambodia 2000 15.5 2.5 17.1 47.1 56.8 45.3 15.1 53.1 6.8 21.0 747 

India 1998-99 9.4 2.6 11.7 19.2 27.1 58.1 11.3 22.7 6.0 52.1 2,020 

Indonesia 1997 21.8 - 21.8 48.7 59.1 51.4 25.0 - - 40.9 564 

Nepal 2000 21.2 - 21.2 24.3 37.6 34.1 10.0 30.1 6.5 45.0 764 

Philippines 1998 20.6 2.7 21.8 49.5 56.7 48.8 24.4 18.5 15.0 30.9 246 

Vietnam 1997 26.4 21.0 39.2 54.2 65.7 44.9 23.2 19.9 18.6 21.8 88 

Median 21.2 2.7 21.8 47.1 56.8 45.3 19.5 26.4 6.7 30.9 

Mean 24.3 10.0 28.6 41.4 54.3 46.4 18.4 30.0 9.8 32.5 

Latin America/Caribbean Bolivia 1998 15.6 23.5 34.5 57.0 68.3 51.0 27.2 21.1 8.5 27.1 604 

Brazil 1996 34.7 17.7 47.3 49.9 67.3 49.5 20.6 10.2 11.0 26.2 290 

Colombia 2000 14.9 15.2 27.5 25.9 45.4 52.6 10.4 10.6 29.5 34.0 330 

Dominican Rep. 2002 15.7 5.5 18.8 30.7 43.2 54.1 13.1 17.0 17.0 39.6 732 

Guatemala 1998-99 16.4 3.0 19.3 38.4 49.7 39.9 16.0 57.0 7.1 22.8 290 

Haiti 2000 28.7 6.9 35.0 33.3 49.3 38.4 9.2 16.7 15.2 36.5 1,001 

Nicaragua 2001 33.3 10.0 37.9 34.3 53.1 43.5 16.4 37.6 9.0 24.9 337 

Peru 2000 11.0 15.1 22.3 47.9 57.8 36.9 13.5 8.8 32.6 27.8 800 

Median 16.1 12.6 31.0 36.4 51.4 46.5 14.8 16.9 13.1 27.5

Mean 21.3 12.1 30.3 39.7 54.3 45.7 15.8 22.4 16.2 29.9

Note: Figures in parentheses are based on 25-49 unweighted cases. A dash indicates that information was not collected about this treatment..
50 Diarrhea

The regional mean likelihood of use of recommended home fluids (RHF) ranges 

from 11 (North Africa/West Asia/Europe) to 33 (South/East Africa) percent, and is 

less than 30 percent in the majority of countries. RHF use is below 5 percent in 

Ghana, Comoros, Madagascar, Cambodia, and India.1

 RHF use exceeds 50 percent 

in only four countries: Nigeria, Kenya, South Africa, and Zimbabwe. 

With respect to increasing fluids in response to diarrhea, the regional mean likelihood ranges from 48 percent in South/East Africa to 72 percent in Central Asia. Increasing fluids is reported the least often by mothers in Mauritania, Namibia, Egypt, 

and India, all under 30 percent. Continuing to feed the child who has diarrhea is reported less often than increasing fluids, in nearly every country. The regional mean 

likelihood of continued feeding ranges from 24 to 44 percent and is markedly low in 

two countries, Ethiopia (5 percent) and Kyrgyz Republic (16 percent). 

The use of pills, syrups, injections, or intravenous (IV) fluids is 50 percent or more 

in a majority (36 of 50) of countries. Hence, the regional mean likelihoods of use are 

all relatively high, ranging from 48 percent in Latin America/Caribbean to 74 percent in Central Asia. The likelihood of use of these generally nonrecommended 

treatments for diarrhea among children taken to a health provider is less than 25 percent in just two countries, Burkina Faso (2 percent) and Mauritania (1 percent). 

Treatment of Children with Diarrhea Not Taken to a Health Provider 

Table 3.10.2 is based on children with diarrhea in the past two weeks for whom 

treatment was not sought at any time during that episode. The regional mean likelihood of use of an ORS packet ranges fairly narrowly, from 12 to 24 percent, with a 

considerable amount of variability within regions. In nine countries, less than 10 percent of children with a recent diarrheal episode who were not taken to a health provider received ORS: Burkina Faso, Mali, Senegal, Ethiopia, Madagascar, Rwanda, 

Jordan, Turkey, and India. The only country in which ORS packet use exceeds 50 

percent is Bangladesh. 

The regional mean likelihood of use of RHF ranges from 7 to 24 percent. There is 

high variability in RHF use within regions. RHF use exceeds 50 percent in just three 

countries: Kenya, South Africa, and Zimbabwe. 

With respect to increasing fluids in response to diarrhea, the regional mean likelihood ranges from 37 percent in South/East Africa to 60 percent in Central Asia. Increasing fluids is reported least often by mothers in Namibia, Rwanda, Uganda, 

Egypt, and India, all less than 20 percent. The regional mean likelihood of continued 

feeding ranges narrowly from 38 to 46 percent, and falls below 20 percent in just one 

country, Ethiopia. 

There is wide variability in the use of pills, syrups, injections, or IV fluids for children with recent diarrhea who were not taken to a health provider. In 10 of 50 countries, use is less than 10 percent, while in another 9 countries, use exceeds 40 percent. 

The regional mean likelihood of use of these nonrecommended treatments ranges 

from 15 percent in South/East Africa to 48 percent in Central Asia. 

 

1

 This information is not available from some surveys, as denoted by a single dash. 

The use of pills, syrups, 

injections, or 

intravenous (IV) fluids 

for treatment of 

diarrhea is 50 percent 

or more in a majority 

(36 of 50) of countries. 

The regional mean 

likelihood of use of an 

ORS packet to treat 

diarrhea ranges from 

12 to 24 percent. 
Diarrhea 51

Use of Oral Rehydration Solutions by Careseeking 

Treatment with oral rehydration solutions (ORS or RHF) differs consistently and 

substantially between children with diarrhea for whom advice or treatment was or 

was not sought from an appropriate provider. 

In each region, the average percentage of children who were given an oral rehydration solution is at least twice as large for those who were taken to an appropriate provider as for those who were not (Figure 3.10.1). The regional mean percentage of 

children with diarrhea who were taken to an appropriate provider and received, at any 

point in the diarrhea episode, an oral rehydration solution ranges from 54 percent in 

North Africa/West Asia/Europe to 75 percent in South/East Africa. The comparable 

statistics for children who were not taken to an appropriate provider are more similar, 

ranging from 20 to 33 percent. 

Figure 3.10.1 

Percentage of children under age three years with diarrhea in the two weeks 

preceding the survey who received oral rehydration solutions (ORS or RHF), by 

contact with health care provider and region 

Within each country, the difference in the percentage of children who received an 

oral rehydration solution among those children with diarrhea taken and not taken to 

an appropriate provider was calculated. All of these differentials are large and positive, ranging from 15 percentage points in Colombia to 57 in Burkina Faso. The regional mean differentials range from 33 to 44 percentage points. 

Increasing Fluids by Careseeking 

Overall, there is a strong positive association between careseeking and following 

the recommended practice of increasing fluids during a diarrhea episode. 

In each region, the 

average percentage 

of children who were 

given an oral 

rehydration solution 

is at least twice as 

large for those taken 

to an appropriate 

provider as for those 

who were not. 
52 Diarrhea

The regional average percentage of children with diarrhea who were given more 

fluids than usual at any time during the illness episode is again consistently higher 

among children who were taken to an appropriate provider, compared with children 

who were not taken (Figure 3.10.2). 

Figure 3.10.2 

Percentage of children under age three years with diarrhea in the two weeks 

preceding the survey who received increased fluids, by contact with health care 

provider and region 

For each country, the difference in the percentage of children who were given increased fluids among those children with diarrhea taken and not taken to an appropriate provider was computed. All but 3 of these differentials are positive, and more 

than half (29 of 52) are ten or more percentage points. Three differentials exceed 

positive 20 percentage points: Madagascar (26), Armenia (36), and Kyrgyz Republic 

(21). The regional mean differentials vary narrowly, from 9 to 12 percentage points. 

Continuing to Feed by Careseeking 

A consistent and strong negative association between careseeking and following 

the recommended practice of continuing to feed a child with diarrhea is observed. 

In this report, continuing to feed is defined as offering the same/about the 

same/more food than usual. Adherence to this treatment recommendation is very 

different from that of administering oral rehydration solutions or increasing fluids. 

As seen in Figure 3.10.3, in each region, the average percentage of children with 

diarrhea who continued to feed is about the same or lower among children who were 

taken to an appropriate provider compared with children who were not taken. The 

largest discrepancy is seen in Central Asia, where a regional mean of 24 percent of 

sick children who were taken to an appropriate provider continued to feed, compared 

with a regional mean of 42 percent of children who were not taken. 

There is a strong positive 

association between 

careseeking and 

following the 

recommended practice of 

increasing fluids during a 

diarrhea episode. 

There is a strong negative 

association between 

careseeking and 

following the 

recommended practice of 

continued feeding during 

a diarrhea episode. 
Diarrhea 53

Figure 3.10.3 

Percentage of children under age three years with diarrhea in the two weeks 

preceding the survey who received enough food, by contact with health care 

provider and region 

The difference in the percentage of children who continued to feed among those 

children with diarrhea who were taken and not taken to an appropriate provider was 

computed for each country. The majority of these differentials are negative, meaning 

that children with diarrhea for whom advice or treatment was sought from an appropriate health provider were less likely to be offered the same/about the same/more 

food than usual than their counterparts for whom care was not sought. In 17 of 50 

countries, the magnitude of the negative differentials exceeds ten percentage points 

Use of Nonrecommended Treatments by Careseeking 

As evidenced in Figure 3.10.4, children for whom advice or treatment was sought 

for diarrhea are consistently more likely than children for whom care was not sought 

to have been given pills, syrups, injections, or IV, none of which is recommended in 

the absence of blood in the stool, suspected cholera, or other signs and/or symptoms 

of certain severe disease, which typically comprise a small proportion of all diarrheal 

episodes. 
54 Diarrhea

Figure 3.10.4 

Percentage of children under age three years with diarrhea in the two weeks 

preceding the survey who received medication (pills, syrups, injections, or IV 

fluids), by contact with health care provider and region 

Among children with diarrhea for whom care was sought, the regional mean percentage who received, at any time during the illness, one of these nonrecommended 

treatments ranges from 48 percent in Latin America/Caribbean to 74 percent in 

Central Asia. In only two countries does this percentage fall below 25 percent: Burkina Faso, at just 2 percent, and Mauritania at 1 percent. 

In contrast, among children for whom care was not sought, the regional mean percentage of children who received one of these nonrecommended treatments ranges 

from 15 percent in South/East Africa to 48 percent in Central Asia. At the country 

level, this percentage falls below 10 in just ten countries, nine of which are in subSaharan Africa, and falls at or above 40 in nine countries, including the four countries included from Central Asia. 

For each country, the difference in the percentage of sick children who received 

any of these nonrecommended treatments between those taken and not taken to an 

appropriate provider was calculated. These differentials are all positive and are less 

than ten percentage points in only four countries (Burkina Faso, Ghana, Mauritania, 

and Armenia). The regional mean differentials are large, ranging from 26 to 41 percentage points. 

3.2.2 Diarrhea Treatment by Residence and Maternal Education 

While mother’s education can be used as a measure of individual productivity and 

hence contributes to the household’s economic status, it is also assumed that better 

educated women are more likely than less educated women to both understand and 

adopt practices for preventive and curative child health care as promoted through 

health education outreach programs or by health care providers that may at times be 

at odds with customary practices. 

Among children with 

diarrhea for whom care 

was sought, the regional 

mean percentage who 

received, at any time 

during the illness, one of 

the nonrecommended 

treatments ranges from 

48 percent in Latin 

America/Caribbean to 74 

percent in Central Asia. 
Diarrhea 55

Use of Oral Rehydration Solutions 

A largely consistent and strong positive association is observed between mother’s 

education and the administration of oral rehydration solutions to young children with 

diarrhea, in both urban and rural areas and in most countries and regions. 

In Table 3.11, the percentage of sick children who were given oral rehydration solutions is shown by residence and mother’s education (highest level completed). Data 

are sparse in some categories, particularly for rural children of mothers with secondary or higher education in West/Middle African countries, and both urban and rural 

children of mothers with less than secondary education in Central Asian countries. 

As shown in Figure 3.11.1, the regional average prevalence of use of oral rehydration solutions with urban sick children increases consistently with increasing maternal 

education in West/Middle Africa, South/East Africa, and South/Southeast Asia. 

This pattern of use is repeated in all regions, apart from Central Asia, with rural sick 

children, as seen in Figure 3.11.2. 

The difference between the percentage of sick children receiving oral rehydration 

solutions whose mothers have no formal education versus a secondary or higher education was computed, where possible, by urban and rural residence. The majority of 

these differentials, both urban and rural, are negative. 

In urban areas, sick children of mothers with no formal education are less likely 

than sick children of mothers with a secondary or higher education to receive oral 

rehydration solutions by more than 20 percentage points in five countries (Ghana, 

Nigeria, Rwanda, Uganda, and Cambodia). In only one country, Guatemala, is an 

equally large positive differential observed. In rural areas, a large negative differential 

of 20 or more percentage points is observed in nine countries (Cameroon, Nigeria, 

Rwanda, Zambia, Zimbabwe, Turkey, Cambodia, Nepal, and Haiti). 

A largely consistent and 

strong positive 

association is observed 

between mother’s 

education and the 

administration of oral 

rehydration solutions 

to young children with 

diarrhea, in both urban 

and rural areas and 

in most countries 

and regions. 
56 Diarrhea

Table 3.11 

Percentage of children under age three with diarrhea in the two weeks preceding the survey who received oral rehydration solutions (ORS or RHF), by residence and mother’s education, Demographic and 

Health Surveys 1996-2002 

 Urban Rural 

Highest level of education Highest level of education 

 Survey None Primary Secondary + Total 

Number 

of children None Primary Secondary + Total 

Number 

of children 

West/Middle Africa 

Benin 2001 33.6 (29.8) * 36.7 129 29.8 44.4 * 33.0 340 

Burkina Faso 1998-99 39.8 (42.2) (54.5) 43.3 84 14.4 (31.6) * 15.5 721 

Cameroon 1998 (31.7) (49.6) 50.8 44.1 106 13.9 47.2 (42.9) 30.4 323 

Chad 1996-97 38.2 44.8 54.0 42.5 228 18.9 41.4 * 24.5 786 

Côte d’Ivoire 1998-99 33.6 (47.9) (43.5) 40.2 85 21.9 (31.0) * 24.8 234 

Gabon 2000 * 40.6 34.9 37.2 381 * 38.0 (42.1) 39.4 112 

Ghana 1998 (27.0) * (51.4) 38.9 90 30.0 25.4 36.1 30.6 302 

Guinea 1999 52.0 (39.1) (54.3) 49.3 179 37.1 (51.6) * 38.4 609 

Mali 2001 49.2 72.9 61.1 55.3 288 24.8 19.8 * 24.6 1,301 

Mauritania 2000-01 35.6 48.9 29.5 39.1 320 31.8 (33.6) * 32.6 333 

Niger 1998 52.5 49.2 (46.7) 51.2 231 22.3 29.9 * 22.9 1,432 

Nigeria 1999 38.8 (74.0) (76.5) 60.8 124 36.6 56.5 77.6 47.8 366 

Senegal 1997 29.1 35.6 (29.4) 31.5 242 31.1 46.9 * 33.3 529 

Togo 1998 30.2 33.4 (40.2) 33.5 234 18.5 22.3 (33.0) 20.0 914 

Median 35.6 44.8 50.8 41.4 24.8 35.8 42.1 30.5 

Mean 37.8 46.8 48.2 43.1 25.5 37.1 46.3 29.8 

South/East Africa 

Comoros 1996 (34.9) * * 35.7 70 26.8 (33.3) * 29.9 174 

Eritrea 2002 (59.3) 75.2 (72.2) 69.6 162 47.4 56.8 * 49.4 396 

Ethiopia 2000 58.5 (63.3) 61.4 60.6 150 14.0 22.3 * 15.6 1,782 

Kenya 1998 * 86.5 * 81.9 103 66.7 66.2 62.5 65.7 446 

Madagascar 1997 * 31.9 54.7 42.3 212 14.5 16.6 28.3 18.0 746 

Malawi 2000 (36.6) 52.5 (51.6) 50.0 171 44.3 50.2 (62.6) 48.6 1,439 

Mozambique 1997 (73.8) 64.1 * 66.8 247 31.4 48.0 * 40.3 540 

Namibia 2000 * (67.5) 64.2 65.5 138 65.7 44.5 70.0 58.2 244 

Rwanda 2000 (7.6) 35.0 (31.8) 29.0 117 16.2 18.7 (39.5) 19.0 853 

South Africa 1998 * (87.4) 80.7 82.2 207 93.0 79.4 84.6 83.8 301 

Tanzania 1999 * (55.7) * 55.7 49 63.6 53.6 * 55.7 266 

Uganda 2000-01 (34.4) 47.4 65.5 52.6 104 44.6 41.5 (43.1) 42.5 985 

Zambia 2001-02 * 54.4 64.6 58.6 315 38.3 55.0 67.2 52.8 702 

Zimbabwe 1999 * (65.5) (70.8) 68.0 111 55.4 65.2 75.3 67.9 261 

Median 36.6 63.3 64.4 59.6 44.5 49.1 62.6 49.0 

Mean 43.6 60.5 61.8 58.5 44.4 46.5 59.2 46.2 

North Africa/West Asia/Europe 

Armenia 2000 * * (41.6) (41.6) 38 * * 42.5 41.0 50 

Egypt 2000 (29.3) (32.7) 24.7 27.0 208 42.8 47.6 40.8 42.8 422 

Jordan 2002 * (12.1) 22.3 22.2 529 * (26.0) 20.9 22.6 174 

Turkey 1998 26.9 34.6 34.9 33.0 414 17.9 23.9 (37.9) 23.4 327 

Yemen 1997 45.7 41.8 43.5 44.5 486 33.3 43.1 (43.5) 34.6 1,858 

Median 29.3 33.6 34.9 33.0 33.3 34.6 40.8 34.6 Mean 34.0 30.3 33.4 33.7 31.3 35.2 37.1 32.9 

Central Asia 

Kazakhstan 1999 * * 41.6 41.6 65 * * 21.3 22.6 82 

Kyrgyz Rep. 1997 * * (32.1) (32.1) 38 * * 46.8 46.8 156 

Turkmenistan 2000 * * (55.5) (56.0) 50 * * (49.0) (50.1) 29 

Uzbekistan 1996 * * (43.3) (43.3) 35 * * (30.5) (30.5) 33 

Median u u 42.4 42.4 u u 38.6 38.6 

Mean u u 43.1 43.3 u u 36.9 37.5 

South/Southeast Asia 

Bangladesh 1999-00 (89.6) (72.6) (79.6) 79.7 61 69.5 69.4 (76.1) 70.8 258 

Cambodia 2000 (25.4) 23.8 (53.8) 33.9 110 11.9 23.2 41.0 21.2 878 

India 1998-99 28.4 34.7 42.1 36.3 1,338 24.0 27.9 34.7 26.8 4,464 

Indonesia 1997 * 44.4 43.9 42.8 315 50.1 45.3 48.2 46.2 911 

Nepal 2000 (35.6) * (37.3) 37.7 53 27.0 37.0 50.2 30.3 926 

Philippines 1998 * (38.7) 48.8 46.7 178 * 36.4 47.9 42.0 255 

Vietnam 1997 * * * * 15 * (35.7) 56.5 48.2 163 

Median 32.0 38.7 46.4 40.3 27.0 36.4 48.2 42.0 Mean 44.8 42.8 50.9 46.2 36.5 39.3 50.7 40.8 

Latin America/Caribbean 

Bolivia 1998 * 55.2 53.4 54.1 512 40.8 38.7 43.9 39.9 437 

Brazil 1996 (51.4) 57.1 53.2 54.5 326 (38.9) 53.2 * 53.7 118 

Colombia 2000 * 38.2 30.8 33.7 314 * 26.5 (34.4) 29.6 165 

Dominican Rep. 2002 (34.1) 34.4 24.3 30.1 736 43.5 40.4 32.7 38.7 427 

Guatemala 1998-99 (72.0) 35.8 (45.2) 44.4 163 33.2 29.0 * 30.1 289 

Haiti 2000 52.1 52.3 52.7 52.4 371 34.5 37.3 (64.2) 37.5 823 

Nicaragua 2001 (56.0) 51.4 61.6 56.5 269 53.7 56.1 (55.6) 55.2 364 

Peru 2000 * 37.4 38.0 38.0 653 36.2 34.6 26.9 33.1 687 

Median 52.1 44.8 49.0 48.4 38.9 38.0 39.2 38.1 

Mean 53.1 45.2 44.9 45.5 40.1 39.5 43.0 39.7 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases 

and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
Diarrhea 57

Figure 3.11.1 

Percentage of urban children under age three years with diarrhea in the two 

weeks preceding the survey who received oral rehydration solutions (ORS or 

RHF), by mother’s education and region 

u = Unknown (insufficient data) 

Figure 3.11.2 

Percentage of rural children under age three years with diarrhea in the two 

weeks preceding the survey who received oral rehydration solutions (ORS or 

RHF), by mother’s education and region 

u = Unknown (insufficient data) 
58 Diarrhea

Increasing Fluids and Continuing to Feed 

Overall, these data support a positive association between maternal education and 

the recommended practice of increasing fluids and continuing to feed a child who has 

diarrhea in both urban and rural areas in most countries and regions. 

Table 3.12 shows the percentage of sick children who were given both increased 

fluids and the same/about the same/more food than usual by residence and categories 

of mother’s highest completed level of education. Data are again sparse in some categories, particularly for rural children of mothers with secondary or higher education 

in sub-Saharan African countries, and both urban and rural children of mothers with 

less than secondary education in Central Asian countries. 

On the basis of available data for urban children, excluding entirely the Central 

Asia region, the regional average percentage of sick children who were given both 

more fluids and the same amount or more of food increases consistently with increasing level of mother’s education in West/Middle Africa, South/Southeast Asia, and 

Latin America/Caribbean, as seen in Figure 3.12.1. On the basis of the available data 

for rural children, again excluding Central Asia, this same pattern is shown consistently in each of the remaining five regions (Figure 3.12.2). 

The difference between the percentage of children offered both more fluids and 

the same amount or more food whose mothers have no formal education versus a 

secondary or higher education was computed, where possible, by urban and rural residence. In urban areas, sick children of mothers with no formal education are less 

likely than sick children of mothers with a secondary or higher education to be offered both more fluids and the same amount or more food by more than 20 percentage points in four countries (Chad, Côte d’Ivoire, Togo, and Haiti). A positive differential of equally large magnitude is observed in only one country, Rwanda (23 

percentage points). In rural areas, a large negative differential exceeding 20 percentage points is observed in four countries (Cameroon, Malawi, Zimbabwe, and the 

Dominican Republic). 

The data support a positive 

association between 

maternal education and the 

recommended practice of 

increasing fluids and 

continuing to feed a child 

who has diarrhea. 
Diarrhea 59

Table 3.12 

Percentage of children under age three with diarrhea in the two weeks preceding the survey who 

received both increased fluids and continued feeding, by residence and mother's education, Demographic and Health Surveys 1996-2002 

 Urban Rural 

Highest level of education Highest level of education 

Survey None Primary Secondary+ Total 

Number 

of 

children None Primary Secondary+ Total 

Number

of 

children

West/Middle Africa Benin 2001 19.4 (15.3) * 17.5 129 16.4 16.1 * 16.5 340 

Cameroon 1998 (25.8) (35.7) 33.2 31.5 106 16.4 28.1 (40.5) 24.5 323 

Chad 1996-97 19.7 35.6 42.4 28.1 228 15.1 16.5 * 15.4 786 

Côte d’Ivoire 1998-99 21.7 (30.3) (42.6) 28.6 85 14.6 (37.9) * 20.2 234 

Gabon 2000 * 46.1 40.0 43.2 381 * 30.3 (23.1) 29.7 112 

Ghana 1998 (14.2) * (30.8) 27.9 90 19.4 16.6 20.6 19.0 302 

Guinea 1999 23.7 (30.6) (31.7) 26.6 179 18.3 (28.9) * 18.9 609 

Mali 2001 25.9 23.5 24.4 25.2 288 18.9 25.0 * 19.7 1,301 

Mauritania 2000-01 21.2 29.6 22.7 24.4 320 18.1 (22.3) * 18.0 333 

Niger 1998 33.1 29.0 (35.1) 32.5 231 20.0 14.8 * 19.7 1,432 

Nigeria 1999 24.0 (23.5) (31.3) 26.6 124 24.3 18.2 23.1 22.8 366 

Togo 1998 18.8 25.2 (40.7) 25.8 234 22.4 20.2 (35.0) 22.2 914 

Median 21.7 29.6 33.2 27.3 18.3 21.2 23.1 19.7 

Mean 22.5 29.5 34.1 28.2 18.5 22.9 28.5 20.5 

South/East Africa Comoros 1996 (20.9) * * 20.0 70 23.6 (30.6) * 24.1 174 

Eritrea 2002 (13.1) 13.5 (22.1) 16.2 162 10.7 11.0 * 10.8 396 

Ethiopia 2000 5.4 (1.0) 0.0 2.6 150 3.3 2.6 * 3.2 1,782 

Kenya 1998 * 38.7 * 37.0 103 25.6 28.2 30.5 28.2 446 

Madagascar 1997 * 15.2 33.2 23.0 212 19.5 13.4 20.8 16.1 746 

Malawi 2000 (20.7) 22.2 (20.6) 21.6 171 21.3 27.6 (51.8) 26.3 1,439 

Mozambique 1997 (49.1) 28.5 * 29.9 247 19.7 29.3 * 25.0 540 

Namibia 2000 * (15.1) 8.6 11.3 138 3.3 4.5 7.3 5.1 244 

Rwanda 2000 (31.2) 8.4 (8.1) 12.7 117 5.5 8.8 (3.0) 7.3 853 

South Africa 1998 * (35.4) 23.2 26.5 207 28.1 18.0 17.3 18.9 301 

Tanzania 1999 * (21.0) * 21.9 49 3.9 24.0 * 19.7 266 

Uganda 2000-01 (7.9) 7.4 12.3 9.2 104 8.6 9.2 (16.3) 9.5 985 

Zambia 2001-02 * 18.0 26.1 21.1 315 14.2 14.9 21.1 15.4 702 

Zimbabwe 1999 * (25.2) (19.7) 21.4 111 6.8 17.6 27.7 20.1 261 

Median 20.7 18.0 20.2 21.3 12.5 14.9 20.8 17.5 

Mean 21.2 19.2 17.4 19.6 13.9 17.1 21.8 16.4 

North Africa/West Asia/Europe Armenia 2000 * * (16.8) (16.8) 38 * * 20.6 19.9 50 

Egypt 2000 (6.8) (3.8) 6.4 6.1 208 3.3 5.3 3.3 3.6 422 

Jordan 2002 * (26.4) 15.8 16.5 529 * (5.9) 14.6 13.3 174 

Turkey 1998 15.1 16.4 17.3 16.3 414 15.7 19.7 (10.9) 17.9 327 

Yemen 1997 14.1 21.4 19.5 16.6 486 9.2 11.8 (19.0) 9.7 1,858 

Median 14.1 18.9 16.8 16.5 9.2 8.8 14.6 13.3 

Mean 12.0 17.0 15.2 14.5 9.4 10.7 13.7 12.9 

Central Asia Kazakhstan 1999 * * 24.7 24.7 65 * * 16.7 16.4 82 

Kyrgyz Rep. 1997 * * (23.8) (23.8) 38 * * 10.8 10.8 156 

Turkmenistan 2000 * * (19.6) (20.6) 50 * * (13.1) (12.9) 29 

Uzbekistan 1996 * * (15.2) (15.2) 35 * * (21.8) (21.8) 33 

Median u u 21.7 22.2 u u 14.9 14.6 

Mean u u 20.8 21.1 u u 15.6 15.5 

South/Southeast Asia Bangladesh 1999-00 (25.1) (32.1) (34.8) 31.2 61 15.0 20.8 (32.0) 20.0 258 

Cambodia 2000 (10.3) 15.2 (29.1) 18.3 110 16.9 13.0 10.1 14.0 878 

India 1998-99 11.7 9.4 19.7 15.2 1,338 11.1 11.4 16.7 12.3 4,464 

Indonesia 1997 * 21.4 37.2 29.8 315 21.2 22.4 38.0 25.5 911 

Nepal 2000 8.5 * (16.9) 13.6 53 8.9 18.8 25.1 11.6 926 

Philippines 1998 * (35.1) 27.6 29.0 178 * 21.8 28.0 24.9 255 

Vietnam 1997 * * * * 15 * 11.9 26.5 20.2 163 

Median 11.0 21.4 28.4 23.7 15.0 18.8 26.5 20.0 

Mean 13.9 22.6 27.5 22.9 14.6 17.2 25.2 18.4 

Latin America/Caribbean Bolivia 1998 * 28.6 30.6 30.5 512 23.4 23.8 26.5 24.2 437 

Brazil 1996 (25.6) 23.3 20.5 21.9 326 (14.2) 9.1 * 12.9 118 

Colombia 2000 * 7.7 17.1 13.2 314 * 9.7 (11.5) 9.2 165 

Dominican Rep. 2002 (5.7) 12.2 18.5 14.7 736 2.6 10.1 29.7 14.6 427 

Guatemala 1998-99 (11.7) 25.5 (7.4) 17.3 163 7.6 13.2 * 12.0 289 

Haiti 2000 2.9 6.3 23.6 10.6 371 3.1 13.2 (1.7) 8.0 823 

Nicaragua 2001 (22.9) 12.9 28.3 20.9 269 13.3 15.7 (18.8) 15.2 364 

Peru 2000 * 10.4 15.2 14.0 653 10.5 14.0 15.0 13.8 687 

Median 11.7 12.6 19.5 16.0 10.5 13.2 16.9 13.4 

Mean 13.8 15.9 20.1 17.9 10.7 13.6 17.2 13.7 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted 

cases and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
60 Diarrhea

Figure 3.12.1 

Percentage of urban children under age three years with diarrhea in the two 

weeks preceding the survey who received increased fluids and continued feeding, by mother’s education and region 

u = Unknown (insufficient data) 

Figure 3.12.2 

Percentage of rural children under age three years with diarrhea in the two 

weeks preceding the survey who received increased fluids and continued feeding, by mother’s education and region 

u = Unknown (insufficient data) 
Diarrhea 61

3.2.3 Diarrhea Treatment by Demographic Characteristics 

3.2.3.1 Use of Oral Rehydration Solutions 

Table 3.13 shows the percentage of children with diarrhea in the past two weeks 

who received oral rehydration solutions by child’s sex, age in months, birth order, and 

mother’s age. 

Child’s Sex 

The regional average prevalence of use of oral rehydration solutions does not differ 

substantially by child’s sex except in Central Asia. Intracountry differentials in the use 

of oral rehydration solutions for male versus female children with diarrhea are relatively small, with the exception of three countries. In Turkmenistan and Uzbekistan, 

males are more likely to receive the solutions by 10 and 17 percentage points, respectively, but the denominators are small for those estimates. In Haiti, females are more 

likely to receive the solutions by 10 percentage points. 

Child’s Age 

In Table 3.13, child’s age in months is grouped into four categories: 0-5, 6-11, 12-

23, and 24-35. With few exceptions, oral rehydration solutions are substantially less 

likely to be administered to infants age 0-5 months than older children. 

In Central Asian countries, the data available for children with diarrhea by age categories are too sparse to compute acceptable regional prevalence estimates of use of 

oral rehydration solutions. Elsewhere, a consistent pattern emerges in which the prevalence of use of these solutions is lower at age 0-5 months than at older ages (Figure 

3.13). In each region other than South/East Africa, the prevalence of use of these 

solutions declines in the third year of life. 

Intracountry differentials in the use of oral rehydration solutions for sick children 

age 0-5 months versus those age 24-35 months are all negative with four exceptions. 

Three of the four positive differentials exceed 10 percentage points: Gabon (24), 

South Africa (12), and Haiti (12). Elsewhere, sick children age 0-5 months are less 

likely than sick children age 24-35 months to receive oral rehydration solutions by 

more than ten percentage points in 25 countries. The greatest differences are found 

in Eritrea, Bangladesh, and Indonesia. 

The regional average 

prevalence of use of oral 

rehydration solutions does not 

differ substantially by child’s 

sex except in Central Asia. 

