Global Forum on Gender Statistics,
Manila, Philippines, 11-13 October, 2010
Integrating gender into tools for the
production and Analysis of
Health Statistics
Mrs.Hang Lina
Deputy Director General, NIS
CAMBODIA
ESA/STAT/AC.219/25
Introduction
• The National Institute of Statistics (NIS) has been closely
working with a number of concerning line ministries (MOWA,
MOH, MOE, MOA) and development partners (UNFPA, SIDA,
and JICA) to promote gender equality and gender statistics in
Cambodia.
• A Gender Mainstreaming Action Group (GMAG) was
formed in July 2006, supporting by UNFPA. A Gender
Mainstreaming Action Plan (GMAP) had been
produced for 2008-2010 and now is updating for 20092013. Training courses on Gender Mainstreaming into
Statistics and Planning had been conducted for the
senior officers of the Ministry of Planning and by
provinces.
Introduction
• A Gender Statistics Working Group was established in
February, 2007. A Gender booklet “Women and Men” in
Cambodia (1st edition) had been published for 2008 and now
is updating for 2010 (2nd edition) with the support from SIDA.
Another publication namely “Gender in Cambodia” is an indepth analysis based on 2008 Population Census results with
the support from UNFPA.
Introduction
• The National Institute of Statistics has conducted two
Censuses and several Surveys which serve as major
sources of gender statistics for Cambodia. They are:
– The Population Census (every ten years ,1998 and 2008)
– The Socio-Economic Survey (every year from 1996)
– The Demographic and Health Survey (every five
years,2000,2005 and 2010).
The Population census does not cover much on health
though it provides mortality and cause of death indicators
as well as population figures up to the village level
disaggregated by sex, age group etc that are useful in
estimating health indicators. The other two
surveys,however, do provide health statistics.
Introduction
• NIS incorporate with MOH conduct
Demographics and Health survey (DHS) since
2000, 2005. Then 2010 is on the way of
collection data.
Key Gender issues in Cambodia
•
•
•
•
•
•
Economic empowerment of women;
Enhancing women’s and girls’ education;
Legal protection of women and girls;
Promotion of health of women and girls;
Promotion of women in decision-making; and
Gender mainstreaming in national policies and
programs
Promotion of health of women
• Women continue to report problems in accessing health
care:
– Women and men are accessing treatment for illness or injury,
but women continue to report problem in accessing health
care. No information is available on the problems faced by
men in accessing health services. As of 2005, 91.5 percent of
people who were ill sought at least one treatment, an increase
over 88.6 percent reported in 2000.
– While no data is available on the proportion of males
reporting problems in accessing health services, the
proportion of women reporting at least one problem in
accessing health care decreased from 93 percent in 2000 to
88.5 percent in 2005.
Promotion of health of women
– However, the overall number of women reporting problem
remains very high. Getting money for treatment remains
the main problem (88.1 percent in 2000 and 74.1 percent
in 2005), followed by concern that no provider or drugs are
available, and not wanting to go to health services alone.
– There are significant differences in utilization of public
sector health services, 70 percent of health center and 58
percent of referral hospital clients are female. This gender
bias is more pronounced in urban than in rural areas, and
during reproductive years (15-49).
Maternal Health
• Antenatal Care: DHS 2005
– 69 percent of women received ANC from trained
personnel (doctors, nurses, and midwives) at least once.
– 61 percent of women received care during pregnancy from
midwives;
– 6 percent of women received care from a doctor, and
– 2 percent of women went to a nurse.
– 28 percent of women received no antenatal care for birth
in the preceding five years against 55 percent in year 2000.
Maternal Health (cont.)
• Child Birth and Delivery:
– A large majority of births (78 %) in the five years before the
survey were delivered at home;
– Only 22 percent being delivered in a health facility;
– 50 % of children born in urban areas were delivered in a
health facility. It was three time (17 %) of children born in
rural areas.
– The proportion of births delivered in a health facility is
only 10 % for uneducated mothers, compared with 48 %
for mothers with secondary and higher education.
Maternal Health (cont.)
• Assistance at Delivery:
– In 2005 44 % of births are delivered with the
assistance of a trained health professional (doctor,
nurse, or midwife). Increase from 32% in 2000.
