Albania - Multiple Indicator Cluster Survey - 2000

Publication date: 2000

1 0XOWLSOH�,QGLFDWRU�&OXVWHU�6XUYH\�5HSRUW $OEDQLD 'HFHPEHU �� ���� 81,&() ² $OEDQLD ,PSOHPHQWLQJ ,QVWLWXWLRQ� 1DWLRQDO ,QVWLWXWH RI 6WDWLVWLFV 3DUWQHUV� &RPPLWWHH RQ :RPHQ DQG )DPLO\ ,QVWLWXWH RI 3XEOLF +HDOWK )DFXOW\ RI 6RFLDO 6FLHQFHV 2 Contents List of Figures 4 Foreword and Acknowledgements 5 Executive Summary 6 Summary Indicators 10 I. Introduction 12 Background of the Survey 12 Albanian Background 12 Survey Objectives 15 II. Survey Methodology 16 Sample Design 16 Questionnaires 16 Fieldwork and Processing 16 III. Sample Characteristics and Data Quality 18 Response Rates 18 Age Distribution and Missing Data 18 Characteristics of the Household Population 19 IV. Results 20 A. Infant and Under-Five Mortality 20 B. Education 21 Early Childhood Education 21 Basic Education 21 Literacy 21 C. Water and Sanitation 22 Use of Drinking Water 22 Use of Sanitation 22 D. Child Malnutrition 22 Nutritional Status 22 Breastfeeding 23 Salt Iodization 25 Vitamin A Supplementation 25 Low Birth Weight 26 E. Child Health 26 Immunization Coverage 26 Diarrhea 27 Acute Respiratory Infection 28 IMCI Initiative 28 F. HIV/AIDS 29 AIDS Knowledge 29 AIDS testing 30 G. Reproductive Health 31 Contraception 31 Prenatal Care 31 Assistance at Delivery 32 H. Child Rights 33 Birth Registration 33 3 Orphaned children and living arrangements of Children 33 Child Labor 33 Appendix A: Sample Tables 35 4 List of Figures Figure 1: Single year age distribution of household populations by sex, Albania 2000 Figure 2: Infant mortality rate based on other sources Figure 3: Percentage of children of primary school age attending primary school, Albania 2000 Figure 4: Percent distribution of living children by breastfeeding status, Albania 2000 Figure 5 : Percentage of children aged 12-23 months who received immunizations by age 12 months, Albania 2000 Figure 6 : Percentage of women aged 15-49 who have sufficient knowledge of HIV/AIDS transmission by level of education Albania 2000 Figure 7 : Percent distribution of women who have given a birth in the last year by type of personnel delivering antenatal care, Albania 2000 5 Acknowledgements Thanks to the team of experts who successfully implemented the survey. Prof. Dr. Dhimiter Tole, the director of Informatics / Methodology Department in National Institute of Statistics designed the sample. Mrs. Vojsava Progri managed the work in the field. Together they lead the team which worked on data processing and analysis. Mrs. Lavdije Ruci, the chairwomen of the National Committee of Woman and Family, M.D.Ph.D Silva Bino, the Director of Institute of Public Health, Prof. Dr.Ylli Pango, the Dean of Faculty of Social Sciences and Prof.As.Dr. Aleksander Kocani of the Faculty of Social Sciences, contributed to questionnaire design, supervision of survey implementation, data analysis and drafting conclusions. Special thanks to Mrs. Milva Ekonomi, the General Director of National Institute of Statistics in Tirana; who was the overall manager of the survey. She provided the necessary technical assistance and quality control, together with her staff. She provided facilities and equipment, mobilizing human resources of the central and local levels. Finally, thanks for the support provided by Mrs. Arlinda Ymeraj, Evaluation, Planning and Monitoring officer, who coordinated the project implementation and Mr. Dale Rutstein, Communication Officer in UNICEF-Tirana office, who assisted in editing the final text of the report. 6 Executive Summary The 2000 Albania Multiple Indicator Cluster Survey (MICS) is a nationally representative survey of households, women, and children. The main objectives of the survey are to provide information for assessing the situation of children and women in Albania at the end of the decade, to furnish data needed for monitoring progress toward goals established at the World Summit for Children and, finally, as a basis for future action. Infant and Under Five Mortality • Infant and under five mortality rate estimates were obtained using the United Nations QFIVE program. The information for calculating these ratios was provided by a MICS survey carried out between June and July of 2000. The infant mortality rate calculated from these results is 28 per 1000 live births. The under five rate is 33 per 1000. Education • Overall ninety percent of children of primary school age in Albania are attending primary school. In urban areas, 91 percent of children attend school while in rural areas 90 percent attend. • 82 percent of children who enter the first grade of primary school reach grade five. • The vast majority (88 percent) of the population over 15 years of age is literate. The percentage of literacy declines to 93 percent among those aged 15-34 and to 65 percent among the population aged 65 and older. Water and Sanitation • More than 45 percent of the population uses drinking water piped into their dwellings. Twenty percent uses water piped into a yard or plot, and 16.4 percent uses water from a public tap. However, it should be mentioned that these data most likely do not estimate the real access of the population to drinking water due to poor infrastructure and the lack of water. Child Malnutrition • Four percent of children under age five in Albania are underweight or too thin for their age. Seventeen percent of children are stunted and 4 percent are wasted. • Children whose mothers have secondary or higher education are least likely to be underweight and stunted compared to children of mothers with less education. Breastfeeding • Approximately 9 percent of children aged under four months are exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 24 percent of children are receiving breast milk and solid or semi-solid foods. By age 20-23 months, only 6 percent continue to breastfeed. 7 Salt Iodization • Seventy six percent of households in Albania have adequately iodized salt. The percentage of households with adequately iodized salt ranges from 70.9 percent in urban areas to 47.8 percent in the rural areas. Vitamin A Supplementation • During the six months prior to the MICS survey, 7.4 percent of children aged 6-59 months had received a high dose of Vitamin A supplement. Approximately 5 percent did not receive a supplement in the last 6 months, but did receive one prior to that time. • A mother’s level of education effects the likelihood of Vitamin A supplementation. The percentage receiving a supplement in the last six months increases from 6.5 percent among children whose mothers have primary education to 11 percent among children of mothers with higher education. • Only about 3 percent of mothers who had given birth in the year preceding the MICS survey received a Vitamin A supplement within eight weeks of giving birth Low Birth weight • Approximately 3 percent of infants are estimated to weigh less than 2500 grams at birth. The prevalence of low birth weight does not vary much between urban and rural areas or by the mother’s education. Immunization Coverage • Information on immunization coverage provided by the MICS survey is based on vaccination cards that mothers possess. However, this information might not be periodically updated, due to the fact that many immunization campaigns are carried out during emergencies or mothers are not provided with vaccination cards. Eighty percent of children aged 12 – 23 months received a BCG vaccination and 71 percent were given the first dose of DPT by the age of 12 months. The percentage declines for subsequent doses of DPT to 61 percent for the second dose, and 52 percent for the third dose. Similarly, 57.3 percent of children received the first dose of polio vaccine by age 12 months. This declines to 28.7 percent by the third dose. The coverage for measles vaccine by 12 months is at 61 percent. Male and female children are vaccinated at roughly the same rate. Vaccination coverage is highest among children whose mothers have secondary or higher education. Diarrhea • Approximately 94 percent of children with diarrhea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF). • Only 48.2 percent of children with diarrhea received increased fluids and continued eating as recommended. Acute Respiratory Infection 8 • Acute lower respiratory infections, particularly pneumonia, are among the leading causes of child mortality in Albania. 83 percent of children with ARI were taken to an appropriate health provider. IMCI Initiative • Among children under five who were reported to have had diarrhea or some other illness in the two weeks preceding the MICS survey, 47 percent received increased fluids and continued feeding as recommended under the IMCI program. • In rural areas, mothers especially those with low education recognized at least two of the signs that a child should be taken immediately to a health facility. Malaria According to official data there are no malaria cases reported in Albania. HIV/AIDS • 25 percent of women aged 15-49 know all three of the main ways to prevent HIV transmission. Fifty five percent believe that having only one uninfected sex partner can prevent HIV transmission. Fourty two percent believe that using a condom every time, and abstaining from sex can prevent HIV transmission. Less than two percent of women correctly stated that AIDS couldn’t be transmitted by supernatural means, whereas 12.6 percent stated that AIDS couldn’t be spread by mosquito bites. More than 40 percent of women correctly believe that a healthy looking person can be infected. • Twenty three percent of women of reproductive age in Albania know where to get tested for AIDS. According to MICS results, only 0.7 percent of women have been tested for AIDS. Contraception • Current use of contraception was reported by 58 percent of married or in union women. The most popular method is withdrawal, which is used by 33 percent of married women. Prenatal Care • Thirty percent of women who had recently given birth in Albania are protected against neonatal tetanus. The vast majority of these women had received two doses of tetanus toxoid within the last three years. • Virtually all women in Albania receive some type of prenatal care and 95 percent receive antenatal care from skilled personnel (doctor, nurse or midwife). Assistance at Delivery • In the year prior to MICS, 57 percent of births were assisted by doctors, 37 percent by nurses and one in ten deliveries were assisted by a midwife. Less than one percent of deliveries did not have any assistance in the year prior to MICS survey. Birth Registration 9 • The births of 99 percent of children under five years in Albania have been registered. There are no significant variations in birth registration across sex, age, or education categories. Orphans and Living Arrangements of Children • In Albania, 96.5 percent of children aged 0 – 14 are living with both parents. A very small percentage of children aged 0 – 14 years old have one or both parents dead, 0.2 percent are not living with a biological parent. Child Labor • In Albania, MICS estimates that less than one percent of children aged 5 – 14 years old engage in paid work. About 3 percent participate in unpaid work for someone other than a household member. Variations across urban and rural areas are greatest in the percentage of children who engage in less than four hours of domestic work a day. This percentage ranges from 49 percent in urban areas to 60 percent in rural areas. Summary Indicators World Summit for Children Indicators Under-five mortality rate Probability of dying before reaching age five 33 per 1000 Infant mortality rate Probability of dying before reaching age one 28 per 1000 Underweight prevalence Proportion of under-fives who are too thin for their age 4 percent Stunting prevalence Proportion of under-fives who are too short for their age 17 percent Wasting prevalence Proportion of under fives who are too thin for their height 3.6 percent Use of safe drinking water Proportion of population who use a safe drinking water source 97 percent Use of sanitary means of excreta disposal Proportion of population who use a sanitary means of excreta disposal 90 percent Children reaching grade five Proportion of children entering first grade of primary school who eventually reach grade five 82 percent Net primary school attendance rate Proportion of children of primary school age attending primary school 90 percent Literacy rate Proportion of population aged 15+ years who are able to read a letter or newspaper 88 percent Antenatal care Proportion of women aged 15-49 attended at least once during pregnancy by skilled personnel 95 percent Contraceptive prevalence Proportion of married women aged 15-49 who are using a contraceptive method 58 percent Childbirth care Proportion of births attended by skilled health personnel 95 percent Birth weight below 2.5 kg. Proportion of live births that weigh below 2500 grams 3 percent Iodized salt consumption Proportion of households consuming adequately iodized salt 56 percent Children receiving Vitamin A supplementation Proportion of children aged 6-59 months who have received a Vitamin A supplement in the last 6 months 7 percent Mothers receiving Vitamin A supplementation Proportion of mothers who received a Vitamin A supplement before infant was 8 weeks old 2.6 percent Exclusive breastfeeding rate Proportion of infants aged less than 4 months who are exclusively breastfed 9 percent Timely complementary feeding rate Proportion of infants aged 6-9 months who are receiving breast milk and complementary food 24 percent Continued breastfeeding rate Proportion of children aged 12-15 months and 20-23 months who are breastfeeding 65 percent (12-15) 6 percent (20-23) DPT immunization coverage Proportion of children immunized against diptheria, pertussis and tetanus by age one DPT1 71 percent Measles immunization coverage Proportion of children immunized against measles by age one 61 percent Polio immunization coverage Proportion of children immunized against polio 1 by age one 57 percent Tuberculosis immunization coverage Proportion of children immunized against tuberculosis by age one 80 percent Children protected against neonatal tetanus Proportion of one year old children protected against neonatal tetanus through immunization of their mother 30 percent ORT use Proportion of under-five children who had diarrhea in the last 2 weeks who were treated with 35 percent 11 oral dehydration salts or an appropriate household solution Home management of diarrhea Proportion of under-five children who had diarrhea in the last 2 weeks and received increased fluids and continued feeding during the episode 48 percent Care seeking for acute respiratory infections Proportion of under-five children who had ARI in the last 2 weeks and were taken to an appropriate health provider 83 percent Preschool development Proportion of children aged 36-59 months who are attending some form of organized early childhood education program 26 percent Indicators for Monitoring Children’s Rights Birth registration Proportion of under-five children whose births are reported registered 99 percent Children’s living arrangements Proportion of children aged 0-14 years in households not living with a biological parent 0.2 percent Orphans in household Proportion of children aged 0-14 years who are orphans living in households 0.1 percent (both parents) 1.2 percent (one parent) Child labor Proportion of children aged 5-14 years who are currently working 32 percent Indicators for Monitoring IMCI and Malaria Home management of illness Proportion of under-five children reported ill during the last 2 weeks who received increased fluids and continued feeding 47 percent Care seeking knowledge Proportion of caretakers of under-five children who know at least 2 signs for seeking care immediately 86 percent Bednets Proportion of under-five children who sleep under an insecticide impregnated bednet Malaria treatment Proportion of under five children who were ill with fever in the last 2 weeks who received anti- malarial drugs Indicators for Monitoring HIV/AIDS Knowledge of preventing HIV/AIDS Proportion of women who correctly state the 3 main ways of avoiding HIV infection 25 percent Knowledge of misconceptions of HIV/AIDS Proportion of women who correctly identify 3 misconceptions about HIV/AIDS 0.2 percent Knowledge of mother to child transmission Proportion of women who correctly identify means of transmission of HIV from mother to child 64 percent Attitude to people with HIV//AIDS Proportion of women expressing a discriminatory attitude towards people with HIV/AIDS 76 percent Women who know where to be tested for HIV Proportion of women who know where to get a HIV test 23 percent Women who have been tested for HIV Proportion of women who have been tested for HIV 0.7 percent I. Introduction Background of the Survey Albania ratified the Convention on the Rights of Children in February 1992, but as yet no country report on its implementation has been prepared. However, the Government of Albania is working on the compilation of a National Strategy for Children based on the four principles of the CRC. This strategy will be followed by a “Plan of Action” for Children. By the UN General Assembly Special Session on Children, to be held in New York in 2001, Albania will have its National Program on Children with goals and objectives set for five years (2001-2005). A great assistance in understanding the situation of children and a base for the preparation of the initial and second report of CRC is the 2000 Multiple Indicator Cluster Survey (MICS)-Albania. MICS Albania was conducted in order to provide end of decade information on a number of critical indicators. There are 75 indicators of specific aspects on the situation of children and women. The 2000 MICS Albania was lead by the UNICEF- Tirana office, providing funds and creating a working group made up of representatives from different professional governmental and scientific institutions. The members of this group were drawn from the Central Office of Statistics, Public Health Institute, State Committee on Women and Family and researchers of the Faculty of Social Sciences. Albania’s Background Geographical and Socio-political data Albania is located in the southwestern part of the Balkan Peninsula. It has a total area of 28,748 km2 ; 34.8 percent comprises forests, 15 percent pastures, 24.3 percent arable land and 4 percent lakes. Its land area is mainly mountainous, with an average altitude of 714 m above sea level, which is double the European one. The Albanian state border line is 1094 km long, out of which 529 km is the border with the Former Republic of Yugoslavia (north and northeast) and 271 km is that with Greece (south and southeast). The coastal line is 476 km long. Since 1990, the country has undergone significant social and political changes and is currently going through a delicate transition towards a market economy and democratic governance. This period has been brutally suspended twice. First in 1991-1992 due to the social turmoil and then in 1999, due to the war in Kosovo. Albania has a current GDP of 810USD per capita (World Bank Report, 1999), which ranks it as the country with the lowest income per capita in Europe. Out of the total population, 30 percent living in rural areas and 15 percent in urban areas are considered poor. Since the breakdown brought about by the collapse of the pyramid schemes in 1996-1997, Albania’s percentage of people living in poverty has increased. The problems that have arisen during the transition period have greatly affected the capacity of the central government to provide basic education services. The rate of children who drop out of school is on the increase, which can be expected to result in an increase in illiteracy. Data 13 collected in the survey show that only 35 percent of the 14-18 year age group attended school in the period 1993-1995. As a result of a decade of economic decline, migration from rural areas has led to a weakening of village social structure and a rapid and uncontrolled rise of the urban population. This migration is exerting stress on the social and physical infrastructure all over the country. Health care and social services are facing an increase in demand for services together with a decrease in service capacity. This affects the quality of services currently offered (particularly in rural areas). Other infrastructure elements such as roads and transportation are also being adversely affected. A large number of international development agencies are operating in Albania and they have highlighted the need for an overall development program. This program aims at promotion and maintenance of sustainable economic development through promotion of democratic, institutional and legal reforms and the establishment of a free market system. The government has embarked on the implementation of an extensive program of institutional reforms, supported by a range of international agencies, but meaningful results remain to be seen. Privatization, foreign investment and trade are also being encouraged. With assistance from the World Bank, the Albanian government has designed programs that aim at a reduction of poverty in the country. Demographics The total population of Albania is 3.354,300. Compared to the rest of Europe, Albania has a younger population with an average age of 28.6 ranging as follows: 1/3 (33%) are below 15 years old, about 40 percent below 18 years and about half of the population (49%) are below 25 years. The annual average rate of the natural growth of population tends to decrease. This is indicated by the population census carried out over the period 1979 – 1989. Emigration has become a major factor since 1992. Statistics prove that more than half a million people have left the country. In 1996, 96 percent of emigrants were between the ages of 19-40. The uncontrolled shift of population brought significant changes to the overall rural/urban population ratio. In spite of the redistribution of land in rural areas, the lack of employment in the provinces led to poor management of resources that was worsened by land erosion, deforestation and pollution of underground water resources. This has impacted agriculture, which still remains Albania’s main economic activity. This vicious circle has led to an increase of migration towards bigger towns, especially the capital of the country. In 1989, according to the last population census, 35.7 percent of the population lived in urban areas. By 1997 the urban population had increased to 45 percent. In the Tirana region, population increased by 30% due to migration. According to calculations it is predicted that rural population growth will be negative (-0.3%), while the urban population will experience 3.8% growth, with an average growth rate of 10% in a 10-year period. Thus, in 2009, 55% of the population is expected to live in urban areas. In 1998, the birth rate was 17.6 per 1000 and the death rate 5.1 per 1000. Statistics prove that the death rate has been stable, except for the period of civil turmoil in 1997 when an above average number of young people died. The following table shows a gradual decrease in the number of live births in recent years. Fertility indicators have also decreased. 14 1994 1995 1996 1997 1998 Population in million 3.2 3.24 3.28 3.32 3.35 % of population 18 years 40.3 40.1 39.6 40 40.5 Birth/death rate 6.9 6.5 5.7 4.8 3.49 Live births per 1000 inhabs. 23.1 22.2 20.8 18.6 17.6 Death per 1000 inhabitants 5.5 5.6 5.7 5.5 5.1 The data brings to light the necessity of adjusting services in urban areas to a migrating population. In spite of the new social problems that a migrating population has brought such as drugs, prostitution, violence, we could hardly expect the overall picture of health care service to improve. Priority should be given to building up improvement of health care for the youngest age groups in the population, as a long-term social investment. Gender Issues in Albania Women in Albania comprise 51 percent of the population. Until recent years, a patriarchal type of family was dominant with 2-3 generations living together under the same roof and males occupying a preferential status over females. In 1990, when Albania opened up to the international community, emigration and migration from rural to urban areas were two of the factors that accelerated the breakdown of the patriarchal family. The education level of the population in general, and women of in particular, has significantly improved in the last several decades. But gender equality is a principle that is new to Albanian society and has not yet been embraced by a significant percentage of the population. However, significant changes have taken place with regard to family planning and sex education in Albania. Prior to 1999, family planning was a taboo subject due to the strict policies that the former regime followed with regard to birth rate. Results of surveys organized by the Institute of Pedagogical Research Studies with regard to inclusion of sex education in school programs, show that 86 percent of parents and 95 percent of teachers are in favor of it. In 1994, Albania was among the 183 countries that approved the Action Plan of the International Conference on Population and Development that took place in Cairo, Egypt. This plan places the health of women in the center of reproductive health services and calls upon health institutions to consider reproductive health issues a priority. However, a proper national policy on the health of women has not yet been developed. We should highlight that the number of NGO-s and other social institutions that focus on gender issues has increased. 1994 1995 1996 1997 1998 Population (in milion) 3.2 3.24 3.28 3.32 3.35 % of population <18 years 40.3 40.1 39.6 40 40.5 Rate births / death 6.9 6.5 5.7 4.8 3.49 Live births per1000 inhab 23.1 22.2 20.8 18.6 17.6 Deaths per 1000 inhab 5.5 5.6 5.7 5.5 5.1 Source : INSTAT, MOH 15 Survey Objectives The 2000 Albania Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Albania at the end of the decade in order to develop effective policies and strategies over the next decade; • To furnish data on the situation of children needed for the compilation of the initial and second CRC country reports; • To measure Albania’s performance vis a vis the 1990 World Summit for Children goals. • To provide analysis of the situation of children for inclusion in deliberations at the United Nations Special Session on children as a basis for future action. • To contribute to the improvement of data and monitoring systems in Albania and to strengthen technical expertise in design, implementation, and analysis of such systems. 16 II. Survey Methodology Sample Design The sample for MICS Albania was designed to provide estimates of various indicators at the national level, for urban and rural areas. The sample was selected in two stages. At the first stage, 376 primary Sampling Units (PSU) were systematically selected from 1665 PSU. At the second stage, households were selected systematically within each PSU. The total sample had 5182 households. Because the sample was stratified by urban and rural areas, it is not self-weighting. For reporting national level results, sample weights are used. Questionnaires The questionnaires for MICS Albania were based on the MICS Model Questionnaire with some modifications and additions. A household questionnaire was administered in each household, and collected various information on household members including sex, age, literacy, marital status, and orphaned children status. The household questionnaire also included education, child labor, water and sanitation and salt iodization modules. In addition to a household questionnaire, special questionnaires were administered in each household for women age 15-49 and children under age five. For children, the questionnaire was administered to the mother or caretaker of the child. The questionnaire for women contained the following modules: Child mortality Tetanus toxoid Maternal and newborn health Contraceptive use HIV/AIDS. The questionnaire for children under age five included modules on: Birth registration and early learning Vitamin A Vitamin D Breastfeeding Care of Illness Respiratory illness Immunization Anthropometry. From the MICS model English version, the questionnaires were translated into the Albanian language. The questionnaires were pre-tested during May 2000. Based on the results of the pretest, modifications were made to the wording and translation of the questionnaires. Fieldwork and Processing The field staff , 36 regional supervisors and also enumerators of Tirana city were trained for four days in early May 2000. All regional teams (36 districts) , collected the data; each team was comprised of a number of interviewers, and a supervisor. A demonstration of how to use the UNICEF equipment and salt iodization test was done on the last day. The MICS Coordinator provided overall supervision. The field work began in June 2000 and concluded in the first week of July 2000. The field work was organized according to a set timetable. Strong communication 17 was established among the enumerators, controllers, supervisors and the Coordinator during the survey. The team organized trips in various districts to provide information on how the enumerators and supervisors carried out their duties. Data was entered on four microcomputers using IMPS software. In order to ensure quality control, internal consistency checks were performed. Procedures and standard programs developed under MICS and adapted to the Albanian questionnaire were used throughout. Data processing began in July 2000 and finished in September 2000. 18 III. Sample Characteristics and Data Quality Response Rates Of the 5182 households selected for the Albania MICS sample, 4970 were found to be occupied (Table 1). Of these, 4821 were successfully interviewed for a household response rate of 97 percent. The response rate was higher in urban areas (98 percent) than in rural areas (95.7 percent). In the interviewed households, 5496 eligible women aged 15-49 were identified. Of these, 5456 were successfully interviewed, yielding a response rate of 99.3 percent. In addition, 1453 children under age five were listed in the household questionnaire. Of these, questionnaires were completed for 1452 children for a response rate of 99.9 percent. Age Distribution and Missing Data Figure 1 shows the single year age distribution of household members by sex. This distribution is almost the same for male and female. There appears to be gaps for both male and female in the 5 year old age group. Table 3 shows the percentage of cases missing information. Seven percent of household members have gaps in information on their level of education and years of schooling. Among female respondents, 7.7 percent did not report if they have been tested for HIV/AIDS. The data on weight and height are the most likely to be left out. Approximately 4 percent of children surveyed did not yield this information. This may be a result of the child not being present, refusal to comply with the questionnaires, or other reasons. By international standards, this percentage is relatively low in comparison to other surveys in which anthropometric measurements are taken. Figure 1. Single year age distribution of the household population by sex, Albania 2000 0 0.5 1 1.5 2 2.5 3 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Male Female 19 Characteristics of the Household Population Information on the characteristics of the household population and the survey respondents is provided to assist in the interpretation of the survey findings and to serve as a basic check on the sample implementation. Table 4 presents the percent distribution of households in the sample by background characteristics. About 40 percent of the households (1928 households) are urban and 60 percent (2893 households) are rural. Most of the households are composed of between two and five members. Twenty five percent of the households contain at least one child under age five and 82 percent contain at least one woman age 15-49. Table 5 shows the characteristics of female respondents aged 15-49. Women age 15-19 form the greatest percentage of the sample at around 20 percent. This percentage declines steadily across age groups until age 45-49 where it is nine percent. Approximately 67 percent of women in the sample are married and 82 percent have given birth. The majority of women have had at least some primary education. Table 6 shows the characteristics of children under age five. Fifty one percent of the children are male and 49 percent are female. Approximately 51 percent of mothers of children under age five have a primary education, while those with no education represent only 2,2 percent. Note that, for children whose mothers did not live in the household, the education of the child’s caretaker is measured. There are almost the same number of children aged under six months and aged 6-11 month; approximately 8 percent. 20 IV. Results A. Infant and Under-Five Mortality The infant mortality rate is based on the probability of an infant dying before its first birthday. The under five mortality rate is the probability of a child dying before its fifth birthday. In MICS, infant and under five mortality rates are calculated based on an indirect estimation technique (the Brass method). The data used in the estimation is: the mean number of all children born to five year age groups of women between age 15 and 49, the proportion of these children that have died, also for five year age groups of women. The technique converts these data into probabilities of death by taking account of both the mortality risks to which children are exposed to and their length of exposure to the risk of death. The data used for mortality estimation is shown in Table 7. Infant and under five mortality estimates were obtained using the United Nations QFIVE program The mean number of all children born rises from 0.03 among 15-19 year olds to 3.15 among 45-49 year olds as expected. However, the proportion of children who have died has an irregular pattern. In particular, the proportion of children dead among women aged 20 - 24 is low and the proportions among younger women appear to be too high. The infant mortality rate and under five mortality rate estimations for several years plotted in Figure 2 are based on other administrative sources. At the end of 1998 the infant mortality rate was 20 per 1000. According to official data of the Ministry of Health the main reasons for this high proportion are respiratory illness, congenital abnormality, diarrhea and other infections. The Ministry of Health periodically estimates the under five mortality rate for the age group 1 – 4 years old. In 1998 the under five mortality rate was 21 per 1000, which implies a reduction by half compared to the 1998 ratio. Source : MOH Figure 2. Infant mortality rate based on other sources 25 3028 2022 2122 29 33 40 0 5 10 15 20 25 30 35 40 45 1990 1995 1996 1997 1998 Infant mortality rate Under-five mortality rate 21 B. Education Universal access to basic education and the completion of primary education by the world’s children are two of the most important goals of the World Summit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labor, sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. Early childhood education Around 26 percent of children 36-59 months are attending an organized early childhood education program in urban areas while in rural areas only 13 percent attend. These are usually kindergartens or community childcare centers with organized learning activities (Table 9). Approximately equal percentages of girls and boys attend such programs. Relatively few children attend at age three (36-47 months) while the majority of children attend at age four (48-59 months). Finally, the education of the mother is strongly related to the likelihood that a child will attend an early childhood education program. The percentage of children attending increases from 12 percent to 42 percent as the mother’s education increases from primary to higher education. Basic education Overall, 90 percent of children of primary school age in Albania are attending primary school (Table 10). In urban areas, 91 percent of children attend school while in rural areas 90 percent attend. At the national level, there is virtually no difference between male and female primary school attendance. At the national level, 82 percent of children who enter the first grade of primary school eventually reach grade five. (Table 11) However, there are large urban-rural disparities in those children who complete grade five. Approximately 87 percent of urban children who enter grade one reach grade five compared to 77 percent of children in rural areas. Literacy 88 percent of the population over 15 years of age in Albania are literate (Table 12). The literate population includes those who are reported to read ‘easily or with difficulty’. Overall, females are slightly less likely than males to be literate (84.7 vs. 90.9 percent). There are some disparities in the literacy level between urban ( 93 percent) and rural areas ( 81 percent). Literacy declines with increasing age. The literate percentage declines from 93 percent among those aged 15-34 to 65 percent among the population aged 65 and older. Figure 3. Percentage of children of primary school age attending primary school, Albania 2000 91.4 90.3 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Urban Rural 22 C. Water and Sanitation Use of drinking water Safe drinking water is a basic necessity for good health and development. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water is important for women and children, particularly in rural areas as they bear the primary responsibility for carrying water, often for long distances. More than 45 percent of the population use drinking water piped into their dwelling, 20 percent use water piped into their yard or plot and 16.4 percent use water from a public tap. These are the main important sources of drinking water in Albania. Sources of drinking water for the population vary between urban and rural areas (Table 13). In urban areas, 90 percent of the population uses drinking water that is piped into their dwelling. In the rural areas the most important source of drinking water is piped into their yard (26.3 percent), from a public tap (25 percent) and piped into their dwelling (19.8 percent). The populations using safe drinking water sources are those that use any of the following types of supply: piped water, public tap, borehole/tubewell, protected well, protected spring or rainwater. Overall, 96.7 percent of the population has access to safe drinking water – 99.4 percent in urban areas and 95 percent in rural areas. However, it should be mentioned that this data does not estimate the real access of the population to drinking water due to rapidly deteriorating infrastructure and the failure of municipal systems to provide water. Use of sanitation The inadequate disposal of human excreta and poor personal hygiene is associated with a range of diseases including diarrheal diseases and polio. Sanitary means of excreta disposal include: flush toilets connected to sewage systems or septic tanks, other flush toilets, improved pit latrines, and traditional pit latrines. Ninety percent of the population of Albania is living in households with sanitary means of excreta disposal (Table 14). This percentage is 98.8 in urban areas and 84.5 percent in rural areas. More than 14 percent of the rural population uses an open pit as toilet facilities. D. Child Malnutrition Nutritional status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply and are not exposed to repeated illness, they reach their growth potential and are considered well nourished. In a well-nourished population, there is a standard distribution of height and weight for children under age five. Undernourishment in a population can be gauged by comparing children to this standard distribution. The standard or reference used here is the NCHS standard, which is recommended for use by UNICEF and the World Health Organization. Each of the three nutritional status indicators are expressed in standard deviation units (z-scores) from the median of this reference population. 23 Weight for age is a measure of both acute and chronic malnutrition. Children whose weight for age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight for age is more than three standard deviations below the median are classified as severely under weight. Height for age is a measure of linear growth. Children whose height for age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height for age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight for height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. The children who were not weighed (3.1 percent) and measured (4.9 percent) are excluded. In addition, a small number of children whose birth dates are not known were excluded. Table 15 shows the percentage of children under age five, who are severely or moderately undernourished. Almost one in seven children (14 percent) under age five in Albania is moderately underweight and 4.4 percent are classified as severely underweight. Almost one in three children (31.7 percent) under age five is moderately stunted and 17.3 percent are classified as severely stunted. One in nine children (11.1 percent) under age five is moderately undernourished and 3.6 percent are severely undernourished. There are slight differences among children underweight in rural and urban areas. Those whose mothers have secondary or higher education are least likely to be underweight and stunted, compared to children of mothers with less education. Boys appear more likely to be underweight, stunted and wasted than girls. The age pattern shows that a higher percentage of children aged 6 – 11 months are undernourished according to all three indices in comparison to children who are younger and older. Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon, and there are often pressures to switch to infant formula, which can contribute to growth faltering and micro nutrient malnutrition and is unsafe if clean water is not readily available. The World Summit for Children goal states that children should be exclusively breastfed for four to six months, that breastfeeding should be complemented with appropriate foods from the age of around six months, and that children continue to be breastfed for two or more years. In Table 16, breastfeeding status is based on women’s reports of children’s consumption in the 24 hours prior to the interview. Exclusive breastfeeding refers to children who receive only breast milk and vitamins, mineral supplements, or medicine. Complementary feeding refers to children who receive breast milk and solid or semi-solid food. The last two columns of the table include children who are continuing to be breastfed at one and at two years of age. Percentages according to region and mother’s education are not shown due to small sample sizes. For the same reason, the sex and urban-rural residence breakdowns should be interpreted with caution. 24 Approximately 9 percent of children aged less than four months are exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 24 percent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, 65 percent of children are still being breastfed and by age 20-23 months, 6 percent are still breastfed. Figure 3 shows the detailed pattern of breastfeeding status by the child’s age in months. The characteristic for Albania is that children continue to be breastfed over one year of age. Figure 4A: Percent distribution of living children by breastfeeding status, Albania, 2000 Figure 4B: Percent distribution of living children by breastfeeding status, Albania, 2000 0% 20% 40% 60% 80% 100% 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 Age in months Exclusively breastfed Breast milk and water only Breast milk and supplements Not breastfed 0% 20% 40% 60% 80% 100% 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 Age in months Exclusively breastfed Breast milk and water only Breast milk and liquids only Breast milk and solid/mushy food Not breastfed 25 Salt iodization Deficiency of iodine in the diet causes goiter, enlargement of the thyroid gland, and can cause brain damage before birth or during infancy or childhood. The iodization of salt is a low-cost way of preventing iodine deficiency disorders (IDD). In MICS, interviewers tested household salt for iodine levels by means of a testing kit. Adequately iodized salt contains 15 ppm (parts per million) of iodine or more. Approximately 98 percent of households had salt that was tested during MICS (Table 17). Among households in which salt was tested, 56 percent had adequately iodized salt. The percentage of households with adequately iodized salt ranges from 70.9 percent in the urban areas to 47.8 percent in the rural areas. Vitamin A supplementation Vitamin A deficiency (VAD) can cause eye damage and blindness in children. It also impairs children's immune systems, increasing their chances of dying of common childhood diseases and undermines the health of pregnant and lactating women. Yet vitamin A supplementation, food fortification or dietary change can easily prevent it. Based on UNICEF/WHO guidelines, the Albanian Ministry of Health recommends that children aged 6-11 months be given one high dose Vitamin A capsules a year and children aged older than one year be given two capsules. In some parts of the country, Vitamin A capsules are linked to immunization services and are given when the child has contact with these services after six months of age. It is also recommended that mothers take a Vitamin A supplement within eight weeks of giving birth due to increased Vitamin A requirements during pregnancy and lactation. Within the six months prior to MICS, 7.4 percent of children aged 6-59 months received the high dose Vitamin A supplement (8,2 percent of boys and 6,5 percent of girls - Table 18). Approximately 5 percent did not receive the supplement in the last 6 months but did receive one prior to that time. Thirteen percent of children received a Vitamin A supplement at some time in the past but their mother/caretaker was unable to specify when. Vitamin A supplementation coverage is quite low, more than 60 percent of children have never received it. The age pattern of Vitamin A supplements shows that supplements in the last six months is higher among children aged 6-11 months 20,3 percent and then declines steadily with age to six percent among the oldest children. The mother’s level of education is also related to the likelihood of Vitamin A supplements. The percentage receiving a supplement in the last six months increases from 6.5 percent among children whose mothers have primary education to 11 percent of those whose mothers have higher education. Only 3 percent of mothers with a birth in the year before the MICS received a Vitamin A supplement within eight weeks of the birth (Table 19). More than 87 percent of mothers who gave birth in the year before MICS answered that they are not sure if they received a Vitamin A supplement within eight weeks of the birth 26 Low birth weight Infants who weigh less than 2500 grams (2.5 kg.) at birth are categorized as low birth weight babies. Since many infants are not weighed at birth and those who are weighed may be a biased sample of all births, reported birth weight cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth. Eighty seven percent of births in the Albania MICS were weighed at birth. First, the two items are cross-tabulated for those children who were weighed at birth to obtain the proportion of births in each category of size who weighed less than 2500 grams. This proportion is then multiplied by the total number of children falling in the size category to obtain the estimated number of children in each size category who were of low birth weight. The numbers for each size category are added together to obtain the total number of low birth weight children. This number is divided by the total number of live births to obtain the percentage with low birth weight. In Albania, approximately 3 percent of infants are estimated to weigh less than 2500 grams at birth (Table 20). The prevalence of low birth weight does not vary much according to urban and rural areas or by the mother’s education. E. Child Health Immunization coverage According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. In MICS, mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Mothers were also probed to report any vaccinations the child received that did not appear on the card. Overall, 86 percent of children had health cards. If the child did not have a card, the mother was read a short description of each vaccine and asked to recall whether or not the child had received it and, for DPT and Polio, how many times. Table 21 shows the percentage of children aged 12 to 23 months who received each of the vaccinations. The denominator for the table is comprised of children aged 12-23 months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. However, this information might not be periodically updated, due to the fact that many immunization campaigns are carried out during emergencies. Approximately 80 percent of children (from vaccination cards) aged 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 71 percent. The percentage declines for subsequent doses of DPT to 61 percent for the second dose, and 52 percent for the third dose (Figure 4). Similarly, 57.3 percent of children received Polio 1 by age 27 12 months and this declines to 28.7 percent by the third dose. The coverage for measles vaccine by 12 months is at 61 percent. Note: The data are from vaccination’s cards and mothers’ declaration As a result, the percentage of children who had all eight recommended vaccinations by their first birthday is low at only 17 percent In Table 22, the percentage of children age 12-23 months currently vaccinated against childhood diseases is shown according to background characteristics. Unlike the previous table, the estimates in this table refer to children who received the vaccinations by the time of the survey, even if they did not occur prior to the age of 12 months. Male and female children are vaccinated at roughly the same rate. Rural children are more likely to be vaccinated than urban children. Vaccination coverage is higher among children whose mothers have secondary or higher education. In general the education differences are greatest for the third doses of DPT and Polio. Diarrhea In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 7 percent of under five children had diarrhea in the two weeks preceding the survey (Table 23). Diarrhea prevalence was not significantly higher in the urban and rural areas. The peak of diarrhea prevalence occurs in the weaning period, among children age 6 - 11 months at 14,5 percent Table 23 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhea. 39 percent of children received breast milk while they had diarrhea. Children under age 12 months are especially likely to have received breast milk. About 19 percent of children received gruel and 35 percent received ORS. Children of mothers with secondary education appear to be less likely than other children to receive ORS. Approximately 94 percent of children with diarrhea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF). Figure 5. Percentage of children aged 12 - 23 months who received immunizations by age 12 months, Albania 2000 79.6 70.7 61.1 51.7 24.1 57.3 46.2 28.7 61 0 10 20 30 40 50 60 70 80 90 BCG DPT1 DPT2 DPT3 Polio 0 Polio 1 Polio 2 Polio 3 Measles 28 62 percent of under five children with diarrhea drank more than usual while 38 percent drank the same or less (Table 24). About 55 percent ate somewhat less, the same, or more than usual while 45 percent ate much less than usual or nothing. Overall, only 48.2 percent of children with diarrhea received increased fluids and continued eating as recommended. Acute respiratory infection Acute lower respiratory infections, particularly pneumonia, are one of the leading causes of child deaths in Albania. In the MICS questionnaire, children with acute respiratory infection are defined as those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were due to a problem in the chest, or both a problem in the chest and a blocked nose, or whose mother did not know the source of the problem. Less than 2 percent of children under five had an acute respiratory infection in the two weeks prior to the survey according to these criteria (Table 25). Of these, 30 percent were taken to a doctor for treatment, and 35 percent were taken to a nurse or health assistant. Eighteen percent were taken to a specialist or family member, friend, or neighbor. Fewer than 3 percent were taken to another type of health provider. Overall, almost 83 percent of children with ARI were taken to an appropriate health provider (i.e., doctor, specialist, nurse/health assistant, hospital). IMCI initiative The Integrated Management of Childhood Illnesses (IMCI) is a program developed by UNICEF and WHO that combines strategies for control and treatment of five major killers of children – acute lower respiratory tract infections, diarrheal dehydration, measles, malaria, and malnutrition. The program focuses on the improvement of case management skills by health workers, improvement of the health system, and improvement of family and community practices in the prevention and early management of childhood illnesses. Appropriate home management of illness is one component of IMCI. The approach teaches mothers that appropriate home management of diarrhea or any other illness requires giving more fluids and continuing to feed sick children as they are normally fed. Table 26 presents information on the drinking and eating behavior of sick children. Almost 15 percent of children were reported to have had diarrhea or some other illness in the two weeks preceding the survey. Of these, 62 percent drank more liquids during the illness and 57 percent continued eating (i.e., ate somewhat less, the same, or more). Overall, 47 percent of sick children received increased fluids and continued eating as recommended under the IMCI program. Promoting knowledge among caretakers about when it is appropriate to seek care for sick children is another important component of the IMCI program. In the Albania MICS, mothers or caretakers of children were asked to name all of the symptoms that would cause them to take a child to a health facility right away. The most common response, given by 85 percent of mothers, was that they would take their child to a health facility right away if he/she developed a fever (Table 27). 47 percent said that the child becoming sicker would cause them to take the child to a health facility and 55 percent mentioned difficulty breathing. 24 percent of mothers cited an inability to breastfeed, 48 percent fast breathing, 42 percent blood in stools, and 19 percent drinking poorly as reasons for taking a child to a health facility right away. Rural mothers and those with no education were more likely to mention at least two signs for seeking care than other mothers. 29 F. HIV/AIDS AIDS knowledge One of the most important strategies for reducing the rate of HIV/AIDS infection is the promotion of accurate knowledge of how AIDS is transmitted and how to prevent transmission. Among women aged 15-49 in Albania, 92.7 percent have ever heard of AIDS ( ). This percentage is very high in urban areas (97,6 percent) and somewhat lower in rural areas (88.9 percent). Women in MICS were read several statements about means of HIV/AIDS transmission and asked to state whether they believed the statements were true. Fifty five percent believe that having only one uninfected sex partner can prevent HIV transmission. 42 percent believe that using a condom every time one has sex can prevent HIV transmission and 36 percent agreed that abstaining from sex prevents HIV transmission. Overall, 25 percent knew all three ways and 60 percent were aware of at least one of the means of preventing transmission. Education is also a very important factor in AIDS awareness. The percentage who know all three means of preventing transmission is the same among women with primary, secondary or higher education .Big differences across age groups do not exist; the percentage of women who know all three means is on average 25 percent for all age groups. Less than two percent of women correctly stated that AIDS can’t be transmitted by supernatural means whereas 12.6 percent stated that AIDS can’t be spread by mosquito bites (Table 31). More than 40 percent of women correctly believe that a healthy looking person can be infected. About 57 percent of women in the urban areas recognize at least one misconception and 43 percent of these women do not correctly identify any misconceptions, while in rural areas 41 percent of women recognize at least one misconception and 59 percent of these women do not correctly identify any misconceptions. Sixty four percent of women in Albania know that AIDS can be transmitted from mother to child (Table 32). When asked specifically about the mechanisms through which mother to child transmission can take place, 65 percent said that transmission during pregnancy was possible, 55 percent said that transmission at delivery was possible, and only 46 percent agreed that AIDS can be transmitted through breast milk. Slightly less than one in three women knew all three modes of transmission. This percentage does not vary much across background categories. The MICS survey also attempted to measure discriminatory attitudes towards people living with HIV/AIDS. To this end, respondents were asked whether they agreed with two questions. The first asked whether a teacher who has the AIDS virus but is not sick should be allowed to continue teaching in school. The second question asked whether the respondent would buy food from a shopkeeper or food seller who the respondent knew to be infected with AIDS. The results are presented in Table 33. Only one in five of respondents believe that a teacher with HIV/AIDS should not be allowed to work. The percentage is highest in urban areas at 32 percent and lowest in rural areas at 16 percent. Urban women and those with secondary or higher education are more likely to express this discriminatory attitude than rural women and those with primary or no education. Eleven percent of women would not buy food from a person infected with AIDS. Interestingly, this measure shows a different regional pattern than the first question. Women in the urban areas who 30 express a discriminatory attitude on this question are twice as many than in rural areas About 34 percent of women in urban areas agree with at least one of the discriminatory statements while in rural areas this drops to 17 percent. Knowledge of HIV/AIDS transmission by level of education (Figure 6) has shown that 90 percent of women generally have heard about HIV/AIDS transmission but they have no sufficient knowledge about ways to prevent HIV/AIDS or do not correctly identify the three misconceptions. AIDS testing Voluntary testing for AIDS, accompanied by counseling, allows those infected to seek health care and to prevent the infection of others. Testing is particularly important for pregnant women who can then take steps to prevent infecting their babies. The indicators shown in Table 35 are designed to monitor whether women are aware of places to get tested for HIV/AIDS, the extent to which they have been tested, and the extent to which those tested have been told the result of the test. In some places, a relatively large proportion of people who are tested do not return to get their results due to fear of having the disease, fear that their privacy will be violated, or other reasons. Twenty three percent of women of reproductive age in Albania know a place to get tested for AIDS. Women living in urban areas are most likely to know a place compared to those of rural areas. Only 13 percent of women with primary education know of a place to get tested compared to 28 percent of women with secondary education and 51 percent of women with higher education. 0.7 percent of women respondents have been tested for AIDS (350 women). The very low percentage of women tested shows that this is not a statistically valid sample. Out of this sample, 1.7 percent are from urban areas and 3,4 percent have received a higher education. 31 G. Reproductive Health Contraception Current use of contraception was reported by 58 percent of married or in union women (Table 36). The most popular method is withdrawal, which is used by 33 percent of women who use contraceptives in Albania. More than 42 percent of married or in union women do not use any contraception. Only 15 percent of women use modern methods while 42 percent use traditional methods. The next most popular method are condoms, which account for 7.9 percent of married women. Between three and eight percent of women reported use of LAM and periodic abstinence. Contraceptive prevalence is at the same level in urban and rural areas. Young women are far less likely to use contraception than older women. Only about 38 percent of married or in union women aged 15-19 currently use a method of contraception compared to 46 percent of 20-24 years old and 60 percent of older women. Women’s education level is strongly associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 11 percent among those with primary education to 18 percent among women with secondary education, and to 25 percent among women with higher education. Prenatal care Quality prenatal care can contribute to the prevention of maternal mortality by detecting and managing potential complications and risk factors, including pre-eclampsia, anemia, and sexually transmitted diseases. Antenatal care also provides opportunities for women to learn the danger signs of pregnancy and delivery, to be immunized against tetanus, to learn about infant care, and be treated for existing conditions, such as malaria and anemia. Tetanus toxoid injections are given to women during pregnancy to protect infants from neonatal tetanus, a major cause of infant death that is due primarily to unsanitary conditions during childbirth. Two doses of tetanus toxoid during pregnancy offer full protection. However, if a woman was vaccinated during a previous pregnancy, she may only need a booster to give full protection. Five doses are thought to provide lifetime protection. Thirty percent of women with recent births in Albania are protected against neonatal tetanus (Table 37). All of these women received two doses of tetanus toxoid within the last three years. In the country as a whole, women living in urban areas are most likely to be protected (33 percent) while those living in rural areas are least likely (28percent). Note, however, that regional estimates are based on small numbers of cases and should be interpreted with caution. Women with primary education are more likely to be protected against tetanus than those with either no education or secondary or higher education. Female respondents who had had a birth in the year prior to the Albania MICS were asked whether they had received antenatal care and, if so, what type of person provided the care. If the woman saw more than one type of provider, all were recorded in the questionnaire. Table 38 presents the percent distribution of women with a birth in the year prior to the MICS by the type of personnel who delivered antenatal care. If more than one provider was mentioned by the respondent, she is categorized as having seen the most skilled person mentioned. 32 Virtually all women in Albania receive some type of prenatal care and 95 percent receive antenatal care from skilled personnel (doctor, nurse, midwife). Less than 45 percent of women with a birth in the year prior to the survey received antenatal care from a doctor, 42 percent from a nurse, and 8 percent from a midwife (Figure 7). Health assistants providing prenatal care for urban areas is at 98 percent and in rural areas it is 93 percent. Assistance at delivery The provision of delivery assistance by trained attendants can greatly improve outcomes for mothers and children by the use of technically appropriate procedures, and accurate and speedy diagnosis and treatment of complications. Skilled assistance at delivery is defined as assistance provided by a doctor, nurse, or midwife. About 99 percent of births occurring in the year prior to MICS were delivered by skilled personnel (Table 39). This percentage is highest in urban areas at 100 percent and in rural areas at 98.6 percent. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled person. Doctors assisted with the delivery of 57 percent of births, nurses assisted with 37 percent and one in ten births were delivered by midwives. Less than one percent of the births in the year prior to the MICS survey were delivered with no assistance. H. Child Rights Birth registration The International Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The births of 99 percent of children under five years in Albania. (Table 40). There are no significant variations in Figure 7. Percent distribution of women with a birth in the last year by type of personnel delivering antenatal care, Albania 2000 No antenatal care received 5% Traditional birth attendance 0%Midwife 8% Nurse 42% Doctor 45% 33 birth registration across sex, age, education categories, or urban and rural areas. A similar situation exists in urban and rural areas. Orphans and the living arrangements of children Children who are orphaned or living away from their parents may be at increased risk of impoverishment, discrimination, denial of property rights and rights to inheritance, various forms of abuse, neglect, and exploitation of their labor or sexuality. Monitoring the condition level of orphaned children and the living arrangements of children assists in identifying those who may be at risk and in tracking changes over time. In Albania, 96.5 percent of children aged 0-14 are living with both parents (Table 41). A very small percentage of children aged 0-14 have one or both parents dead, 0,2 percent are not living with a biological parent Child labor It is important to monitor the extent to which children work and the type of work in which they participate for several reasons. Children who are working are less likely to attend school and more likely to drop out. This pattern can trap children in a cycle of poverty and disadvantage. Working conditions for children are often unregulated with few safeguards against potential abuse. In addition, many types of work are intrinsically hazardous and others present less obvious hazards to children, such as exposure to pesticides in agricultural work, carrying heavy weights and scavenging in garbage dumps. In Albania, MICS estimates that less than one percent of children aged 5-14 years engage in paid work (Table 42). About 3 percent participate in unpaid work for someone other than a household member. ‘Domestic work’ is defined as cooking, shopping, cleaning, washing clothes, fetching water, and caring for children. Slightly more than half of children do these tasks for less than four hours a days while one percent spend more than four hours a day on such tasks. Overall, girls are somewhat more likely than boys and older children (aged 10-14) are more likely than younger children (aged 5-19 years) to do domestic work. Variations across regions are greatest in the percentage of children who engage in less than four hours of domestic work a day. This percentage ranges from 49 percent in the urban areas and 60 percent in rural areas. Children who have done any paid or unpaid work for someone who is not a member of the household or who did more than four hours of housekeeping chores in the household or who did other family work are considered to be ‘currently working’. Overall, 32 percent of children are classified as currently working. There is a difference between boys and girls (30 percent of boys and 28 percent of girls). Regionally, the percentage of children working is lowest in the urban areas at 7 percent and highest in the rural areas 45 percent. In Albania rural children are far more likely to work than urban children. 34 Appendix A: Tables Urban Rural Total Sampled ho 2977 2205 5182 Occupied h 2897 2073 4970 Interviewed 2838 1983 4821 Households 98.0 95.7 97.0 Eligible wom 3183 2313 5496 Interviwed 3163 2293 5456 Women res 99.4 99.1 99.3 Children un 804 649 1453 Interviewed 803 649 1452 Child respo 99.9 100.0 99.9 Table 1. NUMBER OF HOUSEHOLDS AND WOMEN, AND RESPOND RATES, ALBANIA 2000 Age Number Percent Number Percent 0 93 0.9 77 0.7 1 131 1.2 108 1.0 2 178 1.7 148 1.4 3 150 1.4 182 1.7 4 210 2.0 210 2.0 5 112 1.1 136 1.3 6 222 2.1 221 2.1 7 200 1.9 191 1.8 8 241 2.3 198 1.9 9 236 2.2 197 1.9 10 241 2.3 230 2.2 11 218 2.1 215 2.1 12 217 2.1 243 2.3 13 252 2.4 247 2.4 14 220 2.1 223 2.1 15 197 1.9 189 1.8 16 243 2.3 220 2.1 17 212 2.0 207 2.0 18 229 2.2 220 2.1 19 171 1.6 181 1.7 20 175 1.7 208 2.0 21 151 1.4 167 1.6 22 183 1.7 175 1.7 23 148 1.4 154 1.5 24 144 1.4 158 1.5 25 168 1.6 147 1.4 26 156 1.5 169 1.6 27 131 1.2 131 1.3 28 144 1.4 173 1.7 29 131 1.2 147 1.4 30 162 1.5 162 1.6 31 124 1.2 145 1.4 32 138 1.3 150 1.4 33 138 1.3 143 1.4 34 120 1.1 124 1.2 35 128 1.2 144 1.4 36 159 1.5 157 1.5 37 142 1.4 151 1.4 38 147 1.4 150 1.4 39 180 1.7 169 1.6 40 198 1.9 206 2.0 41 142 1.4 153 1.5 42 151 1.4 179 1.7 43 138 1.3 131 1.3 44 143 1.4 130 1.2 45 169 1.6 158 1.5 46 127 1.2 104 1.0 47 153 1.5 110 1.1 48 82 0.8 93 0.9 49 89 0.8 116 1.1 Table 2. SINGLE YEAR AGE DISTRIBUTION OF HOUSEHOLD POPULATION BY SEX , ALBANIA 2000 Male Female 50 128 1.2 114 1.1 51 117 1.1 100 1.0 52 113 1.1 114 1.1 53 90 0.9 92 0.9 54 78 0.7 73 0.7 55 80 0.8 74 0.7 56 97 0.9 81 0.8 57 101 1.0 87 0.8 58 110 1.1 79 0.8 59 81 0.8 69 0.7 60 126 1.2 105 1.0 61 73 0.7 56 0.5 62 72 0.7 75 0.7 63 68 0.6 67 0.6 64 66 0.6 51 0.5 65 96 0.9 75 0.7 66 50 0.5 50 0.5 67 55 0.5 74 0.7 68 52 0.5 47 0.4 69 39 0.4 51 0.5 70+ 481 4.6 563 5.4 Missing/dk 0 0.0 6 0.1 Total 10514 100.0 10449 100.0 Reference population Percent Number Level of education Household members 6+ 7.9 19229 Year of education Household members 6+ 7.9 19229 Level of education Household members 7+ 5.9 18786 Year of education Household members 7+ 5.9 18786 Number of hours worked Working children age 5 - 14 0 148 Complete birth date Women 15 - 49 0 5456 Date of last tetanus toxoid injection Women with a live birth in the last year 0 69 Ever been tested for HIV Women 15 - 49 7.7 5456 Complete birth date Children under 5 0 1453 Diarrhoea in last weeks Children under 5 0 1453 Weight Children under 5 3.1 1453 Height Children under 5 4.9 1453 Table 3. PERCENTAGE OF CASES WITH MISSING INFORMATION, ALBANIA 2000 Urban Rural Total Number of HH members 1 3.2 5.2 4.4 2 - 3 30.0 22.7 25.6 4 - 5 54.5 42.5 47.3 6 - 7 10.7 22.8 18.0 8 - 9 1.4 5.3 3.7 10+ 0.3 1.5 1 Total 100 100 100 At least one 59.9 62.4 61.4 At least one 23.2 25.3 24.5 At least one 83.3 81.5 82.2 Number 1928 2893 4821 Unweighted 2838 1983 4821 Table 4. PERCENT DISTRIBUTION OF HOUSEHOLDS BY BACKGROUND CHARACTERISTICS Area Urban Rural Total Age 15 - 19 17.4 20.9 19.5 20 - 24 12.6 16.5 15.0 25 - 29 12.6 14.5 13.8 30 - 34 14.3 12.7 13.3 35 - 39 15.9 13.5 14.4 40 - 44 16.3 13.1 14.3 45 - 49 11.0 8.8 9.6 Marital status Currently m 70.0 64.8 66.8 Not current 30.0 35.2 33.2 Ever given birth Yes 85.6 79.3 81.8 No 14.4 20.7 18.2 Education level Primary 23.2 68.8 51.2 Secondary 59.0 28.3 40.2 Higher 17.8 2.8 8.6 Total Number 2112 3344 5456 Unweighted 3163 2293 5456 Table 5. PERCENT DISTRIBUTION OF WOMEN 15 - 49 BY BACKGROUND CHARACTERISTICS, ALBANIA 2000 Area Urban Rural Total Male 50.9 51.4 51.2 Female 49.1 48.6 48.8 Age < 6 months 8.0 8.2 8.1 6 - 11 mont 10.1 6.8 8.0 12 - 23 mon 20.5 19.6 19.9 24 - 35 mon 20.2 20.8 20.6 36 - 47 mon 25.4 27.4 26.7 48 - 59 mon 15.9 17.3 16.8 Mother's education None 0.1 3.4 2.2 Primary 23.2 67.0 51.4 Secondary 57.7 27.3 38.1 Higher 19.0 2.3 8.2 Total 100.0 100.0 100.0 Number 516 937 1453 Unweighted 803 649 1452 Table 6. PERCENT DISTRIBUTION OF CHILDREN UNDER 5 BY BACKGROUND CHARACTERISTICS , ALBANIA 2000 Area Mean numbeProportion Number of CEB dead of women Age 15 - 19 0.032 0.036 1066 20 - 24 0.421 0.018 818 25 - 29 1.216 0.029 753 30 - 34 2.130 0.033 726 35 - 39 2.693 0.040 786 40 - 44 3.063 0.052 782 45 - 49 3.156 0.045 525 Total 1.651 0.041 5456 Table 7. MEAN NUMBER OF CHILDREN EVER BORN ( CEB ) AND PROPORTION DEAD BY MOTHER'S AGE ALBANIA 2000 Infant Under-five mortality mortality rate rate Total 28 per 1000 33 per 1000 Table 8. INFANT AND UNDER-FIVE MORTALITY RATES Attending Number programme of children Male 17.0 302 Female 17.7 330 Urban 25.5 213 Rural 13.2 418 36 - 47 months 16.6 387 48 - 59 months 18.5 244 Mother's education None 0.0 21 Primary 12.2 336 Secondary 21.3 225 Higher 42.0 50 Table 9. PERCENTAGE OF CHILDREN AGED 36 - 59 MONTHS WHO ARE ATTENDING SOME FORM OF ORGANIZED EARLY CHILHOOD EDUCATION PROGRAMME, ALBANIA 2000 Table 10. PERCENTAGE OF CHILDREN OF PRIMARY SCHOOL AGE ATTENDING PRIMARY SCHOOL, ALBANIA 2000 Attending Number Attending Number Attending Number Urban 91.3 610 91.4 620 91.4 1230 Rural 90.0 1215 90.7 1124 90.3 2339 Age 7 45.8 200 47.7 191 46.7 392 8 89.0 241 90.1 198 89.5 439 9 98.1 236 97.6 197 97.9 433 10 99.3 241 99.3 230 99.3 471 11 95.3 218 98.4 215 96.8 433 12 97.8 217 98.3 243 98.0 460 13 96.8 252 97.8 247 97.3 499 14 95.3 220 91.8 223 93.5 443 Total ( 7 - 10 ) years 77.0 1825 77.4 1744 77.3 3569 Total ( 8 - 11 ) years 95.1 1825 96.3 1744 95.9 3569 Total ( 8 - 9 ) years 93.2 1825 93.6 1744 93.4 3569 Male Female Total Percent in Percent in Percent in Percent in Percent grade 1 grade 2 grade 3 grade 4 who reach eventually eventually eventually eventually grade 5 of reaching reaching reaching reaching those who grade 2 grade 3 grade 4 grade 5 enter grade Male 91 92 93 93 84 Female 94 94 95 95 80 Urban 98 98 97 98 87 Rural 89 90 92 90 77 Total 93 93 94 94 82 Table 11. PERCENTAGE OF CHILDREN ENTERING FIRST GRADE OF PRIMARY SCHOOL WHO EVENTUALLY REACH GRADE 5, ALBANIA, 2000 Literate Not known Number Literate Not known Number Literate Not known Number Urban 94.1 1.0 3310 91.8 0.8 3267 92.9 0.9 6577 Rural 86.4 3.4 2274 75.5 3.1 2539 80.7 3.2 4814 Age 15 - 24 93.2 2.7 1580 93.3 0.8 1634 93.2 1.7 3214 25 - 34 94.9 1.4 1325 91.7 1.3 1338 93.3 1.4 2663 35 - 44 93.9 1.3 1145 88.2 1.5 1100 91.1 1.4 2245 45 - 54 90.2 1.2 642 78.5 2.5 709 84.0 1.9 1350 55 - 64 81.4 2.5 434 68.3 3.8 514 74.3 3.2 948 65 + 74.4 3.4 459 56.2 3.9 511 64.8 3.7 970 Total 90.9 2.0 5585 84.7 1.8 5806 87.7 1.9 11391 Male Female Total Table 12. PERCENTAGE OF THE POPULATION AGED 15 YEARS AND OLDER THAT IS LITERATE, ALBANIA 2000 Urban 89.6 6.4 1.5 0.4 1.4 0.1 0.6 0.0 0.0 0.0 100.0 99.4 7719 Rural 19.8 26.3 25.1 4.4 13.8 5.6 0.1 2.5 1.6 0.8 100.0 95.0 13243 Total 45.5 19.0 16.4 2.9 9.2 3.6 0.3 1.6 1.0 0.5 100.0 96.7 20962 Number of persons Unprotec- ted spring Tanker truck vendor Total Total with safe drinking water Main source of water Table 13. PERCENTAGE OF POPULATION USING IMPROVED DRINKING WATER SOURCES, ALBANIA 2000 Piped into dwelling Piped into yard Public tap Tube-well bore-hole with pump Protec- ted dug well Protec- ted spring Bottl- ed water Unprotec- ted dug well Flush sevage Pour flush Improved pit Traditional Open Missing Total Total with Number system latrine latrine pit latrine pit sanitary of persons means Urban 94.8 3.3 0.4 0.4 0.8 0.4 100.0 98.8 7719 Rural 36.6 38.6 2.8 6.5 14.3 1.2 100.0 84.5 13243 Total 58.0 25.6 1.9 4.3 9.3 0.9 100.0 89.8 20962 Type of toilet facility Table 14. PERCENTAGE OF POPULATION USING SANITARY MEANS OF EXCRETA DISPOSAL, ALBANIA 2000 Male 15.3 4.8 34.1 19.8 11.9 4.8 524 Female 13.3 3.8 29.4 14.8 10.3 2.4 519 Urban 14.1 4.9 23.8 12.2 11.9 3.7 402 Rural 14.4 4.0 36.7 20.5 10.6 3.5 641 Age < 6 months 7.3 2.4 19.2 5.7 11.4 5.4 81 6 -11 months 10.7 4.8 27.4 10.7 16.5 10.1 77 12 - 23 months 20.1 9.2 36.0 22.9 14.6 3.5 193 24 - 35 months 15.5 6.9 37.4 21.4 8.2 2.0 216 36 - 47 months 12.0 1.0 30.6 16.1 8.9 2.5 289 48 - 59 months 14.8 2.1 29.8 16.5 11.7 3.6 188 Mother's education Primary 16.9 4.6 38.3 19.7 12.1 4.2 556 Secondary 11.7 4.2 25.4 15.9 10.7 3.1 396 Higher 9.3 3.0 19.2 9.4 6.7 1.4 91 Total 14.3 4.3 31.7 17.3 11.1 3.6 1043 Table 15. PERCENTAGE OF UNDER-FIVE CHILDREN WHO ARE SEVERELY OR MODERATELY UNDERNOURISHED, ALBANIA 2000 Percent below - 2 SD Percent below - 3 SD Percent below -2 SD Percent below -3 SD Percent below -2 SD Percent below -3 SD Number of children Weight for age Height for age Weight for height Exclusive breastfeeding Number of children Complementary feeding rate Number of children Continued breastfeeding rate Number of children Continued breastfeeding rate Number of children Children 0-3 months Children 6-9 months Children 12-15 months Children 20-23 months Male 13.3 31 25 47 59 52 7 51 Female 6.1 49 22 19 72 56 6 44 Urban 10.1 28 26 29 58 38 6 37 Rural 8.2 52 23 37 70 70 6 58 Mother's education Primary 4.4 33 27 32 71 60 8 52 Secondary 10.2 40 20 26 60 40 4 38 Higher 22.6 7 26 8 49 8 8 6 Total 8.9 80 24 66 65 108 6 95 Table 16. PERCENT OF LIVING CHILDREN BY BREASTFEEDING STATUS, ALBANIA 2000 Percent of Percent of Number households households of with no salt in which salt < 15 15 + households was tested PPM PPM Urban 0.0 98.1 29.1 70.9 7719 Rural 0.0 97.9 52.2 47.8 13243 Total 0.0 98.0 43.7 56.3 20962 Percent of households with salt testing Table 17. PERCENTAGE OF HOUSEHOLDS CONSUMING ADEQUATELY IODIZED SALT, ALBANIA 2000 RECEIVED A HIGH DOSE VITAMIN A SUPPLEMENT IN THE LAST 6 MONTHS, ALBANIA 2000 Not sure Never Total Number Within last Prior to last Not sure if received of 6 months 6 months when received children Male 8.2 5.4 13.7 12.8 59.9 100.0 690 Female 6.5 4.5 11.8 14.3 62.9 100.0 646 Urban 7.5 4.3 14.6 10.9 62.6 100.0 475 Rural 7.3 5.3 11.7 15.0 60.7 100.0 860 Age 6 - 11 months 20.3 3.2 6.1 11.0 59.5 100.0 116 12 - 23 months 7.2 3.7 7.4 10.9 70.8 100.0 289 24 - 35 months 6.7 4.4 18.8 12.5 57.5 100.0 299 36 - 47 months 5.0 5.7 13.2 15.4 60.6 100.0 387 48 - 59 months 6.0 6.8 14.1 16.1 57.0 100.0 244 Mother's education Primary 6.5 4.8 13.9 14.7 60.1 100.0 727 Secondary 7.9 5.4 11.1 13.0 62.7 100.0 499 Higher 10.8 4.1 13.0 8.0 64.1 100.0 110 Total 7.4 5.0 12.8 13.5 61.4 100.0 1335 Table 18 PERCENT DISTRIBUTION OF CHILDREN AGED 6 - 59 MONTHS BY WHETHER THEY HAVE Percent of children who received Vitamin A : Received Not sure Number vitamin A if of suplement received women Urban 3.4 95.9 103 Rural 2.1 81.9 157 Mother's education Primary 2.7 81.9 126 Secondary 2.4 91.7 110 Higher 2.9 97.4 24 Total 2.6 87.5 260 Table 19. PERCENTAGE OF WOMEN WITH A BIRTH IN THE LAST 12 MONTHS BY WHETHER THEY RECEIVED A HIGH DOSE VITAMIN A SUPPLEMENT BEFORE THE INFANT WAS 8 WEEKS OLD, ALBANIA 2000 Number Below 2500 Weighed of live grams at birth births Urban 3.4 95.9 103 Rural 2.1 81.9 157 Mother's education Primary 2.4 81.6 124 Secondary 2.4 91.7 110 Higher 2.9 97.4 24 Total 2.6 87.5 260 Percent of live births Table 20. PERCENTAGE OF LIVE BIRTHS IN THE LAST 12 MONTHS THAT WEIGHED BELOW 2500 GRAMS AT BIRTH, ALBANIA 2000 Table 21. PERCENTAGE OF CHILDREN AGE 12 - 23 MONTHS IMMUNIZED AGAINST CHILDHOOD DISEASES AT ANY TIME BEFORE THE SURVEY AND BEFORE THE FIRST BIRTHDAY, ALBANIA 2000 BCG DPT1 DPT2 DPT3 Polio 0 Polio 1 Polio 2 Polio 3 Measles All None Vaccination card 41.2 41.7 40.2 39.2 6.8 22.6 22.4 18.4 32.3 13.6 0.7 Mother's report 38.4 29.0 20.9 12.5 17.3 34.7 23.8 10.3 28.7 3.5 14.8 Either 79.6 70.7 61.1 51.7 24.1 57.3 46.2 28.7 61.0 17.1 15.5 Vaccinated before 12 months 98.9 96.2 96.5 94.4 100.0 99.0 99.5 100 71.7 35.5 0.0 Percentage of children who received : Table 22. PERCENTAGE OF CHILDREN AGE 12 - 23 MONTHS CURRENTLY VACCINATED BCG DPT1 DPT2 DPT3 Polio 0 Polio 1 Polio 2 Polio 3 Measles All None Male 80.4 70.7 62.9 52.6 25.9 60.2 49.8 28.3 61.0 15.8 15.3 43.6 157 Female 78.8 70.7 59.6 50.5 22.0 54.0 41.9 29.2 61.1 18.4 15.7 45.3 132 Urban 81.9 77.9 69.9 63.3 19.8 44.2 40.2 21.8 66.4 12.8 12.0 61.1 106 Rural 78.4 66.6 56.5 44.9 26.6 64.9 49.6 32.6 58.0 19.5 17.5 34.7 183 Mother's education Primary 79.8 65.7 56.3 42.7 24.7 62.9 46.5 29.8 59.4 17.9 15.7 36.1 159 Secondary 78.2 75.4 66.3 61.0 19.6 47.1 42.5 27.2 63.7 15.8 16.3 52.8 109 Higher 85.6 84.5 74.3 71.2 43.0 68.2 62.9 28.0 60.2 16.8 9.0 63.0 21 Total 79.6 70.7 61.4 51.7 24.1 57.4 46.2 28.7 61.1 17.0 15.5 44.3 289 AGAINST CHILDHOOD DISEASES, ALBANIA 2000 % with health care Number of children Table23. PERCENTAGE OF UNDER-FIVE CHILDREN WITH DIARRHEA IN THE LAST TWO WEEKS AND TREATMENT WITH ORS OR ORT, ALBANIA 2000 Had diarrhea Number Number in last two of Breast Gruel Local Other Water ORS Any No of weeks children milk acceptable milk with packet recommended treatment children under 5 feeding treatment Male 8.7 745 41.5 16.9 48.7 18.6 5.3 33.7 93.1 6.9 65 Female 5.8 709 35.1 21.8 44.0 31.1 17.3 37.2 95.0 5.0 41 Urban 6.7 516 46.8 17.6 47.3 30.4 9.6 33.3 98.2 1.8 35 Rural 7.6 937 35.2 19.4 46.7 20.2 10.2 36.0 91.7 8.3 71 Age < 6 months 7.8 118 76.4 0.0 46.0 0.0 23.6 29.0 100.0 0.0 9 6 -11 months 14.5 116 59.7 24.7 37.2 20.4 11.4 39.3 93.7 6.3 17 12 - 23 months 10.5 289 42.9 9.8 49.2 22.1 2.7 26.9 91.0 9.0 30 24 - 35 months 8.5 299 30.8 32.9 44.0 30.4 11.6 51.7 89.0 11.0 25 36 - 47 months 2.9 387 4.3 35.9 59.0 41.7 19.4 38.8 100.0 0.0 11 48 - 59 months 5.4 244 22.6 3.9 49.8 18.2 4.3 17.9 100.0 0.0 13 Mother's education Primary 9.9 780 36.0 21.5 43.3 23.3 10.3 41.9 91.5 8.5 78 Secondary 3.8 554 46.1 12.7 62.1 20.3 12.0 14.2 100.0 0.0 21 Higher 5.9 120 50.3 7.8 40.8 34.9 0.0 23.7 100.0 0.0 7 Total 7.3 1453 39.0 18.8 46.9 23.5 10.0 35.1 93.8 6.2 106 Children with diarrhea who received Table 24. PERCENTAGE OF UNDER - FIVE CHILDREN WITH DIARRHEA IN THE LAST TWO WEEKS WHO TOOK INCREASED FLUIDS AND CONTINUED TO FEED DURING THE EPISODE, ALBANIA 2000 Had diarrhea Number of Received Number in last two children More Total Much Total increased of children weeks under 5 less/none fluids/eating with diarrhea Male 8.7 745 53.7 46.3 100 48.9 51.1 100 42.8 65 Female 5.8 709 75.0 25.0 100 64.9 35.1 100 56.6 41 Urban 6.7 516 68.4 31.6 100 55.6 44.4 100 48.6 35 Rural 7.6 937 58.9 41.1 100 54.9 45.1 100 48.0 71 Age < 6 months 7.8 118 76.1 23.9 100 66.9 33.1 100 51.0 9 6 -11 months 14.5 116 73.1 26.9 100 78.2 21.8 100 64.6 17 12 - 23 months 10.5 289 54.1 45.9 100 55.0 45.0 100 52.0 30 24 - 35 months 8.5 299 67.8 32.2 100 54.1 45.9 100 47.7 25 36 - 47 months 2.9 387 56.5 43.5 100 38.5 61.5 100 34.2 11 48 - 59 months 5.4 244 49.7 50.3 100 33.8 66.2 100 29.5 13 Mother's education Primary 9.9 780 64.7 35.3 100 56.1 43.9 100 49.8 78 Secondary 3.8 554 56.7 43.3 100 56.0 44.0 100 47.2 21 Higher 5.9 120 48.6 51.4 100 42.0 58.0 100 34.2 7 Total 7.3 1453 62.0 38.0 100 55.1 44.9 100 48.2 106 Children with diarrhea who drank: Children with diarrhea who ate: Same/ less Somewhat less/ same Table 25. PERCENTAGE OF UNDER - FIVE CHILDREN WITH ACUTE RESPIRATORY INFECTION IN THE LAST Male 1.7 745 30.7 25.7 0.0 0.0 26.6 0.0 0.0 77.8 13 Female 1.1 709 29.6 51.8 0.0 35.9 5.4 0.0 9.5 91.8 8 Urban 2.3 516 35.0 20.3 0.0 0.0 31.4 0.0 5.9 81.1 12 Rural 0.9 937 23.4 57.8 0.0 33.1 0.0 0.0 0.0 85.8 8 Age < 6 months 1.8 118 0.0 100.0 0.0 0.0 0.0 0.0 0.0 100.0 2 6 -11 months 2.3 116 0.0 76.9 0.0 0.0 25.3 0.0 0.0 76.9 3 12 - 23 months 1.3 289 67.9 0.0 0.0 0.0 0.0 0.0 0.0 67.9 4 24 - 35 months 2.5 299 38.7 15.3 0.0 35.5 41.1 0.0 9.4 100.0 8 36 - 47 months 0.5 387 0.0 19.7 0.0 0.0 0.0 0.0 0.0 19.7 2 48 - 59 months 0.9 244 35.1 64.9 0.0 0.0 0.0 0.0 0.0 100.0 2 Mother's education Primary 1.7 748 21.4 43.8 0.0 21.4 13.3 0.0 0.0 81.4 13 Secondary 1.1 554 48.9 20.0 0.0 0.0 24.3 0.0 11.5 82.3 6 Higher 1.2 120 28.4 28.4 0.0 0.0 43.3 0.0 0.0 100.0 1 Total 1.4 1453 30.3 35.4 0.0 13.3 18.8 0.0 3.5 83.0 20 Any appropriate provider Hosp- ital Number of children with ARI Children with ARI who were taken to Had acute respitory infection Number of children under 5 PERCENTAGE OF UNDER-FIVE CHILDREN WITH ACUTE RESPITORY INFECTION IN THE TWO WEEKS AND TREATMENT BY HEALTH PROVIDERS, ALBANIA 2000 Health center Dispen- cary Village health workers Private physic- ians Traditi- onal healer Other Table 26. PERCENTAGE OF CHILDREN 0-59 MONTHS OF AGE REPORTED ILL DURING THE LAST TWO WEEKS WHO RECEIVED INCREASED FLUIDS AND CONTINUED FEEDING, ALBANIA 2000 Male 16.3 745 55.1 44.9 100.0 52.8 47.2 100.0 45.6 121 Female 12.2 709 70.4 29.6 100.0 61.7 38.3 100.0 48.0 87 Urban 16.3 516 63.0 37.0 100.0 59.0 41.0 100.0 48.0 84 Rural 13.2 937 60.5 39.5 100.0 54.9 45.1 100.0 45.6 124 Age < 6 months 10.6 118 70.9 29.1 100.0 64.5 35.5 100.0 41.3 13 6 -11 months 22.3 116 65.7 34.3 100.0 73.3 26.7 100.0 60.2 26 12 - 23 months 20.0 289 58.2 41.8 100.0 51.5 48.5 100.0 46.2 58 24 - 35 months 18.5 299 64.4 35.6 100.0 54.8 45.2 100.0 45.7 55 36 - 47 months 7.9 387 57.4 42.6 100.0 62.3 37.7 100.0 46.2 31 48 - 59 months 10.6 244 58.9 41.1 100.0 43.8 56.2 100.0 38.7 26 Mother's education Primary 16.8 780 64.0 36.0 100.0 57.1 42.9 100.0 49.3 131 Secondary 10.4 554 59.2 40.8 100.0 56.6 43.4 100.0 44.3 58 Higher 16.5 120 51.7 48.3 100.0 52.9 47.1 100.0 35.6 20 Total 14.3 1453 61.5 38.5 100.0 56.5 43.5 100.0 46.6 208 Number of children under 5 Reported illness in last 2 weeks Children with illness who drank Some-what less/ sameSame/ less TotalMore Received increased fluids/ eating Number of sick childrenTotal Much less/ none Children with illness who ate Table 27. PERCENTAGE OF CARETAKERS OF CHILDREN 0 - 59 MONTHS WHO KNOW AT LEAST 2 SIGNS FOR SEEKING CARE IMMEDIATELY ALBANIA 2000 Urban 21.6 46.6 85.3 46.5 52.7 48.9 17.9 86.6 516 Rural 25.9 47.6 84.6 49.1 55.8 38.1 19.5 85.6 937 Mother's education Primary 25.1 46.9 84.5 47.3 58.1 39.4 18.7 86.5 780 Secondary 23.9 48.3 84.9 49.1 50.1 43.9 18.7 86.0 554 Higher 22.1 44.0 86.7 49.5 53.7 49.4 21.6 82.8 120 Total 24.4 47.2 84.8 48.2 54.7 41.9 18.9 86.0 1453 Knows at least 2 signs Number of care-takers Knows child should be taken to health facility if child Not able to drink/ breastfeed Becomes sicker Develops a fever Has fast breathing Has difficulty breathing Has blood in stool Is drinking poorly Table 30. PERCENTAGE OF WOMEN AGED 15 - 49 WHO KNOW THE MAIN WAYS OF PREVENTING HIV TRANSMISSION, ALBANIA 2000 Heard of Have only Using a Knows both Knows Does not Number AIDS one faithful condom two at least know of uninfected every ways one any women sex partner night way way Urban 97.6 64.8 53.6 49.3 69.1 30.9 2112 Rural 88.9 48.2 33.9 31.7 50.4 49.6 3344 Age 15 - 19 91.6 53.2 41.0 37.6 56.6 43.4 1066 20 - 24 94.0 56.4 42.7 40.1 59.0 41.0 818 25 - 29 95.0 57.6 40.9 37.7 60.7 39.3 753 30 - 34 96.3 57.3 42.4 39.7 60.0 40.0 726 35 - 39 91.4 55.8 43.7 40.5 59.1 40.9 786 40 - 44 89.4 52.1 41.4 38.6 55.0 45.0 782 45 - 49 87.1 49.2 37.3 34.5 52.0 48.0 525 Education Primary 88.1 45.9 32.4 29.9 48.4 51.6 2792 Secondary 96.3 62.5 49.8 46.4 66.0 34.0 2192 Higher 97.9 69.8 57.2 53.1 73.9 26.1 471 Total 92.3 54.7 41.5 38.5 57.7 42.3 5456 Table 31. PERCENTAGE OF WOMEN AGED 15 - 49 WHO CORRECTLY IDENTIFY MISCONCEPTIONS ABOUT HIV/AIDS, ALBANIA 2000 A healthy Knows all Knows at Does not Heard Supernatural Mosquito looking three least one correctly Number of means bites person can misconsep- misconsep- identify any of AIDS be infected tions tions misconceptions women Urban 97.6 1.5 15.5 49.1 0.2 57.0 43.0 2112 Rural 88.9 1.7 10.4 34.7 0.1 40.9 59.1 3344 Age 15 - 19 91.6 1.4 14.3 41.7 0.2 49.5 50.5 1066 20 - 24 94.0 1.7 12.7 38.7 0.5 45.2 54.8 818 25 - 29 95.0 1.1 13.2 40.4 0.2 47.7 52.3 753 30 - 34 96.3 1.1 13.1 40.9 0.0 47.4 52.6 726 35 - 39 91.4 3.0 12.3 42.4 0.1 50.5 49.5 786 40 - 44 89.4 1.4 10.6 39.0 0.2 44.5 55.5 782 45 - 49 87.1 1.8 8.9 37.3 0.0 42.8 57.2 525 Education Primary 88.1 1.7 9.8 33.9 0.0 39.8 60.2 2792 Secondary 96.3 1.5 13.7 45.2 0.3 52.7 47.3 2192 Higher 97.9 1.9 21.2 54.6 0.5 64.2 35.8 471 Total 92.3 1.6 12.4 40.2 0.2 47.1 52.9 5456 Percent who know that: AIDS can not be transmitted by: Know AIDS can be Did not transmitted know Number from mother During Through Knows all any specific of to child pregnancy At delivery breastmilk three way women Urban 75.1 78.0 67.4 50.4 44.1 18.0 2112 Rural 56.6 57.4 46.5 42.4 33.4 37.9 3344 Age 15 - 19 54.6 58.8 45.4 38.4 31.4 37.5 1066 20 - 24 64.3 64.7 55.2 45.3 36.0 28.6 818 25 - 29 67.6 66.4 56.1 45.9 37.9 28.4 753 30 - 34 69.9 70.3 59.8 48.3 40.6 26.6 726 35 - 39 66.7 69.8 60.0 49.0 40.9 27.0 786 40 - 44 61.7 63.8 54.7 47.1 39.0 30.5 782 45 - 49 66.2 67.5 54.7 48.1 40.5 29.6 525 Education Primary 56.0 56.9 46.8 40.8 32.7 38.3 2792 Secondary 70.2 72.6 61.4 50.3 42.2 23.0 2192 Higher 80.0 82.1 69.1 50.9 45.1 15.0 471 Total 63.8 65.4 54.6 45.5 37.6 30.2 5456 Percent who know AIDS can be transmitted : Table 32. PERCENTAGE OF WOMEN AGED 15 - 49 WHO CORRENTLY IDENTITY MEANS OF HIV TRANSMISSION FROM MOTHER TO CHILD , ALBANIA 2000 Table 33. PERCENTAGE OF WOMEN AGED 15 - 49 WHO EXPRESS A DISCRIMINATORY ATTITUDE TOWARDS PEOPLE WITH HIV/AIDS, ALBANIA 2000 Believe that Would not Agree with Agree with Number a teacher with HIV buy food at least one neither of should not be from a person discriminatory discriminatory women allowed to work with HIV/AIDS statement statement Urban 31.7 16.5 34.2 65.8 2112 Rural 15.6 7.2 17.0 83.0 3344 Age 15 - 19 25.7 12.6 28.1 71.9 1066 20 - 24 27.0 13.5 28.8 71.2 818 25 - 29 25.2 12.1 26.8 73.2 753 30 - 34 17.1 8.8 18.9 81.1 726 35 - 39 17.4 9.2 19.2 80.8 786 40 - 44 18.2 8.8 19.8 80.2 782 45 - 49 19.5 9.4 20.9 79.1 525 Education Primary 13.8 7.1 15.6 84.4 2792 Secondary 27.4 13.2 29.3 70.7 2192 Higher 43.6 22.0 45.3 54.7 471 Total 21.8 10.8 23.7 76.3 5456 Percent of women who : Heard of Know 3 ways Correctly identify 3 Have Number AIDS to prevent HIV misconceptions sufficient of transmission about HIV transmission knowledge women Urban 97.6 31.1 0.2 0.1 2112 Rural 88.9 21.5 0.1 0.0 3344 Age 15 - 19 91.6 25.0 0.2 0.0 1066 20 - 24 94.0 25.8 0.5 0.0 818 25 - 29 95.0 25.3 0.2 0.0 753 30 - 34 96.3 26.0 0.0 0.0 726 35 - 39 91.4 27.0 0.1 0.1 786 40 - 44 89.4 25.1 0.2 0.1 782 45 - 49 87.1 21.3 0.0 0.0 525 Education Primary 88.1 21.1 0.0 0.0 2792 Secondary 96.3 29.8 0.3 0.1 2192 Higher 97.9 28.3 0.5 0.0 471 Total 92.3 25.2 0.2 0.0 5456 Table 34 . PERCENTAGE OF WOMEN AGED 15 - 49 WHO HAVE SUFFICIENT KNOWLEDGE OF HIV/AIDS TRANSMISSION, ALBANIA 2000 If tested Number Know a place Have been have been of to get tested tested told result women Urban 35.3 1.7 100.0 2112 Rural 14.9 0.1 100.0 3344 Age 15 - 19 24.4 0.3 100.0 1066 20 - 24 23.9 0.7 100.0 818 25 - 29 22.8 1.0 100.0 753 30 - 34 20.8 0.6 100.0 726 35 - 39 22.8 1.2 100.0 786 40 - 44 21.2 1.0 100.0 782 45 - 49 22.8 0.4 100.0 525 Education Primary 13.9 0.2 100.0 2792 Secondary 28.0 0.9 100.0 2192 Higher 51.2 3.4 100.0 471 Total 22.8 0.7 100.0 5456 Table 35. PERCENTAGE OF WOMEN AGED 15 - 49 WHO KNOW WHERE TO GET AN AIDS TEST AND WHO HAVE BEEN TESTED, ALBANIA 2000 Urban 39.1 0.7 0.2 7.2 0.7 12.0 2.7 6.3 30.9 0.2 100.0 20.9 40.0 60.9 1429 Rural 44.7 1.1 0.3 4.5 0.6 5.2 2.5 8.3 32.5 0.3 100.0 11.6 43.7 55.3 2124 Age < 20 years 62.3 0.0 0.0 3.9 0.0 10.5 1.9 5.5 15.9 0.0 100.0 14.4 23.3 37.7 76 20 - 24 54.1 0.4 0.1 4.5 0.2 6.3 7.7 3.8 22.1 0.8 100.0 11.5 34.4 45.9 336 25 - 49 40.7 1.0 0.3 5.8 0.7 8.0 2.1 8.0 33.3 0.2 100.0 15.8 43.5 59.3 3142 Education Primary 44.4 1.1 0.3 4.6 0.7 4.8 2.2 8.5 33.1 0.3 100.0 11.5 44.1 55.6 1874 Secondary 41.0 0.8 0.1 6.5 0.6 10.4 3.1 6.5 30.9 0.2 100.0 18.3 40.6 59.0 1363 Higher 37.0 0.5 0.6 8.2 0.9 15.2 3.1 6.2 28.3 0.0 100.0 25.4 37.6 63.0 316 Total 42.5 0.9 0.2 5.6 0.7 7.9 2.6 7.5 31.8 0.2 100 15.3 42.2 57.5 3553 Any tradit- ional method Any method Number of currently married women With- drawal Other Total Any modern method Percent of married or in-union women who are using Table 36. PERCENTAGE OF MARRIED OR IN UNION WOMEN AGED 15 - 49 WHO ARE USING (OR WHOSE PARTNER IS USING) A CONTRACEPTIVE METHOD, ALBANIA 2000 No method Female steriliza- tion Male steriliz- ation Pill Injections Condom Periodic abstin-enceLAM Received at Received at Received at Protected Number of least 2 doses, least 3 doses, least 5 doses, against mothers last within 3 years last within 10 years during lifetime tetanus Urban 33.4 0 0 33.4 103 Rural 28.5 0 0 28.5 157 Education Primary 30.6 0 0 30.6 126 Secondary 27.4 0 0 27.4 110 Higher 43.2 0 0 43.2 24 Total 30.4 0 0 30.4 260 Percent of mothers with a birth in the last 12 months who : Table 37. PERCENTAGE OF MOTHERS WITH A BIRTH IN THE LAST 12 MONTHS PROTECTED AGAINST NEONATAL TETANUS, ALBANIA 2000 Traditional No antenatal Any skilled Number Doctor Nurse Midwife birth attendant care received Total personnel of women Urban 71.5 20.2 6.4 0.5 1.4 100.0 98.1 103 Rural 26.8 56.8 9.7 0.0 6.6 100.0 93.4 157 Education Primary 28.5 58.1 8.2 0.0 5.3 100.0 94.7 126 Secondary 54.7 33.0 8.1 0.0 4.2 100.0 95.8 110 Higher 82.0 2.9 10.8 2.1 2.1 100.0 95.7 24 Total 44.5 42.3 8.4 0.2 4.5 100.0 95.3 260 Table 38. PERCENT DISTRIBUTION OF WOMEN AGED 15 - 49 WITH A BIRTH IN THE LAST YEAR BY TYPE OF PERSONNEL DELIVERING ANTENATAL CARE, ALBANIA Person delivering antenatal care: No Any skilled Number Doctor Nurse Midwife assistance Total personnel of women Urban 73.1 16.5 10.4 0.0 100.0 100.0 103 Rural 46.5 41.6 10.5 1.4 100.0 98.6 157 Education Primary 36.1 46.9 15.2 1.8 100.0 98.2 126 Secondary 74.0 19.9 6.1 0.0 100.0 100.0 110 Higher 88.6 5.9 5.5 0.0 100.0 100.0 24 Total 57.0 31.6 10.5 0.9 100.0 99.1 260 Person assisting at delivery: Table 39. PERCENT DISTRIBUTION OF WOMEN AGED 15 - 49 WITH A BIRTH IN THE LAST YEAR BY TYPE OF PERSONNEL ASSISTING AT DELIVERY, ALBANIA 2000 Birth is Cost too Must travel Other DK or Total Number of registered much too far missing children Male 98.7 0.6 0.2 0.5 0.0 100.0 745 Female 99.0 0.1 0.1 0.7 0.1 100.0 709 Urban 98.7 0.1 0.1 0.9 0.1 100.0 516 Rural 98.9 0.5 0.2 0.5 0.0 100.0 937 Age < 6 months 92.1 3.2 0.6 4.1 0.0 100.0 118 6 -11 months 97.0 0.0 1.3 1.2 0.5 100.0 116 12 - 23 months 99.3 0.5 0.0 0.2 0.0 100.0 289 24 - 35 months 99.7 0.0 0.0 0.3 0.0 100.0 299 36 - 47 months 100.0 0.0 0.0 0.0 0.0 100.0 387 48 - 59 months 99.5 0.0 0.0 0.5 0.0 100.0 244 Mother's education Primary 98.6 0.6 0.2 0.7 0.0 100.0 780 Secondary 99.1 0.1 0.0 0.7 0.1 100.0 554 Higher 99.4 0.0 0.6 0.0 0.0 100.0 120 Total 98.8 0.4 0.2 0.6 0.0 100.0 1,453 Birth is not registered because: Table 40 . PERCENT DISTRIBUTION OF CHILDREN AGED 0 - 59 MONTHS BY WHETHER BIRTHS IS REGISTERED AND REASONS FOR NON - REGISTRATION, ALBANIA 2000 Male 96.4 0.0 0.2 0.1 1.8 0.7 0.5 0.3 100.0 0.3 1.1 2921 Female 96.6 0.0 0.1 0.1 1.5 1.1 0.4 0.2 100.0 0.2 1.4 2825 Urban 96.3 0.0 0.4 0.2 2.0 0.3 0.5 0.3 100.0 0.6 0.9 1990 Rural 96.7 0.0 0.0 0.0 1.4 1.3 0.4 0.2 100.0 0.0 1.4 3756 Age 0 - 4 years 97.0 0.0 0.2 0.0 2.1 0.6 0.1 0.0 100.0 0.2 0.6 1486 5 - 9 years 97.2 0.0 0.1 0.1 1.5 0.5 0.5 0.2 100.0 0.2 0.7 1954 10 - 14 years 95.6 0.0 0.2 0.2 1.5 1.5 0.6 0.4 100.0 0.4 2.1 2306 Total 96.5 0.0 0.2 0.1 1.6 0.9 0.4 0.2 100 0.2 1.2 5746 Number of children Not living with a biological parentTotal One or both parents dead Living with neither parent Table 41 . PERCENT DISTRIBUTION OF CHILDREN 0 - 14 YEARS OF AGE IN HOUSEHOLDS NOT LIVING WITH A BIOLOGICAL PARENT , ALBANIA 2000 Living with both parents Mother only alive Both are alive Both are dead Father alive Father dead Mother alive Mother dead Table 42. PERCENTAGE OF CHILDREN 5 - 14 YEARS OF AGE WHO ARE CURRENTLY WORKING, ALBANIA 2000 Paid work Unpaid work < 4 hours/day 4 or more hours/day Currently working Number of children Male 1.0 2.9 48.0 0.4 33.5 35.6 2159 Female 0.8 2.2 62.4 1.5 25.4 27.7 2101 5 - 9 years 0.6 1.6 33.5 0.1 15.2 16.3 1954 10 - 14 years 1.2 3.4 73.4 1.7 41.6 44.7 2306 Urban 0.5 2.9 49.1 0.6 3.3 6.7 1462 Rural 1.1 2.4 58.2 1.2 43.2 44.8 2798 Total 0.9 2.6 55.1 1.0 29.5 31.7 4260 Domestic work Family work (farm or business) Contents List of figures Acknowledgements Executive Summary Summary Indicators I. Introduction Background of the survey Albania's Background Survey Objectives II. Survey Methodology Sample Design Questionnaires Fieldwork and Processing III. Sample Characteristics and Data Quality Response Rates Age Distribution and Missing Data Characteristics of the Household Population IV. Results A. Infant and Under-Five Mortality B. Education C. Water and Sanitation D. Child Malnutrition E. Child Health F. HIV/AIDS G. Reproductive Health H. Child Rights Appendix A: Tables

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