With few exceptions, oral 

rehydration solutions are 

substantially less likely to be 

administered to infants age 0-

5 months than older children. 
62 Diarrhea

Table 3.13 

Percentage of children under age three with diarrhea in the two weeks preceding the survey who received oral rehydration solutions (ORS or RHF), by child's sex, age, birth order, and mother’s age, 

Demographic and Health Surveys 1996-2002 

Child’s sex Child’s age in months Birth order Mother’s age 

Survey Male Female 0-5 6-11 12-23 24-35 1 2-3 4-5 6+ <20 20-34 35+ Total

Number

of 

children

West/Middle Africa Benin 2001 34.2 33.8 (8.0) 38.5 36.4 33.8 39.2 32.9 25.7 38.1 (26.8) 33.6 37.9 34.0 469 

Burkina Faso 1998-99 19.2 17.7 15.5 19.9 19.6 17.0 21.8 19.0 20.5 14.6 18.0 19.3 15.9 18.5 806 

Cameroon 1998 37.4 30.0 (21.6) 37.1 39.7 25.3 34.2 34.3 26.8 38.4 26.2 35.2 35.6 33.8 428 

Chad 1996-97 29.0 28.0 17.0 25.9 33.1 30.3 29.6 26.3 25.3 33.2 23.9 27.9 34.3 28.5 1,014 

Côte d’Ivoire 1998-99 30.1 27.8 * 28.4 34.5 20.3 27.3 35.3 35.4 15.3 (17.7) 34.6 (14.6) 28.9 319 

Gabon 2000 39.2 36.2 (53.1) 38.6 38.6 28.7 35.6 39.9 43.8 30.2 33.0 39.9 33.6 37.7 493 

Ghana 1998 33.3 31.5 (23.8) 31.2 38.5 26.7 30.1 38.6 33.2 27.0 * 33.0 28.4 32.5 391 

Guinea 1999 42.0 39.7 22.9 47.8 43.9 41.0 45.9 36.2 42.1 41.3 41.1 41.2 39.5 40.9 788 

Mali 2001 30.4 29.9 27.1 33.6 30.7 28.1 32.9 30.4 31.1 28.0 31.2 30.6 28.5 30.2 1,589 

Mauritania 2000-01 37.3 34.2 26.6 28.5 37.9 45.2 36.6 39.2 35.0 32.0 (35.8) 37.5 30.7 35.8 653 

Niger 1998 26.0 27.8 14.0 29.2 30.9 27.1 22.3 24.6 27.5 30.1 20.4 27.7 28.2 26.8 1,663 

Nigeria 1999 47.7 54.6 (37.8) 57.5 51.5 50.3 53.4 52.7 44.9 54.0 (36.5) 52.5 52.9 51.1 490 

Senegal 1997 33.6 31.9 23.1 33.8 30.5 42.1 23.4 32.1 38.1 34.8 18.0 34.0 34.9 32.7 771 

Togo 1998 21.1 24.4 10.5 26.9 23.3 23.8 20.2 25.7 22.5 21.3 21.6 24.0 19.3 22.8 1,147 

Median 33.5 30.8 22.9 32.4 35.5 28.4 31.5 33.6 32.2 31.1 25.0 33.8 32.2 32.6 

Mean 32.9 32.0 23.2 34.1 34.9 31.4 32.3 33.4 32.3 31.3 26.9 33.6 31.0 32.4 

South/East Africa Comoros 1996 33.3 29.8 (14.0) 31.0 43.2 (28.6) (33.3) 33.8 41.5 21.8 * 31.2 29.4 31.6 244 

Eritrea 2002 55.2 55.3 (24.0) 49.0 63.6 57.9 56.1 61.1 43.3 56.2 (68.2) 54.9 53.0 55.3 558 

Ethiopia 2000 18.3 19.9 17.7 20.6 18.2 19.6 24.6 19.5 18.6 15.7 30.7 18.6 16.8 19.1 1,932 

Kenya 1998 69.4 68.0 56.3 63.2 71.8 74.8 65.9 65.9 74.2 71.9 49.9 69.5 75.5 68.7 549 

Madagascar 1997 23.5 23.3 9.6 22.5 25.2 26.8 25.9 24.9 16.9 25.0 15.5 22.7 32.7 23.4 957 

Malawi 2000 48.3 49.2 35.1 50.6 52.5 44.9 52.3 49.6 52.2 40.8 46.3 50.8 41.1 48.8 1610 

Mozambique 1997 44.6 53.3 34.3 59.8 47.9 47.4 39.9 50.9 54.9 44.2 40.3 51.5 43.7 48.6 787 

Namibia 2000 62.3 59.4 (53.0) 49.8 66.4 65.3 60.0 60.5 70.3 48.3 (60.5) 60.5 62.2 60.9 382 

Rwanda 2000 17.7 22.8 4.2 23.4 22.9 19.1 23.8 18.6 22.1 17.7 (15.0) 20.5 19.9 20.2 970 

South Africa 1998 85.5 80.7 86.5 85.5 85.0 74.9 84.4 82.4 81.7 84.1 88.1 82.3 83.4 83.1 508 

Tanzania 1999 55.9 55.5 (57.8) 63.8 49.5 54.6 50.3 49.3 62.8 63.5 (37.2) 53.2 72.0 55.7 315 

Uganda 2000-01 46.1 40.4 23.0 44.8 48.5 43.2 35.2 47.1 42.7 44.3 30.9 45.7 40.8 43.4 1,088 

Zambia 2001-02 55.2 54.0 48.1 50.3 57.7 54.4 52.8 58.4 52.4 52.7 50.2 57.4 44.7 54.6 1,018 

Zimbabwe 1999 64.9 71.2 * 62.0 73.0 71.7 60.7 70.8 76.7 64.8 (55.5) 68.2 75.0 67.9 372 

Median 51.8 53.7 29.2 50.1 51.0 50.9 51.3 50.3 52.3 46.3 46.3 52.4 44.2 51.7 Mean 48.6 48.8 35.7 48.3 51.8 48.8 47.5 49.5 50.7 46.5 45.3 49.1 49.3 48.7 

North Africa/West Asia/ 

Europe Armenia 2000 38.7 (45.5) * * (37.8) * (36.3) (44.9) * * * 44.3 * 41.3 88 

Egypt 2000 38.3 36.8 31.9 41.5 39.5 34.2 35.6 39.1 39.4 34.8 (32.2) 38.4 36.6 37.6 630 

Jordan 2002 23.9 20.7 19.9 17.9 26.8 20.4 19.4 26.0 15.7 27.7 (34.3) 21.4 23.7 22.3 703 

Turkey 1998 26.6 31.5 23.8 26.3 34.0 25.0 28.8 30.5 29.2 19.9 26.4 30.0 20.6 28.8 740 

Yemen 1997 37.9 35.3 27.3 43.5 39.9 32.1 39.2 35.0 37.5 36.3 36.8 36.7 36.3 36.6 2,344 

Median 37.9 35.3 25.6 33.9 37.8 28.6 35.6 33.4 31.3 33.2 36.7 30.0 36.6 Mean 33.1 34.0 25.7 32.3 35.6 27.9 31.9 35.1 30.5 29.7 32.4 34.2 29.3 33.3 

Central Asia Kazakhstan 1999 33.7 29.0 * (37.2) 28.4 (33.0) 34.6 31.1 * * * 30.1 * 31.0 148 

Kyrgyz Rep. 1997 44.1 43.6 * (63.3) 38.8 (38.5) 37.0 46.2 (54.7) * * 43.5 (48.2) 43.9 194 

Turkmenistan 2000 (58.5) (48.8) * * (50.9) * (37.3) (65.1) * * * 54.1 * 53.9 79 

Uzbekistan 1996 (46.4) (29.1) * * (31.7) * (32.0) (33.3) * * * 35.3 * 37.1 69 

Median 45.2 36.4 u 50.2 35.2 35.8 35.8 39.8 u u u 39.4 u 40.5 Mean 45.7 37.6 u 50.2 37.5 35.8 35.2 43.9 u u u 40.8 u 41.5 

South/Southeast Asia Bangladesh 1999-00 69.8 75.6 (30.4) 69.0 75.8 84.0 72.3 74.0 66.7 (77.3) 78.3 71.1 (71.0) 72.5 319 

Cambodia 2000 21.4 24.0 12.0 19.8 25.8 26.1 23.3 24.7 20.7 20.9 (25.0) 22.6 22.4 22.6 988 

India 1998-99 29.2 28.9 16.0 28.1 33.9 30.4 30.9 30.6 25.5 23.9 25.1 30.1 24.4 29.0 5,802 

Indonesia 1997 44.6 46.3 10.7 48.3 49.6 48.9 49.0 45.1 43.0 38.6 41.8 47.3 39.0 45.4 1,226 

Nepal 2000 32.7 28.7 11.2 23.8 39.2 32.9 35.3 32.8 26.4 24.9 31.1 30.4 32.0 30.7 979 

Philippines 1998 41.8 46.3 (23.9) 49.6 47.9 38.5 42.4 50.1 36.5 41.1 * 44.8 42.7 43.9 434 

Vietnam 1997 54.6 45.3 * 43.8 54.8 (58.1) 55.3 48.0 * * * 52.1 * 50.8 178 

Median 41.8 45.3 14.0 43.8 47.9 38.5 42.4 45.1 31.5 31.8 31.1 44.8 35.5 43.9 Mean 42.0 42.2 17.4 40.3 46.7 45.6 44.1 43.6 36.5 37.8 40.3 42.6 38.6 42.1 

Latin America/Caribbean Bolivia 1998 49.6 45.5 26.3 45.7 53.1 47.1 48.1 45.9 51.5 45.8 43.0 47.9 48.3 47.6 948 

Brazil 1996 50.8 57.7 49.5 62.8 53.0 50.7 56.6 53.6 49.1 57.1 65.2 53.7 41.1 54.3 444 

Colombia 2000 33.1 31.2 14.9 29.5 36.2 35.3 28.1 31.2 44.9 (33.0) 28.1 31.7 40.3 32.3 479 

Dominican Rep. 2002 35.6 30.5 27.8 31.2 37.1 30.4 29.1 34.0 41.6 34.6 36.7 32.6 28.7 33.2 1,163 

Guatemala 1998-99 35.1 35.5 25.7 42.6 35.9 31.0 40.4 36.7 29.4 33.9 35.6 35.6 33.4 35.3 452 

Haiti 2000 37.2 47.6 39.4 45.3 48.5 27.9 44.9 37.6 47.7 40.5 55.3 40.9 38.7 42.1 1,194 

Nicaragua 2001 59.0 52.1 41.3 63.2 56.7 55.2 58.4 54.3 55.4 54.7 54.6 56.7 52.5 55.7 633 

Peru 2000 35.6 35.3 13.6 27.8 41.9 37.3 33.1 34.4 41.3 35.8 29.4 37.2 32.4 35.5 1,340 

Median 36.4 40.5 27.1 44.0 45.2 36.3 42.7 37.2 46.3 38.2 39.9 39.1 39.5 38.8 

Mean 42.0 41.9 29.8 43.5 45.3 39.4 42.3 41.0 45.1 41.9 43.5 42.0 39.4 42.0 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases 

and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
Diarrhea 63

Figure 3.13 

Percentage of children under age three years with diarrhea in the two weeks 

preceding the survey who received oral rehydration solutions, by age in months 

and region 

Birth Order 

The regional average prevalence of use of oral rehydration solutions does not vary 

consistently with increasing birth order. Data is sparse in Central Asian countries for 

children with diarrhea who are of higher birth orders. Intracountry differentials in the 

prevalence of use of these solutions for sick children of birth order one versus birth 

order six and higher were computed where possible. The majority of these differentials are relatively small. 

Mother’s Age 

For countries in Central Asia, there are insufficient data available for sick children 

whose mothers are either under 20 or over 34 years of age. Elsewhere, the regional 

average prevalence of use of oral rehydration solutions is higher among mothers age 

20-34, except in Latin America/Caribbean, where regional averages are similar across 

age groups. However, a closer examination of the percentages across age groups within countries reveals a lot of inconsistency. 

3.2.3.2 Increasing Fluids and Continuing to Feed 

In Table 3.14, the percentage of children under three years of age who had diarrhea in the past two weeks and were given both more fluids than usual and the same 

amount or more food is tabulated by categories of child’s sex, age in months, and 

birth order, and by mother’s age. Differentials based on these percentages were computed for each country between males and females, children ages 6-11 months and 

24-35 months, children of birth order one and birth order six or more, and children 

born to mothers under 20 and 35 or more years of age. 
64 Diarrhea

Child’s Sex 

The regional average prevalence of following the recommendation to increase fluids and continue feeding does not differ substantially between male and female children with diarrhea. The differential between sexes reaches ten percentage points in 

only two countries. In Mauritania, the recommendation is followed for 26 percent of 

males and 16 percent of females with diarrhea, while in Guatemala, 9 percent of 

males and 19 percent of females are treated in this manner. 

Child’s Age 

Similar to the findings regarding the use of oral rehydration solutions by child’s 

age, the interpretation of treatment estimates for those age 0-5 months is problematic 

because of the ambiguity of asking the mother of an infant who is primarily breast- or 

bottlefed questions about increasing fluids and continuing to feed. An examination of 

Table 3.14 shows that, aside from this youngest age group, there is no consistent pattern of treatment by increasing age in the regional average prevalence of this combined recommended practice. In four countries (Ghana, Madagascar, Kyrgyz Republic, and Bolivia), children age 24-35 months are more likely by more than ten 

percentage points than children age 6-11 months to be offered more fluids and the 

same amount or more food during the diarrhea episode, while an equally large difference in the opposite direction is seen in only one country, Kazakhstan. 

Birth Order 

Likewise, the regional average prevalence of this recommended treatment does not 

reveal a consistent pattern associated with birth order. There are only four countries 

in which the percentage of sick children given more fluids and the same amount or 

more food is substantially larger (at least ten percentage points) for children of birth 

order one, compared with those of birth order six or higher: Eritrea, Mozambique, 

Tanzania, and Nepal. 

The regional average 

prevalence of following 

the recommendation to 

increase fluids and 

continue feeding does not 

differ substantially 

between male and female 

children with diarrhea. 
Diarrhea 65

Table 3.14 

Percentage of children under age three with diarrhea in the two weeks preceding the survey who received both increased fluids and continued feeding, by child’s sex, age, birth order, and mother’s age, 

Demographic and Health Surveys 1996-2002 

Child’s sex Child’s age in months Birth order Mother's age 

Survey Male Female 0-5 6-11 12-23 24-35 1 2-3 4-5 6+ <20 20-34 35+ Total

Number

of 

children

West/Middle Africa 

Benin 2001 21.1 12.5 (10.5) 19.9 17.2 15.0 17.8 14.9 16.9 17.9 (19.0) 16.0 19.0 16.7 469 

Cameroon 1998 28.2 24.2 (16.0) 31.1 25.0 29.4 28.3 26.4 26.2 24.1 26.7 25.7 28.2 26.2 428 

Chad 1996-97 19.7 16.7 23.1 17.2 18.5 16.5 17.4 16.6 20.4 18.9 15.0 18.0 21.7 18.3 1,014 

Côte d’Ivoire 1998-99 23.0 21.9 * 13.8 24.0 23.0 21.2 23.7 23.5 20.8 (21.6) 23.8 (17.1) 22.4 319 

Gabon 2000 40.2 40.2 (40.7) 38.9 42.2 37.2 39.6 41.9 34.6 43.5 40.2 39.9 41.4 40.2 493 

Ghana 1998 19.7 22.5 (17.4) 8.0 23.3 28.9 15.8 21.6 26.2 20.6 * 18.9 29.1 21.0 391 

Guinea 1999 19.1 22.3 20.6 22.9 19.0 21.5 22.0 19.8 17.5 24.1 19.3 19.8 24.6 20.6 788 

Mali 2001 18.6 23.1 15.2 23.3 18.7 24.0 19.4 18.1 27.6 19.3 15.8 21.9 19.4 20.7 1,589 

Mauritania 2000-01 26.2 16.1 12.9 22.9 19.3 27.6 23.8 20.6 20.5 19.9 (32.9) 21.0 18.4 21.1 653 

Niger 1998 24.1 18.5 21.7 20.6 21.2 22.6 22.6 21.1 21.7 21.1 20.6 22.2 19.7 21.5 1,663 

Nigeria 1999 23.4 24.1 (24.1) 24.0 20.4 29.0 18.4 25.3 22.8 27.5 (20.2) 24.8 21.6 23.7 490 

Togo 1998 22.9 23.0 16.4 24.9 20.6 27.0 24.2 19.1 25.2 24.5 17.7 23.5 22.8 22.9 1,147 

Median 23.0 22.4 17.4 22.9 20.5 25.5 21.6 20.9 23.2 21.0 20.2 22.1 21.7 21.3 

Mean 23.9 22.1 19.9 22.3 22.5 25.1 22.5 22.4 23.6 23.5 22.6 23.0 23.6 22.9 

South/East Africa 

Comoros 1996 26.0 19.8 (27.9) 25.4 17.3 (24.5) (21.4) 25.4 22.6 21.8 * 21.4 27.5 23.0 244 

Eritrea 2002 14.6 9.5 (3.4) 11.2 12.6 15.4 19.8 13.9 7.3 8.9 (22.2) 12.8 9.1 12.4 558 

Ethiopia 2000 3.2 3.2 1.7 2.5 2.5 5.3 3.9 4.3 2.1 2.3 3.2 3.2 3.3 3.2 1,932 

Kenya 1998 29.6 30.1 26.9 28.7 27.0 38.0 34.3 32.3 20.5 27.9 37.6 27.4 37.6 29.8 549 

Madagascar 1997 18.0 17.2 14.1 11.6 18.4 22.6 22.0 14.9 15.3 19.1 17.6 17.3 19.1 17.6 957 

Malawi 2000 24.0 27.7 20.8 25.2 28.0 24.5 30.6 26.0 22.7 23.8 32.8 24.4 27.7 25.8 1,610 

Mozambique 1997 29.8 22.9 14.7 27.0 29.9 25.5 34.7 24.2 27.7 21.6 15.3 29.8 22.1 26.6 787 

Namibia 2000 8.0 6.7 (0.7) 3.1 12.3 5.4 5.2 8.3 8.7 7.6 (6.0) 8.7 3.5 7.4 382 

Rwanda 2000 7.2 8.8 0.3 5.2 9.5 12.7 6.4 8.2 7.8 9.2 (6.1) 7.3 10.3 8.0 970 

South Africa 1998 25.5 18.3 28.9 19.3 22.1 21.0 15.4 28.6 22.8 18.8 15.6 21.6 27.0 22.0 508 

Tanzania 1999 23.3 15.9 (11.3) 20.1 17.5 29.0 21.6 22.7 23.5 11.1 (19.2) 19.9 21.2 20.1 315 

Uganda 2000-01 7.4 11.8 0.5 8.8 10.4 13.5 9.9 7.3 9.8 11.7 7.9 9.2 12.0 9.5 1,088 

Zambia 2001-02 18.7 15.6 4.3 18.5 15.2 22.9 16.2 16.5 15.7 21.3 15.9 16.7 21.1 17.2 1,018 

Zimbabwe 1999 16.4 24.9 * 14.5 19.8 24.0 18.7 26.5 9.6 16.2 (15.7) 22.1 16.3 20.5 372 

Median 18.4 16.6 17.6 16.5 17.4 22.8 19.3 19.6 15.5 17.5 15.7 18.6 20.1 18.9 

Mean 18.0 16.6 12.0 15.8 17.3 20.3 18.6 18.5 15.4 15.8 16.5 17.3 18.4 17.4 

North Africa/West Asia/Europe 

Armenia 2000 19.3 (17.5) * * (16.1) * (12.7) (24.0) * * * 18.3 * 18.6 88 

Egypt 2000 5.0 3.8 4.1 3.3 5.1 5.0 4.1 4.7 3.4 5.9 (2.2) 4.2 6.6 4.4 630 

Jordan 2002 15.6 15.9 8.9 13.3 20.8 13.2 13.3 17.0 16.6 15.1 (15.0) 16.7 10.7 15.7 703 

Turkey 1998 17.9 15.9 23.4 19.1 15.1 15.0 18.3 17.6 14.8 12.1 25.0 16.5 12.5 17.0 740 

Yemen 1997 12.0 10.2 9.4 9.5 10.4 14.1 12.7 13.6 9.3 9.8 7.4 12.1 9.6 11.1 2,344 

Median 15.6 15.9 9.2 11.4 15.1 13.7 12.7 17.0 12.1 11.0 11.2 16.5 10.2 15.7 

Mean 14.0 12.7 11.4 11.3 13.5 11.8 12.2 15.4 11.0 10.7 12.4 13.6 9.9 13.4 

Central Asia Kazakhstan 1999 21.6 18.9 * (37.7) 14.5 (12.3) 14.8 27.6 * * * 21.8 * 20.1 148 

Kyrgyz Rep. 1997 14.1 12.4 * (2.3) 15.0 (20.3) 9.8 16.3 (13.7) * * 14.2 (13.5) 13.4 194 

Turkmenistan 2000 (19.6) (15.7) * * (11.6) * (16.2) (22.4) * * * 17.5 * 17.7 79 

Uzbekistan 1996 (26.9) (11.2) * * (24.4) * (14.4) (27.0) * * * 19.6 * 18.4 69 

Median 20.6 14.0 u 20.0 14.8 16.3 14.6 24.7 u u u 18.6 u 18.1 

Mean 20.5 14.6 u 20.0 16.4 16.3 13.8 23.3 u u u 18.3 u 17.4 

South/Southeast Asia 

Bangladesh 1999-00 22.4 21.8 (6.0) 23.3 22.8 25.6 21.8 21.4 19.6 (29.7) 19.4 22.3 (27.8) 22.1 319 

Cambodia 2000 14.5 14.6 10.1 15.9 12.7 17.6 20.0 12.8 16.6 10.6 (4.2) 16.0 12.3 14.5 988 

India 1998-99 13.0 12.9 10.8 10.3 13.5 15.5 13.1 13.2 13.2 10.9 10.4 13.4 12.5 12.9 5,802 

Indonesia 1997 25.9 27.4 16.4 26.7 26.1 30.2 23.1 31.4 21.4 26.6 18.0 27.4 27.8 26.6 1,226 

Nepal 2000 14.4 9.2 1.3 9.9 14.0 14.9 19.3 11.7 9.6 5.2 12.7 12.1 9.2 11.7 979 

Philippines 1998 26.0 27.3 (14.3) 27.6 27.9 28.9 19.7 31.6 23.1 29.1 * 25.5 32.0 26.6 434 

Vietnam 1997 17.8 23.0 * 21.2 16.7 (17.0) 18.3 25.7 * * * 20.2 * 19.9 178 

Median 17.8 21.8 10.4 21.2 16.7 17.6 19.7 21.4 18.1 18.8 12.7 20.2 20.2 19.9 

Mean 19.1 19.5 9.8 19.3 19.1 21.4 19.3 21.1 17.3 18.7 12.9 19.6 20.3 19.2 

Latin America/Caribbean 

Bolivia 1998 25.2 30.0 7.3 20.3 28.9 37.5 25.6 30.7 30.1 22.3 14.1 30.0 24.3 27.6 948 

Brazil 1996 22.1 16.9 18.0 19.0 23.1 15.2 19.3 24.1 10.9 16.9 23.2 19.1 16.7 19.5 444 

Colombia 2000 12.0 11.6 5.8 12.4 12.7 12.2 13.8 10.0 12.8 (11.1) 7.9 12.2 13.7 11.8 479 

Dominican Rep. 2002 13.3 16.3 11.0 10.3 17.0 16.5 17.3 13.5 13.3 12.1 14.1 15.6 6.6 14.7 1,163 

Guatemala 1998-99 9.3 19.4 8.6 13.4 15.2 13.8 7.6 18.6 13.4 14.0 11.2 13.7 16.7 13.9 452 

Haiti 2000 9.3 8.3 3.0 8.4 11.1 8.2 10.3 7.2 10.1 8.4 7.9 8.8 9.3 8.8 1,194 

Nicaragua 2001 20.3 14.7 6.5 22.6 17.9 18.3 14.7 18.9 19.5 18.2 12.8 19.2 17.3 17.6 633 

Peru 2000 14.0 13.7 2.3 13.5 13.7 18.2 13.0 15.0 13.9 12.9 10.1 14.3 14.2 13.9 1,340 

Median 13.7 15.5 6.9 13.5 16.1 15.9 14.3 16.8 13.4 13.5 12.0 15.0 15.5 14.3 

Mean 15.7 16.4 7.8 15.0 17.5 17.5 15.2 17.3 15.5 14.5 12.7 16.6 14.9 16.0 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases 

and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
66 Diarrhea

Mother’s Age 

There is an association between lower maternal age and lower adherence to the 

recommended treatment of giving more fluids and the same amount or more food to 

a young child with diarrhea. 

Data are too sparse for countries in Central Asia to estimate the prevalence of this 

recommended treatment for children with diarrhea whose mothers are younger than 

20 or older than 34 years old. Elsewhere, in every region except North Africa/West 

Asia/Europe, younger mothers under age 20 are less likely, on average, than mothers 

age 20 and above to follow this recommendation. 

Within countries, most of the differentials in treatment prevalence between sick 

children with younger (<20) versus older (>34) mothers are negative. There are just 

three countries in which younger mothers are significantly more likely (by more than 

ten percentage points) than older mothers to follow these recommendations: Mauritania, Eritrea, and Turkey. 

There is an association 

between lower maternal 

age and lower adherence 

to the treatments 

recommended for young 

children with diarrhea. 

Acute Lower Respiratory Infection 67

 4

Acute Lower Respiratory Infection 

4.1 Prevalence Levels and Differentials of ALRI Symptoms 

4.1.1 Residence 

able 4.1 shows the percentage of children under age three years who, in the two 

weeks preceding the survey, experienced a cough accompanied by short, rapid 

breaths by place of residence and in total. While not a definitive diagnosis, these 

combined symptoms are associated with episodes of acute lower respiratory infection 

(ALRI), generally pneumonia or bronchiolitis. 

The highest regional average prevalences of ALRI symptoms are found in Latin 

America/Caribbean, with a mean of 25 percent (range 11 to 43 percent), and in 

South/East Africa, with a mean of 22 percent (range 12 to 29 percent). Total prevalence of ALRI symptoms is lowest in countries of Central Asia, ranging from 1 to 4 

percent. In all other countries except Jordan, at 7 percent, the total prevalence is 10 

percent or higher. 

Overall, young children in rural areas are slightly more likely than their urban 

counterparts to experience ALRI symptoms. Figure 4.1 shows the percentage of children with symptoms of ALRI by country and residence, arranged by region. The difference in prevalence of ALRI symptoms between urban and rural children within 

each country was computed. The majority of these differentials are negative, and 

most are small (less than five percentage points). ALRI symptoms are lower by ten or 

more percentage points in urban children in only three countries: Eritrea, Malawi, 

and Haiti. 

T

The highest regional 

average prevalences of 

ALRI symptoms are found 

in Latin America/ 

Caribbean, with a mean 

of 25 percent, and in 

South/East Africa, with a 

mean of 22 percent. 
68 Acute Lower Respiratory Infection

Table 4.1 

Children under age three with symptoms of acute lower respiratory infection (ALRI) in the 

two weeks preceding the survey, by residence and age, Demographic and Health Surveys 

1996-2002 

Residence Age in months 

Survey Urban Rural 0-5 6-11 12-17 18-23 24-29 30-35 Total 

Number 

of children 

West/Middle Africa Benin 2001 12.3 13.4 10.8 15.9 15.2 14.8 11.4 10.0 13.0 2,912 

Burkina Faso1998-99 11.9 15.8 13.7 17.4 19.7 18.0 12.5 10.9 15.4 3,219 

Cameroon 1998 20.2 19.5 19.0 28.3 20.6 18.7 13.2 17.5 19.7 2,260 

Chad 1996-97 14.4 13.8 13.2 14.4 16.2 14.5 10.8 14.9 13.9 3,938 

Côte d’Ivoire 1998-99 16.3 19.7 9.1 22.2 22.2 20.6 16.2 18.9 18.6 1,221 

Gabon 2000 15.9 12.8 14.6 17.5 15.8 16.4 13.8 11.8 15.1 2,324 

Ghana 1998 11.6 17.8 12.4 20.6 15.3 18.5 14.2 16.0 16.2 1,802 

Guinea 1999 16.6 19.0 17.5 25.4 20.9 19.0 12.7 17.0 18.3 3,005 

Mali 2001 11.2 11.0 9.1 13.1 12.4 11.1 12.0 8.2 11.0 6,973 

Mauritania 2000-01 13.3 9.1 10.2 17.0 9.3 10.7 10.3 6.2 10.9 2,796 

Niger 1998 14.2 14.2 16.7 17.6 14.9 11.8 11.9 10.2 14.2 4,403 

Nigeria 1999 10.3 11.7 7.5 13.0 13.2 13.3 11.3 9.2 11.3 3,208 

Togo 1998 18.8 20.7 19.4 24.6 24.2 22.3 15.0 15.5 20.2 3,693 

Median 14.2 14.2 13.2 17.5 15.8 16.4 12.5 11.8 15.1 

Mean 14.4 15.3 13.3 19.0 16.9 16.1 12.7 12.8 15.2 

South/East Africa Comoros 1996 22.0 22.3 19.5 24.5 26.3 18.3 26.7 16.4 22.3 1,056 

Eritrea 2002 14.9 24.8 17.3 24.4 24.7 21.5 20.3 21.4 21.5 3,281 

Ethiopia 2000 19.3 28.5 23.3 33.1 29.3 28.3 27.8 22.9 27.6 6,412 

Kenya 1998 17.6 20.7 15.5 21.3 23.2 20.7 20.4 18.9 20.1 3,205 

Madagascar 1997 21.1 24.6 22.3 28.9 29.4 19.5 22.3 18.9 23.9 3,537 

Malawi 2000 17.2 31.1 29.2 34.8 30.2 28.1 27.7 25.0 29.3 6,862 

Mozambique 1997 15.7 10.8 10.7 11.2 13.6 9.7 15.4 9.5 11.8 3,803 

Namibia 2000 17.4 22.8 15.8 26.0 28.5 18.8 17.2 18.2 20.9 2,346 

Rwanda 2000 18.9 26.9 25.8 33.2 28.0 21.4 19.5 20.6 25.7 4,293 

South Africa 1998 21.0 22.8 20.8 24.9 24.8 22.7 18.7 19.2 21.9 2,912 

Tanzania 1999 15.2 17.5 12.3 26.1 22.3 16.9 13.0 11.6 17.1 1,817 

Uganda 2000-01 22.9 26.6 22.1 32.8 29.4 27.5 23.6 19.4 26.2 4,245 

Zambia 2001-02 16.3 18.1 16.5 21.4 18.5 17.5 16.8 14.2 17.5 3,681 

Zimbabwe 1999 12.3 21.0 13.8 20.6 20.4 20.8 22.4 11.0 18.1 2,029 

Median 17.5 22.8 18.4 25.5 25.6 20.8 20.4 18.9 21.7 

Mean 18.0 22.8 18.9 25.9 24.9 20.8 20.8 17.7 21.7 

North Africa/West Asia/Europe Armenia 2000 9.6 12.3 6.4 10.7 9.6 10.4 14.3 14.5 10.9 880 

Egypt 2000 7.9 11.6 8.3 12.5 11.6 10.3 9.2 9.2 10.2 6,741 

Jordan 2002 7.5 6.7 4.9 10.2 8.8 7.1 6.7 5.6 7.4 3,454 

Yemen 1997 23.7 25.5 22.6 28.5 28.4 24.3 24.1 21.9 25.1 7,056 

Median 8.8 12.0 7.4 11.6 10.6 10.4 11.8 11.9 10.6 

Mean 12.2 14.0 10.6 15.5 14.6 13.0 13.6 12.8 13.4 

Central Asia Kazakhstan 1999 2.6 3.4 0.9 1.9 4.1 5.2 4.0 1.7 3.1 788 

Kyrgyz Rep. 1997 2.5 5.0 2.2 10.7 5.6 1.5 1.8 4.6 4.4 1,104 

Turkmenistan 2000 1.4 0.4 0.5 0.3 1.6 0.0 0.8 1.5 0.8 1,968 

Uzbekistan 1996 2.5 0.5 0.3 1.9 2.0 1.1 1.0 0.2 1.2 1,325 

Median 2.5 2.0 0.7 1.9 3.1 1.3 1.4 1.6 2.2 

Mean 2.3 2.3 1.0 3.7 3.3 2.0 1.9 2.0 2.4 

South/Southeast Asia Bangladesh 1999-00 17.8 19.8 21.8 20.6 22.5 19.4 18.0 12.9 19.5 3,927 

Cambodia 2000 20.7 22.0 14.6 27.3 24.3 23.6 21.2 20.6 21.8 4,232 

India 1998-99 16.0 20.1 16.4 23.7 21.9 17.7 19.0 15.9 19.1 30,668 

Indonesia 1997 8.4 10.4 6.7 12.2 11.1 11.2 7.9 10.0 9.9 9,322 

Nepal 2000 30.1 27.0 28.1 36.3 30.9 24.6 23.0 20.1 27.2 3,840 

Philippines 1998 13.7 16.4 10.8 14.2 17.4 18.8 17.5 12.0 15.2 4,415 

Vietnam 1997 11.0 14.7 8.9 11.8 19.2 15.4 11.0 17.4 14.2 1,769 

Median 16.0 19.8 14.6 20.6 21.9 18.8 18.0 15.9 19.1 

Mean 16.8 18.6 15.3 20.9 21.0 18.7 16.8 15.6 18.1 

Latin America/Caribbean Bolivia 1998 24.4 27.7 17.9 29.7 27.5 26.6 25.5 26.5 25.8 3,826 

Brazil 1996 24.8 25.6 16.5 27.0 28.0 27.2 25.1 25.6 25.0 2,757 

Colombia 2000 10.7 10.2 8.5 12.2 12.0 11.3 8.8 10.4 10.6 2,725 

Dominican Rep. 2002 21.0 22.9 20.0 24.8 20.8 24.6 20.5 19.1 21.7 6,395 

Guatemala 1998-99 17.9 23.0 20.7 24.5 25.6 19.7 18.2 17.5 21.1 2,618 

Haiti 2000 36.3 46.5 37.1 50.1 43.9 46.7 39.1 40.7 43.2 3,645 

Nicaragua 2001 30.8 36.1 22.6 36.0 40.9 34.2 34.4 30.8 33.4 3,807 

Peru 2000 20.6 22.2 16.5 24.3 22.4 23.6 21.8 19.0 21.3 6,790 

Median 22.7 24.3 19.0 25.9 26.6 25.6 23.5 22.4 23.4 

Mean 23.3 26.8 20.0 28.6 27.6 26.7 24.2 23.7 25.3 
Acute Lower Respiratory Infection 69

Figure 4.1 

Percentage of children under age three years with symptoms of ALRI in the two weeks preceding the 

survey, by residence 
70 Acute Lower Respiratory Infection

4.1.2 Child’s Age 

The two-week period prevalence of ALRI symptoms by six-month age groups is also 

tabulated in Table 4.1. The regional mean prevalences by age are displayed graphically in Figure 4.2. In each region, the mean prevalence is lowest in the youngest infants (age 0-5 months), peaks from age 6-17 months, then begins to decline. The 

mean prevalence by age 30-35 months is about the same or slightly higher than at age 

0-5 months. 

Figure 4.2 

Mean percentage of children under age three years with symptoms of ALRI in 

the two weeks preceding the survey, by age in months 

0

5

10

15

20

25

30

35

0-5 6-11 12-17 18-23 24-29 30-35

West/Middle Africa South/East Africa North Africa/West Asia/Europe

Central Asia South/Southeast Asia Latin America/Caribbean

4.1.3 Socioeconomic Characteristics 

Residence and Wealth Index 

A largely consistent and significant negative association is demonstrated between 

household wealth and the probability of recent ALRI symptoms in young children in 

both urban and rural settings. 

Table 4.2 summarizes the period prevalence of ALRI symptoms by residence and 

three categories of the country-specific household wealth index distribution. Data are 

sparse for countries in Central Asia in the category of urban children in the lowest 40 

percent and in both Central Asia and Latin America/Caribbean in the category of 

rural children in the highest 20 percent of the household wealth index distribution. 

Otherwise, with the exception of West/Middle Africa, there is a consistent pattern of 

decreasing regional average prevalence of ALRI symptoms by increasing household 

wealth for both urban and rural children. 

There is a negative 

association between 

household wealth and the 

probability of recent ALRI 

symptoms in young 

children in both urban 

and rural settings. 
Acute Lower Respiratory Infection 71

Table 4.2 

Percentage of children under age three with symptoms of acute lower respiratory infection (ALRI) in 

the two weeks preceding the survey, by residence and wealth index, Demographic and Health Surveys 

1996-2002 

 Urban Rural 

 Household wealth index Household wealth index 

Survey 

Lowest 

40% 

Middle 

40% 

Highest 

20% Total 

Number 

of children 

Lowest 

40% 

Middle 

40% 

Highest 

20% Total 

Number 

of children 

West/Middle Africa Benin 2001 11.2 13.8 11.4 12.3 931 12.8 14.5 10.2 13.4 1,981 

Burkina Faso 1998-99 * (25.3) 11.3 11.9 346 17.1 14.1 17.5 15.8 2,872 

Cameroon 1998 (12.0) 23.8 17.7 20.2 622 19.1 21.4 10.9 19.5 1,639 

Chad 1996-97 7.6 13.3 15.2 14.4 865 11.8 15.9 21.0 13.8 3,073 

Côte d’Ivoire 1998-99 * 15.9 14.9 15.5 362 22.6 14.8 * 18.7 729 

Gabon 2000 16.5 16.9 12.6 15.9 1,697 13.2 10.1 * 12.8 627 

Ghana 1988 * 11.8 10.8 11.6 459 17.6 17.0 (29.0) 17.8 1,343 

Guinea 1999 * 17.6 16.1 16.6 795 18.8 19.2 (19.0) 19.0 2,210 

Mali 2001 18.7 7.7 12.1 11.2 1,706 10.7 11.1 14.2 11.0 5,265 

Mauritania 2000-01 10.1 13.8 13.2 13.3 1,189 8.2 12.0 (0.0) 9.1 1,606 

Niger 1998 * 15.2 14.2 14.2 733 14.1 14.7 10.1 14.2 3,671 

Togo 1998 14.6 20.7 17.9 18.8 865 21.0 20.2 19.1 20.7 2,828 

Median 12.0 15.6 13.7 14.3 15.6 14.8 15.8 15.0 

Mean 13.0 16.3 13.9 14.7 15.6 15.4 15.1 15.5 

South/East Africa Comoros 1996 20.5 24.2 20.9 22.0 255 25.8 18.9 18.1 22.3 801 

Eritrea 2002 (13.3) 18.5 11.5 14.9 1,097 24.8 24.6 * 24.8 2,184 

Ethiopia 2000 * 13.0 19.9 19.3 649 26.2 30.8 28.9 28.5 5,762 

Kenya 1998 (12.1) 26.1 13.5 17.6 600 22.4 18.8 18.0 20.7 2,606 

Madagascar 1997 28.0 23.9 15.7 21.1 704 26.4 23.1 16.5 24.6 2,833 

Malawi 2000 22.6 24.7 14.6 17.2 890 29.9 33.4 28.4 31.2 5,967 

Mozambique 1997 * 16.4 15.7 15.7 806 11.7 8.7 16.7 10.8 2,996 

Namibia 2000 30.1 17.7 15.4 17.4 810 23.8 22.3 10.6 22.8 1,536 

Rwanda 2000 (28.9) 22.3 17.6 18.9 690 28.4 26.5 22.9 26.9 3,604 

South Africa 1998 21.5 21.5 19.5 21.0 1,422 23.5 19.5 (30.1) 22.8 1,490 

Tanzania 1999 (10.6) 17.9 14.6 15.2 354 16.3 18.6 20.1 17.5 1,463 

Uganda 2000-01 (13.2) 23.5 23.1 22.9 486 27.9 26.0 21.6 26.6 3,759 

Zambia 2001-02 * 21.7 9.8 16.3 1,124 18.7 17.1 16.5 18.1 2,556 

Zimbabwe 1999 * 12.0 12.2 12.3 668 21.4 20.5 * 21.0 1,361 

Median 21.0 21.6 15.6 17.5 24.3 21.4 19.1 22.8 

Mean 20.1 20.2 16.0 18.0 23.4 22.1 20.7 22.8 

North Africa/West Asia/Europe Armenia 2000 6.5 9.7 10.4 9.6 453 13.1 8.5 * 12.3 427 

Egypt 2000 12.3 7.9 6.9 7.9 2,625 13.0 9.8 6.0 11.6 4,116 

Jordan 2002 8.7 6.7 5.9 7.5 2,680 6.9 6.6 4.8 6.7 774 

Yemen 1997 (23.1) 25.7 22.5 23.7 1,631 27.6 24.3 14.8 25.5 5,425 

Median 10.5 8.8 8.7 8.8 13.1 9.2 6.0 12.0 

Mean 12.6 12.5 11.4 12.2 15.1 12.3 8.5 14.0 

Central Asia 

Kazakhstan 1999 * 2.2 1.9 2.6 326 3.7 2.5 * 3.4 462 

Kyrgyz Rep. 1997 (2.8) 2.8 2.1 2.5 253 5.7 3.9 (4.3) 5.0 851 

Turkmenistan 2000 0.0 1.6 1.7 1.4 769 0.4 0.3 * 0.4 1,192 

Uzbekistan 1996 0.0 1.3 5.0 2.5 414 0.6 0.5 (0.0) 0.5 911 

Median 0.0 1.9 2.0 2.5 2.2 1.5 2.2 2.0 

Mean 0.9 2.0 2.7 2.3 2.6 1.8 2.2 2.3 

South/Southeast Asia Bangladesh 1999-00 26.5 18.8 14.2 17.8 644 21.5 18.1 16.5 19.8 3,283 

Cambodia 2000 18.1 20.7 22.0 20.7 552 22.3 22.4 18.0 22.0 3,680 

India 1998-99 20.7 18.3 13.0 16.0 6,928 21.1 19.2 15.7 20.1 23,741 

Indonesia 1997 8.3 10.2 6.3 8.4 2,624 10.6 10.4 9.1 10.4 6,698 

Nepal 2000 (20.7) 34.3 30.1 30.1 237 26.3 28.2 25.1 27.0 3,603 

Philippines 1998 15.8 14.2 10.4 13.7 2,049 16.7 17.0 8.2 16.4 2,366 

Vietnam 1997 * 9.8 10.6 11.0 255 16.0 13.5 9.1 14.7 1,513 

Median 19.4 18.3 13.0 16.0 21.1 18.1 15.7 19.8 

Mean 18.4 18.0 15.2 16.8 19.2 18.4 14.5 18.6 

Latin America/Caribbean Bolivia 1998 28.4 23.4 23.5 24.4 2,219 28.3 24.0 * 27.7 1,606 

Brazil 1996 30.4 22.1 19.0 24.8 2,104 25.4 27.6 * 25.6 653 

Colombia 2000 15.3 9.9 7.0 10.7 1,863 10.2 9.3 * 10.2 862 

Guatemala 1998-99 19.8 18.4 15.6 17.9 991 23.5 22.5 (19.9) 23.0 1,627 

Haiti 2000 54.1 38.8 32.5 36.3 1203 49.5 42.1 (23.5) 46.5 2,442 

Nicaragua 2001 40.0 32.2 23.6 30.8 1931 37.6 30.4 * 36.1 1,875 

Peru 2000 23.2 21.1 17.1 20.6 3744 22.6 19.1 * 22.2 3,046 

Median 28.4 22.1 19.0 24.4 25.4 24.0 21.7 25.6 

Mean 30.2 23.7 19.8 23.6 28.2 25.0 21.7 27.3 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases 

and has been suppressed. 
72 Acute Lower Respiratory Infection

These patterns are supported by the differentials in prevalence between children in 

the lowest versus the highest categories of wealth index by residence. Among urban 

children, 14 of the 37 differentials are positive by more than five percentage points, 7 

of which are positive by more than ten percentage points. There are four notable exceptions for which urban children from households in the lowest 40 percent of the 

wealth index distribution are less likely to experience ALRI symptoms than their 

wealthier counterparts by five to ten percentage points: Cameroon, Chad, Uganda, 

and Nepal. 1

 

Similarly, among rural children, 13 of the 36 differentials by wealth category are 

positive by more than five percentage points. The largest such difference is seen in 

Haiti, where the period prevalence of ALRI symptoms is 50 percent versus 24 percent among children from the lowest versus the highest wealth categories. 

Residence and Mother’s Education 

The period prevalence of symptoms of ALRI by residence and mother’s education 

(highest level completed) is shown in Table 4.3. In Central Asia, very few mothers 

have not completed at least one year of secondary school, resulting in sparse data in 

the first two education categories. 

Lower mother’s education is more consistently associated with an increased probability of recent ALRI symptoms in young children in urban areas than in rural areas. 

Looking at regional average prevalence by level of education, prevalence of ALRI 

symptoms among urban children decreases with increasing maternal education in 

South/East Africa, South/Southeast Asia, and Latin America/Caribbean. Seventeen 

of the 42 intracountry differentials computed for urban children whose mothers have 

no completed years of education versus one or more completed years of secondary 

education are positive values exceeding five percentage points, in comparison with six 

negative values of the same magnitude found in Burkina Faso, Côte d’Ivoire, and 

Gabon in West/Middle Africa, and in Ethiopia, Kenya, and Tanzania in South/East 

Africa.2

 

In rural areas, the average prevalence decreases most strongly in the Latin America/Caribbean region. The intracountry differences in ALRI symptom prevalence 

between rural children with mothers in the lowest versus the highest education categories were computed. These differentials exceed positive five percentage points in 

just 8 out of 42 countries, 4 of which are in Latin America/Caribbean (Brazil, the 

Dominican Republic, Guatemala, and Nicaragua). 

 

1

 In Cameroon, Uganda, and Nepal, the number of urban children in these samples from 

households in the lowest wealth category is less than 50. 

2

 In Kenya, the number of urban children whose mothers fall within the lowest category of 

maternal education is less than 50.

Lower mother’s education 

is more consistently 

associated with an 

increased probability of 

recent ALRI symptoms in 

young children in urban 

areas than in rural areas. 
Acute Lower Respiratory Infection 73

Table 4.3 

Percentage of children under age three with symptoms of acute lower respiratory infection (ALRI) 

in the two weeks preceding the survey, by residence and mother’s education, Demographic and 

Health Surveys 1996-2002 

 Urban Rural 

 Highest level of education Highest level of education 

Survey None Primary Secondary+ Total

Number of 

children None Primary Secondary+ Total 

Number of 

children 

West/Middle Africa 

Benin 2001 14.0 12.4 7.0 12.3 931 13.0 14.7 16.2 13.4 1,981 

Burkina Faso 1998-99 10.4 10.4 17.2 11.9 346 15.8 16.3 * 15.8 2,872 

Cameroon 1998 27.6 19.4 17.2 20.2 622 19.0 19.6 19.9 19.5 1,639 

Chad 1996-97 14.0 14.0 17.1 14.4 865 13.0 16.8 * 13.8 3,073 

Côte d’Ivoire 1998-99 13.3 17.9 22.4 16.3 412 20.0 19.8 * 19.7 809 

Gabon 2000 6.3 15.2 17.5 15.9 1,697 (13.1) 14.3 9.7 12.8 627 

Ghana 1988 17.8 8.6 10.5 11.6 459 17.7 18.2 17.7 17.8 1,343 

Guinea 1999 17.6 15.0 14.4 16.6 795 19.0 17.7 (21.1) 19.0 2,210 

Mali 2001 10.8 10.0 14.4 11.2 1,706 11.0 10.7 10.2 11.0 5,267 

Mauritania 2000-01 13.2 13.3 13.4 13.3 1,189 9.6 7.1 (8.0) 9.1 1,606 

Niger 1998 13.5 16.7 13.7 14.2 733 14.6 10.4 (2.6) 14.2 3,671 

Nigeria 1999 10.1 8.5 11.4 10.3 896 11.8 12.0 11.2 11.7 2,312 

Togo 1998 19.6 21.0 13.3 18.8 865 20.7 20.6 20.1 20.7 2,828 

Median 13.5 14.0 14.4 14.2 14.6 16.3 13.7 14.2 

Mean 14.5 14.0 14.6 14.4 15.3 15.2 13.7 15.3 

South/East Africa 

Comoros 1996 22.3 18.5 23.9 22.0 255 23.2 19.8 22.6 22.3 801 

Eritrea 2002 18.5 16.4 10.7 14.9 1,097 24.6 25.0 (29.4) 24.8 2,184 

Ethiopia 2000 17.4 17.2 22.8 19.3 649 28.6 28.2 27.0 28.5 5,762 

Kenya 1998 (5.6) 21.5 14.5 17.6 600 20.7 21.1 19.5 20.7 2,606 

Madagascar 1997 18.6 25.4 17.5 21.1 704 28.3 23.9 21.2 24.6 2,833 

Malawi 2000 12.4 18.8 16.3 17.2 891 28.2 32.6 33.2 31.1 5,972 

Mozambique 1997 20.3 16.0 4.1 15.7 806 10.2 11.7 (0.5) 10.8 2,996 

Namibia 2000 23.9 22.8 14.7 17.4 810 19.0 26.4 20.8 22.8 1,536 

Rwanda 2000 27.5 20.5 14.5 18.9 690 25.8 28.4 19.4 26.9 3,604 

South Africa 1998 (19.8) 23.3 20.4 21.0 1,422 20.8 21.6 24.0 22.8 1,490 

Tanzania 1999 12.7 15.1 17.9 15.2 354 17.0 17.8 16.7 17.5 1,463 

Uganda 2000-01 17.4 26.6 19.3 22.9 486 27.0 26.7 24.9 26.6 3,758 

Zambia 2001-02 (27.2) 18.7 12.5 16.3 1,124 19.9 18.0 15.8 18.1 2,556 

Zimbabwe 1999 * 9.0 13.4 12.3 668 24.6 20.0 21.6 21.0 1,361 

Median 18.6 18.8 15.5 17.5 23.9 22.8 21.4 22.8 

Mean 18.7 19.3 15.9 18.0 22.7 22.9 21.2 22.8 

North Africa/West Asia/Europe 

Armenia 2000 * * 9.6 9.6 453 * 12.2 12.3 427 

Egypt 2000 9.0 9.2 7.3 7.9 2,625 13.8 8.9 9.7 11.6 4,116 

Jordan 2002 4.4 8.8 7.5 7.5 2,680 10.4 9.1 5.8 6.7 774 

Yemen 1997 25.4 25.7 17.3 23.7 1,631 25.3 27.7 22.9 25.5 5,425 

Median 9.0 9.2 8.6 8.8 13.8 9.1 11.0 12.0 

Mean 12.9 14.6 10.4 12.2 16.5 15.2 12.6 14.0 

Central Asia 

Kazakhstan 1999 * * 2.6 2.6 327 * * 3.4 3.4 462 

Kyrgyz Rep. 1997 * * 2.5 2.5 253 * * 5.0 5.0 851 

Turkmenistan 2000 * * 1.3 1.4 775 * * 0.4 0.4 1,192 

Uzbekistan 1996 * * 2.5 2.5 414 * * 0.5 0.5 911 

Median u u 2.5 2.5 u u 2.0 2.0 

Mean u u 2.2 2.3 u u 2.3 2.3 

South/Southeast Asia 

Bangladesh 1999-00 20.7 19.1 14.6 17.8 644 21.2 19.3 17.5 19.8 3,283 

Cambodia 2000 25.0 19.7 18.9 20.7 552 21.9 22.1 21.5 22.0 3,680 

India 1998-99 19.2 17.0 14.0 16.0 6,925 20.8 19.8 18.4 20.1 23,733 

Indonesia 1997 9.4 7.4 8.9 8.4 2,624 8.9 11.2 9.3 10.4 6,698 

Nepal 2000 30.5 41.5 25.6 30.1 237 26.7 29.9 25.0 27.0 3,603 

Philippines 1998 * 13.3 13.6 13.7 2,049 10.8 19.4 14.3 16.4 2,366 

Vietnam 1997 * 12.3 10.6 11.0 255 10.7 16.5 14.3 14.7 1,513 

Median 20.7 17.0 14.0 16.0 20.8 19.4 17.5 19.8 

Mean 21.0 18.6 15.2 16.8 17.3 19.7 17.2 18.6 

Latin America/Caribbean 

Bolivia 1998 33.6 24.6 23.7 24.4 2,219 28.1 27.9 26.2 27.7 1,606 

Brazil 1996 29.9 29.1 22.3 24.8 2,104 29.4 26.9 20.5 25.6 653 

Colombia 2000 (19.5) 12.4 9.9 10.7 1,863 9.3 11.5 6.9 10.2 862 

Dominican Rep. 2002 15.5 23.2 19.5 21.0 4,192 29.2 24.0 19.7 22.9 2,204 

Guatemala 1998-99 17.4 18.1 17.9 17.9 991 23.1 24.3 11.3 23.0 1,627 

Haiti 2000 31.8 39.7 34.2 36.3 1,203 47.6 45.8 45.0 46.5 2,442 

Nicaragua 2001 38.4 35.1 27.3 30.8 1,931 40.3 35.4 28.4 36.1 1,875 

Peru 2000 24.6 23.2 19.9 20.6 3,744 21.9 23.1 20.1 22.2 3,046 

Median 27.3 23.9 21.1 22.7 28.7 25.6 20.3 24.3 

Mean 26.3 25.7 21.8 23.3 28.6 27.4 22.3 26.8 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25

unweighted cases and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
74 Acute Lower Respiratory Infection

4.1.4 Demographic Characteristics 

In Table 4.4, the percentage of children with recent symptoms of ALRI is tabulated 

by categories of child’s sex, birth order (one, two to three, four to five, six or higher), 

birth interval (first birth, <24 months, 24-35 months, 36 or more months), and 

mother’s age (<20, 20-34, 35 or more years). Differences in ALRI symptom prevalence by sex are negligible in nearly all countries. The largest difference by sex is 

found in Vietnam, where the period prevalence is 17 percent for boys and 11 percent 

for girls under three years of age. 

In general, the two-week period prevalence of ALRI symptoms does not vary 

markedly by birth order or by birth interval. Within countries, the difference in prevalence among children of birth order one versus six or more and among children of 

birth intervals less than 24 versus 36 or more months were computed. These differentials exceed five percentage points in only three and six countries, respectively, 

and are all less than ten percentage points. 

For the most part, children of mothers in the lowest age category (less than 20 

years) do not differ consistently or significantly from children of mothers in the highest age category (35 or more years) with respect to ALRI symptoms period prevalence. The two largest differentials are observed in Armenia and the Kyrgyz Republic, with differentials of 9 and 11 percentage points, respectively, in favor of children 

with older mothers. 

Differences in ALRI 

symptom prevalence by 

sex are negligible in 

nearly all countries. 
Acute Lower Respiratory Infection 75

Table 4.4 

Percentage of children under age three with symptoms of acute lower respiratory infection (ALRI) in the 

two weeks preceding the survey, by child's sex, birth order, birth interval, and mother’s age, Demographic 

and Health Surveys 1996-2002 

 Child’s sex Birth order Birth interval (months) Mother’s age 

Survey Male Female 1 2-3 4-5 6+ 

First 

birth <24 24-35 36+ <20 20-34 35+ Total

Number

of 

children

West/Middle Africa Benin 2001 12.7 13.4 13.0 12.6 13.1 13.8 13.0 14.4 13.1 12.7 9.6 13.1 14.0 13.0 2,912 

Burkina Faso 1999 15.7 15.1 12.3 14.9 16.9 16.6 12.3 16.3 15.7 16.2 15.4 15.2 16.1 15.4 3,219 

Cameroon 1998 20.3 19.0 20.9 19.1 19.1 19.8 21.1 19.8 20.1 18.2 18.6 19.9 19.5 19.7 2,260 

Chad 1997 13.7 14.2 14.0 12.1 14.4 15.6 14.0 14.5 14.3 13.3 12.9 13.4 17.1 13.9 3,938 

Côte d’Ivoire 1998 17.8 19.4 20.5 17.9 17.5 18.6 20.5 18.5 16.6 18.8 21.2 16.9 22.7 18.6 1,221 

Gabon 2000 14.9 15.2 16.3 16.2 10.9 15.4 16.1 17.8 12.1 14.9 15.3 15.0 14.9 15.1 2,324 

Ghana 1988 15.7 16.8 17.9 16.2 17.6 13.0 18.0 14.1 14.5 16.6 12.6 17.9 12.1 16.2 1,802 

Guinea 1999 18.5 18.1 15.4 19.0 18.7 19.2 15.5 14.4 17.0 21.2 17.1 18.3 19.0 18.3 3,005 

Mali 2001 11.1 11.0 12.3 10.6 10.0 11.6 12.3 10.8 12.2 9.7 10.8 10.6 12.6 11.0 6,973 

Mauritania 2000 10.9 10.9 11.8 10.4 10.2 11.5 11.8 10.9 11.8 10.0 14.2 11.0 9.5 10.9 2,796 

Niger 1998 15.8 12.5 13.7 12.5 14.9 15.3 13.7 15.2 13.1 15.1 13.8 14.3 14.1 14.2 4,403 

Nigeria 1999 11.8 10.9 13.3 10.0 11.5 11.4 13.2 12.8 11.5 9.4 15.2 11.0 10.8 11.3 3,208 

Togo 1998 20.5 19.9 21.2 19.3 17.9 23.0 21.3 22.0 18.8 20.3 19.7 20.5 19.4 20.2 3,693 

Median 15.7 15.1 14.0 14.9 14.9 15.4 14.0 14.5 14.3 15.1 15.2 15.0 14.9 15.1 

Mean 15.3 15.1 15.6 14.7 14.8 15.8 15.6 15.5 14.7 15.1 15.1 15.2 15.5 15.2 

South/East Africa Comoros 1996 22.6 21.9 18.9 24.0 26.9 19.2 19.6 22.2 24.0 22.2 26.6 22.6 19.9 22.3 1,056 

Eritrea 2002 22.5 20.5 21.4 19.9 20.3 25.0 21.2 20.0 24.7 19.6 21.5 20.9 22.7 21.5 3,281 

Ethiopia 2000 27.9 27.2 29.2 27.4 29.4 25.3 29.5 26.5 26.6 27.8 30.5 27.1 28.0 27.6 6,412 

Kenya 1998 20.3 19.9 18.4 18.8 24.7 20.1 18.4 22.5 20.7 19.7 24.5 19.9 18.4 20.1 3,205 

Madagascar 1997 23.9 23.9 22.9 23.6 25.3 23.9 23.0 23.7 26.0 22.5 28.0 23.9 20.7 23.9 3,537 

Malawi 2000 29.0 29.6 28.3 29.3 28.6 31.2 28.3 29.8 30.1 29.3 28.8 29.1 30.5 29.3 6,862 

Mozambique 1997 12.0 11.7 9.2 11.3 13.7 13.3 9.4 19.4 12.8 10.6 11.4 11.9 11.9 11.8 3,803 

Namibia 2000 20.2 21.6 22.2 18.8 21.9 23.2 22.1 17.0 24.8 19.0 25.4 20.0 21.9 20.9 2,346 

Rwanda 2000 27.5 23.8 26.4 26.4 25.9 23.9 26.3 25.1 26.7 24.7 27.1 26.3 23.8 25.7 4,293 

South Africa 1998 21.9 21.9 21.7 23.2 19.2 21.9 21.7 20.2 19.9 22.8 23.9 22.4 19.1 21.9 2,912 

Tanzania 1999 18.7 15.3 18.2 16.2 17.3 16.9 18.2 15.2 17.2 16.8 15.9 17.0 18.0 17.1 1,817 

Uganda 2000 26.4 25.9 24.6 25.1 26.8 28.0 24.4 23.8 28.1 26.8 24.5 26.2 27.4 26.2 4,245 

Zambia 2001 17.8 17.2 17.8 17.5 17.9 16.9 17.6 21.7 16.4 17.3 19.4 17.5 16.0 17.5 3,681 

Zimbabwe 1999 17.9 18.4 15.3 21.2 19.7 14.5 15.2 18.7 20.1 19.6 14.7 19.3 15.1 18.1 2,029 

Median 22.2 21.8 21.6 22.2 23.3 22.6 21.5 22.0 24.4 21.0 24.5 21.7 20.3 21.7 

Mean 22.0 21.3 21.0 21.6 22.7 21.7 21.1 21.8 22.7 21.3 23.0 21.7 21.0 21.7 

North Africa/West Asia/Europe Armenia 2000 9.5 12.8 8.7 13.1 10.3 * 8.6 14.5 13.3 10.6 21.7 9.9 12.6 10.9 880 

Egypt 2000 10.8 9.5 9.9 9.4 11.4 11.2 9.9 10.0 11.0 9.9 12.1 10.3 8.8 10.2 6,741 

Jordan 2002 8.6 6.1 8.1 7.4 7.2 6.6 8.0 8.6 6.0 6.9 3.2 8.3 4.2 7.4 3,454 

Yemen 1997 26.1 24.0 24.0 23.5 26.0 26.1 24.1 25.2 24.2 26.3 29.1 24.5 25.6 25.1 7,056 

Median 10.2 11.2 9.3 11.3 10.9 11.2 9.3 12.3 12.2 10.3 16.9 10.1 10.7 10.6 

Mean 13.8 13.1 12.7 13.4 13.7 14.6 12.6 14.6 13.6 13.4 16.5 13.3 12.8 13.4 

Central Asia Kazakhstan 1999 2.8 3.3 3.3 3.5 0.8 * 3.3 2.1 4.1 2.9 (1.3) 3.2 2.6 3.1 788 

Kyrgyz Rep. 1997 4.7 4.1 5.1 4.2 2.9 5.7 5.1 4.2 3.3 4.5 (13.5) 4.2 2.1 4.4 1,104 

Turkmenistan 2000 1.2 0.3 0.5 1.1 0.7 0.0 0.5 0.7 1.1 1.0 (0.0) 0.8 0.6 0.8 1,968 

Uzbekistan 1996 1.5 0.8 2.0 0.9 0.7 0.0 2.0 0.4 0.5 1.4 3.0 1.2 0.0 1.2 1,325 

Median 2.2 2.1 2.7 2.3 0.8 0.0 2.7 1.4 2.2 2.2 2.2 2.2 1.4 2.2 

Mean 2.5 2.1 2.7 2.4 1.3 1.9 2.7 1.9 2.3 2.5 4.4 2.3 1.3 2.4 

South/Southeast Asia Bangladesh 2000 20.0 18.9 18.2 18.6 22.5 21.5 18.3 19.3 19.4 20.4 20.4 18.8 22.5 19.5 3,927 

Cambodia 2000 22.2 21.4 21.6 20.0 24.9 21.8 21.7 25.8 22.1 20.4 21.2 21.6 22.4 21.8 4,232 

India 1999 20.5 17.7 19.5 18.5 19.9 19.7 19.5 17.7 19.3 19.4 22.0 18.7 18.8 19.1 30,668 

Indonesia 1997 10.2 9.5 9.6 10.4 9.1 9.7 10.0 10.2 10.4 9.5 13.1 10.0 8.1 9.9 9,322 

Nepal 2000 28.5 25.9 28.1 26.2 26.8 28.8 28.0 24.8 27.3 27.6 29.5 26.4 30.5 27.2 3,840 

Philippines 1998 15.5 14.7 12.9 14.4 15.3 20.2 12.9 14.6 16.4 16.9 15.0 14.6 17.1 15.2 4,415 

Vietnam 1997 16.9 11.3 15.9 12.5 17.1 7.9 15.9 8.3 14.8 13.8 (17.7) 14.3 12.7 14.2 1,769 

Median 20.0 17.7 18.2 18.5 19.9 20.2 18.3 17.7 19.3 19.4 20.4 18.7 18.8 19.1 

Mean 19.1 17.1 18.0 17.2 19.4 18.5 18.0 17.2 18.5 18.3 19.8 17.8 18.9 18.1 

Latin America/Caribbean Bolivia 1998 26.7 24.8 25.9 24.8 25.0 28.1 25.9 28.5 26.0 23.7 34.6 24.7 26.2 25.8 3,826 

Brazil 1996 26.9 23.1 24.0 24.2 28.1 29.0 24.1 27.0 26.1 24.5 29.6 24.4 24.0 25.0 2,757 

Colombia 2000 11.0 10.1 9.2 10.8 13.9 10.6 9.1 11.4 14.3 10.4 14.4 9.7 11.6 10.6 2,725 

Dominican Rep. 2002 22.7 20.6 19.8 21.8 22.7 28.5 19.8 26.2 23.5 19.9 24.1 21.4 20.3 21.7 6,395 

Guatemala 1999 22.8 19.3 20.8 19.3 23.4 21.9 20.8 19.9 20.3 23.2 18.5 20.9 23.2 21.1 2,618 

Haiti 2000 42.9 43.4 39.3 44.3 47.1 42.4 39.3 47.7 45.2 41.2 42.4 44.4 39.8 43.2 3,645 

Nicaragua 2001 34.3 32.6 32.0 32.4 36.7 35.9 32.0 32.9 37.2 33.0 36.2 32.4 35.3 33.4 3,807 

Peru 2000 22.8 19.8 19.1 22.0 22.6 23.3 19.2 22.9 24.8 21.0 20.5 21.6 20.9 21.3 6,790 

Median 24.8 21.9 22.4 23.1 24.2 28.3 22.5 26.6 25.4 23.5 26.9 23.0 23.6 23.4 

Mean 26.3 24.2 23.8 25.0 27.4 27.5 23.8 27.1 27.2 24.6 27.5 24.9 25.2 25.3 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and 

has been suppressed. 
76 Acute Lower Respiratory Infection

4.1.5 Nutritional Status 

The percentage of children with ALRI symptoms in the past two weeks is tabulated 

in Table 4.5 by severe (≤-3.0), moderate (-3.0 to -2.01), and mild/normal categories 

(≥-2.0) of three indicators of nutritional status: underweight (low weight-for- age), 

stunting (low height-for-age), and wasting (low weight-for-height). 

Overall, these data support an association between undernutrition and a higher 

probability of recent ALRI symptoms, particularly with respect to underweight. 

Figure 4.3 shows the range, mean, and median prevalence of ALRI symptoms for 

the countries included in the report by region and categories of underweight. Data 

are too sparse to be displayed for severe underweight in the North Africa/West 

Asia/Europe and Central Asia regions. Elsewhere, though, a consistent pattern is 

demonstrated by which the average prevalence of ALRI symptoms decreases with 

increasing weight-for-age. 

The regional mean ALRI symptom prevalence by categories of stunting also decreases with increasing height-for-age, with the exception of the Central Asia region, 

where the pattern is irregular.3

 However, the decrements in ALRI symptom prevalence by height-for-age categories are noticeably smaller than those by weight-forage categories. 

In most of the countries, the prevalence of severe wasting is low. Data are especially sparse in this category for the regions of North Africa/West Asia/Europe, Central Asia, and Latin America/Caribbean. On the basis of regional averages, children 

classified as mild or normal with respect to wasting are less likely to have experienced 

recent ALRI symptoms, compared with their more wasted counterparts. 

Differentials were computed between the prevalence of ALRI symptoms in children classified as severe versus mild/normal for each of the three indicators. In 9 of 

41 countries, the period prevalence of ALRI symptoms is more than ten percentage 

points higher for children who are severely underweight versus mildly underweight 

children or those of normal weight-for-age. These countries include Burkina Faso, 

Côte d’Ivoire, Guinea, Comoros, Namibia, Egypt, Colombia, Haiti, and Nicaragua. 

A difference of this same magnitude in the opposite direction is seen in only one 

country: the Dominican Republic. 

Fewer large differentials are observed when the nutritional indicator is either 

stunting or wasting. In Côte d’Ivoire and Brazil, the period prevalence of ALRI 

symptoms is higher by more than ten percentage points for children who are severely 

stunted versus mildly stunted children or those of normal height-for-age. In six countries (Benin, Burkina Faso, Ethiopia, Zimbabwe, Egypt, and Haiti), ALRI symptom 

prevalence for children who are severely wasted exceeds that for children who are 

mildly wasted or of normal weight-for-age by more than ten percentage points. 

 

3

 In the Central Asian countries included here, the prevalence of ALRI symptoms is also very 

low, less than 5 percent. 

Overall, these data 

support an association 

between undernutrition 

and a higher probability 

of recent ALRI symptoms, 

particularly with respect 

to underweight. 
Acute Lower Respiratory Infection 77

Table 4.5 

Percentage of children under age three with symptoms of acute lower respiratory infection (ALRI) in the two 

weeks preceding the survey, by nutritional status indices, Demographic and Health Surveys 1996-2002 

 Weight-for-age Z-score Height-for-age Z-score Weight-for-height Z-score 

Survey ≤-3.0 -3.0 to-2.01 ≥-2.0 ≤-3.0 -3.0 to-2.01 ≥-2.0 ≤-3.0 -3.0 to-2.01 ≥-2.0 Total 

Number of 

children 

West/Middle Africa Benin 2001 13.7 14.0 12.9 12.8 13.6 13.1 29.2 16.3 12.5 13.2 2,610 

Burkina Faso 1998-99 23.5 16.6 13.3 17.8 13.4 15.4 27.3 22.3 13.7 15.4 2,530 

Cameroon 1998 25.9 22.5 19.7 22.2 21.4 19.9 * 19.5 20.5 20.5 1,923 

Chad 1996-97 15.9 13.0 14.5 11.6 12.9 15.5 17.8 14.6 14.2 14.4 3,541 

Côte d’Ivoire 1998-99 (33.3) 25.6 17.2 31.0 23.8 17.3 * 17.8 19.5 19.3 1,099 

Gabon 2000 5.8 18.0 15.1 18.8 17.0 14.5 * 7.1 15.3 15.1 2,013 

Ghana 1988 19.1 19.1 16.0 14.4 20.5 16.3 (16.1) 19.9 16.4 16.8 1,638 

Guinea 1999 31.3 19.1 18.5 26.2 20.4 18.4 23.1 22.9 18.9 19.4 2,067 

Mali 2001 11.8 14.1 10.4 10.1 13.2 11.2 12.1 13.0 11.2 11.4 6,120 

Mauritania 2000-01 12.5 10.1 12.3 9.6 12.4 12.1 11.7 13.6 11.6 11.8 2,227 

Niger 1998 15.1 13.8 14.4 15.0 13.6 14.5 18.6 14.7 14.1 14.4 4,022 

Nigeria 1999 18.0 11.4 9.7 13.6 13.7 8.5 13.6 14.3 10.4 10.8 1,473 

Togo 1998 20.3 21.2 20.1 18.1 19.1 20.7 27.0 19.2 20.3 20.3 3,260 

Median 18.0 16.6 14.5 15.0 13.7 15.4 18.2 16.3 14.2 15.1 

Mean 18.9 16.8 14.9 17.0 16.5 15.2 19.6 16.6 15.3 15.6 

South/East Africa Comoros 1996 31.5 23.0 20.8 26.8 22.9 20.8 * 24.1 21.7 22.0 921 

Eritrea 2002 26.1 23.0 20.6 22.3 24.4 21.1 28.7 20.7 21.9 21.9 2,996 

Ethiopia 2000 33.1 30.5 25.4 31.5 29.8 26.1 41.4 27.2 28.0 28.1 6,011 

Kenya 1998 26.9 22.5 20.2 22.5 19.7 21.0 (12.1) 23.2 20.9 20.9 2,821 

Madagascar 1997 32.5 24.0 23.2 25.4 22.2 25.5 (28.3) 30.8 24.2 24.6 3,080 

Malawi 2000 30.5 31.4 29.1 30.1 28.5 30.0 29.0 29.4 29.7 29.7 6,177 

Mozambique 1997 10.6 13.0 12.6 10.9 15.1 12.0 (6.5) 13.6 12.5 12.5 2,837 

Namibia 2000 30.1 27.0 19.7 29.6 25.4 20.1 (25.2) 29.4 20.5 21.3 2,188 

Rwanda 2000 31.5 31.1 24.7 28.8 25.6 25.9 27.1 27.1 26.2 26.3 3,915 

Tanzania 1999 23.3 17.2 17.2 22.0 18.2 16.4 * 17.9 17.4 17.6 1,674 

Uganda 2000-01 33.1 34.0 24.3 30.3 29.8 24.7 * 36.6 26.1 26.5 3,740 

Zambia 2001-02 24.8 18.9 16.7 18.7 19.9 16.8 (11.0) 20.4 17.8 17.9 3,432 

Zimbabwe 1999 (20.3) 25.0 17.9 15.9 19.2 19.0 (31.3) 23.1 18.2 18.7 1,684 

Median 30.1 24.0 20.6 25.4 22.9 21.0 27.7 24.1 21.7 21.9 

Mean 27.3 24.7 21.0 24.2 23.1 21.5 24.1 24.9 21.9 22.2 

North Africa/West Asia/Europe Armenia 2000 * * 10.9 * 13.1 10.4 * * 11.1 10.8 805 

Egypt 2000 (20.6) 15.0 9.8 14.6 12.2 9.3 (25.6) 7.9 10.0 10.0 6,264 

Jordan 2002 * 10.1 7.6 8.8 10.9 7.6 * 14.8 7.6 7.8 2,845 

Yemen 1997 31.2 26.7 23.7 27.2 25.7 25.1 29.7 29.8 25.0 25.7 4,966 

Median 25.9 15.0 10.4 14.6 12.7 9.9 27.6 14.8 10.6 10.4 

Mean 25.9 17.3 13.0 16.9 15.5 13.1 27.6 17.5 13.4 13.6 

Central Asia Kazakhstan 1999 * * 1.9 * (11.7) 1.2 * * 1.9 1.8 354 

Kyrgyz Rep. 1997 * 4.7 4.4 2.5 8.0 3.6 * (9.5) 4.2 4.3 1,015 

Turkmenistan 2000 (0.0) 0.6 0.8 0.0 0.0 1.0 * 2.1 0.7 0.8 1,745 

Uzbekistan 1996 (0.0) 0.3 1.3 0.3 0.9 1.3 * 3.7 0.9 1.1 989 

Median 0.0 0.6 1.6 0.3 4.4 1.3 u 3.7 1.4 1.5 

Mean 0.0 1.9 2.1 0.9 5.2 1.8 u 5.1 1.9 2.0 

South/Southeast Asia Bangladesh 1999-00 25.5 20.2 18.6 25.7 19.1 19.0 (22.0) 24.2 19.5 20.0 3,306 

Cambodia 2000 26.4 24.2 21.5 24.1 19.0 22.3 19.5 22.8 22.1 22.1 4,006 

India 1998-99 22.8 20.6 18.2 20.9 20.7 18.8 23.1 20.9 19.3 19.6 27,094 

Nepal 2000 23.3 27.3 28.8 22.9 28.2 28.5 28.4 30.6 27.2 27.5 3,707 

Median 24.4 22.4 20.1 23.5 19.9 20.7 22.6 23.5 20.8 21.1 

Mean 24.5 23.1 21.8 23.4 21.8 22.1 23.3 24.6 22.0 22.3 

Latin America/Caribbean Bolivia 1998 29.4 34.2 25.6 29.0 26.0 26.0 * 28.5 26.2 26.3 3,451 

Brazil 1996 * 29.3 24.7 43.4 29.9 24.1 * 33.8 24.8 25.0 2,306 

Colombia 2000 (23.2) 19.7 10.1 19.1 13.9 10.2 * (10.4) 10.8 10.8 2,498 

Dominican Rep. 2002 (11.1) 24.0 22.2 19.9 24.7 22.1 * 14.1 22.3 22.2 5,612 

Guatemala 1998-99 26.3 23.6 20.8 21.6 18.6 22.9 * 28.7 21.4 21.6 2,149 

Haiti 2000 55.5 45.3 43.1 46.0 48.8 42.9 (61.0) 37.4 44.0 43.8 3,532 

Nicaragua 2001 60.3 37.0 32.9 35.3 41.0 32.6 * 46.2 33.4 33.7 3,443 

Peru 2000 23.4 26.5 21.3 25.2 23.1 21.1 * 21.0 21.7 21.7 6,070 

Median 26.3 27.9 23.5 27.1 25.4 23.5 u 28.6 23.6 23.6 

Mean 32.7 30.0 25.1 29.9 28.3 25.2 u 27.5 25.6 25.6 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and 

has been suppressed. 

u = Unknown
78 Acute Lower Respiratory Infection

Figure 4.3 

Percentage of children under age three years with ALRI symptoms in the two 

weeks preceding the survey, by low weight-for-tage status and region 

u = Unknown (insufficient data) 

4.1.6 Immunization Status 

Measles and pertussis are diseases that are often complicated by pneumonia. Lanata 

and Black (2001) conjecture that “increasing immunization coverage with measles 

vaccine and with diphtheria-pertussis-tetanus vaccine would be expected to lower the 

deaths from these two vaccine-preventable causes of acute respiratory infections.” 