– 55% of births are delivered with assistance of a
traditional birth attendant
Maternal Health (cont.)
• Postnatal Care and Practices:
– 30 % of women received no postnatal care;
– 64 % of mothers received postnatal care within the first
two days of delivery;
– 32 % receiving care within four hours of delivery.
– Urban women are more likely to receive postnatal care(74
%) than rural women during the first two days after
delivery (62 %);
– 37 % of women did not deliver in a health facility and did
not receive a postnatal check-up.
Child Health
• Child’s size at birth :
Birth weight is a major determinant of infant and child health
and mortality. Children whose birth weight is less than 2.5
kg, or children reported to be “very small” or “smaller than
average” are considered to have a higher than average risk
of early childhood death. According to DHS 2005;
– 85 % of births were considered by their mothers
to be of average or larger than average size;
– 11 % were perceived as smaller than average;
– 4 % were considered very small.
Child Health (cont.)
• Immunization of Children :
– 60 % of children age 12-23 months were fully vaccinated
by 12 months of age;
– 91 % of children had received BCG vaccination;
– 70 % had been vaccinated against measles;
– 90 % received the first doses of DPT and of polio and
three- fourths received the third doses.
Child Health (cont.)
• Acute respiratory infection: ARI
– 9 % of children under five years of age showed symptoms
of ARI at some time in the two weeks preceding the
survey(2005)
– 11 % of children age 6-11 and 12-23 months had
experienced the symptom of ARI in higher proportions
than other age group.
• Fever :
– 35 % of children under five of age had a fever at some time
in the two weeks preceding the survey
– Children age 6-11 and 12-23 months are more commonly
sick with fever (46 and 42 percent, respectively) then other
children.
Child Health (cont.)
• Diarrhea :
– 20 % of all children under five had diarrhea while 3
percent had diarrhea with blood;
– As with ARI and fever, young children age 6-11 and 12-23
months are more prone to diarrhea than children in the
other age group (32 % and 28 %, respectively)
– Diarrhea is slightly more common among rural children (20
%) than urban children (16 %)
Nutrition of children and women
• Nutrition status of children :
–
–
–
–
37 % of children under five are stunted;
13 % are severely stunted;
7 % are wasted; and
36 % are underweight.
More rural children are stunted (38 %) than urban
children (31 % ).
Nutrition of children and women (cont.)
• Initiation of breastfeeding :
– Breastfeeding is nearly universal in Cambodia, with 97% of
children born in the five years preceding the survey having
been breastfed at some time.
– About one in three children is breastfed within one hour of
birth (35 percent) and 68 percent within one day of birth. 56
percent of children were given a pre-lacteal feed, that is
something other than breast milk during the first three days
of life.
– Contrary to WHO’s recommendations less than half of
Cambodian children age 4-5 months is exclusively breastfed.
Nutrition of children and women (cont.)
• Prevalence of anemia in children :
– Anemia is a critical public health problem in Cambodia,
where more than half (62 percent) of Cambodian children
6-59 months old are anemic, with 29 percent mildly
anemic, 32 percent moderately anemic, and 1 percent
severely anemic.
Nutrition of children and women (cont.)
• Nutritional Status of Women :
– Two indicators of nutritional status for women (age 15-49)
are height and body mass index BMI;
– The data analysis on BMI is based on 7,799 women, while
the height analysis is based on 8,370 women age 15-49.
– Overall, 8 percent of women are shorter than 145 cm.
– 20 percent of women were found to be underweight (BMI
less than 18.5), while 10 percent were overweight or
obese.
Nutrition of children and women (cont.)
• Foods consumed by mother:
– The staple diet of mothers of young children in Cambodia
consists of foods made from grains (99 percent), and meat,
fish, shellfish, poultry, and eggs (94 percent).
– Three out of four women consume fruits and vegetables
rich in vitamin A.
– Smaller proportion of mothers consume milk or other milk
products (6 percent) and foods made from beans, peas, or
nuts (10 percent).
– 31 percent of mothers consume foods made with oil, fat or
butter or sugary foods.
Nutrition of children and women (cont.)
• Prevalence of Anemia in women :
– 47 percent of women age 15-49 are having anemia.
Among them, 35 percent mildly anemic, 10 percent
moderately anemic and just 1 percent severely anemic.
