Survey shows ‘high fertility and youth’ in Gambians

“More than 60 percent of the interviewed men and women are younger than age 30, and only 6 percent of them are in the age 45 – 49 group”.

It was the first demographic and health survey conducted in The Gambia, and was carried out by the Gambia Bureau of Statistics (GBoS) and the ministry of Health and Social Welfare in Banjul.

The survey was funded by the Gambia government and its partners including USAID, UNFPA, UNDP), UNICEF, UNAIDS, and the Global Fund.

The main objective of this survey was to provide comprehensive data on fertility and mortality, family planning, and maternal and child health and nutrition, as well as information on maternal mortality and domestic violence. The survey also provides data on household-based measurements of malaria and HIV prevalence.

A total of 6,217 households, 10,233 women age 15-49 and 3,821 men age 15-59 were interviewed, between February and April 2013.

Regarding the characteristics of the respondents, the report said the vast majority of respondents were Muslims (96 percent); and the largest ethnic groups were Mandinka/Jahanka, representing one-third of the population, and the Fula/Tukulur/ Lorobo, representing slightly more than 20 percent of the population. Twenty-nine percent of the women and 61 percent of the men were single and, conversely, 66 percent of women and 38 percent of men were married.

“It is hoped that the 2013 GDHS data will meet its objectives of facilitating important government policies and programs, promoting maternal and child health, and preventing the spread of infectious diseases”, said the country’s Statistician General, Nyakassi Sanyang, in the preface to the report.

Fertility

According to the report, the data collected were used to calculate age-specific fertility rates and the total fertility rate (TFR), two of the most commonly used measures of current fertility.

The TFR is a summary measurement of fertility and can be interpreted as the average number of children women of reproductive age would bear in their lifetime, if the current age-specific fertility rates were to remain unchanged.

The TFR for the three-year period before the survey was 5.6 for the country as a whole, 6.8 in rural areas, and 4.7 in urban areas. This means that the TFR in rural areas is two children higher than in urban areas.

Current Use of Family Planning

Contraceptive prevalence in The Gambia is very low, with only 9 percent of currently married women using a contraceptive method of any kind, and 8 percent use a modern method. The prevalence of modern contraceptive method use in urban areas is three times higher than in rural areas (12 percent versus 4 percent, respectively).

Women with secondary or higher education are more likely to use a modern contraceptive method: 15 percent of them use a modern method compared with 6 percent of women with less education.

The most commonly used methods are Depo-Provera injections, favored by 4 percent of married women, and contraceptive pills, used by 2 percent of married women. Less than 1 percent use long-term methods, such as an IUD or implant. One percent uses a traditional method, including withdrawal, periodic abstinence, or some folkloric traditional method.

Mortality

Compared with other countries in the sub-Saharan region, childhood mortality is relatively low in The Gambia. Under-5 mortality for the period 0-4 years before the survey, which corresponds approximately to the calendar years 2009-2013, is 54 deaths per 1,000 births.

Following the usual pattern, most of the early childhood mortality occurs in the first year of life; the infant mortality is 34 deaths per 1,000 births, while mortality between the first and the fifth birthday is 20 deaths per 1,000.

As expected, neonatal mortality (mortality during the first month) is higher than post-neonatal mortality (22 deaths per 1,000 compared with 12 deaths per 1,000), representing 65 percent of the overall infant mortality.

Mortality shows a downward trend. Infant mortality decreased from 50 deaths per 1,000 births in the 10 – 14 years before the survey (1999 – 2003) to 46 in the 5 – 9 years before the survey (2004 – 2008) and 34 in the 0 – 4 years before the survey (2009 -2013). According to the report, in The Gambia the large majority of women receive antenatal care from a skilled provider, and 86 percent of women received antenatal care from a skilled health professional, that is, a doctor, nurse, or midwife, during the pregnancy for their most recent birth in the five years preceding the survey.

Antenatal coverage varies little by mother’s characteristics, and even among women with no education 84 percent received antenatal care. Among rural women the proportion is 85 percent.

Immunization and child health

Regarding vaccination information for children age 12-23 months, the age by which it is expected they should have received all vaccinations. Mothers were able to show the interviewer a health card for 90 percent of children.

According to the health cards and mothers’ reports, 76 percent of children age 12-23 months have received all of the recommended vaccinations in The Gambia.

Children in rural areas and children of mothers with little or no education are more likely to be malnourished. Thus, 29 percent of children in rural areas are short for their age compared with 19 percent of children in urban areas. Similarly, 15 percent of children whose mothers reach secondary or higher education are short for their age, compared with 30 percent of children whose mothers attended primary school and 27 percent of children whose mothers never attended school.

Anemia

Nutritional anemia includes anemia due to deficiency in iron plus deficiencies in folate, vitamins B, and B12, and certain trace elements involved with red blood cell production. About half of the global burden of anemia is due to iron deficiency.

Iron deficiency, in turn, is largely due to an inadequate dietary intake of bioavailable iron, especially during periods of increased iron requirements, such as pregnancy and infancy, and increased blood loss due to hookworm infestation and infections such as malaria.

Anemia in children is associated with impaired mental and physical development and with increased morbidity and mortality. Anemia can be a particularly serious problem for pregnant women, leading to premature delivery and low birth weight.

Anemia is very common among children and women in The Gambia. Almost three-quarters of children age 6 – 59 months were found to be anemic; 26 percent had mild anemia, 43 percent had moderate anemia, and 4 percent had severe anemia.

Among women, the prevalence of anemia is also high. Sixty percent of women suffer some form of anemia, 41 percent suffer from mild anemia, 17 percent have moderate anemia, and 2 percent have severe anemia.

Anemia in all its forms is significantly more common in rural areas than in urban areas, and consequently, prevalence is lower in Banjul and Kanifing, the main urban areas of the country.

Malaria prevalence

In general, malaria prevalence was found to be very low in The Gambia. Only 1 percent of the children tested by microscopy were found to be positive for malaria…One reason for the observed low prevalence is that the 2013 GDHS survey was conducted between February and April, during the dry season. Malaria in The Gambia is known to be highly seasonal, with transmission occurring as Anopheles gambiae populations expand during and immediately after a single annual rainy season that usually lasts from June to October.

Knowledge of HIV/AIDS

The 2013 GDHS included a series of questions that inquired about men’s and women’s knowledge of AIDS and their awareness of modes of transmission of the human immunodeficiency virus (HIV) that causes AIDS.

The results show that almost all Gambians know about HIV. Even among people with no education and among those living in rural areas, more than 95 percent of respondents, men and women alike, have heard of this disease.

Awareness of ways to prevent HIV/AIDS

Overall, the use of condoms as a way of avoiding HIV infection is more widely recognized by men than by women (78 percent compared with 71 percent), while limiting sexual intercourse to one uninfected sexual partner is equally recognized by about 86 percent of men and women alike.

More than two-thirds are aware that using condoms and limiting sex to one uninfected partner reduces the risk of contracting AIDS.