On the other hand, most episodes of both ALRI morbidity and mortality are not a 

complication of measles or pertussis, but rather are attributable to a myriad of both 

viral (primarily respiratory syncytial virus [RSV], adenovirus, parainfluenza virus and 

influenza virus) and bacterial (primarily Streptococcus pneumoniae and Haemophilus 

influenzae) agents4

 (Lanata and Black, 2001). 

Full Immunization Coverage 

Figure A.2 in Appendix A shows, by country and residence, the percentage of children age 12-23 months5

 who received all recommended infant vaccinations at any 

time preceding the date of interview, according to either a vaccination card or 

mother’s recall. The data in Figure A.2 are derived from Table A.1 included in Appendix A. 

 

4 Haemophilus influenzae type b (Hib) is another etiological agent of pneumonia for which an 

effective vaccine is available, although it is not included as a routine childhood vaccination to 

date in most developing countries. 

5

 For Peru and Nicaragua, this age range is 18 to 29 months because the recommended age for 

measles vaccination in those countries is 15 rather than 9 months. 
Acute Lower Respiratory Infection 79

The WSC goal 22 for the end of the decade (year 2000) was the maintenance of a 

high level of full immunization coverage, specifically, greater than 90 percent of infants by 12 months of age. (In this report, completion is based on the date of interview rather than on the first birthday.) Only one country, Egypt, had met this goal in 

the year of its last full survey (2000), where full immunization was achieved among 

both urban and rural children in excess of 90 percent. Eighty percent coverage was 

achieved in urban areas in four countries (Tanzania, Mozambique, Eritrea, and 

Turkmenistan) and in rural areas in two countries (Uzbekistan and Turkmenistan). 

On the basis of regional averages, West/Middle Africa had the lowest percentages 

and Central Asia had the highest percentages of both urban and rural children age 

12-23 months who were fully immunized, according to the most recent surveys available. 

Urban-rural differentials in the percentage of children age 12-23 months fully 

immunized were computed for each country. Three-fourths (38 of 51) of these differentials are in excess of positive five percentage points; 12 exceed positive 20 percentage points. In West/Middle Africa, the regional mean urban-rural differential is 

the highest, at 21 percentage points. The largest urban-rural differentials are found in 

Burkina Faso, Niger, Ethiopia, Mozambique, and Yemen, ranging from 31 to 49 

percentage points. 

ALRI Symptoms and Full Immunization 

The percentage of children age 12-35 months with symptoms of ALRI in the two 

weeks preceding the survey is shown in Table 4.6 by age group and receipt or nonreceipt of all commonly recommended infant vaccines at any time prior to the date of 

interview. There is no evidence of a consistent significant association between receipt 

of all recommended infant vaccines and a lower probability of recent ALRI symptoms. 

The regional average prevalence values within age groupings do not differ appreciably by full immunization status. For each country, the difference in prevalence between fully immunized and not fully immunized children within each age group was 

computed. For age group 12 to 23 months, 13 differentials exceed an absolute value 

of five percentage points: 9 are negative and 4 are positive. The largest differential is 

found in Haiti, where ALRI symptoms were reported for 35 percent of fully immunized children versus 51 percent of not fully immunized children age 12-23 months. 

For the age group 24 to 35 months, only six differentials exceed an absolute value 

of five percentage points, the largest of which is in Armenia, where 12 percent of 

fully immunized versus 28 percent of not fully immunized children experienced recent ALRI symptoms.6

 

 

6

 The number of fully immunized children age 24-35 months in the Armenian sample is less 

than 50. 

There is no evidence of 

a consistent association 

between receipt of all 

recommended infant 

vaccines and a lower 

probability of recent 

ALRI symptoms. 
80 Acute Lower Respiratory Infection

Table 4.6 

Percentage of children age 12-23 months and 24-35 months with symptoms of acute lower 

respiratory infection (ALRI) in the two weeks preceding the survey, by immunization status, 

Demographic and Health Surveys 1996-2002 

Children age 12-23 months 

fully vaccinated 

Children age 24-35 months 

fully vaccinated 

Survey Yes No Yes No Total 

Number of 

children 

West/Middle Africa Benin 2001 13.0 18.0 9.7 12.1 12.9 1,848 

Burkina Faso 1998-99 19.2 18.8 12.1 11.6 15.4 2,030 

Cameroon 1998 14.2 22.9 14.7 15.4 17.5 1,443 

Chad 1996-97 22.7 14.7 16.1 12.0 14.1 2,431 

Côte d’Ivoire 1998-99 20.9 22.0 16.4 18.4 19.6 810 

Gabon 2000 22.7 14.9 10.0 13.3 14.5 1,529 

Ghana 1988 16.8 17.0 16.6 12.6 16.0 1,193 

Guinea 1999 19.9 20.6 16.0 13.2 17.1 1,906 

Mali 2001 11.9 11.9 11.2 9.7 11.1 4,223 

Mauritania 2000-01 9.2 10.2 10.5 7.8 9.3 1,771 

Niger 1998 13.6 13.5 10.8 11.3 12.4 2,757 

Nigeria 1999 13.1 13.2 9.9 10.6 12.0 2,099 

Togo 1998 17.7 25.8 16.8 14.4 19.2 2,324 

Median 16.8 17.0 12.1 12.1 14.5 

Mean 16.5 17.2 13.1 12.5 14.7 

South/East Africa Comoros 1996 24.4 20.8 24.1 18.4 22.4 674 

Eritrea 2002 22.5 25.4 21.1 19.9 21.9 2,000 

Ethiopia 2000 26.4 29.2 23.7 25.9 27.2 4,226 

Kenya 1998 21.4 22.9 19.3 20.2 20.9 2,118 

Madagascar 1997 21.0 27.2 17.1 23.2 23.0 2,257 

Malawi 2000 28.2 31.4 25.9 28.0 27.8 4,345 

Mozambique 1997 9.0 14.6 13.9 12.0 12.4 2,362 

Namibia 2000 25.0 21.7 19.7 14.9 21.0 1,529 

Rwanda 2000 24.8 27.6 20.9 17.6 22.9 2,562 

South Africa 1998 26.5 19.0 22.1 13.6 21.4 1,906 

Tanzania 1999 21.7 15.3 13.5 9.5 16.0 1,181 

Uganda 2000-01 24.2 31.0 21.8 21.7 25.4 2,760 

Zambia 2001-02 17.7 18.6 14.4 18.5 16.8 2,442 

Zimbabwe 1999 20.1 21.5 16.6 17.1 18.7 1,368 

Median 23.4 22.3 20.3 18.5 21.7 

Mean 22.4 23.3 19.6 18.6 21.3 

North Africa/West Asia/Europe Armenia 2000 8.4 13.9 12.0 (28.5) 12.1 581 

Egypt 2000 10.9 11.3 9.0 12.3 10.1 4,379 

Jordan 2002 9.1 7.5 7.8 5.5 7.0 2,289 

Yemen 1997 25.3 27.1 23.8 22.7 24.8 4,512 

Median 10.0 12.6 10.5 17.5 11.1 

Mean 13.4 14.9 13.1 17.3 13.5 

Central Asia Kazakhstan 1999 3.9 6.6 3.1 2.3 3.8 545 

Kyrgyz Rep. 1997 2.3 6.5 4.1 1.6 3.4 738 

Turkmenistan 2000 0.7 1.6 1.0 2.6 1.0 1,275 

Uzbekistan 1996 1.1 3.4 0.6 0.6 1.1 909 

Median 1.7 5.0 2.1 2.0 2.3 

Mean 2.0 4.5 2.2 1.8 2.3 

South/Southeast Asia Bangladesh 1999-01 20.7 21.9 13.8 19.3 18.5 2,615 

Cambodia 2000 22.6 24.9 21.5 20.7 22.4 2,632 

India 1998-99 17.2 22.1 14.2 19.8 18.8 20,125 

Indonesia 1997 10.7 11.7 8.3 9.6 10.0 6,109 

Nepal 2000 27.1 28.9 20.9 23.2 24.7 2,558 

Philippines 1998 18.0 18.4 14.9 14.8 16.5 2,921 

Vietnam 1997 17.5 16.7 13.6 15.3 15.7 1,240 

Median 18.0 21.9 14.2 19.3 18.5 

Mean 19.1 20.7 15.3 17.5 18.1 

Latin America/Caribbean Bolivia 1998 28.3 26.6 28.9 24.1 26.5 2,510 

Brazil 1996 28.0 26.4 25.0 26.9 26.5 1,853 

Colombia 2000 11.7 11.5 8.8 11.0 10.6 1,784 

Dominican Rep. 2002 23.4 22.4 18.8 20.3 21.3 4,384 

Guatemala 1998-99 20.8 25.6 17.9 18.0 20.3 1,716 

Haiti 2000 34.9 50.6 42.1 38.4 42.7 2,450 

Nicaragua 2001 32.8 38.1 32.0 27.4 33.2 2,012 

Peru 2000 22.1 23.8 18.8 19.3 21.5 3,500 

Median 25.7 26.0 21.9 22.2 24.0 

Mean 25.3 28.1 24.0 23.2 25.3 

Note: Figures in parentheses are based on 25-49 unweighted cases. 
Acute Lower Respiratory Infection 81

4.1.7 Environmental Factors 

Environmental risk factors for respiratory illnesses are well documented. Poor housing quality may result in the spread of molds and other allergens throughout the living quarters. The burning of biomass fuels in inefficient stoves or poorly ventilated 

living spaces increases the level of inhalation of suspended particulates, while crowding increases the spread of airborne infectious agents from person to person. 

In Tables 4.7.1 and 4.7.2, the percentage of urban or rural children, respectively, 

with recent symptoms of ALRI is shown by categories of several potential risk factors 

at the household level: natural floors (earth, sand, or dung) versus improved floors; 

smoke- or fume-producing cooking fuel versus clean-burning fuel; many (five or 

more) versus few (one to two) persons, on average, sharing sleeping rooms; and a larger (six or more) versus a smaller (one to five) number of household members. (The 

number of household members is included because many countries did not collect 

information on the number of sleeping rooms). 

4.1.7.1 Urban Residence 

Main Flooring Material 

Natural floors (earth, sand, or dung) are associated with a higher probability of recent 

ALRI symptoms among urban young children in many countries, particularly in 

South/East Africa and Latin America/Caribbean. 

Data for urban children in homes with primarily natural floors are too sparse to 

permit comparisons in the Central Asia region. Elsewhere, with the exception of 

West/Middle Africa, the regional average prevalence of ALRI symptoms is higher 

for urban children from homes with primarily natural floors in comparison with other 

urban children. 

The intracountry differentials in prevalence by natural versus improved flooring 

were computed. Fourteen of the 41 differentials exceed positive five percentage 

points, including 6 of 13 countries in South/East Africa and 4 of 8 countries in Latin 

America/Caribbean. The two largest positive differentials are found in Zambia and 

Brazil, where urban children in homes with primarily natural floors have a much 

higher period prevalence of ALRI symptoms than other urban children (28 versus 14 

percent and 40 versus 24 percent, respectively). 

Main Cooking Fuel 

On the basis of a limited number of surveys, there is a strong association between 

exposure to biomass fuels and ALRI symptoms in young urban children. 

Few of the surveys included in this report contained a household question about 

the main type of cooking fuel. However, where available, intracountry differentials in 

ALRI symptom prevalence were computed between children in urban homes using 

mainly smoke- or fume-producing cooking fuels and children in urban homes using 

mainly clean-burning cooking fuels. Twelve of the 14 computed differentials are 

positive, indicating a higher prevalence of ALRI symptoms among urban children 

exposed to greater amounts of smoke or fumes from cooking fuels. The largest positive difference is found in Haiti, where 38 percent of exposed children versus 16 percent of nonexposed children had recently experienced ALRI symptoms. 

Natural floors (earth, 

sand, or dung) are 

associated with a higher 

probability of recent ALRI 

symptoms among young 

urban children, 

particularly in South/East 

Africa and Latin 

America/Caribbean. 

There is a strong 

association between 

exposure to biomass fuels 

and ALRI symptoms in 

young urban children. 
82 Acute Lower Respiratory Infection

Table 4.7.1 

Percentage of urban children under age three with symptoms of acute lower respiratory infection 

(ALRI) in the two weeks preceding the survey, by potential environmental risk factors, Demographic 

and Health Surveys 1996-2002 

 Main cooking fuel

Main floor 

material Persons per sleeping room 

Number in 

household 

Survey Natural Improved 

Smoke or 

fume 

producing

Clean 

burning 1-2 3-4 5+ 1-5 6+ Total 

Number 

of children 

West/Middle Africa 

Benin 2001 9.1 13.1 12.6 9.0 * * * 13.2 11.6 12.3 931 

Burkina Faso 1999 (17.5) 11.4 - - 11.7 10.1 (19.8) 11.4 12.2 11.9 346 

Cameroon 1998 21.8 19.8 - - 18.6 22.0 (26.5) 16.6 21.3 20.2 622 

Chad 1997 13.9 16.7 - - 14.1 13.7 15.9 16.2 13.5 14.4 865 

Côte d’Ivoire 1998 * 15.7 - - 13.2 15.5 20.2 16.8 16.1 16.3 412 

Gabon 2000 15.4 15.9 - - 15.0 15.1 23.1 14.5 16.4 15.9 1,697 

Ghana 1998 * 11.5 - - 7.2 14.8 9.6 11.9 11.1 11.6 459 

Guinea 1999 13.3 16.9 - - 14.1 16.3 25.1 15.0 17.0 16.6 795 

Mali 2001 10.2 11.9 11.2 * - - - 13.0 10.2 11.2 1,706 

Mauritania 2000 12.9 13.6 - - 11.6 17.1 11.2 13.8 13.1 13.3 1,189 

Niger 1998 13.1 14.6 - - 16.9 13.7 10.5 15.2 13.8 14.2 733 

Nigeria 1999 9.5 10.5 - - 7.5 11.7 11.8 7.6 12.9 10.3 896 

Togo 1998 20.0 18.7 - - 15.1 20.2 25.9 20.7 17.5 18.8 865 

Median 13.3 14.6 11.9 u 14.1 15.1 19.8 14.5 13.5 14.2 

Mean 14.2 14.6 11.9 u 13.2 15.5 18.1 14.3 14.4 14.4 

South/East Africa 

Comoros 1996 22.1 21.9 - - 26.4 22.9 9.1 18.2 23.6 22.0 255 

Eritrea 2002 19.2 13.0 16.9 14.1 - - - 15.7 14.3 14.9 1,097 

Ethiopia 2000 20.2 16.9 21.6 10.4 - - - 18.4 20.3 19.3 649 

Kenya 1998 25.3 15.3 - - 17.3 17.8 17.7 18.2 16.4 17.6 600 

Madagascar 1997 17.5 21.6 - - 19.7 19.1 24.2 17.3 24.7 21.1 704 

Malawi 2000 20.8 15.3 18.7 7.0 - - - 14.5 20.4 17.2 891 

Mozambique 1997 16.1 15.4 - - 13.8 18.4 12.5 12.8 16.8 15.7 806 

Namibia 2000 18.2 17.2 17.8 17.3 - - - 13.7 20.4 17.4 810 

Rwanda 2000 23.5 16.3 19.1 * - - - 18.3 19.4 18.9 690 

South Africa 1998 15.3 21.3 - - 18.0 22.8 27.8 21.3 20.5 21.0 1,422 

Tanzania 1999 14.4 15.7 - - - - - 13.4 17.1 15.2 354 

Uganda 2000 26.7 21.6 23.2 17.9 - - - 23.7 21.7 22.9 486 

Zambia 2001 27.5 13.9 19.3 10.9 - - - 15.3 16.8 16.3 1,124 

Zimbabwe 1999 * 12.5 * 12.0 - - - 14.1 8.3 12.3 668 

Median 20.2 16.0 19.1 12.0 18.0 19.1 17.7 16.5 19.8 17.5 

Mean 20.5 17.0 19.5 12.8 19.0 20.2 18.3 16.8 18.6 18.0 

North Africa/West 

Asia/Europe 

Armenia 2000 8.1 10.4 (7.2) 9.8 - - - 7.3 11.3 9.6 453 

Egypt 2000 16.9 7.5 * 7.9 - - - 8.0 7.8 7.9 2,625 

Jordan 2002 * 7.5 * 7.5 - - - 7.2 7.8 7.5 2,680 

Yemen 1997 27.4 23.0 - - 23.8 24.7 21.5 24.3 23.5 23.7 1,631 

Median 16.9 8.9 u 7.9 u u u 7.7 9.6 8.8 

Mean 17.5 12.1 u 8.4 u u u 11.7 12.6 12.2 

Central Asia 

Kazakhstan 1999 * 2.6 - - - - - 2.4 2.9 2.6 327 

Kyrgyz Rep. 1997 * 2.5 - - 1.6 6.7 (0.0) 3.7 0.8 2.5 253 

Turkmenistan 2000 1.3 1.7 * 1.4 - - - 0.9 1.9 1.4 775 

Uzbekistan 1996 * 2.6 - - 3.1 1.9 * 4.2 1.6 2.5 414 

Median u 2.5 u u 2.3 4.3 u 3.1 1.8 2.5 

Mean u 2.3 u u 2.3 4.3 u 2.8 1.8 2.3 

South/Southeast Asia 

Bangladesh 2000 21.5 14.2 - - - - - 17.2 18.3 17.8 644 

Cambodia 2000 20.6 20.9 20.5 (22.2) - - - 17.1 22.6 20.7 552 

India 1999 - - - - - - - 14.8 16.7 16.0 6,928 

Indonesia 1997 4.1 8.6 - - - - - 8.5 8.2 8.4 2,624 

Nepal 2000 34.3 26.7 31.3 29.0 - - - 29.0 30.7 30.1 237 

Philippines 1998 11.1 13.8 - - 11.9 13.4 16.8 14.3 13.3 13.7 2,049 

Vietnam 1997 (14.2) 10.6 - - 10.4 11.7 10.6 9.7 12.7 11.0 255 

Median 17.4 14.0 25.9 25.6 11.1 12.5 13.7 14.8 16.7 16.0 

Mean 17.6 15.8 25.9 25.6 11.1 12.6 13.7 15.8 17.5 16.8 

Latin America/Caribbean 

Bolivia 1998 29.4 23.4 - - 23.9 20.6 26.7 23.0 26.0 24.4 2,219 

Brazil 1996 39.8 24.0 - - 22.9 26.5 28.2 24.0 26.2 24.8 2,104 

Dominican Rep. 2002 28.3 20.7 22.6 21.0 - - - 19.9 22.9 21.0 4,192 

Guatemala 1999 18.9 17.5 - - 8.4 20.5 21.7 17.5 18.2 17.9 991 

Haiti 2000 38.8 35.8 37.5 16.4 - - - 41.0 31.0 36.3 1,203 

Nicaragua 2001 35.6 27.9 36.0 26.3 - - - 29.7 31.5 30.8 1,931 

Peru 2000 23.2 19.3 22.1 20.4 - - - 18.2 22.8 20.6 3,744 

Median 29.4 23.4 29.3 20.7 22.9 20.6 26.7 23.0 26.0 24.4 

Mean 30.6 24.1 29.5 21.0 18.4 22.5 25.5 24.8 25.5 25.1 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted 

cases and has been suppressed. A dash indicates that information was not collected about this household factor. 

u = Unknown (too few cases to calculate estimate) 
Acute Lower Respiratory Infection 83

Table 4.7.2 

Percentage of rural children under age three with symptoms of acute lower respiratory infection (ALRI) 

in the two weeks preceding the survey, by potential environmental risk factors, Demographic and 

Health Surveys 1996-2002 

 Main cooking fuel 

Main floor 

material Persons per sleeping room 

Number in 

household 

Survey Natural Improved 

Smoke or 

fume producing 

Clean 

burning 1-2 3-4 5+ 1-5 6+ Total 

Number 

of children 

West/Middle Africa 

Benin 2001 12.9 14.0 13.5 * - - - 12.3 14.0 13.4 1,981 

Burkina Faso 1999 16.1 14.6 - - 15.8 16.2 15.2 15.1 16.1 15.8 2,872 

Cameroon 1998 19.3 19.9 - - 16.4 22.6 30.4 19.4 19.5 19.5 1,639 

Chad 1997 13.7 * - - 18.0 12.9 10.2 11.5 15.1 13.8 3,073 

Côte d’Ivoire 1998 24.5 17.2 - - 24.7 16.7 17.5 20.0 19.7 19.7 809 

Gabon 2000 14.2 11.0 - - 11.7 14.1 16.0 10.2 13.4 12.8 627 

Ghana 1998 21.1 16.8 - - 19.5 17.9 15.8 18.0 17.5 17.8 1,343 

Guinea 1999 18.1 21.5 - - 19.7 19.7 13.2 21.1 18.4 19.0 2,210 

Mali 2001 10.9 12.8 11.0 * - - - 10.2 11.5 11.0 5,269 

Mauritania 2000 8.9 9.8 - - 10.3 5.9 9.9 8.0 9.7 9.1 1,606 

Niger 1998 14.2 12.9 - - 15.9 13.8 11.7 13.3 14.6 14.2 3,671 

Nigeria 1999 11.4 12.1 - - 11.7 11.7 12.9 11.8 11.7 11.7 2,312 

Togo 1998 23.4 19.0 - - 19.8 20.3 25.5 22.4 20.0 20.7 2,828 

Median 14.2 14.3 12.3 u 16.4 16.2 15.2 13.3 15.1 14.2 

Mean 16.1 15.1 12.3 u 16.7 15.6 16.2 14.9 15.5 15.3 

South/East Africa Comoros 1996 26.2 16.3 - - 19.2 22.7 27.9 23.2 22.1 22.3 801 

Eritrea 2002 24.6 26.2 25.0 22.3 - - - 23.7 25.5 24.8 2,184 

Ethiopia 2000 28.3 39.1 28.5 * - - - 30.5 26.9 28.5 5,762 

Kenya 1998 20.9 19.8 - - 16.9 22.0 22.6 21.0 20.4 20.7 2,606 

Madagascar 1997 26.5 24.4 - - 25.8 23.5 25.1 23.6 25.4 24.6 2,833 

Malawi 2000 31.8 24.8 31.2 * - - - 31.2 31.1 31.1 5,972 

Mozambique 1997 10.8 10.8 - - 11.0 10.0 12.3 11.7 10.0 10.8 2,996 

Namibia 2000 24.8 13.9 23.6 16.0 - - - 21.0 23.5 22.8 1,536 

Rwanda 2000 27.0 25.5 26.9 * - - - 29.5 23.5 26.9 3,604 

South Africa 1998 24.2 22.0 - - 23.1 23.8 19.4 24.6 21.7 22.8 1,490 

Tanzania 1999 17.2 23.8 - - - - - 20.5 16.0 17.5 1,463 

Uganda 2000 26.9 23.5 26.6 28.0 - - - 26.1 27.0 26.6 3,759 

Zambia 2001 18.3 16.5 18.0 (21.0) - - - 18.2 17.9 18.1 2,556 

Zimbabwe 1999 21.9 20.1 21.1 (18.6) - - - 23.1 19.3 21.0 1,361 

Median 24.7 22.8 25.8 21.0 19.2 22.7 22.6 23.4 22.8 22.8 

Mean 23.5 21.9 25.1 21.2 19.2 20.4 21.5 23.4 22.2 22.8 

North Africa/West Asia/Europe Armenia 2000 13.5 8.1 12.5 12.0 - - - 9.4 13.6 12.3 427 

Egypt 2000 14.9 9.6 15.9 11.4 - - - 10.6 12.0 11.6 4,116 

Jordan 2002 * 6.7 * 6.7 - - - 6.7 6.7 6.7 774 

Yemen 1997 26.5 24.4 - - 24.7 26.5 24.8 26.8 25.1 25.5 5,425 

Median 14.9 8.9 14.2 11.4 u u u 10.0 12.8 12.0 

Mean 18.3 12.2 14.2 10.0 u u u 13.4 14.4 14.0 

Central Asia Kazakhstan 1999 * 3.6 - - - - - 3.5 3.3 3.4 462 

Kyrgyz Rep. 1997 4.1 5.0 - - 5.2 2.8 3.8 4.1 5.3 5.0 851 

Turkmenistan 2000 0.4 0.0 * 0.4 - - - 0.6 0.2 0.4 1,192 

Uzbekistan 1996 0.0 0.8 - - 0.5 0.7 0.0 0.8 0.4 0.5 911 

Median 0.4 2.2 u u 2.8 1.8 1.9 2.2 1.9 2.0 

Mean 1.5 2.3 u u 2.8 1.8 1.9 2.3 2.3 2.3 

South/Southeast Asia Bangladesh 2000 19.9 18.0 - - - - - 21.2 18.7 19.8 3,283 

Cambodia 2000 22.1 18.8 22.0 * - - - 22.4 21.7 22.0 3,680 

India 1999 * * - - - - - 20.7 19.8 20.1 23,741 

Indonesia 1997 10.0 10.6 - - - - - 9.6 11.7 10.4 6,698 

Nepal 2000 27.2 22.5 26.8 30.2 - - - 28.6 26.1 27.0 3,603 

Philippines 1998 18.5 16.0 - - 14.7 15.6 18.3 14.9 17.5 16.4 2,366 

Vietnam 1997 15.3 14.2 - - 15.2 13.6 15.7 16.0 12.9 14.7 1,513 

Median 19.2 17.0 24.4 u 14.9 14.6 17.0 20.7 18.7 19.8 

Mean 18.9 16.7 24.4 u 14.9 14.6 17.0 19.3 18.4 18.8 

Latin America/Caribbean Bolivia 1998 28.3 26.0 - - 22.5 25.1 29.2 27.8 27.6 27.7 1,606 

Brazil 1996 25.7 25.6 - - 21.7 27.1 36.5 23.7 28.0 25.6 653 

Dominican Rep. 2002 25.9 22.4 23.9 22.5 - - - 21.6 24.8 22.9 2,204 

Guatemala 1999 22.7 23.6 - - 23.6 23.5 22.9 21.3 23.8 23.0 1,627 

Haiti 2000 47.1 45.3 46.6 * - - - 46.9 46.3 46.5 2,442 

Nicaragua 2001 37.2 31.7 36.7 27.7 - - - 34.6 37.0 36.1 1,875 

Peru 2000 22.8 18.0 22.1 23.1 - - - 22.5 22.0 22.2 3,046 

Median 25.9 25.6 30.3 23.1 22.5 25.1 29.2 23.7 27.6 25.6 

Mean 30.0 27.5 32.3 24.4 22.6 25.2 29.5 28.3 29.9 29.1 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted 

cases and has been suppressed. A dash indicates that information was not collected about this household factor. 

u = Unknown (too few cases to calculate estimate) 
84 Acute Lower Respiratory Infection

Crowding 

On the basis of a limited number of surveys, crowding as measured by average number of persons per sleeping room is positively associated with an increased prevalence 

of ALRI symptoms in young urban children, but not crowding as measured by number of household members. 

Less than half of the surveys collected the number of rooms in the home used for 

sleeping. For those that did, the average number of persons per sleeping room can be 

used as a measure of crowding. Intracountry differentials in the period prevalence of 

ALRI symptoms between urban children in less crowded homes (one to two persons 

per sleeping room) and more crowded homes (five or more persons per sleeping 

room) were computed where possible. Seventeen of the 23 differentials are negative, 

indicating a lower prevalence of ALRI symptoms among urban children in less 

crowded homes; 8 of these are in excess of five percentage points. The largest negative difference is found in Guatemala (8 versus 21 percent). In contrast, just one 

equally large positive difference is found, in Comoros (26 versus 9 percent). 

The number of household members is a second, but broader, measure of crowding 

that is available from every survey. The regional average period prevalence of ALRI 

symptoms is not appreciably different for urban children in smaller (one to five) 

households compared with larger (six or more) households. The corresponding intracountry differentials were computed. Three-fifths of these 49 differentials are negative, but most are relatively small. Of the eight differentials with an absolute value in 

excess of five percentage points, two are positive, the largest being that of Haiti (41 

versus 31 percent). 

4.1.7.2 Rural Residence 

Main Flooring Material 

In general, natural floor materials (earth, sand, or dung) are associated with a higher 

probability of recent ALRI symptoms in young rural children. 

With the exception of Central Asia, for which the country-specific prevalences of 

ALRI symptoms are all under 5 percent, the regional average prevalence of ALRI 

symptoms is higher for rural children in homes with primarily natural floors compared with other rural children. The intracountry differentials in prevalence by natural versus improved flooring were computed. Three-fourths of these 45 differentials 

are positive, but only 7 exceed positive five percentage points. The largest positive 

difference is found in Namibia, where rural children in homes with primarily natural 

floors have a substantially higher period prevalence of ALRI symptoms than other 

rural children (25 versus 14 percent). However, in Ethiopia, an equally large negative 

difference is found (28 versus 39 percent). 

Main Cooking Fuel 

Only 11 intracountry differentials in the period prevalence of ALRI symptoms could 

be computed between children in rural homes using mainly smoke- or fumeproducing cooking fuels and children in rural homes using mainly clean- burning 

cooking fuels. Of these, only two were larger than positive five percentage points 

(Namibia and Nicaragua). 

Crowding as measured by 

average number of persons 

per sleeping room is positively 

associated with an increased 

prevalence of ALRI symptoms 

in young urban children. 

Natural floor materials 

(earth, sand, or dung) 

are associated with a 

higher probability of 

recent ALRI symptoms in 

young rural children. 
Acute Lower Respiratory Infection 85

Crowding 

In rural areas, crowding as measured by either persons per sleeping room or household members is not significantly associated with ALRI symptom prevalence in 

young children. 

Intracountry differentials in the period prevalence of ALRI symptoms between rural children in less crowded homes (one to two persons per sleeping room) and more 

crowded homes (five or more persons per sleeping room) were computed where possible. Just half of the 24 differentials are negative. The largest negative differences are 

those from Cameroon (16 versus 30 percent) and Brazil (22 versus 36 percent). 

Turning to the second measure of crowding, the regional average period prevalence of ALRI symptoms is not appreciably different for rural children in smaller 

households (one to five) compared with larger (six or more) households. The corresponding intracountry differentials were computed. All but 1 of these 49 differentials 

is relatively small, with an absolute value of less than five percentage points; less than 

half are negative. 

In rural areas, crowding 

is not significantly 

associated with ALRI 

symptom prevalence in 

young children. 

References 87
Fever 87

 5

Fever 

5.1 Prevalence Levels and Differentials 

ever is the most common symptom1 of illness in young children, and it is associated with a wide range of causes in different regions of the world. Thus, differential diagnosis by a health care practitioner of a child presenting with fever requires 

knowledge of locally endemic and epidemic diseases that may or may not be seasonal. 

Fever is a common symptom of both non-life-threatening illnesses, which do not 

require medical attention, like most viral-based acute upper respiratory illnesses, and 

extremely life-threatening illnesses which do require urgent medical attention, like 

cerebral malaria, meningitis, septicemia, and typhoid. In surveys such as DHS surveys, it is not possible to either validate or determine the cause of any recent fever 

that the mother reports for her child, and thus whether or not particular types of 

treatments, such as antimalarials or antibiotics, might have been appropriate. 

5.1.1 Residence 

The percentage of children under age three years whose mothers reported that the 

child had experienced a fever at any time in the two weeks preceding the survey is 

shown in Table 5.1 by place of residence. The highest regional average prevalence of 

fever is found in South/Southeast Africa, with a mean of 39 percent (range 22 to 50 

percentage points). In every country included in sub-Saharan Africa, South/Southeast Asia, and Latin America/Caribbean, the two-week period prevalence of fever 

exceeds 20 percent. The lowest regional average prevalence is found in Central Asia, 

with a mean of 10 percent (range 5 to 14 percentage points). In North Africa/West 

Asia/Europe, however, the only country among the four included for which the 

prevalence of fever exceeds 20 percent is Yemen, at 43 percent. 

Overall, young children in rural areas are somewhat more likely than their urban 

counterparts to have experienced recent fever symptoms. 

Figure 5.1 shows the percentage of children with fever by country and residence, 

arranged by region. The difference in prevalence of fever between urban and rural 

children within each country was computed. The majority of these differentials are 

negative. In 14 countries, fever prevalence among rural children exceeds that among 

same-age urban children by more than five percentage points, while a positive differential of the same magnitude is found in only one country, Turkmenistan. 

 

1

 Technically speaking, fever refers to a measured elevation in body temperature, which is 

considered a sign, whereas feverishness refers to a subjective sensation of abnormal warmth, 

which is considered a symptom. 

F

The highest regional 

average prevalence of 

fever is found in 

South/Southeast Africa, 

with a mean of 

39 percent. 

Young children in rural 

areas are somewhat more 

likely than their urban 

counterparts to have 

experienced recent 

fever symptoms. 
88 Fever

Table 5.1 

Percentage of children under age three with a fever in the two weeks preceding the survey, by 

residence and age, Demographic and Health Surveys 1996-2002 

Residence Age in months 

Survey Urban Rural 0-5 6-11 12-17 18-23 24-29 30-35 Total 

Number 

of 

children 

West/Middle Africa Benin 2001 39.9 49.6 29.1 53.4 54.3 52.8 45.2 45.9 46.5 2,912 

Burkina Faso1998-99 33.6 41.6 27.3 50.7 49.7 48.6 38.1 31.9 40.8 3,219 

Cameroon 1998 29.3 30.4 18.0 37.6 39.4 30.1 30.8 24.7 30.1 2,260 

Chad 1996-97 36.1 36.7 28.6 42.4 42.5 36.1 37.1 32.3 36.5 3,938 

Côte d’Ivoire 1998-99 35.2 43.3 23.0 48.5 46.1 42.7 42.7 35.1 40.5 1,221 

Gabon 2000 33.3 29.5 21.9 34.4 41.5 31.1 34.5 28.7 32.3 2,324 

Ghana 1998 26.4 29.6 11.2 31.2 32.3 34.2 28.6 35.0 28.8 1,802 

Guinea 1999 44.2 50.3 41.2 57.3 56.2 53.3 44.4 42.8 48.7 3,005 

Mali 2001 28.7 31.5 22.2 35.3 35.9 35.8 31.0 26.7 30.8 6,973 

Mauritania 2000-01 35.5 32.0 29.1 38.5 36.0 36.4 30.3 29.1 33.5 2,796 

Niger 1998 40.3 49.9 43.2 57.7 55.0 46.5 46.2 39.1 48.3 4,403 

Nigeria 1999 26.5 31.7 21.6 35.7 34.3 34.8 27.9 26.0 30.2 3,208 

Togo 1998 37.1 37.4 24.9 45.1 47.2 42.5 34.6 30.3 37.3 3,693 

Median 35.2 36.7 24.9 42.4 42.5 36.4 34.6 31.9 36.5 

Mean 34.3 38.0 26.3 43.7 43.9 40.4 36.3 32.9 37.3 

South/East Africa Comoros 1996 47.8 47.6 39.5 55.2 55.6 51.8 41.2 39.3 47.6 1,056 

Eritrea 2002 30.4 37.1 19.3 44.8 45.9 39.6 34.2 27.8 34.9 3,281 

Ethiopia 2000 29.6 32.9 25.7 39.5 38.1 32.4 32.0 26.3 32.5 6,412 

Kenya 1998 41.7 42.4 31.6 46.4 47.8 45.5 44.3 36.8 42.3 3,205 

Madagascar 1997 30.6 32.6 25.7 36.2 38.2 34.0 29.2 29.0 32.2 3,537 

Malawi 2000 37.0 49.8 37.2 56.2 55.6 51.8 47.6 40.1 48.1 6,862 

Mozambique 1997 49.2 42.7 36.6 46.8 54.2 39.2 47.1 38.2 44.0 3,803 

Namibia 2000 24.7 21.2 19.7 28.0 25.0 25.3 16.3 19.3 22.4 2,346 

Rwanda 2000 25.6 37.8 30.9 44.2 40.4 35.7 30.6 28.9 36.9 4,293 

Tanzania 1999 39.0 41.9 32.1 50.7 57.3 44.0 31.3 32.8 41.3 1,817 

Uganda 2000-01 38.6 50.7 32.3 56.6 57.2 57.8 47.7 40.4 49.3 4,245 

Zambia 2001-02 39.0 54.9 34.4 59.0 57.1 54.7 51.0 43.7 50.0 3,681 

Zimbabwe 1999 27.4 31.5 18.1 39.0 38.6 34.2 31.7 19.7 30.2 2,029 

Median 37.0 41.9 31.6 46.4 47.8 39.6 34.2 32.8 41.3 

Mean 35.4 40.2 29.5 46.4 47.0 42.0 37.2 32.5 39.4 

North Africa/West Asia/Europe Armenia 2000 17.2 16.2 2.8 17.8 19.1 17.3 18.5 25.0 16.7 880 

Egypt 2000 16.8 21.4 15.3 25.7 21.3 20.4 19.4 15.5 19.6 6,741 

Jordan 2002 11.4 10.5 6.8 13.6 17.5 12.3 9.3 7.0 11.2 3,454 

Yemen 1997 39.7 43.9 34.9 47.0 49.4 45.8 41.8 39.1 43.0 7,056 

Median 17.0 18.8 11.1 21.8 20.2 18.9 19.0 20.3 18.2 

Mean 21.3 23.0 15.0 26.0 26.8 24.0 22.3 21.7 22.6 

Central Asia Kazakhstan 1999 12.5 14.1 7.4 15.2 26.9 15.0 10.9 4.0 13.5 788 

Kyrgyz Rep. 1997 14.5 12.6 8.4 16.0 16.4 19.0 7.6 11.0 13.1 1,104 

Turkmenistan 2000 8.2 3.0 2.1 7.5 6.5 4.1 6.0 4.3 5.1 1,968 

Uzbekistan 1996 9.7 7.5 7.8 7.8 9.6 8.4 7.8 7.6 8.2 1,325 

Median 11.1 10.1 7.6 11.5 13.0 11.7 7.7 6.0 10.7 

Mean 11.2 9.3 6.4 11.6 14.9 11.6 8.1 6.7 10.0 

South/Southeast Asia Bangladesh 1999-00 42.6 41.1 34.4 49.6 48.4 39.0 39.6 38.2 41.4 3,927 

Cambodia 2000 38.9 39.4 27.7 47.7 43.5 43.7 40.0 34.8 39.4 4,232 

India 1998-99 28.2 29.2 19.7 33.6 34.0 32.1 29.0 25.8 29.0 30,668 

Indonesia 1997 29.0 29.2 15.1 38.9 34.1 32.2 27.0 26.7 29.1 9,322 

Nepal 2000 33.4 37.3 27.9 47.8 41.7 40.2 34.9 29.9 37.1 3,840 

Philippines 1998 28.2 30.9 20.8 39.7 35.7 31.9 28.3 20.5 29.7 4,415 

Vietnam 1997 20.6 21.2 14.8 26.4 30.5 21.7 15.8 17.0 21.1 1,769 

Median 29.0 30.9 20.8 39.7 35.7 32.2 29.0 26.7 29.7 

Mean 31.6 32.6 22.9 40.5 38.3 34.4 30.7 27.6 32.4 

Latin America/Caribbean Bolivia 1998 34.1 37.3 25.0 43.4 41.3 36.8 33.5 31.2 35.5 3,826 

Brazil 1996 28.0 33.0 21.7 36.6 33.4 29.8 26.0 26.7 29.2 2,757 

Colombia 2000 29.6 23.9 16.1 31.0 34.0 29.1 26.7 28.8 27.8 2,725 

Dominican Rep. 2002 29.3 30.1 20.2 35.3 35.0 33.3 26.1 26.8 29.6 6,395 

Guatemala 1998-99 27.1 32.3 24.8 38.2 34.6 34.5 27.9 21.8 30.3 2,618 

Haiti 2000 34.7 50.0 27.4 55.2 48.5 51.5 41.1 43.2 45.0 3,645 

Nicaragua 2001 26.3 29.3 15.7 31.9 32.3 31.8 26.8 26.1 27.8 3,807 

Peru 2000 24.7 33.4 21.1 32.0 32.4 31.5 28.3 25.5 28.6 6,790 

Median 28.7 32.7 21.4 36.0 34.3 32.6 27.4 26.8 29.4 

Mean 29.2 33.7 21.5 38.0 36.4 34.8 29.6 28.8 31.7 
Fever 89

Figure 5.1 

Percentage of children under age three years with fever in the two weeks preceding the survey, by 

residence 
90 Fever

5.1.2 Child’s Age 

As a child ages, his/her immune system matures. Simultaneously, however, the 

child becomes exposed to increasing opportunities for infection as his/her social network expands. 

Table 5.1 shows the prevalence of fever by child’s age in months. The regional 

mean prevalence by age is shown in Figure 5.2. The trajectories are fairly similar for 

all regions. In each region, the mean prevalence of fever is lowest for the youngest 

infants (age 0-5 months), peaks at age 6-17 months, and then declines. At age 30-35 

months, however, the mean prevalence of fever is still higher than at age 0-5 months, 

outside of Central Asia. 

Figure 5.2 

Mean percentage of children under age three years with fever in the two weeks 

preceding the survey, by age in months 

0

5

10

15

20

25

30

35

40

45

50

0-5 6-11 12-17 18-23 24-29 30-35

West/Middle Africa South/East Africa North Africa/West Asia/Europe

Central Asia South/Southeast Asia Latin America/Caribbean

5.1.3 Socioeconomic Characteristics 

Residence and Wealth Index 

Table 5.2 shows the prevalence of fever by residence and three categories of the 

country-specific household wealth index distribution. A strong negative association 

between household wealth and the probability of recent fever in young children is 

observed in both urban and rural areas, with few exceptions. 
Fever 91

Table 5.2 

Percentage of children under age three with a fever in the two weeks preceding the survey, by residence 

and wealth index, Demographic and Health Surveys 1996-2002 

 Urban Rural 

 Household wealth index Household wealth index 

Survey 

Lowest 

40% 

Middle 

40% 

Highest 

20% Total 

Number 

of children 

Lowest 

40% 

Middle 

40% 

Highest 

20% Total 

Number 

of children 

West/Middle Africa Benin 2001 51.5 42.5 32.2 39.9 931 51.5 48.7 28.9 49.6 1,981 

Burkina Faso 1998-99 * (44.6) 33.2 33.6 346 40.8 42.0 45.8 41.6 2,872 

Cameroon 1998 (35.3) 33.1 25.2 29.3 622 29.3 33.3 25.0 30.4 1,639 

Chad 1996-97 30.3 35.6 36.6 36.1 865 35.0 39.2 37.0 36.7 3,073 

Côte d’Ivoire 1998-99 * 38.8 28.9 35.0 362 49.4 34.1 * 43.5 729 

Gabon 2000 32.0 35.5 29.9 33.3 1,697 30.2 23.3 * 29.5 627 

Ghana 1988 * 26.1 26.7 26.4 459 31.9 25.4 (29.9) 29.6 1,343 

Guinea 1999 * 39.9 47.3 44.2 795 49.8 50.9 (54.6) 50.3 2,210 

Mali 2001 50.3 24.3 28.8 28.7 1,706 32.1 31.5 22.8 31.6 5,265 

Mauritania 2000-01 45.4 35.2 33.9 35.5 1,189 31.7 34.2 (13.2) 32.0 1,606 

Niger 1998 * 44.3 39.2 40.3 733 49.9 50.5 45.1 49.9 3,671 

Togo 1998 45.0 38.2 35.5 37.1 865 38.6 35.5 35.0 37.4 2,828 

Median 45.0 36.9 32.7 35.3 36.8 34.9 32.4 37.1 

Mean 41.4 36.5 33.1 35.0 39.2 37.4 33.7 38.5 

South/East Africa Comoros 1996 42.3 50.5 50.0 47.8 255 47.2 48.1 47.2 47.6 801 

Eritrea 2002 (34.4) 36.0 24.6 30.4 1,097 38.7 34.9 * 37.1 2,184 

Ethiopia 2000 * 28.9 29.8 29.6 649 31.2 34.6 32.7 32.9 5,762 

Kenya 1998 (37.9) 48.4 38.4 41.7 600 44.6 40.4 37.3 42.4 2,606 

Madagascar 1997 32.0 32.0 28.9 30.6 704 32.7 32.4 32.3 32.6 2,833 

Malawi 2000 50.7 43.2 34.4 37.0 890 50.2 48.9 51.4 49.8 5,967 

Mozambique 1997 * 52.9 46.4 49.2 806 44.7 42.3 33.0 42.7 2,996 

Namibia 2000 34.5 26.9 21.0 24.7 810 21.7 19.7 28.1 21.2 1,536 

Rwanda 2000 (36.7) 42.2 24.2 27.8 690 40.9 37.1 36.7 38.6 3,604 

Tanzania 1999 (52.3) 42.4 36.6 39.0 354 42.4 41.3 41.7 41.9 1,463 

Uganda 2000-01 (31.1) 44.2 37.7 38.6 486 54.1 46.8 48.8 50.7 3,759 

Zambia 2001-02 * 45.8 30.8 39.0 1,124 55.8 54.7 29.0 54.9 2,556 

Zimbabwe 1999 * 27.9 27.1 27.4 668 31.4 32.0 * 31.5 1,361 

Median 36.7 42.4 30.8 37.0 42.4 40.4 36.7 41.9 

Mean 39.1 40.1 33.1 35.6 41.2 39.5 38.0 40.3 

North Africa/West Asia/Europe Armenia 2000 21.2 19.2 13.0 17.2 453 16.9 15.2 * 16.2 427 

Egypt 2000 19.2 19.3 13.5 16.8 2,625 21.5 21.2 20.5 21.4 4,116 

Jordan 2002 12.2 11.5 8.1 11.4 2,680 10.3 11.7 4.9 10.5 774 

Yemen 1997 (29.2) 39.4 40.6 39.7 1,631 49.1 39.8 27.8 43.9 5,425 

Median 20.2 19.3 13.3 17.0 19.2 18.2 20.5 18.8 

Mean 20.5 22.4 18.8 21.3 24.5 22.0 17.7 23.0 

Central Asia Kazakhstan 1999 * 13.3 10.4 12.5 326 14.4 13.5 * 14.1 462 

Kyrgyz Rep. 1997 (3.7) 17.9 14.1 14.5 253 14.1 11.6 (3.1) 12.6 851 

Turkmenistan 2000 8.1 7.9 8.0 7.9 769 2.7 3.5 * 3.0 1,192 

Uzbekistan 1996 1.6 10.0 12.0 9.7 414 7.5 8.1 (0.0) 7.5 911 

Median 3.7 11.7 11.2 11.1 10.8 9.9 1.6 10.1 

Mean 4.5 12.3 11.1 11.1 9.7 9.2 1.6 9.3 

South/Southeast Asia Bangladesh 1999-00 47.7 42.9 40.6 42.6 644 43.8 38.6 36.1 41.1 3,283 

Cambodia 2000 34.9 35.5 43.2 38.9 552 39.1 40.4 37.0 39.4 3,680 

India 1998-99 25.7 30.9 26.1 28.2 6,928 29.5 29.0 27.5 29.2 23,741 

Indonesia 1997 25.3 32.1 26.2 29.0 2,624 29.3 29.9 24.1 29.2 6,698 

Nepal 2000 (25.6) 45.0 31.7 33.4 237 36.7 38.8 34.2 37.3 3,603 

Philippines 1998 34.0 28.8 21.0 28.2 2,049 31.1 32.2 20.3 30.9 2,366 

Vietnam 1997 * 25.8 17.6 20.6 255 20.1 25.1 10.1 21.2 1,513 

Median 29.8 32.1 26.2 29.0 31.1 32.2 27.5 30.9 

Mean 32.2 34.4 29.5 31.6 32.8 33.4 27.0 32.6 

Latin America/Caribbean Bolivia 1998 35.3 33.9 33.8 34.1 2,219 37.2 38.1 * 37.3 1,606 

Brazil 1996 32.7 25.5 23.4 28.0 2,104 33.1 32.6 * 33.0 653 

Colombia 2000 33.5 27.8 28.7 29.6 1,863 23.7 27.1 * 23.9 862 

Guatemala 1998-99 33.7 28.8 19.6 27.1 991 35.0 29.7 (14.5) 32.3 1,627 

Haiti 2000 46.0 37.1 31.4 34.7 1,203 53.2 44.0 (44.7) 50.0 2,442 

Nicaragua 2001 33.5 26.1 23.3 26.3 1,931 30.6 22.7 * 29.3 1,875 

Peru 2000 28.9 26.2 17.7 24.7 3,744 34.7 21.5 * 33.4 3,046 

Median 33.5 27.8 23.4 28.0 34.7 29.7 29.6 33.0 

Mean 34.8 29.3 25.4 29.2 35.4 30.8 29.6 34.2 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25

unweighted cases and has been suppressed. 
92 Fever

In Figures 5.3.1 and 5.3.2, the range, mean, and median prevalence of fever are 

shown by residence, region, and level of household wealth. With the exception of 

Central Asia, the prevalence of fever in young children generally decreases with increasing household wealth in both urban and rural areas. 

For each country, the difference between the period prevalence of fever among 

children in households in the lowest 40 percent of the wealth index distribution and 

children in households in the highest 20 percent was computed. In urban areas, over 

half of these differentials (19 of 36) are positive by more than five percentage points, 

and over a third (13 of 36) exceed ten percentage points. The largest positive differential is found in Mali, where 50 percent of urban children in the least wealthy 

households have had a recent episode of fever, compared with 29 percent of those in 

the wealthiest households. In Latin America/Caribbean, all seven of the urban differentials are positive. In contrast, in Yemen, the Kyrgyz Republic, and Uzbekistan, urban children in the least wealthy households were less likely by more than ten percentage points to have had fever in the past two weeks compared with urban children 

in the wealthiest households.2

 

In rural areas, again, half of the computed differentials in fever prevalence by 

household wealth are greater than positive five percentage points (17 of 35). In four 

countries (Benin, Zambia, Yemen, and Guatemala), rural children in the poorest 

households are more likely by more than 20 percentage points to have experienced 

fever in the past two weeks than rural children in the wealthiest households. 

In rural areas, only 6 of 35 differentials are negative. 

Residence and Mother’s Education 

The period prevalence of fever by residence and mother’s education (highest level 

completed) is shown in Table 5.3. Because few mothers in Central Asia have not 

completed at least one year of secondary school, data in the first two educational 

categories are sparse for that region. 

In most countries, a moderate to strong negative association is seen between 

mother’s educational attainment and the probability of recent fever in urban children. 

On the basis of regional average prevalence by education, prevalence of fever 

among urban children decreases most prominently with increasing maternal education in the regions of South/East Africa, South/Southeast Asia, and Latin America/Caribbean. 

 

2

 The number of urban children in the poorest wealth index category is less than 50 for the 

samples from Yemen and the Kyrgyz Republic. 

With the exception of 

Central Asia, the 

prevalence of fever in 

young children generally 

decreases with increasing 

household wealth. 

In most countries, a 

negative association is 

seen between mother’s 

education and the 

probability of recent fever 

in urban children. 
Fever 93

Figure 5.3.1 

Percentage of urban children under age three years with fever in the two 

weeks preceding the survey, by wealth index and region 

Figure 5.3.2 

Percentage of rural children under age three years with fever in the two weeks 

preceding the survey, by wealth index and region 

u = Unknown (insufficient data) 
94 Fever

Table 5.3 

Percentage of children under age three with a fever in the two weeks preceding the survey, 

by residence and mother’s education, Demographic and Health Surveys 1996-2002 

 Urban Rural 

 Highest level of 

education 

Highest level of 

education 

Survey None Primary Secondary+ Total 

Number 

of children None Primary Secondary+ Total 

Number 

of children 

West/Middle Africa 

Benin 2001 45.4 36.8 29.2 39.9 931 49.7 49.9 45.7 49.6 1,981 

Burkina Faso 1998-99 34.6 37.9 27.2 33.6 346 41.4 43.8 * 41.6 2,872 

Cameroon 1998 30.6 29.1 28.9 29.3 622 23.8 34.7 33.6 30.4 1,639 

Chad 1996-97 32.7 38.4 46.7 36.1 865 35.1 44.4 * 36.7 3,073 

Côte d’Ivoire 1998-99 35.2 32.3 40.0 35.2 412 45.6 38.8 * 43.3 809 

Gabon 2000 23.0 35.3 33.5 33.3 1,697 (40.5) 27.4 32.4 29.5 627 

Ghana 1988 29.8 27.6 24.7 26.4 459 31.1 29.3 28.0 29.6 1,343 

Guinea 1999 42.8 44.6 48.6 44.2 795 50.4 48.2 (53.3) 50.3 2,210 

Mali 2001 29.5 25.2 29.2 28.7 1,706 31.3 33.1 41.7 31.6 5,267 

Mauritania 2000-01 38.2 35.3 29.6 35.5 1,189 31.8 31.4 (39.4) 32.0 1,606 

Niger 1998 41.2 36.5 41.7 40.3 733 50.3 44.6 (46.4) 49.9 3,671 

Nigeria 1999 28.1 29.3 24.1 26.5 896 30.4 36.2 29.6 31.7 2,312 

Togo 1998 38.9 37.7 33.2 37.1 865 39.8 31.8 35.4 37.4 2,828 

Median 34.6 35.3 29.6 35.2 39.8 36.2 37.4 36.7 

Mean 34.6 34.3 33.6 34.3 38.6 38.0 38.5 38.0 

South/East Africa 

Comoros 1996 47.7 51.9 45.1 47.8 255 47.3 50.0 44.0 47.6 801 

Eritrea 2002 39.0 30.4 23.6 30.4 1,097 38.5 34.3 (10.9) 37.1 2,184 

Ethiopia 2000 28.0 23.6 35.2 29.6 649 32.5 35.5 30.5 32.9 5,762 

Kenya 1998 (32.0) 46.8 36.9 41.7 600 45.5 43.3 38.1 42.4 2,606 

Madagascar 1997 30.9 32.4 28.5 30.6 704 35.3 31.8 31.2 32.6 2,833 

Malawi 2000 38.0 39.7 30.9 37.0 891 50.5 50.2 38.5 49.8 5,972 

Mozambique 1997 53.1 49.3 40.2 49.2 806 42.3 42.8 (48.7) 42.7 2,996 

Namibia 2000 35.9 28.3 22.2 24.7 810 21.9 21.9 20.2 21.2 1,536 

Rwanda 2000 48.6 29.7 19.6 27.8 690 38.3 39.8 29.3 38.6 3,604 

Tanzania 1999 48.4 39.9 26.4 39.0 354 44.0 41.3 28.7 41.9 1,463 

Uganda 2000-01 35.3 46.1 30.0 38.6 486 50.2 51.3 47.0 50.7 3,758 

Zambia 2001-02 (63.3) 42.9 32.2 39.0 1,124 58.1 55.4 47.3 54.9 2,556 

Zimbabwe 1999 * 27.0 27.8 27.4 668 28.9 31.3 32.5 31.5 1,361 

Median 38.5 39.7 30.0 37.0 42.3 41.3 32.5 41.9 

Mean 41.7 37.5 30.7 35.6 41.0 40.7 34.4 40.3 

North Africa/West Asia/Europe 

Armenia 2000 * * 17.2 17.2 453 * * 15.9 16.2 427 

Egypt 2000 16.5 18.9 16.5 16.8 2,625 22.4 18.4 21.2 21.4 4,116 

Jordan 2002 3.4 8.0 11.8 11.4 2,680 14.5 13.1 9.5 10.5 774 

Yemen 1997 40.6 39.3 37.8 39.7 1,631 44.6 41.5 31.8 43.9 5,425 

Median 16.5 18.9 16.9 17.0 22.4 18.4 18.6 18.8 

Mean 20.2 22.1 20.8 21.3 27.2 24.3 19.6 23.0 

Central Asia 

Kazakhstan 1999 * * 12.5 12.5 327 * * 14.2 14.1 462 

Kyrgyz Rep. 1997 * * 14.5 14.5 253 * * 12.7 12.6 851 

Turkmenistan 2000 * * 8.2 8.2 775 * * 2.8 3.0 1,192 

Uzbekistan 1996 * * 9.7 9.7 414 * * 7.5 7.5 911 

Median u u 11.1 11.1 u u 10.1 10.1 

Mean u u 11.2 11.2 u u 9.3 9.3 

South/Southeast Asia 

Bangladesh 1999-00 43.3 44.0 41.0 42.6 644 42.2 40.9 39.2 41.1 3,283 

Cambodia 2000 41.6 37.2 39.5 38.9 552 39.8 39.7 37.4 39.4 3,680 

India 1998-99 29.9 28.9 27.1 28.2 6,925 29.2 29.3 29.1 29.2 23,733 

Indonesia 1997 22.4 29.8 28.8 29.0 2,624 28.8 29.8 27.8 29.2 6,698 

Nepal 2000 36.3 36.3 29.9 33.4 237 37.6 37.4 35.6 37.3 3,603 

Philippines 1998 * 32.6 27.2 28.2 2,049 20.0 32.9 29.8 30.9 2,366 

Vietnam 1997 * 22.3 20.3 20.6 255 16.3 22.4 21.2 21.2 1,513 

Median 36.3 32.6 28.8 29.0 29.2 32.9 29.8 30.9 

Mean 34.7 33.0 30.5 31.6 30.6 33.2 31.4 32.6 

Latin America/Caribbean 

Bolivia 1998 35.1 34.5 33.9 34.1 2,219 38.0 37.2 37.0 37.3 1,606 

Brazil 1996 26.6 30.6 26.7 28.0 2,104 43.9 31.2 30.7 33.0 653 

Colombia 2000 (34.4) 30.9 29.0 29.6 1,863 19.8 25.3 21.1 23.9 862 

Dominican Rep. 2002 31.8 31.3 27.5 29.3 4,192 38.7 31.3 26.5 30.1 2,204 

Guatemala 1998-99 33.6 26.9 23.2 27.1 991 32.9 33.6 17.6 32.3 1,627 

Haiti 2000 30.8 35.3 36.2 34.7 1,203 52.5 47.7 51.0 50.0 2,442 

Nicaragua 2001 31.5 28.3 24.6 26.3 1,931 32.2 28.6 24.5 29.3 1,875 

Peru 2000 36.2 29.2 23.4 24.7 3,744 34.3 35.0 28.7 33.4 3,046 

Median 32.7 30.8 27.1 28.7 36.2 32.5 27.6 32.7 

Mean 32.5 30.9 28.1 29.2 36.5 33.7 29.6 33.7 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25

unweighted cases and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
Fever 95

Eighteen of the 41 intracountry differentials in fever prevalence among urban children whose mothers have no completed years of education versus one or more completed years of secondary education are positive in excess of five percentage points; 

nine are large, exceeding ten percentage points. Those nine countries are Benin, Eritrea, Mozambique, Namibia, Rwanda, Tanzania, Zambia, Guatemala, and Peru. 

Only two countries, Chad and Gabon, have negative urban differentials in excess of 

ten percentage points. 

As with urban children, in most countries, a moderate to strong negative association is seen between mother’s educational attainment and the probability of recent 

fever in young rural children. 

In rural areas, the regional average prevalence of fever decreases steadily with increasing maternal education in North Africa/West Asia/Europe and Latin America/Caribbean. In South/East Africa, the average prevalence of fever is similar for 

rural children whose mothers have no completed years of formal education and those 

whose mothers have at least one year of primary, but not secondary, education. 

Intracountry differentials in fever prevalence were computed between rural children whose mothers fall into the lowest versus the highest education categories. In 

eight countries (Eritrea, Malawi, Tanzania, Zambia, Yemen, Brazil, the Dominican 

Republic, and Guatemala), rural children whose mothers have the least education are 

more likely by more than ten percentage points to have had a recent fever episode 

than same-age children whose mothers have the most education. In four countries, a 

negative differential of about ten percentage points is found: Cameroon, Mali, Mauritania, and the Philippines. 

5.1.4 Demographic Characteristics 

In Table 5.4, the period prevalence of fever is tabulated by categories of child’s sex, 

birth order, birth interval, and mother’s age. 

Child’s Sex 

The average prevalence of fever does not differ substantially by child’s sex in any of 

the six regions. Differentials in fever prevalence in each country by child’s sex are 

generally small (less than plus or minus five percentage points). This magnitude was 

exceeded in only three countries. In Côte d’Ivoire and Kazakhstan, fever prevalence is 

higher among female children by seven and nine percentage points, respectively, 

while in the Kyrgyz Republic, fever prevalence is higher among male children by six 

percentage points. 

The average prevalence 

of fever does not 

differ substantially 

by child’s sex in any of 

the six regions. 
96 Fever

Table 5.4 

Percentage of children under age three with a fever in the two weeks preceding the survey, by child’s sex, 

birth order, birth interval, and mother’s age, Demographic and health Surveys 1996-2002 

Child’s sex Birth order Birth interval (months) Mother’s age 

Survey Male Female 1 2-3 4-5 6+ 1st birth <24 24-35 36+ <20 20-34 35+ Total 

Number 

of children 

West/Middle Africa 

Benin 2001 47.8 45.3 46.2 44.1 46.6 50.5 46.2 49.9 43.5 48.4 45.8 46.4 47.4 46.5 2,912 

Burkina Faso 1998-99 43.1 38.4 36.7 38.4 40.9 45.4 36.8 40.5 42.5 41.2 36.5 40.1 44.0 40.8 3,219 

Cameroon 1998 31.9 28.4 27.7 30.2 27.1 35.2 28.0 30.5 29.7 31.8 25.8 29.3 37.3 30.1 2,260 

Chad 1996-97 37.4 35.7 34.9 36.7 36.3 37.7 35.1 35.3 37.7 36.9 35.1 36.8 36.6 36.5 3,938 

Côte d’Ivoire 1998-99 36.9 44.1 40.1 39.7 38.8 43.9 40.1 39.2 41.2 40.7 37.5 41.7 38.5 40.5 1,221 

Gabon 2000 33.4 31.2 31.3 33.3 31.5 32.7 31.2 32.7 30.5 34.2 28.7 33.8 29.7 32.3 2,324 

Ghana 1988 28.6 28.9 27.0 27.4 29.9 32.0 26.8 30.8 26.3 30.6 20.1 29.1 29.7 28.8 1,802 

Guinea 1999 50.0 47.2 47.3 47.0 50.7 49.7 47.3 43.5 48.8 50.5 49.2 49.0 47.5 48.7 3,005 

Mali 2001 31.0 30.7 32.3 30.4 30.0 31.1 32.2 29.8 31.1 30.5 33.4 30.1 31.9 30.8 6,973 

Mauritania 2000-01 32.6 34.4 34.3 30.6 35.6 34.5 34.2 33.0 31.5 34.4 35.4 33.7 32.3 33.5 2,796 

Niger 1998 49.1 47.5 42.0 46.9 47.3 53.3 41.8 50.6 48.9 50.2 44.0 48.1 52.2 48.3 4,403 

Nigeria 1999 31.8 28.6 29.0 27.7 31.1 34.3 28.9 30.5 32.0 29.5 29.7 30.3 30.2 30.2 3,208 

Togo 1998 39.5 35.2 35.4 36.1 39.7 37.9 35.5 38.1 37.5 37.8 36.5 36.8 39.2 37.3 3,693 

Median 36.9 35.2 34.9 36.1 36.3 37.7 35.1 35.3 37.5 36.9 35.4 36.8 37.3 36.5 

Mean 37.9 36.6 35.7 36.0 37.3 39.9 35.7 37.3 37.0 38.2 35.2 37.3 38.2 37.3 

South/East Africa 

Comoros 1996 46.6 48.7 47.4 45.8 49.8 48.1 48.5 49.4 44.9 48.6 50.0 48.5 44.4 47.6 1,056 

Eritrea 2002 35.8 34.0 30.5 33.0 35.2 40.8 30.4 32.6 39.2 34.5 33.8 33.6 38.1 34.9 3,281 

Ethiopia 2000 33.0 32.1 32.7 32.3 33.4 32.0 32.6 35.5 30.2 33.3 34.3 32.0 33.8 32.5 6,412 

Kenya 1998 42.4 42.2 41.5 37.5 44.7 49.5 41.5 43.9 44.8 40.3 42.8 41.6 45.2 42.3 3,205 

Madagascar 1997 32.8 31.6 30.2 31.9 34.0 32.7 30.3 32.7 33.5 31.8 32.7 32.4 31.0 32.2 3,537 

Malawi 2000 48.3 48.0 45.9 46.2 50.8 51.2 45.9 53.7 50.5 45.8 50.6 47.4 49.8 48.1 6,862 

Mozambique 1997 45.8 42.2 35.5 46.9 45.2 46.6 35.6 49.7 45.3 46.2 41.8 45.4 40.4 44.0 3,803 

Namibia 2000 21.4 23.4 20.9 20.4 26.7 25.2 21.1 21.9 24.9 22.1 28.9 21.6 22.1 22.4 2,346 

Rwanda 2000 37.3 36.5 37.0 38.0 36.6 35.5 36.9 36.0 36.8 37.5 42.7 38.1 33.3 36.9 4,293 

Tanzania 1999 42.8 39.8 41.7 42.4 42.1 38.6 41.7 44.7 40.6 40.7 37.1 41.5 42.8 41.3 1,817 

Uganda 2000-01 49.8 48.8 44.0 48.6 50.8 52.0 44.0 51.4 51.4 47.9 52.8 49.0 48.5 49.3 4,245 

Zambia 2001-02 49.1 50.9 47.5 49.2 51.1 52.9 47.7 53.5 50.8 49.7 49.1 49.3 54.2 50.0 3,681 

Zimbabwe 1999 32.2 28.0 26.8 33.9 28.1 29.7 26.7 30.7 33.5 31.5 26.5 30.7 30.5 30.2 2,029 

Median 42.4 39.8 37.0 38.0 42.1 40.8 36.9 43.9 40.6 40.3 41.8 41.5 40.4 41.3 

Mean 39.8 38.9 37.0 38.9 40.7 41.1 37.1 41.2 40.5 39.2 40.2 39.3 39.5 39.4 

North Africa/West Asia/Europe 

Armenia 2000 15.3 18.5 18.1 15.6 15.9 * 18.0 16.5 12.3 16.9 15.3 16.7 18.3 16.7 880 

Egypt 2000 20.3 18.8 20.6 17.9 21.6 20.0 20.4 17.5 20.2 19.5 23.7 19.5 18.9 19.6 6,741 

Jordan 2002 11.0 11.4 12.1 10.7 10.6 11.9 11.9 11.5 11.0 10.6 11.6 11.4 10.4 11.2 3,454 

Yemen 1997 44.4 41.5 41.2 40.4 42.8 45.5 41.4 44.2 42.2 43.4 42.9 41.9 46.2 43.0 7,056 

Median 17.8 18.7 19.4 16.8 18.8 20.0 19.2 17.0 16.3 18.2 19.5 18.1 18.6 18.2 

Mean 22.8 22.5 23.0 21.1 22.7 25.8 22.9 22.4 21.4 22.6 23.4 22.4 23.5 22.6 

Central Asia 

Kazakhstan 1999 8.9 18.1 16.1 12.9 9.7 * 16.1 13.0 8.3 12.6 * 13.9 10.9 13.5 788 

Kyrgyz Rep. 1997 16.3 9.8 11.9 15.8 9.5 9.0 11.8 14.7 15.1 11.7 * 13.5 10.6 13.1 1,104 

Turkmenistan 2000 5.6 4.5 5.3 5.5 3.1 4.7 5.3 5.2 2.7 6.7 * 5.2 4.2 5.1 1,968 

Uzbekistan 1996 7.8 8.6 9.7 8.2 6.5 4.1 9.7 9.8 5.5 7.7 6.9 8.3 7.6 8.2 1,325 

Median 8.4 9.2 10.8 10.6 8.0 4.7 10.8 11.4 6.9 9.7 u 10.9 9.1 10.7 

Mean 9.6 10.3 10.8 10.6 7.2 5.9 10.7 10.7 7.9 9.7 u 10.2 8.3 10.0 

South/Southeast Asia 

Bangladesh 1999-00 43.3 39.4 39.1 39.9 46.3 45.3 39.2 41.1 42.4 42.5 39.8 41.1 47.8 41.4 3,927 

Cambodia 2000 39.6 39.1 39.8 39.0 40.6 38.3 40.0 44.8 38.9 37.5 35.8 39.5 39.6 39.4 4,232 

India 1998-99 29.9 28.0 29.4 28.0 30.7 29.2 29.4 27.4 30.0 28.6 30.6 28.6 30.0 29.0 30,668 

Indonesia 1997 30.4 27.8 29.6 29.1 27.6 30.5 29.7 29.3 30.1 28.4 34.2 29.4 26.2 29.1 9,322 

Nepal 2000 37.3 36.9 34.3 36.6 37.1 43.3 34.3 38.7 38.2 37.4 36.4 36.7 39.9 37.1 3,840 

Philippines 1998 29.8 29.5 27.9 28.6 30.7 33.5 27.9 31.0 29.0 30.7 34.7 29.5 29.2 29.7 4,415 

Vietnam 1997 22.1 20.1 22.8 20.0 24.2 11.4 22.9 23.1 18.7 20.0 * 22.4 14.3 21.1 1,769 

Median 30.4 29.5 29.6 29.1 30.7 33.5 29.7 31.0 30.1 30.7 35.3 29.5 30.0 29.7 

Mean 33.2 31.5 31.8 31.6 33.9 33.1 31.9 33.6 32.5 32.2 35.3 32.5 32.4 32.4 

Latin America/Caribbean 

Bolivia 1998 35.8 35.2 35.6 33.2 36.8 38.2 35.7 36.7 34.8 35.0 33.8 35.5 36.0 35.5 3,826 

Brazil 1996 30.1 28.2 29.6 26.9 32.0 34.7 29.6 30.0 28.3 28.5 28.4 29.0 30.9 29.2 2,757 

Colombia 2000 28.8 26.7 25.8 29.1 27.8 31.2 25.7 27.2 27.5 30.6 26.6 27.5 30.2 27.8 2,725 

Dominican Rep. 2002 30.2 29.0 28.6 29.2 30.1 37.3 28.7 31.5 31.3 28.5 31.8 29.2 28.8 29.6 6,395 

Guatemala 1998-99 32.1 28.6 31.0 26.7 30.1 35.6 31.0 31.0 30.3 29.1 29.0 30.2 31.5 30.3 2,618 

Haiti 2000 43.5 46.5 43.3 42.5 48.2 47.6 43.6 49.1 45.4 42.9 42.6 46.7 40.9 45.0 3,645 

Nicaragua 2001 28.1 27.5 25.7 28.8 26.2 31.6 25.7 24.9 32.0 29.1 27.5 27.7 28.6 27.8 3,807 

Peru 2000 29.6 27.6 24.4 28.5 32.7 34.1 24.5 29.1 32.8 29.9 26.2 28.6 29.6 28.6 6,790 

Median 30.2 28.4 29.1 29.0 31.1 35.2 29.2 30.5 31.7 29.5 28.7 29.1 30.6 29.4 

Mean 32.3 31.2 30.5 30.6 33.0 36.3 30.6 32.4 32.8 31.7 30.7 31.8 32.1 31.7 

Note: An asterisk indicates that a figure is bases on fewer than 25 unweighted cases and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
Fever 97

Birth Order 

The data indicate there is a small increased probability of recent fever associated 

with higher birth order in young children, with the notable exception of the Central 

Asian countries included here. 