– Women with high parity, with little or no education, are
pregnant, and living in poor households have higher
prevalence of anemia.
– Anemia is also higher among rural than urban women.
Maternal Mortality
• Maternal death is defined as any death that occurred
during pregnancy, childbirth, or within two months
after the birth or termination of a pregnancy.
– DHS 2005: Maternal Mortality Ratio ( MMR) was 472 per
100,000 live births
– Population Census 2008: MMR was 461 per 100,000 live
birth.
Infant and Child Mortality
• Infant mortality: the probability of dying between birth and
the first birthday;
• Child mortality: the probability of dying between the first and
fifth birthday;
• Under-five mortality: the probability of dying between birth
and the fifth birthday;
DHS 2005
- IMR
66 per 1,000 live births
- Under- five MR 83 per 1,000 live births
Census 2008
60 per 1,000 live births
Causes of death among infants and children
• The most commonly reported causes of death
are:
– Baby being premature;
– Fever;
– Illness of the respiratory system;
– Dengue hemorrhagic fever;
– Accidents; and
– Tetanus type convulsions
Cause of death among males age-groups 5-59 and 60+,
Cambodia 2008 Census
Males aged 5-59 years
Cause of death
Males aged 60 years and more
Per cent of deaths
Cause of death
Per cent of deaths
All causes
100.0
All causes
100.0
Accidents
24.6
Other illness
41.7
Dengue fever and malaria
18.6
Heart disease
17.8
Other illness
15.0
Tuberculosis
13.9
Fever
12.6
Fever
7.7
Heart disease
7.7
Accidents
6.2
Tuberculosis
6.0
Not Known
5.4
Tetanus
4.8
Dengue fever and malaria
3.1
Not Known
4.5
Diarrhoea
2.5
Diarrhoea
3.7
Tetanus
1.6
HIV/AIDS
2.5
HIV/AIDS
0.2
Cause of death among females age-groups 5-59, and 60+ and
15-49, Cambodia 2008 Census
Females aged 5-59 years
Cause of death
Females aged 60 years and more
Per cent
deaths
of Cause of death
Per cent
deaths
Females aged 15-49 years
of Cause of death
Per cent of deaths
All causes
100.0
All causes
100.0
All causes
100.0
Dengue fever and malaria
18.3
Other illness
48.9
Other illness
20.8
Other illness
16.6
Heart disease
14.6
Dengue fever and malaria
17.4
Fever
15.6
Tuberculosis
12.7
Heart disease
13.4
Accidents
12.3
Fever
6.9
Accidents
11.8
Heart disease
9.7
Accidents
6.5
Fever
10.8
Tuberculosis
7.2
Not Known
4.4
Tuberculosis
9.8
Tetanus
4.7
Diarrhoea
3.1
Delivery complications
6.4
Delivery complications
4.1
Dengue fever and
malaria
1.5
Not Known
4.1
Diarrhoea
3.7
Tetanus
1.0
Tetanus
3.9
Not Known
3.6
Pregnancy
complications
0.3
HIV/AIDS
3.5
HIV/AIDS
2.6
Delivery complications
0.1
Pregnancy complications
2.6
Pregnancy complications
1.7
HIV/AIDS
0.0
Diarrhoea
2.5
Disability
• The five types of disability identified for the 2008
census purpose are as follows:
1.
2.
3.
4.
5.
In Seeing
In Speech
In Hearing
In moving
Mental
Disability (cont.)
• According to 2008 Population census, there are
192,538 disabled persons in Cambodia (or 1.44
percent of country’s population), of which;
– 56.3 percent are males and
– 43.7 percent are females
• Among the disabled in the country only 61,151
(31.76 percent) persons are congenitally disabled.
Distribution of Disabled Population by type of
Disability, Cambodia 2008
CONCLUSIONS
• Decennial population and housing censuses and
periodic surveys which are serving as major tools for
the production and analysis of health statistics in
Cambodia do integrate gender to a great extent.
• However there is a need for a satisfactory civil
registration system in the country which would provide
on a continuous basis, statistics on births, deaths,
causes of death, health, marriage divorce etc . This
would go a long way in monitoring public health with
particular reference to gender
• More hospitals or public health centers especially in
the rural areas for women and children is yet another
area that requires attention. .
Thank you for your attention