Egypt Demographic And Health Survey Research Articles

Understanding inequities in child mortality in Egypt: Socioeconomic and proximate factors

ABSTRACT While there have been notable advancements in child health in Egypt, disparities in child mortality still exist. Understanding these disparities is crucial to addressing them. The objective of this study is to explore the factors linked to child mortality in Egypt, providing a comprehensive understanding of the disparities in child mortality rates. The study utilises cross-sectional data from Egypt's Demographic and Health Survey (EDHS) in 2014 to examine child mortality. The dataset consists of 15,848 observations from mothers with children born within five years prior to the survey. The choice of explanatory variables was guided by the Mosely and Chen Framework and logistic multivariate regression was used to conduct the analyses. The study finds lower education, early childbearing, insufficient birth spacing, lack of breastfeeding, and absence of improved toilet facilities (proxy for living conditions) were all significantly linked to an increased likelihood of child loss. Additionally, poorer people in rural settings experienced the worst child mortality. The findings align with the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health (CSDH). Recommended policy interventions include targeting women in rural areas, improving living conditions and removing financial/other barriers to accessing care.

Prevalence and correlates of overweight and obesity among under-five children in Egypt.

Evidence suggests that Egypt, a country in North Africa, has a significant number of children at serious risk of excess body weight. Yet, there is a dearth of studies on overweight and obesity among children under 5 years in the country. This study examined the prevalence and correlates of overweight and obesity among under-five children in Egypt. Data were retrieved from the latest (2008 and 2014) Egypt Demographic and Health Surveys (EDHS). A total of 42,568 children under 5 years were included. The prevalence of overweight and obesity was described using proportions whereas the factors associated with the prevalence were examined using logistic regression. Of the 42,568 children under 5 years, about one in every six (17%) were overweight or obese. Children aged 19-37 months, those with birth weights >4 kg, those given large portions of protein foods (eggs and meat), and those whose mothers were in the rich wealth quintile had significant risks of overweight or obesity. Overweight and obesity are highly prevalent among children under 5 years in Egypt. Interventions developed to address these two overnutrition indicators in Egypt need to consider variations in risk factors across age, birth weight, food types and portions, and maternal wealth status.

Patterns and Determinants of Gap between Fertility Intentions and Fertility Outcomes in Egypt

This paper describes the current fertility behavior and fertility intentions in Egypt. Moreover, the current paper used Logistic regression model to reveal the factors determining gap between fertility intentions and fertility behavior in Egypt. According to data from Egypt Demographic and Health Survey (EDHS) in 2014, the mean ideal number of children is 3.01 and the mean number of children ever born is 2.69. The results indicate that the higher values of mean ideal number of children and mean number of CEB are demonstrated among uneducated women and families who have child mortality. The findings reveal that wealth index, women's age and women's education decrease the gap between fertility intentions and fertility behavior, while child mortality increases the probability of having a gap between fertility intentions and fertility behavior.

The impact of method choice on the risk of contraceptive discontinuation: Egypt 2014

Purpose In Egypt, the IUD is the most common contraceptive method since 1988 and has remained so despite a recent drop in its share from 59.9% in 2008 to 51.5% in 2014 in favour of hormonal methods, which increased from 19.7% for pills and 12.3% for injectables in 2008 to 27.4% and 14.5% in 2014 according to 2014 Egypt demographic and health survey (EDHS). The recent shift away from intrauterine contraceptive device (IUDs) to hormonal methods have contributed to increased discontinuation. This paper aims to answer three questions: To what extent does the method type influence the hazard of contraceptive discontinuation in Egypt? Is the interaction between method type and duration of use a predictor of the probability of discontinuation after controlling other variables? What are the other important background variables that affect the hazard of contraceptive discontinuation? Design/methodology/approach Using data from EDHS2014, separate multilevel discrete-time proportional hazard models for events of interest (abandoned use while in need, switched to another method in the month following discontinuation and method failure) were built. Findings Only IUD users are significantly less likely to abandon use while in need and to experience method failure and a reduced risk of switching. During the first 6–10 months of use, all types of discontinuation can be significantly reduced for all three methods. Demographic variables do not significantly affect abandonment but strongly affect switching and significantly affect failure. Socio-economic variables do not significantly affect abandonment and switching. Exposure to media has a significant effect on abandonment but not on switching. Community contraceptive prevalence rate strongly affects switching. Originality/value Results confirm that the counselling should be more intense during the first year of method use and should pay special attention to women who are 25 years old and above and those who have two or more children. Also, media campaigns are important and especially those addressing the issue of abandoning while in need.

The decline of FGM in Egypt since 1987: a cohort analysis of the Egypt Demographic and Health Surveys

BackgroundFemale genital mutilation (FGM) has been a longstanding tradition in Egypt and until recently the practice was quasi-universal. Nevertheless, there are indications that the practice has been losing support and that fewer girls are getting cut. This study analyzes the prevalence of FGM in different birth cohorts, to test whether the prevalence declined over time. The study also examines whether such a decline is occurring in all segments of society or whether it is limited mostly to certain more modernized segments of society.MethodsThis study pooled data from the 2005, 2008 and 2014 waves of the Egypt Demographic and Health Surveys (EDHS). The women participating in the EDHS provided data on 62,507 girls born to them between 1987 and 2014, including whether they were cut and at what age. Kaplan-Meier and Weibull proportional hazard survival analyses were used to examine trends in the prevalence and hazards of FGM across birth cohorts. Controls for region, religion and socioeconomic status of the parents were included in the Weibull regression.ResultsThe results show a steady decline in FGM across the birth cohorts studied. The base hazard for the 2010 birth cohort is only 30% that of the 1987 one. Further analyses show that the decline in FGM occurred in all segments of Egyptian society in a fairly similar manner although differences by region, religion and socioeconomic status persisted.ConclusionsThis study confirms that FGM is declining in Egypt. The proportion of girls getting cut has declined rapidly over the past few decades. This decline is not limited to the more modernized segments of society, but has spread to the more traditional segments as well. The latter increases prospects for the eventual eradication of the practice.

Prevalence and Predictors of Intimate Partner Violence Among Married Women in Egypt.

Intimate partner violence (IPV) among married women of childbearing age can significantly enhance their risk of adverse health outcomes such as injury and disability, depression and anxiety, unwanted pregnancies, premature labor, complications with delivery, and perinatal and neonatal mortality. The objective of this study was to examine the prevalence and individual and societal factors associated with IPV among Egyptian women. Cross-sectional data on 12,205 ever-married women between the ages of 15 to 49 years were collected from the Egypt Demographic and Health Survey (EDHS). Data from the 2005 and 2014 EDHS were pooled and analyzed. Self-reported responses on violence by husbands were classified into physical, sexual, and emotional violence. The factors of association were quantified using logistic regression methods. The prevalence of experiencing any form of violence among ever-married women in Egypt was 29.4%. Overall, women reported experiencing physical, emotional, and sexual violence at 26.7%, 17.8%, and 4.6%, respectively. Women in the age group of 25 to 29 years had the highest odds (odds ratio [OR] = 1.539, 95% confidence interval [CI] = [1.327, 1.785]) of suffering from any form of IPV. Women residing in urban areas (OR = 1.149, 95% CI = [1.046, 1.262]), having only a primary-level education (OR = 1.756, 95% CI = [1.543, 1.999]), being followers of Islam (OR = 1.713, 95% CI = [1.379, 2.126]), and having husbands with no education (OR = 1.422, 95% CI = [1.263, 1.601]) reported having higher odds of experiencing any form of IPV. Nearly one third of married women of childbearing age are exposed to IPV of any form in Egypt. IPV intervention programs should pay special attention to the socioeconomically vulnerable segments of the population and promote educational status among men and women to curb the occurrence of IPV.

Prevalence and risk factors for child labour and violence against children in Egypt using Bayesian geospatial modelling with multiple imputation.

BackgroundThe incidence of child labour, especially across developing nations, is of global concern. The use of children in employment in developing economies constitutes a major threat to the societies, and concerted efforts are made by the relevant stakeholders towards addressing some of the factors and issues responsible. Significant risk factors include socio-demographic and economic factors such as poverty, neglect, lack of adequate care, exposure of children to various grades of violence, parental education status, gender, place of residence, household size, residence type or size, wealth index, parental survivorship and household size. Egypt is the largest country in Africa by population. Although UNCIF 2017 reported that the worst forms of child labour in Egypt are concentrated in domestic work, forced begging and commercial sexual exploitation, the situation has received little attention. There are still very few studies initiated specifically to look at child labour in domestic service in Egypt and those that exist have been limited in the scope of their methodology. Geographical coverage and research for child labour in Egypt is also limited, as are accurate statistics and data. There was, therefore, a strong case for looking again at the domestic child labour phenomenon in Egypt, especially after the Demographic Health Survey (DHS) released the first data about child labour in Egypt in 2014. This study builds on the few findings of earlier work, and broadens coverage by including advanced methods and geographical effects of this problem.ObjectivesThis study focuses on identifying socio-demographic, economic and geospatial factors associated with child labour participation.MethodsWe used the 2014 Egypt Demographic and Health Survey (EDHS) from the Ministry of Health and Population in Egypt, with the record of 20,560 never-married children aged 5–17 years engaging in economic activities, in and out of their home. The data focused on demographic and socio-economic characteristics of household members. Multivariate Bayesian geo-additive models were employed to examine the demographical and socio-economic factors for children working less than 16 hrs; between 16 and less 45 hrs; and over 45 hrs weekly.ResultsThe results showed that at least 31.6% of the children in the age group from 5–10 were working, 68.5% of children aged 11–17 years were engaged in child labour for a wage, and 44.7% of the children in the age group from 5–10 were engaged in hazardous work. From the multivariate Bayesian geo-additive models, female children (with male children as reference category) working at least 16 hrs (OR: 1.3; with 95% CI: 1.2–1.5) were more likely to be engaged in child labour than girls working 16 to 45 hrs (OR: 1; 95% CI: 0.3–1.5). Children born to women without formal education, in non-hazardous jobs, irrespective of the hours spent at work, were more likely to be involved in child labour (52.9%, 56.8%, 62.4%) compared to children of mothers with some level of education. Finally, children who have experienced psychological aggression and physical punishment are more likely to be used as child labour than those without such experience across the job types and hours spent. North-eastern Egypt has a higher likelihood of child labour than most other regions, while children who live in the Delta are more engaged in hazardous work.ConclusionThis study revealed a significant influence of socio-demographic and economic factors on child labour and violence against children in Egypt. Poverty, neglect, lack of adequate care and exposure of children to various grades of violence are major drivers of child labour across the country. The spatial effect suggests the need to give more attention to some areas that have high rates of child labour, such as the Nile Delta, Upper Egypt, and North-eastern Egypt.

Determinants of Antenatal Health Care Utilization in Egypt (2000-2014) Using Binary and Count Outcomes

Aim: This study seeks to investigate the factors determining the utilization of antenatal care services, the frequency of that use, and the timing of receiving antenatal care among Egyptian women utilizing a national representative data from Egypt Demographic and Health Surveys (EDHS) in 2000 and 2014. Methods: The paper estimates the logistic regression model, zero-inflated negative binomial model (ZINB), and negative binomial regression model (NB) to identify the most important determinants of antenatal health care utilization. Results: The findings indicate that the period 2000-2014 has experienced a significant increase in the use of antenatal health care services. The use of the public sector antenatal care services relative to that of the private sector has been decreasing over time. Moreover, wealth index, women’s education and quality of health services play significant roles in increasing accessibility of antenatal health care services. On the other hand, women’s empowerment has shown a positive effect in 2000 only. Conclusion: The study highlights the most vulnerable groups that are less likely to have access to antenatal health care services, mainly women who are less educated, poor and living in rural areas especially Upper Egypt. This certainly requires a more targeted health strategy with an equity lens.

Associations Between Acute Conflict and Maternal Care Usage in Egypt: An Uncontrolled Before-and-After Study Using Demographic and Health Survey Data.

Background: United Nations’ (UN) data indicate that conflict-affected low- and middle-income countries (LMICs) contribute considerably to global maternal deaths. Maternal care usage patterns during conflict have not been rigorously quantitatively examined for policy insights. This study analysed associations between acute conflict and maternal services usage and quality in Egypt using reliable secondary data (as conflict-affected settings generally lack reliable primary data). Methods: An uncontrolled before-and-after study used data from the 2014 Egypt Demographic and Health Survey (EDHS). The ‘pre-conflict sample’ included births occurring from January 2009 to January 2011. The ‘peri-conflict sample’ included births from February 2011 to December 2012. The hierarchical nature of demographic and household survey (DHS) data was addressed using multi-level modelling (MLM). Results: In total, 2569 pre-conflict and 4641 peri-conflict births were reported. After adjusting for socioeconomic variables, conflict did not significantly affect antenatal service usage. Compared to the pre-conflict period, periconflict births had slightly lower odds of delivery in public institutions (odds ratio [OR]: 0.987; 95% CI: 0.975-0.998; P<.05), institutional postnatal care (OR: 0.995; 95% CI: 0.98-1.00; P=.05), and at least 24 hours post-delivery stay (OR: 0.921; 95% CI: 0.906-0.935; P<.01). Peri-conflict births had relatively higher odds of doctor-assisted deliveries (OR: 1.021; 95% CI: 1.004-1.035; P<.05), institutional deliveries (OR: 1.022; 95% CI: 1.00-1.04; P<.05), private institutional deliveries (OR: 1.035; 95% CI: 1.017-1.05; P<.001), and doctor-assisted postnatal care (OR: 1.015; 95% CI: 1.003-1.027; P<.05). Sensitivity analysis did not change results significantly. Conclusion: Maternal care showed limited associations with the acute conflict, generally reflecting pre-conflict usage patterns. Further qualitative and quantitative research could identify the effects of larger conflicts on maternal careseeking and usage, and inform approaches to building health system resilience.

Rising up: Fertility trends in Egypt before and after the revolution.

In 2014, Egypt’s Demographic and Health Survey (EDHS) documented an increase in the total fertility rate (TFR) to 3.5, up from a low of 3.0 recorded by the 2008 EDHS. The increase has been anecdotally attributed to the social upheaval following Egypt’s January 2011 revolution, but little is known about when fertility first began to increase and among which sub-groups of women. Using birth histories from seven rounds of EDHS (1992–2014), this study reconstructed fertility rates for single years from 1990–2013 and examined patterns of childbearing in five-year birth cohorts of women. We found that the decline in fertility reversed in 2007, earlier than postulated, plateaued and then increased again in 2013. The increase in TFR coincided with a convergence of fertility rates across education levels, and there is evidence of a shift toward childbearing at younger ages among more educated women, which may be inflating period measures of fertility.

Trend of caesarean deliveries in Egypt and its associated factors: evidence from national surveys, 2005\u20132014

BackgroundThe continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide. This study assessed the trend of c-section deliveries and examined factors associated with a rise in c-section deliveries among the Egyptian mothers, from 2005 to 2014, by place of delivery.MethodsThis study utilized the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS). The EDHS reported on the mode of delivery for the last birth occurred within five years preceding each survey including place of delivery and sociodemographic information for a total sample of over 29,000 mothers in the three surveys. To document trend of c-section, the EDHS-2005 was set as a reference in two binary logistic regression models; among all mothers together and for mothers stratified by place of delivery (public or private). P-value for the trend was assessed by entering the year of the survey as a continuous variable. The study followed STROBE statement in reporting observational studies.ResultsInstitutional-based c-sections increased by 40.7 points from EDHS-2005 to EDHS-2014 (aOR, 3.46, 95%CI: 3.15–3.80, Ptrend < 0.001). Compared to mothers with low socioeconomic status (SES), mothers with high SES had higher odds (aOR, 1.78, 95%CI: 1.25–2.54, P = 0.001) for c-section, but only in EDHS-2005. The adjusted trend of c-sections was found to be 4.19-time (95%CI: 3.73–4.70, P < 0.001) higher in private sector while that in public sector it was 2.67-time (95%CI: 2.27–3.13, P = 0.001) higher, in EDHS-2014 relative to EDHS-2005. This increase in the private sector is explained by significant increases among mothers who are potentially at low risk for c-sections; mothers aged 19-24 years vs. ≥35 years (aOR: 0.31, 95%CI: 0.21–0.45, in EDHS-2005 vs. 0.43, 95%CI: 0.33–0.56, in EDHS-2014, P < 0.001); primigravida mothers vs. mothers with ≥4 children (aOR: 1.62, 95%CI: 1.12–2.34, in EDHS-2005 vs. 3.76, 95%CI: 2.94–4.80 in EDHS-2014); and among normal compared to high risk birth weight babies (aOR: 0.79, 95%CI: 0.62–0.99 in EDHS-2005 P < 0.05 vs. 0.83, 95%CI: 0.65–1.04 in EDHS-2014, P > 0.05).ConclusionsResults showed a steady rise in c-sections in Egypt that has reached an alarming level in recent years. This increase appears to be associated with a shift towards delivery in private health care facilities. More vigilance of c-section deliveries, particularly in the private sector, is warranted.

Trends and Determinants of Contraceptive Use among Young (15 - 24 Year) Married Women : A Secondary Analysis Based on the 2008 and 2014 Egypt Demographic and Health Surveys

Background: young females in Egypt still face a number of challenges regarding their reproductive health (RH) despite efforts to enhance it. Importance of young women’s reproductive choices arises from the concept that early childbearing can impair their health and their productive participation in community. Aim: the paper aimed to explore the key determinant of the contraceptive (CC) use amongst young married females in Egypt using the 2008 and 2014 Egypt Demographic and Health Survey (EDHS) with a comprehensive look at the CC use changes occurred in the study period 2008-2014. Subjects and Methods: data from the 2008 and 2014 EDHS were secondary analyzed. Variables were selected to assess their effect on CC use. Multivariable regression analyses were performed. Odds ratio was computed. Results: overall contraceptive prevalence (CP) decreased from 53.7% in 2008 to 51.2% in 2014. Traditional methods were responsible for this decrease. Younger age, being from rural Upper Egypt, husband desire for more children, no visit to health facility were the most important risk factors for not using any CC method among Egyptian young married females in 2008. Added to these factors; low women autonomy, no exposure to family planning message, in the poster and women justifying husband violence in 2014. However, region lost its significance as a determinant in 2014. Conclusions: our results discovered the determinants that modulate the CC use behavior among Egyptian young married females.

Characterizing the Copts in Egypt: Demographic, socioeconomic and health indicators

Background: The demography of Copts in Egypt is subject to an intense debate in the context of a dearth of analytical studies on this community. Our objective was to estimate the size of the Coptic community in Egypt, map its geographical clustering, and describe demographic, socioeconomic, and health-associated indicators. Methods: We conducted descriptive and Kulldorff spatial scan statistics analyses using the 2008 Egypt Demographic and Health Survey (EDHS) data. We also used chi-square trend analysis and earlier EDHS data to examine the temporal trend in the proportion of Copts. Results: The proportion of Copts in the 15–59 years population was 5.1% (95% confidence interval (CI): 4.6%–5.5%). This translates to 4,274,145 (95% CI: 3,855,111–4,609,372) Copts. We identified three main clusters of Copts: Minya-Assuit cluster (17.6%), Assuit-Souhag cluster (15.1%) and the metropolitan Cairo cluster (9.4%). The proportion of Copts was stable since 1988 (P = 0.11). Copts had higher educational attainment (P = 0.002), and a wealth index quintiles distribution skewed towards the rich (P &lt; 0.001). Copts also had stronger representation in white collar job types, but limited representation in security agencies. The majority of demographic, socioeconomic and health indicators were similar among Copts and Muslims. Conclusions: One in every 20 Egyptians is a Copt, a proportion smaller than commonly circulated in the scholarly literature and public sphere. Despite some identified disparities, our study indicates a well-integrated Egyptian society regardless of religious affiliation. Our study provides evidence to inform the ongoing debate on the status of Copts in Egypt.

Contraceptive Discontinuation Among Egyptian Women: Results From Egypt Demographic And Health Survey 2005

Background: Unintended pregnancy is a major public health problem that affects not only the individuals directly involved but also society. Most couples who want to avoid pregnancy practice contraception. Objective: The objectives of this study were to determine the prevalence of discontinuation of the different methods of contraception and describe the most common reasons of discontinuation of contraception usage. Method: The 2005 Egypt Demographic and Health Survey (EDHS) is a nationally representative household survey of 19 474 married women aged 15–49 years. The study sample was selected using a multistage sampling technique. A face-to-face structured interview was conducted with the selected women. The response rate was 99.5% for completing the questionnaires. The 2005 EDHS provides a wealth of information on fertility, family planning, maternal and child health and nutrition, and violence against women. Results: The results of this study showed that 46.4% of women discontinued the use of contraception. Side effects of the method were the most frequent reason of discontinuation. Conclusion: Nearly half of Egyptian women discontinued the use of contraception due to side effects and wanted more children.

DOMESTIC VIOLENCE AND OBESITY IN EGYPTIAN WOMEN

Domestic violence and obesity are global public health problems.This study explores associations of domestic violence and obesity in 5015 ever-married, non-pregnant women aged 15-49 years who took part in the 2005 Egypt Demographic and Health Survey (EDHS). Women's mean body mass index (BMI) was 30.4 kg/m², and 48% were obese. Thirty-seven percent reported any prior psychological, physical or sexual domestic violence.Compared with their counterparts, the adjusted odds of being obese were marginally higher among women who reported any prior sexual (aOR=1.31),physical or sexual (aOR=1.18), or psychological, physical or sexual (aOR=1.17) domestic violence. Women who experienced severe or repeated domestic violence--as measured by reported exposure to three or more acts of physical(aOR=1.25), psychological or physical (aOR=1.18), physical or sexual(aOR=1.36), and psychological, physical or sexual (aOR=1.26) domestic violence--had higher adjusted odds of being obese. Marginally significant adjusted dose-response relationships remained between obesity and the number of specific acts of: (1) physical or sexual violence and (2) psychological, physical or sexual domestic violence. Obesity among women in poorer settings like Egypt may partly have its roots in gender subordination, as manifested in women's exposure to multiple acts of domestic violence.

The Influence of Changes in Fertility Related Norms on Contraceptive Use in Egypt, 1995–2005

The debate around the relative influence of ideation versus development on fertility reduction has been on-going at least since Cleland &amp; Wilson’s “iconoclastic view” of fertility transition was published in 1987. While there is fairly wide recognition that the diffusion of new behaviors through a community can play an important role in fertility transitions, there is relatively little research on the effect of changes in the normative environment—a predictable consequence of the ideational process—on a woman’s fertility decisions. For the current study, we focus on collective or group norms, which have been defined as “regularities in attitudes and behavior that characterize a social group and differentiate it from other groups.” We infer these regularities in behavior and attitudes by aggregating across individual reports to calculate the objective prevalence of these phenomena within groups. Using multilevel analysis of consecutive 1995, 2000 and 2005 Egypt Demographic and Health Surveys (EDHS), we test the effect of changes in the norms related to the desire for a large family and the use of family planning at parity 0 or 1 on self-reported contraceptive use among married women in Egypt. The analysis included 2432 married women 15–49 years for the 1995–2000 period and 5285 women for the 2000–2005 period. Norms are defined at the cluster level, which serves as our community-level unit of analysis. After controlling for individual and other community factors, including changes in literacy, we found that women residing in communities where the desire for large families increased from 1995–2000 were more than 70% less likely to use a contraceptive method. While the trend was similar, no such effect of desired family size was observed from 2000–2005. Instead, residence in a community where use of family planning after the first child increased from 2000–2005 resulted in a more than three-fold increase in contraceptive use in 2005. Results indicate that changes in norms measured at the collective level affect individual contraceptive use. Specific attitudinal and behavioral changes that influenced individual action, however, changed over time, consistent with shifts in the emphasis of the national family planning program.

The Egypt National Perinatal/Neonatal Mortality Study 2000

To estimate stillbirth, perinatal (PMR) and neonatal mortality rates (NMR) in Egypt and to assign main causes of death. Data were collected from a representative sample of women who gave birth from 17,521 households which were included in the Egypt Demographic and Health Survey (EDHS) 2000. Comparisons were made between three systems for classifying causes of death. The NMR was 25 per 1000 live births (17 early and eight late). Half the deaths occurred in the first two days of life. Neonatal causes of death were pre-maturity (39%), asphyxia (18%), infections (7%), congenital malformation (6%) and unclassified (29%). The PMR was 34 per 1000 births, mainly attributed to: asphyxia (44%) and prematurity (21%). The revised Wigglesworth classification agreed well with the physicians except the panel attributed more deaths to infections (20%). The WHO verbal autopsy algorithm left 48% of deaths unclassified. Infant mortality in Egypt is showing an epidemiological transition with a significant decrease in mortality, resulting in a disproportionate percentage of deaths in the first week of life. Infant mortality in Egypt declined 64% from 124 per 1000 between 1974 and 1978 to 44 per 1000 between 1995 and 1999, the decline being greatest among older infants; 55% of all infant deaths occurred during the neonatal period. The neonatal mortality rate in this study was estimated to be 25 per 1000 live births.

Levels of Fertility Have Declined Steadily in Egypt, But Unwanted Childbearing Remains Common

In the 1995 Egypt Demographic and Health Survey (EDHS) a total of 14779 ever-married women aged 15-49 were interviewed. Data on marriage and fertility contraceptive use fertility preferences maternal and child health and female circumcision were obtained. Overall it is noted that fertility in Egypt has declined by about 30% since 1980. Between the 1980 Egypt Fertility Survey and the 1995 EDHS the total fertility rate among the women dropped from 5.3 lifetime births per woman to 3.6 births. Such a decline has been greatest in rural areas. If such trends continue it is believed that the average Egyptian woman will have 3.6 live births over her total reproductive years. Moreover knowledge of a contraceptive method was reported to be nearly universal among married women but only 48% actually use one. The most widely used method is the IUD (30%) followed by the pill (10%). It is also noted that almost 97% of these women have undergone female genital excision.

Lower Egyptian Fertility Linked to Later Marriage, Increased Method Use

This paper reports on several analyses of contraceptive use trends and fertility determinants in Egypt. Analysis is based primarily on data from the 1992 Egypt Demographic and Health Survey (EDHS). One study used data from the 1980 Egypt Fertility Survey the 1984 Egypt Contraceptive Prevalence Survey and the 1988 and 1992 EDHS. This study documents the doubling of contraceptive use among married women during 1982-90. The second study uses birth history from the 1992 EDHS in the analysis of fertility decline and its determinants. The first study indicates that contraceptive prevalence rose from 24% in 1980 to 47% in 1992. Slower prevalence rate increases occurred in high-prevalence regions of Lower Egypt and Urban Governorates. A rapid increase in prevalence rate occurred in rural areas of Upper Egypt. There was a shift in choice of methods. IUD use increased and use of oral contraceptives decreased slightly. Increases in use occurred in all age groups. Levels of use were lowest among adolescents and women in their early 20s. 32% of women with 1 child used contraception in 1992 compared to only 16% in 1980. 59% of women with 3 children used contraception in 1992 compared to only 29% in 1980. Method use was highest among the most educated women. Findings from a logistic model indicated that urban women were 1.5 times more likely to use contraception. Women living in Lower Egypt or Urban Governorates were twice as likely to use contraception as women in Upper Egypt. In the second study researchers found that delayed age at marriage changes in postpartum insusceptibility and an increase in the proportion of reproductive age women contributed to a 13% decline in fertility during 1988-92. Women born between 1963 and 1977 had much lower fertility than women born earlier. The number of women with a second birth within 5 years of the first declined between 1988-92. Both studies confirmed a fertility transition.

Reweighting DHS Data to Serve Multiple Perspectives

Information about health and family planning infrastructures is collected through the service availability module (SAM), an important feature of the Demographic and Health Surveys (DHS) conducted in many developing countries. The DHS samples were designed to provide a representative sample of households and women of reproductive age. Using the weights routinely provided with DHS data sets, service accessibility can be described straightforwardly at the individual and household levels. However, without further adjustment, SAM data do not provide a representative picture of service delivery at the community, or primary sampling unit, level, where the data are collected. This report proposes a methodology for reweighting the SAM data, using rural data from the Egypt DHS as an illustration, so that available family planning facilities at this level may be usefully characterized at little additional cost.