In every region except North Africa/West Asia/Europe and Central Asia, the average prevalence of fever is slightly higher at birth orders four and above than at three 

and below. In North Africa/West Asia/Europe, the average fever prevalence is lowest 

at birth orders two to three and highest at orders six and above. In Central Asia, the 

average fever prevalence follows a different pattern and decreases from orders two to 

three to a low at orders six and above. 

Differentials in fever prevalence were computed for each country between children 

of birth order one and birth orders six and above. Thirty-five of these 47 differentials 

are negative. In 18 countries, children of birth orders six and above have a prevalence 

of fever more than five percentage points higher than that of firstborn children. 

There are just two countries in which the opposite occurs. In Uzbekistan and Vietnam, the prevalence of fever among first-born children is more than five percentage 

points higher than that of children at birth orders six and above. 

Birth Interval 

The most consistent evidence of an increased probability of recent fever associated 

with a short birth interval (<24 months) is found in the South/East Africa region. 

The average prevalence of fever does not differ substantially by birth interval in 

most regions. The exception is South/East Africa, where children born less than 24 

months following a prior birth have a higher prevalence than either first-born children or children born after an interval of 24 months or more. 

Two sets of intracountry differentials were computed for fever prevalence: first 

births versus birth interval less than 24 months and birth interval less than 24 months 

versus 36 or more months. Thirty-five of the 49 differentials in fever prevalence between first-born children and their short birth interval (less than 24 months) counterparts are negative. While most are small, six of these differentials are negative by 

more than five percentage points: Niger, Madagascar, Malawi, Tanzania, Uganda, 

and Haiti. Differentials in fever prevalence between the shortest (less than 24 

months) and longest (36 or more months) birth intervals are more evenly split between positive and negative values. 

Mother’s Age 

The regional average prevalence of fever does not differ substantially by mother’s 

age except in South/Southeast Asia. However, the pattern seen there of a higher 

prevalence of fever among children of the youngest mothers (under 20 years) is not 

corroborated by the intracountry differentials in prevalence between children of the 

youngest versus the oldest (35 or more years) mothers for countries in that region. 

5.1.5 Nutritional Status 

In Table 5.5, the percentage of children with a recent fever episode is shown by 

three indices of undernutrition—underweight, stunting, and wasting—broken down 

by three levels of severity. Data are sparse in the North Africa/West Asia/Europe and 

Central Asia regions for children in the severe categories of underweight and wasting, 

and in the Latin America/Caribbean region for severely wasted children. 

There is a small 

increased probability 

of recent fever 

associated with 

higher birth order 

in young children, 

with the exception 

of the Central 

Asian countries. 

The average 

prevalence of fever 

does not differ 

substantially by 

birth interval in 

most regions. 
98 Fever

Table 5.5 

Percentage of children under age three with a fever in the two weeks preceding the survey, by nutritional status indices, Demographic and Health Surveys 1996-2002 

Weight-for-age Z-score Height-for-age Z-score Weight-for-height Z-score 

Survey ≤-3.0 -3.0 to -2.01 ≥-2.0 ≤-3.0 -3.0 to -2.01 ≥-2.0 ≤-3.0 -3.0 to -2.01 ≥-2.0 Total

Number

of 

children

West/Middle Africa Benin 2001 60.1 56.9 43.3 56.8 49.0 44.8 67.0 56.5 45.3 46.6 2,610 

Burkina Faso 1998-99 53.4 44.9 37.8 43.6 41.7 41.0 60.2 52.8 38.8 41.5 2,530 

Cameroon 1998 39.5 31.1 29.6 33.7 31.8 29.5 * 32.7 30.1 30.4 1,923 

Chad 1996-97 46.2 37.4 33.7 41.3 36.0 35.4 47.2 42.8 35.0 36.5 3,541 

Côte d’Ivoire 1998-99 (64.9) 49.5 40.5 43.4 46.9 42.3 * 58.4 41.3 43.0 1,099 

Gabon 2000 38.8 37.8 33.9 39.7 38.6 33.3 * 30.0 34.6 34.4 2,013 

Ghana 1988 37.2 37.1 26.2 33.4 34.6 27.6 (36.2) 38.6 27.6 28.9 1,638 

Guinea 1999 62.0 57.2 48.1 51.9 55.0 49.8 56.4 65.7 49.0 50.7 2,067 

Mali 2001 39.9 36.4 27.9 31.0 35.0 30.2 45.1 43.9 29.3 31.2 6,120 

Mauritania 2000-01 41.1 39.0 33.2 39.2 37.8 33.6 39.5 42.8 33.9 35.0 2,227 

Niger 1998 59.9 50.4 44.6 52.4 50.5 48.0 73.8 61.7 45.7 49.4 4,022 

Nigeria 1999 42.2 34.4 30.0 33.4 33.7 30.8 45.1 39.2 30.7 32.0 1,473 

Togo 1998 48.6 47.3 34.4 45.3 42.0 36.2 48.1 47.6 36.3 37.7 3,260 

Median 46.2 39.0 33.9 41.3 38.6 35.4 47.7 43.9 35.0 36.5 

Mean 48.8 43.0 35.6 41.9 41.0 37.1 51.9 47.1 36.7 38.3 

South/East Africa Comoros 1996 69.9 47.9 46.9 49.6 54.3 47.0 * 58.6 47.7 48.9 921 

Eritrea 2002 49.3 42.1 29.9 40.8 42.3 32.4 54.2 46.1 33.4 35.5 2,996 

Ethiopia 2000 40.6 35.9 29.2 36.3 33.7 31.4 46.1 40.4 31.8 33.0 6,011 

Kenya 1998 57.9 48.0 41.8 52.6 43.5 42.2 (44.0) 49.2 43.4 43.7 2,821 

Madagascar 1997 40.0 36.1 30.2 34.9 30.3 33.8 * 41.2 32.3 33.1 3,080 

Malawi 2000 62.2 54.6 45.9 51.8 51.8 46.5 54.0 57.3 48.2 48.8 6,177 

Mozambique 1997 64.0 52.7 42.1 53.3 45.4 44.2 (78.7) 52.3 44.7 45.9 2,837 

Namibia 2000 27.5 26.1 21.6 24.0 24.8 22.1 (23.6) 30.0 22.0 22.5 2,188 

Rwanda 2000 47.3 43.6 34.6 38.8 39.4 35.8 48.9 39.5 36.6 37.0 3,915 

Tanzania 1999 52.4 47.2 40.4 53.8 42.0 40.7 * 30.8 43.5 42.8 1,674 

Uganda 2000-01 66.2 61.0 46.5 49.9 56.7 48.2 * 69.5 49.2 50.2 3,740 

Zambia 2001-02 62.7 57.8 47.3 54.0 55.4 47.8 (50.2) 63.8 50.1 50.8 3,432 

Zimbabwe 1999 (32.3) 44.5 28.5 35.1 29.1 30.1 (48.4) 38.1 29.6 30.4 1,684 

Median 51.7 47.2 40.4 49.6 42.3 40.7 48.9 46.1 43.4 42.8 

Mean 51.7 46.0 37.3 44.2 42.2 38.6 49.8 47.4 39.4 40.2 

North Africa/West Asia/Europe Armenia 2000 * * 17.3 * 20.6 16.6 * * 17.4 17.1 805 

Egypt 2000 (27.2) 26.3 19.2 25.5 22.9 18.5 (33.8) 19.7 19.4 19.5 6,264 

Jordan 2002 * 8.3 11.4 14.6 11.8 11.2 * 15.2 11.3 11.3 2,845 

Yemen 1997 49.2 45.1 39.1 43.6 42.5 41.8 50.9 50.6 40.9 42.4 4,966 

Median 38.2 26.3 18.3 25.5 21.8 17.6 42.4 19.7 18.4 18.3 

Mean 38.2 26.6 21.8 27.9 24.5 22.0 42.4 28.5 22.3 22.6 

Central Asia Kazakhstan 1999 * * 13.5 * (27.3) 12.5 * * 13.6 13.5 354 

Kyrgyz Rep. 1997 * 24.7 11.7 24.0 17.1 11.2 * (17.1) 13.0 13.1 1,015 

Turkmenistan 2000 (2.0) 4.0 5.2 8.7 3.5 5.0 * 2.1 5.2 5.0 1,745 

Uzbekistan 1996 (11.2) 5.1 8.7 5.0 9.9 8.7 * 8.9 7.8 8.4 989 

Median 6.6 5.1 10.2 8.7 13.5 10.0 u 8.9 10.4 10.8 

Mean 6.6 11.3 9.8 12.6 14.4 9.4 u 9.4 9.9 10.0 

South/Southeast Asia Bangladesh 1999-00 48.0 45.0 39.3 44.6 44.4 40.8 (46.6) 54.9 40.8 42.3 3,306 

Cambodia 2000 49.9 43.0 38.5 42.3 41.4 39.3 42.4 38.9 39.7 39.7 4,006 

India 1998-99 34.7 32.3 26.8 31.4 32.3 27.9 33.9 35.5 28.5 29.5 27,094 

Nepal 2000 42.6 40.8 34.3 39.8 39.5 36.0 46.6 45.3 36.5 37.5 3,707 

Median 45.3 41.9 36.4 41.1 40.5 37.7 44.5 42.1 38.1 38.6 

Mean 43.8 40.3 34.7 39.5 39.4 36.0 42.4 43.7 36.4 37.3 

Latin America/Caribbean Bolivia 1998 51.9 49.4 34.3 40.6 38.3 34.6 * 49.3 35.5 35.7 3,451 

Brazil 1996 * 29.1 29.7 37.3 36.1 29.0 * 33.7 29.5 29.7 2,306 

Colombia 2000 (33.9) 44.2 27.1 28.5 31.5 27.8 * (42.5) 28.0 28.2 2,498 

Dominican Rep. 2002 (27.9) 35.3 29.9 33.7 33.8 29.8 * 18.7 30.2 30.1 5,612 

Guatemala 1998-99 29.4 42.6 28.8 34.5 34.1 29.1 * 40.6 30.9 31.3 2,149 

Haiti 2000 68.4 62.1 42.1 61.1 56.6 42.6 (72.5) 53.7 44.8 45.4 3,532 

Nicaragua 2001 50.2 34.8 26.9 29.6 31.1 27.4 * 40.6 27.6 27.9 3,443 

Peru 2000 42.3 35.4 28.5 37.3 31.1 28.0 * 33.6 29.0 29.1 6,070 

Median 42.3 39.0 29.3 35.9 34.0 29.1 u 40.6 29.9 29.9 

Mean 43.4 41.6 30.9 37.8 36.6 31.0 u 39.1 31.9 32.2 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25

unweighted cases and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
Fever 99

These data lend support to a strong and largely consistent negative association between nutritional status and the probability of a recent episode of fever among young 

children. 

The range, mean, and median period prevalence of fever for countries included in 

each region are depicted in Figure 5.4 by severe, moderate, and mild/normal categories of underweight. There is a strong and consistent decrease in fever prevalence 

with improved weight-for-age in each region except Central Asia. Strong and consistent decreases in fever prevalence are similarly observed with improved height-for-age 

and weight-for-height with the exception, again, of Central Asia. 

Figure 5.4 

Percentage of children under age three years with fever in the two weeks preceding the survey, by low weight-for-age status and region 

u = Unknown (insufficient data) 

For each indicator of undernutrition, the difference in fever prevalence between 

children falling into the severe and the mild/normal categories was computed for 

each country. With respect to underweight, only 5 differentials are less than positive 

five percentage points, and 26 of 41 are in excess of positive ten percentage points. In 

five countries (Côte d’Ivoire, Comoros, Mozambique, Haiti, and Nicaragua), children who are severely underweight have a fever prevalence more than 20 percentage 

points higher than that of children who are mildly underweight or normal weightfor-age. 

For stunting, 18 of 44 differentials exceed positive five percentage points. Children 

who are severely stunted have a fever prevalence more than ten percentage points 

higher than that of children who are mildly stunted or normal height-for-age in five 

countries: Benin, Kenya, Tanzania, the Kyrgyz Republic, and Haiti. 

For wasting, more than half (15 of 26) of the differentials exceed positive 10 percentage points, and in six countries (Benin, Burkina Faso, Niger, Eritrea, Mozambique, and Haiti), children who are severely wasted are more likely by more than 20 

The data support a 

negative association 

between nutritional 

status and the 

probability of a recent 

episode of fever among 

young children. 

In five countries (Côte 

d’Ivoire, Comoros, 

Mozambique, Haiti, and 

Nicaragua), children who 

are severely underweight 

have a fever prevalence 

more than 20 percentage 

points higher than that of 

children who are mildly 

underweight or normal 

weight-for-age. 
100 Fever

percentage points to have had a recent fever episode, compared with same-age children who are mildly wasted or normal weight-for-height. 

5.1.6 Immunization Status 

Fever and Full Immunization 

Table 5.6 shows the percentage of one- and two-year-old children with a fever 

episode in the past two weeks by immunization status, i.e., receipt of all recommended vaccinations at any time before the date of interview. Children in their second year of life appear to have a slightly reduced likelihood of fever if they have received all recommended vaccinations. This advantage does not appear to persist into 

the third year of life. 

In each region, with the exceptions of South/East Africa and Central Asia, there is 

a small but consistent increase in the average prevalence of fever among one-year-old 

children who have not been fully immunized, compared with fully immunized children of the same age. Among two-year-olds, these small increases are not present, 

with the exception of the North Africa/West Asia/Europe region. 

For each age group, the intracountry differences in fever prevalence by receipt versus nonreceipt of all recommended vaccinations were computed. Among one-yearolds, more than three-fourths of these differentials are negative; 12 are negative by 

more than five percentage points. The largest negative differentials are found in Côte 

d’Ivoire (39 versus 50 percent), Zambia (53 versus 64 percent), and Haiti (41 versus 

55 percent). In contrast, only three countries have differentials that are positive by 

more than five percentage points (Namibia, Tanzania, and Uzbekistan). Among twoyear-olds, the number of negative and positive differentials in fever prevalence by 

immunization status is nearly equal. 

Children in their second 

year of life appear to 

have a slightly reduced 

likelihood of fever if 

 they have received 

all recommended 

vaccinations. 
Fever 101

Table 5.6 

Percentage of children age 12 to 23 months and 24-35 months with fever in the two weeks 

preceding the survey, by immunization status, Demographic and Health Surveys 1996-2002 

Children age 12-23 months 

fully vaccinated 

Children age 24-35 months 

fully vaccinated 

 Survey Yes No Yes No 

 

Total 

Number of 

children 

West/Middle Africa Benin 2001 49.5 59.4 45.5 45.7 49.6 1,848 

Burkina Faso 1998-99 44.6 51.2 29.7 37.8 42.4 2,030 

Cameroon 1998 36.8 34.2 32.3 25.1 31.8 1,443 

Chad 1996-97 33.8 40.9 34.3 35.1 37.5 2,431 

Côte d’Ivoire 1998-99 38.8 50.3 43.8 34.7 42.0 810 

Gabon 2000 36.5 37.1 33.9 31.5 34.5 1,529 

Ghana 1988 31.6 35.9 31.7 31.2 32.5 1,193 

Guinea 1999 55.1 55.3 46.4 42.9 49.4 1,906 

Mali 2001 34.3 36.5 26.4 30.0 32.5 4,223 

Mauritania 2000-01 36.3 36.1 27.0 31.0 33.2 1,771 

Niger 1998 50.1 51.6 39.8 43.9 47.3 2,757 

Nigeria 1999 34.5 34.5 24.5 27.8 31.2 2,099 

Togo 1998 41.8 46.3 31.1 33.2 38.5 2,324 

Median 36.8 40.9 32.3 33.2 37.5 

Mean 40.3 43.8 34.3 34.6 38.6 

South/East Africa Comoros 1996 55.7 51.8 47.1 28.9 47.8 674 

Eritrea 2002 42.9 43.0 33.0 26.9 36.9 2,000 

Ethiopia 2000 39.6 34.7 30.9 29.1 32.5 4,226 

Kenya 1998 44.5 50.0 40.9 40.4 43.8 2,118 

Madagascar 1997 32.1 38.7 23.8 32.7 33.0 2,257 

Malawi 2000 52.7 56.1 44.0 43.9 49.0 4,345 

Mozambique 1997 47.3 48.3 42.8 43.7 45.7 2,362 

Namibia 2000 29.8 16.5 19.6 15.0 21.7 1,529 

Rwanda 2000 37.7 45.6 30.7 37.1 36.1 2,562 

Tanzania 1999 55.3 41.0 31.1 34.3 41.5 1,181 

Uganda 2000-01 52.2 60.6 42.4 46.4 51.6 2,760 

Zambia 2001-02 52.6 63.6 46.5 49.4 51.9 2,442 

Zimbabwe 1999 37.1 35.6 27.7 22.4 31.3 1,368 

Median 44.5 45.6 33.0 34.3 41.5 

Mean 44.6 45.0 35.4 34.6 40.2 

North Africa/West 

Asia/Europe Armenia 2000 17.2 21.1 20.2 (31.0) 20.0 581 

Egypt 2000 20.7 22.5 17.3 20.5 19.2 4,379 

Jordan 2002 13.0 15.6 6.9 8.5 11.4 2,289 

Yemen 1997 45.2 48.8 39.7 40.9 44.0 4,512 

Median 19.0 21.8 18.8 25.6 19.6 

Mean 24.0 27.0 21.0 25.2 23.6 

Central Asia Kazakhstan 1999 20.2 23.6 9.0 3.4 14.3 545 

Kyrgyz Rep. 1997 16.1 21.4 9.6 8.9 13.6 738 

Turkmenistan 2000 5.6 3.8 3.8 15.4 5.2 1,275 

Uzbekistan 1996 10.4 3.9 7.9 6.6 8.4 909 

Median 13.3 12.7 8.5 7.8 11.0 

Mean 13.1 13.2 7.6 8.6 10.4 

South/Southeast Asia Bangladesh 1999-00 43.5 45.7 39.1 39.0 41.7 2,615 

Cambodia 2000 41.9 44.7 36.0 38.6 40.5 2,632 

India 1998-99 32.1 34.0 26.3 28.4 30.4 20,125 

Indonesia 1997 31.7 35.0 27.0 26.8 30.1 6,109 

Nepal 2000 38.8 44.9 31.2 35.4 36.8 2,558 

Philippines 1998 34.0 33.7 23.9 26.9 29.3 2,921 

Vietnam 1997 25.3 26.1 18.0 14.1 21.1 1,240 

Median 34.0 35.0 27.0 28.4 30.4 

Mean 35.3 37.7 28.8 29.9 32.8 

Latin America/Caribbean Bolivia 1998 38.5 39.2 34.8 30.7 35.8 2,510 

Brazil 1996 31.9 31.1 26.9 24.1 29.0 1,853 

Colombia 2000 30.0 33.1 27.1 29.1 29.7 1,784 

Dominican Rep. 2002 33.6 34.4 27.1 26.1 30.3 4,384 

Guatemala 1998-99 33.2 36.5 26.7 22.8 29.9 1,716 

Haiti 2000 40.7 54.8 39.9 43.8 46.1 2,450 

Nicaragua 2001 28.5 31.6 27.7 21.7 28.4 2,012 

Peru 2000 29.9 30.0 24.6 27.2 28.5 3,500 

Median 32.6 33.8 27.1 26.7 29.8 

Mean 33.3 36.3 29.4 28.2 32.2 

Note: Figures in parentheses are based on 25-49 unweighted cases. 
102 Fever

5.2 Treatment of Fever 

During surveys conducted in malaria-endemic countries under MEASURE 

DHS+, information was optionally collected on any drugs taken by young children for 

treatment of a fever. In Table 5.7, the percent distribution of children under the age 

of three years with a fever episode at any time in the past two weeks who received an 

antimalarial drug, another drug (no antimalarial), or no drug is shown by urban-rural 

residence for the 17 countries in this report that collected this information. 

One of the messages promoted through WHO’s IMCI strategy is that in malariaendemic areas, young children with a fever should be presumed to have malaria and 

should be treated with a locally recommended antimalarial drug. Since fever alone 

does not signify a need for urgent medical attention, mothers in these areas are encouraged to begin administering an antimalarial on their own (Nicoll, 2000). 

As seen in Figure 5.5, the use of antimalarials for the treatment of fever is highly 

variable. In the region of South/East Africa, less than 10 percent of either urban or 

rural children with a fever were given an antimalarial in the countries of Rwanda and 

Zimbabwe, in contrast to more than half of children with a fever in Tanzania, Namibia, and Zambia. Use of antimalarials is low in the four non-African countries 

listed in the table, being nearly nonexistent in Nicaragua and Colombia. 

Table 5.7 

Percent distribution of children under age three with fever in the two weeks preceding the survey, by residence and medication received, Demographic and Health Surveys 1999-2002 

 Urban Rural 

Survey 

Any antimalarial Any other 

drug No drug Total 

Number 

of children 

Any antimalarial Any other 

drug No drug Total 

Number 

of 

children 

West/Middle Africa Benin 2001 74.2 15.2 10.6 100.0 372 71.2 13.9 14.9 100.0 983 

Gabon 2000 78.6 16.4 5.0 100.0 566 74.3 12.9 12.8 100.0 185 

Mali 2001 61.7 26.8 11.5 100.0 489 42.7 25.5 31.8 100.0 1,662 

Mauritania 2000 48.2 25.0 26.7 100.0 422 29.4 17.0 53.6 100.0 514 

South/East Africa 

Eritrea 2002 15.5 45.7 38.9 100.0 333 10.9 33.6 55.5 100.0 811 

Ethiopia 2000 16.2 37.5 46.3 100.0 193 7.8 11.1 81.1 100.0 1,894 

Malawi 2000 25.0 70.4 4.6 100.0 330 23.2 66.1 10.7 100.0 2,972 

Namibia 2000 73.1 13.6 13.3 100.0 200 60.6 14.8 24.6 100.0 325 

Rwanda 2000 4.8 49.9 45.3 100.0 177 6.8 15.5 77.7 100.0 1,364 

Tanzania 1999 59.1 34.0 6.9 100.0 138 52.0 31.4 16.6 100.0 613 

Uganda 2000 17.3 1.4 81.3 100.0 187 19.1 6.0 75.0 100.0 1,904 

Zambia 2001 73.4 16.3 10.3 100.0 439 66.3 10.1 23.6 100.0 1,403 

Zimbabwe 1999 4.8 0.8 94.4 100.0 183 7.3 3.2 89.5 100.0 429 

South/Southeast Asia 

Cambodia 2000 11.8 83.3 4.9 100.0 215 17.9 72.1 10.0 100.0 1,451 

Latin America/Caribbean 

Colombia 2000 0.7 96.2 3.1 100.0 551 0.0 87.2 12.8 100.0 206 

Haiti 2000 6.7 66.0 27.4 100.0 418 12.2 45.0 42.8 100.0 1,221 

Nicaragua 2001 0.4 95.4 4.2 100.0 509 2.3 83.8 14.0 100.0 549 

Urban children with fever are, in general, more likely than rural children to be 

given an antimalarial drug. For each country, the difference in the percentage of children with fever who were given any antimalarial drug was computed between urban 

One of the messages 

promoted through WHO’s 

IMCI strategy is that in 

malaria-endemic areas, 

young children with a 

fever should be presumed 

to have malaria and 

should be treated with a 

locally recommended 

antimalarial drug. 
Fever 103

Figure 5.5 

Percentage of children under age three years with fever in the two weeks preceding the survey who 

received an antimalarial drug, by residence 

and rural residents. In one-third of these countries (6 of 17), urban children with fever were more likely by more than five percentage points to receive an antimalarial, 

compared with rural children. The largest positive differences are found in Mali (62 

versus 43 percent) and Mauritania (48 versus 29 percent). In Cambodia and Haiti, 

rural children with fever are more likely to be treated with an antimalarial drug than 

urban children by about six percentage points. 

5.3 Seeking Care for Symptoms of ALRI and/or Fever 

During surveys conducted under MEASURE DHS+, questions about careseeking 

were not asked separately for cough and fever. Hence, in the event that a child had 

separate rather than joint episodes of cough and fever, it is not possible to discern if 

care was sought for the cough episode, the fever episode, or both. Therefore, in this 

section, careseeking behavior is combined to describe those children with symptoms 

of ALRI (cough with short, rapid breaths), fever, or both. 

Urban children with 

fever are more likely 

than rural children 

to be given an 

antimalarial drug. 
104 Fever

5.3.1 Residence 

Figure 5.6 shows the percentage of children for whom advice or treatment was 

sought from an appropriate health care provider (exclusive of pharmacists, shopkeepers, and traditional practitioners) among children under age three years with symptoms of ALRI and/or fever by urban-rural residence and region. In 11 of 50 countries, care was sought for at least half of both urban and rural sick children. Care was 

sought for at least half of urban sick children in an additional four countries and for 

half of rural sick children in one more country. In all but two countries (Zimbabwe 

and the Kyrgyz Republic), sick children from urban areas were more likely than those 

from rural areas to be taken to an appropriate health care provider. 

5.3.2 Residence and Wealth Index 

In Table 5.8, the percentage of children for whom advice or treatment was sought 

from an appropriate health care provider among children with symptoms of ALRI 

and/or fever is shown by residence and by three categories of the country-specific 

household wealth index distribution. In the countries included from Central Asia, 

data are very sparse in all columns because of small numbers of sick children in those 

samples. Elsewhere, data are sparse in some columns because of the skewed distribution of sick children by wealth index. 

In all but two countries 

(Zimbabwe and the Kyrgyz 

Republic), sick children from 

urban areas were more likely 

than those from rural areas to 

be taken to an appropriate 

health care provider. 
Fever 105

Figure 5.6 

Among children under age three years with symptoms of ALRI and/or fever in the two weeks preceding the 

survey, percentage for whom advice or treatment was sought from an appropriate health care provider 
106 Fever

Table 5.8 

Among children under age three with symptoms of acute lower respiratory infection (ALRI) and/or fever 

in the two weeks preceding the survey, percentage taken to an appropriate health care provider, by residence and wealth index, Demographic and Health Surveys 1996-2002 

 Urban Rural 

 Household wealth index Household wealth index 

Survey 

Lowest 

40% 

Middle 

40% 

Highest 

20% Total 

 Number 

of children 

Lowest 

40% 

Middle 

40% 

Highest 

20% Total 

Number 

of children 

West/Middle Africa Benin 2001 35.9 48.5 60.0 49.5 417 41.4 51.4 * 46.0 1,059 

Burkina Faso 1998-99 * * 42.7 41.1 130 13.1 13.5 33.4 14.7 1,298 

Cameroon 1998 * 34.0 30.0 31.5 243 15.5 24.3 * 20.3 653 

Chad 1996-97 * 15.6 26.0 23.1 363 9.5 14.0 28.3 12.4 1,305 

Côte d’Ivoire 1998-99 * 30.6 30.6 30.0 148 19.3 19.2 * 19.4 356 

Gabon 2000 37.9 39.6 41.2 39.4 677 24.7 (45.6) * 26.8 224 

Ghana 1988 * 16.2 25.4 20.8 145 12.2 19.5 * 14.9 518 

Guinea 1999 * 35.8 39.5 37.7 381 14.4 24.7 (44.1) 19.1 1,184 

Mali 2001 (42.9) 63.0 70.4 66.1 551 35.0 35.4 56.2 35.7 1,836 

Mauritania 2000-01 24.6 24.0 28.5 25.8 473 4.5 14.8 * 7.9 566 

Niger 1998 * 28.1 30.0 29.0 327 7.3 10.3 9.3 8.6 1,903 

Togo 1998 (8.1) 25.0 31.6 27.5 378 13.2 16.7 (24.3) 14.7 1,283 

Median 35.9 30.6 31.1 30.8 13.8 19.4 30.8 17.0 

Mean 29.9 32.8 38.0 35.1 17.5 24.1 32.6 20.0 

South/East Africa Comoros 1996 (40.0) (30.6) (39.1) 36.2 130 33.2 37.6 (36.8) 35.2 420 

Eritrea 2002 * 35.5 40.3 36.9 406 27.5 37.2 * 30.9 1,025 

Ethiopia 2000 * * 51.3 48.6 239 14.6 14.8 25.6 15.5 2,406 

Kenya 1998 * 42.7 38.7 39.9 270 30.0 29.0 40.4 30.4 1,238 

Madagascar 1997 31.4 39.1 35.1 35.3 271 25.8 22.9 (40.5) 25.3 1,201 

Malawi 2000 (12.8) 25.3 27.2 25.9 392 13.8 16.9 22.5 16.0 3,605 

Mozambique 1997 * 38.5 47.9 43.6 427 14.5 17.1 26.1 16.5 1,351 

Namibia 2000 * 53.1 65.8 57.8 239 44.5 52.2 * 47.4 502 

Rwanda 2000 * 21.8 29.7 27.2 255 19.0 21.2 20.7 20.2 1,762 

South Africa 1998 93.7 79.9 78.4 82.4 298 75.5 86.1 * 77.9 339 

Tanzania 1999 * (82.6) 80.3 81.9 154 70.7 74.5 77.5 72.7 666 

Uganda 2000-01 * 73.3 81.8 79.8 221 62.5 69.1 76.5 66.1 2,184 

Zambia 2001-02 * 75.6 67.6 72.6 483 66.6 70.5 * 68.1 1,494 

Zimbabwe 1999 * 40.4 53.2 47.0 211 52.5 52.0 * 52.5 524 

Median 35.7 40.4 49.6 45.3 31.6 37.4 36.8 33.1 

Mean 44.5 49.1 52.6 51.1 39.3 42.9 40.7 41.0 

North Africa/West Asia/Europe Armenia 2000 * (32.4) (23.8) 28.8 101 22.4 * * 24.4 101 

Egypt 2000 40.2 45.0 47.3 45.2 520 39.0 38.3 (39.6) 38.7 1,075 

Jordan 2002 69.6 70.7 (78.2) 71.0 414 66.9 72.8 * 69.7 113 

Yemen 1997 * 33.5 34.4 34.4 747 18.1 25.5 37.9 21.7 2,722 

Median 54.9 39.3 40.8 39.8 30.7 38.3 38.8 31.6 

Mean 54.9 45.4 45.9 44.8 36.6 45.5 38.8 38.6 

Central Asia Kazakhstan 1999 * (36.4) * (31.7) 44 (22.7) * * 20.1 70 

Kyrgyz Rep. 1997 * * * (20.0) 38 27.0 (28.8) * 28.3 129 

Turkmenistan 2000 * * * (55.0) 61 * * * (52.2) 36 

Uzbekistan 1996 * (23.3) (45.0) 32.8 44 (5.3) * * 4.8 70 

Median u 29.8 u 32.2 22.7 u U 24.2 

Mean u 29.8 u 34.9 18.3 u U 26.4 

South/Southeast Asia Bangladesh 1999-00 37.2 23.1 50.1 39.3 300 18.9 25.1 42.2 22.8 1,486 

Cambodia 2000 34.3 40.8 45.5 41.8 222 30.4 37.4 51.3 34.9 1,502 

India 1998-99 49.8 60.8 60.5 59.7 2,371 44.8 55.5 61.8 49.9 8,642 

Indonesia 1997 61.5 73.7 73.7 72.8 809 58.2 72.2 80.7 64.8 2,110 

Nepal 2000 * (42.4) 35.8 35.3 105 21.5 26.0 34.7 24.6 1,619 

Philippines 1998 44.3 56.0 46.9 50.8 682 37.6 48.2 59.3 40.8 888 

Vietnam 1997 * (22.5) 58.0 48.0 63 46.2 45.4 47.6 45.9 397 

Median 44.3 42.4 50.1 48.0 37.6 45.4 51.3 40.8 

Mean 45.4 45.6 52.9 49.7 36.8 44.3 53.9 40.5 

Latin America/Caribbean Bolivia 1998 34.7 45.6 54.0 45.1 934 29.0 31.6 * 29.2 722 

Brazil 1996 40.3 44.1 57.7 44.6 853 25.0 (53.2) * 28.5 297 

Colombia 2000 49.1 59.0 62.7 56.7 551 34.6 * * 36.6 206 

Guatemala 1998-99 65.5 47.2 (30.6) 47.5 354 23.9 31.8 * 27.4 662 

Haiti 2000 (10.3) 27.2 39.8 31.6 574 27.0 30.3 * 27.9 1,532 

Nicaragua 2001 67.1 62.6 74.6 66.5 778 53.5 65.4 * 55.3 844 

Peru 2000 49.5 65.3 81.8 65.1 1,301 49.0 67.8 * 50.3 1,213 

Median 49.1 47.2 57.7 47.5 29.0 42.5 U 29.2 

Mean 45.2 50.1 57.3 51.0 34.6 46.7 U 36.5 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases 

and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
Fever 107

Higher household wealth is consistently associated with the likelihood that advice 

or treatment will be sought for young children with symptoms of ALRI and/or fever 

in both urban and rural areas. 

Figures 5.7.1 and 5.7.2 show for urban and rural areas, respectively, the range, 

mean, and median percentage of sick children for whom advice or treatment was 

sought for countries included in each region by categories of the household wealth 

index distribution. On average, sick children in households in the highest 20 percent 

of the country’s wealth index distribution were more likely than children in households in the lowest 40 percent of the distribution to be taken for care. 

In the regions of West/Middle Africa, South/Southeast Asia, and Latin America/Caribbean, the average prevalence of care for urban sick children in the middle 40 

percent of the wealth index distribution is similar to that for children in the lowest 40 

percent of the distribution (Figure 5.7.1). However, in these same regions, the average prevalence of care for rural children increases from the lowest category to the 

middle category of the wealth index (Figure 5.7.2). 

5.3.3 Residence and Mother’s Education 

Careseeking for ALRI symptoms and/or fever is shown in Table 5.9 by residence 

and categories of the mother’s education (highest level completed). In the Central 

Asian countries shown plus Armenia and Jordan, there are very few mothers of sick 

children who have not completed at least one year of secondary school. Hence, data 

in the first two education categories are sparse for those countries. 

There is a strong and largely consistent positive association between careseeking 

for ALRI symptoms and/or fever in young children and mother’s educational attainment in both urban and rural areas, with the notable exception of Guatemala. 

Higher household wealth 

is associated with the 

likelihood that advice or 

treatment will be sought 

for young children with 

symptoms of ALRI 

and/or fever. 
108 Fever

Figure 5.7.1 

Percentage of urban children under age three years with symptoms of ALRI 

and/or fever in the two weeks preceding the survey, who were taken to an appropriate health care provider, by wealth index and region 

u = Unknown (insufficient data) 

Figure 5.7.2 

Percentage of rural children under age three years with symptoms of ALRI 

and/or fever in the two weeks preceding the survey, who were taken to an appropriate health care provider, by wealth index and region 

u = Unknown (insufficient data) 
Fever 109

Table 5.9 

Among children under age three with symptoms of acute lower respiratory infection (ALRI) and/or 

fever in the two weeks preceding the survey, percentage taken to an appropriate health care provider, by residence and mother’s education, Demographic and Health Surveys 1996-2002 

 Urban Rural 

 Highest level of education Highest level of education 

Survey None Primary Secondary+ Total 

Number

of 

children None Primary Secondary+ Total 

Number

of 

children 

West/Middle Africa 

Benin 2001 45.8 58.9 47.8 49.5 417 44.8 53.1 (42.5) 46.0 1,059 

Burkina Faso 1998-99 34.7 (41.7) 56.2 41.1 130 14.1 28.4 * 14.7 1,298 

Cameroon 1998 17.1 27.4 43.0 31.5 243 7.7 24.7 28.4 20.3 653 

Chad 1996-97 21.2 23.8 28.9 23.1 363 10.6 18.9 * 12.4 1,305 

Côte d’Ivoire 1998-99 24.2 36.9 33.9 29.9 170 19.3 25.9 * 20.7 394 

Gabon 2000 (25.6) 36.9 42.0 39.4 677 * 28.1 25.8 26.8 224 

Ghana 1988 (21.0) (13.7) 23.8 20.8 145 16.2 16.1 12.7 14.9 518 

Guinea 1999 35.1 46.7 37.4 37.7 381 17.4 39.4 (47.0) 19.1 1,184 

Mali 2001 61.3 73.8 76.9 66.1 551 35.5 37.0 (40.2) 35.7 1,836 

Mauritania 2000-01 26.5 21.8 32.8 25.8 473 8.0 8.5 * 7.9 566 

Niger 1998 24.1 37.8 38.0 29.0 327 8.5 8.7 * 8.6 1,903 

Nigeria 1999 22.1 26.2 37.3 29.8 273 14.7 20.6 24.4 18.3 834 

Togo 1998 20.7 30.0 34.8 27.5 378 12.7 18.7 23.1 14.7 1,283 

Median 24.2 36.9 37.4 29.9 14.4 24.7 27.1 18.3 

Mean 29.2 36.6 41.0 34.7 17.5 25.2 30.5 20.0 

South/East Africa 

Comoros 1996 37.9 (27.6) (40.0) 36.2 130 33.8 39.2 (35.9) 35.2 420 

Eritrea 2002 25.7 47.7 37.0 36.9 406 28.6 42.2 * 30.9 1,025 

Ethiopia 2000 44.8 41.7 55.2 48.6 239 14.7 19.3 (25.5) 15.5 2,406 

Kenya 1998 * 36.4 45.1 39.9 270 29.9 28.8 36.1 30.4 1,238 

Madagascar 1997 (16.9) 35.7 41.2 35.3 271 21.1 24.9 34.9 25.3 1,201 

Malawi 2000 25.1 22.9 34.4 25.9 392 13.6 16.2 32.6 16.0 3,608 

Mozambique 1997 32.6 46.8 (35.5) 43.6 427 13.1 18.3 * 16.5 1,351 

Namibia 2000 * 55.1 57.0 57.8 239 49.0 41.3 53.4 47.4 502 

Rwanda 2000 16.4 27.2 33.7 27.2 255 20.2 20.0 23.6 20.2 1,762 

South Africa 1998 * 81.7 83.3 82.4 298 (76.4) 84.5 74.3 77.9 339 

Tanzania 1999 (86.1) 79.2 (98.1) 81.9 154 62.8 77.3 (73.5) 72.7 666 

Uganda 2000-01 (70.7) 80.4 80.8 79.8 221 58.8 67.8 75.1 66.1 2,184 

Zambia 2001-02 * 68.5 76.9 72.6 483 58.6 69.2 78.3 68.1 1,494 

Zimbabwe 1999 * (24.2) 52.9 47.0 211 33.8 52.4 57.0 52.5 524 

Median 32.6 44.3 49.0 45.3 31.9 40.3 46.6 33.1 

Mean 39.6 48.2 55.1 51.1 36.7 43.0 50.0 41.0 

North Africa/West Asia/Europe 

Armenia 2000 * * 28.8 28.8 101 * * 24.8 24.4 101 

Egypt 2000 40.9 48.9 45.7 45.2 520 37.2 38.4 41.2 38.7 1,075 

Jordan 2002 * * 71.7 71.0 414 * (84.4) 69.1 69.7 113 

Yemen 1997 35.5 36.3 29.5 34.4 747 20.4 28.1 47.1 21.7 2,722 

Median 38.2 42.6 37.6 39.8 28.8 38.4 44.2 31.6 

Mean 38.2 42.6 43.9 44.8 28.8 50.3 45.5 38.6 

Central Asia 

Kazakhstan 1999 * * (31.7) (31.7) 44 * * 20.1 20.1 70 

Kyrgyz Rep. 1997 * * (20.0) (20.0) 38 * * 28.3 28.3 129 

Turkmenistan 2000 * * 56.2 55.7 64 * * (47.8) (52.2) 36 

Uzbekistan 1996 * * 32.8 32.8 44 * * 4.8 4.8 70 

Median u u 32.2 32.2 u u 24.2 24.2 

Mean u u 35.2 35.0 u u 25.3 26.4 

South/Southeast Asia 

Bangladesh 1999-00 30.1 41.4 45.8 39.3 300 18.0 21.6 35.4 22.8 1,486 

Cambodia 2000 36.9 43.2 43.7 41.8 222 26.4 36.7 50.7 34.9 1,502 

India 1998-99 56.5 60.7 61.4 59.8 2,370 45.9 53.7 57.4 49.9 8,639 

Indonesia 1997 * 71.1 76.0 72.8 809 57.0 62.1 75.2 64.8 2,110 

Nepal 2000 19.6 (35.0) 52.2 35.3 105 22.4 31.6 30.1 24.6 1,619 

Philippines 1998 * 41.9 52.7 50.8 682 (17.9) 36.2 46.2 40.8 888 

Vietnam 1997 * * 45.5 48.0 63 (24.0) 45.1 48.5 45.9 397 

Median 33.5 42.6 52.2 48.0 24.0 36.7 48.5 40.8 

Mean 35.8 48.9 53.9 49.7 30.2 41.0 49.1 40.5 

Latin America/Caribbean 

Bolivia 1998 (29.4) 32.5 53.3 45.1 934 23.6 28.8 39.0 29.2 722 

Brazil 1996 (31.3) 40.0 48.1 44.6 853 15.7 30.2 33.6 28.5 297 

Colombia 2000 * 48.0 60.6 56.7 551 * 32.8 50.1 36.6 206 

Dominican Rep. 2002 57.1 63.9 70.3 66.9 1,506 59.0 63.3 63.4 63.0 820 

Guatemala 1998-99 60.2 46.1 39.5 47.5 354 27.8 27.5 (21.3) 27.4 662 

Haiti 2000 28.1 26.9 40.6 31.6 574 23.0 29.8 47.0 27.9 1,532 

Nicaragua 2001 70.0 61.2 69.9 66.5 778 45.3 60.5 63.8 55.3 844 

Peru 2000 (46.9) 51.6 69.5 65.1 1,301 42.0 49.8 57.5 50.3 1,213 

Median 46.9 47.1 57.0 52.1 27.8 31.5 48.6 32.9 

Mean 46.1 46.3 56.5 53.0 33.8 40.3 47.0 39.8 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted 

cases and has been suppressed. 

u = Unknown (too few cases to calculate estimate) 
110 Fever

Figures 5.8.1 and 5.8.2 show for urban and rural areas, respectively, the range, 

mean, and median percentage of sick children for whom advice or treatment was 

sought for countries in each region by mother’s education. Among urban residents in 

Latin America/Caribbean, the regional averages are the same for children of mothers 

with either no education or only primary education. Among rural residents in North 

Africa, the regional averages overlap for children of mothers with primary and secondary or higher education. Otherwise, there is a clear and consistent rise in the percentage of sick children taken for care with increasing level of mother’s education 

Differentials in careseeking for sick children between mothers in the lowest versus 

the highest education categories were computed for each country separately for urban 

and rural residents, where data allowed. Nearly all of the differentials are negative in 

both urban and rural areas. 

In urban areas, 20 of 35 differentials are negative in excess of ten percentage 

points. In six countries (Burkina Faso, Cameroon, Madagascar, Nepal, Bolivia, and 

Peru), urban children with symptoms of ALRI and/or fever are less likely by more 

than 20 percentage points to be taken for medical care if their mothers have no formal education, compared with children whose mothers have completed at least one 

year of secondary school. The largest negative urban differential is found in Nepal (20 

versus 52 percent). Guatemala is the only country in which a large positive urban differential is observed: sick urban children of mothers with no education are substantially more likely to have been taken for medical care (60 percent) than children of 

mothers with secondary or higher education (40 percent). 

This reverse pattern is also found in rural Guatemala, although the magnitude is 

much smaller (28 versus 21 percent). In contrast, 22 of 35 differentials computed for 

rural residents are negative by more than 10 percentage points; 8 differentials are 

negative by more than 20 percentage points (Cameroon, Guinea, Zimbabwe, Yemen, 

Cambodia, the Philippines, Vietnam, and Haiti). 

There is a consistent 

rise in the 

percentage of sick 

children taken for 

care with increasing 

level of mother’s 

education 
Fever 111

Figure 5.8.1 

Percentage of urban children under age three years with symptoms of ALRI 

and/or fever in the two weeks preceding the survey, who were taken to an appropriate health care provider, by mother’s education and region 

u = Unknown (insufficient data 

Figure 5.8.2 

Percentage of rural children under age three years with symptoms of ALRI 

and/or fever in the two weeks preceding the survey, who were taken to an appropriate health care provider, by mother’s education and region 

u = Unknown (insufficient data 
112 Fever

5.3.4 Demographic Characteristics 

Table 5.10 shows the percentage of children with symptoms of ALRI and/or fever 

for whom medical advice or treatment was sought from an appropriate provider by 

child’s sex, age in months, birth order, birth interval, and mother’s age. 

Child’s Sex 

The regional average prevalence of careseeking for symptoms of ALRI and/or fever is similar for male and female children with the exception of South/Southeast 

Asia, where young male children were somewhat more likely, on average, to have 

been taken for care than female children. At the country level, differentials in careseeking by child’s sex were computed. Four of these differentials are positive by more 

than ten percentage points, in favor of males (Jordan, Turkmenistan, Uzbekistan, and 

Vietnam), while two are negative by more than ten percentage points, in favor of females (Armenia and the Kyrgyz Republic). 

Age in Months 

In the Central Asian countries, the number of children under age one year with 

symptoms is too small to provide stable estimates of careseeking. In the other regions, 

the mean prevalence of careseeking is higher at age 6-11 months than at age 0-5 

months. The mean prevalence then declines by age 24-35 months to a level near or 

below that at age 0-5 months, except in South/Southeast Asia, where careseeking 

continues to remain higher through age 12-23 months. 

Intracountry differentials were computed for careseeking at age 0-5 months compared with age 24-35 months. Careseeking for sick children age 0-5 months is substantially lower than for sick children age 24-35 months in just one country, Tanzania (61 versus 79 percent), and is substantially higher (by more than ten percentage 

points) in five countries: Benin, Gabon, Ghana, Namibia, and Colombia. 

Birth Order 

There is a moderate to strong negative association between increasing birth order 

and the likelihood of seeking advice or treatment for a young child with symptoms of 

ALRI and/or fever, especially in South/Southeast Asia and Latin America/Caribbean. 

The number of sick children of birth orders four and above from the Central 

Asian countries is too small to provide stable estimates of careseeking. In 

West/Middle Africa, South/Southeast Asia, and Latin America/Caribbean, the regional average prevalence of careseeking declines steadily with increasing birth order. 

Intracountry differentials in the prevalence of careseeking were computed between 

children of birth order one versus six and above. All but one of the 44 differentials 

computed are positive; 14 are positive by more than ten percentage points. The four 

largest positive differentials (in percentage points) are found in Brazil (22), Colombia 

(28), the Dominican Republic (19), and Peru (18). 

The regional average 

prevalence of careseeking 

for symptoms of ALRI 

and/or fever is similar for 

male and female children 

with the exception of 

South/Southeast Asia. 

There is a negative 

association between 

increasing birth order and 

the likelihood of seeking 

advice or treatment for a 

young child with symptoms 

of ALRI and/or fever. 
Fever 113

Table 5.10 

Percentage of children under age three with symptoms of acute lower respiratory infection (ALRI) and/or fever in 

the two weeks preceding the survey who were taken to an appropriate health provider, by child’s sex, age in 

months, birth order, birth interval, and mother’s age, Demographic and Health Surveys 1996-2002 

Child’s sex Child’s age in months Birth order Birth interval (months) Mother’s age 

Survey Male Female 0-5 6-11 21-23 24-35 1 2-3 4-5 6+ 1st birth <24 24-35 36+ <20 20-34 35+ Total 

Number 

of 

children

West/Middle Africa Benin 2001 49.9 44.1 53.8 51.2 47.9 40.2 52.2 50.8 42.8 41.2 52.2 37.1 50.4 43.9 48.4 47.4 45.0 47.0 1,476 

Burkina Faso 1998-99 17.7 16.5 17.1 19.3 17.4 15.2 20.0 17.7 15.7 16.2 19.9 14.9 15.0 18.2 13.7 17.6 16.9 17.1 1,428 

Cameroon 1998 21.3 25.6 22.1 27.5 21.1 23.6 25.2 24.7 24.1 19.6 24.8 25.0 22.0 22.9 26.5 24.0 19.0 23.4 896 

Chad 1996-97 16.1 13.3 14.8 15.8 12.6 16.4 16.5 13.6 15.3 14.2 16.6 14.9 14.8 13.4 15.3 14.6 14.7 14.7 1,668 

Côte d’Ivoire 1998-99 22.9 24.0 (24.1) 24.6 25.3 20.2 26.6 29.5 17.3 16.8 26.6 (20.9) 24.7 21.6 21.2 24.3 22.2 23.5 564 

Gabon 2000 40.5 32.0 43.4 44.4 32.5 33.1 37.8 37.6 34.7 33.5 37.7 32.7 42.7 33.2 34.0 35.7 41.7 36.3 901 

Ghana 1998 17.0 15.5 28.3 21.8 15.7 10.1 18.1 18.7 15.0 11.3 17.9 16.7 8.4 18.6 (8.7) 17.8 12.7 16.2 663 

Guinea 1999 22.5 25.0 22.1 28.8 24.2 21.2 31.6 24.8 20.8 20.1 31.3 16.8 21.4 23.6 24.7 24.2 21.4 23.7 1,565 

Mali 2001 42.4 43.0 36.3 42.4 43.8 45.3 46.3 41.5 46.0 39.7 46.3 48.4 41.1 40.5 43.6 43.4 40.1 42.7 2,387 

Mauritania 2000-01 16.3 15.8 15.0 17.7 14.2 17.8 16.7 18.7 14.6 13.9 16.7 13.4 15.8 16.7 17.7 16.0 15.6 16.0 1,039 

Niger 1998 11.4 11.9 10.0 11.9 12.5 11.3 16.1 11.8 9.9 10.5 16.1 12.6 10.1 10.5 12.4 11.6 11.1 11.6 2,230 

Nigeria 1999 20.7 21.6 13.5 22.8 21.6 22.9 24.7 19.4 22.0 19.2 24.8 20.5 20.7 19.3 21.4 21.3 20.3 21.1 1,106 

Togo 1998 16.6 18.7 16.6 22.6 16.8 15.0 20.3 20.8 14.7 14.8 20.7 16.9 17.5 16.5 17.3 19.0 13.3 17.6 1,660 

Median 20.7 21.6 22.1 22.8 21.1 20.2 24.7 20.8 17.3 16.8 24.8 16.9 20.7 19.3 21.2 21.3 19.0 21.1 

Mean 24.3 23.6 24.4 27.0 23.5 22.5 27.1 25.4 22.5 20.8 27.0 22.4 23.4 23.0 23.5 24.4 22.6 23.9 

South/East Africa Comoros 1996 36.7 34.2 38.0 37.5 37.0 30.1 32.3 40.9 41.7 27.5 32.0 35.4 36.9 36.2 (40.0) 35.4 34.5 35.5 550 

Eritrea 2002 32.7 32.4 28.9 38.4 36.3 25.3 37.1 37.8 25.1 29.4 36.9 32.7 29.4 33.2 41.6 33.9 27.6 32.6 1,431 

Ethiopia 2000 20.5 16.3 15.1 20.0 20.0 17.5 22.7 20.2 16.3 15.5 22.4 21.0 17.8 16.1 22.3 19.2 15.3 18.5 2,645 

Kenya 1998 32.4 31.8 28.7 34.0 30.4 34.4 27.8 35.8 36.3 27.6 27.6 32.2 32.4 35.2 22.1 32.9 34.8 32.1 1,508 

Madagascar 1997 25.6 28.6 26.3 31.6 25.9 26.1 29.7 30.8 26.6 20.5 29.5 26.8 28.5 24.2 27.4 28.3 21.7 27.1 1,472 

Malawi 2000 16.8 17.2 15.8 20.0 17.4 14.9 19.4 16.9 14.6 17.0 19.2 14.5 15.7 17.5 18.0 16.5 18.6 17.0 4,000 

Mozambique 1997 22.1 24.0 22.9 29.5 21.7 20.3 22.9 19.8 30.7 19.8 23.5 27.7 19.8 23.8 19.4 25.4 15.5 23.0 1,778 

Namibia 2000 49.4 52.0 55.8 52.3 53.4 42.0 54.8 48.6 54.6 43.1 54.3 49.0 44.0 52.5 56.6 51.7 44.6 50.7 741 

Rwanda 2000 20.5 21.8 18.4 27.9 19.7 17.7 20.7 22.1 20.2 20.8 20.7 19.3 23.3 20.4 15.4 21.5 20.5 21.1 2,017 

South Africa 1998 78.9 81.0 77.9 82.7 83.1 75.3 83.7 78.3 79.7 74.6 83.8 (79.8) 70.6 79.4 80.5 80.4 77.7 80.0 637 

Tanzania 1999 75.9 72.7 61.3 79.4 73.6 79.1 76.8 69.9 79.4 74.3 76.8 61.4 73.1 79.0 60.3 76.4 71.8 74.4 820 

Uganda 2000-01 68.5 66.1 62.6 72.6 70.6 60.8 70.9 68.6 65.5 65.7 70.7 65.0 68.5 65.6 64.9 68.9 61.5 67.4 2,405 

Zambia 2001-02 68.6 69.8 68.1 75.1 71.2 63.3 72.3 70.9 68.6 64.3 71.9 72.9 69.1 66.3 71.0 70.8 61.2 69.2 1,978 

Zimbabwe 1999 52.8 48.8 46.8 46.5 52.6 53.0 54.1 49.9 52.3 44.8 54.1 52.0 47.2 50.2 54.8 51.4 45.7 50.9 736 

Median 34.7 33.3 33.5 38.0 36.7 32.3 34.7 39.4 39.0 28.5 34.5 34.1 34.7 35.7 40.8 34.7 34.7 34.1 

Mean 43.0 42.6 40.5 46.3 43.8 40.0 44.7 43.6 43.7 38.9 44.5 42.1 41.2 42.8 42.5 43.8 39.4 42.8 

North Africa/ 

West Asia/Europe Armenia 2000 21.1 32.8 * (41.1) 22.9 23.4 28.5 25.1 * * 28.5 (23.5) * 31.0 * 29.9 * 26.6 202 

Egypt 2000 40.9 40.8 40.7 47.4 40.5 36.7 40.6 42.6 39.6 37.9 40.7 39.7 39.8 42.3 50.7 40.3 40.2 40.9 1,595 

Jordan 2002 76.6 64.1 67.5 82.4 64.8 70.0 77.5 64.7 70.1 74.0 77.5 67.2 75.4 65.4 * 71.0 64.9 70.7 526 

Yemen 1997 24.4 24.5 19.6 26.6 26.1 23.7 26.1 23.9 25.2 23.8 26.2 23.0 23.6 25.9 24.5 24.2 25.2 24.5 3,469 

Median 32.7 36.8 40.7 44.2 33.3 30.2 34.6 33.9 39.6 37.9 34.6 31.6 39.8 36.7 37.6 35.1 40.2 33.8 

Mean 40.8 40.5 42.6 49.4 38.6 38.5 43.2 39.1 45.0 45.2 43.2 38.3 46.3 41.2 37.6 41.3 43.4 40.7 

Central Asia Kazakhstan 1999 (27.2) 23.2 * * 30.8 * (25.8) 25.4 * * (25.8) * * (20.5) * 25.1 * 24.7 114 

Kyrgyz Rep. 1997 21.4 34.5 * (18.2) 30.7 (21.5) (36.9) 23.2 * * (36.9) (28.8) (19.9) (20.1) * 27.2 * 26.4 167 

Turkmenistan 2000 (58.9) (48.7) * * (63.5) (51.2) (46.3) (57.6) * * (46.3) * * * * 55.6 * 54.4 100 

Uzbekistan 1996 21.0 10.5 * * 20.0 (6.5) (21.7) 14.0 * * (21.7) (6.8) * (20.2) * 13.9 * 15.6 115 

Median 24.3 28.8 u u 30.8 21.5 31.4 24.3 u u 31.4 17.8 u 20.2 u 26.2 u 25.6 Mean 32.1 29.2 u u 36.3 26.4 32.7 30.0 u u 32.7 17.8 u 20.3 u 30.5 u 30.3 

South/Southeast Asia Bangladesh 1999-00 27.3 23.7 22.0 21.3 28.6 26.4 31.8 25.9 21.1 16.7 32.1 22.9 21.0 24.1 29.1 25.4 18.5 25.6 1,786 

Cambodia 2000 38.4 33.1 26.8 37.8 41.1 32.7 38.6 40.0 33.3 28.9 38.9 33.1 32.9 37.1 34.8 37.5 31.7 35.8 1,725 

India 1998-99 55.0 48.5 47.8 56.2 51.4 52.0 58.1 51.2 46.5 47.2 58.1 49.3 50.2 48.8 54.0 52.1 46.0 52.0 11,013 

Indonesia 1997 65.7 68.6 59.6 72.5 69.5 62.0 67.5 68.7 64.1 62.9 67.6 59.7 64.3 69.1 61.9 67.8 65.6 67.0 2,919 

Nepal 2000 28.1 22.7 23.4 29.1 27.6 20.5 33.6 23.8 21.4 21.9 33.5 17.8 23.5 24.5 34.5 24.3 24.4 25.3 1,724 

Philippines 1998 47.8 42.2 41.7 50.0 47.4 40.1 50.5 47.4 43.2 36.2 50.5 40.9 40.6 48.2 47.0 45.9 42.3 45.2 1,570 

Vietnam 1997 52.1 38.9 (44.8) 37.4 49.5 47.8 50.3 42.3 48.2 * 50.1 (21.3) 47.5 48.9 * 45.4 (51.7) 46.2 460 

Median 47.8 38.9 41.7 37.8 47.4 40.1 50.3 42.3 43.2 32.6 50.1 33.1 40.6 48.2 40.9 45.4 42.3 45.2 

Mean 44.9 39.7 38.0 43.5 45.0 40.2 47.2 42.8 39.7 35.6 47.3 35.0 40.0 43.0 43.5 42.6 40.0 42.4 

Latin America/ 

Caribbean Bolivia 1998 39.5 36.8 39.1 39.2 39.1 36.0 44.9 40.7 35.8 28.2 45.0 36.5 31.4 39.2 44.0 39.2 32.5 38.2 1,656 

Brazil 1996 42.0 38.6 39.4 47.7 42.5 34.2 48.0 40.9 28.3 26.4 47.9 29.8 30.0 42.4 38.1 41.4 37.7 40.4 1,150 

Colombia 2000 53.6 48.5 58.3 55.3 51.6 46.3 59.3 50.3 41.1 (31.8) 59.0 48.0 33.1 51.7 43.2 52.9 50.1 51.2 757 

Dominican 2002 65.1 66.0 74.2 67.2 62.9 64.3 68.1 65.6 67.7 49.3 67.9 60.3 62.2 68.3 65.0 66.5 57.7 65.5 2,327 

Guatemala 1998-99 37.9 30.5 31.9 42.2 33.3 31.9 37.1 35.3 32.6 32.4 37.1 38.0 29.5 34.1 34.9 35.9 28.1 34.4 1,016 

Haiti 2000 27.3 30.6 32.9 28.4 32.7 23.6 33.9 28.8 30.0 23.4 33.8 29.3 26.1 27.6 30.5 30.2 24.5 28.9 2,106 

Nicaragua 2001 62.4 58.8 57.4 63.2 62.1 58.6 65.1 61.4 56.2 54.3 65.1 49.0 54.0 65.9 63.7 60.8 55.3 60.7 1,622 

Peru 2000 57.5 58.4 56.5 65.6 59.2 52.6 63.6 63.3 46.6 45.5 63.8 52.5 51.9 58.6 55.6 59.3 54.0 57.9 2,514 

Median 47.8 43.6 48.0 51.5 47.1 41.2 53.7 45.6 38.5 32.1 53.5 43.0 32.3 47.1 43.6 47.2 43.9 45.8 

Mean 48.2 46.0 48.7 51.1 47.9 43.4 52.5 48.3 42.3 36.4 52.5 42.9 39.8 48.5 46.9 48.3 42.5 47.2 

Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been 

suppressed. 

u = Unknown (too few cases to calculate estimate) 
114 Fever

Birth Interval 

There appears to be a modest, though somewhat inconsistent, association between 

short birth intervals and a lower probability of careseeking for symptoms of ALRI 

and/or fever in young children. 

By definition, children of birth order one in Table 5.10 are the same as those 

shown in the first category of birth interval. Looking at regional average prevalence of 

careseeking across the remaining three categories, no consistent pattern was seen. In 

West/Middle Africa and South/East Africa, the regional average values are similar 

across birth interval categories. In North Africa/West Asia/Europe, the regional average value is highest in the middle category (24 to 35 months); in South/Southeast 

Asia, the regional average values increase; and in Latin America/Caribbean, the regional average value is lowest in the middle category (24 to 35 months). 

There is more consistency in careseeking differentials between children with the 

shortest birth interval (less than 24 months) versus those with the longest (36 or 

more months). Two-thirds (31 of 48) of these differentials are negative. In five countries (Tanzania, Uzbekistan, Vietnam, Brazil, and Nicaragua), children with the 

shortest birth interval are less likely by more than ten percentage points than children 

with the longest birth interval to have been taken for medical care. 

Mother’s Age 

These data support a modest, though somewhat inconsistent, association between 

younger maternal age and a higher probability of careseeking for symptoms of ALRI 

and/or fever in young children. 

The number of sick children whose mothers are in either the youngest (less than 

20) or oldest (35 or older) age group from the Central Asian countries is too small to 

provide stable estimates of careseeking. Elsewhere, the regional average prevalence of 

careseeking does not vary consistently or substantially across the three maternal age 

classes. 

Differentials in careseeking prevalence were computed between children of the 

youngest versus the oldest mothers. Almost three-fourths of these computed differentials are positive, indicating a higher probability of careseeking by the youngest 

mothers, compared with the oldest mothers. In six countries, the computed differential is positive by more than ten percentage points: Eritrea, Namibia, Egypt, Bangladesh, Nepal, and Bolivia. However, there are two countries with equally large negative differentials: Kenya and Tanzania. 

The data support an 

association between 

younger maternal age 

and a higher probability 

of careseeking for 

symptoms of ALRI and/or 

fever in young children. 
References 115
Summary and Conclusions 115

 6

Summary and Conclusions 

n important strength of nationally representative sample surveys such as the 

DHS surveys is their ability to provide statistically reliable estimates of reported 

morbidities and other indicators not only at a national level, but for major geographic, socioeconomic, and demographic subgroups. 

The data presented in this report show wide variation both within and between 

world regions in the prevalence1

 of diarrhea, fever, and the symptoms of ALRI in 

young children. There is also substantial variation in maternal careseeking and treatment responses to early childhood illnesses. 

Cross-sectional surveys are not designed to prove or disprove causal relationships, 

but they can be used to assess the relative strength of associations between social, 

economic, biological, and environmental factors. It should be borne in mind, however, while every effort is made to ensure the reliability and validity of questions in 

the DHS surveys, cultural and linguistic factors may affect the ways in which questions are understood by respondents in each country. 

As put forth by Mosley and Chen (1984), socioeconomic determinants operate 

through proximate determinants to influence morbidity. These distal determinants 

include community-level variables such as season of the year, and household- and 

individual-level variables. 

Seasonality, with changes in rainfall and temperature, directly affects the day-today risk of exposure to pathogens associated with these illnesses. A limitation of 

cross-sectional surveys such as the DHS surveys is the inability to capture longitudinal variation in prevalence due to seasonality. In this report, it was not possible to 

assess the extent to which intra- or interregional variation might be explained by differences in the seasons at the time of data collection. 

However, other distal determinants were available for examination, including residence (urban-rural), a household wealth index developed recently by ORC Macro in 

collaboration with the World Bank, and mother’s highest level of completed formal 

education. 

Four groups of proximate determinants influence the rate at which a healthy child 

becomes unhealthy. These groups include maternal factors, nutrient deficiency, environmental contamination, and injury, the last of which is not relevant to the illnesses 

covered in this report. 

Maternal and child characteristics available from DHS surveys include mother’s 

age, birth interval, birth order, child’s age, and sex. 

Nutrient deficiency is ascertained in several ways in the DHS surveys. Weight, 

height, sex, and date of birth are used to classify children according to standard indi-

 

1

 Prevalence is defined here as the mother’s report of illness symptoms for the index child at 

any time in the two weeks prior to the interview. 

A

The data presented in this 

report show wide 

variation both within and 

between world regions in 

the prevalence of 

diarrhea, fever, and the 

symptoms of ALRI in 

young children. 
116 Summary and Conclusions

ces of nutritional status, namely height-for-age, weight-for-height, and weight-forage. In addition, mothers are asked several questions that together allow the child to 

be classified according to breastfeeding status.2

 

The extent of environmental contamination to which a child is exposed is routinely measured in DHS surveys with questions about the source of drinking water, 

the type of toilet facilities, and the main flooring material in the home, plus the number of household members, which can be used as a measure of crowding. In some 

surveys, additional environmental information is collected, such as the main type of 

fuel used for cooking and the number of rooms for sleeping.3

 Where available, these 

household-level variables were included this report. At the individual level, mothers 

are asked about offering their child a bottle with a nipple and offering plain water—

both potential sources of contaminants—during the day or night prior to the interview. 

A fifth group of proximate determinants, personal illness control, influences the 

frequency of illness (via prevention) and the rate of recovery (via treatment). One important means of preventing illness in young children is through adherence to the 

recommended immunization schedule, which, in the DHS surveys, is ascertained 

from immunization cards or mother’s recall. 

6.1 Prevalence of Diarrhea 

For children whose mothers reported a recent episode of diarrhea, followup questions are asked about careseeking from appropriate health care providers, use of oral 

rehydration solutions and generally nonrecommended treatments, and feeding practices during the diarrheal episode. For children whose mothers reported a recent episode of fever and/or cough with rapid breathing, followup questions are asked about 

careseeking from appropriate health care providers and the use of antimalarials 

(where included). 

The prevalence of diarrhea among children under age three years is, on average, 

about 20 percent in Sub-Saharan Africa, North Africa/West Asia/Europe, and Latin 

America/Caribbean, 16 percent in South/Southeast Asia, and 11 percent in Central 

Asia. In general, diarrhea is more prevalent among rural children than urban children. When viewed by six-month age groups, diarrhea is highest for children age 

6-17 months, consistent with the introduction of weaning foods and a reduction of 

the early benefit of passively acquired antibodies from the mother through the placenta to the fetus and via breast milk prior to the maturation of the infant’s secretory 

immune system. 

Children living in households in the highest 20 percent of the wealth index distribution for that country are consistently less likely to have had a recent diarrheal episode than children in households in the lowest 40 percent, with the exception of children in Central Asia. This finding holds for both urban and rural children. 

 

2

 In recent years, in a number of countries, anemia testing and/or testing of household salt for 

iodine has been conducted in conjunction with DHS surveys and mothers have been asked 

about child’s receipt of a vitamin A supplement in the past 6 months. However, these 

variables were not examined in this report because of their limited availability. 

3

 In less than 10 of the 52 surveys, other questions about handwashing and disposal of child’s 

stools were included in the DHS questionnaire. These variables were not examined in this 

report because of their limited availability. 

Children living in 

households in the highest 

20 percent of the wealth 

index distribution for that 

country are consistently 

less likely to have had a 

recent diarrheal episode 

than children in 

households in the lowest 

40 percent, with the 

exception of Central Asia. 
Summary and Conclusions 117

Children of mothers with more years of formal education are less likely to have 

had diarrhea recently than children of less educated mothers. While this association 

is demonstrated for both urban and rural children, it is somewhat stronger for urban 

children. Perhaps, in rural areas, the greater lack of hygienic water supplies and adequate sanitary facilities preclude a significant influence of mother’s education on diarrhea. 

In a number of countries in North Africa/West Asia/Europe, Central Asia, and 

Latin America/Caribbean, modest to strong differences in diarrhea prevalence are 

seen by mother’s age: children of mothers age 35 and over are less likely than children 

of mothers under age 20 to have had diarrhea recently. Diarrhea prevalence is not 

noticeably affected by increments in birth intervals or birth order, or by child’s sex. 

The association between nutritional status (defined by three nutritional indices) 

and diarrhea prevalence is strong and generally consistent, with better nourished 

children being less likely to have had a recent diarrheal episode than children who are 

less well nourished. Central Asia is the exception to this pattern. It is probable that in 

Central Asia the nearly universal access to adequate santitation facilities and the more 

temperate climate reduce the influence of nutritional status on diarrhea in that region. 

Breastfeeding status is another indicator of nutrient deficiency. Among infants 

under six months of age, the prevalence of diarrhea is generally much lower for fully 

breastfed infants compared with partially breastfed infants, except in the Latin America/Caribbean region. This association continues to hold among children age 6 to 11 

months. 

There is wide variation by residence and within and between regions in household 

access to safe drinking water. The percentage of urban households with access to safe 

drinking water ranges from 25 to 100 percent; the range for rural households is 4 to 

99 percent. 

Overall, the prevalence of diarrhea in urban areas does not differ markedly by access to safe drinking water except in Sub-Saharan Africa. Likewise, there is no consistent association between diarrhea prevalence and safe drinking water in rural areas. 

This finding is not surprising in light of research indicating the primary importance 

of sanitation in diarrhea prevalence (see below) and evidence that the quantity of water available to the household is a better predictor of diarrhea risk than the quality 

(Esrey and Habicht, 1986). 

The means of disposing of human waste varies substantially by residence in most 

countries. In a majority of countries, more than 90 percent of urban households have 

adequate sanitary facilities, while in two-fifths of countries, less than half of rural 

households meet this criteria. 

In urban areas, the prevalence of diarrhea is lower for children in households with 

adequate sanitary facilities than for children in households without adequate sanitary 

facilities. This association is especially strong in South/East Africa and Latin America/Caribbean. The finding also holds for rural areas. 

Another indicator of environmental contamination is the type of flooring material 

used in the home. In general, for children living in urban areas, there is a strong association between natural floors (earth, sand, or dung) and the likelihood of a recent 

episode of diarrhea. The association also holds for rural children but is not as strong. 

A measure of crowding, the number of children in the household below the age of 

five years, is not consistently associated with diarrhea prevalence among either urban 

or rural children, with the possible exception of rural children in South/East Africa. 

The association between 

nutritional status and 

diarrhea prevalence is 

strong and generally 

consistent, with better 

nourished children being 

less likely to have had a 

recent diarrheal episode 

than children who are 

less well nourished. 

In general, for children 

living in urban areas, 

there is a strong 

association between 

natural floors (earth, 

sand, or dung) and the 

likelihood of a recent 

episode of diarrhea. 
118 Summary and Conclusions

Two variables that are ascertained along with information about breastfeeding and 

feeding practices are used as indicators of environmental contamination. These are 

giving a child plain water or a bottle with a nipple on the day or night preceding the 

interview. For infants under six months, a clear and consistent association is seen 

wherein infants who were given water in the past 24 hours are more likely to have 

experienced a recent episode of diarrhea. This finding does not hold for infants age 

6 to 11 months. 

Similarly, diarrhea prevalence is higher among infants under six months who were 

given a bottle with a nipple in the past 24 hours compared with infants not given a 

bottle, with the exception of the Latin America/Caribbean region. However, it is 

interesting to note that at age 6 to 11 months, this association is largely reversed. 

While acknowledging the limitations of linking a behavior that occurred in the 

past 24 hours with an outcome that occurred at any time in the past two weeks, this 

reverse association could be real and might be logically explained if mothers of older 

infants are more likely than mothers of younger infants to give oral rehydration solutions in response to diarrhea, and do so using a bottle with a nipple. The data show 

that children under six months are less likely to be given oral rehydration solutions 

than older children. 

There is wide variation by residence and within and between regions in measles 

immunization, a personal illness prevention measure. The region with the lowest 

level of measles immunization in both urban and rural areas is West/Middle Africa, 

which also has the largest mean difference in measles immunization by residence. 

Only two countries (Jordan and Egypt) met the World Summit for Children’s goal of 

90 percent measles immunization coverage in both urban and rural areas. 

There is a strong and consistent negative association between measles immunization and the likelihood of a recent diarrheal episode among children in their second 

and third years of life. It is recognized that this association may be explained by socioeconomic factors related to the probability of being vaccinated. 

6.2 Careseeking and Treatment for Diarrhea 

Seeking care for diarrhea from an appropriate health care provider varies considerably even within regions. In Rwanda, the percentages of urban and rural children 

taken for care are among the lowest (both 15 percent), while in South Africa and 

Tanzania, the percentages of urban and rural children taken for care are among the 

highest: 64 and 69 percent of urban children and 59 and 60 percent of rural children, 

respectively. 

Although the proportion of children with diarrhea who had symptoms consistent 

with a need for medical attention cannot be ascertained from these data, it is likely to 

be relatively small. Therefore, the wide variation in careseeking across countries is 

likely to be primarily correlated with the availability, accessibility, and affordability of 

health care facilities and providers relative to the population of each country. 

Except for Central Asia, there is a relatively consistent differential in careseeking 

by residence, wherein urban children with diarrhea are more likely to be taken to a 

health care provider than their rural counterparts. 

There is considerable variation within regions in the use of oral rehydration salts 

(ORS) to treat children with diarrhea. Among children with diarrhea who were taken 

to a health provider, ORS use ranges from 49 to 68 percent by region. Among children not taken to a health provider, ORS use ranges from 12 to 24 percent. 

For infants under six 

months, an association 

is seen wherein infants 

given water in the past 

24 hours are more 

likely to have 

experienced a recent 

episode of diarrhea. 

Only two countries 

(Jordan and Egypt) met 

the World Summit for 

Children’s goal of 90 

percent measles 

immunization coverage 

in both urban and 

rural areas. 
Summary and Conclusions 119

Recommended homemade fluids (RHF) are used considerably less than ORS to 

treat diarrhea. Among children who were taken to a health provider, the mean percentage given RHF ranges from 11 to 33 percent by region. Among children not 

taken to a health provider, RHF use ranges from 7 to 24 percent by region. 

There is a strong and consistent difference in the use of oral rehydration solutions 

(either ORS or RHF) by careseeking behavior. Children taken to a health provider 

are more likely to have been given a solution at some time during the diarrheal episode. While it may be the case that health providers are likely to have ORS on hand 

and correctly administer it to treat dehydration, it may also be the case that women 

who initiate ORS or RHF use at home are more likely than other women to subsequently take their sick children to a health provider. 

Mothers are advised by health care providers and through health education messages to increase fluids and continue to feed a child with diarrhea. The mean percentage of sick children offered more fluids ranges by region from 48 to 72 percent 

among children taken to a health provider and from 37 to 60 percent among children 

not taken for care. 

Among sick children taken to a health provider, the mean percentage offered 

about the same or more food than usual ranges from 24 to 44 percent by region. In 

nearly every country, continued feeding is reported less often than increasing fluids 

for children taken for care. On average, among sick children not taken for care, the 

percentage continuing to be offered about the same or more food ranges from 38 to 

46 percent by region. 

Sick children who are taken to a health provider are more likely to be offered more 

fluids than children not taken for care. The opposite association is found with respect 

to continued feeding: children with diarrhea who are taken to a health provider are 

less likely to be offered about the same or more food than usual than children not 

taken for care. One explanation for this negative association may be that a sharp drop 

in appetite and refusal to eat may be an important factor in a mother’s decision to 

seek care. 

It is appropriate for a health provider to treat diarrhea with an antibiotic when 

other signs or symptoms point to cholera or dysentery. In the vast majority of cases, 

however, the use of antibiotics and other drugs (e.g., antimotility agents) is not warranted and their use is discouraged because of concerns about increasing antibiotic 

resistance in a population and ineffectiveness, respectively. 

The DHS data show that antibiotics and other nonrecommended treatments are 

still widely used. The mean percentage of children with diarrhea who were taken to a 

health provider and who received, at any time during the diarrheal episode, a nonrecommended treatment, ranges from 48 to 74 percent by region. Among sick children not taken to a health provider, the mean percentage who received a nonrecommended treatment ranges from 15 to 48 percent by region. 

There is a strong and consistent difference by careseeking in the likelihood that a 

child with diarrhea will be given a nonrecommended treatment during the diarrheal 

episode, with children taken for care more likely to receive a nonrecommended treatment than those not taken. 

The DHS data show that 

antibiotics and other 

nonrecommended 

treatments are still 

widely used. 
120 Summary and Conclusions

The DHS child illness questions do not allow assessment of the severity of the diarrhea episode or whether a particular treatment was an antibiotic. Under the assumption that the proportion of children with diarrhea in need of an antibiotic is 

small and that the proportion of all medications given by health care providers for 

diarrhea that are antibiotics is large, it could be hypothesized that antibiotics are 

widely overprescribed by health providers. However, the level of reported use of these 

same treatments for sick children who were not taken for care is substantial, suggesting that mothers are purchasing or otherwise obtaining many medications on their 

own without appropriate medical advice. 

In most countries, better educated mothers, with at least one completed year of 

secondary school, in both urban and rural areas are more likely to administer oral rehydration solutions, to increase fluids, and to continue feeding than less well educated mothers. 

Mother’s age, birth order, and child’s sex are not associated with differential use of 

oral rehydration solutions for diarrhea. However, infants under six months are less 

likely to be treated with these solutions than older children. Since most of these 

young infants are still breastfeeding, it may be that their mothers prefer to increase 

breast milk consumption during the diarrheal episode as a treatment strategy rather 

than to administer oral rehydration solutions. 

Birth order, child’s age, and sex are not associated with differential practices of increasing fluids and continuing to feed during diarrhea. However, there is a modest 

but largely consistent association with mother’s age, wherein mothers under age 20 

are less likely to engage in these practices. 

6.3 Prevalence of ALRI Symptoms 

The prevalence of symptoms of ALRI varies widely by region from a low mean 

value of 2 percent in Central Asia to a high mean value of 25 percent in Latin America/Caribbean. Rural children are slightly more likely than urban children to have 

experienced recent ALRI symptoms. An examination of prevalence by six-month age 

groups shows that, like diarrhea, symptoms of ALRI peak at age 6 to 17 months. 

With the exception of West/Middle Africa, there is a largely consistent negative 

association between household wealth and the likelihood of recent ALRI symptoms 

in both urban and rural areas. The negative association between ALRI symptoms 

and mother’s education is more consistent in urban than in rural areas. Mother’s age, 

birth interval, birth order, and child’s sex are not associated with differential prevalence of ALRI symptoms. 

In general, nutritional status, as measured by weight-for-age, height-for-age, and 

weight-for-height, is associated with the prevalence of ALRI symptoms, wherein 

better nourished children are less likely to have experienced recent symptoms of 

ALRI than children who are less well nourished. This is seen especially for weightfor-age, with the exception of the Central Asian region. 

Regarding environmental factors, in urban areas, children in households with 

natural floors (earth, sand, or dung) are generally more likely to have had ALRI 

symptoms recently than children from households with finished floors, particularly in 

the regions of South/East Africa and Latin America/Caribbean. This relationship 

also holds for children in rural areas. 

Information about the type of fuel used by the household for cooking was available 

for only 12 countries. Nonetheless, in urban areas a strong association is seen between 

The level of reported use 

of antibiotics and other 

drugs for sick children 

who were not taken for 

care is substantial, 

suggesting that mothers 

are purchasing or 

otherwise obtaining many 

medications on their own 

without appropriate 

medical advice. 

In general, nutritional 

status, as measured by 

weight-for-age, heightfor-age, and weight-forheight, is associated with 

the prevalence of ALRI 

symptoms, wherein better 

nourished children are 

less likely to have 

experienced recent 

symptoms of ALRI than 

children who are less 

well nourished. 
Summary and Conclusions 121

the use of biomass fuels and increased likelihood of recent ALRI symptoms among 

children. The association is not seen among children in rural areas. It can be hypothesized that adequate ventilation is a greater problem in urban areas, where housing is more crowded, than in rural areas. 

One measure of crowding, the average number of persons per sleeping room for 

the household, was available for 24 countries. In urban areas, children living in 

households with 5 or more persons per sleeping room are generally more likely to 

have had recent ALRI symptoms than children living in households with 1 to 2 persons per sleeping room. This relationship is not seen among children in rural areas. A 

second measure of crowding, the total number of household members, is not significantly associated with the prevalence of ALRI symptoms in either urban or rural areas. The average number of persons per sleeping room in urban areas thus appears to 

be a better indicator of risk for symptoms of ALRI in young children than household 

size. Perhaps it is a better indicator of the intensity of exposure to airborne pathogens. 

Receipt of all recommended childhood vaccinations varies widely. At the time of 

the survey, only one country, Egypt, had met the World Summit for Children’s goal 

of 90 percent full immunization coverage for both urban and rural children; 80 percent coverage was achieved by four countries in urban areas and by two countries in 

rural areas. Differentials in immunization coverage by residence are substantial and 

are especially large in West/Middle Africa, with higher coverage among urban children. 

There is no evidence of a consistent significant association between the receipt of 

all recommended vaccinations and the likelihood of recent ALRI symptoms. 

6.4 Prevalence of Fever 

The prevalence of fever (in the two-week period preceding the survey) is highest in 

West/Middle Africa and South/East Africa (about 38 percent) and lowest in Central 

Asia (10 percent). While fever is a common symptom associated with many diseases, 

this pattern is consistent with malaria endemicity. 

The prevalence of fever is consistently higher in rural than in urban areas. Examining fever prevalence by six month age groups shows that, like diarrhea and symptoms 

of ALRI, fever also peaks at age 6 to 17 months. 

In both urban and rural areas, the prevalence of fever is negatively associated with 

the household wealth index, with children in the lowest wealth index category having 

the highest prevalence of fever. In most countries, mother’s educational attainment is 

also negatively associated with the prevalence of fever. 

Mother’s age and child’s sex are not significantly associated with the likelihood of 

a recent occurrence of fever. An examination of fever prevalence by birth interval 

categories shows inconsistencies. However, with the exception of Central Asia, differentials in fever prevalence between children born after a short birth interval (<24 

months) and first births are small but consistent, wherein children born after a short 

interval are more likely to have had fever recently. Similar findings are seen when 

birth order is considered. Children of birth order six or higher are more likely than 

first-born children to have had fever recently. 

In all regions except Central Asia, better nourished children, as measured by three 

indices of nutritional status, are less likely than children who are less well nourished 

to have had a recent occurrence of fever. 

The prevalence of fever is 

consistently higher in 

rural than in urban areas. 

Examining fever 

prevalence by six month 

age groups shows that, 

like diarrhea and 

symptoms of ALRI, fever 

also peaks at age 

6 to 17 months. 
122 Summary and Conclusions

Looking at a measure of personal illness prevention, fully immunized children in 

their second year of life are slightly less likely than children not fully immunized to 

have had fever recently. However, this association no longer holds by the third year of 

life. 

6.5 Use of Antimalarials 

Treatment of fever with antimalarials was ascertained in 17 malaria endemic countries. Use is highly variable across these countries and is less than 5 percent in 

Rwanda, Zimbabwe, Colombia, and Nicaragua. Antimalarials are more likely to have 

been used to treat fever in urban children than rural children. These findings may be 

explained by differences among countries in the local availability and cost of antimalarial drugs, or the intensity of educational campaigns to promote their use as a presumptive treatment for malaria. However, the differences may also reflect variation 

among countries in the most prevalent Plasmodium species, their severity, and the 

epidemic state of the disease at the time of the survey. 

6.6 Careseeking for ALRI Symptoms and/or Fever 

Finally, we focus on careseeking in response to symptoms of ALRI and/or fever. 

In most countries, less than half of either urban or rural children with symptoms of 

ALRI and/or fever in the two weeks prior to the survey were taken to an appropriate 

health care provider for advice or treatment. In all but three countries, urban children 

are more likely than rural children to have been taken for care. 

When careseeking for symptoms of ALRI and/or fever is examined by age groups 

(0-5, 6-11, 12-23, 24-35 months), it is found that careseeking peaks at age 6 to 11 

months, except in South/Southeast Asia, where the level of careseeking remains high 

throughout the second year of life. 

Careseeking is generally higher for children living in households in the highest 20 

percent of the wealth index distribution for that country than for children whose 

households are in the lowest 40 percent. This relationship holds for both urban and 

rural children. 

Generally, in both urban and rural areas, there is a consistent increase in the percentage of children with symptoms of ALRI and/or fever taken to a health care provider by mother’s increasing educational attainment. 

The exception to this pattern is Guatemala, where urban mothers with no formal 

education are significantly more likely to have taken a sick child to a health provider 

than mothers with at least one completed year of secondary school. A similar reversed pattern is seen across wealth categories for urban areas of Guatemala. This 

suggests that primary health care resources, at least in urban areas, may have been 

targeted at the time of the survey toward lower income families (and thus less educated parents). 

Younger mothers (under age 20) are somewhat more likely than older mothers 

(age 35 and over) to have taken a child with symptoms of ALRI and/or fever to a 

health care provider. Children born after a shorter birth interval (<24 months) are 

less likely, overall, than children born after a longer birth interval (36+ months) to 

have been taken for care. 

There is a moderate to strong negative association between birth order and the 

likelihood of seeking advice or treatment for symptoms of ALRI and/or fever, particularly in South/Southeast Asia and Latin America/Caribbean. It may be that 

Antimalarials are more 

likely to have been used 

to treat fever in urban 

children than 

rural children. 

In both urban and rural 

areas, there is a 

consistent increase in 

the percentage of 

children with symptoms 

of ALRI and/or fever 

taken to a health care 

provider by increasing 

level of mother’s 

educational attainment. 
Summary and Conclusions 123

mothers with many children are more confident in their ability to care for a sick child 

on their own or, alternatively, that inexperienced mothers, who are typically younger, 

may be more aware of messages promoting appropriate careseeking behaviors. 

Child’s sex is not differentially associated with the likelihood of seeking care with 

the exception of South/Southeast Asia, where male children are somewhat more 

likely than female children to be taken for care. 

6.7 Special Comments about Central Asia 

Throughout the report, several exceptions to otherwise largely consistent associations have been noted with respect to the Central Asia region. Most importantly, 

there is a lack of association between household wealth and diarrhea prevalence, a 

lack of association between nutritional status and either ALRI symptom or fever 

prevalence, and a lack of association between birth interval and birth order and fever 

prevalence in Central Asia as a region. 

It should be borne in mind that in the four countries of Central Asia included in 

this report, the prevalence of ALRI symptoms is lower than in all the other countries, 

and the prevalence of diarrhea and fever are among the lowest. In addition, there are 

very few children in these four countries who are either severely underweight or severely wasted. Likewise, the numbers are small for children in urban households in 

the lowest 40 percent of the wealth index distribution for the country and for children in rural households in the highest 20 percent. In contrast, mean immunization 

coverage is highest in the Central Asian region. Last, since malaria and other tropical 

diseases are not endemic in these four countries, the morbidities with which fever 

symptoms are associated and hence factors associated with their risk can reasonably 

be expected to differ. 

In the Central Asia region, 

there is a lack of 

association between 

household wealth and 

diarrhea prevalence, a 

lack of association 

between nutritional 

status and either ALRI 

symptom or fever 

prevalence, and a lack of 

association between birth 

interval and birth order 

and fever prevalence. 

References 125

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Appendix 

Appendix 129

Table A.1 

Percentage of children age 12-23 months immunized at any time before the survey, by residence, Demographic 

and Health Surveys 1996-2002 

 Urban Rural 

Survey BCG 

DPT 

(3 

doses) 

Polio 

(3 

doses) Measles All None

Vaccination

card 

seen 

Number 

of children BCG 

DPT 

(3 

doses)

Polio 

(3 

doses) Measles All None

Vaccination 

card 

seen 

Number 

of children 

West/Middle Africa Benin 2001 91.0 80.1 74.0 75.3 64.4 4.7 74.5 325 89.3 68.4 66.8 64.1 56.1 8.7 72.7 606 

Burkina Faso 1999 96.4 73.3 71.6 75.5 59.5 1.3 87.5 107 69.5 37.2 39.1 42.3 25.9 13.6 52.2 934 

Cameroon 1998 91.8 67.9 61.9 67.6 48.6 3.8 60.7 200 68.6 44.2 41.6 49.3 31.2 15.6 52.8 548 

Chad 1997 71.4 41.6 36.0 38.9 20.5 17.8 41.9 247 30.4 13.8 13.5 18.6 9.0 51.2 23.6 963 

Côte d’Ivoire 1998 94.3 78.3 77.5 82.0 69.6 2.6 83.9 140 78.8 52.7 52.7 58.8 41.8 11.5 68.5 299 

Gabon 2000 92.5 41.5 29.3 61.1 17.8 3.2 65.1 591 79.9 20.6 16.8 37.1 5.7 6.4 56.6 211 

Ghana 1998 93.4 83.7 81.8 81.5 72.3 3.7 78.5 180 85.7 67.7 67.6 69.2 58.0 8.4 75.1 463 

Guinea 1999 91.3 64.7 59.0 66.9 47.3 5.8 62.2 246 70.2 39.4 37.3 46.7 26.7 25.9 40.7 675 

Mali 2001 90.4 68.4 64.5 70.8 50.3 7.1 64.3 546 62.0 30.1 31.1 41.3 21.5 26.4 43.0 1,650 

Mauritania 2000 86.5 48.7 49.7 74.3 38.0 9.7 39.0 402 66.1 33.4 39.5 53.0 27.4 18.9 31.0 548 

Niger 1998 89.6 72.4 67.0 67.1 54.2 7.0 77.6 257 38.0 14.6 14.6 27.8 10.5 47.3 25.4 1,173 

Nigeria 1999 75.0 44.7 41.8 61.5 31.7 19.6 28.1 310 46.0 19.5 18.5 32.7 11.3 45.1 16.3 851 

Togo 1998 88.0 61.9 64.4 58.0 46.3 8.4 71.3 249 72.3 36.4 41.6 38.2 26.5 18.5 54.8 885 

Median 91.0 67.9 64.4 67.6 48.6 5.8 65.1 69.5 36.4 39.1 42.3 26.5 18.5 52.2 

Mean 88.6 63.6 59.9 67.7 47.7 7.3 64.2 65.9 36.8 37.0 44.5 27.0 22.9 47.1 

South/East Africa Comoros 1996 90.2 68.5 65.2 63.0 56.5 7.6 72.8 92 91.0 68.2 65.7 63.5 53.8 8.3 74.7 277 

Eritrea 2002 97.6 93.5 91.3 93.8 88.4 1.8 82.7 355 87.7 76.5 78.6 78.5 68.6 7.2 73.2 604 

Ethiopia 2000 70.7 51.3 60.3 63.1 42.0 4.7 51.3 225 42.7 17.2 31.5 22.3 11.0 17.9 24.2 1,919 

Kenya 1998 98.0 79.0 72.0 92.8 58.3 1.6 42.5 210 95.3 79.2 75.0 76.1 59.8 2.9 58.5 888 

Madagascar 1997 80.3 59.2 58.8 60.8 46.4 12.4 57.3 256 62.1 45.5 44.8 42.0 33.5 21.4 47.6 953 

Malawi 2000 96.3 92.4 85.8 90.6 78.6 1.1 77.4 307 91.8 82.8 78.9 82.0 68.7 3.0 81.6 1,930 

Mozambique 1997 98.2 93.8 88.9 93.0 85.0 1.3 89.2 281 72.2 49.6 45.5 47.1 36.4 25.0 59.3 963 

Namibia 2000 95.5 85.3 80.5 84.3 69.5 2.4 68.2 277 87.2 76.3 75.2 78.4 62.4 6.6 76.4 539 

Rwanda 2000 98.3 86.5 87.2 89.9 77.0 1.1 63.5 217 96.8 85.9 87.6 86.3 75.8 1.8 66.8 1,113 

South Africa 1998 98.0 81.7 75.5 85.1 67.1 1.6 75.3 491 95.6 71.0 68.6 79.3 59.6 2.7 73.8 483 

Tanzania 1999 100.0 89.9 84.8 90.3 80.5 0.0 69.6 112 91.0 78.9 78.8 75.3 65.5 6.5 75.1 481 

Uganda 2000 91.9 59.1 60.0 68.4 42.1 6.2 42.6 167 77.0 44.5 53.4 55.3 36.0 13.7 47.8 1,337 

Zambia 2001 95.5 87.9 85.1 85.5 76.9 3.2 81.3 379 93.3 76.8 78.1 83.9 67.2 3.4 78.8 920 

Zimbabwe 1999 92.5 86.1 67.8 86.2 65.0 7.5 61.3 227 86.0 78.4 68.3 75.7 63.6 13.6 72.0 472 

Median 95.9 85.7 78.0 85.8 68.3 2.1 68.9 89.3 76.4 71.8 75.9 61.1 6.9 72.6 

Mean 93.1 79.6 75.9 81.9 66.7 3.8 66.8 83.6 66.5 66.4 67.6 54.4 9.6 65.0 

North Africa/West Asia/Europe Armenia 2000 90.6 87.1 91.1 76.0 73.2 7.0 93.0 169 90.6 93.1 93.2 72.1 69.1 4.0 96.0 131 

Egypt 2000 99.7 93.5 94.3 97.8 92.8 0.2 68.9 843 99.1 94.3 95.3 96.2 91.8 0.3 74.7 1,327 

Jordan 2002 35.2 98.4 97.6 95.4 34.0 0.0 75.7 879 6.8 97.3 97.5 94.2 6.8 0.4 84.1 256 

Turkey 1998 91.6 63.9 69.0 82.2 51.2 2.9 45.5 424 83.7 50.3 57.0 72.7 36.8 4.8 27.5 265 

Yemen 1997 81.8 70.8 66.1 71.9 56.4 9.1 54.9 513 45.2 30.3 39.6 33.8 19.6 12.9 23.4 1,675 

Median 90.6 87.1 91.1 82.2 56.4 2.9 68.9 83.7 93.1 93.2 72.7 36.8 4.0 74.7 

Mean 79.8 82.7 83.6 84.7 61.5 3.8 67.6 65.1 73.1 76.5 73.8 44.8 4.5 61.1 

Central Asia Kazakhstan 1999 89.1 86.9 84.2 81.4 74.9 10.1 90.4 118 90.5 90.1 82.3 76.2 71.7 9.0 91.0 151 

Kyrgyz Rep. 1997 98.5 88.4 89.9 83.7 76.2 0.0 84.3 76 97.9 80.4 84.1 84.5 68.0 0.1 76.9 296 

Turkmenistan 2000 89.0 86.5 86.1 81.8 80.1 10.8 89.2 281 96.7 96.6 95.6 92.0 88.5 1.9 98.1 365 

Uzbekistan 1996 97.5 83.8 87.5 84.2 68.7 0.0 87.4 145 97.5 90.9 93.6 94.7 83.2 0.0 91.6 321 

Median 93.3 86.7 86.8 82.8 75.6 5.1 88.3 97.1 90.5 88.8 88.3 77.4 1.0 91.3 

Mean 93.5 86.4 86.9 82.8 75.0 5.2 87.8 95.7 89.5 88.9 86.8 77.8 2.8 89.4 

South/Southeast Asia Bangladesh 2000 95.2 82.0 79.6 80.7 69.7 3.7 52.9 220 90.2 70.0 69.0 68.9 58.5 8.9 41.6 1,095 

Cambodia 2000 75.4 53.5 54.9 61.0 46.3 19.8 48.9 156 70.8 47.8 51.0 54.6 39.0 21.9 47.3 1,096 

India 1999 86.8 73.4 78.2 69.2 60.5 6.3 46.0 2,306 67.1 49.8 58.3 45.3 36.6 16.8 30.1 7,888 

Indonesia 1997 92.6 75.2 84.9 79.2 65.8 2.3 37.5 927 81.6 59.4 68.8 67.3 50.0 7.0 28.0 2,161 

Nepal 2000 88.4 78.2 95.4 80.6 74.9 0.0 17.5 87 84.2 71.7 91.2 69.9 65.0 0.9 16.1 1,226 

Philippines 1998 95.0 85.5 85.5 82.2 76.1 3.8 42.1 700 86.9 76.7 78.4 75.9 69.8 11.2 40.8 775 

Vietnam 1997 96.5 77.5 68.2 85.5 60.2 1.7 25.9 101 88.2 63.7 59.8 75.5 48.3 3.8 10.9 530 

Median 92.6 77.5 79.6 80.6 65.8 3.7 42.1 84.2 63.7 68.8 68.9 50.0 8.9 30.1 

Mean 90.0 75.0 78.1 76.9 64.8 5.4 38.7 81.3 62.7 68.1 65.3 52.5 10.1 30.7 

Latin America/Caribbean Bolivia 1998 92.3 56.2 43.3 54.8 27.9 4.8 42.6 735 80.6 38.3 33.3 45.4 22.2 13.7 36.8 541 

Brazil 1996 95.1 84.8 84.3 90.2 77.5 2.2 79.2 725 84.2 66.6 68.0 76.5 55.2 6.1 77.8 209 

Colombia 2000 94.8 78.9 73.5 71.6 54.8 0.3 76.3 605 90.4 72.3 66.8 69.0 46.0 1.8 71.1 285 

Dominican Rep. 2002 94.5 58.7 44.7 89.5 36.2 1.5 49.9 1,430 91.6 52.1 42.6 86.0 32.4 1.4 51.1 754 

Guatemala 1999 93.9 73.6 62.2 80.8 55.2 2.3 62.2 320 88.3 68.5 69.4 80.4 62.1 4.6 72.2 528 

Haiti 2000 82.5 49.0 49.9 60.9 33.6 4.5 69.9 415 65.1 39.7 39.3 50.2 33.5 21.3 64.4 810 

Nicaragua 2001 98.7 84.7 86.9 89.8 73.9 0.9 77.0 661 92.5 80.7 82.7 83.1 69.4 3.4 79.9 709 

Peru 2000 98.0 89.4 80.4 86.1 71.6 0.8 63.1 1,307 93.9 78.8 71.4 82.2 59.6 3.0 51.8 1,046 

Median 94.7 76.3 67.8 83.4 55.0 1.9 66.5 89.4 67.6 67.4 78.4 50.6 4.0 67.8 

Mean 93.7 71.9 65.7 78.0 53.8 2.2 65.0 85.8 62.1 59.2 71.6 47.5 6.9 63.1 
130 Appendix

Figure A.1 

Percentage of children age 12-23 months immunized against measles at any time before the survey, by 

residence 
Appendix 131

Figure A.2 

Percentage of children age 12-23 months fully immunized at any time before the survey by residence 
132 Appendix

Figure A.3 

Percentage of households with access to safe drinking water, by residence 
Appendix 133

Figure A.4 

Percentage of households with sanitary means of excreta disposal, by residence 
134 Appendix

Figure A.5 

Undernutrition/infection cycle 

Adapted from Tomkins and Watson, 1989 
DHS Comparative Reports Series 

1. Westoff, Charles F. 2001. Unmet Need at the End of the Century. 

2. Westoff, Charles F. and Akinrinola Bankole. 2002. Reproductive Preferences in Developing 

Countries at the Turn of the Century. 

3. Rutstein, Shea O. 2002. Fertility Levels, Trends, and Differentials 1995-1999. 

4. Mahy, Mary. 2003. Childhood Mortality in the Developing World: A Review of Evidence from 

the Demographic and Health Surveys. 

5. Westoff, Charles F. 2003. Trends in Marriage and Early Childbearing in Developing Countries. 

6. Rutstein, Shea O. and Kiersten Johnson. 2004. The DHS Wealth Index. 

7. Yoder, P. Stanley, Noureddine Abderrahim, and Arlinda Zhuzhuni. 2004. Female Genital Cutting 

in the Demographic and Health Surveys: A Critical and Comparative Analysis. 

8. Stallings, Rebecca Y. 2004. Child Morbidity and Treatment Patterns. 

9. Rutstein, Shea O. and Iqbal H. Shah. 2004. Infecundity, Infertility, and Childlessness in 

Developing Countries. 
DHS Comparative Reports Series 

1. Westoff, Charles F. 2001. Unmet Need at the End of the Century. 

2. Westoff, Charles F. and Akinrinola Bankole. 2002. Reproductive Preferences in Developing 

Countries at the Turn of the Century. 

3. Rutstein, Shea O. 2002. Fertility Levels, Trends, and Differentials 1995-1999. 

4. Mahy, Mary. 2003. Childhood Mortality in the Developing World: A Review of Evidence from 

the Demographic and Health Surveys. 

5. Westoff, Charles F. 2003. Trends in Marriage and Early Childbearing in Developing Countries. 

6. Rutstein, Shea O. and Kiersten Johnson. 2004. The DHS Wealth Index. 

7. Yoder, P. Stanley, Noureddine Abderrahim, and Arlinda Zhuzhuni. 2004. Female Genital Cutting 

in the Demographic and Health Surveys: A Critical and Comparative Analysis. 

8. Stallings, Rebecca Y. 2004. Child Morbidity and Treatment Patterns. 

9. Rutstein, Shea O. and Iqbal H. Shah. 2004. Infecundity, Infertility, and Childlessness in 

Developing Countries.