Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 1
Extended Analysis of Multiple Indicator Cluster Survey (MICS) 2014: Religion
June 2016 l No. 1 Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 2 Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 3
Extended Analysis of Multiple Indicator Cluster Survey (MICS) 2014: Religion
June 2016 l No. 1 Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 4
Acknowledgements
The authors gratefully acknowledge the technical support provided by the MICS program and in particular the analytical support provided by the Chief of Social policy and Research, Samson Muradzikwa, The Zimbabwe National Statistics Office (ZIMSTAT) team, namely Taizivei Mungate, Evelyn Marima, Hendricks Chigiji, Lloyd Mahere, Lovemore Ziswa, Jacob Chitiyo, Tinashe Mwadiwa and Tidings Matangira (Team leaders in MICS 2014 in Zimbabwe) during extended analysis workshops in Zimbabwe in June 2016. The authors also thank Brian Hungwe, Ben Zwizwai and Rueben Musarandega for thorough content review during the paper writing process.
Lead author: Dirk Westhof, Independent International Consultant, Bangkok, Thailand
Corresponding authors: Rumbidza Tizora, United Nations Children’s Fund, Zimbabwe, E-mail: [email protected] Brian Maguranyanga, Independent National Consultant, Harare, Zimbabwe
The MICS 2014 Extended Analysis series is based on further analysis of data collected in the Multiple Indicator Cluster Survey 2014. The full versions of the papers with all the tables used in the analysis is available on the website of UNICEF Zimbabwe, www.unicef.org/zimbabwe. The views expressed are those of the authors and do not necessarily reflect the views of UNICEF or the governments of Sweden or Zimbabwe.
Recommended citation: UNICEF Zimbabwe (2016) Extended Analysis of Multiple Indicator Cluster Survey (MICS) 2014: Religion Harare: UNICEF
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Table of Contents
List of Tables...... 2
List of Figures...... 3
List of Abbreviations...... 4
Section 1: Introduction ...... 5 1.1 Background...... 5 1.2 Religion, health and social inequities in Zimbabwe ...... 5 1.3 Methodology ...... 6
Section 2: Results and discussions...... 7 2.1 Analysis Step 1: The context: size and location of religious groups ...... 7 2.1.1 Size of the various religious groups...... 7 2.1.2 Location of the various religious groups ...... 8 2.2 Religion and Wealth index quintiles ...... 10 2.3 Religion and water and sanitation...... 10 2.4 Fertility...... 11 2.5 Child mothers and Teenage marriage...... 12 2.6 Child health...... 13 2.6.1 Vaccination, care seeking for fever and diarrhoea...... 13 2.6.2 Neonatal tetanus protection...... 14 2.6.3 Breastfeeding...... 15 2.7 Maternal health...... 15 2.7.1 Antenatal care...... 15 2.7.2 Assistance during delivery...... 17 2.7.3 Post-natal health checks...... 17 2.8 Use of contraceptives ...... 18 2.9 Outcome indicators...... 18 2.9.1 Under-five mortality...... 18 2.9.2 Stunting...... 19 2.10 Education...... 20 2.11 Birth registration...... 21 2.12 HIV knowledge and attitudes ...... 21 2.13 Violence ...... 22 2.13.1 Attitude towards domestic violence ...... 22 2.13.2 Exposure to mass media ...... 22 2.14 Analysis Step 2: Religion within the same context...... 23 2.14.1 Stunting...... 23 2.14.2 Vaccination ...... 24 2.14.3 Delivery in a health facility ...... 24 2.15 Step 3: Results for Apostolic sect only...... 25
Section 3: Conclusions and recommendations ...... 29 3.1 Recommendations...... 30
References ...... 31
Annex...... 32
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Table of Contents
List of Tables
Table 1: Proportion of religious groups in Zimbabwe, MICS 2014...... 7
Table 2: Percent distribution of religion by wealth index quintiles, MICS 2014...... 10
Table 3: Distribution of fertility by religion and wealth quintiles, MICS 2014...... 12
Table 4: Vaccination and Care seeking for fever by religion, MICS 2014 ...... 14
Table 5: ANC coverage by religion and wealth quintiles, MICS 2014...... 16
Table 6: Antenatal care visits by religion and wealth quintiles, MICS 2014...... 16
Table 7: Early childhood education, NAR Secondary and Literacy among young women by religion, MICS 2014...... 20
Table 8: Gender parity index for secondary school by religion, MICS 2014 ...... 20
Table 9: Mother-child HIV knowledge and Accepting attitudes towards people with HIV by religion, MICS 2014...... 21
Table 10: Distribution of Exposure to mass media (women) by religion, MICS 2014 ...... 23
Table 11: Percentage of fully vaccinated children by religion and area, MICS 2014...... 24
Table 12: Delivery in a health facility by religion, MICS 2014 ...... 24
Table 13: Provincial data for Delivered in a health facility by religion, MICS 2014 ...... 26
Table 14: Provincial data for Neonatal tetanus protection, MICS 2014 ...... 27
Table 15: Categories of indicators of importance by poverty and Apostolic sect, MICS 2014...28
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Table of Contents
List of Figures
Figure 1: Growth of the Apostolic sect according to ZDHS 1994, ZDHS 2005/6 and ZDHS 2010/11...... 8
Figure 2: Distribution of the Apostolic sect heads of households by provinces, MICS 2014 ...... 8
Figure 3: Distribution of the Roman Catholics, Protestants and Pentecostal heads of households by provinces, MICS 2014...... 9
Figure 4: Distribution of the Apostolic sect, Traditional and No religion heads of households by provinces, MICS 2014...... 9
Figure 5: Improved drinking water and sanitation by religion and wealth Index quintiles, MICS 2014 ...... 11
Figure 6: Child mothers and Teenage marriage by religion and area, MICS 2014 ...... 13
Figure 7: Neonatal tetanus protection by religion, MICS 2014...... 14
Figure 8: Breastfeeding by religion, MICS 2014...... 15
Figure 9: Assistance by any skilled attendant during delivery by religion, MICS 2014 ...... 17
Figure 10: Post-natal health checks for mothers and new-borns by religion, MICS 2014...... 17
Figure 11: Use of contraception methods by religion, MICS 2014...... 18
Figure 12: Under 5 Mortality Rate by religion, MICS 2014...... 19
Figure 13: Stunting by religion, MICS 2014...... 19
Figure 14: Birth registration by religion, MICS 2014...... 21
Figure 15: Percentage of women age 15 - 49 years who accept domestic violence by religion, MICS 2014...... 22
Figure 16: Stunting by religion and area, MICS 2014 ...... 23
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List of Abbreviations
ABR Adolescent Birth Rate
ANC Antenatal Care
4+ANC More than 4 ANC visits
ASFR Age-specific Fertility Rate
DHS Demographic Health Survey
GPI Gender Parity Index
HIV Human Immunodeficiency Virus
MICS Multiple Indicator Cluster Survey
MOHCC Ministry of Health and Child Care
MOPSE Ministry of Primary and Secondary Education
MNCH Maternal, new-born and child health
NAR Net Attendance Rate
ORS Oral Rehydration Solution
SDGs Sustainable Development Goals
SRH Sexual and reproductive health
TFR Total Fertility Rate
U5MR Under 5 Mortality Rate
UNICEF United Nations Children’s Fund
WASH Water, Sanitation and Hygiene
WQ Wealth Quintile
ZDHS Zimbabwe Demographic and Health Surveys
ZimAsset Zimbabwe Agenda for Sustainable Socio-Economic Transformation
ZIMSTAT Zimbabwe National Statistics Agency
ZUNDAF Zimbabwe United Nations Development Assistance Framework
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Section 1: Introduction
1.1 Background
This paper on Religion, is part of a series of five Multiple Indicator Cluster Survey (MICS) 2014 extended analysis reports that address different thematic areas. The other four papers are on Health, Nutrition, and Water, Sanitation and Hygiene (WASH); Education; Child Protection, Child marriage and A Story of Inequality and Inequity in Zimbabwe. The purpose of the extended analysis is to examine more closely the MICS 2014 data, present results that complement the MICS report as well as informing and guiding policy and programming initiatives of Government and development partners. In particular, this analysis is aimed at informing the implementation of the Zimbabwe Agenda for Sustainable Socio-Economic Transformation (ZimAsset), the 2016 - 2020 Zimbabwe United Nations Development Assistance Framework (ZUNDAF) and the Sustainable Development Goals (SDGs).
The MICS 2014 extended analysis was conducted by a United Nations Children’s Fund (UNICEF) independent consultant, an expert in MICS and Demographic and Health Surveys (DHS), and a UNICEF’s local consultant in collaboration with Zimbabwe National Statistics Agency (ZIMSTAT), University of Zimbabwe, Ministry of Health and Child Care (MOHCC) and Ministry of Primary and Secondary Education (MOPSE).
1.2 Religion, health and social inequities in Zimbabwe
Religion is an important component of the socio-cultural landscape in Zimbabwe. Socio-cultural factors, primarily religious beliefs and practices, shape people’s health care seeking behaviours, particularly acceptance or rejection of modern healthcare services1. Refusal of medical treatment and/or advice on uptake of maternal, newborn and child health (MNCH) contribute to maternal and child morbidity and mortality2. The resistance towards uptake of sexual and reproductive health (SRH) and modern maternal, newborn and child health (MNCH) services has direct consequences on health outcomes.
Since religion is a critical determinant of behavior, this secondary analysis of MICS 2014 data on religion offers evidence on its influence on health, educational and social outcomes. All religions, except Islam, were analyzed. Adding the religious dimension to various stratifiers strengthened understanding of the different outcomes and performance of social indicators in the country.
The analysis also focused specifically on Apostolic sect in order to examine the relationship between Apostolic religion and health and social indicators. Past evidence revealed poor performance of Apostolic sect across various MNCH indicators3. Such performance has been closely linked to Apostolic religious doctrine, practices and beliefs that contributed to religious objection or reticence towards modern health services based. Apostolic sect’s faith and ‘healing’ systems include: l use of “holy water” for healing and spiritual protection l use of Apostolic traditional birth attendants and Zvitsidzo (Apostolic ‘health centres and shrines’) for antenatal care, delivery, spiritual protection and post-natal care
1 UNICEF (2011) Apostolic Religion, Health and Utilization of Maternal and Child Health Services in Zimbabwe, Harare: Collaborating Center for Operational Research and Evaluation (CCORE) UNICEF, Harare: UNICEF Zimbabwe. Report by Maguranyanga B. UNICEF (2015) The Apostolic Maternal Empowerment and Newborn Intervention (AMENI) Model: Improving Maternal and Newborn Child Health Outcomes among Apostolic Religious Groups in Zimbabwe. Report by Maguranyanga B and Feltoe G (author) 2 UNDP, 2011. “Keeping the Promises: United to Achieve the Millenium Development Goals, Facts, Millenium Development Goals” Pp. 8-10, Harare: The Saturday Herald, 12 March 2011 3 UNICEF 2015 - AMENI; Machingura 2014; OPHID 2014; Muchabaiwa et al 2012; Ha et al 2012; UNICEF 2011
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Section 1: Introduction
l ‘healing’ rituals and practices of Apostolic sect’s prophets and faith healers
l emphasis on faith and divine healing (OPHID 2015; Machingura 2014; UNICEF 2011 and UNICEF 2015)
The structure of this paper includes: (i) the introduction, (ii) discussion of results, and (iii) conclusions and recommendations.
The results of this analysis reflect descriptive statistics, and no inferential statistical analysis (bivariate or multivariate) was conducted to demonstrate the effect of variables and their significant influence. In addition, the results largely focused on household data, particularly for the household head and do not provide religion information on other household members. The paper is exploratory in nature, and unpacks important dimensions of equity and inequity in Zimbabwe. Within the identified limitations, it provides useful starting points and areas for further exploration to improve understanding of causality. Therefore, future studies should apply advanced statistical analysis including multi-level logistic regression to test and reveal the strengths of different causes.
1.3 Methodology
The analysis involved three steps outlined below:
Step 1:
Most tables produced for the MICS 2014 report were re-analysed and added religion as a stratifier. The analysis highlighted religion as the driving force for differences in several health- related indicators. Poverty-related indicators were analysed, followed by health and other indicators.
Step 2:
The analysis focused on behavioural outcomes of religions within the same context (area or wealth index quintiles4) to ascertain whether poverty or religion, and location or religion were the main forces behind differences.
Step 3:
This phase of the analysis focused on the Apostolic sect only. The Apostolic sect in Zimbabwe constitutes 32% of heads of households and 38% of children under-five years of age (MICS 2014). This religion is heterogeneous, and includes moderate to very conservative sub-groups. However, in this analysis the Apostolic sect was treated as a homogeneous group. Some tables for “Apostolic sect only” were analysed to explore the proposition that health care seeking behaviour among Apostolic sect is related to specific geographical locations where they are dominant.
Data on religion was compared with extreme values to show that different factors (e.g., area and wealth quintiles) other than religion also play a role in the behavioural outcomes and in health and social inequities. All complete tables are in the Annex.
DISCLAIMER: All the religion tables are based on the MICS 2014 question “religion of head of household”, so the religion of the other household members is unknown.
4 The wealth index is a background characteristic used as a proxy for a household's cumulative living standard. It is based on the data for dwelling characteristics, source of drinking water, toilet facilities and other characteristics related to the socioeconomic status of households. The standard numeration of the wealth index quintiles goes from 1-Poorest to 5-Richest. 6 Extended Analysis of MICS 2014: Religion Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 7
Section 2: Results and Discussions
This section presents the results from the extended analysis by context, water and sanitation, fertility, adolescent reproductive health, child and maternal health, contraception, outcome indicators, child protection and nutrition. Several additional indicators were also analysed by religion.
2.1 Analysis Step 1: The context: size and location of religious groups
Table 1 shows that Apostolic sect5 is the largest religion in Zimbabwe constituting 32% of heads of households in the reproductive age (15-49 years), which equals Protestant and Pentecostal combined. This highlights the sheer size of the Apostolic population by head of household compared with No religion (which the Apostolic sect doubles) and Traditional, which is only one sixth of the Apostolic sect population. In addition, the proportion of children under-five years in Apostolic sect headed households was 38%. It is therefore evident that the weight of the Apostolic sect in national results is substantial and should not be overlooked.
2.1.1 Size of the various religious groups
Table 1: Proportion of religious groups in Zimbabwe, MICS 2014 Religion of household head Proportion of households (%) Roman Catholic 9 Protestant 17 Pentecostal 15 Apostolic sect 32 Other Christian 6 Islam*6 1 Traditional 5 Other religion*6 0 No religion 16 Total 100
According to ZDHS the Apostolic sect in Zimbabwe has grown from 20% in 1994 to 33% in 2010/11. ZDHS 2010/11 states that 38% of women age 15-49 years are affiliated with the Apostolic sect. In contrast MICS 2014 indicates 32% of male and female heads of households belonged to the Apostolic sect (see Figure 1).
5 MICS 2014 does not disaggregate the Apostolic sect data and treats the sect as a homogenous group. It therefore does not show the differences and sizes of the moderate to very conservative Apostolic sub-groups. 6 In this analysis, those categories with proportions 1% and below (Islam and Other religion) were excluded. 7 Extended Analysis of MICS 2014: Religion Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 8
Section 2: Results and Discussions
Figure 1: Growth of the Apostolic sect based on ZDHS 1994, 2005/6 and 2010/11
35 33
30 25 25 20 20
15
10
5 Percentage of Apostolic sect Percentage of Apostolic 0 4991 6002 1102 Years
2.1.2 Location of the various religious groups
Figure 2 shows the provincial distribution of Apostolic sect by heads of households. Apostolic sect dominates in the following provinces, Mashonaland Central (38%), Matabeleland South (38%), Mashonaland East (37%) and Manicaland (36%). In spite of the historical emergence and concentration of Apostolic sect in Manicaland, this religion has grown extensively in other provinces. However, metropolitan provinces, Bulawayo and Harare have the lowest proportion (23%) of the Apostolic sect.
Figure 2: Distribution of the Apostolic sect heads of households by provinces, MICS 2014
Key 23 - 28 Low 29 - 34 Average 35 - 38 High
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Section 2: Results and Discussions
Figure 3 shows the provincial distribution of mainline religions (Roman Catholics, Protestants and Pentecostal)7 by heads of households. The range goes from 19% in Mashonaland Central to 59% in Bulawayo
Figure 3: Distribution of the Roman Catholics, Protestants and Pentecostal heads of households by provinces, MICS 2014
Key 19 - 32 Low 33 - 46 Average 47 - 59 High
Figure 4 indicates the distribution of three non-mainline religions: Apostolic, Traditional and No religion. These three religions are largely concentrated in Mashonaland Central (76%) and Matabeleland South with 64% and lowest in metropolitan provinces, Harare and Bulawayo (37%).
Figure 4: Distribution of the Apostolic sect, Traditional and No religion heads of
households by provinces, MICS 2014
Key 37 - 50 Low 51 - 63 Average 64 - 76 High
7 The differences in outcomes between Roman Catholics, Protestants and Pentecostal (mainline religions) are normally very limited, and hence the three religions have been grouped in Figure 3.
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Section 2: Results and Discussions
2.2 Religion and Wealth index quintiles
In this section, the analysis explores the relationship between religion and wealth quintiles. Table 2 shows the distribution of religion of household heads by wealth quintile. Any number above 20% in the poorest WQ or 40% in the two poorest WQs means an over-representation in the poorest category, and any number below 20% in the richest wealth quintile means an under-representation. There was a lower proportion of Roman Catholic, Protestant and Pentecostal than non-mainline in the poorest wealth quintiles while “Other Christian” was closer to national average in across wealth quintiles.
The non-mainline religions (Apostolic sect, Traditional and No Religion) constituted the majority in poorest wealth quintiles, with religious groups Traditional and No religion even poorer. These non-mainline religions are under-represented in the richest wealth quintiles. The results indicate that Traditional religion is over-represented in the two poorest wealth quintiles (two thirds), and extremely lowly represented in the richest quintile (only 3%) and hence Traditional headed households are very poor.
As stated earlier, 32% of all households belong to Apostolic sect, and half of them are in the two poorest quintiles thus representing 40% of the households in the two poorest quintiles. This raises the question whether poor people flock to Apostolic sect or Apostolic sect religion contributes to one being poor? Are the health and social outcomes for the Apostolic sect related to poverty or to Apostolic religion? These questions have no simple answers given that the association between religion and wealth quintiles could also be influenced by socio-economic conditions of the geographic locations. For example, over-representation of a religious group in an area of low socio- economic potential would predispose the members of that religious group to poverty or being poor. Arguably, religion may not be the issue but rather limited socio-economic opportunities.
Table 2: Percent distribution of religion by wealth index quintiles, MICS 2014
Religion of Wealth quintiles (%) household head WQ1 (Poorest) WQ1 and WQ2 (Two poorest) WQ 5 (Richest) Roman Catholic 15 32 26 Protestant 12 27 30 Pentecostal 11 21 41 Apostolic sect 23 48 11 Other Christian 22 44 18 Traditional 37 64 3 No religion 27 50 12 Total 20 40 20
2.3 Religion and water and sanitation
In Zimbabwe, 30% of the households have access to improved water and sanitation. Figure 5 shows that the three mainline religions - Roman Catholic, Protestant and Pentecostal have access to water and sanitation way above the national average of 30%. In contrast, the Apostolic sect, Traditional and No religion groups have much lower access to water and sanitation, an indicator strongly related to wealth quintile (Table 2 highlights the over-representation of these three religions
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Section 2: Results and Discussions
in the poorest wealth quintiles) or over-representation in geographical settings with limited access to water and sanitation.
In comparison, all religions had better access to improved water and sanitation than the poorest wealth quintile, and thus access to improved water and sanitation is strongly related to poverty. The fourth wealth quintile was affected by category ‘shared’ toilet facility in urban areas and hence the decline in the proportion of households with improved drinking water and sanitation.
Figure 5: Improved drinking water and sanitation by religion and wealth Index quintiles, MICS 2014
70 63 60
50 45 40 39 40 37 30 30 26 30 23 18 20 20 16 and sanita on
10 5
0 Percentage with improved drinking water
Religion of household head Wealth quin les
2.4 Fertility
Traditional headed households had the highest Adolescent birth rate (ABR) or Age-specific fertility rate (ASFR) (183) for women age 15-19 years followed by No religion (167) and Apostolic sect (139). These three religions also had the highest Total Fertility Rate (5). The ABR and Total Fertility Rate (TFR) for these three religions were way above national average as shown in Table 3.
Roman Catholic, Protestant and Pentecostal had relatively similar ABR and TFR, 83 and 4 respectively, both below national average. In contrast, 21% of the population in the groups “Traditional” and “No religion” had the highest fertility (183 and 167) and TFR (5 for both) respectively.
However, when comparing religion and wealth quintile, the poorest wealth quintile had higher TFR than the Apostolic Sect. Interestingly, the three religious groups (Apostolic sect, Traditional, and No religion) constitute the majority of those in the poorest wealth quintile, and hence addressing high TFR may require tackling both poverty-related aspects and religious issues. Thus, the double- burden of poverty and religion on fertility requires further exploration.
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Section 2: Results and Discussions
Table 3: Distribution of fertility by religion and wealth quintiles, MICS 2014 Stratifier Adolescent birth rate Total fertility rate Religion Roman Catholic 83 4 Protestant 82 4 Pentecostal 87 4 Apostolic sect 139 5 Other Christian 132 5 Traditional 183 5 No religion 167 5 Total 120 4 Wealth quintiles WQ1 (Poorest) 164 6 WQ2 155 5 WQ3 129 4 WQ4 138 4 WQ5 (Richest) 47 3 National average 83 4
2.5 Child mothers and Teenage marriage
The proportion of child mothers (gave birth before age 18) in Apostolic sect households was similar to Traditional religion, and slightly above No religion. In contrast, the proportion of child mothers in the above mentioned religions doubled that of Protestant and Pentecostal households. In addition, Apostolic sect, Traditional and No religion had a much higher proportion of teen marriages than other religions (see Figure 6).
The proportion of child mothers and teenage marriages in rural areas was 29% and double that of urban areas. Earlier sections revealed the predominance of Traditional, Apostolic a sect and No religion in specific rural provinces than metropolitan provinces, and this presents a case for focusing on areas with high proportion of these religions.
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Section 2: Results and Discussions
Figure 6: Child mothers and Teenage marriage by religion and area, MICS 2014
40 35 34 35 29 30 29 29 29 30 28 25 25 22 20 21 20 17 17 18 15 15 15 14 15 12 marriages 10 5 0 Percentage of child mothers and teenage mothers Percentage of child
Religion of household head Area
Child mother Teenage marriage
2.6 Child health
2.6.1 Vaccination, care seeking for fever and diarrhoea
Table 4 shows that child health outcomes among members of Apostolic sect clearly deserve more attention than other religions, particularly in none vaccination and care seeking for fever. Across all the indicators shown in Table 4, Apostolic sect performed poorly and well below national average. In terms of the indicator “zero vaccinations”, the Apostolic sect was the worst, and hence confirms resistance to vaccinations among Apostolic sub-groups (religious objectors). The results also show that Traditional and No religion headed households had poor child health outcomes. In contrast, Roman Catholic, Protestant and Pentecostal performed much better, and thus clear differences with other religions emerge.
The poor performance of Apostolic sect in terms of health care seeking behaviours (vaccination) and care seeking for fever can possibly be explained by Apostolic doctrine, faith healing systems and rituals as well as religious objections to modern child health care services among some Apostolic sub-groups.
In terms of “advice sought in case of diarrhoea”, the Apostolic sect performed similar to Pentecostal and there were no real differences (see Table A in Annex). The overall use of Oral Rehydration Solution (ORS) was 73% (national average) compared to 74% for the Apostolic sect. This reflects similarities in health seeking behaviour.
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Section 2: Results and Discussions
Table 4: Vaccination and Care seeking for fever by religion, MICS 2014 Religion of Vaccinated Vaccinated Care Seeking Household Head Full (%) None (%) for Fever (%) Roman Catholic 85 3 54
Protestant 92 1 49
Pentecostal 84 2 48
Apostolic sect 75 9 41
Other Christian 78 5 53
Traditional 73 3 55
No religion 82 2 49
Total 80 4 50
2.6.2 Neonatal tetanus protection
The Apostolic sect performed poorly in terms of Neonatal tetanus protection and was below the national average of 64%. This possibly reflects the influence of the religion on uptake of vaccinations related to Neonatal tetanus protection (see Figure 7).
Figure 7: Neonatal tetanus protection by religion, MICS 2014
80 71 67 70 64 66 65 64 59 60 60
50
40
30
20
10
Percentage protected against tetanus Percentage protected 0 Roman Protestant Pentecostal Apostolic Other Tradi onal No religion Total Catholic sect Chris an Religion of household head
In comparison with the poorest wealth quintile (64%), the Apostolic sect was the worst performer. All wealth quintiles had basically the same values thus, showing almost total equity in neonatal tetanus protection. For this indicator religion was the key stratifier.
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Section 2: Results and Discussions
2.6.3 Breastfeeding
Figure 8 shows that the Apostolic sect had the lowest proportion of children who were exclusively breastfed (34%), seven percentage points below national average. This may be attributed to introduction of “holy water” or “anointed oil” and other religious concoctions to infants under-six months of age as part of Apostolic faith and spiritual healing. Furthermore, the proportion of predominant breastfeeding in the Apostolic sect was a point below the national average of 64%. The proportion of continuous breastfeeding at one year for all religious groups was approximately 85-86% although the Apostolic sect was the worst in feeding practices (see Table B in Annex).
Figure 8: Breastfeeding by religion, MICS 2014
80 72 70 70 67 66 64 62 63 60 57 53 50 46 46 44 45 41 39 40 34
30
20
10
Percentage of children age 0 -of children Percentage breas ed 5 months 0 Roman Protestant Pentecostal Apostolic Other Tradi onal No Religion Total Catholic Sect Chris an Religion of household head Percentage exclusively breas ed Percentage predominantly breas ed
2.7 Maternal health
2.7.1 Antenatal care
Table 5 shows that Antenatal care (ANC) by Any skilled provider was relatively uniform and above national average (94%) for all religions except the Apostolic sect (88%). However, the use of a Medical doctor in ANC was lowest among Traditional, No religion and Apostolic sect. The analysis also highlighted huge differences between urban (28%) and rural (8%) areas in the use of Medical doctor in ANC.
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Section 2: Results and Discussions
Table 5: ANC coverage by religion and wealth quintiles, MICS 2014 Stratifier Medical doctor (%) Any skilled provider (%) Religion Roman Catholic 25 98 Protestant 20 100 Pentecostal 23 97 Apostolic sect 10 88 Other Christian 13 94 Traditional 6 97 No religion 9 96 Wealth quintiles WQ1 (Poorest) 6 92 WQ2 6 91 WQ3 7 95 WQ4 13 94 WQ5 (Richest) 39 98 Total 14 94
The Apostolic sect households performed the worst in terms of No ANC visits and 4+ANC visits, and slightly worse than the poorest wealth quintile (see Table 6).
Table 6: Antenatal care visits by religion and wealth quintiles, MICS 2014 Stratifier No ANC visits (%) 4+ANC visits (%) Religion Roman Catholic 2 74 Protestant 1 76 Pentecostal 3 75 Apostolic sect 8 66 Other Christian 6 69 Traditional 3 72 No religion 4 68 Wealth quintiles WQ1 (Poorest) 7 65 WQ2 6 69 WQ3 3 74 WQ4 5 68 WQ5 (Richest) 2 78 Total 5 70
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Section 2: Results and Discussions
2.7.2 Assistance during delivery
The Apostolic sect had the lowest proportion of women (73%) who had Delivery assisted by any skilled attendant but it was slightly better than WQ1 and WQ2 (see Figure 9).
Figure 9: Assistance by any skilled attendant during delivery by religion, MICS 2014
100 96 91 88 90 90 86 80 78 80 80 73 75 74 70 71 70 60 50 40 a endant 30 20 10 0 Percentage of women assisted by any skilled by any skilled assisted of women Percentage
Religion of household head Wealth quin les
2.7.3 Post-natal health checks
In terms of post-natal health checks, households belonging to Traditional religion (67%) and poorest wealth quintile (66%) were the worst performers. The Apostolic sect was among the four religions performing below the national average of 75% (see Figure 10).
Figure 10: Post-natal health checks for mothers and new-borns by religion, MICS 2014
100 88 90 82 80 80 75 78 80 74 73 71 67 70 70 66 60 50 40 30 20 10 0 Percentage of health checks post-natal
Religion of household head Wealth quin les
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Section 2: Results and Discussions
2.8 Use of contraceptives
Figure 11 shows that Apostolic sect had the lowest use of contraception (62%) among religious groups, and similar to the poorest wealth quintile (WQ1). Interestingly, Roman Catholic had the highest use of contraceptives (72%) despite the official position on modern (artificial) contraception.
Figure 11: Use of contraception methods by religion, MICS 2014
80 72 69 70 68 68 69 70 70 66 66 67 62 62 64 60
50
40
30
20
10
Perecntage that used contracep on 0
Religion of household head Wealth quin les
2.9 Outcome indicators
2.9.1 Under-five mortality8
In this extended analysis only religious groups that had more that 10% of heads of household were analysed. Figure 12 shows that U5MRs of households headed by Other Christian (85), Apostolic sect (85), and No religion (79) was higher than national average of 75 deaths per 1,000 live births. The high U5MR in the Apostolic sect may be attributed to sub-optimal health seeking behaviours and limited utilisation of modern MNCH services.
The Protestant and Pentecostal again had the best indicator values for the U5MR. Interestingly, U5MR for Traditional religion was almost similar to that of the mainline religions, Roman Catholic and Protestant.
8 The reporting of U5MR by background characteristics in MICS 2014 does not give the most accurate results because several groups are too small to calculate that mortality.
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Section 2: Results and Discussions
Figure 12: Under 5 Mortality Rate by religion, MICS 2014 90 85 86 79 80 75 68 70 60 57 57 56 50 40 30 20 10
Under 5 deaths per 1,000 live births 0 Roman Protestant Pentecostal Apostolic Other Tradi onal No Religion Total Catholic Sect Chris an Religion of household head
2.9.2 Stunting
The mainline religions had lower stunting rates than the Apostolic sect, Traditional and No religion whose rate were above national average (see Figure 13).
In comparing religion-related results on stunting and geographical location, Manicaland (34%) and Mashonaland Central (32%) provinces had higher stunting rates than Apostolic sect, Traditional and No religion (each with 30%). The value of stunting in the rural areas equalled that of the three religions. Stunting in the poorest wealth quintile and second wealth quintile was 33% and 31% respectively. For wasting (acute malnutrition), there was hardly any differences across the religious groups (see Table C in Annex).
Figure 13: Stunting by religion, MICS 2014
35 30 30 30 30 27 28 25 23 23 22 20 15 10 5 0 Percentage of stunted children Percentage of stunted
Religion of household head
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Section 2: Results and Discussions
2.10 Education
Apostolic sect, Traditional and No religion had the worst educational outcomes in terms of education (Early childhood education, NAR Secondary, and Literacy among young women). Traditional headed households had the least NAR Secondary (38%). There were slight differences in values between Apostolic sect and rural area across the three indicators (see Table 7).
Table 7: Early childhood education, NAR Secondary and Literacy among young women by religion, MICS 2014
Early childhood Literacy among young Stratifier NAR: Secondary education women
Religion Roman Catholic 24 62 95 Protestant 32 63 97 Pentecostal 30 67 96 Apostolic sect 17 51 90 Other Christian 24 48 92 Traditional 18 38 86 No religion 17 42 90 Area Urban 26 76 98 Rural 20 49 89 Total 22 55 92
Table 8 shows that the Gender Parity Index (GPI) for all religions was in favour of girls although Roman Catholic, Pentecostal and Other Christian were closer to parity. More girls than boys were attending secondary school at the appropriate age among Protestant, Apostolic sect, Traditional and No religion.
Table 8: Gender parity index for secondary school by religion, MICS 2014 Religion of household head GPI: Secondary school
Roman Catholic 1.05
Protestant 1.16
Pentecostal 1.07
Apostolic Sect 1.20
Other Christian 1.03
Traditional 1.37
No Religion 1.27
Total 1.17
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Section 2: Results and Discussions
2.11 Birth registration
Figure 14 shows a differentiated pattern regarding Birth registration with the non-mainline religions having the lowest birth registration. Rural areas (23%) and the poorest wealth quintile (17%) also had low birth registration.
Figure 14: Birth registration by religion, MICS 2014
50 45 45 43 40 40 35 28 29 30 26 25 20 18 15 10
Percentage of registered births Percentage of registered 5 0 Roman Protestant Pentecostal Apostolic sect Other Tradi onal No religion Catholic Chris an Religion of household head
2.12 HIV knowledge and attitudes
In terms of knowledge of mother-to-child HIV transmission, there were hardly any differences in values across all religions, thus indicating total equity. The non-mainline religions had the lowest proportion of people with accepting attitudes towards people with HIV as shown in Table 9.
Table 9: Knowledge of mother-to-child HIV transmission and accepting attitudes towards people living with HIV by religion, MICS 2014 Knowledge of mother-to-child Accepting attitudes towards Religion of household head HIV transmission (%) people living with HIV (%) Roman Catholic 56 42
Protestant 55 40
Pentecostal 54 39
Apostolic sect 55 37
Other Christian 56 35
Traditional 55 34
No religion 56 34
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Section 2: Results and Discussions
2.13 Violence
2.13.1 Attitude towards domestic violence
Figure 15 shows that women age 15-49 affiliated with Apostolic sect, No religion and Traditional religions had higher acceptance of domestic violence towards women than those from other religions.
Figure 15: Percentage of women age 15 - 49 years who accept domestic violence by religion, MICS 2014 70 60 58 60 57 53 52 49 50 45 43 40
30
20
10 Percentage who accept violence Percentage who 0 Roman Protestant Pentecostal Apostolic Other Tradi onal No Religion Total Catholic Sect Chris an Religion of household head
2.13.2 Exposure to mass media
Table 10 shows that a higher proportion of women in the non-mainline religions had No media exposure for at least a week than those from mainline religions. This can possibly be explained by the influence of religion and poverty.
Table 10: Distribution of Exposure to mass media (women) by religion, MICS 2014 Stratifier No media exposure9 for at least a week (%) Religion Roman Catholic 29 Protestant 27 Pentecostal 25 Apostolic sect 45 Other Christian 40 Traditional 52 No religion 42 Wealth quintiles WQ1 (Poorest) 70 WQ2 56 WQ3 46 WQ4 25 WQ5 (Richest) 6 Total 37
9 The three media sources are newspaper, radio and television. 22 Extended Analysis of MICS 2014: Religion Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 23
Section 2: Results and Discussions
2.14 Analysis Step 2: Religion within the same context
In this section, the analysis focuses on behavioural outcomes of religions within the same context (area or wealth quintile) to ascertain whether poverty or religion and location or religion were the main forces behind the differences.
2.14.1 Stunting
Figure 16 shows that stunting among children in Apostolic sect, Traditional and No religion was higher than other religions in both rural and urban areas (within the same context). This highlights that religion remains an important factor even after excluding other factors such as area.
Figure 16: Stunting by religion and area, MICS 2014 35 32 31 32 30 29 30 30 30 30 28 26 26 26 27 26 24 25 23 23 22 22 19 20 20 20 16 17 15
10
5
Percentage of stunted children Percentage of stunted 0 Roman Protestant Pentecostal Apostolic Other Tradi onal No Religion Total Catholic Sect Chris an Religion of household head
Zimbabwe Urban Rural
2.14.2 Vaccination
The Apostolic sect, Traditional and Other Christians had lower proportions of fully vaccinated children than other religions in Zimbabwe and were below the national average of 80%. In urban areas the Apostolic sect had the lowest value of fully vaccinated children (76%) while all other religions were above the urban average of 85%. In rural areas, Apostolic sect, Traditional and Other Christian had values lower than the rural average (78%). The underperformance of the Apostolic sect highlights the influence of this religion on health-care seeking behaviours and uptake of vaccinations and child health services.
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Section 2: Results and Discussions
Table 11: Percentage of fully vaccinated children by religion and area, MICS 2014
Area Religion of household head Zimbabwe Urban Rural
Roman Catholic 85 92 80
Protestant 92 90 92
Pentecostal 84 88 79
Apostolic sect 75 76 75
Other Christian 78 N.d10 76
Traditional 73 N.d 71
No religion 82 87 79
Total 80 85 78
2.14.3 Delivery in a health facility
Table 12 shows that Apostolic sect had the lowest value (72%) of Delivery in a health facility, and 65% of Apostolic women in the two poorest wealth quintiles (WQ1 and WQ2) delivered in a health facility. These results indicate that wealth quintile and religion are important factors for Delivery in a health facility.
Table 12: Delivery in a health facility by religion, MICS 2014
Religion of household head Delivery in a health facility (%) Poorest 2 WQ’s (%)
Roman Catholic 88 78
Protestant 91 84
Pentecostal 90 80
Apostolic sect 72 65
Other Christian 74 65
Traditional 74 73
No religion 80 73
Total 80 70
10 No data available.
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Section 2: Results and Discussions
Overall, the Apostolic sect performed the worst in most indicators than the other three mainline religions (Roman Catholic, Protestant and Pentecostal) but relatively similar to Traditional and No religion. Its performance was also not so different from the lowest wealth quintiles, and its values were below average in most cases. The differences observed across religions within the same context indicate that religion matters and influences health and social behaviours, as well as affects various indicators.
2.15 Analysis Step 3: Results for Apostolic sect only
The Apostolic sect constitutes the largest religious population in Zimbabwe. It represents 32% of heads of households and 38% of children under the age of five. This is a significant proportion of the population, and its sheer size has implications on health and social development outcomes in the country. While the Apostolic sect is treated as a homogeneous group in this analysis it has many sub-groups ranging from moderate to very conservative.
In this section, tables for “Apostolic sect only” were analysed to explore the proposition that the health behaviour is very much related to geographical location. Only two tables (Delivery in a health facility and Neonatal tetanus protection), with sufficient numbers, were analysed to test the above proposition.
Table 13 provides provincial data for Delivery in a health facility by religion. Overall, Delivery in a health facility among women in Apostolic sect headed households (72%) is much lower than national average and for all other religions excluding Apostolic (83%). The analysis of provincial data11 for all religions and for the Apostolic sect only show some interesting results. Manicaland, Midlands, Mashonaland East, Mashonaland Central and Masvingo had the lowest proportion of women from the Apostolic sect only delivering in a health facility and were below the national average of 72%. Bulawayo, Matabeleland North, and Mashonaland Central had slight differences between the proportion of Apostolic women and women from all other religions delivering in a health facility. Huge differences between these two groups were observed in Manicaland, Mashonaland East, Midlands and Harare.
Interestingly, in Matabeleland South, the proportion of Apostolic women delivering in a health facility was much higher than that of women of all other religions excluding Apostolic sect. The variation of health behaviour, Delivery in a health facility among Apostolic women by province ranging from 60-90%, reflects heterogeneity within the Apostolic sect. Huge differences or variations in values observed can be attributed to the strong influences of Apostolic religion.
11 Be careful because of the numbers and confidence intervals.
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Section 2: Results and Discussions
Table 13: Provincial data for Delivery in a health facility by religion, MICS 2014
Delivered in a health facility (%) Difference between all All other other religions Province religions Apostolic All religions (excluding excluding sect only Apostolic) and Apostolic sect Apostolic sect
Bulawayo 94 94 93 1
Manicaland 72 79 60 19
Mashonaland Central 71 72 69 3
Mashonaland East 80 88 67 21
Mashonaland West 73 74 70 4
Matabeleland North 89 89 88 1
Matabeleland South 84 83 86 -3
Midlands 76 81 63 18
Masvingo 75 78 69 9
Harare 89 92 79 13
Total 80 83 72 11
The second analysis of tables explored the proposition that health behaviour and Neonatal tetanus protection is related to geographical location. Table 14 shows that metropolitan provinces, Harare and Bulawayo, had the lowest values for Neonatal tetanus protection among all religions. Apostolic sect only, Bulawayo and Matabeleland North had the highest proportion of children who had Neonatal tetanus protection than all other provinces.
Bulawayo and Harare had higher differences between Apostolic children and children of all other religions who had Neonatal protection. This indicates that more Apostolic children had Neonatal tetanus protection than those of all other religions. However, in some provinces such as, Manicaland, Mashonaland West, Matabeleland South and Midlands, the proportion of Apostolic children who had Neonatal protection was less than that of all other religions.
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Section 2: Results and Discussions
Table 14: Provincial data for Neonatal tetanus protection, MICS 2014
Protected against tetanus (%) Difference between all other religions Province All other Apostolic (excluding Apostolic) All regions religions excluding sect only and Apostolic sect Apostolic sect
Bulawayo 57 55 65 -10 Manicaland 67 72 58 14 Mashonaland Central 61 62 59 3 Mashonaland East 64 67 59 8 Mashonaland West 70 74 61 13 Matabeleland North 73 73 72 1 Matabeleland South 64 68 57 11 Midlands 63 66 55 11 Masvingo 59 61 55 6 Harare 54 53 57 -4 Total 64 66 59 7
Therefore, this analysis confirmed the proposition12. In several provinces, there were no differences in health-care seeking behaviour between Apostolic sect and other religions health behaviour in Matabeleland North, Matabeleland South and Mashonaland Central. However, huge differences were noted in Manicaland, Midlands and Mashonaland East provinces.
From this analysis, two categories emerged with an inventory of indicators of importance in terms of poverty and Apostolic religion (see Table 15):
l Category 1: Indicators that mostly reflect poverty and rural locations where the three non-mainline religions (Apostolic sect, No religion and Traditional) dominate.
l Category 2: Indicators in which Apostolic sect should be targeted.
12 Caution should be exercised since numbers here were small thus the differences.
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Section 2: Results and Discussions
Table 15: Categories of indicators of importance by poverty and Apostolic sect, MICS 2014
Category 1: Poverty Category 2: Apostolic sect
WASH Contraception
Fertility, TFR U5MR
Fertility, Teenage Exclusive breastfeeding
Stunting No vaccinations
LBW Care seeking for fever
ANC-Medical doctor Neonatal Tetanus
ANC-Skilled birth attendant ANC-Skilled birth attendant
Post Natal Checks 4+ ANC
Child Mother Delivery in health facility
Teenage Marriage
Early Childhood education
NAR Secondary
Literacy
Birth registration
Access to Media
For nine indicators, Apostolic religion emerged as key variable, and therefore highlighting the influence of Apostolic doctrine, beliefs and practices on health-care seeking behaviours and social practices.
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Section 3: Conclusions and Recommendations
The Apostolic sect constitute 32% of the total households and 38% of children under five years of age in Zimbabwe. Apostolic headed households make up 40% of the two poorest wealth quintiles (WQ1 and WQ2), and therefore poverty and religion have an influence on health and social outcomes of Apostolic sect members. Given the sheer size of the Apostolic sect population in Zimbabwe, its weight on health and social outcomes cannot be under estimated especially in locations and wealth quintiles where Apostolic sect members are dominant. In contrast, the mainline religious groups constitute the majority in the two richest wealth quintiles (WQ4 and WQ5) while the non-mainline religions (Apostolic sect, Traditional and No religion) are significantly under- represented.
The results show that children and women living in Apostolic headed households performed badly for almost all indicators compared to those in households headed by mainline religions (Roman Catholic, Protestants and Pentecostal). In a wide range of indicators, the Apostolic sect results did not differ much from those of No religion and Traditional groups.
Furthermore, the non-mainline religions are the worst performers across all the key indicators. Therefore, the focus on religion should be on these three non-mainline religions, taking into account the areas and wealth quintiles where they are predominant. However, deeper analysis of maternal and child health indicators shows that Apostolic sect perform poorly or often stand out negatively especially for Vaccination, Neonatal Tetanus, Access to ANC, Care Seeking for Fever and Exclusive Breastfeeding even when compared with the poorest wealth quintile only. While the Apostolic sect perform poorly in ANC, interestingly they perform well in Post-natal checks up.
In exploring the proposition that religion matters in health care seeking behaviour an analysis was done on the indicator Neonatal tetanus protection. The results showed that religion is a key factor, and the coverage range for Neonatal tetanus protection was 59% for Apostolic sect compared to 71% for Protestant. Religion remains important for several other indicators.
The analysis of religion within the same context (wealth quintile and area) showed that relationships stay similar. For example, the relationship between religion and stunting remained the same within the same context signifying the importance of religion. However, Apostolic sect, Traditional and No religion headed households were the worst performers in stunting with slight differences among them.
The evidence also demonstrates that the Apostolic sect may deserve special attention for a range of health indicators. However, the slight differences13 in the values of Apostolic sect, Traditional and No religion warrant focus on these three religions particularly in some locations (Mashonaland Central, Mashonaland East, Matabeleland South and Manicaland) that had poor health and social outcomes.
13 The aggregated data tends to hide significant differences that may exist at various sub-national levels.
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Section 3: Conclusions and Recommendations
3.1 Recommendations
l For all indicators in which the Apostolic sect is the worst performer, there is need for religiously sensitive and contextually-relevant interventions to address the poor outcomes.
w Religious and traditional leaders’ engagement and dialogue.
w Targeted health and social interventions that recognize and empower Apostolic women’s agency to improve MNCH and social outcomes.
w Communication for development (C4D) strategy for MNCH, WASH, and Child Protection targeting the religious and socio-cultural objectors or the three religions (Apostolic sect, Traditional and No religion).
l Implement community-wide approaches in provinces with high proportion of Apostolic sect, Traditional and No-religion.
w This approach facilitates the implementation of health and social interventions that do not socially label these religions as religious and socio-cultural objectors.
w Focus on the poorest rural areas in improving health and social outcomes will ensure that the three religions are covered by the interventions.
w Provincial/location targeting with significant proportion of non-mainline religions and households in two poorest wealth quintiles enables interventions to address the burden of religion and poverty on health and social outcomes.
l Strengthen youth and women empowerment and poverty alleviation through a multi- sectoral approach.
l Engage ZIMSTAT to review the demographic profile sheet (MICS questionnaire) to ask questions on religion of other household members rather than focusing on religion of the household head only.
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References
Ha W, Salama P, Gwavuya S and Kanjala C (2012) “Equity and Maternal and Child Health – Is Religion the Forgotten Variable? Evidence from Zimbabwe”, Paper Presented at “Addressing Inequalities: The Heart of the Post-2015 Development Agenda and the Future We Want for All, Global Thematic Consultation”, October 2012.
Machingura, F (2014) “The Martyring of People over Radical Beliefs: A Critical Look at the Johane Marange Apostolic Church’s Perception of Education and Health (Family Planning Methods)” in Chitando E, Gunda MR and Kugler J (Eds.), Multiplying in the Spirit, Bamberg: University of Bamberg Press, p175-198
Muchabaiwa L, Mazambani D, Chigusiwa L, Bindu S & Mudavanhu V (2012) “Determinants of Maternal Healthcare Utilization in Zimbabwe”, International Journal of Economic Sciences and Applied Research, 5(2): 145-162.
OPHID (2014) Exploring the Forgotten Variable: Engaging, Listening and Learning from Apostolic Birth Attendants. An Exploratory Qualitative Study of the Role of Apostolic Midwives in Mashonaland Central Province, Zimbabwe, Unpublished Report, Harare: OPHID
UNDP (2011) “Keeping the Promises: United to Achieve the Millennium Development Goals, Facts, Millennium Development Goals” Pp. 8-10, Harare: The Saturday Herald, 12 March 2011
UNICEF (2011) Apostolic Religion, Health and Utilization of Maternal and Child Health Services in Zimbabwe, Collaborating Center for Operational Research and Evaluation (CCORE) UNICEF, Harare: UNICEF Zimbabwe. Report by Maguranyanga B.
UNICEF (2015) The Apostolic Maternal Empowerment and Newborn Intervention (AMENI) Model: Improving Maternal and Newborn Child Health Outcomes among Apostolic Religious Groups in Zimbabwe, Harare: UNICEF. Report by Maguranyanga B and Feltoe G.
Zimbabwe National Statistics Agency (2012) Zimbabwe Population Census 2012 National Report, Harare: Population Census Office http://www.zimstat.co.zw/sites/default/files/img/National_Report.pdf
Central Statistical Office (CSO) [Zimbabwe] (2004) Zimbabwe Population Census 2002, Harare: CSO
Zimbabwe National Statistics Agency (2015) Zimbabwe Multiple Cluster Indicator Survey 2014, Final Report, Harare: ZIMSTAT
Central Statistical Office (CSO) [Zimbabwe] and Macro International Inc. (2007) Zimbabwe Demographic and Health Survey 2005-06. Calverton, Maryland: CSO and Macro International Inc.
Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International (2012) Zimbabwe Demographic and Health Survey 2010-11, Calverton, Maryland: ZIMSTAT and ICF International Inc.
Zimbabwe National Statistics Agency (2010) Zimbabwe Multiple Indicator Monitoring Survey (MIMS) 2009, Harare: ZIMSTAT and UNICEF
31 Extended Analysis of MICS 2014: Religion Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 32 Annex
TABLE A: Care-seeking during diarrhoea Percentage of children age 0-59 months with diarrhoea in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Zimbabwe, 2014
Percentage of children with diarrhoea for whom:
Advice or treatment was sought from: Number of children age 0-59 Health facilities or providers No months A health advice or with Village/ facility or treatment diarrhoea City sought in the last Other provider Public Private Mission health two weeks source [1] [b] provider [a]
Total 40.0 2.5 2.7 2.7 3.8 44.3 51.1 1529
Sex Male 39.9 2.5 2.6 3.2 4.0 44.2 51.2 761
Female 40.1 2.6 2.8 2.3 3.7 44.4 51.1 769
Province Bulawayo 34.7 5.2 0.0 24.7 0.0 38.2 60.2 62
Manicaland 46.1 .4 3.7 2.6 6.8 49.5 44.3 218
Mashonaland Central 58.4 1.3 1.3 4.9 2.8 60.6 36.5 101
Mashonaland East 52.1 1.4 1.1 .5 3.1 54.6 42.3 160
Mashonaland West 35.7 2.5 3.8 2.7 2.0 41.1 55.3 223
Matabeleland North 48.2 0.0 3.2 4.9 4.9 51.4 43.8 97
Matabeleland South 30.4 0.0 2.3 0.0 7.9 31.5 60.6 94
Midlands 35.4 3.5 4.0 1.1 4.9 41.9 52.8 199
Masvingo 31.0 1.4 3.4 .9 2.6 35.8 60.6 231
Harare 35.0 10.5 0.0 0.0 2.5 41.9 52.4 144
Area Urban 36.2 6.6 .2 4.2 1.7 40.4 55.9 362
Rural 41.2 1.2 3.4 2.3 4.5 45.5 49.6 1167
Age 0-11 41.2 1.8 3.7 2.7 3.9 45.5 49.7 259
12-23 43.1 2.9 3.9 3.6 3.8 49.0 46.1 501
24-35 43.2 2.7 1.8 1.8 3.7 46.8 49.2 358
36-47 33.6 2.8 1.4 2.5 4.0 36.5 58.0 251
48-59 31.5 1.5 1.3 2.5 3.9 34.3 62.5 161
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Annex
TABLE A: Care-seeking during diarrhoea Percentage of children age 0-59 months with diarrhoea in the last two weeks for whom advice or treatment was sought, by source of advice or treatment, Zimbabwe, 2014
Mother's education None 28.8 0.0 4.6 .8 10.0 33.4 54.3 48
Primary 39.6 .9 2.1 2.2 5.2 42.4 52.3 614
Secondary 41.7 3.0 3.0 3.2 2.7 46.5 49.9 829
Higher 23.2 20.3 2.2 2.9 0.0 41.6 56.1 38
Missing/DK 0
Religion of household Roman 37.8 5.3 6.4 4.3 1.3 47.2 50.0 86 head Catholic
Protestant 48.3 2.5 1.7 2.1 .8 52.1 46.8 189
Pentecostal 36.0 4.1 3.0 3.1 3.8 41.7 52.8 191
Apostolic Sect 37.0 2.2 2.1 2.8 6.2 40.7 52.7 587
Other Christian 30.4 6.3 1.2 .5 .7 36.9 61.4 92
Islam 24.0 0.0 0.0 0.0 7.8 24.0 68.2 8
Traditional 47.9 0.0 4.3 5.0 7.5 51.5 41.7 95
Other Religion/ 45.0 .9 3.2 2.5 1.4 48.1 49.2 281 No Religion
Missing/DK 0
Wealth index Poorest 36.4 0.0 4.1 3.2 5.9 40.2 53.1 350 quintile
Second 42.0 .3 2.3 1.9 5.1 44.5 50.9 338
Middle 41.8 2.1 4.7 1.7 2.9 48.1 48.8 272
Fourth 44.0 4.8 1.2 3.2 2.8 48.5 47.3 390
Richest 32.1 7.2 .7 3.9 1.0 37.3 59.4 180
[1] MICS indicator 3.10 - Care-seeking for diarrhoea [a] Community health providers includes both public (Village/City health worker and Mobile/Outreach clinic) and private (Mobile clinic) health facilities [b] Includes all public and private health facilities and providers, but excludes private pharmacy
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Annex
TABLE B: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Zimbabwe, 2014 Median duration (in months) of Number Exclusive Predominant of children Any breast- breast- breast- age feeding [1] feeding feeding 0-35 months
Median 17.7 2.0 3.8 5859 Sex Male 17.8 2.0 3.5 2936 Female 17.7 2.0 4.0 2924 Province Bulawayo 16.7 2.1 2.8 410 Manicaland 17.7 1.7 4.5 779 Mashonaland Central 19.3 .7 3.9 330 Mashonaland East 18.9 1.3 3.1 655 Mashonaland West 17.6 1.7 3.3 773 Matabeleland North 19.3 3.2 4.3 535 Matabeleland South 16.2 3.1 4.4 452 Midlands 16.9 2.4 4.4 700 Masvingo 18.1 2.1 2.8 663 Harare 17.0 2.1 3.8 561 Area Urban 16.9 2.2 3.6 1627 Rural 18.1 1.9 3.8 4232 Mother's education None 17.1 .5 4.7 139 Primary 18.4 1.6 3.9 1995 Secondary 17.5 2.2 3.8 3426 Higher 16.6 1.6 3.1 298 Religion Roman Catholic 16.5 2.2 3.2 414 Protestant 16.9 1.8 4.0 800 Pentecostal 17.1 2.3 3.5 783 Apostolic Sect 18.0 1.6 3.6 2152 Other Christian 17.8 2.8 4.5 336 Islam 17.4 2.2 5.1 31 Traditional 18.2 2.3 4.9 312 Other Religion 18.1 2.2 3.9 1030 No Religion /Missing/DK 2 Wealth index quintile Poorest 18.9 2.2 4.2 1256 Second 18.0 1.7 3.7 1205 Middle 17.2 1.5 4.0 1040 Fourth 17.4 2.1 3.6 1353 Richest 17.2 2.2 3.5 1006 Mean 17.7 2.6 4.4 5859
[1] MICS indicator 2.11 - Duration of breastfeeding
34 Extended Analysis of MICS 2014: Religion Religion_FINAL_Layout 1 05/07/2016 12:02 PM Page 35
Annex of 883 780 878 600 538 1119 1195 9550 1272 1045 4748 4802 1240 age 5 under Number children .0 .0 .1 .1 .0 .0 .1 -.1 -.2 -.1 -.1 -.3 -.1 (SD) Mean Z-Score [7] 3.6 3.6 3.5 4.2 2.1 3.4 4.9 1.8 3.3 3.3 5.2 2.4 4.9 Over- above + 2 SD weight Percent .5 .9 .7 .9 .6 .3 .7 .4 .8 .3 [6] 1.1 1.2 1.0 - 3 SD Weight for height Weight Wasted [5] 3.3 2.9 2.6 2.8 3.6 3.6 3.8 3.9 3.7 2.8 3.7 3.8 2.1 Percent below - 2 SD of 537 887 779 598 879 1196 1121 1046 9558 4753 4805 1275 1239 age 5 under Number children -1.3 -1.3 -1.4 -1.1 -1.5 -1.3 -1.4 -1.2 -1.6 -1.3 -1.4 -1.4 -1.1 (SD) Mean Z-Score [4] 7.8 8.2 8.8 9.7 6.5 8.8 7.0 7.6 7.9 7.3 5.8 4.1 10.0 - 3 SD Height for age Stunted [3] 25.8 26.9 27.6 31.1 20.0 34.0 31.8 25.7 28.0 30.1 24.1 29.4 21.0 Percent below - 2 SD of 896 539 780 601 883 1198 1124 1277 1049 9591 4771 4820 1243 age 5 under Number children -.8 -.8 -.8 -.5 -.8 -.7 -.6 -.9 -.9 -.8 -.7 -.7 -1.0 (SD) Mean Z-Score .7 [2] 2.2 2.0 1.5 2.9 2.1 2.5 2.7 2.1 2.1 2.8 2.5 2.4 - 3 SD Weight for age Weight [1] 9.8 7.0 9.6 Under-weight 11.7 11.1 11.2 11.4 12.5 10.8 13.0 12.5 13.9 10.9 Percent below - 2 SD Bulawayo Male Female Manicaland Mashonaland Central Mashonaland West Masvingo Harare Mashonaland East Matabeleland North Matabeleland South Midlands Nutritional status of children TABLE C: C: TABLE Sex Total Province Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for height,Zimbabwe, 2014
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Annex 1 828 923 932 313 431 674 1004 2068 3462 5344 1316 1243 3509 2535 7015 1987 1807 .1 .0 .2 .0 .0 .2 .0 .0 .1 -.1 -.1 -.2 -.1 -.2 -.2 -.1 -.1 1.6 3.6 1.1 5.6 0.0 4.0 3.4 9.4 3.6 2.3 1.7 3.6 3.2 3.9 3.5 3.4 4.5 3.6 3.4 .9 .7 .7 .6 .6 .8 .3 .9 .8 .7 .9 .5 .4 .3 2.0 0.0 1.2 1.6 3.5 0.0 3.2 2.9 2.4 3.6 2.5 4.9 5.3 6.4 4.3 1.8 1.8 2.6 4.5 3.4 3.2 1.8 1 846 930 308 677 922 432 2537 1006 1983 1806 3461 1321 1244 3505 7021 2064 5355 -.8 -.5 -.7 -.8 -1.2 -1.4 -1.2 -1.7 -1.7 -1.5 -1.6 -1.2 -1.1 -1.4 -1.1 -1.2 -1.5 -1.3 6.3 8.7 5.8 7.9 0.0 4.8 5.4 9.3 5.2 5.7 4.7 1.8 5.4 4.4 11.0 13.1 13.8 10.3 0.0 23.1 22.8 21.9 30.4 30.4 14.1 15.8 39.0 28.4 22.0 33.5 13.9 20.0 25.2 38.6 30.9 24.7 1 308 853 926 935 434 678 2545 1006 1989 1810 3477 1322 1249 3525 7047 2072 5371 .9 -.9 -.4 -.7 -.8 -.9 -.9 -.9 -.3 -.6 -.7 -.6 -.9 -.5 -.5 -.9 -.7 -1.0 .3 2.0 0.0 3.0 1.5 5.3 1.9 1.2 2.5 2.3 2.8 3.7 1.4 2.7 1.8 1.3 2.4 2.6 9.5 7.2 7.8 5.4 0.0 8.3 6.8 9.9 8.2 11.0 12.7 14.7 10.9 12.8 13.4 10.8 15.2 14.0 36-47 None 0-5 24-35 Higher Urban Rural 6-11 12-17 18-23 48-59 Primary Secondary Pentecostal Apostolic Sect Missing/DK Roman Catholic Protestant Nutritional status of children TABLE C: C: TABLE Age Area Mother's education Religion of household head Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for height,Zimbabwe, 2014
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Annex 3 47 541 526 2113 1691 2028 1751 2095 1563 .0 .1 .0 .0 .0 -.1 -.1 -.7 -.2 -.1 4.5 3.8 3.4 0.0 5.9 3.7 3.4 4.8 2.7 3.5 .3 .9 .3 .5 .5 .5 .7 0.0 0.0 1.3 4.1 3.2 3.4 0.0 2.0 3.2 4.5 3.2 2.6 3.6 3 46 524 541 1563 1697 2027 1750 2095 2123 .0 -.9 -1.5 -1.3 -1.4 -1.4 -1.5 -1.5 -1.4 -1.3 6.1 8.4 9.5 0.0 7.1 7.9 8.6 7.5 3.1 11.3 [4] MICS indicator 2.2b - Stunting prevalence (severe) [5] prevalence (moderate and severe) MICS indicator 2.3a - Wasting [6] prevalence (severe) MICS indicator 2.3b - Wasting [7] MICS indicator 2.4 - Overweight prevalence 0.0 42.0 30.6 30.5 33.4 31.3 15.0 28.3 27.0 27.2 3 46 542 528 1697 1755 1568 2133 2036 2100 -.7 -.9 -.9 -.6 -.9 -.7 -.4 -.9 -.9 -.8 .7 1.2 0.0 2.5 2.7 0.0 2.1 3.2 2.2 2.3 8.2 0.0 4.4 11.2 10.5 15.2 12.7 18.2 15.4 13.6 Other Christian Fourth Islam Traditional Other Religion/ No Religion Missing/DK Middle Richest Poorest Second Nutritional status of children and severe) TABLE C: C: TABLE Wealth index Wealth quintile Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for height,Zimbabwe, 2014 [1] MICS indicator 2.1a and MDG 1.8 - Underweight prevalence (moderate [2] MICS indicator 2.1b - Underweight prevalence (severe) [3] MICS indicator 2.2a - Stunting prevalence (moderate and severe)
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