Belize - Multiple Indicator Cluster Survey - 2006

Publication date: 2006

1 Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Belize, 2006 Data Value Topic MICS Indicator Number MDG Indicator Number Indicator Total Unit CHILD MORTALITY 1 13 Under-five mortality rate 27 per thousand live births Child mortality 2 14 Infant mortality rate 22 per thousand live births NUTRITION 6 4 Underweight prevalence 6.1 percent 7 Stunting prevalence 17.6 percent Nutritional status 8 Wasting prevalence 1.4 percent 45 Timely initiation of breastfeeding 50.6 percent 15 Exclusive breastfeeding rate 10.2 percent 16 Continued breastfeeding rate at 12-15 months at 20-23 months 41.6 26.8 percent percent 17 Timely complementary feeding rate 44.0 percent 18 Frequency of complementary feeding 36.8 percent Breastfeeding 19 Adequately fed infants 22.5 percent 42 Vitamin A supplementation (under-fives) 23.8 percent Vitamin A 43 Vitamin A supplementation (post-partum mothers) 45.3 percent 9 Low birth weight infants 8.1 percent Low birth weight 10 Infants weighed at birth 92.5 percent CHILD HEALTH 25 Tuberculosis immunization coverage 90.2 percent 26 Polio immunization coverage 68.6 percent 27 DPT/HepB/HiB immunization coverage 74.6 percent 28 15 Measles immunization coverage 81.9 percent Immunization 31 Fully immunized children 56.3 percent Tetanus toxoid 32 Neonatal tetanus protection 58.3 percent 33 Use of oral rehydration therapy (ORT) 60.6 percent 34 Home management of diarrhoea 9.3 percent 35 Received ORT or increased fluids, and continued feeding 25.9 percent 23 Care seeking for suspected pneumonia 70.9 percent Care of illness 22 Antibiotic treatment of suspected pneumonia 43.9 percent Solid fuel use 24 29 Solid fuels 13.6 percent ENVIRONMENT 11 30 Use of improved drinking water sources 96.5 percent 13 Water treatment 19,9 percent 12 31 Use of improved sanitation facilities 93.7 percent Water and Sanitation 14 Disposal of child's faeces 23.8 percent REPRODUCTIVE HEALTH 21 19c Contraceptive prevalence 34.3 percent 98 Unmet need for family planning 31.2 percent Contraception and unmet need 99 Demand satisfied for family planning 52.4 percent 20 Antenatal care 94.0 percent Maternal and newborn health 44 Content of antenatal care 2 Data Value Topic MICS Indicator Number MDG Indicator Number Indicator Total Unit Blood test taken 94.7 percent Blood pressure measured 95.4 percent Urine specimen taken 87.8 percent Weight measured 95.9 percent 4 17 Skilled attendant at delivery 95.8 percent 5 Institutional deliveries 88.2 percent CHILD DEVELOPMENT 46 Support for learning 85.3 percent 47 Father's support for learning 52.0 percent 48 Support for learning: children’s books 56.7 percent 49 Support for learning: non-children’s books 71.4 percent 50 Support for learning: materials for play 25.6 percent Child development 51 Non-adult care 4.0 percent EDUCATION 52 Pre-school attendance 30.7 percent 53 School readiness 32.8 percent 54 Net intake rate in primary education 55.2 percent 55 6 Net primary school attendance rate 90.2 percent 56 Net secondary school attendance rate 37.1 percent 57 7 Children reaching grade five 98.7 percent 58 Transition rate to secondary school 52.3 percent 59 7b Primary completion rate 25.2 percent Education 61 9 Gender parity index primary school secondary school 1.00 1.02 ratio Literacy 60 8 Adult literacy rate 89.4 percent CHILD PROTECTION Birth registration 62 Birth registration 94.4 percent Child discipline 74 Child discipline Any psychological/physical punishment 67.7 percent Domestic violence 100 Attitudes towards domestic violence 12.2 percent Disability 101 Child disability 26.3 percent HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED AND VULNERABLE CHILDREN 82 19b Comprehensive knowledge about HIV prevention among young people 39,7 percent 89 Knowledge of mother- to-child transmission of HIV 59.7 percent 86 Attitude towards people with HIV/AIDS 26.8 percent 87 Women who know where to be tested for HIV 82.3 percent 88 Women who have been tested for HIV 48.0 percent 90 Counselling coverage for the prevention of mother- to-child transmission of HIV 74.0 percent 91 Testing coverage for the prevention of mother-to- child transmission of HIV 71.3 percent 83 19a Condom use with non-regular partners 49.5 percent HIV/AIDS Knowledge and attitudes 85 Higher risk sex in the last year 41.1 percent 75 Prevalence of orphans 5.1 percent 78 Children’s living arrangements 6.6 percent Orphaned Children 77 20 School attendance of orphans versus non-orphans 0.66 ratio 3 Table of Contents Summary Table of Findings. 1 Table of Contents. 3 Acknowledgements. 7 7 Executive Summary . 8 8 I. Introduction. 1 Background . 1 Survey Objectives . 2 II. Sample and Survey Methodology. 3 Sample Design. 3 Questionnaires . 3 Training and Fieldwork . 4 III. Sample Coverage and the Characteristics of Households. 5 and Respondents . 5 Sample Coverage . 5 Characteristics of Households . 5 IV. Child Mortality . 8 V. Nutrition . 11 Nutritional Status . 11 Breastfeeding. 13 Vitamin A Supplements . 15 Low Birth Weight . 17 VI. Child Health . 19 Immunization. 19 Oral Rehydration Treatment. 21 Care Seeking and Antibiotic Treatment of Pneumonia . 23 Solid Fuel Use. 24 VII. Environment. 26 Water and Sanitation. 26 VIII. Reproductive Health . 29 Contraception. 29 Antenatal Care . 30 Assistance at Delivery. 31 IX. Child Development . 33 X. Education. 35 Pre-School Attendance and School Readiness. 35 Primary and Secondary School Participation . 36 Adult Literacy . 37 XI. Child Protection. 38 Birth Registration. 38 Child Discipline . 38 Domestic Violence . 38 Child Disability . 39 XII. HIV/AIDS, Sexual Behaviour, and Orphaned Children . 40 Knowledge of HIV Transmission and Condom Use . 40 Orphaned Children . 45 4 List of References .46 46 Tables 47 Table HH.1: Results of household and individual interviews.47 Table HH.2: Household age distribution by sex .48 Table HH.3: Household composition.49 Table HH.4: Women's background characteristics .50 Table HH.5: Children's background characteristics.51 Table CM.1: Child mortality.52 Table CM.2: Children ever born and proportion dead.53 Table NU.1: Child malnourishment.54 Table NU.2: Initial breastfeeding.55 Table NU.3: Breastfeeding .56 Table NU.4: Adequately fed infants .57 Table NU.5: Children's vitamin A supplementation .58 Table NU.6: Post-partum mothers' vitamin A supplementation .59 Table NU.7: Low birth weight infants .60 Table CH.1: Vaccinations in first year of life .61 Table CH.2: Vaccinations by background characteristics .62 Table CH.3: Neonatal tetanus protection .63 Table CH.4: Oral rehydration treatment .64 Table CH.5: Home management of diarrhoea .65 Table CH.6: Knowledge of the two danger signs of pneumonia .66 Table CH.7: Solid fuel use.67 Table CH.8: Solid fuel use by type of stove or fire .68 Table EN.1: Use of improved water sources .69 Table EN.2: Household water treatment.70 Table EN.3: Time to source of water .71 Table EN.4: Person collecting water.72 Table EN.5: Use of sanitary means of excreta disposal.73 Table EN.6: Disposal of child's faeces.74 Table EN.7: Use of improved water sources and improved sanitation .75 Table RH.1: Use of contraception.76 Table RH.2: Unmet need for contraception .77 Table RH.3: Antenatal care provider .78 Table RH.4: Antenatal care.79 Table RH.5: Assistance during delivery .80 Table CD.1: Family support for learning.81 Table CD.2: Learning materials.82 Table CD.3: Children left alone or with other children .83 Table ED.1: Early childhood education .84 Table ED.2: Primary school entry.85 Table ED.3: Primary school net attendance ratio.86 (* ) Figures that are based on 25-49 unweighted casesTable ED.4: Secondary school net attendance ratio.86 Table ED.4: Secondary school net attendance ratio.87 Table ED.4w: Secondary school age children attending primary school.88 Table ED.5: Children reaching grade 5.89 Table ED.6: Primary school completion and transition to secondary education .90 Table ED.7 : Education gender parity.91 Table ED.8: Adult literacy .92 Table ED.1: Early childhood education .93 Table ED.2: Primary school entry.94 Table ED.3: Primary school net attendance ratio.95 5 Table ED.4: Secondary school net attendance ratio . 96 Table ED.4w: Secondary school age children attending primary school . 97 Table ED.5: Children reaching standard 3 . 98 Table ED.6: Primary school completion and transition to secondary education. 99 Table ED.7 : Education gender parity . 100 Table ED.8: Adult literacy . 101 Table CP.1: Birth registration. 102 Table CP.2: Child discipline. 103 Table CP.3: Attitudes toward domestic violence . 104 Table CP.4: Child disability . 105 Table HA.1: Knowledge of preventing HIV transmission . 106 Table HA.2: Identifying misconceptions about HIV/AIDS . 107 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission. 108 Table HA.4: Knowledge of mother-to-child HIV transmission . 109 Table HA.5: Attitudes toward people living with HIV/AIDS. 110 Table HA.6: Knowledge of a facility for HIV testing . 111 Table HA.7: HIV testing and counseling coverage during antenatal care. 112 Appendix A. Distribution of Sampled Households . 116 Appendix B. List of Personnel Involved in the Survey. 117 Appendix C. Estimates of Sampling Errors . 122 Table SE.1: Indicators selected for sampling error calculation. 123 Table SE.2: Sampling errors: Total sample. 124 Table SE.4: Sampling errors: Rural areas . 126 Table SE.5: Sampling errors: Corozal . 127 Table SE.6: Sampling errors: Orange Walk . 128 Table SE.7: Sampling errors: Belize . 129 Table SE.8: Sampling errors: Cayo . 130 Table SE.9: Sampling errors: Stann Creek. 131 Table SE.9: Sampling errors: Toledo . 132 Appendix D. Data Quality Tables . 133 Table DQ.1: Age distribution of household population . 133 Table DQ.2: Age distribution of eligible and interviewed women . 134 Table DQ.3: Age distribution of eligible and interviewed under-5s . 134 Table DQ.4: Age distribution of under-5 children . 135 Table DQ.5: Heaping on ages and periods . 136 Table DQ.6: Percentage of observations missing information for selected questions and indicators (Under-5 uestionnaire, weighted), Country, Year. 137 Table DQ.7: Presence of mother in the household and the person interviewed for the under-5 questionnaire. 137 Table DQ.8: School attendance by single age . 138 Table DQ.9: Sex ratio at birth among children ever born and living . 139 Table DQ.10: Distribution of women by time since last birth . 139 Appendix E. MICS Indicators: Numerators and Denominators. 140 Appendix F. Questionnaires . 144 table 1: childREN AgED 2-14 YEARS ELIGIBLE for child Discipline questions. 153 table 2: selection of random child for child Discipline questions . 153 6 List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care BCG Bacillis-Cereus-Geuerin (Tuberculosis) CDC Center for Disease Control CSPro Census and Survey Processing System DHS Demographic Health Surveys DPT Diphteria Pertussis Tetanus ED Enumeration District EPI Expanded Programme on Immunization FHS Family Health Survey GPI Gender Parity Index HIV Human Immunodeficiency Virus IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS3 The Current Multiple Indicator Cluster Survey MoH Ministry of Health NAR Net Attendance Rate NCHS National Centre for Health Statistics NHDAC National Human Development Advisory Committee ORS Oral Rehydration Solution ORT Oral Rehydration Treatment PSU Primary Sampling Unit RHF Recommended Home Fluid SIB Statistical Institute of Belize STIs Sexually Transmitted Infections SPSS Statistical Package for Social Sciences U5MR Under-5 Mortality Rate UNAIDS United Nations Programme on HIV/AIDS UNCT United Nations Country Team UNDAF United Nations Development Framework UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit For Children WHO World Health Organization 7 Acknowledgements It is a pleasure for the Statistical Institute of Belize (SIB) to make publicly available this final report which provides information on MDG indicators as well as indicators of the World Fit for Children and other international conventions. We would like to share the satisfaction of having completed the Multiple Indicators Cluster Survey Report with the national and international organizations that were involved during the process. Upon the occasion of making the MICS results available, the SIB wishes to acknowledge its infinite gratitude to the United Nations Children’s Fund (UNICEF) for joining efforts with the Institute by providing financial and technical support and for having participated in all phases of the survey, from its initial planning to the writing of the final report. It also wishes to use the occasion to publicly express its appreciation to all the individuals and institutions who contributed to the success of the survey, to the permanent staff for their professionalism, to the temporary staff for their work ethic during the collection, and above all to the women or caretakers of children under-5 for their disposition to be interviewed. 8 Executive Summary The Belize Multiple Indicator Cluster Survey is a nationally representative sample survey of households, women and children. It was introduced by UNICEF in the early 1990s in recognition of the need for indicators to develop goals and targets and to monitor and evaluate progress in human development, particularly the situation of children and women. Child Mortality • In 2006, the infant mortality rate was estimated at 22 per thousand, whereas the under-5 mortality rate (U5MR) was 27 per thousand. Nutritional Status • In Belize, 6.1 percent of children under age five are moderately underweight and 0.7 percent are classified as severely underweight. • Approximately 18 percent of children are stunted or too short for their age and less than two percent are wasted or too thin for their height. • 10.3 percent of children under age five are overweight. Breastfeeding • Just above ten percent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. • Those mothers who did not practice exclusive breastfeeding were mainly from rural areas and had higher levels of education. Vitamin A Supplements • 23.8 percent of children aged 6-59 months received a high dose Vitamin A supplement within six months prior to the MICS. Low Birth Weight • In Belize, approximately eight percent of children who were weighed had a birth weight of less than 2,500 grams at birth. Immunization • Overall, 64.3 percent of children had health cards recording their vaccines. • In Belize, 90.2 percent of children aged 18-29 months received a BCG vaccination by the age of 12 months and 89 percent had received their first dose of DPT. • 88.3 percent of children received Polio 1 vaccine by age 12 months. • Of children aged 18-29 months, 65.8 percent had received all eight recommended vaccinations before the survey and 56.3 before their first birthday. Regarding sex, boys have higher coverage than girls for all recommended vaccinations, the overall difference being 14.8 percent points. Tetanus Toxoid • Overall, 58.3 percent of the women in Belize received vaccines against tetanus during pregnancy with 46.6 percent receiving at least two doses during their last pregnancy. • The highest proportion of women who are protected against tetanus is in Belize District (75.1 percent) and the lowest in Toledo where only 29.5 percent are protected. Significant differences are also observed by area of residence, education level of mother and economic status of household. 9 Oral Rehydration Treatment (ORT) • Overall, 12.1 percent of the under-five children had diarrhoea in the two weeks preceding the survey. Approximately sixty percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF), while 39.4 percent received no treatment. Care Seeking and Antibiotic Treatment of Pneumonia • 5.4 percent of children aged 0-59 months had suspected pneumonia in the last two weeks preceding the survey. Of these children, 70.9 percent were taken to an appropriate provider. • An estimated 43.9 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. • Overall, only 14.7 percent of women know of the two danger signs of pneumonia (fast and difficult breathing). Mother’s knowledge of the danger signs was highest in Corozal (43.1 percent) and lowest in Cayo (2.9 percent). As expected, knowledge of danger sings seems to be positively correlated with education of mother. Solid Fuel Use • Less than 14 percent of all households in Belize are using solid fuels for cooking, however more than half of the households in Toledo (53.3 percent) are utilizing wood for cooking, and only 44.1 percent are using butane gas. The district with the lowest percentage is Belize with only 1.6 percent of the households using wood for cooking. • As expected, the use of solid fuels is very low in urban areas (2.1 percent), but relatively high in rural areas, where more than a quarter of the households (27.1 percent) are using solid fuels. Water and Sanitation • 96.5 percent of the population is using an improved source of drinking water – 99.2 percent in urban areas and 94.0 percent in rural areas. The urban-rural disparity is greatest in the use of bottled water – 49.8 and 15.2 percent respectively. • The main source of drinking water in Belize is bottled water which is consumed by 32.0 percent of the population followed by water piped into dwelling (23.1 percent). The district where most of the population drink bottled water is Belize (53.0 percent). In the other extreme, Toledo is the district where bottled water is consumed the least (5.5 percent). • Rain-water and bottled water are very important in Orange Walk and Corozal as these are the main sources there. • 93.7 percent of the population use sanitary means of excreta disposal. • Whilst 80.9 percent of the urban households have access to a toilet either linked to a sewer system or to a septic tank, only 33.1 percent of the rural households use this type of sanitation facility. • Approximately 63 percent of the rural population continue to use pit latrines or less-sanitary facilities. The population in Toledo are less likely to use improved sanitation facilities (81.7 percent) than people in other districts. Additionally, 16.5 of the households in Toledo have no sanitary facilities and use the bush or field to dispose of excreta. Contraception • In Belize, the percentage of women currently married or in union currently using contraception is 34.3 percent (Table RH.1). The most popular method of contraception is the pill (10.8 percent). The next most popular method is female sterilization, which accounts for 8.9 percent of married women. All other contraceptive methods do not exceed five percent. Less than one percent use withdrawal, male sterilization, vaginal methods, or the lactational amenorrhea method (LAM). 10 • Differences in contraceptive prevalence are observed between married women in urban areas and rural areas (38.8 percent compared to 29.4 percent). Contraceptive prevalence is highest in Orange Walk at 47.5 percent and lowest in Toledo at 23.4 percent. • Adolescents are far less likely to use contraception than older women. As expected, younger women between 15-19 years don’t use sterilization but older women do. Only 13.5 percent of women with no living children are using a contraceptive method as a great percentage of them is seeking a pregnancy. • The percentage of women using any method of contraception in Maya-speaking households is very low (15.4 percent). Unmet Need • Almost one third of women, married or in union, in Belize have an unmet need for contraception. • The demand for contraception is less satisfied among younger women. Antenatal Care • Coverage of antenatal care (by a doctor, nurse, or midwife) is quite high in Belize with 98.1 percent of women receiving antenatal care at least once during the pregnancy. • Antenatal care was provided mainly by medical doctors (45.9 percent) and nurses or midwives (46.6 percent). Around 93-100 percent of women in all districts received antenatal care (ANC) provided by skilled personnel except in Toledo where it is only 79.5 percent. Assistance at Delivery • Assistance at delivery by professional health personnel is high in Belize as nearly 96 percent of women who gave birth during the two years preceding the MICS survey were assisted by skilled personnel. Practically, all of mothers in the Belize District (98.8 percent) gave birth in a health facility compared to roughly half of mother in Toledo (52.4 percent). • The majority of deliveries in Belize, Corozal and Orange Walk were assisted by a medical doctor whereas a nurse or midwife assisted in most of the deliveries in Cayo, Stann Creek and Toledo. Child Development • For 85.3 percent of children under five, an adult household member engaged in at least four activities that promote learning and school readiness during the 3 days preceding the survey. The average number of activities was 5.1. The father’s involvement in such activities was lower (52 percent) with an average number of activities of 2.1. A larger proportion of fathers with secondary or higher education (74.8 percent) engaged in activities with children than fathers with primary or no education (59.1 percent). The district with the largest proportion of adults engaging in learning and school readiness activities with children was Stann Creek (94.8 percent) and the district with the smallest is Toledo at 69.3 percent. • In Belize, 71.4 percent of children are living in households where at least 3 non-children’s books are present. However, only 56.7 percent of children aged 0-59 months have 3 or more children’s books. Both the median number of non-children’s books and the median number of children’s books are low (10 and 4 books). • Urban children appear to have more access to both types of books than those living in rural households. • One in four children aged 0-59 months had 3 or more playthings to play with in their homes, while 5.7 percent had none of the playthings asked to the mothers/caretakers. • 4 percent of children were left with inadequate care during the week preceding the survey. A child in Toledo was 10 times more likely to be left with inadequate care than a child in Orange Walk or Stann Creek. 11 Pre-School Attendance and School Readiness • Less than one-third of children aged 36-59 months are attending an organized early childhood education programme, such as kindergarten or community childcare with organized learning activities. Urban-rural differentials are significant – the figure is 43.7 percent in urban areas, compared to 20.7 percent in rural areas. Among children aged 36-59 months, attendance to pre- school is most prevalent in Corozal (50.0 percent) and Belize (46.7 percent) and least in Toledo where only 17.1 percent attend pre-school. • Differentials by education of mother and by socio-economic status are significant. The percentage of children attending early childhood education increases from 21.6 to 49.7 percent as the mother’s education increases to secondary or above. • 32.8 percent of children who are currently age 5 and attending the first grade of primary school were attending pre-school the previous year. Primary and Secondary School Participation by ISCED Levels • 71.0 percent of children who are of primary school entry age are attending grade 1. Significant differentials are present by districts. In Cayo, for instance, the value of the indicator reaches 82.5 percent, while it is only 48.0 percent in Orange Walk. • 95.2 percent of children of primary school age attend primary school, nevertheless, one in every twenty girls and one in every twenty boys are not attending primary school. At the district level, Orange Walk (91.5 percent) and Stann Creek (92.5 percent) have the lowest net attendance rates and Toledo the highest (97.5 percent). • Of all children starting grade one, the majority of them (98.7 percent) will eventually reach grade five. • Approximately six in every ten (58.7 percent) children of secondary school age are attending secondary school. Of the remaining 41.3 percent, 14.9 percent are still attending primary school and the remaining 26.4 percent are out of school. • The survey found that 7 in 10 (70.4 percent) children who had attended the last grade of primary school had completed primary school; of these children, 92.9 percent had continued on to secondary education. • Gender parity for primary school is 1.00, indicating no difference in the attendance of girls to boys at the primary level. At the secondary level, the value of the indicator increases to 1.03 indicating no discrimination or exclusion of girls on the basis of gender from the education system in comparison to boys. However when analysed by language, households which spoke Maya (0.86) and Garifuna (0.84) indicated a pronounced level of gender disparity for girls. Additionally, the Stann Creek District also shows a high level of gender disparity for girls at 0.85 while for the Cayo District it is the reverse at 1.17. Primary and Secondary School Participation by National Educational Levels • 55.2 percent of children who are of primary school entry age are attending infant 1. Significant differentials are present by districts. In Stann Creek, for instance, the value of the indicator reaches 85.6 percent, while it is only 26.8 percent in Corozal. • 90.2 percent of children of primary school age attend primary school, nevertheless, one in every ten girls and one in every ten boys are not attending primary school. At the district level, Orange Walk (85.5 percent) and Corozal (86.0 percent) have the lowest net attendance rates and Cayo the highest (94.1 percent). • Of all children starting infant one, the majority of them (98.7 percent) will eventually reach standard three. • 37.1 percent children of secondary school age are attending secondary school. Of the remaining 62.9 percent, 36.0 percent are still attending primary school and the remaining 26.9 percent are out of school. 12 • The survey found that 1 in 4 (25.2 percent) children who had attended the last grade of primary school had completed primary school; of these children, 52.3 percent had continued on to secondary education. • Gender parity for primary school is 1.00, indicating no difference in the attendance of girls to boys at the primary level. At the secondary level, the value of the indicator increases to 1.02 indicating no discrimination or exclusion of girls on the basis of gender from the education system in comparison to boys. However when analysed by language, households which spoke Maya (0.48) indicated a pronounced level of gender disparity for girls. Additionally, the Stann Creek District also shows a high level of gender disparity for girls at 0.70 while for the Cayo District it is the reverse at 1.21. Adult Literacy • Approximately 90 percent of women between 15-24 years are literate nationwide. There are no major variations by residential area or language. However, there are important differences in terms of age and socio-economic status of women. The proportion of women in the age-group 15-19 who are literate is higher (92.7 percent) than that of women in the age-group 20-24 (85.3 percent). Similarly, a lower percentage of literate women is found among the poorer three quintiles compared to the richer two quintiles. Birth Registration • The births of 94.4 percent of Belizean children, under five years of age, have been registered. The districts which show higher registration percentages are Cayo and Corozal where around 98 out of every hundred children were registered. On the other hand, Stann Creek shows the highest percentage for non-registration (12.4 percent). Rural children are to some extent less likely to be registered than their urban peers; 91.8 and 96.5 percent respectively. Child Discipline • In Belize, 67.7 percent of children aged 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. • Although 25.3 percent of mothers/caretakers believed that children should be physically punished only 6.6 percent of children were subjected to severe physical punishment. Domestic Violence • 12.2 percent of women justify physical violence under any of the circumstances; the situation with the highest justification being when they neglect the children (8.4 percent). • The rates of justification vary by district, economic status, education and language of household head. Whereas 34.2 percent of the women in Toledo justify physical violence in any of the situations only 6.2 percent do so in Belize District. Likewise, it is more accepted among women in the poorer three quintiles (17 percent) than it is among the two richest quintiles (5.9 percent). Child Disability • More than a quarter (26.3 percent) of children aged 2-9 years were reported to have at least one disability. Child disabilities are more frequent in Toledo (50.9 percent) and less common in Belize District (17.1 percent). Knowledge of HIV Transmission and Condom Use • In Belize, 96.6 percent of women aged 15-49 years have heard of AIDS. However, the percentage of women who know of all three main ways of preventing HIV transmission is about half of them (49.7 percent). Accurate knowledge is somewhat less among women in Toledo compared to other districts as only 26.8 percent of women in Toledo know all three ways of preventing HIV/AIDS transmission 13 • Of the interviewed women, 53.8 percent reject the two most common misconceptions and know that a healthy-looking person can be infected. Approximately 85 percent of women know that HIV cannot be transmitted by supernatural means, and 68.4 percent of women know that HIV cannot be transmitted by mosquito bites, while 84.5 percent of women know that a healthy-looking person can be infected. • Only 37.3 percent of women in Belize have comprehensive knowledge about HIV transmission (identify 2 prevention methods and 3 misconceptions). The percentage of young women who have comprehensive knowledge of HIV transmission is comparable to all other age-groups (39.7 percent). • 91.6 percent of women know that HIV can be transmitted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is 59.7 percent, while 5 percent of women did not know of any specific way. • 73.2 percent of the women 15-49 years who have heard of AIDS agree with at least one of the discriminatory statements. Around 44 percent of them would want to keep the HIV status of a family member a secret, 32.2 percent thought that an HIV positive teacher should not be allowed to work and 42.2 percent would not buy fresh vegetables from a person with HIV/AIDS. Overall people having HIV/AIDS are less discriminated and are cared for more in Belize than in other districts. Approximately 29 percent of women in Toledo would not care for a family member who is sick with AIDS. • The majority of women (82.3 percent) of reproductive age know a place to get tested for AIDS but only 48 percent have actually been tested. Of those who were tested for HIV, 91.3 percent were told the result. This is clearly not the case in Toledo where merely 51.5 percent of women knew a place to get tested, 31.5 percent actually got tested and 80.4 actually received the result. Sexual Behaviour Related to HIV Transmission • Over 40 percent of women 15-24 years report having sex with a non-regular partner in the 12 months prior to the MICS. Of those women less than half (49.5 percent) reported using a condom when they had sex with the high risk partner. Condom usage during high risk sex was highest in Orange Walk District (100 percent) and lowest in Toledo (33.6 percent). Significant differentials are also observed by residential area, age, economic status and education level of women. Orphaned Children • 68.3 percent of children aged 0-17 years are living with both parents. An important percentage of children (18.2 percent) are living with their mother only, even though their father is alive. This percentage is higher in urban areas at 24.7 percent compared to rural areas at 12.9 percent. Children who have one or both parents dead totalled 5.1 percent of all children aged 0-17 years. Approximately 6 percent of children are living with neither parent even though both parents are alive. • Less than one percent of children aged 10-14 in Belize have lost both parents. Among those, only 62.1 percent are currently attending school. Among the children ages 10-14 who have not lost a parent and who live with at least one parent, 93.6 percent are attending school. This would suggest that double orphans are disadvantaged compared to the non-orphaned children in terms of school attendance. 1 I. Introduction Background This report is based on the Belize Multiple Indicator Cluster Survey, conducted in 2006 by the Central Statistical Office, now the Statistical Institute of Belize (SIB). The survey provides valuable information on the situation of children and women in Belize, 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. 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) “…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.” Belize, as one of the countries that signed onto the Millennium Declaration and the World Fit For Children (WFFC), elaborated in 2004 its National Plan of Action for Children and Adolescents 2004-2015. This plan which was fully endorsed by the Prime Minister and the Leader of the Opposition was hailed as a historical achievement as the first bi-partisan policy document for, with and on behalf of children and 2 adolescents in Belize. To this end, the Belize government committed itself to improving conditions for all children and to monitor towards that end. Additionally, the National Poverty Strategy and its attendant plans were finalized and launched in 2007 by the National human Development Advisory Committee (NHDAC) while in 2006, the UNCT had engaged in the elaboration of the United Nations Development Framework (UNDAF) as a common strategic framework for the UN system in Belize for the period 2007-2011. The UNDAF will guide agencies in formulating their operational activities in support of the people and the government of Belize, and serve as a roadmap for goals to be achieved over the indicated period. To this end, and to address the notable challenges with regards to the paucity of data with which to track progress on the MDGs, the Belize MICS was developed and embraced as a tool for measuring progress towards key national and international targets as laid out in the development plans while yielding internationally comparable data and information on the situation of children and women in Belize. In this regard, the MICS is an invaluable information source as it represents Belize’s largest single source of data for reporting on the progress of the aforementioned goals. This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2006 Belize Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Belize; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration, 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 Belize and to strengthen technical expertise in the design, implementation, and analysis of such systems. 3 II. Sample and Survey Methodology Sample Design The sample for the Belize 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 the 6 districts: Corozal, Orange Walk, Belize, Cayo, Stann Creek and Toledo. The sample was selected in two stages: (i) the selection of 3 enumeration districts (EDs) within each of the sampling region designated as Primary Sampling Units (PSUs) and (ii) the systematic selection of 20 households within each PSU. The sample is self-weighting with each household in the sample universe being given an equal probability of being represented in the sample. A total of 2,400 households were sampled countrywide. However, there were some non-interviews which were uneven across geographical areas. For reporting national level results, sample weights were used. A more detailed breakdown of households and sampling regions by district and urban/rural areas can be found in Appendix A. Questionnaires Three questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members, the household, and the dwelling; 2) a women’s questionnaire administered in each household to all women aged 15-49 years; and 3) an under-5 questionnaire, administered to mothers or caretakers of all children under 5 living in the household. The questionnaires included the following modules: The Household Questionnaire included the following modules: o Household Listing o Education o Water and Sanitation o Household Characteristics o Child Discipline o Disability o Salt Iodization1 The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: o Child Mortality o Tetanus Toxoid o Maternal and Newborn Health o Contraception and Unmet Need o Attitudes Toward Domestic Violence o Sexual Behaviour o HIV/AIDS 1 While a component of the “Household” Questionnaire, data on this indicator was not collected due to unavailability of the necessary/requisite salt testing kits at the time of the survey. 4 The Questionnaire for Children Under-Five was administered to mothers or caretakers of children under-5 years of age2 living in the households. Normally, the questionnaire was administered to mothers of under- 5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: o Birth Registration and Early Learning o Child Development o Vitamin A o Breastfeeding o Care of Illness o Immunization o Anthropometry The questionnaires are based on the MICS3 model questionnaire3. The MICS3 model questionnaires were adapted and pre-tested during December 2006. Based on the results of the pre-test, modifications were made to the wording of the questionnaires. A copy of the Belize MICS questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams measured the weights and heights of children under 5 years. Details and findings of these measurements are provided in the respective sections of the report. Training and Fieldwork Training for the fieldwork was conducted for 12 days from the 23rd of January to the 3rd of February, 2006. The editors and field supervisors attended an extra day of training. Training sessions took place in four different locations: Belize City, Orange Walk, San Ignacio and Dangriga Town. In order to ensure standardization of the training a training manual was used at all training sites and all concerns or queries were reported to the Chief Statistician who after consultation responded by memo to trainers at all sites. Training included lectures on interviewing techniques and the contents of the questionnaires, practical tests, mock interviews between trainees to gain practice in asking questions and field practice of the questionnaires and anthropometry. The data were collected by 9 work teams; each was comprised of 4 interviewers, one driver, one editor/measurer and a field supervisor. Fieldwork began February 2006 and concluded in March 2006. Data Processing Data were entered using the CSPro software. The data were entered on two microcomputers and carried out by 2 data entry operators and a data entry supervisor over a five-week period. In order to ensure quality control, all questionnaires were entered twice and internal consistency checks were performed. Procedures and standard programs developed under the global MICS3 project and adapted to Belize’s questionnaire were used throughout. Data processing began in March 2006 and finished in April 2006. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, version 10, and the model syntax and tabulation plans developed by UNICEF for this purpose. 2 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 3 The model MICS3 questionnaire can be found at www.childinfo.org, or in UNICEF, 2006. 5 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 2,400 households selected for the sample, 2,068 were found to be occupied. Of these, 1,832 were successfully interviewed for a household response rate of 88.6 percent. In the interviewed households, 1,828 women (age 15-49) were identified. Of these, 1,675 were successfully interviewed, yielding a response rate of 91.6 percent. In addition, 835 children under age five were listed in the household questionnaire. Questionnaires were completed for 796 of these children, which corresponds to a response rate of 95.3 percent. Overall response rates of 81.2 and 84.5 are calculated for the women’s and under-5’s interviews respectively (Table HH.1). The children’s overall response rate was significantly lower (81.5 percent) in urban areas compared to rural areas (87.8 percent). At the district level, Corozal had the highest overall response rate (96.9 percent) distantly followed by Cayo and Stann Creek both with 87.1 percent and Toledo with 82.1 percent. Characteristics of Households The age and sex distribution of survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 1,832 households successfully interviewed in the survey, 7,619 household members were listed. Of these, 3,836 were males, and 3,782 were females. These figures also indicate that the survey estimated the average household size at 4.2. The child population (aged 0-14 years) accounts for 37.2 percent of the total sample population of which males comprise 36.8 percent and females 37.6 percent. This sample age distribution is slightly lower than the 2000 Census figures which stood at 41 percent for this sub-population. 6 Figure HH.1: Age and Sex Distribution of Household Population, Belize, 2006 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Percent Males Females Table HH.3 provides basic background information on the households. Within households, the sex of the household head, region, urban/rural status, number of household members, and language4 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. Table HH.3 presents critical background information on the households. The distribution of households by area of residence showed that 53.7 percent of the households were located in urban areas and 46.3 percent were located in rural areas. The Belize District had the highest percentage of households (35.0 percent), remotely followed by 19.3 percent in the Cayo District. Most of the households (61.0 percent) had between two and five members, and were headed by males (73.4 percent). Regarding language, English combined with Creole was spoken by 42.3 percent of the household narrowly followed by Spanish which was spoken by approximately 40 percent. The remaining 17.9 percent was constituted by households which spoke mainly Garifuna, Maya, German, Chinese, Taiwanese, or an Indian language. Characteristics of Respondents Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. 4 This was determined by asking “What is the first language of the head of this household?” 7 Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to district, urban-rural areas, age, motherhood status, education5, wealth index6, and language of household head. Women aged 15-19 comprise the greatest percentage of the sample at 21 percent. This percentage declines steadily across age groups until age 45-49 where it is 8.8 percent. With regard to motherhood status, 68.7 percent had given birth. Less than half (45.7 percent) of the women have gone beyond primary level education. Some background characteristics of children under 5 are presented in Table HH.5. These include distribution of children by several attributes: sex, district and area of residence, age in months, mother’s or caretaker’s education, wealth, and language of household head. With regard to sex, 49.7 percent of the children under the age of 5 were male and 50.3 percent were female. Percentages of children under-5 in each specified one-year age group are similar, indicating a fairly steady birth rate over time. Mothers of only 34.2 percent of children under 5 had at least secondary education, while mothers of almost two thirds (65.0 percent) of the children age 5 had not moved beyond primary level. More children (66.9 percent) than women (56.5) are located in the poorer 60-percent wealth index category. In addition, Spanish- speaking households had the highest share of children under 5 followed by 32.2 percent in English or Creole-speaking households. 5 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 6 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 obtain wealth scores for each household in the sample (The assets used in these calculations were as follows: number of rooms for sleeping per member, main material of floor, main material of roof, main material of wall, type of fuel used for cooking, electricity, radio, television, mobile phone, non-mobile telephone, refrigerator, watch, bicycle, motorcycle or scooter, animal-drawn cart, car or truck, boat with motor, main source of drinking water, main source of water used for other purposes and kind of toilet facility). Each household was then weighted by the number of household members, and the household population was divided into two groups: the poorer 60 percent and the richer 40 percent, 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. The wealth index does not provide information on absolute poverty, current income or expenditure levels, and 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. 8 IV. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). The data used in the estimation are: the mean number of children ever born for five-year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women. The technique converts these data into probabilities of dying by taking into account both the mortality risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Belize, the West model life table was selected as most appropriate. Table CM.1 provides estimates of child mortality by various selected characteristics, while Table CM.2 provides the basic data used in the calculation of the mortality rates for the national total. The current infant mortality rate is estimated at 22 per thousand live births, whereas the under-5 mortality rate (U5MR) is 27 per thousand live births. There are major variations between the probabilities of dying between males and females. For males the survey shows a rate of 28, compared to a rate of 16 for females in infant mortality, and rates of 35 and 19 respectively in the under-5 mortality. Both infant and under-5 mortality rates are slightly lower in the urban areas (21 and 26), while the figures for the rural areas stood at 22 and 27 respectively. Unlike area of residence, differences in mortality rates in terms of educational level and language are significant. Differentials in under-5 mortality rates by background characteristics are shown in Figure CM.1. 9 Figure CM.1 Under-5 Mortality Rates by Selected Characteristics, Belize, 2006 35 19 26 27 30 17 27 0 5 10 15 20 25 30 35 40 M al e Fe m al e U rb an R ur al N on e/ P rim ar y S ec on da ry + C ou nt ry Sex Area Mother's Education Selected Characteristics Pe r 1 ,0 00 li ve b irt hs Figure CM.2 shows the series of U5MR estimates of the survey, based on responses of women in different age groups, and referring to various points in time, thus showing the estimated trend in U5MR based on the survey. The MICS estimates indicate a decline in mortality over the period 1991 to 1999, but a slight rise in the subsequent two years. The 2002 U5MR estimate of 21.1 per thousand live births from the Ministry of Health is even lower than the estimate from MICS 2006 of 27.6 per thousand live births. While the trend indicated by the MICS survey results is in broad agreement with the estimates from the Family Health Surveys 1991, Census 2000 and the Ministry of Health’s administrative data sources, the results are considerably higher. 10 Figure CM.2: Trend in Under-5 Mortality Rates, Belize, 2006 0 20 40 60 80 100 1976 1980 1984 1988 1992 1996 2000 2004 2008 FHS 1991 Census 2000 MICS 2006 MoH 11 V. Nutrition Nutritional Status 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 for those who survive, have recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development 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 2 years of age. A reduction in the prevalence of malnutrition will assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is the WHO/CDC/NCHS reference, which was recommended for use by UNICEF and the World Health Organization at the time the survey was implemented. Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In MICS, weights and heights of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF (UNICEF, 2006). Findings in this section are based on the results of these measurements. 12 Table NU.1 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population. In Table NU.1, children who were not weighed and measured (7.4 percent of children) and those whose measurements are outside a plausible range are excluded. In addition, a small number of children whose birth dates are not known are also excluded. Malnutrition weakens the immune system, increasing the risk of ill health, which in turn aggravates malnutrition. Also, children who are moderately or severely underweight are more likely to die from infectious diseases than well nourished children. In Belize, 6.1 percent of children under-five are moderately underweight and 0.7 percent are classified as severely underweight (Table NU.1). Approximately 18 percent of children are stunted or too short for their age and more than two percent are wasted or too thin for their height. Figure NU.1: Percentage of children under-5 who are undernourished, Belize, 2006 0 5 10 15 20 25 30 0 6 12 18 24 30 36 42 48 54 60 Age (in Months) Pe rc en t Underweight Stunted Wasted Children residing in rural areas (7.9 percent and 23 percent) are more likely to be underweight and stunted than other children (3.8 percent and 10.9 percent). Also, growth retardation is more apparent in children of Maya descent (approximately 50 percent). Unsurprisingly, the number of overweight children is slightly higher in the urban areas (11.6 percent) than in the rural areas (9.2 percent). Those children whose mothers have secondary or higher education (3.7 percent and 9.4 percent) are less likely to be underweight and stunted compared to children of mothers with primary or no education (7.1 percent and 21.6 percent). There is no significant discrepancy between boys and girls. However, age pattern shows that a higher percentage of children aged 24-35 months are underweight (10.3 percent) and wasted (3.1 percent) in 13 comparison to children who are younger and older, while the highest proportion of stunted children are found between the ages 12-23 months (24.9 percent) (Figure NU.1). In Belize, 10.3 percent of children under-5 are overweight. There are significant differences in prevalence among districts; for example 18.2 percent of children from Belize District compared to 3 percent from Orange Walk are overweight. Obesity is most prevalent among children below six months of age (18.5 percent) than in other age-groups. Looking at other background characteristics we can see that obesity is more common among children in urban households, children whose mothers have secondary or higher education, and among children in wealthier households. Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and 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 6 months and continue to be breastfed with safe, appropriate and adequate complementary feeding for up to 2 years of age and beyond. WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators of recommended child feeding practices are as follows: • Exclusive breastfeeding rate (< 6 months & < 4 months) • Timely complementary feeding rate (6-9 months) • Continued breastfeeding rate (12-15 & 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.2 provides the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth (which includes those who started within one hour). A little over half of the women (50.6 percent) started breastfeeding their infants within one hour of birth. This proportion augments to 78.1 percent for breastfeeding within one day of birth. Both rates were highest among women in Stann Creek District (74.1 percent and 85.1 percent) and the lowest among women in Belize District (41.1 percent) and Corozal (68.2 percent) accordingly. Differentials are clear regarding women’s area of residence, women’s education, wealth and language. Women residing in rural areas (55.0 percent) were more likely to have started breastfeeding their infants within one hour of birth than those in the urban areas (45.2 percent). This difference narrows down for breastfeeding within one day of birth, 77.7 percent in urban areas and 78.5 percent in rural areas. The percentages were also lower for women with at least secondary education (40.5 percent and 73.9 percent) than for women with primary or no education (56.5 percent and 80.8 percent). The rate significantly varies with household economic status; a higher percentage of women in poor households (55.9 percent and 79.9 percent) start 14 breastfeeding within one hour of birth and within one day of birth than women in rich households (39.1 percent and 74.7 percent). Figure NU.2 Percentage of mothers who started breastfeeding within one hour and within one day of birth, Belize, 2006 68.2 78.5 78.6 84.2 85.1 72.8 77.7 78.5 78.1 41.5 59.4 41.1 51.0 74.1 50.0 45.2 55 50.6 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 Co roz al Or an ge W alk Be lize Ca yo Sta nn C ree k To led o Ur ba n Ru ral Co un try Pe rc en t Within one day Within one hour In Table NU.3, 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 interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows 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 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. Although exclusive breastfeeding during the first six months of life is recommended by the World Health Organization and UNICEF, it is not fully practiced in Belize. Just above ten percent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 44 percent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, 41.6 percent of children are still being breastfed and by age 20-23 months, 26.8 percent are still breastfed. Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. The characteristic for Belize is that children continue to be breastfed over two years of age. Up to one month, 20.9 percent of children are exclusively breastfed but considerably declines to 6.4 percent by their third month of age. Even at the earliest ages, 3 months and younger, the majority of children are receiving liquids or foods other than breast milk. By the end of the third month, the percentage of children exclusively breastfed is below 10 percent but more than half (54.8 percent) are being given other milk or formula and complementary foods. Only about 26.3 percent of children are receiving breast milk after 2 years. 15 Figure NU.3 Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group, Belize, 2006 0 10 20 30 40 50 60 70 80 90 100 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 Age (in Months) P er ce nt Weaned (not breastfed) Breastfed and complementary foods Breastfed and other milk/ formula Breastfed and non-milk liquids Breastfed and plain water only Exclusively breastfed The adequacy of infant feeding in children below 12 months is provided in Table NU.4. Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding. 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 eating complementary food at least three times a day. Among children age 0-11 months, girls appear to be more adequately fed (27.2 percent compared to boys (18.1 percent). Similarly, children in the urban areas (27.0 percent) are more adequately fed than children living in rural areas (18.5 percent). Disparities also exist in relation to mother’s education while insignificant differentials are found between rich and poor households. Vitamin A Supplements Vitamin A is essential for eye health and 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 intakes are further compromised by increased requirements for the vitamin as children grow 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 under-five deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference 16 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 deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under- five mortality by the year 2015. 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 high-dose vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months of life and helps to replenish the mother's stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A supplementation programs, the definition of the indicator is the percent of children 6-59 months of age receiving at least one high dose vitamin A supplement in the last six months. Based on UNICEF/WHO guidelines, the Ministry of Health recommends that children who are not breastfed be given low doses of vitamin A at 2 and 4 months of age (50,000 IU). At 6 months, every child receives a 100,000 IU dose and thereafter (12-59 months) every 6 months a mega-dose (200,000 IU) is given as part of the Expanded Programme on Immunization. It is also recommended that mothers take a vitamin A supplement within 8 weeks of giving birth due to increased vitamin A requirements during pregnancy and lactation. Within the six months prior to the MICS, 23.8 percent of children aged 6-59 months received a high dose Vitamin A supplement (Table NU.5). Approximately 12 percent did not receive the supplement in the last 6 months but did receive one prior to that time. Twenty-one percent of children received a Vitamin A supplement at some time in the past but their mother/caretaker was unable to specify when. Analysed by districts, Belize (14.5 percent) had the lowest proportion of children 6-59 months who reportedly never received Vitamin A supplementation while Toledo (71.9) had the highest proportion. With respect to residential area children in urban are more likely to receive Vitamin A supplement than children in rural areas. The age pattern of Vitamin A supplementation shows that supplementation in the last six months is higher (33.9 percent) among children aged 6-11 months and declines steadily with age to 17.6 percent among the oldest children. The mother’s level of education is also related to the likelihood of Vitamin A supplementation. The percentage receiving a supplement in the last six months increases from 20.3 percent among children whose mothers have primary or no education to 30.9 percent for those whose mothers have secondary or higher education. Vitamin A coverage in the last six months is relatively low for children in Maya speaking households (8.9 percent) compared to the national rate of 23.8 percent. Roughly 45 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 (Table NU.6). This percentage is highest in Belize (72.1 percent) and Cayo District (57.5 percent) and lowest in Corozal at 13.6 percent. Vitamin A coverage increases with the education of the mother and socio-economic status of household. 17 Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth7 . In Belize, approximately eight percent of children who were weighed had a birth weight of less than 2,500 grams at birth (Table NU.7). The incidence of low birth weight is not significantly affected by area of residence, mother’s education, economic status and household language; however, it varies slightly among districts. In Belize District, for example, more than 10 percent of the births weighted less than 2,500 grams compared to 5.8 percent in Corozal (Figure NU.4). 7 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. 18 Figure NU.4 Percentage of Infants Weighing Less Than 2500 Grams at Birth, Belize, 2006 5.8 9.6 10.2 6.6 6.1 8.0 8.1 0.0 2.0 4.0 6.0 8.0 10.0 12.0 Corozal Orange Walk Belize Cayo Stann Creek Toledo Country Regions P er ce nt 19 VI. Child Health Immunization The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. 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. Worldwide, there are still 27 million children overlooked by routine immunization and as a result, vaccine- preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, 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. Mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Overall, 64.3 percent of children had health cards (Table CH.2). 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. The percentage of children aged 18 to 29 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children aged 18-29 months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday, as recommended, 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. In Belize, 90.2 percent of children aged 18-29 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 89 percent. The percentage declines for subsequent doses of DPT to 84.5 percent for the second dose, and 74.6 percent for the third dose (Figure CH.1). Similarly, 88.3 percent of children received Polio 1 by age 12 months and this declines to 68.6 percent by the third dose. Since children usually receive the measles vaccine after their first birthday, 18 months was used when calculating the rate, furnishing a value of 81.9 percent after eighteen months and 85 percent at any time before the survey. Of children aged 18-29 months, 65.8 percent had received all eight recommended vaccinations before the survey and 56.3 before their first birthday (Table CH. 1). In Belize, Hepatitis B, Haemophilus Influenza Type B, Rubella and Mumps are also recommended as part of the immunization schedule. The Expanded Programme on Immunization started in Belize in the mid 70’s. Ten antigens are provided routinely to children under-5 presented in four vaccines (1 oral and 3 injected). The BCG is given once (birth – 11 months), antipolio and pentavalent (5 antigens) vaccines are given at 2, 4 and 6 months of age with a booster before five years of age, MMR vaccine is given twice starting at 12 and 24 months of age. 20 Figure CH.1 Percentage of children aged 18-29 months who received the recommended vaccinations by 12 months (18 months for measles), Belize, 2006 90.2 89.0 84.5 74.6 88.3 84.6 68.6 81.9 56.3 0 10 20 30 40 50 60 70 80 90 100 BCG DPT1DPT2DPT3 Polio1Polio2Polio3 Measles All P er ce nt Table CH.2 shows vaccination coverage rates among children 18-29 months by background characteristics. Unlike the previous table, these figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caretakers’ reports. Regarding sex, boys have higher coverage than girls for all recommended vaccinations, the overall difference being 14.8 percent points. There is little variation in vaccination coverage by mother’s education level nonetheless it is higher for children whose mothers have not gone beyond primary education. In general, the education differences are greatest for the first dose of Polio and measles, both being higher for children whose mothers were more educated. Tetanus Toxoid One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. Prevention of maternal and neonatal tetanus is to assure all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during the pregnancy, they (and their newborn) are also considered to be protected if the following conditions are met: • Received at least two doses of tetanus toxoid vaccine, the last within the prior 3 years; • Received at least 3 doses, the last within the prior 5 years; • Received at least 4 doses, the last within 10 years; • Received at least 5 doses during lifetime. Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 24 months. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. Overall, 58.3 percent of the women in Belize received vaccines against tetanus during 21 pregnancy with 46.6 percent receiving at least two doses during their last pregnancy. The highest proportion of women who are protected against tetanus is in Belize District (75.1 percent) and the lowest in Toledo where only 29.5 percent are protected. Significant differences are also observed by area of residence, education level of mother and economic status of household. Figure CH.2 Percentage of women with a live birth in the last 24 months who are protected against neonatal tetanus Belize, 2006 57.6 66.8 75.1 54.9 48.1 29.5 63.7 53.9 53.7 66.2 58.3 0 10 20 30 40 50 60 70 80 Districts Corozal Orange Walk Belize Cayo Stann Creek Toledo Area Urban Rural Mother's Education No education/Primary Secondary + Country Percent Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea- related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in 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 (Millennium Development Goals). 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 22 • (ORT or increased fluids) AND continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 12.1 percent of the under five children had diarrhoea in the two weeks preceding the survey (Table CH.4). Of those children with diarrhoea, 60.6 percent received ORT with oral rehydration solution (ORS). Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add to 100. About 27 percent received fluids from ORS packets; 25.8 percent received pre-packaged ORS fluids, and 33 percent received recommended home-made fluids. There are important differences by education of mother. Oral rehydration treatment is more evident among children whose mothers have secondary or higher education (71.6 percent) than other children (55.1 percent). Differences in the home management of diarrhoea are evident by district and education of mother. Figure CH.3 Percentage of children aged 0-59 months with diarrhoea who received oral rehydration treatment, Belize, 2006 63.5 57.7 57.3 63.5 55.1 71.6 60.6 0 10 20 30 40 50 60 70 80 Ma le Fe ma le Ur ba n Ru ral No ne /Pr im ary Se co nd ary + Co un try Sex Area Mother's Education P er ce nt A small number of under-five children with diarrhoea drank more than usual (22.4 percent) while the majority (73.5 percent) drank the same or less (Table CH.5). Approximately 42 percent ate somewhat less, same or more (continued feeding), but about 56 percent ate much less or ate almost none. Roughly, only a quarter of children received increased fluids and at the same time continued feeding. Combining the information in Table CH.5 with those in Table CH.4 on oral rehydration therapy, it is observed that 25.9 percent of children either received ORT or fluid intake was increased, and at the same time, feeding was continued. 23 There are significant differences in the home management of diarrhoea by background characteristics. Significant disparities exist by area of residence and mother’s education. In rural areas, only 19.9 percent of children received ORT or increased fluids and continued feeding and 23 percent of children whose mother’s level of education was primary or none. Figure CH.4 Percentage of children aged 0-59 with diarrhoea who received ORT or increased fluids, AND continued feeding Belize, 2006 26.4 25.4 32.8 19.9 23.0 34.6 25.9 0 5 10 15 20 25 30 35 40 Sex Male Female Area Urban Rural Mother's Education None/Primary Secondary + Country Percent Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one-third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were NOT due to a problem in the chest and a blocked nose. The indicators are: • Prevalence of suspected pneumonia • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the danger signs of pneumonia The results of the survey showed that 5.4 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, 70.9 percent were taken to an appropriate provider. In Belize, an estimated 43.9 percent of under-5s children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. 24 Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, only 14.7 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 is if the child develops a fever (77.2 percent). Thirty-eight percent of mothers identified difficult breathing and 24 percent of mothers identified fast breathing as symptoms for taking children immediately to a health care provider. Other identified signs for taking children immediately to a health care provider included when the child becomes sicker (26.5 percent) or had blood in stool (27.7 percent). Mother’s knowledge of the danger signs was highest in Corozal (43.1 percent) and lowest in Cayo (2.9 percent). As expected, knowledge of danger sings seems to be positively correlated with education level of mother. Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. 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. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Overall, less than 14 percent of all households in Belize are using solid fuels for cooking (Table CH.7). This figure contrasts significantly with the global average. Generally, higher rates of solid fuel use exist in regions with higher level of poverty. This is substantiated by the fact that in Toledo, more than half of the households (53.3 percent) are utilizing wood for cooking and only 44.1 percent are using butane gas. The district with the lowest percentage is Belize with only 1.6 percent of the households using wood for cooking. As expected, the use of solid fuels is very low in urban areas (2.1 percent), but relatively high in rural areas, where more than a quarter of the households (27.1 percent) are using solid fuels. Differentials with respect to household wealth and the educational level of the household head are also significant. The major difference in the use of solid fuels occurs between the poorer three quintiles and richer two quintiles with 24.8 and 0.0 percent respectively (Figure CH.5). Butane gas is the fuel used by most Belizean households (81.5 percent), while the use of charcoal and biogas is almost non-existent. 25 Figure CH.5 Percentage of Households Using Solid Fuels for Cooking, Belize 2006 27.8 14.8 1.6 9.3 2.1 27.1 19.6 1.9 24.8 0 13.6 53.3 10.6 0 10 20 30 40 50 60 C or oz al O ra ng e W al k B el iz e C ay o S ta nn C re ek To le do U rb an R ur al N on e/ P rim ar y S ec on da ry + P oo re st 6 0% R ic he st 4 0% To ta l District Residence Education of household head Wealth index quintiles Total Household Characteristics Pe rc en t Solid fuel use alone is a poor proxy for indoor air pollution, since the concentration of the pollutants is different when the same fuel is burnt in different stoves or fires. Use of closed stoves with chimneys minimizes indoor pollution, while open stove or fire with no chimney or hood means that there is no protection from the harmful effects of solid fuels. The type of stove used with a solid fuel is depicted in Table CH.8. Approximately 92 percent of the household using solid fuels for cooking use open stoves or fire with no chimney or hood while merely 3.8 percent make use of closed stoves with chimney. 26 VII. Environment 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 with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is 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 reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS is as follows: 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 distribution of the population by source of drinking water is shown in Table EN.1 and Figure EN.1. The population using improved sources of drinking water are those using any of the following types of 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 an improved water source for other purposes, such as hand-washing and cooking. 27 Figure EN.1 Percentage distribution of household members by source of drinking water Belize, 2006 Piped into dwelling, yard or plot 37.8% Rain-water 20.3% Bottled water 32.0% Other improved 6.4% Other 3.5% Other unimproved 0.6% Unimproved Bottled water 0.3% Cart with tank/ drum 0.2% Surface water 0.9% