Bangladesh: Monitoring the situation of children and women: Multiple Indicator Cluster Survey 2006

Publication date: 2007

Bangladesh Monitoring the situation of children and women Multiple Indicator Cluster Survey Volume I: Technical Report Progotir Pathey 2006 2006 Bangladesh Bureau of Statistics Planning Division, Ministry of Planning Government of the People's Republic of Bangladesh United Nations Children's Fund ii PROGOTIR PATHEY 2006 Summary table of findings SUMMARY TABLE OF FINDINGS Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDG) Indicators, Bangladesh, 2006 MICS MDG indicator indicator Topic number number Indicator Value NUTRITION Breastfeeding 45 Timely initiation of breastfeeding 35.6 percent 15 Exclusive breastfeeding rate 37.4 percent 16 Continued breastfeeding rate at 12-15 months 95.4 percent at 20-23 months 89.2 percent 17 Timely complementary feeding rate 51.7 percent 18 Frequency of complementary feeding 48.0 percent 19 Adequately fed infants 43.7 percent Salt iodization 41 Iodized salt consumption 84.3 percent Vitamin A 42 Vitamin A supplementation (under-fives) 89.2 percent 43 Vitamin A supplementation (post-partum mothers) 17.2 percent CHILD HEALTH Immunization 25 Tuberculosis immunization coverage 97.0 percent 26 DPT immunization coverage 90.1 percent 27 Polio immunization coverage 95.6 percent 28 15 Measles immunization coverage 87.5 percent 31 Fully immunized children 84.0 percent 29 Hepatitis B immunization coverage 43.6 percent Tetanus toxoid 32 Neonatal tetanus protection 89.6 Percent Care of illness 33 Use of oral rehydration therapy (ORT) 70.1 percent 34 Home management of diarrhoea 27.7 percent 35 Received ORT or increased fluids, 48.9 percent and continued feeding 23 Care seeking for suspected pneumonia 30.1 percent 22 Antibiotic treatment of suspected pneumonia 21.5 percent Solid fuel use 24 29 Solid fuels (households using solid fuels) 87.6 percent ENVIRONMENT Water and 11 30 Use of improved drinking water sources 97.6 percent sanitation 13 Water treatment 7.4 percent 12 31 Use of improved sanitation facilities 39.2 percent 14 Disposal of child's faeces 22.5 percent Security of tenure 93 Security of tenure 36.4 percent and durability of 94 Durability of housing 7.9 percent housing 95 32 Slum household (having at least one slum condition) 74.0 percent iiiBangladesh Multiple Indicator Cluster Survey 2006 MICS MDG indicator indicator Topic number number Indicator Value REPRODUCTIVE HEALTH Maternal and 20 Antenatal care 47.7 percent newborn health 44 Content of antenatal care Blood test taken 24.5 percent Blood pressure measured 46.2 percent Urine specimen taken 30.1 percent Weight measured 45.1 percent 4 17 Skilled attendant at delivery 20.1 percent 5 Institutional deliveries 16.0 percent CHILD DEVELOPMENT Child 46 Support for learning 47.5 Percent development 47 Father's support for learning 50.3 percent EDUCATION Education 52 Pre-school attendance 14.6 percent 53 School readiness 32.0 percent 54 Net intake rate in primary education 67.4 percent 55 6 Net primary school attendance rate 81.3 percent 56 Net secondary school attendance rate 38.8 percent 58 Transition rate to secondary school 89.1 percent 59 7b Primary completion rate 46.7 percent 61 9 Gender parity index primary school 1.06 ratio secondary school 1.14 ratio Literacy 60 8 Adult literacy rate (female, 15-24 year-olds) 69.9 percent CHILD PROTECTION Birth registration 62 Birth registration 9.8 percent Child labour 71 Child labour 12.8 percent 72 Labourer students 54.9 percent 73 Student labourers 9.2 percent Early marriage 67 Marriage before age 15 33.1 percent and polygyny Marriage before age 18 74.0 percent 68 Young women aged 15-19 currently married/in union 41.9 percent 69 Spousal age difference (10+ years) Women aged 15-19 31.8 percent Women aged 20-24 36.2 percent Disability 101 Child disability (at least one reported disability) 17.5 Percent HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED AND VULNERABLE CHILDREN HIV/AIDS 82 19b Comprehensive knowledge about HIV prevention 15.8 percent knowledge and among young people (female) attitudes 89 Knowledge of mother- to-child transmission of HIV 47.8 percent Support to 75 Prevalence of orphans 5.8 percent orphaned and 78 Children's living arrangements 5.5 percent vulnerable children (not living with a bioloigical parent) 77 20 School attendance of orphans versus non-orphans 0.84 ratio iv PROGOTIR PATHEY 2006 Table of contents TABLE OF CONTENTS SUMMARY TABLE OF FINDINGS .ii TABLE OF CONTENTS .iv LIST OF TABLES .vi LIST OF FIGURES.viii ACRONYMS .ix FOREWARD……………. .xi PREFACE……. .xii MAP OF BANGLADESH .xiii EXECUTIVE SUMMARY.xiv I. INTRODUCTION.1 Background .1 Survey objectives .3 II. SAMPLE AND SURVEY METHODOLOGY .5 Sample Design.5 Questionnaires .6 Training and fieldwork .7 Data processing .7 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS.9 Sample coverage .9 Characteristics of households .9 Characteristics of respondents.14 IV. NUTRITION. .19 Nutritional importance .19 Breastfeeding .19 Salt iodization.26 Vitamin A supplementation .28 V. CHILD HEALTH .33 Immunization .33 Tetanus toxoid .37 Oral rehydration treatment .40 Care seeking and antibiotic treatment of pneumonia .44 Solid fuel use.48 vBangladesh Multiple Indicator Cluster Survey 2006 VI. ENVIRONMENT.53 Water and sanitation .53 Security of tenure and durability of housing.67 VII. REPRODUCTIVE HEALTH .73 Antenatal care .73 Assistance at delivery .78 VIII. CHILD DEVELOPMENT.83 IX. EDUCATION .87 Pre-school attendance and school readiness .87 Primary and secondary school participation .89 Adult literacy.96 X. CHILD PROTECTION.99 Birth registration .99 Child labour .101 Early marriage.104 Child disability .108 Child injury.108 XI. HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED AND VULNERABLE CHILDREN .113 Knowledge of HIV transmission and condom use .113 Orphans and vulnerable children .118 ANNEXURE.122 Annex A: SAMPLE DESIGN.123 Annex B: LIST OF PERSONS INVOLVED IN THE SURVEY .127 Annex C: SAMPLING ERRORS .129 Annex D: DATA QUALITY TABLES.142 Annex E: MICS INDICATORS: NUMERATORS AND DENOMINATORS .151 Annex F: SURVEY QUESTIONNAIRES .154 Annex G: PRIMARY SAMPLING UNITS BY DISTRICT .180 Annex H: MEMBERSHIP OF THE MICS 2006 TECHNICAL COMMITTEE.181 LIST OF REFERENCES .182 vi PROGOTIR PATHEY 2006 List of tables LIST OF TABLES Table HH.1: Results of household and individual interviews .10 Table HH.2: Household age distribution by sex .11 Table HH.3: Household composition.13 Table HH.3.1: Household composition.14 Table HH.4: Women's background characteristics .15 Table HH.5: Children's background characteristics .17 Table NU.1: Initial breastfeeding .20 Table NU.2: Breastfeeding .22 Table NU.3: Adequately fed infants.23 Table NU.3w: Infant feeding patterns .25 Table NU.4: Iodized salt consumption .27 Table NU.5: Children's vitamin A supplementation .30 Table NU.6: Post-partum mother's Vitamin A supplementation .31 Table CH.1: Vaccinations in first year of life .34 Table CH.1c Vaccinations in first year of life (continued) .34 Table CH.2: Vaccinations by background characteristics .35 Table CH.2c: Vaccinations by background characteristics (continued) .36 Table CH.3: Neonatal tetanus protection .39 Table CH.4: Oral rehydration treatment .41 Table CH.5: Home management of diarrhoea .43 Table CH.6: Care seeking for suspected pneumonia .45 Table CH.7: Antibiotic treatment of pneumonia .46 Table CH.7A: Knowledge of the two danger signs of pneumonia.47 Table CH.8: Solid fuel use .49 Table CH.9: Solid fuel use by type of stove or fire .50 Table EN.1: Use of improved water sources .54 Table EN 1a: Tubewells tested/marked for arsenic contamination.55 Table EN.1b: Problems of arsenic contamination.56 Table EN.1c: Protection from arsenic contamination.58 Table EN.2: Household water treatment .60 Table EN.3: Time to source of water .61 Table EN.4: Person collecting water .62 Table EN.5: Use of sanitary means of excreta disposal .64 Table EN.5a: Hand washing after defecation .65 viiBangladesh Multiple Indicator Cluster Survey 2006 Table EN.6: Disposal of child's feaces.66 Table EN.7: Use of improved water sources and improved sanitation.67 Table EN.8: Security of tenure.69 Table EN.9: Durability of housing .70 Table EN.10: Slum housing .71 Table RH.1: Antenatal care provider .74 Table RH.2: Antenatal care content .76 Table RH.3: Assistance during delivery .79 Table RH.4: Place of delivery among women aged 15-49 years with a birth in the two years preceeding the survey .81 Table CD.1: Family support for learning .84 Table ED.1: Early childhood education.88 Table ED.2: Primary school entry .90 Table ED.3: Primary school net attendance ratio .91 Table ED.4: Secondary school net attendance ratio .92 Table ED.4w: Secondary school age children attending primary school .93 Table ED.5: Primary school completion and transition to secondary education.94 Table ED.6: Education gender parity .95 Table ED.7: Adult literacy.97 Table CP.1: Birth registration .100 Table CP.2: Child labour .102 Table CP.3: Labourer students and student labourers .103 Table CP.4: Early marriage.106 Table CP.5: Spousal age difference.107 Table CP.6: Child disability .109 Table CP.7: Child Injury .110 Table CP.7a: Swimming .111 Table HA.1: Knowledge of preventing HIV transmission .114 Table HA.2: Identifying misconceptions about HIV/AIDS.116 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission .117 Table HA.4: Knowledge of mother-to-child HIV transmission .119 Table HA.5: Children's living arrangements and orphanhood .120 Table HA.6: School attendance of orphaned children .121 viii PROGOTIR PATHEY 2006 List of figures LIST OF FIGURES Figure HH.1: Age and sex distribution of household population .12 Figure NU.1: Initial breastfeeding (within one hour and within one day of birth) .21 Figure NU.2: Infant feeding pattern by age .26 Figure NU.3: Households consuming iodized salt.28 Figure NU.4: Children's vitamin A supplementation .31 Figure CH.1: Immunization coverage of children aged 12-23 months.37 Figure CH.2: Neonatal tetanus protection (women with a live birth in last 24 months) .38 Figure CH.3: Percentage of children aged 0-59 with diarrhoea who received ORT or increased fluids, AND continued feeding .42 Figure CH.4: Percentage of children aged 0-59 months in the last two weeks taken to any appropriate health provider .44 Figure EN.1: Household population using sanitary means of excreta disposal .63 Figure RH.1: Antenatal care provider: Any skilled personnel.75 Figure RH.2: Percent of pregnant women receiving ANC one or more times during pregnancy.77 Figure RH.2.1: Antenatal care content .77 Figure RH.3: Type of personnel assisting delivery among women aged 15-49 with a birth in the two years preceeding the survey .80 Figure RH.4: Health facility deliveries among women aged 15-49 years with a birth in the two years preceding the survey .80 Figure HA.1: Comprehensive knowledge of HIV/AIDS transmission .115 ixBangladesh Multiple Indicator Cluster Survey 2006 ACRONYMS ADP Annual Development Program ARI Acute Respiratory Infection BBS Bangladesh Bureau of Statistics BCG Bacillus Calment-Guerin BHIS Bangladesh Health and Injury Survey CDD Control of Diarrhoeal Disease CDDP Control of Diarrhoeal Disease Programme CEDAW Convention on the Elimination of all forms of Discrimination against Women CPS Contraceptive Prevalence Survey CRC Convention on Rights of the Child CSDP Child Survival, Development and Protection CSPro Census and Survey Processing System DHS Demographic and Health Survey DPT Diphtheria, Pertusis, Tetanus EPI Expanded Programme on Immunization FWV Family Welfare Visitor GDP Gross Domestic Product GNI Gross National Income HIES Household Income and Expenditure Survey HDS Health and Demographic Survey HF Home Fluids HH Households HKI Hellen Keller International HNPSP Health, Nutrition and Population Sector Programme HIV/AIDS Human Immune Virus/Acquired Immune Deficiency Syndrome IDD Iodine Deficiency Disorder IMED Implementation, Monitoring and Evaluation Division IMR Infant Mortality Rate IMPS Integrated Multi Purpose Sample IPHN Institute of Public Health and Nutrition ISRT Institute of Statistical Research & Training KCAL Kilo Calorie LG Laban Gur (Mollases + Salt solution) x PROGOTIR PATHEY 2006 Acronyms LPG Liquid Propane Gas MDG Millennium Development Goal MICS Multiple Indicator Cluster Survey MOE Ministry of Education MOHFW Ministry of Health and Family Welfare MOPME Ministry of Primary and Mass Education NCHS National Centre for Health Statistics NID National Immunization Day NPA National Plan of Action OPV Oral Polio Vaccine ORS Oral Rehydration Salt ORT Oral Rehydration Therapy PEDP Primary Education Development Programme ppm Parts Per Million PRS Poverty Reduction Strategy PSU Primary Sampling Unit RD Rural Dispensary RHF Recommended Home Fluids RSO Regional Statistical Officer RW Ring Well SAARC South Asian Association for Regional Cooperation SD Standard Deviation SMA Statistical Metropolitan Area SPSS Statistical Package for Social Sciences STI Sexually Transmitted Infections SVRS Sample Vital Registration System TAPP Technical Assistance Project Performa TBA Traditional Birth Attendant TH Thana Hospital TW Tubewell U5MR Under Five Mortality Rate UN United Nations UNGASS United Nations General Assembly Special Session UNICEF United Nations Children's Fund UNSTAT United Nations Statistics Division WFC World Fit for Children WHO World Health Organization WSC World Summit for Children I am very glad to know that Bangladesh Bureau of Statistics is going to publish the final report of the Multiple Indicator Cluster Survey (MICS), 2006. MICS is an international household survey undertaking initiated by UNICEF. Bangladesh has been conducting MICS since 1993 and the last one was conducted between June and October 2006. The Bangladesh MICS report is published in a document called "Progotir Pathey" (Road to Progress). MICS provides valuable information on the situation of children and women in Bangladesh and is used for monitoring the progress of the goals and targets of the Millennium Declaration adopted by all 191 United Nations member states in September 2001 and the Plan of Action of World Fit for Children adopted by 189 Member states at the United Nations Special Session on Children in May 2002. It may be mentioned that over the years, the content and coverage of MICS increased, MICS is the largest survey undertaking of BBS which generates indicators down to the district level. I express my sincere gratitude to UNICEF for providing technical and financial support to BBS for conducting the survey and publishing the report. My thanks are also due to Mr. A Y M Ekramul Hoque, Director General BBS and Mr. Md. Shamsul Alam, Project Director, Monitoring the Situation of Children and Women (MSCW) and his colleagues for conducting the survey and bringing out the final report within the shortest possible time. The local consulting firm "Mitra and Associates" also deserves special appreciation for field data collection and data entry. Suggestions and comments for improving the survey and report are most welcomed. October 2007 Jafar Ahmed Chowdhury Secretary Planning Division xiBangladesh Multiple Indicator Cluster Survey 2006 FOREWORD xii Preface PREFACE The Bangladesh Bureau of Statistics has been conducting the Multiple Indicator Cluster Survey since 1993 with the technical support of UNICEF. MICS 2006 was conducted during June through October 2006. The MICS 2006 is the ninth survey conducted in Bangladesh. This final report is based on the MICS 2006. A key findings report was published in June 2007. Over the years, the indicators and definitions have changed, thus the MICS is now in its third version (MICS3). More than 50 countries conducted the MICS3 in 2005-2006, which was monitored and coordinated by the global MICS team at UNICEF headquarters. MICS 2006 was conducted in 1,950 Primary Sampling Units (PSUs) and covered as many as 62,463 households throghout the country. For sampling purpose, the whole country was divided into five strata, namely municipal, city corporation, rural, slum and tribal areas. The number of PSUs was 384 in municipal areas, 156 in city corporations, 1,280 in rural areas, 52 in slums and 78 in tribal areas. Each PSU was an enumeration area of population Census 2001 and comprising around 100 households. From each PSU 35 households were selected systematically for enumeration. The data collection and entry was done by the local consulting firm, Mitra and Associates, with close supervision and guidance from the Bangladesh Bureau of Statistics. The report is prepared by a team led by the Project Director, Monitoring the Situation of Children and Women (MSCW) Project, Mr. Md. Shamsul Alam. Dr. Nawshad Ahmed, Planning Officer, Ms. Deqa Ibrahim Musa, Monitoring and Evaluation Specialist, Ms. Misaki Ueda, Chief Planning, Monitoring and Evaluation Section of UNICEF provided technical support for preparing this report. Messrs. Alamgir Hossain, Mizanur Rahman Khandaker and Ms. Delwara Begum, Statistical Officers of BBS also helped in the preparation of the report. Mr. S. M. Anwar Husain, Statistical Assistant with the MSCW Project handled the tabulations and data processing. All of them deserve special thanks. The members of the technical committee also provided valuable inputs towards finalizing this report. Special thanks are also due to the MICS global team at UNICEF New York, Mr. Attila Hancioglu, Ms. Emma Holmberg, Ms. Rhiannon James and Mr. Ngagne Diakhate, for their independent review and validation of the survey findings. The report covers a wide range of issues pertaining to child health and nutrition, reproductive health, child development, child protection, early marriage, orphanhood and child disability. It is presented in two volumes: Volume I is the full technical report, while Volume II presents the district data. We hope the findings of this report will be very useful to the planners, researchers and policy makers of different institutions for developing appropriate measures to improve the lives of children and women in Bangladesh. October 2007 A Y M Ekramul Hoque Director General Bangladesh Bureau of Statistics 26 Number of PSUs 27 - 56 78 Panchgarh Pabna Nilphamari Lalmonirhat Naogaon Joypurhat Kurigram Dinajpur Gaibandha Bogra Gazipur Bandarban Patuakali Jhalkathi Natore Nawabganj Barguna Bhola Barisal Satkhira Jhenaidah Khulna Kushtia Magura Baherhat Chuadanga Jessore Meherpur Faridpur Dhaka Madaripur Kishoreganj Jamalpur Gopalganj Munshiganj Manikganj Netrokona Mymensingh Narayanganj Sherpur Tangail Rajbari Shariatpur Moulvi Bazar Sunamganj Habiganj Sylhet Pirojpur Chandpur Brahmanbaria Comilla Chittagong Feni Cox's Bazar Lakshmipur Khagrachhari Noakhali Rangamati Narail Narsingdi Thakurgaon Sirajganj Rangpur Rajshahi xiiiBangladesh Multiple Indicator Cluster Survey 2006 MAP OF BANGLADESH Map of Bangladesh showing the location and number of sample areas xiv PROGOTIR PATHEY 2006 Executive summary EXECUTIVE SUMMARY The Bangladesh Bureau of Statistics conducted the Multiple Indicator Cluster Survey (MICS) between June and October 2006. The main objective of the survey was to provide up-to-date information for assessing the situation of children and women in Bangladesh. The survey also aimed at furnishing data needed for monitoring progress towards goals established by the MDGs, the goals of A World Fit For Children, and other internationally agreed upon goals, as a basis for future action; as well as contributing to the improvement of data and monitoring systems in Bangladesh and strengthening technical expertise in the design, implementation, and analysis of such systems. A total of 62,463 households were surveyed. Questionnaires were completed for 1) households, 2) women aged 15-49 and 3) mothers or caretakers of under-five children. Breastfeeding Nationally, 37.4 percent of children aged less than six months were being exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 51.7 percent of children were receiving breast milk and solid or mushy food. By age 12-15 months, 95.4 percent of children were still being breastfed and by age 20-23 months, 89.2 percent were still breastfed. Girls were more likely to be exclusively breastfed than boys. More girls than boys also received timely complementary feeding. Salt iodization In the interviewed households, salt used for cooking was tested for iodine content using an iodine testing solution. The iodine testing solution is a quantitative test and cannot detect whether the salt is adequately iodized or not. The MICS 2006 found that in 84.3 percent of Bangladeshi households salt was found to contain 10 parts per million (PPM) or more of iodine. There is a 10 percent variation between urban and rural areas in the consumption of iodized salt, while it was greater between the richest and poorest households at about 20 percent. Vitamin A supplementation Vitamin A supplementation of children aged 9-59 months within the six months prior to the survey stands at 89.2. On the other hand, only 17.2 percent of mothers with a birth in the previous two years before the MICS received a Vitamin A supplement within eight weeks of the birth. There is significant rural-urban variation in Vitamin A supplementation of women with 15 percent in rural areas and 28.1 percent in City Corporations. Immunization In Bangladesh 84 percent of children aged 12-23 months are fully immunized. Dropouts are seen but are not so marked for the series of DPT and Polio immunizations. DPT immunization coverage xvBangladesh Multiple Indicator Cluster Survey 2006 declines from 96.6 percent in the first dose to 90.1 percent by the third dose. Similarly, Polio coverage falls from 99.1 percent in Polio 1 to 95.6 percent by Polio 3. Measles immunization coverage is lower than the other antigens at 87.5 percent. Oral rehydration treatment Nationally, 7.1 percent of under five children had diarrhoea in the two weeks preceding the survey. The incidence of diarrhoea is higher in boys than girls. Several districts, namely, Bhola, Bandarban, Jamalpur and Lalmonirhat had recorded above 12 percent rate of diarrhoea. The peak of diarrhoea prevalence occurs in the weaning period, among children age 6-23 months. The incidence was 11.1 percent in the age group 6-11 months and 10.1 percent in the age group 12-23 months. ORT use rate nationally was 70.1 percent. More than one third (41.1 percent) of under five children with diarrhoea drank more than usual, while 58.2 percent drank the same or less. Slightly more than sixty-six percent ate somewhat less, the same or more (continued feeding), but 33.2 percent ate much less or ate almost none. Given these figures, 48.9 percent children received increased fluids and at the same time continued feeding. About 27.7 percent of households practiced home management of diarrhoea. Care seeking and antibiotic treatment of pneumonia Nationally, 5.3 percent of children aged 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 30.1 percent were taken to an appropriate health care provider. Only 21.5 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Overall, 15.7 percent of women know of the two danger signs of pneumonia - fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility was fever (82.7 percent). Water and sanitation Overall, 97.6 percent of the population had access to improved drinking water sources - 99.2 percent in urban areas and 97.1 percent in rural areas. Only 39.2 percent of the population of Bangladesh lived in households using improved sanitation facilities. This percentage is 68.8 percent in City Corporations, 57.8 percent in urban areas and 31.9 percent in rural areas. Only 22.5 percent of mother's/caretakers dispose of their child’s faeces safely. Security of tenure In urban areas, more than one third (35.1 percent) of households did not have formal documentation for the residence, and 7.9 percent of respondents to the household questionnaire indicated that there is a risk of eviction. Combining these figures, it is observed that 36.4 percent of households do not have security of tenure. In urban slums, the situation was the worst with 89.4 percent of households not having formal documentation for the residence, and 24.7 percent of households respondents believed there was a risk of eviction. xvi PROGOTIR PATHEY 2006 Executive summary Antenatal care Coverage of antenatal care (by a doctor, nurse, or midwife) is relatively low in Bangladesh with 47.7 percent of women receiving antenatal care by a skilled attendant at least once during the pregnancy. The lowest level of antenatal care was in the tribal areas. Assistance at delivery The proportion of births delivered by skilled health personnel is very low in Bangladesh at 20.1 percent. Of these, doctors delivered 15.5 percent while 4.6 percent of the births in the two year's prior to the survey were delivered by a midwife or nurse Child development For almost half (47.5 percent) of under-five children surveyed, an adult engaged in more than four activities that promote learning and school readiness during the three days preceding the survey The average number of activities that adults engaged with children was 3.4. Nationally, 8.4 percent of children were living in a household without their natural fathers. Pre-school, primary and secondary school attendance Only 14.6 percent of children aged 36-59 months attended pre-school. Similarly, secondary school attendance was quite low with about 39 percent of secondary school-age children attending secondary schools. On the other hand primary school attendance was relatively high in Bangladesh with 81.3 percent of primary school age children attending primary school. Adult literacy More than two-thirds (69.9 percent) of Bangladeshi women aged 15-24 years were literate. Variations between geographic areas were noticeably evident with slum areas reporting a literacy rate of 38.2 percent for women in the same age group. Birth registration In Bangladesh birth registration remains very low with only about 10 percent of under-five births having been registered. Child labour Nationally, child labour prevalence was found to be 12.8 percent. Of them, 7.5 percent were working in a family business. There was significant male-female variation in child labour, with 17.5 percent of males and 8.1 percent of females involved in child labour. Early marriage Early marriage is common in Bangladesh: 33.1 percent of women aged 15-49 years were married before their 15th birthday and 74 percent of women aged 20-49 were married before their 18th birthday. There are wide variations between divisions: Rajshahi has the highest rate of marraige before a woman turned 18 (81.4 percent) compared to Sylhet (57.6 percent). xviiBangladesh Multiple Indicator Cluster Survey 2006 Child disability Nationally, 17.5 percent of children aged between two and nine years had at least one reported disability. Child injury Injury is one of the leading causes of child death in Bangladesh. The MICS 2006 found 6.5 percent of children under 18 years suffered from some form of injury. Knowledge of HIV Only 15.8 percent of young women (15-24 age group) have comprehensive knowledge of HIV. The level of education and residence were highly associated with knowledge of HIV. Orphans and vulnerable children In Bangladesh, 5.8 percent of the children below 18 years have either one or both parents dead. The proportion of children under 18 years not living with a biological parent was 5.5 percent: 2.9 percent male and and 8.3 percent female. xviii PROGOTIR PATHEY 2006 © Anwar, BBS 1Bangladesh Multiple Indicator Cluster Survey 2006 I. INTRODUCTION Background This report is based on the Bangladesh Multiple Indicator Cluster Survey 2006, conducted by the Bangladesh Bureau of Statistics in association with Mitra and Associates and funded by UNICEF Bangladesh. The survey provides valuable information on the situation of children and women in Bangladesh, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children (WSC). In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: "We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child- focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning." (A World Fit for Children, paragraph 60) 2 PROGOTIR PATHEY 2006 Introduction By taking active participation in the WSC in 1990, ratifying the Convention on the Rights of the Child (CRC) in 1992, the Optional Protocols in 2000, participating in the preparation of the World Fit for Children (WFFC) and endorsing it in the United Nations Special Session on Children in May 2002, Bangladesh is a strong supporter of the Global Movement for Children. Along with the global agenda, a South Asian agenda emerged through the South Asian Association for Regional Cooperation (SAARC) summit declarations and regional meetings, with a long-term vision and plans of action. The Colombo Resolution 1992 and Rawalpindi Resolution 1996, form the basis of the regional agenda along with the Declaration of the Eleventh SAARC Summit held in January 2002. Bangladesh has been responding to its commitment to children through its development programme, policies and legal provisions. The Children Act 1974 and Children Rules 1976 are the principal instruments for establishing child rights in Bangladesh. They are complemented by the Compulsory Primary Education Policy 1990 and other policies related to health, service delivery and more than 40 specific laws protecting the rights and wellbeing of children. The Government formulated a third National Plan of Action (NPA) for Children (2005-2010) to reflect the aims of the Poverty Reduction Strategy (PRS), Health, Nutrition and Population Sector Programme (HNPSP), and second Primary Education Development Programme (PEDP2). The Government has been keen to create a more comprehensive monitoring system to capture the results for children and women and get an idea about the quality of investment. A strong database is "…We will conduct periodic reviews at the national and sub national levels of progress in order to address obstacles more effectively and accelerate actions.…" (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: "… As the world's lead agency for children, the United Nations Children's Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action." Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: "…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action." 3Bangladesh Multiple Indicator Cluster Survey 2006 needed for this. Monitoring progress will ensure greater realization of the rights of children and women. More systematic data collection on selected indicators and impact results will be institutionalized. Surveys like the MICS, Demographic and Health Survey (DHS), Sample Vital Registration System (SVRS) and Child Nutrition Survey will be continued for getting reliable data and situation reports. This will form the basis for learning, consultation, dialogue and Annual Development Programme (ADP) priority selection. This final report presents the results of the indicators and topics covered in the survey. Survey objectives The following objectives guided the Bangladesh Multiple Indicator Cluster Survey 2006: To provide up-to-date information for assessing the situation of children and women in Bangladesh; To furnish data needed for monitoring progress towards goals established by the MDGs, the goals of A World Fit For Children (WFFC), and other internationally agreed upon goals, as a basis for future action; To contribute to the improvement of data and monitoring systems in Bangladesh and to strengthen technical expertise in the design, implementation, and analysis of such systems. 4 PROGOTIR PATHEY 2006 © Anwar, BBS 5Bangladesh Multiple Indicator Cluster Survey 2006 Sample Design The sample for the Bangladesh Multiple Indicator Cluster Survey (MICS) was designed to provide estimates on a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for all six Divisions, six city corporations, 64 Districts, urban slums in two large metropolitan cities and tribal areas. For the sampling purpose the whole country was divided into five strata: municipal, city corporation, rural, slum and tribal area. Municipal: Those areas where there were municipalities counted in the 2001 Census. The municipal areas declared after the Census were considered as rural areas. The six city corporation areas were not considered under municipal areas. City Corporation: Also called metro cities are six in number, namely Dhaka, Chittagong, Rajshahi, Khulna, Sylhet and Barisal. Dhaka and Chittagong city corporations are divided into slum and non- slum areas while other city corporations are classified as non-slum areas. Rural: The whole geographic area of the country, excluding municipal areas and city corporations is considered rural. Slum: The Slum Survey conducted by BBS in 1997 was used as a sampling frame to select slum areas which are located in Dhaka and Chittagong. Tribal: Tribal areas were taken from the three divisions of Dhaka, Chittagong and Rajshahi where tribal populations are residing. The mauza/mahallas (lowest administrative unit with a boundary) in these divisions having tribal population were considered as the domain for the selection of the primary sampling units (PSUs) from these areas. From these strata 1,950 PSUs were selected using the probability proportional to size (PPS) method. PSUs are the enumeration areas of the Census 2001 comprising around 100 households. The number of PSUs was 1,280 from rural areas, 384 from municipalities, 156 from city corporations, 52 from slums and 78 from tribal areas. After a household listing was carried out within the selected enumeration areas, a systematic sample of 35 households was drawn. All the selected enumeration areas were visited during the fieldwork period. The sample was stratified by region and is not self- weighting. For reporting national level results, sample weights were used. II. SAMPLE AND SURVEY METHODOLOGY 6 PROGOTIR PATHEY 2006 Sample and survey methodology Questionnaires MICS 2006 had three questionnaires. These were: 1) household questionnaire, 2) questionnaire for individual women aged 15-49, and 3) questionnaire for under-five children. These questionnaires were prepared following the global questionnaire set for MICS though tailored to the specifics of the Bangladesh context. The questionnaires included the following modules: Household questionnaire: This questionnaire included modules for the household information panel, household listing form, education, water and sanitation, households characteristics, security of tenure and durability of housing, child labour, disability, salt iodization, and orphaned and vulnerable children. Questionnaire for individual women: Bangladesh included modules for the women's information panel, tetanus toxoid, maternal and newborn health, marriage/union, attitude towards domestic violence, and HIV/AIDS. Questionnaire for under-five children: Bangladesh included the modules for under-five child information panel, child development, birth registration and early learning, vitamin A, breastfeeding, care of illness, and immunization. The questionnaires of MICS 2006 were based on the global format of MICS3 model questionnaire. From the MICS3 model English version, the questionnaires were translated into Bangla and were pre-tested in four sample areas of which two were in rural areas, one in City Corporation and one in the slum area during May 2006. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. The questionnaire for under-five children was administered to mothers or caretakers of under-five children1 living in the households. Normally, the questionnaire was administered to mothers of under- five children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. In addition to the administration of questionnaires, survey teams tested household salt used for cooking for iodine content. In these tests an iodine testing solution was used to detect whether or not iodine was present in the salt. The iodine testing solution is therefore a quantitative test and cannot detect whether the salt is adequately iodized or not. The table below gives the list of areas where pre-tests were held before finalizing the questionnaires. Area District Thana Rural Dhaka Ghior Rural Narayanganj Sonargaon Urban Dhaka SMA Pallabi Slum Dhaka Kamrangirchar 1 The terms "under-5 children", "children aged 0-4 years", and "children aged 0-59 months" are used interchangeably in this report. 7Bangladesh Multiple Indicator Cluster Survey 2006 Training and fieldwork The field staff were trained for eight days in early June 2006. The data were collected by 32 teams; each comprised of four interviewers and a supervisor. There was one quality control officer for every two teams of enumerators: two female and two male. Field work began on June 20 and concluded on 8 October, 2006. Data processing Data were entered on twelve microcomputers using the CSPro software. In order to ensure quality control, all questionnaires were doubly entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS3 project and adapted to the Bangladesh questionnaire were used throughout. Data processing began simultaneously with data collection in July and finished in December 2006. Data were analysed using the SPSS software program and the model syntax and tabulation plans developed for this purpose. 8 PROGOTIR PATHEY 2006 © Anwar, BBS 9Bangladesh Multiple Indicator Cluster Survey 2006 Sample coverage Of the 68,247 households selected and tested for the sample, 67,540 were occupied. Of them, 62,463 households were successfully interviewed for a household response rate of 92.5 percent. Within those interviewed households, 78,260 of the eligible females (aged 15-49) were identified. Of them, 69,860 women were successfully interviewed, yielding a response rate of 89.3 percent. The women's response rate was lowest in the slum area and was attributed to non-availability of respondents: eligible women were away working at the time of the interview. The household interviews identified 34,710 under-5 children; questionnaires were completed for 31,566 of them, a response rate of 90.9 percent. Overall, the individual women’s questionaire had a response rate of 82.6 percent and the under-5 questionnaire had a rate of 84.1 percent (Table HH.1). Characteristics of households Table HH.2 shows the age and sex distribution of the surveyed population, as does the population pyramid in Figure HH.1. The average household size was 4.83 persons. The surveyed population indicates a sex ratio of 102, which is lower than the national sex ratio of 106.6 in the 2001 census. The proportion of the MICS population aged 0-4 year was 11.6 percent (11.8 percent male and 11.4 percent female), while the 2001 census reported it larger, at 13.0 percent (13.1 percent male and 12.9 percent female). This could indicate fertility reduction in recent years. The proportion of the MICS population aged 0-14 years was 35.5 percent (35.8 percent male and 35.1 percent female), while the 2001 census recorded it again larger, at 39.4 percent, (40.1 percent male and 38.6 percent female. The MICS found a demographic dependency ratio2 of 67.2 percent (70.0 percent male and 64.2 percent female) compared to the 76.4 percent of the 2001 census 2001 (79.5 percent male and 73 percent female). 2 Dependency ratio is defined as the ratio of the population aged 0-14 years and 65+ to the population aged 15-64 years. III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 10 PROGOTIR PATHEY 2006 Sample coverage and the characteristics of households and respondents Ta bl e HH .1 : R es ul ts o f h ou se ho ld a nd in di vi du al in te rv ie ws Th e nu m be rs o f h ou se ho ld s, w om en a nd u nd er - 5 c hi ld re n, b y ea ch o f t he th re e ty pe s of re sp on de nt in te rv ie w s an d th ei r r es po ns e ra te , Ba ng la de sh , 2 00 6 Sa m ple d ho us eh old s 44 79 7 13 44 0 54 59 18 20 27 31 63 70 12 74 0 18 20 0 10 01 0 16 37 8 45 49 68 24 7 Oc cu pie d ho us eh old s 44 43 7 13 31 1 53 57 17 56 26 79 63 06 12 53 2 17 98 1 99 54 16 27 5 44 92 67 54 0 In te rv iew ed h ou se ho lds 41 34 2 12 26 2 48 51 15 27 24 81 58 25 11 46 4 16 44 5 93 18 15 21 2 41 99 62 46 3 Ho us eh old re sp on se ra te (% ) 93 .0 92 .1 90 .6 87 .0 92 .6 92 .4 91 .5 91 .5 93 .6 93 .5 93 .5 92 .5 El igi ble w om en (1 5- 49 y ea rs ) 50 68 5 16 11 4 67 56 19 64 27 41 70 65 15 20 1 20 21 1 11 41 1 18 30 6 60 66 78 26 0 In te rv iew ed w om en 45 08 5 14 50 3 61 57 17 09 24 06 62 80 13 50 9 17 95 5 10 28 8 16 51 4 53 14 69 86 0 W om en ’s re sp on se ra te (% ) 89 .0 90 .0 91 .1 87 .0 87 .8 88 .9 88 .9 88 .8 90 .2 90 .2 87 .6 89 .3 W om en 's ov er all re sp on se ra te 82 .8 82 .9 82 .5 75 .7 81 .3 82 .1 81 .3 81 .2 84 .4 84 .3 81 .9 82 .6 El igi ble c hil dr en u nd er 5 24 10 7 63 20 22 50 86 2 11 71 29 49 75 51 90 80 43 98 74 53 32 79 34 71 0 M ot he r/C ar et ak er In te rv iew ed 21 81 3 57 96 20 83 78 6 10 88 26 72 67 98 82 78 40 41 68 32 29 45 31 56 6 Un de r-5 re sp on se ra te (% ) 90 .5 91 .7 92 .6 91 .2 92 .9 90 .6 90 .0 91 .2 91 .9 91 .7 89 .8 90 .9 Un de r-5 o ve ra ll r es po ns e ra te (% ) 84 .2 84 .5 83 .8 79 .3 86 .0 83 .7 82 .4 83 .4 86 .0 85 .7 84 .0 84 .1 Ba ck gr ou nd c ha ra cte ris tic s Ar ea Di vis ion Na tio na l Ru ra l Ur ba n (M un ici pa lity ) Ur ba n slu m Tr iba l Ba ris al Ch itta go ng Dh ak a Kh uln a Ra jsh ah i Sy lhe t Ur ba n no n- slu m (C ity co rp or at ion ) 11Bangladesh Multiple Indicator Cluster Survey 2006 Table HH.2: Household population’s age distribution, by sex Percentage distribution of the household population by five-year age groups and dependency age groups, and the number of children aged 0-17 years, by sex, Bangladesh, 2006 Age 0-4 17924 11.8 16984 11.4 34908 11.6 5-9 18697 12.3 18228 12.2 36925 12.2 10-14 17955 11.8 17261 11.6 35216 11.7 15-19 16437 10.8 17948 12.0 34385 11.4 20-24 12032 7.9 14706 9.8 26738 8.9 25-29 11056 7.3 12411 8.3 23467 7.8 30-34 9485 6.2 10117 6.8 19602 6.5 35-39 10239 6.7 9637 6.4 19876 6.6 40-44 8533 5.6 7239 4.8 15772 5.2 45-49 7688 5.0 6551 4.4 14239 4.7 50-54 5738 3.8 4741 3.2 10478 3.5 55-59 4217 2.8 3966 2.7 8184 2.7 60-64 4092 2.7 3684 2.5 7776 2.6 65-69 2596 1.7 1937 1.3 4533 1.5 70+ 5632 3.7 3995 2.7 9627 3.2 Missing/DK 0 '(*)' 4 '(*)' 4 '(*)' Dependency <15 54576 35.8 52474 35.1 107050 35.5 age groups 15-64 89517 58.8 91000 60.9 180517 59.8 65+ 8228 5.4 5933 4.0 14161 4.7 Missing/DK 0 '(*)' 4 '(*)' 4 '(*)' Age Children aged 0-17 years 64406 42.3 63104 42.2 127509 42.3 Adults 18+/Missing/DK 87916 57.7 86307 57.8 174223 57.7 Total 152322 100.0 149410 100.0 301732 100.0 * An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Note: DK= Doesn’t know Background characteristics Sex Total Male Female Female Percent No. Percent No. Percent 12 PROGOTIR PATHEY 2006 Sample coverage and the characteristics of households and respondents Figure HH.1: Age and sex distribution of household population, Bangladesh, 2006 8 7 6 5 4 3 2 1 0 0 1 2 3 4 5 6 7 8 70+ 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Age in Year Percent Male Female Table HH.3 provides basic background information on the surveyed households: Within households, the sex of the household head, division, urban/rural status, number of household members, and religion of the household head are shown in the table. These background characteristics are also used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. 13Bangladesh Multiple Indicator Cluster Survey 2006 Table HH.3: Household composition Percentage distribution of households by selected characteristics, Bangladesh, 2006 Sex of household head Male 91.0 56822 56911 Female 9.0 5641 5552 Division Barisal 6.3 3909 5825 Chittagong 17.6 11015 11464 Dhaka 32.4 20219 16445 Khulna 12.0 7465 9318 Rajshahi 26.3 16432 15212 Sylhet 5.5 3423 4199 Area Rural 70.0 43735 41342 Urban 29.0 18138 18640 Urban municipality 20.7 12925 12262 City Corporations 8.3 5213 6378 Non-slum 7.7 4793 4851 Slum .7 420 1527 Tribal .9 590 2481 Religion of household head Islam 89.1 55638 52770 Hindu 9.6 5993 6937 Christian .4 237 1111 Buddhist .9 590 1634 Other/no religion/missing '(*)' 5 11 Number of household members 1 1.9 1209 1214 2-3 23.1 14439 14386 4-5 45.1 28187 28246 6-7 20.9 13035 13083 8-9 6.0 3751 3742 10+ 2.9 1841 1792 Total 100.0 62463 62463 * An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Background characteristics Weighted percent No. of households weighted No. of households unweighted 14 PROGOTIR PATHEY 2006 Sample coverage and the characteristics of households and respondents Characteristics of respondents Tables HH.4 and HH.5 provide information on the background characteristics of female respondents aged 15-49 years of age and of under-5 children. In both tables, the total numbers of weighted and un-weighted observations are equal because the sample weights have been standardized. In addition, the table shows the numbers of observations in each background category, which are used in subsequent tabulations throughout this report. Table HH.4 includes information on the distribution of women by division, urban-rural area, age, marital status, motherhood status, education4, wealth index quintiles5, and ethnicity. Of the total women respondents aged 15-49, 67.9 percent lived in a rural area and 31.2 percent in an urban area. Among the urban residents, 21.9 percent lived in a municipality and 9.4 percent in a city corporation. And among the city corporations. 8.7 percent of the women respondents lived in a non- slum area and 0.7 percent lived in a slum. 4 Unless otherwise stated, ‘education’ refers to the educational level attended by the respondent (when it is used as a background variable). 5 A principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to each household asset and thus obtain wealth scores for each household in the sample. The assets and other facilities used in these calculations were as follows: persons per sleeping room, type of floor, roof, wall, cooking fuel; source of drinking water and sanitary facility; items requiring electricity connection such as radio, television, mobile telephone, non-mobile phone, refrigerator, electric fan, computer, washing machine and air conditioner; watches, bicycle, motorcycle/scooter, animal-drawn cart, car/truck, boat with motor, sofa and rickshaw/van). Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, and Filmer and Pritchett, 2001. Table HH.3.1: Household composition Percentage distribution of households by selected characteristics, Bangladesh, 2006 At least one child aged < 18 years 85.9 62463 62463 At least one child aged < 5 years 44.6 62463 62463 At least one woman aged 15-49 years 92.4 62463 62463 Weighted percent No. of households weighted No. of households unweighted Background characteristics 15Bangladesh Multiple Indicator Cluster Survey 2006 Table HH.4: Women's background characteristics Percentage distribution of women aged 15-49 years by background characteristics, Bangladesh, 2006 Division Barisal 6.0 4172 6280 Chittagong 19.1 13372 13509 Dhaka 32.1 22404 17955 Khulna 11.6 8124 10288 Rajshahi 24.9 17394 16514 Sylhet 6.3 4393 5314 Area Rural 67.9 47449 45085 Urban 31.2 21807 22369 Urban municipality 21.9 15267 14503 City Corporations 9.4 6540 7866 Non-slum 8.7 6067 6157 Slum .7 473 1709 Tribal .9 604 2406 Age 15-19 21.9 15284 15020 20-24 18.1 12630 12733 25-29 16.0 11151 11160 30-34 13.4 9376 9395 35-39 12.7 8853 8951 40-44 9.5 6627 6673 45-49 8.5 5939 5928 Marital/Union status Currently married/in union 78.6 54933 54830 Formerly married/in union 5.6 3915 3920 Never married/in union 15.8 11012 11110 Motherhood status Ever gave birth 90.4 53175 53128 Never gave birth 9.6 5673 5622 Education None 34.1 23812 23895 Primary incomplete 13.8 9669 10004 Primary completed 11.9 8286 8241 Secondary incomplete 27.1 18917 18838 Secondary completed or higher 12.8 8923 8663 Non-standard curriculum .4 247 215 Missing/DK '(*)' 6 4 Wealth index quintiles Poorest 18.3 12818 12580 Second 19.1 13359 13677 Middle 19.8 13821 14246 Fourth 20.4 14241 14633 Richest 22.4 15622 14724 Total 100.0 69860 69860 * An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Background characteristics Weighted percent No. of women weighted No. of women unweighted 16 PROGOTIR PATHEY 2006 Sample coverage and the characteristics of households and respondents The largest segment of individual women respondents (21.9 percent) were in the youngest age grouping of 15-19 years, followed by those in the 20-24 age group (18.1 percent), the 25-29 age group (16 percent), 30-34 age group (13.4 percent), 35-39 age group (12.7 percent), 40-44 age group (9.5 percent), and then the 45-49 year-olds (8.5 percent). A large portion of the women respondents (aged 15-49) were married, at 78.6 percent; 5.6 percent of them were formerly married and 15.8 percent had never married. Slightly more than 90 percent of them had given birth at least once, while 9.6 percent of them had not. In terms of education, 34.1 percent of them had never been to school, while 13.8 percent had at least spent a few years in primary school (but dropping out). Another 11.9 percent had completed their primary education. Some 27.1 percent of them had not completed secondary school, while 12.8 percent had. Breaking the individual women respondents down by wealth index, 18.3 percent were the poorest, 19.1 percent were in the second quintile, 19.8 percent were in the middle quintile and 22.4 percent were in the richest quintile. Regarding the surveyed under-5 children (Table HH.5), 73 percent lived in rural areas, 26.2 percent resided in urban areas and 0.8 percent in the tribal areas. Among the urban residents 19.2 percent were in municipalities, while 7 percent were in city corporations. And within the city corporations, 6.4 percent lived in a non-slum community and 0.7 percent were in a slum. By age-group breakdown, 7.3 percent of them were younger than 6 months, 10.7 percent were 6-11 months old, 19.1 percent were 12-23 months old, 20 percent were 24-35 months old, 21.5 percent were 36-47 months old, and 21.4 percent were 48-59 months old. 17Bangladesh Multiple Indicator Cluster Survey 2006 Table HH.5: Children’s background characteristics Percentage distribution of under-5 children by background characteristics, Bangladesh, 2006 Sex Male 51.4 16222 16259 Female 48.6 15344 15307 Division Barisal 5.9 1873 2672 Chittagong 21.5 6797 6798 Dhaka 31.5 9942 8278 Khulna 10.0 3148 4041 Rajshahi 23.1 7284 6832 Sylhet 8.0 2521 2945 Area Rural 73.0 23034 21813 Urban 26.2 8280 8665 Urban municipality 19.2 6061 5796 City Corporations 7.0 2219 2869 Non-slum 6.4 2009 2083 Slum .7 210 786 Tribal .8 253 1088 Age < 6 months 7.3 2302 2300 6-11 months 10.7 3367 3374 12-23 months 19.1 6032 6079 24-35 months 20.0 6320 6281 36-47 months 21.5 6789 6764 48-59 months 21.4 6751 6764 Mother's education None 35.6 11224 11338 Primary incomplete 15.8 4997 5154 Primary completed 12.9 4084 4079 Secondary incomplete 25.2 7948 7877 Secondary completed or higher 10.2 3204 3022 Non-standard curriculum .3 106 94 Missing/DK .0 2 2 Wealth index quintiles Poorest 25.3 7987 7798 Second 21.0 6615 6794 Middle 18.7 5918 6147 Fourth 18.5 5854 5931 Richest 16.4 5192 4896 Total 100.0 31566 31566 Background characteristics Weighted percent No. of under-5 children weighted No. of under-5 children unweighted 18 PROGOTIR PATHEY 2006 ©UNICEF/Naser Siddique 19Bangladesh Multiple Indicator Cluster Survey 2006 Nutritional importance Children's nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of all children deaths worldwide. Undernourished children are more likely to die from common childhood ailments; and those who survive experience recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition have been characterized as only mildly or moderately malnourished - showing no outward sign of their vulnerability. The MDG target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. The World Fit for Children goal is to reduce the prevalence of malnutrition among children under five years of age by at least one-third (between 2000 and 2010), with special attention to children under two years of age. A reduction in the prevalence of malnutrition will assist in the goal to reduce child mortality. Breastfeeding Breastfeeding for the first two 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 micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for six months and continue to be breastfed with safe, appropriate and adequate complementary feeding up to age two and even beyond. The World Health Organization (WHO) and UNICEF jointly recommend: Exclusive breastfeeding for the first six months of life Continued breastfeeding for two years or more Safe, appropriate and adequate complementary foods beginning at six months Frequency of complementary feeding: two times per day for babies aged 6-8 months and three times per day for 9-11 months. IV. NUTRITION 20 PROGOTIR PATHEY 2006 Nutrition Table NU.1: Initial breastfeeding Percentage of individual women respondents aged 15-49 years who had given birth in the two years preceding the survey, who breastfed their baby within one hour of birth and within one day of birth, Bangladesh, 2006 Division Barisal 41.9 82.7 738 Chittagong 32.4 83.1 2554 Dhaka 36.5 79.9 3697 Khulna 32.7 80.9 1145 Rajshahi 34.3 79.0 2740 Sylhet 42.3 89.7 1024 Area Rural 35.5 81.7 8757 Urban 36.0 81.0 3040 Urban municipality 37.0 82.3 2230 City Corporations 33.1 77.5 811 Non-slum 33.0 77.3 729 Slum 34.5 79.1 81 Tribal 29.9 78.9 101 Months since last birth < 6 months 34.6 79.0 2352 6-11 months 37.1 81.8 3443 12-23 months 35.2 82.3 6104 Education None 32.8 79.9 3730 Primary incomplete 34.6 83.1 1892 Primary completed 38.1 82.3 1551 Secondary incomplete 37.5 82.0 3429 Secondary completed or higher 36.9 81.3 1260 Non-standard curriculum (40.6) (85.1) 38 Wealth index quintiles Poorest 34.0 80.8 2908 Second 34.5 80.4 2535 Middle 35.6 82.8 2230 Fourth 38.2 82.5 2238 Richest 36.5 81.3 1989 Total 35.6 81.5 11899 * MICS indicator 45 Figures in parenthesis are based on 25-49 unweighted cases. Background characteristics Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth No. of women with live birth in the two years preceding the survey 21Bangladesh Multiple Indicator Cluster Survey 2006 The WHO and UNICEF also recommended that breastfeeding be initiated within one hour of birth. The indicators for recommended child-feeding practices are as follows: Exclusive breastfeeding rate (< 6 months and < 4 months) Timely complementary feeding rate (6-9 months) Continued breastfeeding rate (12-15 and 20-23 months) Timely initiation of breastfeeding (within 1 hour of birth) Frequency of complementary feeding (6-11 months) Adequately fed infants (0-11 months). Table NU.1 shows the proportion of mothers who started breastfeeding their infants within one hour of birth, and mothers who started breastfeeding within one day of birth (which includes those who started within one hour). Nationally, 35.6 percent of infants in the MICS were breastfed within one hour of birth and 81.5 percent of them within one day of birth. There is no significant variation between divisions or socio-economic status in the early initiation of breastfeeding except in the tribal areas where 29.9 percent of infants were breastfed within one hour of birth. However, in several districts, Lakshimipur, Jessore, Gaibandha, Rangpur and Thakurgaon, more mothers had delayed the start of breastfeeding (see Table NU.1.1 in Volume II). Figure NU.1: Initial breastfeeding (within one hour and within one day of birth) Bangladesh, 2006 Ba ris al Within one hour Pe rc en t Ch itta go ng Dh ak a Kh uln a Ra jsh ah i Sy lhe t Ru ra l Ur ba n Ur ba n m un ici pa lity Ci ty co rp or at ion No n- slu m Sl um Tr iba l Co un try 100 90 80 70 60 50 40 30 20 10 0 Within one day 41.9 32.4 36.5 32.7 34.3 42.3 35.5 36 37 33.1 33 34.5 29.9 35.6 81.581.7 81 82.3 77.5 77.3 79.1 78.9 82.7 83.1 79.9 80.9 79 89.7 22 PROGOTIR PATHEY 2006 Nutrition Ta bl e NU .2 : B re as tfe ed in g Pr op or tio n of c hi ld re n ac co rd in g to b re as tfe ed in g st at us in e ac h ag e gr ou p, B an gl ad es h, 2 00 6 Se x M ale 48 .0 69 4 36 .0 11 92 50 .3 12 01 94 .4 93 8 88 .4 12 01 Fe m ale 51 .5 64 5 39 .0 11 10 53 .2 10 74 96 .6 88 9 90 .0 10 96 Di vis ion Ba ris al 43 .5 75 30 .1 14 2 46 .3 15 2 93 .7 10 6 90 .9 14 1 Ch itta go ng 57 .4 35 5 48 .8 55 0 45 .1 48 6 96 .9 40 3 80 .5 44 6 Dh ak a 44 .0 38 7 30 .4 68 3 48 .6 73 5 95 .0 58 6 89 .4 73 3 Kh uln a 47 .9 12 7 38 .3 20 5 70 .6 18 6 96 .7 19 3 94 .5 24 6 Ra jsh ah i 51 .7 28 5 38 .5 52 4 58 .7 49 3 95 .4 41 9 94 .8 53 3 Sy lhe t 45 .8 11 0 31 .6 19 8 48 .5 22 3 92 .4 11 9 85 .0 19 8 Ar ea Ru ra l 50 .2 98 3 37 .7 17 17 53 .2 16 85 97 .1 13 49 90 .0 16 63 Ur ba n 47 .2 34 2 35 .2 56 2 46 .9 57 2 90 .7 46 5 86 .8 61 8 Ur ba n m un ici pa lity 46 .9 23 7 35 .9 39 4 45 .4 43 2 92 .5 34 4 86 .4 45 7 Ci ty Co rp or at ion s 47 .9 10 5 33 .7 16 8 51 .4 14 0 85 .5 12 1 87 .8 16 1 No n- slu m 46 .5 95 32 .0 15 5 50 .9 12 3 84 .2 10 8 87 .7 14 8 Sl um (6 1. 0) 10 52 .5 14 54 .7 17 (9 5. 7) 13 (8 9. 8) 12 Tr iba l 72 .8 14 68 .6 23 56 .8 18 (1 00 .0 ) 12 92 .1 16 M ot he r's e du ca tio n No ne 48 .1 39 7 37 .2 68 0 46 .3 74 6 96 .8 55 0 89 .4 72 9 Pr im ar y inc om ple te 56 .5 19 3 40 .0 34 8 48 .6 34 5 97 .8 30 0 90 .6 35 6 Pr im ar y co m ple te d 49 .6 17 1 34 .3 30 5 55 .8 32 9 97 .1 24 0 92 .0 29 9 Se co nd ar y inc om ple te 49 .9 43 5 38 .5 69 8 56 .7 63 7 95 .1 52 2 87 .5 67 6 Se co nd ar y co m ple te d or h igh er 44 .3 13 8 35 .8 26 4 53 .5 21 7 86 .8 20 0 87 .4 23 4 No n- sta nd ar d cu rri cu lum '(* )' 5 '(* )' 8 '(* )' 1 '(* )' 13 '(* )' 3 W ea lth in de x qu int ile s Po or es t 49 .6 28 3 36 .0 52 1 51 .8 61 0 98 .3 41 6 91 .2 57 6 Se co nd 48 .3 28 7 35 .6 50 0 47 .5 49 4 96 .4 38 5 90 .8 46 9 M idd le 51 .7 26 0 39 .6 42 4 50 .7 38 7 98 .7 37 4 89 .3 40 3 Fo ur th 49 .7 26 4 39 .6 46 3 58 .1 42 8 96 .3 33 2 89 .2 43 4 Ri ch es t 49 .1 24 4 36 .8 39 2 50 .5 35 7 86 .0 32 0 84 .4 41 4 Na tio na l 49 .7 13 38 37 .4 23 02 51 .7 22 75 95 .4 18 26 89 .2 22 97 * M IC S ind ica to r 1 5 * * M IC S ind ica to r 1 7 * ** M IC S ind ica to r 1 6 An a ste ris k ind ica te s th at a fi gu re is b as ed o n fe we r t ha n 25 u nw eig ht ed c as es a nd h as b ee n su pr es se d. Fi gu re s in pa re nt he sis a re b as ed o n 25 -4 9 un we igh te d ca se s. Ba ck gr ou nd c ha ra cte ris tic s Ch ild re n 0- 3 m on th s Ch ild re n 0- 5 m on th s Ch ild re n 6- 9 m on th s Ch ild re n 12 -1 5 m on th s Ch ild re n 20 -2 3 m on th s Pe rc en t ex clu siv ely br ea stf ed No . o f ch ild re n Pe rc en t ex clu siv ely br ea stf ed * No . o f ch ild re n Pe rc en t re ce ivi ng br ea st m ilk an d so lid / m us hy fo od ** No . o f ch ild re n Pe rc en t br ea stf ed *** No . o f ch ild re n Pe rc en t br ea stf ed *** No . o f ch ild re n 23Bangladesh Multiple Indicator Cluster Survey 2006 Ta bl e NU .3 : A de qu at el y fe d in fa nt s Pr op or tio n of in fa nt s un de r 6 m on th s of a ge e xc lu si ve ly b re as tfe d, p ro po rti on o f i nf an ts 6 -1 1 m on th s w ho w er e br ea st fe d an d w ho a te s ol id /s em i-s ol id fo od a t l ea st th e m in im um re co m m en de d nu m be r o f t im es th e da y pr io r t o th e su rv ey , a nd th e pr op or tio n of in fa nt s ad eq ua te ly fe d, B an gl ad es h, 2 00 6 Se x M ale 36 .0 38 .8 52 .9 45 .8 41 .8 29 38 Fe m ale 39 .0 43 .1 57 .2 50 .4 45 .8 27 30 Di vis ion Ba ris al 30 .1 38 .7 34 .5 36 .7 34 .0 34 7 Ch itta go ng 48 .8 32 .5 47 .9 40 .4 44 .0 12 69 Dh ak a 30 .4 39 .1 51 .5 45 .3 39 .5 17 56 Kh uln a 38 .3 60 .3 70 .6 65 .9 54 .6 50 1 Ra jsh ah i 38 .5 46 .1 63 .4 55 .2 48 .4 12 89 Sy lhe t 31 .6 37 .9 59 .5 47 .7 41 .4 50 6 Ar ea Ru ra l 37 .7 43 .4 54 .4 49 .0 44 .4 42 08 Ur ba n 35 .2 33 .2 56 .8 45 .1 41 .2 14 09 Ur ba n m un ici pa lity 35 .9 32 .4 54 .5 43 .4 40 .5 10 25 Ci ty Co rp or at ion s 33 .7 35 .6 63 .1 50 .0 42 .9 38 4 No n- slu m 32 .0 34 .2 63 .4 49 .4 41 .6 34 5 Sl um 52 .5 46 .6 61 .3 54 .5 53 .8 39 Tr iba l 68 .6 42 .0 55 .5 48 .9 57 .7 51 M ot he r's e du ca tio n No ne 37 .2 36 .9 49 .3 43 .1 40 .9 17 97 Pr im ar y inc om ple te 40 .0 38 .0 55 .7 47 .0 44 .2 87 6 Pr im ar y co m ple te d 34 .3 43 .7 58 .4 51 .3 44 .5 76 7 Se co nd ar y inc om ple te 38 .5 47 .1 57 .9 52 .6 46 .6 16 36 Se co nd ar y co m ple te d or h igh er 35 .8 37 .0 59 .5 48 .4 42 .7 58 2 No n- sta nd ar d cu rri cu lum '(* )' '(* )' '(* )' '(* )' '(* )' 11 W ea lth in de x qu int ile s Po or es t 36 .0 41 .6 53 .1 47 .3 43 .1 14 22 Se co nd 35 .6 36 .7 52 .6 45 .0 41 .1 12 17 M idd le 39 .6 41 .4 55 .4 48 .6 44 .8 10 06 Fo ur th 39 .6 45 .0 58 .6 51 .8 46 .7 11 01 Ri ch es t 36 .8 39 .0 56 .9 48 .2 43 .3 92 2 To tal 37 .4 40 .8 55 .0 48 .0 43 .7 56 69 * M IC S ind ica to r 1 8 * * M IC S ind ica to r 1 9 An a ste ris k ind ica te s th at a fi gu re is b as ed o n fe we r t ha n 25 u nw eig ht ed c as es a nd h as b ee n su pr es se d. Ba ck gr ou nd c ha ra cte ris tic s 0- 5 m on th s ex clu siv ely br ea stf ed 6- 8 m on th s wh o re ce ive d br ea stm ilk a nd co m ple m en ta ry fo od a t l ea st 2 tim es in p rio r 24 h ou rs 9- 11 m on th s wh o re ce ive d br ea stm ilk a nd co m ple m en ta ry fo od a t l ea st 3 tim es in p rio r 24 h ou rs 6- 11 m on th s wh o re ce ive d br ea stm ilk a nd co m ple m en ta ry fo od a t l ea st th e m ini m um re co m m en de d No . o f t im es p er da y* 0- 11 m on th s wh o we re ap pr op ria te ly fe d* * No . o f i nf an ts ag ed 0- 11 m on th s 24 PROGOTIR PATHEY 2006 Nutrition In Table NU.2, breastfeeding status is based on the reports of mothers/caretakers of children's consumption of food and fluids in the 24 hours prior to the survey interview. ‘Exclusively breastfed’ refers to infants who received only breast milk and vitamins, mineral supplements, or medicine. Table NU.2 shows the rates of exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children aged 6-9 months and continued breastfeeding of children aged at 12-15 months and 20-23 months. Nationally, 49.7 percent of children in the survey were exclusively breastfed up to the age of three months, and 37.4 percent of children aged less than six months were exclusively breastfed, a level considerably lower than recommended. Between 6 and 9 months, 51.7 percent of the children were receiving breast milk and solid or mushy foods. When they were 12-15 months old, 95.4 percent of the children were still being breastfed; and by age 20-23 months 89.2 percent of them were still breastfed. Girls were more likely to be exclusively breastfed than boys. Also, more girls than boys received timely complementary feeding. There was no significant variation between divisions or socio-economic status in exclusive breastfeeding. However and interestingly, exclusively breastfeeding was much higher among the surveyed tribal population: at 72.8 percent for infants up to three months and 68.6 percent for those under six months. Although the total tribal sample size was small and thus no conclusive statement can be made, it should be investigated further through another survey. Figure NU.2 shows the detailed pattern of breastfeeding by the children's age in months. Even at the earliest stage, the majority of children were being fed liquids or foods other than breast milk. By the end of the fifth month, the proportion of children exclusively breastfed was les than 40 percent. However, 75 percent of children were receiving breast milk beyond two years, which is a very good practice (Table NU.3w). What is ‘adequate feeding’ is defined by different criteria depending on the age of a child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate. Infants aged 6-8 months are considered to be adequately fed if they are receiving breast milk and complementary food at least two times per day, while infants aged 9-11 months are considered to be adequately fed if they are receiving breast milk and complementary food at least three times a day. Nationally, 40.8 percent of infants aged 6-8 months in the survey were adequately fed; 55 percent of children aged 9-11 months were adequately fed; and 43.7 percent of children 0-11 months were adequately fed in terms of both breastfeeding and complementary feeding (Table NU.3). Girls were more likely to be adequately fed than boys. There is some variation among the divisions in feeding patterns but not much difference between populations of different socio-economic background. For example, Khulna Division rated better than the national average, while Barisal and Dhaka Divisions lagged behind. This divisional variation perhaps should be investigated further through another survey to identify positive elements in the feeding of children. 25Bangladesh Multiple Indicator Cluster Survey 2006 Table NU.3w: Infant feeding patterns Proportion of children younger than 3 years by feeding pattern and by age group, Bangladesh, 2006 0-1 57.5 16.1 5.8 17.2 .4 3.1 100.0 540 2-3 44.4 17.1 7.3 28.1 1.5 1.7 100.0 798 4-5 20.4 19.0 12.2 35.3 10.2 2.9 100.0 964 6-7 4.7 16.5 10.6 26.1 38.9 3.2 100.0 1101 8-9 1.5 11.6 6.9 13.9 63.6 2.5 100.0 1174 10-11 .3 7.2 3.8 7.5 77.7 3.4 100.0 1092 12-13 .0 3.5 2.2 3.6 86.5 4.1 100.0 939 14-15 .2 2.8 1.7 4.5 85.7 5.0 100.0 887 16-17 .2 2.7 1.1 3.3 86.9 5.8 100.0 923 18-19 .0 1.6 1.4 2.6 88.5 5.8 100.0 986 20-21 .0 1.0 1.4 2.0 86.3 9.3 100.0 1183 22-23 .0 .5 .8 .9 85.4 12.4 100.0 1114 24-25 .0 .5 .3 .3 74.9 24.0 100.0 936 26-27 .0 .4 .5 .4 65.9 32.8 100.0 939 28-29 .0 .4 .0 .4 62.6 36.6 100.0 985 30-31 .0 .2 .1 .5 58.1 41.1 100.0 1070 32-33 .1 .1 .0 .2 49.3 50.2 100.0 1230 34-35 .1 .1 .1 .8 46.4 52.5 100.0 1160 Total 5.2 5.2 3.0 7.7 61.4 17.5 100.0 18021 Age group (months) Percent exclusively breastfed Percent breastfed and plain water only Percent breastfed and non-milk liquids Percent breastfed and other milk/ formula Percent breastfed and comple- mentary foods Percent weaned (not breastfed) Total No. of children Infant feeding pattern 26 PROGOTIR PATHEY 2006 Nutrition Figure NU.2: Infant feeding pattern by age, Bangladesh, 2006 0- 1 2- 3 4- 5 6- 7 8- 9 10 -1 1 12 -1 3 14 -1 5 16 -1 7 18 -1 9 20 -2 1 22 -2 3 24 -2 5 26 -2 7 28 -2 9 30 -3 1 32 -3 3 34 -3 5 Weaned (not breastfed) Age in months Pe rc en t 100 90 80 70 60 50 40 30 20 10 0 Breastfed and complementary foods Breastfed and other milk/ formula Breastfed and non-milk liquids Breastfed and plain water only Exclusively breastfed Salt iodization Iodine deficiency disorders (IDD) is the world's leading cause of preventable mental disability and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll by impairing mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The international goal is to achieve sustainable elimination of iodine deficiency by 2005; the indicator is the percentage of households consuming adequately iodized salt (>15 ppm). Although the MICS includes a component to analyse the iodine content of household salt used for cooking, the standard salt test kit was not used in Bangladesh. Instead an iodine-testing solution was used, checking for iodine and potassium iodate. However, the iodine-testing solution is a quantitative test and cannot detect whether the salt is adequately iodized or not. The survey tested salt samples in 99 percent of households. At the time of the survey, slightly more than 84 percent of households used salt containing at least 10 ppm of iodine. The lowest use of iodized salt was in Chittagong Division (77.7 percent) and highest in Khulna Division (93.6 percent). In Cox's Bazaar District, only 20.8 percent of the surveyed households were using iodized salt at the time of the survey (see Table NU.4.1 in Volume II). While there was a 10 percent variation between urban and rural areas, it was greater between the richest and poorest households, at 20 percent). 27Bangladesh Multiple Indicator Cluster Survey 2006 Table NU.4 : Iodized salt consumption Percentage of households consuming adeuqately iodized salt, Bangladesh, 20066 Division Barisal 99.1 3909 .6 9.1 90.3 100.0 3901 Chittagong 99.0 11015 .8 21.5 77.7 100.0 10987 Dhaka 98.6 20219 1.0 15.0 84.0 100.0 20128 Khulna 99.1 7465 .7 5.7 93.6 100.0 7445 Rajshahi 98.4 16432 1.3 17.0 81.7 100.0 16379 Sylhet 98.9 3423 .9 7.0 92.1 100.0 3415 Area Rural 98.8 43735 .9 17.8 81.2 100.0 43614 Urban 98.6 18138 1.0 7.5 91.5 100.0 18056 Urban municipality 98.7 12925 1.0 8.5 90.4 100.0 12888 City Corporation 98.3 5213 .8 4.8 94.3 100.0 5169 Non-slum 98.3 4793 .8 4.5 94.6 100.0 4750 Slum 98.5 420 1.0 8.1 90.9 100.0 418 Tribal 98.7 590 .7 11.8 87.6 100.0 586 Wealth Poorest 98.2 13530 1.5 23.4 75.1 100.0 13493 index Second 98.8 13019 .9 19.6 79.5 100.0 12982 quintiles Middle 98.9 12397 .8 15.5 83.7 100.0 12361 Fourth 98.9 11572 .8 10.1 89.1 100.0 11532 Richest 98.9 11946 .6 3.5 95.8 100.0 11888 Total 98.7 62463 1.0 14.8 84.3 100.0 62256 *MICS indicator 41 Percent of households in which salt was tested No. of households interviewed Percent of households with no salt Not iodized Iodized* Total No. of households in which salt was tested or with no salt Percent of households with salt test result 6 Measurement of iodization is at 10 ppm. Background characteristics 28 PROGOTIR PATHEY 2006 Nutrition Figure NU.3: Iodized salt consumption, Bangladesh, 20067 Ba ris al Pe rc en t Ch itta go ng Dh ak a Kh uln a Ra jsh ah i Sy lhe t Ru ra l Ur ba n Ur ba n m un ici pa lity Ci ty co rp or at ion No n- slu m Sl um Tr iba l Co un try 100 90 80 70 60 50 40 30 20 10 0 84.381.2 91.5 90.4 94.3 94.6 90.9 87.6 90.3 77.7 84 93.6 81.7 92.1 7 Measururement of iodization is at 10 ppm Vitamin A supplementation Vitamin A is essential for preserving eye sight (lack of it can lead to blindness) and the proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of Vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where Vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate nutritional intakes are further compromised by increased requirements of a child’s growing body or during periods of illness, as well as increased losses during common childhood infections. As a result, Vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of deaths among under-5 children. One of the goals from the 1990 World Summit for Children called for the elimination of Vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly's Special Session on Children in 2002. The critical role of Vitamin A for child health and immune function also makes control of its deficiency a primary component of child survival efforts and thus critical for achieving the fourth MDG: a two-thirds reduction in under-5 mortality by the year 2015. 29Bangladesh Multiple Indicator Cluster Survey 2006 For countries with Vitamin A deficiency problems, current international recommendations call for high- dose Vitamin A supplementation every four to six months, targeted to all children between the ages of six to 59 months living in affected areas. Providing young children with two doses of Vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating its deficiency and improving child survival. Giving supplements to new mothers who are breastfeeding helps protect their baby during the first months of life and helps to replenish her stores of the vitamin, which are depleted during pregnancy and lactation. For countries with Vitamin A supplementation programmes, the indicator for adequacy is the proportion of children 6 to 59 months receiving at least one high-dose Vitamin A supplement in the previous six months. Based on UNICEF/WHO guidelines, the Bangladesh Ministry of Health and Family Welfare (MOHFW) recommends that children aged 9-11 months be given low dose Vitamin A capsule and children aged 12-59 months be given high potency vitamin A capsule every six months. In 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. In Bangladesh within the six months prior to the MICS, 89.2 percent of children aged 9-59 months received a high dose vitamin A supplement (Table NU.5). There is no significant variation between divisions but there is 7.3 percent difference in Vitamin A supplementation between the poorest and the richest quintiles. Dhaka District leads with 95.7 percent while Netrokona District ranks the lowest with a 79.2 percent (see table NU.5.1 in Volume II). The age pattern of vitamin A supplementation shows that supplementation in the last six months rises from 48.4 percent among children aged 9-11 months to 88.7 percent among children aged 12-23 months and keeps on rising with age to 93.1 percent among the oldest children. The mother's level of education is somewhat related to the likelihood of Vitamin A supplementation. The percentage receiving a supplement in the last six months increases from 86.8 percent among children whose mothers have no education to 94.1 percent of those whose mothers have secondary or higher education. The consumption of a Vitamin A supplementation among post-partum mothers is low in Bangladesh. Only 17.2 percent of mothers who gave birth in the two years prior to the survey interview received a Vitamin A supplement within eight weeks of giving birth (Table NU.6). The proportion was highest in Barisal Division (23.5 percent) and lowest in Sylhet division (11.1 percent). There was a significant rural-urban variation, with 15.8 percent in rural areas and 28.1 percent in city corporations receiving the suppliment. Vitamin A suppliment coverage increased with the education level of the mother, from 12.7 percent who had no education to 31.6 percent among those with a secondary or higher education. There also was significant difference between the poorest and the richest quintiles, varying from 11.4 percent to 26.4 percent. Several districts had quite low rates of supplementation: Brahmonbaria (6.3 percent), Lakshipur (5.2 percent), Rajbari (7.1 percent), Chuadanga (6.4 percent) and Sunamganj (4.1 percent) (see table NU.6.1 in Volume II for details). 30 PROGOTIR PATHEY 2006 Nutrition Table NU.5: Children's Vitamin A supplementation Percentage distribution of children aged 9-59 months who did or did not receive a high dose Vitamin A supplement in the last six months prior to the survey interview, Bangladesh, 2006 Sex Male 89.6 2.1 1.2 .4 6.8 100.0 14153 Female 88.8 1.9 1.3 .4 7.6 100.0 13456 Division Barisal 88.4 2.9 1.9 .5 6.3 100.0 1623 Chittagong 90.0 1.3 .9 .4 7.5 100.0 5897 Dhaka 88.7 2.1 1.1 .4 7.8 100.0 8727 Khulna 91.7 2.1 .8 .1 5.4 100.0 2809 Rajshahi 88.9 2.5 1.9 .6 6.1 100.0 6398 Sylhet 87.3 1.4 1.1 .3 9.9 100.0 2155 Area Rural 88.3 2.2 1.3 .4 7.9 100.0 20094 Urban 92.0 1.6 .9 .4 5.1 100.0 7298 Urban municipality 92.0 1.6 .8 .5 5.2 100.0 5350 City Corporations 92.1 1.5 1.0 .3 5.1 100.0 1948 Non-slum 92.5 1.5 1.0 .2 4.8 100.0 1763 Slum 88.0 1.8 1.7 .5 8.0 100.0 185 Tribal 82.0 3.0 1.7 .6 12.7 100.0 216 Age 9-11 months 48.4 .2 .7 .4 50.3 100.0 1711 12-23 months 88.7 1.9 .9 .3 8.3 100.0 6032 24-35 months 92.6 2.0 1.4 .4 3.6 100.0 6320 36-47 months 92.9 2.5 1.3 .5 2.9 100.0 6789 48-59 months 93.1 2.1 1.4 .3 3.0 100.0 6751 Mother's None 86.8 2.0 1.7 .5 9.0 100.0 9987 education Primary incomplete 88.6 2.6 1.4 .5 6.9 100.0 4391 Primary completed 89.3 2.1 .7 .3 7.6 100.0 3554 Secondary incomplete 91.1 2.0 .8 .3 5.8 100.0 6793 Secondary completed 94.1 .9 .7 .2 4.0 100.0 2783 or higher Non-standard 90.2 1.9 1.2 .1 6.6 100.0 99 curriculum Missing/DK '(*)' '(*)' '(*)' '(*)' '(*)' 100.0 2 Wealth Poorest 86.2 2.3 1.6 .4 9.5 100.0 7010 index Second 86.7 2.8 1.5 .4 8.7 100.0 5772 quintiles Middle 89.9 1.6 1.1 .6 6.7 100.0 5213 Fourth 91.6 1.5 1.2 .3 5.4 100.0 5072 Richest 93.5 1.5 .5 .2 4.3 100.0 4541 National 89.2 2.0 1.2 .4 7.2 100.0 27609 * MICS indicator 42 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Within last 6 months * Prior to last 6 months Not sure when Not sure if received Never received Vitamin A Total No. of children aged 9-59 months Percent of children who received Vitamin A: TotalBackground characteristics 31Bangladesh Multiple Indicator Cluster Survey 2006 Division Barisal 23.5 1.8 738 Chittagong 17.3 1.3 2554 Dhaka 18.7 1.1 3697 Khulna 15.6 .6 1145 Rajshahi 16.3 1.3 2740 Sylhet 11.1 .6 1024 Area Rural 15.8 1.0 8757 Urban 21.0 1.8 3040 Urban municipality 18.4 1.7 2230 City Corporation 28.1 2.0 811 Non-slum 29.0 2.2 729 Slum 19.9 .2 81 Tribal 24.1 .8 101 Education None 12.7 1.2 3730 Primary incomplete 13.6 .7 1892 Primary completed 14.9 .9 1551 Secondary incomplete 19.9 1.1 3429 Secondary completed or higher 31.6 2.2 1260 Non-standard curriculum (13.9) .0 38 Wealth index quintiles Poorest 11.4 1.0 2908 Second 13.9 1.0 2535 Middle 18.8 1.0 2230 Fourth 18.6 1.0 2238 Richest 26.4 2.0 1989 Total 17.2 1.2 11899 * MICS indicator 43 Figures in parenthesis are based on 25-49 unweighted cases. Received Vitamin A supplement* Not sure if received Vitamin A No. of women aged 15-49 years Figure NU.4: Children's Vitamin A supplementation, Bangladesh 2006 Pe rc en t 100 90 80 70 60 50 40 30 20 10 0 89.287.3 88.3 92 88.4 90 88.7 91.7 88.9 Table NU.6: Post-partum mother's Vitamin A supplementation Percentage of mothers aged 15-49 years with a birth in the two years preceding the survey who did or did not receive a high-dose Vitamin A supplement before the infant was 8 weeks old, Bangladesh, 2006 Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Rural Urban National Background characteristics 32 PROGOTIR PATHEY 2006 ©UNICEF/G.M.B. Akash 33Bangladesh Multiple Indicator Cluster Survey 2006 V. CHILD HEALTH Immunization Immunization plays a key function in realizing the fourth MDG of reducing child mortality by two thirds between 1990 and 2015. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. However, worldwide there are still 27 million children overlooked by routine immunization. As a result, vaccine- preventable diseases cause more than two million deaths every year. The World Fit for Children goal on immunizations expects countries to reach 90 percent coverage in immunizing fully every child younger than a year, with at least 80 percent coverage in every district or equivalent administrative unit. 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. During the MICS interview, reaserchers asked mothers to show the vaccination cards of any under-5 children to copy the information into the questionnaire. That exercise indicates that only half (53.4 percent) of the surveyed under-5 children had vaccination cards. If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio how many times. Table CH.1 shows the proportion of children aged 12-23 months who received each of the vaccinations. Only children within that age group - old enough to be fully vaccinated - were 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 recall. 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. Approximately 97 percent of children aged 12-23 months received a BCG vaccination by the age of 23 months, and 96.6 percent of them received the first dose of DTP (Table CH.1). The proportion declines for subsequent doses of DPT, to 94.6 percent for the second dose, and 90.1 percent for the third dose. Similarly, 99.1 percent of children received the first Polio vaccination by age 23 months but this declined to 95.6 percent by the third dose. The coverage for measles vaccination at 23 months was lower than for the other immunizations, at 87.5 percent. 34 PROGOTIR PATHEY 2006 Child health Table CH.1: Vaccinations in the first year of life Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Bangladesh, 2006 Vaccination card 65.3 65.2 64.1 61.7 .2 65.1 63.9 61.5 54.2 59.1 .0 6032 Mother's recall 31.7 31.3 30.5 28.5 7.0 34.0 34.3 34.1 33.3 24.9 .8 6032 Either 97.0 96.6 94.6 90.1 7.2 99.1 98.2 95.6 87.5 84.0 .8 6032 Vaccinated by age 96.7 96.3 94.3 89.7 7.2 98.9 98.0 95.1 85.3 81.4 .9 6032 12 months * MICS Indicator 25 ** MICS Indicator 26 *** MICS Indicator 27 **** MICS Indicator 28; MDG Indicator 15 ***** MICS Indicator 31 BCG* DPT 1 DPT 2 DPT 3** Polio 0 Polio 1 Polio 2 Polio 3*** Measles **** All ***** None No. of children aged 12-23 months Table CH.1c: Vaccinations in the first year of life (continued) Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Bangladesh, 2006 Vaccination card 46.0 44.5 41.7 6032 Mother's recall 2.8 1.5 1.9 6032 Either 48.7 46.1 43.6 6032 Vaccinated by age 12 months 48.5 45.7 43.0 6032 * MICS Indicator 29 HepB1 HepB2 HepB3* No. of children aged 12-23 months A Hepatitis B vaccine is also recommended as part of the immunization schedule in Bangladesh. Approximately 48.7 percent of children aged 12-23 months had received the first dose of Hepatitis B vaccine (Table CH.1c). As with the other vaccination series, the proportion receiving the subsequent dose declined to 46.1 percent for the second and 43.6 percent for the third. Tables CH.2 and CH.2c show vaccination coverage rates (up to the day of the survey interveiw) among children aged 12-23 months, by background characteristics and based on vaccination cards or each mother’s/caretaker’s recall. There was some variation between income groups and areas: slums and tribal areas had comparatively a lower coverage rate for all immunizations. Also, children of mothers with at least some secondary education were more likely to receive their vaccinations as compared to those of mothers with less education. Background characteristics Background characteristics 35Bangladesh Multiple Indicator Cluster Survey 2006 Ta bl e CH .2 : Va cc in at io ns b y ba ck gr ou nd c ha ra ct er is tic s Pe rc en ta ge o f c hi ld re n ag ed 1 2- 23 m on th s cu rre nt ly v ac ci na te d ag ai ns t c hi ld ho od d is ea se s, B an gl ad es h, 2 00 6 Se x M ale 97 .7 97 .1 95 .2 91 .0 7. 1 99 .0 98 .1 95 .5 88 .5 85 .0 .9 65 .9 31 09 Fe m ale 96 .3 96 .0 93 .9 89 .1 7. 3 99 .2 98 .3 95 .6 86 .5 83 .0 .7 65 .0 29 23 Di vis ion Ba ris al 98 .1 97 .6 95 .8 89 .6 13 .1 98 .9 97 .6 94 .4 90 .4 83 .5 .9 64 .8 37 6 Ch itta go ng 96 .4 95 .7 94 .3 91 .3 6. 2 98 .9 98 .0 94 .4 86 .6 84 .0 1. 1 64 .5 12 82 Dh ak a 97 .4 96 .7 94 .8 89 .1 6. 6 99 .4 98 .6 96 .2 85 .5 82 .1 .5 60 .0 18 68 Kh uln a 98 .9 98 .9 97 .5 95 .9 6. 2 99 .8 99 .5 98 .6 92 .8 90 .8 .2 70 .3 60 9 Ra jsh ah i 97 .9 97 .6 95 .4 90 .6 8. 0 99 .6 98 .8 96 .4 90 .8 86 .2 .2 70 .3 13 86 Sy lhe t 91 .9 91 .7 87 .7 83 .3 6. 3 96 .4 94 .7 91 .5 79 .9 77 .6 3. 4 69 .3 51 0 Ar ea Ru ra l 96 .7 96 .2 94 .1 89 .4 5. 9 99 .0 98 .0 95 .3 87 .2 83 .4 .9 65 .3 44 03 Ur ba n 98 .0 97 .7 96 .1 92 .5 10 .8 99 .4 98 .9 96 .6 88 .7 85 .9 .5 65 .8 15 83 Ur ba n m un ici pa lity 98 .3 98 .2 96 .7 93 .5 8. 9 99 .3 99 .1 96 .8 89 .0 86 .7 .6 69 .1 11 91 Ci ty Co rp or at ion 97 .3 96 .1 94 .5 89 .5 16 .7 99 .7 98 .4 95 .9 87 .8 83 .2 .3 56 .0 39 2 No n- slu m 97 .7 96 .6 95 .2 90 .5 17 .5 99 .7 98 .8 96 .3 89 .3 84 .6 .3 57 .2 35 9 Sl um 92 .4 90 .7 86 .8 78 .7 7. 7 98 .7 94 .5 91 .9 71 .3 68 .9 1. 3 42 .5 33 Tr iba l 88 .8 87 .0 85 .1 80 .6 2. 5 94 .0 92 .1 86 .4 78 .7 76 .2 5. 1 67 .8 46 M ot he r's e du ca tio n No ne 94 .6 93 .4 90 .2 83 .8 4. 0 98 .5 97 .2 93 .6 82 .3 77 .5 1. 4 59 .8 19 19 Pr im ar y inc om ple te 97 .1 96 .9 93 .7 87 .9 4. 4 99 .1 97 .3 93 .1 83 .5 79 .1 .9 66 .5 93 9 Pr im ar y co m ple te d 97 .3 97 .1 95 .7 91 .9 5. 3 99 .0 98 .2 96 .4 88 .2 84 .8 .9 67 .2 75 5 Se co nd ar y inc om ple te 98 .9 98 .9 98 .0 95 .7 8. 8 99 .7 99 .6 98 .3 92 .5 91 .2 .1 70 .6 17 27 Se co nd ar y co m ple te d or h igh er 99 .3 99 .2 98 .6 95 .7 18 .5 99 .1 99 .1 97 .2 95 .1 91 .1 .7 65 .7 66 6 No n- sta nd ar d cu rri cu lum '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' 26 M iss ing /D K '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' 1 W ea lth in de x qu int ile s Po or es t 94 .1 93 .6 90 .4 84 .3 4. 2 98 .6 96 .9 93 .9 82 .7 78 .2 1. 3 62 .3 14 38 Se co nd 97 .1 96 .2 93 .9 88 .1 4. 9 98 .9 98 .2 94 .8 84 .0 80 .5 1. 0 64 .1 12 83 M idd le 96 .8 96 .5 94 .6 89 .7 6. 5 98 .8 98 .0 95 .0 87 .6 83 .3 1. 2 67 .9 11 75 Fo ur th 99 .0 98 .7 97 .3 95 .1 7. 0 99 .6 99 .1 97 .3 91 .9 89 .8 .2 67 .7 11 01 Ri ch es t 99 .1 98 .9 98 .1 95 .8 15 .1 99 .8 99 .4 97 .8 93 .8 91 .1 .0 66 .3 10 36 Na tio na l 97 .0 96 .6 94 .6 90 .1 7.2 99 .1 98 .2 95 .6 87 .5 84 .0 .8 65 .5 60 32 An a ste ris k ind ica te s th at a fi gu re is b as ed o n fe we r t ha n 25 u nw eig ht ed c as es a nd h as b ee n su pr es se d. BC G DP T 1 DP T 2 DP T 3 Po lio 0 Po lio 1 Po lio 2 Po lio 3 M ea sle s Al l No ne Pe rc en t wi th he alt h ca rd No . o f ch ild re n ag ed 12 -2 3 m on th s Ba ck gr ou nd c ha ra cte ris tic s 36 PROGOTIR PATHEY 2006 Child health Table CH.2c: Vaccinations by background characteristics (continued) Percentage of children aged 12-23 months currently vaccinated against childhood diseases, Bangladesh, 2006 Sex Male 48.6 46.0 43.4 65.9 3109 Female 48.9 46.1 43.8 65.0 2923 Division Barisal 51.1 49.2 46.5 64.8 376 Chittagong 47.7 45.3 42.0 64.5 1282 Dhaka 46.0 43.3 40.9 60.0 1868 Khulna 59.7 58.4 57.2 70.3 609 Rajshahi 47.4 44.2 42.3 70.3 1386 Sylhet 50.3 46.0 42.4 69.3 510 Area Rural 47.5 44.6 42.2 65.3 4403 Urban 52.1 49.9 47.3 65.8 1583 Urban municipality 50.9 48.6 45.8 69.1 1191 City Corporation 55.6 53.9 51.8 56.0 392 Non-slum 56.9 55.5 53.3 57.2 359 Slum 41.3 37.0 35.3 42.5 33 Tribal 52.3 49.8 45.1 67.8 46 Mother's education None 41.7 37.8 35.3 59.8 1919 Primary incomplete 49.7 45.9 42.1 66.5 939 Primary completed 48.3 46.4 44.7 67.2 755 Secondary incomplete 54.4 52.8 50.4 70.6 1727 Secondary completed or higher 53.4 52.2 50.6 65.7 666 Non-standard curriculum '(*)' '(*)' '(*)' '(*)' 26 Missing/DK '(*)' '(*)' '(*)' '(*)' 1 Wealth index quintiles Poorest 42.3 38.4 36.2 62.3 1438 Second 45.7 43.0 39.6 64.1 1283 Middle 50.1 47.0 44.4 67.9 1175 Fourth 53.2 51.1 48.7 67.7 1101 Richest 55.1 54.0 52.5 66.3 1036 Total 48.7 46.1 43.6 65.5 6032 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. HepB1 HepB2 HepB3 Percent with health card No. of children aged 12-23 months Background characteristics 37Bangladesh Multiple Indicator Cluster Survey 2006 Figure CH.1: Vaccinations in the first year of life, Bangladesh, 2006 Pe rc en t 100 90 80 70 60 50 40 30 20 10 0 87.5 84 99.1 98.2 95.697 96.6 94.6 90.1 DPT1 DPT2 DPT3 Polio1 Polio2 Polio3 AllMeaslesBCG Tetanus toxoid The fifth MDG expects countries to reduce by three quarters (between 1990 and 2015) their maternal mortality ratio. One strategy to achieve this is to eliminate the incidence of maternal tetanus. The MDG also includes the reduction of neonatal tetanus to less than one case per 1,000 live births in every district. The World Fit for Children goal on this issue calls for the elimination of both maternal and neonatal tetanus by 2005. To prevent maternal and neonatal tetanus requires that all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during their pregnancy, they (and their newborn) are still considered protected under the following conditions: Received at least two doses of tetanus toxoid vaccine, the last within three years prior to the survey interiew; Received at least three doses, the last within the prior five years; Received at least four doses, the last within ten years; Received at least five doses up to the present. Figure CH.2 and Table CH.3 show the percentage of mothers with a birth in the past 24 months (prior to the survey interview) considered protected against neonatal tetanus. Nationally, 89.6 percent of women had received sufficient protection against tetanus. Geographically, Sylhet Division lags behind the others, at 84.7 percent while Khulna Division leads, at 91 percent. About 55 percent of the surveyed mothers received at least two doses of tetanus toxoid vaccine during their previous pregnancy. 38 PROGOTIR PATHEY 2006 Child health Figure CH.2: Neonatal tetanus protection (women with a live birth in the previous 24 months), Bangladesh, 2006 Percent 0 10 20 30 40 50 60 70 80 90 100 Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Rural Urban Urban municipality City corporation Non-slum Slum Tribal None Primary incomplete Primary completed Secondary incomplete Secondary completed or higher Non-standard curriculum National 88.9 90.8 89.5 91 90.2 84.7 88.9 92.1 91.3 94.5 95.7 83.9 75.2 82.7 88.8 91.1 94.6 96.2 94.7 89.6 39Bangladesh Multiple Indicator Cluster Survey 2006 Table CH.3: Neonatal tetanus protection Percentage of mothers with a birth in the two years prior to the survey interview who were protected against neonatal tetanus, Bangladesh, 2006 Division Barisal 62.8 22.3 2.6 1.1 .0 88.9 738 Chittagong 59.4 26.9 3.0 1.3 .2 90.8 2554 Dhaka 54.4 28.0 3.7 2.6 .8 89.5 3697 Khulna 46.2 37.5 4.0 2.8 .4 91.0 1145 Rajshahi 53.9 29.3 3.5 3.4 .2 90.2 2740 Sylhet 49.6 28.1 4.3 2.6 .1 84.7 1024 Area Rural 54.7 28.0 3.5 2.4 .4 88.9 8757 Urban 54.8 30.9 3.5 2.7 .2 92.1 3040 Urban municipality 51.8 32.9 3.6 2.7 .3 91.3 2230 City Corporations 62.8 25.4 3.5 2.8 .0 94.5 811 Non-slum 64.4 25.1 3.5 2.7 .0 95.7 729 Slum 48.9 28.2 3.1 3.7 .0 83.9 81 Tribal 53.4 19.0 2.0 .6 .3 75.2 101 Age 15-19 years 66.8 22.9 2.0 .4 .0 92.0 2364 20-24 years 57.6 29.8 3.8 1.7 .0 92.8 4111 25-29 years 50.2 32.0 3.8 3.3 .5 89.8 2946 30-34 years 43.7 31.1 4.6 5.0 1.0 85.3 1554 35-39 years 43.5 24.8 3.2 4.5 1.3 77.3 735 40-44 years 40.1 22.3 4.7 5.1 2.3 74.5 150 45-49 years (52.1) (4.9) (2.3) (2.3) (.0) (61.5) 40 Education None 50.6 25.1 3.8 2.8 .5 82.7 3730 Primary incomplete 55.9 25.6 4.6 2.5 .3 88.8 1892 Primary completed 56.1 28.9 2.7 2.9 .5 91.1 1551 Secondary incomplete 57.4 32.1 3.0 1.8 .3 94.6 3429 Secondary completed 55.5 34.1 3.4 2.9 .3 96.2 1260 or higher Non-standard (66.0) (19.3) (9.4) (.0) (.0) (94.7) 38 curriculum Wealth Poorest 53.1 25.2 3.7 2.5 .3 84.8 2908 index Second 55.6 25.8 3.5 1.7 .4 87.0 2535 quintiles Middle 55.7 28.3 3.3 2.7 .3 90.4 2230 Fourth 53.0 33.3 3.4 3.0 .4 93.1 2238 Richest 56.6 32.5 3.7 2.2 .4 95.3 1989 National 54.7 28.6 3.5 2.4 .4 89.6 11899 * MICS Indicator 32 Figures in parenthesis are based on 25-49 unweighted cases. Received at least 2 doses during last pregnancy Received at least 2 doses, the last within prior 3 years Received at least 3 doses, the last within prior 5 years Received at least 4 doses, the last within prior 10 years Received at least 5 doses during lifetime Protected against tetanus* No. of mothers Background characteristics 40 PROGOTIR PATHEY 2006 Child health Oral rehydration treatment Diarrhoea is the second leading cause of death among under-five children worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body through liquid stools. Management of diarrhoea - either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (MDGs). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: Prevalence of diarrhoea Oral rehydration therapy (ORT) Home management of diarrhoea (ORT or increased fluids) AND continued feeding For the MICS, mothers (or caretakers) were asked to report if their child (any younger than 5 years) had diarrhoea in the two weeks prior to the survey interview. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and if this was more or less than the child usually ate and drank. In total, some 7.1 percent of under-5 children had diarrhoea in the two weeks preceding the survey interview (Table CH.4). However, diarrhoea prevalence was not similar in all divisions. Barisal Division registered the highest rate of 8.9 percent while Khulna had the lowest, at 4.4 percent. Several districts (Bhola, Bandarban, Jamalpur and Lalmonirhat) had quite high rates, above 12 percent rate (see Table CH.4.1 in Volume II for details). The peak of diarrhoea prevalence occurs in the weaning period, among children aged 6-23 months. This incidence was 11.1 percent among the younger half (aged 6-11 months) and 10.1 percent in the older half (12-23 months). The incidence was higher among boys than girls. The incidence of diarrhoea is negatively correlated with mothers’ education and income levels. The ORT use rate nationally was 70.1 percent; the rate in urban area was 76.5 percent and 67.7 percent in rural areas. The rate increases with mothers’ education, reaching as high as 84 percent among females who had at least completed their secondary education. Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the diarrhoea episode. (Because mothers mentioned more than one type of liquid, the total of the percentages goes beyond 100). About 62.7 percent of the under-5 children with a diarrhoea episode received fluids from ORS packets; 13.5 percent of them received recommended homemade fluids, and 3.7 percent received pre-packaged ORS fluids. 41Bangladesh Multiple Indicator Cluster Survey 2006 Table CH.4: Oral rehydration treatment Percentage of under-5 children with diarrhoea in the two weeks prior to the survey and who were treated with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Bangladesh, 2006 Sex Male 7.4 16222 63.4 12.5 4.4 29.3 70.7 1200 Female 6.9 15344 61.8 14.6 3.0 30.7 69.3 1054 Division Barisal 8.9 1873 61.6 18.3 3.3 31.8 68.2 167 Chittagong 7.6 6797 68.7 12.1 1.0 26.5 73.5 515 Dhaka 7.1 9942 63.0 16.5 6.5 27.2 72.8 704 Khulna 4.4 3148 56.5 4.8 1.9 39.9 60.1 139 Rajshahi 7.4 7284 60.2 12.3 4.0 31.6 68.4 540 Sylhet 7.5 2521 57.9 11.7 1.9 35.5 64.5 188 Area Rural 7.1 23034 59.5 14.1 2.9 32.3 67.7 1630 Urban 7.4 8280 71.2 11.9 6.1 23.5 76.5 611 Urban municipality 7.1 6061 70.3 11.7 4.7 24.3 75.7 428 City Corporation 8.2 2219 73.3 12.4 9.3 21.7 78.3 183 Non-slum 7.9 2009 73.9 13.1 10.1 20.7 79.3 159 Slum 11.2 210 69.0 7.1 3.6 28.6 71.4 24 Tribal 5.1 253 61.5 4.3 3.3 32.8 67.2 13 Age < 6 months 4.7 2302 38.4 4.7 1.1 57.7 42.3 108 6-11 months 11.1 3367 59.1 12.0 2.0 35.6 64.4 375 12-23 months 10.1 6032 68.6 11.7 4.1 26.5 73.5 606 24-35 months 7.0 6320 62.8 15.9 5.0 28.1 71.9 443 36-47 months 5.7 6789 65.1 13.0 2.3 27.3 72.7 388 48-59 months 4.9 6751 61.0 18.7 6.0 26.1 73.9 332 Mother's None 7.9 11224 58.6 11.8 2.1 33.8 66.2 882 education Primary incomplete 8.3 4997 62.2 14.7 3.2 30.2 69.8 417 Primary completed 6.7 4084 60.0 17.6 8.3 30.1 69.9 274 Secondary incomplete 6.2 7948 66.6 12.5 3.8 27.9 72.1 489 Secondary completed 5.5 3204 77.1 15.4 6.2 16.0 84.0 178 or higher Non-standard 13.6 106 67.8 9.3 .0 22.9 77.1 14 curriculum Missing/DK .0 2 . . . . . 0 Wealth Poorest 8.6 7987 57.5 12.6 1.8 34.6 65.4 685 index Second 7.6 6615 59.4 13.9 3.0 32.7 67.3 502 quintiles Middle 7.1 5918 60.9 15.2 3.3 30.5 69.5 420 Fourth 5.6 5854 71.3 13.1 4.6 23.1 76.9 325 Richest 6.2 5192 72.4 12.8 8.7 21.6 78.4 321 National 7.1 31566 62.7 13.5 3.7 29.9 70.1 2254 * MICS Indicator 33 Recommende d homemade fluid Fluid from ORS packet Pre- packaged ORS fluid No treatment ORT use rate * No. of under-5 children with diarrhoea Had diarrhoe a in last two weeks No. of under-5 children Background characteristics 42 PROGOTIR PATHEY 2006 Child health More than one third (41.1 percent) of under-5 children with a diarrhoea episode drank more than usual while 58.2 percent drank the same or less (Table CH.5). Slightly more than 66 percent ate somewhat less, same or more (continued feeding), but 33.2 percent ate much less or ate almost nothing. That leaves 48.9 percent of the relevant children receiving increased fluids and at the same time continued feeding. About 27.7 percent of households practiced home management of diarrhoea. There are significant differences in the home management of diarrhoea by background characteristics. There is some difference between boys and girls and rural and urban areas in the home management of diarrhoea. Geographical variation also exists in this respect. In Rajshahi Division, only 42.6 percent of children received ORT or increased fluids AND continued feeding, while the figure is 57.6 percent in Barisal Division. The families in the richest quintile and the mothers having education level of higher secondary and above had managed diarrhoea quite well. Figure CH.3: Oral rehydration treatment (percentage of under-5 children with diarrhoea who received ORT or increased fluids, and continued feeding), Bangladesh, 2006 Percent 0 10 20 30 40 50 60 70 80 90 100 Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Rural Urban Urban municipality City corporation Non-slum Slum Tribal None Primary incomplete Primary completed Secondary incomplete Secondary completed or higher National 57.6 48.1 52.6 48.1 42.6 47.8 47.8 51.6 51.9 51 50.5 54.1 58.1 46.5 49.5 48.8 48 64.4 48.9 43Bangladesh Multiple Indicator Cluster Survey 2006 Table CH.5: Home management of diarrhoea Percentage of under-5 children with diarrhoea in the last two weeks prior to the survey who received increased fluids and continued to feed during the episode, Bangladesh, 2006 Sex Male 7.4 16222 42.8 56.2 67.1 32.0 29.8 50.6 1200 Female 6.9 15344 39.1 60.4 65.1 34.5 25.4 46.9 1054 Division Barisal 8.9 1873 51.9 48.1 67.3 32.1 34.7 57.6 167 Chittagong 7.6 6797 34.7 64.4 62.8 36.2 23.3 48.1 515 Dhaka 7.1 9942 43.6 55.6 70.1 29.5 32.0 52.6 704 Khulna 4.4 3148 40.8 58.8 70.9 28.6 30.3 48.1 139 Rajshahi 7.4 7284 40.9 58.3 62.2 37.0 24.6 42.6 540 Sylhet 7.5 2521 40.4 59.2 67.9 31.8 24.7 47.8 188 Area Rural 7.1 23034 38.8 60.4 66.1 33.1 26.4 47.8 1630 Urban 7.4 8280 47.2 52.1 66.2 33.3 31.3 51.6 611 Urban municipality 7.1 6061 42.3 57.0 67.1 32.3 27.8 51.9 428 City Corporations 8.2 2219 58.9 40.6 64.1 35.5 39.7 51.0 183 Non-slum 7.9 2009 61.4 38.2 63.9 35.6 41.1 50.5 159 Slum 11.2 210 42.2 57.3 65.5 34.5 30.3 54.1 24 Tribal 5.1 253 31.0 64.4 67.2 31.5 27.8 58.1 13 Age 0-11 months 8.5 5669 33.9 65.1 64.5 34.0 21.7 40.4 483 12-23 months 10.1 6032 42.6 56.5 57.3 42.1 26.9 45.5 606 24-35 months 7.0 6320 42.2 57.6 67.1 32.8 27.1 49.8 443 36-47 months 5.7 6789 45.4 53.8 71.4 27.8 33.6 53.7 388 48-59 months 4.9 6751 42.3 57.1 77.6 22.3 32.3 60.8 332 Mother's None 7.9 11224 39.6 59.7 66.2 33.3 26.2 46.5 882 education Primary incomplete 8.3 4997 39.4 60.1 64.8 34.2 28.5 49.5 417 Primary completed 6.7 4084 35.9 63.3 66.3 33.7 24.2 48.8 274 Secondary incomplete 6.2 7948 41.1 57.7 64.8 34.1 26.4 48.0 489 Secondary completed 5.5 3204 60.4 39.0 74.7 24.9 44.5 64.4 178 or higher Non-standard 13.6 106 '(*)' '(*)' '(*)' '(*)' '(*)' '(*)' 14 curriculum Missing/DK '(*)' 2 '(*)' '(*)' '(*)' '(*)' '(*)' '(*)' 0 Wealth Poorest 8.6 7987 35.7 63.4 62.6 37.0 22.6 44.5 685 index Second 7.6 6615 41.4 58.1 65.7 33.1 28.0 46.9 502 quintiles Middle 7.1 5918 39.3 59.6 68.3 31.0 27.3 49.4 420 Fourth 5.6 5854 41.4 57.8 68.5 31.0 27.6 54.6 325 Richest 6.2 5192 54.0 45.7 69.3 30.3 38.9 55.1 321 National 7.1 31566 41.1 58.2 66.2 33.2 27.7 48.9 2254 * MICS indicator 34 ** MICS indicator 35 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Had diarrhoea in last two weeks No. of under-5 children Children with diarrhoea who drank more Children with diarrhoea who drank the same or less Children with diarrhoea who ate somewhat less, same or more Children with diarrhoea who ate much less or none Home management of diarrhoea * Received ORT or increased fluids AND continued feeding ** No. of under-5 children with diarrhoea Background characteristics 44 PROGOTIR PATHEY 2006 Child health Care seeking and antibiotic treatment of pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics for children under-5 with suspected pneumonia is a key intervention. The World Fit for Children goal for acute respiratory infections is to reduce related deaths by one-third. Children with suspected pneumonia are those who have an illness with a cough, accompanied by rapid or difficult breathing and whose symptoms are not due to a problem in the chest or a blocked nose. The MICS indicators are: Prevalence of suspected pneumonia Care seeking for suspected pneumonia Antibiotic treatment for suspected pneumonia Knowledge of the danger signs of pneumonia Table CH.6 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. Nationally, 5.3 percent of under-5 children were reported to have had symptoms of pneumonia during the two weeks preceding the survey interview. Of them, 30.1 percent were taken to an appropriate health care provider, while 27 percent were taken to traditional practitioners. There was a strong correlation between the education level of the mother as well as the economic status of the household and the appropriate treatment of suspected pneumonia in a child - the more educated a mother was or the more income a family had the more likelihood there was for proper treatment. Figure CH.4: Care seeking for suspected pneumonia (percentage of under-5 children who were taken to any appropriate health care provider in the two weeks prior to the survey, Bangladesh, 2006 Pe rc en t 100 90 80 70 60 50 40 30 20 10 0 55.9 26.0 27.9 41.9 30.1 25.9 44.2 16.8 Rural Urban Poorest Second Middle Fourth RichestNational 45Bangladesh Multiple Indicator Cluster Survey 2006 Ta bl e CH .6 : C ar e se ek in g fo r s us pe ct ed p ne um on ia Pe rc en ta ge o f c hi ld re n ag ed 0 -5 9 m on th s w ho w er e ta ke n to a h ea lth c ar e pr ov id er in th e tw o w ee ks p rio r t o th e su rv ey , B an gl ad es h, 2 00 6 Se x M ale 5. 8 16 22 2 12 .7 .6 2. 7 13 .9 23 .1 5. 5 25 .9 .5 6. 6 30 .0 93 6 Fe m ale 4. 9 15 34 4 12 .4 .4 1. 9 13 .6 20 .1 3. 8 28 .1 1. 0 6. 1 30 .1 74 8 Di vis ion Ba ris al 6. 4 18 73 14 .7 .0 2. 4 7. 5 17 .9 10 .9 24 .9 .0 5. 8 24 .6 12 1 Ch itta go ng 4. 8 67 97 12 .2 .5 3. 3 16 .6 26 .8 2. 3 28 .4 1. 0 6. 5 33 .1 32 8 Dh ak a 4. 4 99 42 15 .6 .8 1. 8 14 .3 25 .4 5. 9 22 .0 .6 1. 1 32 .6 44 1 Kh uln a 4. 4 31 48 16 .8 .8 3. 6 14 .1 20 .6 1. 7 26 .6 .0 8. 8 34 .9 13 9 Ra jsh ah i 6. 9 72 84 9. 7 .3 2. 4 11 .0 16 .0 5. 7 31 .2 1. 2 10 .6 25 .9 50 6 Sy lhe t 5. 9 25 21 8. 6 .0 1. 0 20 .2 23 .9 .7 24 .9 .0 5. 3 29 .8 14 9 Ar ea Ru ra l 5. 6 23 03 4 10 .7 .6 1. 7 12 .1 22 .1 4. 3 30 .9 .8 6. 2 25 .9 12 86 Ur ba n 4. 7 82 80 18 .9 .1 4. 5 19 .7 20 .9 5. 6 13 .6 .4 6. 7 44 .2 38 7 Ur ba n m un ici pa lity 5. 3 60 61 21 .5 .0 4. 8 14 .6 17 .3 6. 8 15 .7 .4 7. 4 42 .2 32 1 Ci ty Co rp or at ion 3. 0 22 19 6. 3 .6 2. 8 44 .2 38 .2 .2 3. 2 .4 3. 5 54 .2 67 No n- slu m 2. 9 20 09 5. 2 .0 2. 5 47 .2 40 .4 .2 2. 9 .0 3. 2 55 .0 59 Sl um 3. 9 21 0 (1 3. 8) (5 .1 ) (5 .1 ) (2 2. 5) (2 2. 4) (.0 ) (5 .1 ) (3 .4 ) (5 .2 ) (4 8. 2) 8 Tr iba l 4. 0 25 3 (6 .5 ) (.0 ) (.8 ) (3 .0 ) (1 6. 7) (2 5. 1) (2 9. 9) (2 .2 ) (6 .5 ) (1 4. 7) 10 Ag e 0- 11 m on th s 8. 5 56 69 10 .6 .5 3. 8 18 .4 20 .3 5. 5 29 .0 .8 7. 2 34 .6 48 3 12 -2 3 m on th s 6. 8 60 32 14 .5 1. 1 2. 7 13 .2 22 .3 2. 9 30 .1 .4 5. 6 31 .5 40 9 24 -3 5 m on th s 5. 1 63 20 14 .7 .1 2. 0 14 .0 23 .2 6. 6 23 .2 .8 2. 8 32 .7 32 0 36 -4 7 m on th s 3. 8 67 89 12 .7 .3 1. 0 9. 5 22 .0 4. 4 24 .3 .7 7. 8 23 .5 25 9 48 -5 9 m on th s 3. 2 67 51 10 .2 .0 .6 9. 1 21 .9 4. 1 24 .7 .9 9. 3 20 .8 21 3 M ot he r's No ne 5. 1 11 22 4 11 .6 .3 1. 4 5. 9 22 .5 5. 4 31 .7 .3 6. 8 19 .6 57 2 ed uc at ion Pr im ar y inc om ple te 5. 5 49 97 10 .2 1. 0 1. 4 9. 3 20 .9 4. 0 30 .7 .7 6. 6 21 .7 27 4 Pr im ar y co m ple te d 5. 9 40 84 9. 1 .9 1. 8 14 .2 24 .1 4. 9 30 .2 .5 5. 0 26 .3 23 9 Se co nd ar y inc om ple te 5. 9 79 48 15 .6 .3 3. 4 20 .6 20 .6 5. 5 20 .5 1. 4 7. 2 42 .4 46 5 Se co nd ar y co m ple te d or h igh er 3. 8 32 04 19 .4 .0 6. 4 33 .4 20 .6 .1 11 .7 .7 3. 1 59 .5 12 1 No n- sta nd ar d cu rri cu lum 8. 5 94 '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' 8 W ea lth Po or es t 5. 8 79 87 9. 5 1. 1 .7 4. 8 19 .3 7. 2 32 .3 .8 7. 3 16 .8 46 5 ind ex Se co nd 6. 2 66 15 12 .3 .0 2. 6 10 .5 20 .8 4. 5 32 .3 .6 6. 7 26 .0 41 0 qu int ile s M idd le 5. 6 59 18 13 .0 .1 1. 6 11 .9 21 .5 3. 2 32 .7 1. 0 7. 8 27 .9 32 9 Fo ur th 4. 7 58 54 15 .4 .7 2. 1 23 .4 25 .1 3. 4 16 .6 .8 4. 2 41 .9 27 6 Ri ch es t 3. 9 51 92 15 .8 .1 7. 4 30 .6 25 .5 3. 7 8. 0 .3 4. 0 55 .9 20 3 Na tio na l 5.3 31 56 6 12 .6 .5 2.4 13 .8 21 .8 4.7 26 .9 .7 6.4 30 .1 16 83 * M IC S ind ica to r 2 3 An a ste ris k ind ica te s th at a fi gu re is b as ed o n fe we r t ha n 25 u nw eig ht ed c as es a nd h as b ee n su pr es se d. Fi gu re s in pa re nt he sis a re b as ed o n 25 -4 9 un we igh te d ca se s. Ba ck gr ou nd c ha ra cte ris tic s Ha d ac ut e re sp ira to ry inf ec tio n No . o f un de r-5 Ch ild re n Go vt. ho sp ita lO th er go vt. Pr iva te ho sp ita l cli nic Pr iva te ph ys ici an Ph ar m ac y Ot he r pr iva te , re lat ive , sh op Tr ad itio na l pr ac titi on er NG O Ho sp ita l/ Cl ini c Ot he r An y ap pr op ria te pr ov ide r * No . o f un de r-5 ch ild re n wi th su sp ec te d pn eu m on ia 46 PROGOTIR PATHEY 2006 Child health Table CH.7: Antibiotic treatment of pneumonia Percentage of under-5 children with suspected pneumonia who received antibiotic treatment, Bangladesh, 2006 Sex Male 936 21.8 Female 748 21.2 Division Barisal 121 13.1 Chittagong 328 22 Dhaka 441 25.2 Khulna 139 24.4 Rajshahi 506 20 Sylhet 149 18.5 Area Rural 1286 22 Urban 387 19.3 Urban municipality 321 18.4 City Corporations 67 23.5 Non-slum 59 -25.4 Slum 8 -10.2 Tribal 10 36.4 Age 0-11 months 483 23.3 12-23 months 409 22.7 24-35 months 320 20.2 36-47 months 259 21.3 48-59 months 213 17.4 Mother's education None 572 18.8 Primary incomplete 274 24 Primary completed 239 20.9 Secondary incomplete 465 20.3 Secondary completed or higher 121 36.1 Non-standard curriculum 11 '(*)' Wealth index quintiles Poorest 465 17.2 Second 410 22.2 Middle 329 22.8 Fourth 276 21.3 Richest 203 28.1 National 1683 21.5 *MICS indicator 22 No. of under-5 children with suspected pneumonia in the two weeks prior the survey Percent under-5 children with suspected pneumonia who received antibiotics in the previous two weeks* Background characteristics 47Bangladesh Multiple Indicator Cluster Survey 2006 Ta bl e CH .7 a: K no wl ed ge o f t he tw o da ng er s ig ns o f p ne um on ia Pe rc en ta ge o f m ot he rs (c ar et ak er s) o f u nd er -fi ve c hi ld re n by k no w le dg e of ty pe s of s ym pt om s fo r t ak in g a ch ild im m ed ia te ly to a h ea lth c ar e fa ci lit y, a nd p er ce nt ag e of m ot he rs w ho re co gn iz e fa st a nd d iff ic ul t b re at hi ng a s si gn s fo r s ee ki ng c ar e im m ed ia te ly, B an gl ad es h, 2 00 6 Di vis ion Ba ris al 3. 0 31 .7 85 .0 32 .8 31 .6 3. 4 4. 5 11 .7 18 73 Ch itta go ng 1. 7 38 .7 85 .1 45 .1 33 .7 3. 0 4. 9 17 .0 67 97 Dh ak a 1. 0 27 .7 83 .3 34 .8 35 .7 3. 5 3. 5 15 .5 99 42 Kh uln a .2 23 .4 80 .9 46 .6 43 .1 3. 0 2. 4 25 .7 31 48 Ra jsh ah i 1. 0 28 .9 80 .4 29 .7 30 .5 3. 8 2. 8 12 .8 72 84 Sy lhe t .2 23 .2 80 .7 24 .4 40 .8 1. 2 1. 5 11 .5 25 21 Ar ea Ru ra l 1. 1 29 .6 82 .3 35 .1 33 .6 3. 3 3. 3 14 .7 23 03 4 Ur ba n 1. 1 30 .1 83 .6 39 .0 39 .1 3. 2 3. 7 18 .7 82 80 Ur ba n m un ici pa lity 1. 1 32 .4 83 .2 35 .9 36 .0 3. 3 4. 1 15 .4 60 61 Ci ty Co rp or at ion 1. 2 23 .9 84 .8 47 .5 47 .7 2. 9 2. 5 27 .8 22 19 No n- slu m 1. 3 23 .7 85 .2 48 .6 48 .7 2. 9 2. 6 28 .8 20 09 Sl um .2 25 .7 80 .5 37 .6 37 .6 2. 5 2. 0 18 .1 21 0 Tr iba l .8 35 .7 83 .0 28 .9 23 .6 1. 7 3. 1 9. 6 25 3 M ot he r's e du ca tio n No ne .9 28 .5 82 .2 31 .5 30 .8 3. 0 2. 9 12 .9 11 22 4 Pr im ar y inc om ple te .9 29 .1 82 .1 34 .7 33 .3 2. 5 3. 2 14 .2 49 97 Pr im ar y co m ple te d 1. 1 28 .7 82 .9 36 .4 36 .6 4. 0 3. 4 16 .7 40 84 Se co nd ar y inc om ple te 1. 4 30 .1 82 .8 40 .0 38 .2 3. 2 3. 4 18 .1 79 48 Se co nd ar y co m ple te d or h igh er 1. 6 36 .2 84 .8 44 .1 42 .2 4. 4 5. 8 20 .5 32 04 No n- sta nd ar d cu rri cu lum .0 20 .1 76 .8 32 .0 36 .4 1. 3 2. 2 12 .7 10 6 M iss ing /D K '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' '(* )' 2 W ea lth in de x qu int ile s Po or es t .7 27 .8 82 .0 31 .6 30 .0 2. 8 2. 8 12 .4 79 87 Se co nd 1. 1 28 .8 82 .5 34 .7 32 .3 3. 3 3. 2 13 .9 66 15 M idd le 1. 3 31 .1 82 .3 34 .3 33 .8 3. 3 3. 3 14 .2 59 18 Fo ur th 1. 4 32 .0 83 .1 38 .8 37 .6 3. 3 4. 4 17 .4 58 54 Na tio na l 1.1 29 .8 82 .7 36 .1 35 .0 3.2 3.4 15 .7 31 56 6 An a ste ris k ind ica te s th at a fi gu re is b as ed o n fe we r t ha n 25 u nw eig ht ed c as es a nd h as b ee n su pr es se d. Ba ck gr ou nd c ha ra cte ris tic s Pe rc en ta ge o f m ot he rs /ca re ta ke rs o f u nd er -fi ve c hil dr en w ho th ink th at a c hil d sh ou ld be ta ke n im m ed iat ely to a h ea lth fa cil ity if th e ch ild : Is no t a ble to d rin k or br ea stf ee d Be co m es sic ke r De ve lop s a fe ve r Ha s fa st br ea th ing Ha s dif fic ult y br ea th ing Ha s blo od in sto ol Is dr ink ing po or ly/ H as an im al bit e/ Ha s sn ak e bit e/ Is dr ow nin g/ Ha s ot he r sy m pt om s M ot he rs / ca re ta ke rs wh o re co gn ize th e tw o da ng er sig ns o f pn eu m on ia No . o f m ot he rs / ca re ta ke rs of u nd er -5 ch ild re n 48 PROGOTIR PATHEY 2006 Child health Table CH.7 shows the proportion of children treated with antibiotics when their mother (caretakers) suspected they may have pneumonia. Overall, only 21.5 percent of under-5 children who were sick in the two-week period prior to the survey interview received any antibiotic for treating pneumonia. Not surprising, the treatment rate increased in parallel to the increasing level of education of the mothers and economic status of households. There was not much variation between the rural and urban areas. However, an antibiotic was less applied among the older of the under-5 children. A mother’s knowledge of the danger signs of pneumonia is an important determinant of care-seeking behaviour. Overall, 15.7 percent of mother’s in the survey correctly knew the two danger signs of pneumonia - fast and difficult breathing. Most mothers (82.7 percent) said fever was the tell-tale symptom of pneumonia and thus the sign for seeking teatment in a health care facility. However, 36.1 percent of the mothers identified fast breathing only, while another 35 percent said difficult breathing only (Table CH.7a). Solid fuel use More than three billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. But using solid fuels leads to high levels of indoor smoke, which is a complex mix of health-damaging pollutants. The problem is the incomplete combustion that takes place, resulting in the release of toxic elements such as carbon monoxide, polyaromatic hydrocarbons and sulphur dioxide. The use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. For the MICS, the primary indicator is the proportion of the population using solid fuels as the main source of energy for cooking. The survey fingings indicate that a very high proportion (87.6 percent) of all households in Bangladesh use solid fuels for cooking (Table CH.8), reflected largely in the reported use of wood (48.4 percent). The prevalence was lowest in city corporations (30.6 percent) but very high in rural areas where almost all the surveyed households (97.2 percent) relied on solid fuels. Again, there were distinctions based on the educational level of the household head and household wealth; for example, 98.2 percent of the poorest quintile-ranking families used solid wood for cooking, compared to 48.9 percent of the richest quintile. Solid fuel use alone is a poor proxy for indoor air pollution because the concentration of the pollutants depends on were it is burned - in a fire or in different types of stoves. A closed stove with a chimney minimizes the indoor pollution, while an open stove or fire with no chimney or hood means that there is no protection from the harmful effects of solid fuels. As table CH.9 shows a very high proportion of households (97.5 percent) were using on open stove or fire with no chimney or hood for there cooking purposes. Only 0.1 percent of the surveyed households used a closed stove with a chimney; 2.3 percent also used an open stove or fire but with a chimney. 49Bangladesh Multiple Indicator Cluster Survey 2006 Table CH.8: Solid fuel use Percentage distribution of households according to type of cooking fuel, and percentage of households that used solid fuels for cooking, Bangladesh, 2006 Division Barisal .1 2.1 .3 83.5 13.4 100.0 97.0 3909 Chittagong .3 15.8 .2 64.2 18.8 100.0 83.0 11015 Dhaka .4 18.0 .3 41.9 37.8 100.0 79.7 20219 Khulna .3 2.5 .3 48.6 46.6 100.0 95.2 7465 Rajshahi .1 2.0 .2 33.7 60.9 100.0 94.6 16432 Sylhet .1 9.1 .2 66.2 23.2 100.0 89.4 3423 Area Rural .1 .9 .1 48.7 48.5 100.0 97.2 43735 Urban .7 32.6 .7 46.9 17.3 100.0 64.3 18138 Urban municipality .5 19.3 .6 55.0 22.9 100.0 77.9 12925 City Corporation 1.1 65.5 .8 27.1 3.6 100.0 30.6 5213 Non-slum 1.1 69.4 .7 23.4 3.4 100.0 26.8 4793 Slum .8 20.9 1.3 69.3 5.2 100.0 74.5 420 Tribal .0 .1 .2 75.0 24.5 100.0 99.4 590 Education None .1 3.0 .1 43.6 51.1 100.0 94.7 27559 of Primary incomplete .1 4.9 .1 52.2 40.8 100.0 93.0 7721 household Primary completed .2 7.4 .1 54.0 36.7 100.0 90.7 6506 head Secondary incomplete .2 11.9 .2 55.2 30.9 100.0 86.1 10349 Secondary completed .9 33.5 .9 48.4 15.4 100.0 63.8 9982 or higher Non-standard .0 5.1 .0 35.3 58.5 100.0 93.8 190 curriculum Missing/DK .3 19.8 .0 49.0 28.6 100.0 77.6 154 Wealth Poorest .0 .0 .0 22.7 75.5 100.0 98.2 13530 index Second .0 .0 .0 52.3 45.4 100.0 97.7 13019 quintiles Middle .0 .3 .1 60.5 36.8 100.0 97.2 12397 Fourth .2 4.3 .3 68.4 25.4 100.0 93.8 11572 Richest 1.1 48.3 .9 41.3 7.5 100.0 48.9 11946 National .2 10.1 .3 48.4 39.2 100.0 87.6 62463 * MICS indicator 24; MDG indicator 29 Note: Liquid propane gas (LPG), natural gas and biogas are considered as gas. Straw/shrubs/grass, animal dung and agricultural crop residue are considered as ‘other’. Electricity Gas Kerosene Wood Other Total Solid fuels for cooking * No. of households Background characteristics 50 PROGOTIR PATHEY 2006 Child health Table CH.9: Solid fuel use by type of stove or fire Percentage distribution of households using solid fuels for cooking by type of stove or fire, Bangladesh, 2006 Division Barisal .2 1.1 98.6 .1 100.0 3791 Chittagong .3 .7 99.0 .0 100.0 9140 Dhaka .0 .8 99.1 .0 100.0 16107 Khulna .5 3.1 96.4 .1 100.0 7108 Rajshahi .0 .8 99.2 .0 100.0 15538 Sylhet .1 22.1 77.8 .0 100.0 3059 Area Rural .1 2.1 97.7 .0 100.0 42497 Urban .2 3.0 96.7 .0 100.0 11661 Urban municipality .2 3.3 96.4 .0 100.0 10063 City Corporations .0 1.0 99.0 .0 100.0 1597 Non-slum .0 1.1 98.9 .0 100.0 1284 Slum .0 .5 99.3 .1 100.0 313 Tribal .0 .5 99.4 .1 100.0 587 Education None .1 1.7 98.2 .0 100.0 26086 of Primary incomplete .1 2.5 97.4 .0 100.0 7179 household Primary completed .1 3.4 96.4 .0 100.0 5901 head Secondary incomplete .3 2.4 97.3 .0 100.0 8912 Secondary completed .4 3.0 96.5 .1 100.0 6368 or higher Non-standard .0 2.8 97.2 .0 100.0 178 curriculum Missing/DK .0 3.9 96.1 .0 100.0 120 Wealth Poorest .0 1.1 98.8 .0 100.0 13282 index Second .0 1.7 98.2 .0 100.0 12717 quintiles Middle .1 2.1 97.8 .0 100.0 12050 Fourth .2 3.1 96.7 .0 100.0 10857 Richest .6 5.1 94.2 .1 100.0 5838 National .1 2.3 97.5 .0 100.0 54745 Total No. of households using solid fuels for cooking Background characteristics Closed stove with chimney Open stove or fire with chimney or hood Open stove or fire with no chimney or hood Other stove Percentage of households using solid fuels for cooking: 51Bangladesh Multiple Indicator Cluster Survey 2006 © Anwar, BBS 52 PROGOTIR PATHEY 2006 Section name ©UNICEF/Naser Siddique 53Bangladesh Multiple Indicator Cluster Survey 2006 Water and sanitation Safe drinking water is a basic necessity for good health. 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 that harmfully affect human health. In addition to its association with disease, access to safe drinking water may be particularly important for women and children, especially in rural areas, because they tend to shoulder the primary responsibility for carrying water, often over long distances. The seventh MDG goal expects countries to reduce by half (between 1990 and 2015) the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a one-third reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water. The MICS used the following indicators: Water Use of improved drinking water sources Use of adequate water treatment method Time to source of drinking water Person collecting drinking water Sanitation Use of improved sanitation facilities Sanitary disposal of child's faeces The population using improved sources of drinking water are those with any of the following types of water supply: piped water (into dwelling, yard or plot), public tap/standpipe, tube well/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is using it for other purposes also, such as hand washing and cooking. As Table EN.1 shows, 97.6 percent of the surveyed population had access to improved drinking water sources - 99.2 percent in urban areas and 97.1 percent in rural areas. By divisions, Khulna Division is relatively worse than the other Divisions; about 92 percent of the population in this Division gets its drinking water from an improved source. It may be mentioned that arsenic contamination is not considered here. VI. ENVIRONMENT 54 PROGOTIR PATHEY 2006 Environment Table EN.1: Use of improved water sources Percentage distribution of household population, according to main source of drinking water, and percentage of household members using improved drinking water sources, Bangladesh, 2006 Division Barisal .5 .2 .9 95.0 .3 3.1 100.0 96.9 19099 Chittagong 4.3 2.2 1.5 87.7 1.5 2.8 100.0 97.2 59424 Dhaka 9.2 5.4 2.5 82.4 .2 .4 100.0 99.6 95557 Khulna .7 1.1 2.5 87.0 .4 8.3 100.0 91.7 33854 Rajshahi .5 .4 .5 97.2 .5 .9 100.0 99.1 73400 Sylhet 2.8 .9 1.1 87.8 .9 6.5 100.0 93.5 20398 Area Rural .1 .2 .3 95.9 .7 2.9 100.0 97.1 212285 Urban 14.3 8.1 5.0 71.5 .2 .8 100.0 99.2 86762 Urban municipality 4.4 3.5 3.2 87.6 .2 1.1 100.0 98.9 62086 City Corporation 39.0 19.8 9.6 31.2 .1 .3 100.0 99.7 24676 Non-slum 42.1 18.2 7.9 31.5 .1 .3 100.0 99.7 22763 Slum 2.4 39.7 29.8 27.7 .1 .3 100.0 99.7 1913 Tribal .0 .3 .2 70.7 7.4 21.5 100.0 78.5 2685 Education None .6 1.7 1.7 92.6 .8 2.6 100.0 97.4 130785 of Primary incomplete 1.3 2.2 1.8 90.9 .7 3.1 100.0 96.9 38100 household Primary completed 2.2 2.1 1.6 91.1 .4 2.6 100.0 97.4 32288 head Secondary incomplete 3.8 3.4 1.7 88.2 .4 2.4 100.0 97.6 50570 Secondary completed 17.8 3.8 1.3 75.3 .4 1.3 100.0 98.7 48344 or higher Non-standard .7 .0 .0 95.5 1.5 2.2 100.0 97.8 846 curriculum Missing/DK .1 15.8 1.9 80.9 .6 .6 100.0 99.4 798 Wealth Poorest .0 .0 .0 98.7 .3 1.0 100.0 99.0 60145 index Second .0 .0 .5 95.0 .8 3.6 100.0 96.4 60461 quintiles Middle .0 .6 2.0 91.7 1.2 4.4 100.0 95.6 60435 Fourth .2 2.5 2.9 91.4 .6 2.5 100.0 97.5 60343 Richest 20.6 9.1 2.8 66.6 .2 .7 100.0 99.3 60349 National 4.2 2.4 1.6 88.7 .6 2.4 100.0 97.6 301732 * MICS indicator 11; MDG indicator 30 Note: Unimproved sources include: unprotected well, unprotected spring and surface water. Other improved sources include protected well, protected spring, rainwater and bottled water. Total Improved source of drinking water* No. of household membersUnimprovedsources Background characteristics Piped into dwelling Piped into yard or plot Public tap/ standpipe Tubewell/ borehole Other improved sources Main source of drinking water Improved sources The source of drinking water for the population varies strongly by division. In Dhaka Division where there is a higher concentration of people (especially the capital city of Dhaka), 14.6 percent of the population used drinking water that is piped into their dwelling, yard or plot. In Barisal, Khulna and Rajshahi Divisions, less than 2 percent of the households used piped water. Tube wells provide the main source of drinking water varying from 82.4 percent in Dhaka Division to 97.2 percent in Rajshahi Division. Public taps provided water to 2.5 percent of households in Dhaka and Khulna Divisions. 55Bangladesh Multiple Indicator Cluster Survey 2006 Table EN 1a: Tubewells tested/marked for arsenic contamination Percentage distribution of households according to testing of tubewells for arsenic contamination, Bangladesh, 2006 Division Barisal 26.0 1.1 72.7 .2 100.00 2815 Chittagong 41.3 17.2 41.3 .2 100.00 7751 Dhaka 32.3 7.6 59.9 .3 100.00 14185 Khulna 20.1 8.6 71.0 .2 100.00 6178 Rajshahi 55.6 2.8 41.5 .2 100.00 10464 Sylhet 34.4 4.1 61.1 .4 100.00 2187 Area Rural 33.8 9.1 56.9 .2 100.00 32344 Urban 48.0 3.8 48.0 .3 100.00 11052 Urban municipality 46.0 4.3 49.5 .2 100.00 9561 City Corporation 60.7 .5 38.0 .8 100.00 1491 Non-slum 60.3 .4 38.4 .8 100.00 1399 Slum 67.8 1.7 30.5 .0 100.00 91 Tribal 51.8 1.9 46.1 .3 100.00 184 Education None 37.1 8.4 54.2 .2 100.00 17816 of Primary incomplete 35.9 8.3 55.6 .2 100.00 5533 household Primary completed 38.3 8.3 53.1 .2 100.00 4871 head Secondary incomplete 38.3 7.3 54.2 .2 100.00 7988 Secondary completed 37.9 5.5 56.3 .3 100.00 7113 or higher Non-standard 39.3 6.5 54.2 .0 100.00 151 curriculum Missing/DK 41.1 4.6 54.2 .0 100.00 107 Wealth Poorest 37.7 9.0 53.1 .3 100.00 8209 index Second 37.4 8.7 53.8 .1 100.00 8963 quintiles Middle 35.4 8.7 55.7 .2 100.00 9420 Fourth 36.1 7.8 55.8 .3 100.00 9584 Richest 41.7 3.7 54.4 .3 100.00 7404 National 37.5 7.7 54.6 .2 100.0 43580 Total No. of households who have heard of arsenic and use a tubewell Background characteristics Not tested Tested/ marked red Tested/ marked green Missing TW tested for arsenic Arsenic contamination of ground water remains a significant issue for Bangladesh. About 8 percent of household respondents reported that the tubewells they relied upon had been tested and marked red, meaning the arsenic level was higher than the Bangladesh standard of 0.05 mg/l and the well water should not be used for drinking and cooking purposes (Table EN.1a). About 55 percent of the surveyed households reported that their tubewells also had been tested but marked green, meaning the arsenic level was lower than the Bangladesh standard. Another 38 percent of houshehold respondents said their tubewells had not been tested yet. The blanket testing of all tubewells has not been carried out nationwide, and has been confined only to the areas considered to be more at risk of arsenic contamination. 56 PROGOTIR PATHEY 2006 Environment Ta bl e EN .1 b: P ro bl em s of a rs en ic c on ta m in at io n Pe rc en ta ge o f h ou se ho ld s w ho se m em be rs h av e he ar d of a rs en ic , a nd p er ce nt ag e of h ou se ho ld s aw ar e of th e sp ec ifi c pr ob le m s or d is ea se s ca us ed b y ar se ni c co nt am in at io n, B an gl ad es h, 2 00 6 Di vis ion Ba ris al 76 .5 39 09 28 .0 31 .8 8. 3 1. 9 26 .4 10 .1 39 .5 29 92 Ch itta go ng 80 .2 11 01 5 36 .1 37 .9 10 .4 2. 1 32 .9 7. 0 33 .4 88 33 Dh ak a 86 .8 20 21 9 31 .0 29 .0 5. 6 1. 6 36 .8 7. 7 35 .3 17 55 1 Kh uln a 93 .7 74 65 30 .7 30 .8 6. 3 1. 1 41 .9 7. 0 34 .6 69 92 Ra jsh ah i 65 .6 16 43 2 20 .9 23 .0 5. 5 1. 3 33 .6 11 .2 41 .9 10 77 5 Sy lhe t 72 .0 34 23 24 .6 21 .3 7. 1 1. 0 27 .0 8. 1 48 .5 24 63 Ar ea Ru ra l 76 .5 43 73 5 26 .3 26 .5 6. 1 1. 3 32 .2 8. 2 41 .5 33 44 2 Ur ba n 87 .8 18 13 8 35 .3 35 .4 8. 3 2. 1 41 .0 8. 6 28 .1 15 92 6 Ur ba n m un ici pa lity 85 .7 12 92 5 33 .8 35 .1 8. 1 1. 4 40 .3 8. 2 29 .7 11 08 3 Ci ty Co rp or at ion 92 .9 52 13 38 .6 36 .0 8. 8 3. 6 42 .7 9. 6 24 .5 48 44 No n- slu m 94 .0 47 93 39 .6 37 .3 9. 0 3. 8 43 .9 9. 4 22 .8 45 06 Sl um 80 .4 42 0 25 .3 19 .7 6. 1 1. 1 26 .0 12 .4 47 .0 33 8 Tr iba l 40 .1 59 0 21 .6 23 .4 4. 9 1. 0 24 .4 12 .4 47 .5 23 7 Ed uc at ion o f No ne 69 .4 27 55 9 21 .0 21 .8 4. 9 1. 0 27 .7 8. 3 48 .2 19 13 7 ho us eh old h ea d Pr im ar y inc om ple te 78 .5 77 21 27 .2 24 .8 5. 8 .9 32 .5 8. 6 41 .1 60 62 Pr im ar y co m ple te d 82 .8 65 06 28 .5 28 .8 6. 2 1. 6 34 .9 8. 4 37 .5 53 86 Se co nd ar y inc om ple te 88 .5 10 34 9 32 .0 33 .0 7. 9 2. 0 37 .9 8. 3 32 .3 91 61 Se co nd ar y co m ple te d or h igh er 96 .0 99 82 44 .6 44 .3 10 .5 2. 6 48 .7 8. 4 17 .3 95 84 No n- sta nd ar d cu rri cu lum 81 .0 19 0 16 .9 17 .0 3. 6 .6 24 .9 11 .5 44 .7 15 4 M iss ing /D K 79 .2 15 4 25 .5 20 .1 4. 5 5. 2 23 .5 5. 5 47 .0 12 2 W ea lth in de x qu int ile s Po or es t 61 .2 13 53 0 17 .0 17 .5 4. 0 .8 24 .8 9. 4 52 .1 82 81 Se co nd 71 .3 13 01 9 21 .7 21 .6 5. 3 1. 0 28 .0 8. 7 47 .6 92 87 M idd le 81 .2 12 39 7 26 .3 25 .9 6. 6 1. 2 32 .2 7. 6 41 .9 10 07 2 Fo ur th 90 .8 11 57 2 33 .6 34 .2 7. 4 1. 8 38 .5 8. 3 31 .4 10 51 2 Ri ch es t 95 .9 11 94 6 42 .5 42 .6 9. 5 2. 7 47 .3 8. 2 19 .2 11 45 3 Nu mb er of ho us eh old s 79 .4 62 46 3 29 .2 29 .3 6.8 1.5 35 .0 8.4 37 .2 49 60 5 Bl ac k, wh ite o r re d sp ot s ov er th e bo dy Ha nd s an d fe et be co m e ro ug h to to uc h Le gs sw ell u p Lo sin g th e fe eli ng s of h an ds an d leg s So re o ve r ha nd a nd leg Ot he r No pr ob lem Ba ck gr ou nd c ha ra cte ris tic s Pr op or tio n of h ou se ho lds a wa re o f t he p ro ble m s of a rs en ic co nt am ina tio n: Pr op or tio n of ho us eh old s wh o ha ve he ar d of ar se nic No . o f ho us eh old s No . o f ho us eh old s wh o ha ve he ar d of ar se nic 57Bangladesh Multiple Indicator Cluster Survey 2006 MICS 2006 also collected data on household’s awareness of the problems or diseases caused by arsenic contamination. Households were asked if they heard of arsenic in water. Some 79.4 percent of households did hear about it (Table EN.1b). According to the households, the most common problems or diseases caused by arsenic are: sores over the limb (35 percent), limbs becoming rough to the touch (29.3 percent), and black, white or red spots over the body (29.2 percent). Asked whether or not they took any measures to avoid arsenic contamination, about one third (31.9 percent) of the households reported that they do not take any specific measures to prevent arsenic contamination. Some 54.5 percent of households said they use water from arsenic-free tubewells. Slightly more than 2 percent indicated that they use filters, including SIDKO filters which are designed to remove arsenic (Table EN.1c). 58 PROGOTIR PATHEY 2006 Environment Table EN.1c: Protection from arsenic contamination Percentage of households protecting themselves from aresenic contamination, Bangladesh, 2006) Division Barisal 57.3 23.4 5.5 1.7 1.1 4.7 32.0 2992 Chittagong 54.7 26.2 7.7 2.4 2.4 6.2 29.9 8833 Dhaka 57.7 20.0 4.5 2.1 2.6 6.2 29.9 17551 Khulna 62.0 19.2 6.9 3.4 2.1 6.4 26.5 6992 Rajshahi 45.7 18.1 2.7 2.4 1.5 7.3 39.0 10775 Sylhet 44.5 24.4 4.2 3.6 3.5 7.1 37.1 2463 Area Rural 53.6 19.4 4.7 2.4 1.5 5.5 34.2 33442 Urban 56.5 24.4 5.9 2.4 3.8 8.5 26.8 15926 Urban municipality 58.1 23.1 5.7 2.4 3.7 7.6 27.7 11083 City Corporation 52.9 27.4 6.3 2.6 3.9 10.7 24.9 4844 Non-slum 54.4 28.0 6.5 2.8 4.1 10.7 23.4 4506 Slum 33.1 19.9 4.4 .2 1.2 10.9 44.8 338 Tribal 41.1 15.7 4.3 2.2 2.4 5.8 46.2 237 Education of None 47.1 17.1 2.9 1.7 .9 5.7 40.2 19137 household Primary incomplete 51.9 19.7 4.0 1.8 1.3 6.1 34.0 6062 head Primary completed 54.3 21.9 5.5 2.6 1.7 6.1 30.9 5386 Secondary incomplete 58.1 24.1 6.0 2.5 2.3 7.4 27.5 9161 Secondary completed 67.8 26.6 8.9 4.2 5.5 7.4 18.5 9584 Non-standard curriculum 49.0 10.4 2.3 1.8 .0 7.5 40.8 154 or higher Missing/DK 51.9 10.2 3.2 .8 3.5 8.3 38.1 122 Wealth Poorest 44.5 14.3 1.8 1.3 .8 5.4 44.5 8281 index Second 46.8 18.0 3.1 2.0 1.1 5.1 40.3 9287 quintiles Middle 52.4 19.1 4.3 2.3 1.5 5.8 34.2 10072 Fourth 60.0 23.5 6.7 2.8 1.9 6.8 25.9 10512 Richest 64.6 27.7 8.0 3.3 5.0 8.5 19.4 11453 Total 54.5 21.0 5.0 2.4 2.2 6.4 31.9 49605 Background characteristics Proportion of households protecting themselves from arsenic contamination by: Using water from arsenic free TW Using boiled pond/ river/ canal water Using rain water Using pond/ sand filter water Using filters (including SIDKO filters) Other Nothing No. of households who have heard of arsenic 59Bangladesh Multiple Indicator Cluster Survey 2006 Households member were asked how they treated water at home to make it safer to drink; boiling, adding bleach or chlorine, using a water filter or using solar disinfection are considered the proper ways to treat water for consumption. Table EN.2 shows the percentage of household members using appropriate water treatment methods as well as of those households using improved or unimproved drinking water sources. Only 7.4 percent of the household population used any of the proper methods to treat their drinking water. Calculated by area, only 2.9 percent of rural households and 18.5 percent of urban households properly treated the water they consumed, but in city corporations the proportion rose 47.5 percent. More household boiled their water (4.9 percent) followed by filters (2 percent). The amount of time it takes household members to obtain water is presented in Table EN.3, and the following Table EN.4 shows which person usually handled that task. These results only refer to one roundtrip from the home to the drinking water source; information on the number of trips made in one day was not collected. For 68 percent of the surveyed households, the drinking water source was on their premises. But this finding varied substantially between divisions: in Barisal, only 27.4 percent of the drinking water sources were on the premises while in Rajshahi this rose to 78.6 percent. By area, 65.1 percent of rural households and 76.6 percent of urban households had a drinking water source on their premises. Only 24.4 percent of tribal households had such proximity to their water source. Having a water source on the premises positively correlated to both educational level of the household head and the economic status of the household. Some 28.5 percent of all households spent less than 30 minutes making a roundtrip to and from their water source, while 2.7 percent of households spent more than 30 minutes but less than an hour. Excluding those households with water on their premises, the average time to the source of drinking water was 12.2 minutes. The time spent in rural areas in collecting water was slightly longer than in urban areas. One important finding is the greater time spent in tribal areas for collecting water - 16.9 minutes on average. As Table EN.4 shows, an adult woman in the majority of surveyed households usually was the one to collect the water (88.8 percent) when the source was not on the premises. Adult men collect water in only 4.7 percent of households, while either female or male children younger than 15 were sent for it in 5.6 percent of households. 60 PROGOTIR PATHEY 2006 Environment Table EN.2: Household water treatment Percentage distribution of household population, according to drinking water treatment method used in the household, and percentage of household members that applied an appropriate water treatment method, Bangladesh, 2006 Division Barisal 93.1 1.0 6.5 19099 3.6 18500 97.0 599 Chittagong 93.4 1.1 6.0 59424 5.6 57765 21.5 1659 Dhaka 87.3 3.4 12.4 95557 12.3 95211 17.8 346 Khulna 90.7 2.6 8.4 33854 3.0 31044 69.0 2810 Rajshahi 98.3 .4 1.4 73400 1.4 72768 .3 632 Sylhet 90.8 1.6 8.2 20398 6.8 19077 28.2 1321 Area Rural 96.7 .8 2.9 212285 1.5 206210 47.4 6075 Urban 80.9 4.5 18.5 86762 18.2 86046 58.3 716 Urban municipality 92.6 1.1 7.0 62086 6.5 61439 60.6 648 City Corporation 51.6 12.9 47.5 24676 47.5 24607 '(*)' 69 Non-slum 48.2 13.8 50.9 22763 51.0 22698 '(*)' 65 Slum 92.4 2.2 6.7 1913 6.6 1910 '(*)' 3 Tribal 96.0 2.7 1.3 2685 1.0 2109 2.7 576 Education None 97.0 1.0 2.5 130785 1.6 127326 34.9 3459 of Primary incomplete 95.1 1.2 4.5 38100 3.1 36909 46.8 1191 household Primary completed 94.0 1.3 5.6 32288 4.1 31435 59.8 853 head Secondary incomplete 91.3 2.1 8.1 50570 6.9 49364 55.1 1206 Secondary completed 76.4 4.8 23.1 48344 22.7 47710 57.5 634 or higher Non-standard 98.3 .0 1.7 846 1.4 827 '(*)' 19 curriculum Missing/DK 84.5 11.0 13.3 798 13.0 794 '(*)' 5 Wealth Poorest 98.9 .3 .9 60145 .6 59542 27.4 603 index Second 97.2 .8 2.3 60461 .9 58271 39.6 2190 quintiles Middle 96.0 1.1 3.5 60435 1.5 57772 45.6 2663 Fourth 95.6 1.0 3.9 60343 2.6 58853 54.6 1490 Richest 73.2 6.1 26.2 60349 26.0 59927 59.8 422 National 92.2 1.9 7.4 301732 6.4 294365 45.0 7367 * MICS indicator 13 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Note: Appropriate water treatment methods include boiling, adding bleach or chlorine, using a water filter and using solar disinfection. Background characteristics Inappro- priate water treatment None All drinking water sources: Appropriate water treatment method * No. of household members Improved drinking water sources: Appropriate water treatment method No. of household members Unimproved drinking water sources: Approprate water treatment method No. of household members Treatment of main source of drinking water 61Bangladesh Multiple Indicator Cluster Survey 2006 Table EN.3: Time to source of water Percentage distribution of households according to length time to and from the source of drinking water, and mean time to source of drinking water, Bangladesh, 2006 Division Barisal 27.4 43.4 16.8 10.4 1.4 .5 100.0 14.6 3909 Chittagong 59.2 26.7 8.9 4.3 .7 .3 100.0 13.3 11015 Dhaka 77.1 17.5 3.8 1.3 .1 .3 100.0 10.3 20219 Khulna 58.6 28.0 7.6 4.3 1.4 .1 100.0 14.4 7465 Rajshahi 78.6 18.4 2.3 .4 .1 .2 100.0 8.3 16432 Sylhet 59.7 24.0 10.3 4.9 .8 .4 100.0 14.5 3423 Area Rural 65.1 24.2 6.9 3.1 .6 .2 100.0 12.5 43735 Urban 76.6 18.2 3.3 1.5 .2 .3 100.0 10.7 18138 Urban municipality 75.6 18.8 3.7 1.6 .2 .2 100.0 11.0 12925 City Corporation 79.2 16.7 2.3 1.3 .1 .5 100.0 9.7 5213 Non-slum 80.6 15.7 2.0 1.1 .0 .5 100.0 9.3 4793 Slum 63.2 27.2 5.5 3.0 .7 .5 100.0 12.0 420 Tribal 24.2 41.8 18.5 11.5 3.7 .2 100.0 16.9 590 Education None 62.0 26.5 7.3 3.3 .6 .3 100.0 12.4 27559 of Primary incomplete 62.7 26.1 6.8 3.5 .7 .1 100.0 12.6 7721 household Primary completed 68.2 22.3 6.0 2.9 .4 .2 100.0 12.4 6506 head Secondary incomplete 73.8 18.7 4.8 2.1 .4 .2 100.0 12.0 10349 Secondary completed 82.8 13.2 2.6 1.0 .1 .3 100.0 10.4 9982 or higher Non-standard 61.4 32.4 4.1 2.0 .0 .0 100.0 8.8 190 curriculum Missing/DK 68.8 20.9 4.8 4.0 1.5 .0 100.0 17.6 154 Wealth Poorest 58.6 29.7 7.9 3.0 .5 .3 100.0 11.7 13530 index Second 59.0 26.7 8.5 4.5 .9 .3 100.0 13.6 13019 quintiles Middle 63.5 25.5 6.8 3.4 .5 .3 100.0 12.4 12397 Fourth 74.7 18.9 4.0 1.9 .3 .2 100.0 11.3 11572 Richest 86.8 10.6 1.9 .5 .1 .2 100.0 10.0 11946 National 68.0 22.6 5.9 2.7 .5 .3 100.0 12.2 62463 Mean time to source of drinking water (excluding those on premises) No. of households TotalBackground characteristics Water on premises Less than 15 minutes 15 minutes to less than 30 minutes 30 minutes to less than 1 hour 1 hour or more Don't Know Time to and from the source of drinking water 62 PROGOTIR PATHEY 2006 Environment Table EN.4: Person collecting water Percentage distribution of households according to the person collecting water used in the household, Bangladesh, 2006 Division Barisal 77.3 11.6 7.8 2.7 .6 100.0 2838 Chittagong 88.3 4.1 5.2 1.7 .6 100.0 4497 Dhaka 91.5 3.1 3.7 .5 1.2 100.0 4634 Khulna 88.5 6.1 3.9 .7 .7 100.0 3091 Rajshahi 94.6 1.5 2.6 .1 1.1 100.0 3523 Sylhet 90.0 3.3 4.7 .8 1.1 100.0 1380 Area Rural 89.1 4.3 4.6 1.1 .8 100.0 15277 Urban 86.9 6.4 4.2 1.1 1.3 100.0 4237 Urban municipality 87.1 6.0 4.4 1.1 1.4 100.0 3152 City Corporation 86.1 7.7 3.7 1.3 1.2 100.0 1085 Non-slum 85.6 8.3 3.5 1.5 1.1 100.0 930 Slum 89.3 4.0 4.8 .3 1.6 100.0 155 Tribal 94.0 2.6 2.8 .2 .4 100.0 448 Education None 90.9 3.2 4.3 .8 .8 100.0 10467 of Primary incomplete 88.0 4.8 5.0 1.3 .9 100.0 2883 household Primary completed 88.2 4.9 5.0 1.2 .8 100.0 2068 head Secondary incomplete 87.0 6.8 3.9 1.2 1.2 100.0 2709 Secondary completed 80.6 11.0 5.1 2.3 1.0 100.0 1713 or higher Non-standard 87.5 2.8 7.5 .0 2.2 100.0 73 curriculum Missing/DK 87.2 5.6 7.2 .0 .0 100.0 48 Wealth Poorest 92.3 2.2 4.0 .5 .9 100.0 5595 index Second 88.7 4.5 4.8 1.2 .7 100.0 5340 quintiles Middle 88.2 5.1 4.8 1.1 .8 100.0 4525 Fourth 87.3 6.1 4.1 1.5 1.0 100.0 2922 Richest 80.4 10.7 5.3 1.8 1.8 100.0 1580 National 88.8 4.7 4.5 1.1 .9 100.0 19962 Adult woman Adult man Female child (under 15) Male child (under 15) DK Total No. of households Background characteristics Person collecting drinking water 63Bangladesh Multiple Indicator Cluster Survey 2006 Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities include: flush toilets connected to sewage systems, septic tanks or pit latrines, ventilated improved pit latrines and pit latrines with slabs, and composting toilets. Only 39.2 percent of the overall surveyed population lived in households with acces to improved sanitation facilities (Table EN.5). By area this broke down to 57.8 percent of urban household, 31.9 percent of rural households; within the urban areas, 68.8 percent households in the city corporations had access to sanitary latrines. There was no major variation among the six divisions, although Barisal Division ranked the highest (48.4 percent). Most of the surveyed population had no facility and used rivers, ponds, fields or the bushes for their sanitation needs. Only 17.2 percent of the surveyed population in the tribal areas used a sanitary latrine. The MICS indicator for the safe disposal of a child's faeces looks at whether or not a child’s (up to age two years) most recent stool (at the time of the survey interview) was disposed into a toilet or rinsed in a toilet or latrine. As Table EN.6 shows, only 22.5 percent of households safely disposed of children’s faeces. There was little variation among the divisions, though the lowest rate of safe disposal was 15.6 percent (in Rajshahi Division). The rural-urban variation was very significant: only 14.9 percent of rural households compared to 43.9 percent of urban households followed the safe procedures. There was a strong positive correlation between the safe disposal of a child's faeces and both the education of mother and economic status of households. Table EN.7 shows the findings for both the use of improved sources of drinking water and sanitary means of excreta disposal. About 39 percent of surveyed household population reported using an improved water source and sanitary means of excreta disposal. The urban population was almost twice as likely (at 57.4 percent) to use an improved source of drinking water and sanitary means of excreta disposal compared to the rural population (at 31.2 percent). In tribal areas, only 14.5 percent of the surveyed household population used both an improved source of drinking water and sanitary means of excreta disposal. Figure EN.1: Household population using sanitary means of excreta disposal, Bangladesh, 2006 Non-Sanitary 60.8% Sanitary 39.2% 64 PROGOTIR PATHEY 2006 Environment Ta bl e EN .5 : U se o f s an ita ry m ea ns o f e xc re ta d is po sa l Pe rc en ta ge d is tri bu tio n of h ou se ho ld p op ul at io n ac co rd in g to ty pe o f t oi le t u se d by th e ho us eh ol d an d th e pe rc en ta ge o f h ou se ho ld m em be rs us in g sa ni ta ry m ea ns o f e xc re ta d is po sa l, Ba ng la de sh , 2 00 6 Di vis ion Ba ris al .8 8. 1 4. 3 35 .2 29 .2 20 .1 1. 0 1. 3 10 0. 0 48 .4 19 09 9 Ch itta go ng .8 16 .6 3. 9 20 .1 33 .5 18 .9 4. 0 2. 3 10 0. 0 41 .4 59 42 4 Dh ak a 7. 4 10 .8 8. 3 11 .0 32 .9 22 .5 5. 7 1. 3 10 0. 0 37 .5 95 55 7 Kh uln a .2 15 .3 8. 2 16 .7 42 .9 12 .6 3. 6 .5 10 0. 0 40 .3 33 85 4 Ra jsh ah i .8 11 .8 5. 0 20 .4 32 .6 11 .5 17 .1 .7 10 0. 0 38 .0 73 40 0 Sy lhe t 1. 6 20 .7 2. 8 9. 3 33 .2 27 .1 4. 2 1. 1 10 0. 0 34 .4 20 39 8 Ar ea Ru ra l .2 7. 2 5. 8 18 .7 38 .6 19 .7 9. 2 .6 10 0. 0 31 .9 21 22 85 Ur ba n 9. 4 28 .3 6. 6 13 .4 22 .4 14 .5 2. 6 2. 8 10 0. 0 57 .8 86 76 2 Ur ba n m un ici pa lity 2. 0 26 .8 8. 0 16 .6 27 .9 12 .6 3. 6 2. 5 10 0. 0 53 .4 62 08 6 Ci ty Co rp or at ion 28 .0 32 .2 3. 1 5. 5 8. 5 19 .3 .1 3. 3 10 0. 0 68 .8 24 67 6 No n- slu m 29 .9 34 .5 3. 2 5. 3 8. 0 15 .8 .1 3. 3 10 0. 0 72 .9 22 76 3 Sl um 5. 1 5. 3 2. 2 7. 6 15 .5 61 .3 .4 2. 6 10 0. 0 20 .1 19 13 Tr iba l .3 1. 5 1. 4 14 .0 33 .9 18 .2 30 .2 .5 10 0. 0 17 .2 26 85 Ed uc at ion o f No ne .9 4. 6 3. 9 15 .0 38 .0 24 .4 12 .1 1. 0 10 0. 0 24 .5 13 07 85 ho us eh old h ea d Pr im ar y i nc om ple te 1. 7 6. 7 5. 7 18 .4 38 .0 20 .4 7. 6 1. 5 10 0. 0 32 .5 38 10 0 Pr im ar y c om ple te d 1. 4 11 .9 6. 5 19 .1 37 .5 17 .0 5. 4 1. 2 10 0. 0 38 .9 32 28 8 Se co nd ar y i nc om ple te 3. 4 17 .0 8. 5 20 .2 33 .1 12 .8 3. 6 1. 4 10 0. 0 49 .1 50 57 0 Se co nd ar y c om ple te d or h igh er 9. 3 38 .3 8. 9 17 .4 17 .7 5. 8 .7 1. 7 10 0. 0 74 .0 48 34 4 No n- sta nd ar d cu rri cu lum .5 9. 8 3. 5 14 .2 40 .6 20 .6 8. 9 1. 9 10 0. 0 28 .1 84 6 M iss ing /D K 7. 9 18 .4 5. 3 19 .4 23 .4 21 .6 3. 2 .7 10 0. 0 51 .1 79 8 W ea lth in de x q uin tile s Po or es t .0 .0 .6 10 .4 43 .9 20 .5 24 .2 .4 10 0. 0 11 .0 60 14 5 Se co nd .0 .2 2. 7 18 .5 42 .9 26 .6 8. 5 .6 10 0. 0 21 .4 60 46 1 M idd le .1 2. 8 6. 3 21 .9 42 .5 21 .7 3. 8 1. 0 10 0. 0 31 .0 60 43 5 Fo ur th 1. 1 13 .4 11 .4 24 .7 32 .8 14 .4 1. 0 1. 2 10 0. 0 50 .6 60 34 3 Ri ch es t 13 .2 49 .7 8. 9 10 .2 7. 3 7. 6 .0 3. 1 10 0. 0 82 .0 60 34 9 Na tio na l 2.9 13 .2 6.0 17 .1 33 .9 18 .2 7.5 1.2 10 0.0 39 .2 30 17 32 * M IC S In dic at or 1 2; M DG In dic at or 3 1 Ba ck gr ou nd ch ar ac te ris tic s Fl us h to pip ed se we r sy ste m Fl us h to se pt ic tan k Fl us h to pit (la tri ne ) Pi t la tri ne wi th sl ab Pi t la tri ne wi th ou t sla b/ op en p it Ha ng ing to ile t/ ha ng ing lat rin e No fa cil itie s or b us h or fie ld Ot he r No . o f ho us eh old m em be rs Pe rce nta ge of po pu lat ion us ing sa nit ar y me an s o f ex cre ta dis po sa l * To tal Ty pe o f t oil et fa cil ity u se d by h ou se ho ld Im pr ov ed sa nit at ion fa cil ity Un im pr ov ed sa nit at ion fa cil ity 65Bangladesh Multiple Indicator Cluster Survey 2006 Table EN.5a: Hand washing after defecation Percentage distribution of households according to hand washing practice of the household head after own or child's defecation, Bangladesh, 2006 Division Barisal 3.4 24.4 13.0 59.1 .1 100.0 3909 Chittagong 9.2 14.7 5.0 71.1 .0 100.0 11015 Dhaka 5.5 23.7 11.7 59.0 .1 100.0 20219 Khulna 1.2 27.4 15.3 56.0 .1 100.0 7465 Rajshahi 4.2 19.1 25.6 51.0 .0 100.0 16432 Sylhet 11.6 21.6 6.1 60.7 .0 100.0 3423 Area Rural 6.2 25.9 17.4 50.4 .1 100.0 43735 Urban 3.0 10.3 7.1 79.5 .1 100.0 18138 Urban municipality 3.3 13.2 9.0 74.5 .1 100.0 12925 City corporation 2.5 3.3 2.3 91.9 .0 100.0 5213 Non-slum 2.0 2.8 1.8 93.4 .0 100.0 4793 Slum 8.4 8.8 8.6 74.2 .0 100.0 420 Tribal 26.6 17.0 12.9 43.3 .1 100.0 590 Education None 8.5 30.6 18.6 42.2 .1 100.0 27559 of Primary incomplete 5.4 23.7 15.1 55.7 .1 100.0 7721 household Primary completed 3.9 17.9 14.9 63.2 .0 100.0 6506 head Secondary incomplete 3.0 12.9 11.8 72.3 .0 100.0 10349 Secondary completed .9 4.6 4.4 90.1 .0 100.0 9982 or higher Non-standard 5.7 23.4 20.4 50.5 .0 100.0 190 curriculum Missing/DK 5.5 18.0 10.8 65.8 .0 100.0 154 Wealth Poorest 10.2 37.2 22.8 29.7 .0 100.0 13530 index Second 7.5 30.2 19.9 42.3 .1 100.0 13019 quintiles Middle 5.3 22.6 16.3 55.7 .1 100.0 12397 Fourth 2.5 11.6 9.6 76.2 .1 100.0 11572 Richest 1.0 1.6 1.4 96.0 .0 100.0 11946 National 5.5 21.3 14.4 58.8 .1 100.0 62463 Background characteristics No. of households TotalOnly water Water and soil Water and ash Water and soap Others Hand washing after defecation Washing hands after defecation (of each individual and after cleaning a child’s stool) is a good way of avoiding intestinal diseases and has been emphasized in hygiene promotion in Bangladesh for several years. As Table Table EN. 5a shows, some 5.5 percent of the surveyed households used only water for hand washing after defecation; 21.3 percent used water and soil, 14.4 percent used water and ash and 58.8 percent used water and soap. The variation between the divisions is large. The rural-urban variation is very significant. There is a strong positive co-relation between hand washing and both the education of the household head and the socio-economic status of the household. 66 PROGOTIR PATHEY 2006 Environment Table EN.6: Disposal of child's feaces Percentage distribution of children aged 0-2 years, according to place of disposal of child's feaces, and the percentage of children aged 0-2 years whose stools are disposed of safely, Bangladesh, 2006 Division Barisal 2.9 22.9 29.0 5.6 31.1 8.6 100.0 25.8 1071 Chittagong 1.3 22.7 22.3 12.0 34.5 7.2 100.0 24.0 3894 Dhaka 1.2 24.5 21.0 12.0 32.0 9.2 100.0 25.8 5748 Khulna .8 23.3 24.1 6.3 39.1 6.4 100.0 24.1 1786 Rajshahi 1.4 14.2 18.7 14.6 43.1 8.0 100.0 15.6 4238 Sylhet 1.3 20.0 28.2 6.3 37.6 6.6 100.0 21.3 1492 Area Rural .8 14.1 22.5 12.3 41.8 8.6 100.0 14.9 13310 Urban 2.9 41.0 21.5 8.4 20.4 5.9 100.0 43.9 4765 Urban municipality 2.6 34.7 22.4 9.1 24.7 6.5 100.0 37.3 3491 City Corporation 3.7 58.1 18.9 6.6 8.5 4.2 100.0 61.8 1274 Non-slum 3.9 61.4 17.1 6.0 7.8 3.9 100.0 65.2 1157 Slum 1.9 26.3 37.0 13.0 15.6 6.2 100.0 28.2 117 Tribal .8 16.5 12.1 6.9 46.5 17.2 100.0 17.4 154 Mother's None .5 10.4 23.4 12.3 44.4 8.9 100.0 10.9 6018 education Primary incomplete 1.0 14.4 24.6 12.1 39.9 8.0 100.0 15.4 2866 Primary completed 1.1 16.5 24.8 12.5 37.5 7.6 100.0 17.6 2343 Secondary incomplete 1.4 27.3 20.9 10.6 32.3 7.5 100.0 28.8 4987 Secondary completed 4.4 54.2 14.6 6.3 13.8 6.7 100.0 58.7 1957 or higher Non-standard (.0) (6.5) (22.0) (16.9) (42.6) (12.0) 100.0 (6.5) 56 curriculum Missing/DK '(*)' '(*)' '(*)' '(*)' '(*)' '(*)' 100.0 '(*)' 2 Wealth Poorest .5 6.2 21.3 13.6 49.8 8.6 100.0 6.8 4496 index Second .6 9.9 23.7 11.8 45.0 9.0 100.0 10.5 3865 quintiles Middle 1.1 16.2 24.3 11.9 37.7 8.8 100.0 17.3 3396 Fourth 1.2 24.6 24.4 12.3 30.0 7.6 100.0 25.7 3398 Richest 3.9 58.8 16.5 5.1 10.5 5.3 100.0 62.7 3073 National 1.3 21.1 22.1 11.2 36.2 8.0 100.0 22.5 18228 * MICS indicator 14 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Figures in parenthesis are based on 25-49 unweighted cases. Proportion of children whose stools are disposed of safely * No. of children aged 0-2 years TotalBackground characteristics Child used toilet/ latrine Put /rinsed into toilet or latrine Put/ rinsed into drain or ditch Thrown into garbage (solid waste) Left in the open Other What was done to dispose of the stools 67Bangladesh Multiple Indicator Cluster Survey 2006 Table EN.7: Use of improved water sources and improved sanitation Percentage of household population using both improved drinking water sources and sanitary means of excreta disposal, Bangladesh, 2006 Division Barisal 96.9 48.4 47.2 19099 Chittagong 97.2 41.4 41.1 59424 Dhaka 99.6 37.5 37.4 95557 Khulna 91.7 40.3 37.4 33854 Rajshahi 99.1 38.0 37.9 73400 Sylhet 93.5 34.4 33.4 20398 Area Rural 97.1 31.9 31.2 212285 Urban 99.2 57.8 57.4 86762 Urban municipality 99.0 53.4 53.0 62086 City Corporation 99.7 68.8 68.6 24676 Non-slum 99.7 72.9 72.7 22763 Slum 99.8 20.1 20.0 1913 Tribal 78.5 17.2 14.5 2685 Education of None 97.4 24.5 24.1 130785 household Primary incomplete 96.9 32.5 31.9 38100 head Primary completed 97.4 38.9 38.1 32288 Secondary incomplete 97.6 49.1 48.3 50570 Secondary completed 98.7 74.0 73.2 48344 or higher Non-standard 97.8 28.1 26.7 846 curriculum Missing/DK 99.4 51.1 50.7 798 Wealth index Poorest 99.0 11.0 10.9 60145 quintiles Second 96.4 21.4 21.0 60461 Middle 95.6 31.0 29.9 60435 Fourth 97.5 50.6 49.5 60343 Richest 99.3 82.0 81.5 60349 National 97.6 39.2 38.6 301732 * MICS indicator 11; MDG indicator 30 ** MICS indicator 12; MDG indicator 31 Background characteristics Percentage of household population using improved sources of drinking water * Percentage of household population using sanitary means of excreta disposal ** Percentage of household population using improved sources of drinking water and using sanitary means of excreta disposal No. of household members 68 PROGOTIR PATHEY 2006 Environment Security of tenure and durability of housing Target 11 of the seventh MDG expects countries to make significant improvements in the lives of at least 100 million slum dwellers, and the related indicator is the proportion of urban household members living in slum housing. In MICS, three indicators were introduced to measure issues related to slum housing: security of tenure, durability of housing, and the proportion living in slum households. An urban household is considered a slum in MICS if it fulfils one of the following conditions: improved drinking water sources are not used, improved sanitation facilities are not used, living area is not sufficient, housing is not durable, or security of tenure is lacking. Lack of security of tenure is defined as the lack of formal documentation for the residence or perceived risk of eviction. Reflecting security of tenure, Table EN.8 shows that 35.1 percent of surveyed urban households did not have formal documentation for the residence; 7.9 percent of surveyed respondents indicated there was a risk of being eviction. A calculation of both these findings shows that 36.4 percent of surveyed households did not have security of tenure. Only 1.1 percent of household members had actually been evicted from any dwelling the five years prior to the survey interview. The situation was the worst in urban slums where 89.4 percent of the surveyed households did not have formal documentation for the residence, and 24.7 percent of household respondents believed there was a risk of being avicted. Further, 5.1 percent of household members had been evicted from a dwelling in the previous five years. 69Bangladesh Multiple Indicator Cluster Survey 2006 Table EN.8: Security of tenure Percentage of household members living in households in urban areas that lack formal documentation for their residence or who feel at risk of eviction from the dwelling, and the percentage of respondents who have been evicted from their home in the five years prior to the survey, Bangladesh, 2006 Division Barisal 25.5 10.8 30.0 2.7 4831 Chittagong 35.8 5.8 36.8 .6 17564 Dhaka 44.1 8.5 45.6 1.5 32415 Khulna 31.1 4.2 31.4 .5 9066 Rajshahi 24.2 10.1 25.1 .6 17607 Sylhet 30.6 7.1 31.3 1.1 5280 Area Urban 35.1 7.9 36.4 1.1 86762 Urban municipality 24.8 7.2 25.9 .8 62086 Metro cities 61.2 9.4 63.0 1.7 24676 Non-slum 58.8 8.2 60.6 1.4 22763 Slum 89.4 24.7 91.1 5.1 1913 Education of None 39.3 12.3 40.4 1.8 26046 household Primary incomplete 33.3 9.1 34.8 1.1 8858 head Primary completed 29.6 6.4 30.5 1.2 8722 Secondary incomplete 32.5 6.4 33.8 .8 16559 Secondary completed 34.9 4.3 36.3 .4 26148 or higher Non-standard 16.8 .0 16.8 .0 96 curriculum Missing/DK 66.1 17.9 68.1 3.3 332 Wealth Poorest 20.8 11.2 21.8 1.4 6255 index Second 23.6 11.1 25.0 .9 7542 quintiles Middle 29.4 11.2 31.2 2.3 11232 Fourth 35.1 9.7 36.2 1.0 17868 Richest 40.7 5.2 41.9 .7 43865 National 35.1 7.9 36.4 1.1 86762 * MICS Indicator 93 Background characteristics Household does not have formal documentation for the residence Respondent feels there is a risk of eviction Household does not have security of tenure * Household members evicted from any dwelling prior 5 years No. of households members 70 PROGOTIR PATHEY 2006 Environment Table EN.9: Durability of housing Percentage of households and household members living in dwellings in urban areas that are not considered durable, by background characteristics, Bangladesh, 2006) Education of None 75.4 18.1 .0 .0 16.3 5531 15.6 26046 household Primary incomplete 64.8 13.5 .0 .0 12.3 1806 11.4 8858 head Primary completed 56.2 7.7 .0 .0 6.9 1784 6.6 8722 Secondary incomplete 39.9 4.8 .0 .0 3.9 3413 3.7 16559 Secondary completed 12.7 .8 .0 .0 .6 5516 .6 26148 or higher Non-standard curriculum '(*)' '(*)' '(*)' '(*)' '(*)' 22 7.5 96 Missing/DK 42.2 13.2 .0 .0 12.5 65 11.4 332 Wealth index Poorest 100.0 22.6 .0 .0 22.6 1438 23.6 6255 quintiles Second 99.6 20.5 .0 .0 20.3 1689 20.2 7542 Middle 99.4 18.3 .0 .0 18.2 2396 17.5 11232 Fourth 73.9 10.7 .0 .0 8.2 3648 8.0 17868 Richest 2.8 1.1 .0 .0 .2 8966 .2 43865 Number of households 46.6 8.8 .0 .0 7.9 18138 7.5 86762 * MICS Indicator 94 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Background characteristics Dwelling has natural floor material Dwelling is in poor condition Dwelling is vulnerable to accidents Dwelling located in hazardous location Percent of households living in dwellings considered non durable * No. of households Percent of household members living in dwelling considered non-durable No. of household members Structure that households are living in are considered as non-durable in MICS if the floor material is natural and there are two or more bad conditions identified (cracks in walls, no windows, windows with brocken glass/no glass, visible holes in the roof, insecure door, etc.), or conditions of vulnerability of accidents in terms of the dwelling’s surroundings exist, or if the structure is located in or near a hazardous area (landslide area, flood-prone area, river bank, railroad, etc.). As Table EN.9 indicates, 7.9 percent of all surveyed households and 7.5 percent of household members lived in dwellings considered ‘non-durable’, with some 47 percent of structures having a natural floor. The housing condition was strongly and positively correlated to the education level of the household head and the socio-economic status of the household. Table EN.10 brings together all five components that characterize slum housing. As indicated 74 percent of the surveyed households (and 71.9 percent of all household members) in the urban areas lived in households having at least one slum condition. About one fourth (24.4 percent) of the households were over-crowded. The housing condition was negatively correlated to the education level of the household head and the socio-economic status of the household. 71Bangladesh Multiple Indicator Cluster Survey 2006 Ta bl e EN .1 0: S lu m h ou si ng Pe rc en ta ge o f h ou se ho ld s an d ho us eh ol d m em be rs in u rb an a re as th at a re c on si de re d as li vi ng in s lu m h ou si ng , by b ac kg ro un d ch ar ac te ris tic s, Ba ng la de sh , 2 00 6 Ed uc at ion o f No ne 15 .6 42 .0 37 .3 1. 1 72 .0 88 .3 55 31 87 .1 26 04 6 ho us eh old h ea d Pr im ar y inc om ple te 11 .4 37 .8 33 .5 .9 65 .8 83 .6 18 06 81 .4 88 58 Pr im ar y co m ple te d 6. 6 33 .2 26 .6 1. 1 58 .4 77 .7 17 84 75 .4 87 22 Se co nd ar y inc om ple te 3. 7 38 .1 22 .9 .8 46 .5 71 .7 34 13 68 .7 16 55 9 Se co nd ar y co m ple te d or h igh er .6 40 .4 8. 3 .4 21 .8 56 .7 55 16 54 .2 26 14 8 No n- sta nd ar d cu rri cu lum 7. 5 '(* )' '(* )' '(* )' '(* )' '(* )' 22 68 .8 96 M iss ing /D K 11 .4 65 .4 48 .3 .0 44 .6 84 .4 65 85 .4 33 2 W ea lth in de x qu int ile s Po or es t 23 .6 22 .1 48 .9 .4 90 .5 96 .6 14 38 96 .6 62 55 Se co nd 20 .2 25 .5 34 .3 1. 3 81 .9 89 .4 16 89 89 .7 75 42 M idd le 17 .5 33 .2 32 .8 1. 4 75 .9 88 .7 23 96 88 .6 11 23 2 Fo ur th 8. 0 39 .7 28 .1 1. 7 61 .9 79 .4 36 48 78 .6 17 86 8 Ri ch es t .2 46 .6 14 .8 .2 25 .4 61 .5 89 66 58 .3 43 86 5 Nu mb er of ho us eh old s 7.5 39 .5 24 .4 .8 49 .9 74 .0 18 13 8 71 .9 86 76 2 *M IC S In dic at or 9 5; M DG In dic at or 3 2 An a ste ris k ind ica te s th at a fi gu re is b as ed o n fe we r t ha n 25 u nw eig ht ed c as es a nd h as b ee n su pr es se d. Dw ell ing co ns ide re d no n du ra ble La ck o f se cu rit y of te nu re Ov er cr ow din g: m or e th an th re e pe rs on s pe r sle ep ing ro om La ck o f u se of im pr ov ed wa te r so ur ce La ck o f u se of im pr ov ed sa nit at ion Pe rc en t o f ho us eh old s co ns ide re d to b e liv ing in slu m ho us ing * No . o f ho us eh old s Pe rc en t o f ho us eh old s m em be rs co ns ide re d to b e liv ing in slu m ho us ing No . o f ho us eh old m em be rs Ba ck gr ou nd c ha ra cte ris tic s 72 PROGOTIR PATHEY 2006 ©UNICEF/Map/Kiron 73Bangladesh Multiple Indicator Cluster Survey 2006 Antenatal care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother's health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform pregnant women and families about the risk of labour and delivery and the related danger signs and symptoms, it may ensure that they do give birth with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of sexually transmitted infections (STIs) can significantly improve foetal outcomes and improve maternal health. Adverse outcomes, such as low birth weight, can be reduced through a combination of interventions to improve women's nutritional status and prevent infections (such as malaria and STIs) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. Based on a review of the effectiveness of different models of antenatal care, the WHO recommends a minimum of four antenatal visits. WHO guidelines are specific on the content on those visits: Blood pressure measurement Urine testing for bateriuria and proteinuria Blood testing to detect syphilis and severe anaemia Weight/height measurement (optional) Coverage of antenatal care (by a doctor, nurse, or midwife) is relatively low in Bangladesh. The MICS findings indicate that 47.7 percent of surveyed mothers received antenatal care at least once during their pregnancy (Table RH.1). The lowest level of antenatal care was recorded in the tribal areas. Antenatal care coverage was 41.2 percent in rural areas and 66.9 percent in urban areas. The VII. REPRODUCTIVE HEALTH 74 PROGOTIR PATHEY 2006 Reproductive health Ta bl e RH .1 : A nt en at al c ar e pr ov id er Pe rc en ta ge d is tri bu tio n of m ot he rs a ge d 15 -4 9 w ho g av e bi rth in th e tw o ye ar s pr ec ed in g th e su rv ey , b y ty pe o f p er so nn el p ro vi di ng a nt en at al ca re , B an gl ad es h, 2 00 6 Di vis ion Ba ris al 34 .2 7. 6 1. 3 3. 5 3. 2 3. 4 46 .7 10 0. 0 41 .8 73 8 Ch itta go ng 39 .8 9. 6 .7 3. 1 .4 3. 6 42 .8 10 0. 0 49 .4 25 54 Dh ak a 40 .0 8. 7 .2 4. 3 .1 1. 9 44 .7 10 0. 0 48 .7 36 97 Kh uln a 41 .6 10 .9 .0 3. 6 .2 2. 5 41 .2 10 0. 0 52 .5 11 45 Ra jsh ah i 30 .5 15 .3 .5 7. 6 .6 4. 2 41 .4 10 0. 0 45 .8 27 40 Sy lhe t 34 .7 8. 6 .1 4. 0 .1 2. 6 49 .9 10 0. 0 43 .3 10 24 Ar ea Ru ra l 31 .1 10 .1 .5 5. 1 .4 3. 6 49 .2 10 0. 0 41 .2 87 57 Ur ba n 54 .9 12 .0 .2 3. 4 .7 1. 5 27 .4 10 0. 0 66 .9 30 40 Ur ba n m un ici pa lity 51 .3 12 .1 .2 3. 5 .8 1. 8 30 .3 10 0. 0 63 .4 22 30 Ci ty Co rp or at ion s 64 .6 11 .8 .2 3. 0 .4 .6 19 .4 10 0. 0 76 .4 81 1 No n- slu m 68 .1 10 .9 .2 3. 0 .4 .6 16 .8 10 0. 0 79 .1 72 9 Sl um 33 .0 19 .6 .2 3. 4 .0 .9 43 .0 10 0. 0 52 .6 81 Tr iba l 21 .3 7. 0 .0 4. 7 .0 1. 8 65 .2 10 0. 0 28 .3 10 1 Ag e 15 -1 9 ye ar s 33 .5 12 .9 .2 6. 1 .2 3. 7 43 .3 10 0. 0 46 .5 23 64 20 -2 4 ye ar s 39 .0 11 .0 .5 4. 3 .5 2. 9 41 .9 10 0. 0 49 .9 41 11 25 -2 9 ye ar s 39 .2 10 .2 .6 4. 9 .8 2. 6 41 .8 10 0. 0 49 .4 29 46 30 -3 4 ye ar s 37 .6 9. 1 .3 3. 1 .6 3. 2 46 .1 10 0. 0 46 .7 15 54 35 -3 9 ye ar s 32 .8 6. 9 .3 4. 4 .3 2. 7 52 .5 10 0. 0 39 .7 73 5 40 -4 4 ye ar s 25 .4 3. 8 .0 4. 5 .0 3. 3 63 .1 10 0. 0 29 .2 15 0 45 -4 9 ye ar s (9 .8 ) (4 .7 ) (3 .8 ) (3 .7 ) (.0 ) (2 .5 ) (7 5. 5) 10 0. 0 (1 4. 5) 40 Ed uc at ion No ne 19 .9 9. 4 .6 4. 5 .7 3. 4 61 .5 10 0. 0 29 .3 37 30 Pr im ar y i nc om ple te 26 .6 12 .2 .2 4. 7 .3 3. 0 53 .0 10 0. 0 38 .8 18 92 Pr im ar y c om ple te d 30 .4 12 .2 .5 5. 4 .6 3. 1 47 .8 10 0. 0 42 .6 15 51 Se co nd ar y i nc om ple te 49 .4 11 .5 .2 5. 2 .4 3. 2 30 .0 10 0. 0 60 .9 34 29 Se co nd ar y c om ple te d or h igh er 79 .4 6. 8 .3 2. 2 .2 1. 5 9. 6 10 0. 0 86 .2 12 60 No n- sta nd ar d cu rri cu lum (1 2. 9) (1 2. 2) (.0 ) (1 9. 4) (.0 ) (.0 ) (5 5. 5) 10 0. 0 (2 5. 0) 38 W ea lth in de x q uin tile s Po or es t 17 .6 9. 5 .4 6. 1 .7 3. 3 62 .4 10 0. 0 27 .1 29 08 Se co nd 24 .5 10 .6 .8 4. 9 .5 3. 9 54 .8 10 0. 0 35 .1 25 35 M idd le 31 .6 13 .3 .5 4. 3 .8 3. 8 45 .8 10 0. 0 44 .9 22 30 Fo ur th 48 .7 12 .0 .1 4. 7 .3 2. 6 31 .4 10 0. 0 60 .8 22 38 Ri ch es t 74 .8 7. 2 .2 2. 5 .1 1. 0 14 .0 10 0. 0 82 .1 19 89 Na tio na l 37 .1 10 .6 .4 4.6 .5 3.0 43 .8 10 0.0 47 .7 11 89 9 * M IC S ind ica to r 2 0 Fi gu re s in pa re nt he sis a re b as ed o n 25 -4 9 un we igh te d ca se s. M ed ica l do cto r Nu rs e/ m idw ife Tr ad itio na l bir th at te nd an t Co m m un it y h ea lth wo rk er Re lat ive / Fr ien d Ot he r/ m iss ing No an te na tal ca re re ce ive d Ba ck gr ou nd ch ar ac te ris tic s Pe rs on p ro vid ing a nt en ata l c ar e No . o f wo m en wh o ga ve bir th in th e 2 ye ar s pr ec ee din g su rv ey An y sk ille d pe rs on ne l * To tal 75Bangladesh Multiple Indicator Cluster Survey 2006 coverage decreased with an increase in the age of mother and was strongly correlated to their educational background and the socio-economic status of their household. Table RH.1 shows the type of personnel providing antenatal care to mothers aged 15-49 who gave birth in the two years preceding the survey. Overall, doctors administered 37.1 percent of antenatal care while nurses or midwives tended to 10.6 percent of mothers. Doctors provided 31.1 percent of the antenatal care in rural areas but in urban areas that rate rose to 54.9 percent. Figure RH.1: Antenatal care provider: Any skilled personnel, Bangladesh, 2006 Pe rc en t 100 90 80 70 60 50 40 30 20 10 0 47.7 43.3 41.2 66.9 41.8 49.4 48.7 52.5 45.8 Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Rural Urban National Table RH.2 and Figure RH.2 show the type of services pregnant women received: Of those who received antenatal care, a blood sample was taken from 24.5 percent, blood pressure was measured in 46.2 percent, a urine sample was taken from 30.1 percent and weight was measured from 45.1 percent. 76 PROGOTIR PATHEY 2006 Reproductive health Table RH.2: Antenatal care content Percentage of pregnant women aged 15-49 who gave birth in the two years preceding the survey and who received antenatal care, and the percentage of pregnant women receiving specific care as part of the antenatal attention, Bangladesh, 2006 Division Barisal 53.3 18.9 37.8 24.5 35.8 738 Chittagong 57.2 27.2 46.4 31.3 44.1 2554 Dhaka 55.3 27.3 47.3 32.0 45.5 3697 Khulna 58.8 26.1 50.9 30.5 48.9 1145 Rajshahi 58.6 19.4 47.1 29.1 49.4 2740 Sylhet 50.1 23.0 40.4 26.7 37.1 1024 Area Rural 50.8 18.5 40.2 24.1 38.6 8757 Urban 72.6 42.1 64.3 47.9 64.5 3040 Urban municipality 69.7 36.2 60.7 42.7 60.1 2230 City Corporations 80.6 58.5 74.3 62.0 76.7 811 Non-slum 83.2 62.5 77.0 65.8 79.7 729 Slum 57.0 22.6 50.5 28.3 50.1 81 Tribal 34.8 13.7 26.5 15.0 26.4 101 Age 15-19 years 56.7 21.0 44.9 28.6 45.6 2364 20-24 years 58.1 25.9 48.2 32.1 46.8 4111 25-29 years 58.2 26.4 48.6 31.1 47.8 2946 30-34 years 53.9 24.8 44.6 29.3 41.6 1554 35-39 years 47.5 22.2 39.4 25.8 37.2 735 40-44 years 36.9 12.8 27.5 16.2 21.3 150 45-49 years (24.5) (8.1) (15.5) (8.1) (15.0) 40 Education None 38.5 10.0 27.9 14.0 27.2 3730 Primary incomplete 47.0 11.6 36.4 17.6 34.5 1892 Primary completed 52.2 17.4 41.1 24.0 39.7 1551 Secondary incomplete 70.0 34.4 59.9 41.8 59.0 3429 Secondary completed 90.4 68.5 84.7 72.8 83.4 1260 or higher Non-standard curriculum (44.5) (12.4) (31.9) (15.9) (31.4) 38 Wealth Poorest 37.6 7.8 26.8 12.5 26.1 2908 index Second 45.2 12.0 33.4 16.4 32.0 2535 quintiles Middle 54.2 17.5 42.7 25.9 42.5 2230 Fourth 68.6 32.7 59.0 39.6 56.4 2238 Richest 86.0 63.3 80.7 67.4 79.8 1989 National 56.2 24.5 46.2 30.1 45.1 11899 * MICS indicator 20 Figures in parenthesis are based on 25-49 unweighted cases. Background characteristics Percent of pregnant women who had: Blood sample taken* Blood pressure measured* Urine specimen taken* Weight measured* No. of women who gave birth in the 2 years preceeding the survey Percent of pregnant women receiving ANC one or more times during pregnancy* Pe rc en t 100 90 80 70 60 50 40 30 20 10 0 77Bangladesh Multiple Indicator Cluster Survey 2006 Figure RH.2: Percentage of pregnant women receiving antenatal care one or more times during pregnancy, Bangladesh, 2006 Pe rc en t 100 90 80 70 60 50 40 30 20 10 0 56.2 50.1 50.8 75.6 53.3 57.2 55.3 58.8 58.6 Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Rural Urban National Figure RH.2.1: Antenatal care content, Bangladesh, 2006 24.5 46.2 30.1 45.1 Blood sample taken Blood pressure measured Urine specimen taken Weight measured 78 PROGOTIR PATHEY 2006 Reproductive health Assistance at delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth and that transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal for maternal and infant health is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and the proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress towards the MDG of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant, which includes a doctor, nurse, midwife or auxiliary midwife. Only 20.1 percent of births occurring in the two years prior to the MICS survey were delivered by skilled personnel (Table RH.3). This proportion was highest in the non-slum areas (49.2 percent) and in city corporations (45.4 percent) and lowest in the slums, tribal areas and rural areas. The more educated a pregnant woman is and wealthier her family, the more likely she delivered with the assistance of a skilled attendant. Only 4.6 percent of the births in the two years prior to the MICS survey interview were delivered with the assistance of a nurse of midwife. Doctors assisted with the delivery of 15.5 percent of births, while a traditional birth attendant delivered 66 percent of babies born in the two year period prior to the survey interview; this finding applied rather uniformly across the country. Relatives and friends were used in 11.2 percent of deliveries. Only 16 percent of all births were delivered in a health facility (Table RH.4). Some 82.2 percent of women delivered at home. 79Bangladesh Multiple Indicator Cluster Survey 2006 Ta bl e RH .3 : A ss is ta nc e du rin g de liv er y Pe rc en ta ge d is tri bu tio n of w om en a ge d 15 -4 9 w ith a b irt h in th e tw o ye ar s pr ec ed in g th e su rv ey , b y ty pe o f p er so nn el a ss is tin g w ith th e de liv er y, Ba ng la de sh , 2 00 6 Ba ck gr ou nd ch ar ac te ris tic s M ed ica l do cto r Nu rs e/ m idw ife Tr ad itio na l bir th at te nd an t Co m m un it y he alt h wo rk er Re lat ive / fri en d Ot he r/ m iss ing No at te nd an t No . o f wo m en wh o ga ve bir th in pr ec ed ing tw o ye ar s De liv er ed in he alt h fa cil ity ** An y sk ille d pe rs on ne l * To ta l Pe rs on a ss ist ing w ith th e de liv er y Di vis ion Ba ris al 10 .7 3. 2 69 .0 .5 13 .9 1. 3 1. 5 10 0. 0 13 .9 10 .3 73 8 Ch itta go ng 12 .6 5. 7 69 .4 1. 3 9. 7 .8 .4 10 0. 0 18 .4 12 .4 25 54 Dh ak a 18 .4 4. 1 64 .5 .7 10 .6 .9 .8 10 0. 0 22 .5 18 .7 36 97 Kh uln a 21 .4 5. 9 66 .5 .5 4. 9 .6 .2 10 0. 0 27 .3 23 .6 11 45 Ra jsh ah i 13 .9 4. 7 60 .3 1. 5 16 .7 1. 6 1. 3 10 0. 0 18 .6 15 .7 27 40 Sy lhe t 12 .8 3. 2 74 .9 .5 7. 4 .7 .5 10 0. 0 16 .0 12 .2 10 24 Ar ea Ru ra l 10 .6 3. 4 71 .1 .9 12 .3 .9 .9 10 0. 0 14 .0 10 .7 87 57 Ur ba n 29 .8 8. 0 51 .0 1. 3 7. 9 1. 3 .6 10 0. 0 37 .9 31 .7 30 40 Ur ba n m un ici pa lity 26 .8 8. 3 53 .3 1. 2 8. 6 1. 1 .6 10 0. 0 35 .1 29 .2 22 30 Ci ty Co rp or at ion s 38 .1 7. 3 44 .5 1. 4 6. 0 1. 9 .8 10 0. 0 45 .4 38 .6 81 1 No n- slu m 41 .1 8. 0 41 .6 1. 5 5. 3 1. 7 .8 10 0. 0 49 .2 42 .0 72 9 Sl um 10 .8 .7 70 .9 .5 12 .8 3. 6 .7 10 0. 0 11 .5 7. 8 81 Tr iba l 4. 6 3. 6 73 .3 .1 17 .0 1. 3 .1 10 0. 0 8. 2 4. 2 10 1 Ag e 15 -1 9 13 .3 5. 7 65 .8 1. 1 12 .3 1. 1 .7 10 0. 0 19 .0 15 .1 23 64 20 -2 4 15 .5 4. 4 65 .4 1. 0 12 .3 1. 0 .4 10 0. 0 19 .9 15 .4 41 11 25 -2 9 17 .8 4. 5 65 .4 .8 9. 7 .9 .9 10 0. 0 22 .3 18 .2 29 46 30 -3 4 15 .4 4. 2 66 .7 .8 10 .4 1. 3 1. 3 10 0. 0 19 .6 16 .6 15 54 35 -3 9 14 .3 4. 3 69 .3 1. 7 9. 2 .4 .7 10 0. 0 18 .7 14 .4 73 5 40 -4 4 9. 6 2. 4 68 .9 .0 13 .2 1. 9 4. 0 10 0. 0 12 .0 7. 9 15 0 45 -4 9 6. 2 2. 2 73 .6 .0 9. 9 1. 5 6. 6 10 0. 0 8. 3 6. 2 40 Ed uc at ion No ne 4. 7 2. 3 76 .7 .5 13 .5 1. 3 1. 1 10 0. 0 7. 0 5. 1 37 30 Pr im ar y inc om ple te 7. 9 3. 7 71 .8 .9 14 .2 .8 .7 10 0. 0 11 .6 8. 6 18 92 Pr im ar y co m ple te d 10 .7 3. 8 71 .2 .6 12 .2 .6 .9 10 0. 0 14 .5 11 .2 15 51 Se co nd ar y inc om ple te 19 .9 6. 2 61 .5 1. 3 9. 4 1. 0 .6 10 0. 0 26 .1 20 .1 34 29 Se co nd ar y co m ple te d or h igh er 52 .7 9. 6 30 .4 2. 1 3. 7 1. 1 .4 10 0. 0 62 .2 54 .5 12 60 No n- sta nd ar d cu rri cu lum 10 .1 .0 84 .5 .0 5. 3 .0 .0 10 0. 0 10 .1 6. 4 38 W ea lth Po or es t 4. 6 1. 9 74 .2 .4 16 .6 1. 1 1. 1 10 0. 0 6. 5 4. 8 29 08 ind ex Se co nd 6. 4 2. 6 75 .3 .6 13 .5 .6 1. 0 10 0. 0 9. 0 6. 2 25 35 qu int ile s M idd le 10 .4 4. 1 71 .0 .8 11 .8 1. 2 .7 10 0. 0 14 .5 11 .0 22 30 Fo ur th 18 .7 6. 0 64 .3 1. 8 7. 5 1. 0 .6 10 0. 0 24 .8 19 .1 22 38 Ri ch es t 44 .9 10 .1 38 .2 1. 5 3. 9 1. 0 .4 10 0. 0 55 .0 47 .1 19 89 Na tio na l 15 .5 4.6 66 .0 1.0 11 .2 1.0 .8 10 0.0 20 .1 16 .0 11 89 9 * M IC S ind ica to r 4 ; M DG in dic at or 1 7 ** M IC S ind ica to r 5 Pe rc en t 100 90 80 70 60 50 40 30 20 10 0 80 PROGOTIR PATHEY 2006 Reproductive health Figure RH.3: Type of personnel assisting with delivery among women aged 15-49 who gave birth in the two years preceeding the survey, Bangladesh, 2006 No attendant 0.8% Medical Doctor 15.5% Murse/Midwife 4.6% Relative/Friend 11.2% Community Health Worker 1% Traditional Birth Attendant 66% Figure RH.4: Health facility deliveries among women aged 15-49 years who gave birth in the two years preceding the survey, Bangladesh 2006 16.0 12.2 10.7 31.7 10.3 12.4 18.7 23.6 15.7 Barisal Chittagong Dhaka Khulna Rajshahi Sylhet Rural Urban National 81Bangladesh Multiple Indicator Cluster Survey 2006 Table RH.4: Place of delivery among women aged 15-49 years who gave birth in the two years preceeding the survey, Bangladesh, 2006 Division Barisal 87.5 4.4 5.8 2.2 100.0 10.3 738 Chittagong 85.9 5.7 6.7 1.8 100.0 12.4 2554 Dhaka 79.7 7.1 11.6 1.6 100.0 18.7 3697 Khulna 75.4 11.6 12.0 1.1 100.0 23.6 1145 Rajshahi 81.7 8.9 6.8 2.6 100.0 15.7 2740 Sylhet 86.9 6.9 5.3 .8 100.0 12.2 1024 Area Rural 88.0 5.5 5.2 1.3 100.0 10.7 8757 Urban 65.0 13.1 18.6 3.3 100.0 31.7 3040 Urban municipality 68.0 13.1 16.1 2.8 100.0 29.2 2230 City Corporation 56.8 13.1 25.5 4.6 100.0 38.6 811 Non-slum 53.0 13.9 28.1 5.0 100.0 42.0 729 Slum 90.9 6.2 1.6 1.3 100.0 7.8 81 Tribal 93.8 3.2 1.0 2.0 100.0 4.2 101 Age 15-19 83.3 8.4 6.7 1.6 100.0 15.1 2364 20-24 82.5 7.0 8.4 2.1 100.0 15.4 4111 25-29 80.3 7.7 10.5 1.5 100.0 18.2 2946 30-34 81.5 7.5 9.1 1.9 100.0 16.6 1554 35-39 84.2 6.7 7.7 1.5 100.0 14.4 735 40-44 89.5 2.6 5.3 2.6 100.0 7.9 150 45-49 90.8 3.0 3.1 3.1 100.0 6.2 40 Education None 93.5 3.4 1.7 1.4 100.0 5.1 3730 Primary incomplete 90.7 5.1 3.6 .6 100.0 8.6 1892 Primary completed 87.4 5.7 5.5 1.4 100.0 11.2 1551 Secondary incomplete 77.5 9.5 10.6 2.4 100.0 20.1 3429 Secondary completed 42.0 19.4 35.0 3.6 100.0 54.5 1260 or higher Non-standard curriculum 93.6 6.4 .0 .0 100.0 6.4 38 Wealth Poorest 94.1 3.3 1.5 1.1 100.0 4.8 2908 index Second 92.5 3.9 2.3 1.3 100.0 6.2 2535 quintiles Middle 87.4 6.5 4.5 1.6 100.0 11.0 2230 Fourth 78.8 9.9 9.2 2.0 100.0 19.1 2238 Richest 49.6 16.3 30.8 3.3 100.0 47.1 1989 National 82.2 7.4 8.6 1.8 100.0 16.0 11899 * MICS indicator 5 Note: ‘Home’ refers to the respondent's home or another home; ‘public sector’ refers to a government hospital/clinic/health centre and other public facility; and ‘private sector’ refers to a private hospital/clinic, private maternity home and other private medical facility. Delivery in a public or private sector facility is thus considered as a delivery in a health facility. Background characteristics Place of delivery Home Public sector Private public sector Other Total Delivered in health facility * No. of women who gave birth in the 2 years preceding the survey 82 PROGOTIR PATHEY 2006 ©UNICEF/Shehzad Noorani 83Bangladesh Multiple Indicator Cluster Survey 2006 Rapid brain development occurs in the first three to four years of life, and the quality of home care is the major determinant of the child's development during this period. Thus adult activities with children, the presence of books for the child in the home and the conditions of care are important indicators of quality of home care. The correcponding World Fit for Children goal is that ‘children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn’ by age five. The MICS looked for a number of activities that support early learning, specifically the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home/compound/yard, playing with children, and spending time with children naming, counting, or drawing things. For almost half (47.5 percent) of under-5 children in the surveyed households, an adult engaged in more than four activities that promoted learning and school readiness during the three days preceding the interview (Table CD.1). On average, adults engaged with children in 3.4 activities. The findings also show that the fathers’ involvement in such activities was quite high: around 50.3 percent of them engaged in one or more activities. Nationally, 8.4 percent of children in the surveyed households were living without their natural father. There was no gender differentials in terms of adult activities with children. Nor was there much difference among the six divisions; in terms of household members engaging in four or more activities, the rate was lowest in Sylhet Division, at 40.3 percent, and highest in Khulna Division, at 55.9 percent. Larger proportions of adults engaged in learning and school readiness activities with children in urban areas (56.4 percent) than in rural areas (44.3 percent). As expected, the more educated mothers and fathers engaged in such activities with children than those with less education. VIII. CHILD DEVELOPMENT 84 PROGOTIR PATHEY 2006 Child development Table CD.1: Family support for learning Percentage of under-5 children in a household in which members are engaged in activities that promoted learning and school readiness, Bangladesh, 2006 Sex Male 47.5 3.4 51.0 1.1 8.1 16222 Female 47.4 3.4 49.6 1.0 8.6 15344 Division Barisal 42.2 3.0 36.0 .8 9.0 1873 Chittagong 47.2 3.4 42.2 .9 14.6 6797 Dhaka 48.5 3.4 50.7 1.1 7.9 9942 Khulna 55.9 3.7 56.9 1.2 5.3 3148 Rajshahi 46.5 3.3 57.9 1.3 4.2 7284 Sylhet 40.3 3.0 51.1 .9 9.2 2521 Area Rural 44.3 3.2 48.3 1.0 8.4 23034 Urban 56.4 3.7 55.4 1.3 8.4 8280 Urban municipality 53.6 3.6 53.3 1.2 8.6 6061 City Corporations 64.2 4.0 61.2 1.5 7.7 2219 Non-slum 66.0 4.1 61.8 1.5 8.0 2009 Slum 46.8 3.3 55.2 1.1 5.7 210 Tribal 42.7 3.3 65.1 1.5 3.5 253 Age 0-23 months 29.0 2.6 45.2 .8 8.0 11701 24-59 months 58.3 3.8 53.3 1.2 8.6 19865 Mother's None 32.7 2.8 47.4 .9 6.7 11224 education Primary incomplete 42.0 3.2 49.7 1.0 6.4 4997 Primary completed 51.9 3.5 49.0 1.0 8.1 4084 Secondary incomplete 59.9 3.8 51.9 1.2 10.7 7948 Secondary completed 72.0 4.4 59.4 1.6 12.1 3204 or higher Non-standard curriculum 28.9 2.5 43.4 .8 9.1 106 Missing/DK '(*)' '(*)' '(*)' '(*)' '(*)' 2 Father's None 35.2 2.9 50.5 .9 .0 11911 education Primary incomplete 42.7 3.2 52.0 1.0 .0 3861 Primary completed 50.9 3.5 54.7 1.1 .0 3311 Secondary incomplete 57.2 3.8 56.2 1.3 .0 5303 Secondary completed 62.3 4.0 42.6 1.1 37.8 6995 or higher Non-standard curriculum 40.3 3.0 49.2 .9 .0 116 Missing/DK 32.5 3.1 42.8 .9 .0 69 Wealth Poorest 32.7 2.8 47.9 .9 5.0 7987 index Second 40.0 3.1 47.8 .9 6.5 6615 quintiles Middle 47.5 3.4 50.2 1.0 8.2 5918 Fourth 58.1 3.8 49.7 1.1 11.7 5854 Richest 67.8 4.2 58.1 1.5 12.3 5192 National 47.5 3.4 50.3 1.0 8.4 31566 * MICS indicator 46, ** MICS indicator 47 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Background characteristics Percentage under-5 children: For whom household members engaged in four or more activities that promote learning and school readiness * Mean No. of activities household members engage in with the child For whom the father engaged in one or more activities that promote learning and school readiness ** Mean No. of activities the father engages in with the child Living in a household without their natural father No. of under-5 years children 85Bangladesh Multiple Indicator Cluster Survey 2006 © Anwar, BBS 86 PROGOTIR PATHEY 2006 ©UNICEF/Shehzad Noorani 87Bangladesh Multiple Indicator Cluster Survey 2006 Pre-school attendance and school readiness Attendance at pre-school education in an organized learning or child education programme is important for the readiness of children to school. One of the World Fit for Children goals is the promotion of early childhood education. According to the MICS findings, only 14.6 percent of children aged 36-59 months were attending pre-school at the time of the survey interview (Table ED.1). Urban-rural and divisional differentials were not so significant. Among children aged 36-59 months, enrolment in a pre-school was highest in Khulna Division (17.4 percent), and lowest in Rajshahi Division (10.3 percent). Slightly more girls than boys were attending pre-school. Differentials by socioeconomic status were not significant, but the findings indicate that the mother's level of education did make a difference: Of mothers having no education, only 11.1 percent of their children were attending a pre-school, but the rate rose to 19.7 percent of children of mothers having a secondary education or higher. There was a big difference between age groups of children also: only 7 percent of children aged 36-47 months were in pre- school, but that finding jumped to 22.3 percent among the older ones (aged 48-59 months). Table ED.1 also shows the proportion of children who were in the first grade of primary school who had attended pre-school the previous year. Overall, this indicator applied to 32 percent of children aged 6 years in the surveyed households. More children in urban areas (41.7 percent) had attended pre-school the previous year compared to rural areas (28 percent). Divisional differentials were not significant; first graders in Barisal and Chittagong Divisions have attended pre-school at a rate of 38.6 and 38.5 percent respectively compared to 26.1 percent in Rajshahi Division. The socio-economic status of the household had a positive correlation with school readiness - while the indicator is only 22.4 percent among the poorest households, it increased to 49.1 percent among those children living in the richest households. IX. EDUCATION 88 PROGOTIR PATHEY 2006 Education Table ED.1: Early childhood education Percentage of children aged 36-59 months who were attending some form of organized early childhood education programme, and percentage of first graders who attended pre-school, Bangladesh, 2006 Sex Male 14.0 6897 31.3 1596 Female 15.3 6644 32.7 1556 Division Barisal 15.5 811 38.6 181 Chittagong 16.2 2940 38.5 619 Dhaka 15.8 4266 31.9 994 Khulna 17.4 1392 32.8 378 Rajshahi 10.3 3086 26.1 734 Sylhet 14.1 1047 27.4 246 Area Rural 15.5 9869 28.0 2264 Urban 12.0 3572 41.7 864 Urban municipality 11.9 2621 36.2 598 City Corporations 12.2 951 53.9 266 Non-slum 12.6 857 55.0 254 Slum 8.6 94 31.6 12 Tribal 25.2 100 53.0 24 Age of 36-47 months 7.0 6789 . 0 child 48-59 months 22.3 6751 . 0 6 years . 0 32.0 3152 Mother's None 11.1 5265 26.3 1194 education Primary incomplete 16.2 2166 30.2 519 Primary completed 16.8 1769 32.7 463 Secondary incomplete 16.1 3012 35.8 654 Secondary completed 19.7 1278 47.5 309 or higher Non-standard curriculum (20.2) 51 '(*)' 13 Missing/DK '(*)' 0 '(*)' 1 Wealth Poorest 11.4 3545 22.4 680 index Second 14.4 2792 26.6 645 quintiles Middle 16.0 2550 30.0 620 Fourth 16.7 2498 33.4 609 Richest 16.2 2156 49.1 598 National 14.6 13541 32.0 3152 * MICS Indicator 52 ** MICS Indicator 53 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Figures in parenthesis are based on 25-49 unweighted cases. Note: Table based on estimated age as of the beginning of the school year. Background characteristics Percentage of children aged 36-59 months currently attending early childhood education* No. of children aged 36-59 months Percentage of children attending first grade who attended preschool program in previous year** No. of children attending first grade 89Bangladesh Multiple Indicator Cluster Survey 2006 Primary and secondary school participation The MDGs and A World Fit for Children goals expect all countries to ensure that all children have access to basic education and that they complete it. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. The indicators for primary and secondary school attendance entail: Net intake rate in primary education Net primary school attendance rate Net secondary school attendance rate Net primary school attendance rate of children of secondary school age Female to male education ratio (GPI) The indicators of school progression entail: Transition rate to secondary school Net primary completion rate The two streams of the Bangladesh education system are managed separately: The Ministry of Primary and Mass Education (MOPME) supervises primary education (grades 1-5), and the Ministry of Education (MOE) administers the post-primary education, which covers junior secondary to higher education. Primary school enrolement typically involves children aged 6-11; secondary education consists of seven years of formal schooling. According to the MICS findings, 67.4 percent of children of primary school-entry age in the surveyed households were attending Grade 1 at the time of the interview (Table ED.2). Among the corresponding findings, there was a positive correlation with the mother's education and the socio- economic status of the household: 75.8 percent of the children of mothers who have at least a secondary shool education were attending the first grade; 72 percent of the children in the richest households were in the first grade while it dropped to 63.3 percent among children in the poorest households. Overall, 81.3 percent of children of primary school age in the surveyed households were attending primary school (Table ED.3). There was no noticeable variation between urban and rural areas. However, the rates were lowest in urban slums, at 52.3 percent, and in tribal areas, at 67.9 percent. Nationally, there was disparity between the sexes, with the attendance rate for girls in primary school at 83.7 percent but only 78.9 percent for the boys. 90 PROGOTIR PATHEY 2006 Education Table ED.2: Primary school entry Percentage of children of primary school-entry age attending grade 1, Bangladesh, 2006 Sex Male 65.7 4096 Female 69.0 4180 Division Barisal 62.6 514 Chittagong 66.5 1666 Dhaka 64.2 2632 Khulna 74.5 836 Rajshahi 68.5 1994 Sylhet 73.5 635 Area Rural 67.5 6072 Urban 67.7 2129 Urban municipality 68.4 1557 City Corporation 65.7 572 Non-slum 68.3 510 Slum 44.9 62 Tribal 49.1 75 Age at beginning of school year 6 67.4 8276 Mother's education None 61.7 4206 Primary incomplete 70.0 1324 Primary completed 73.1 925 Secondary incomplete 76.3 1212 Secondary completed or higher 75.8 572 Non-standard curriculum (57.9) 32 Missing/DK '(*)' 6 Wealth index quintiles Poorest 63.3 2358 Second 66.2 1831 Middle 68.3 1553 Fourth 70.7 1354 Richest 72.0 1181 National 67.4 8276 * MICS Indicator 54 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Figures in parenthesis are based on 25-49 unweighted cases. Note: Table based on estimated age at the beginning of the school year. Background characteristics Percentage of children of primary school entry age currently attending grade 1 * No. of children of primary school entry age 91Bangladesh Multiple Indicator Cluster Survey 2006 Table ED.3: Primary school net attendance ratio Percentage of children of primary school age attending primary school. Bangladesh, 2006 Division Barisal 80.9 1278 87.3 1286 84.1 2563 Chittagong 80.9 4038 85.7 3789 83.2 7826 Dhaka 75.6 5928 81.1 5704 78.3 11632 Khulna 84.9 1975 89.3 1852 87.0 3827 Rajshahi 78.1 4405 81.9 4130 79.9 8534 Sylhet 79.5 1414 83.9 1401 81.7 2815 Area Rural 79.0 13772 84.2 13238 81.5 27010 Urban 79.0 5090 83.0 4762 80.9 9851 Urban municipality 79.6 3796 84.5 3460 81.9 7257 City Corporation 77.3 1293 78.9 1301 78.1 2595 Non-slum 81.3 1149 81.2 1168 81.2 2317 Slum 45.8 145 59.4 133 52.3 278 Tribal 67.6 176 68.1 161 67.9 337 Age at 6 71.3 4096 76.2 4180 73.8 8276 beginning of 7 80.6 4041 84.4 3972 82.5 8014 school year 8 83.1 3330 87.1 3209 85.1 6538 9 79.2 4641 85.7 4044 82.2 8685 10 82.0 2930 87.2 2755 84.5 5685 Mother's None 72.1 9830 79.1 9332 75.5 19161 education Primary incomplete 82.7 3042 85.9 2865 84.3 5907 Primary completed 85.6 2233 90.7 2017 88.0 4250 Secondary incomplete 90.0 2680 91.5 2602 90.8 5281 Secondary completed 89.4 1151 85.0 1272 87.1 2422 or higher Non-standard curriculum 70.5 91 87.1 62 77.2 153 Missing/DK '(*)' 12 '(*)' 11 '(*)' 23 Wealth Poorest 69.8 4767 77.0 4726 73.4 9493 index Second 78.1 4172 83.4 3909 80.6 8080 quintiles Middle 79.5 3833 86.4 3565 82.8 7399 Fourth 84.8 3353 88.9 3059 86.8 6412 Richest 87.6 2912 86.4 2901 87.0 5813 National 78.9 19038 83.7 18161 81.3 37198 * MICS indicator 55; MDG indicator 6 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Note: Table based on estimated age as of the beginning of the school year. Background characteristics Male Female Total Net attendance ratio No. of children Net attendance ratio No. of children Net attendance ratio* No. of children 92 PROGOTIR PATHEY 2006 Education As shown in Table ED.4, some 38.8 percent of the children of secondary school age were attending secondary school at the time of the survey interview. Of the remaining 61 percent, some had either dropped out of school or were attending primary school (Table ED.4w). The sex disparity of the primary years continued through secondary education, with 41.4 percent of girls attending while only 36.2 percent of boys were in shcool. In term of areas, 36.5 percent of the rural children in the surveyed households and 44.6 percent of the urban children were attending secondary school. Table ED.4: Secondary school net attendance ratio Percentage of children of secondary school age attending secondary or higher school (NAR), Bangladesh, Year Division Barisal 40.8 1590 43.7 1650 42.2 3239 Chittagong 35.2 5334 40.7 5533 38.0 10866 Dhaka 34.7 7607 40.4 7856 37.6 15464 Khulna 42.6 2611 50.3 2615 46.5 5226 Rajshahi 37.4 5963 41.5 6074 39.4 12037 Sylhet 28.0 1730 32.1 1750 30.1 3480 Area Rural 33.6 17783 39.4 17660 36.5 35443 Urban 42.9 6856 46.1 7600 44.6 14456 Urban municipality 41.7 4961 48.4 5324 45.2 10284 City Corporation 46.2 1895 40.7 2277 43.2 4172 Non-slum 49.2 1743 43.3 2095 46.0 3838 Slum 11.9 152 11.2 182 11.5 334 Tribal 38.5 196 36.9 217 37.6 414 Age at 11 30.4 4301 41.6 3886 35.7 8187 beginning 12 44.1 2992 57.5 3488 51.3 6480 of school 13 46.2 3091 58.7 3089 52.4 6180 year 14 40.5 3657 48.8 3644 44.7 7301 15 36.3 3343 39.9 3719 38.2 7062 16 36.8 2830 28.7 3267 32.5 6097 17 25.9 4621 20.7 4386 23.4 9007 Mother's None 24.3 10897 38.8 9116 30.9 20013 education Primary incomplete 41.0 2728 57.9 2508 49.1 5236 Primary completed 55.1 2208 67.7 2077 61.2 4285 Secondary incomplete 70.5 2376 82.1 2320 76.2 4695 Secondary completed 57.8 1933 25.9 4998 34.8 6931 or higher Non-standard curriculum 24.5 66 62.8 55 41.9 122 Missing/DK '(*)' 7 '(*)' 18 '(*)' 24 Wealth Poorest 14.9 4381 22.9 4194 18.8 8574 index Second 25.7 5328 32.1 5207 28.9 10536 quintiles Middle 33.5 5424 39.5 5549 36.6 10973 Fourth 44.5 5057 50.4 5304 47.5 10360 Richest 62.4 4646 58.3 5223 60.2 9869 National 36.2 24835 41.4 25477 38.8 50313 * MICS indicator 56 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Note: Table based on estimated age as of the beginning of the school year. Background characteristics Male Female Total Net attendance ratio No. of children Net attendance ratio No. of children Net attendance ratio* No. of children 93Bangladesh Multiple Indicator Cluster Survey 2006 About one in ten (10.2 percent) of the children of secondary school age were still attending primary school (Table ED.4w); 9.5 percent of the girls and 10.9 percent of the boys. The timely attendance rate was better in urban areas than in rural areas. Table ED.4w: Secondary school-aged children attending primary school Percentage of children of secondary school age attending primary school, Bangladesh, 2006 Division Barisal 11.4 1590 10.0 1650 10.7 3239 Chittagong 13.1 5334 12.0 5533 12.5 10866 Dhaka 10.8 7607 9.5 7856 10.1 15464 Khulna 8.9 2611 7.6 2615 8.3 5226 Rajshahi 9.4 5963 7.8 6074 8.6 12037 Sylhet 11.9 1730 9.3 1750 10.6 3480 Area Rural 11.9 17783 10.5 17660 11.2 35443 Urban 8.2 6856 7.0 7600 7.5 14456 Urban municipality 8.4 4961 7.5 5324 7.9 10284 City Corporation 7.6 1895 5.7 2277 6.6 4172 Non-slum 7.5 1743 5.5 2095 6.4 3838 Slum 8.8 152 7.9 182 8.3 334 Tribal 13.0 196 11.3 217 12.1 414 Age at 11 36.9 4301 38.1 3886 37.4 8187 beginning 12 20.1 2992 16.4 3488 18.1 6480 of school 13 9.1 3091 7.6 3089 8.4 6180 year 14 4.1 3657 2.3 3644 3.2 7301 15 1.6 3343 .6 3719 1.1 7062 16 .3 2830 .3 3267 .3 6097 17 .4 4621 .1 4386 .3 9007 Mother's None 15.5 10897 17.8 9116 16.6 20013 education Primary incomplete 15.7 2728 15.3 2508 15.5 5236 Primary completed 11.7 2208 10.1 2077 10.9 4285 Secondary incomplete 9.5 2376 5.4 2320 7.5 4695 Secondary completed 3.3 1933 1.2 4998 1.7 6931 or higher Non-standard curriculum 16.6 66 (13.9) 55 15.4 122 Missing/DK '(*)' 7 '(*)' 18 '(*)' 24 Wealth Poorest 15.7 4381 14.7 4194 15.2 8574 index Second 12.4 5328 12.2 5207 12.3 10536 quintiles Middle 11.7 5424 8.9 5549 10.2 10973 Fourth 8.9 5057 8.0 5304 8.4 10360 Richest 5.9 4646 4.7 5223 5.2 9869 National 10.9 24835 9.5 25477 10.2 50313 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been supressed. Figures in parenthesis are based on 25-49 unweighted cases. Note: Table based on estimated age at the beginning of the school year. Background characteristics Male Female Total Percent attending primary school No. of children Percent attending primary school No. of children Percent attending primary school No. of children 94 PROGOTIR PATHEY 2006 Education At the time of the survey inter

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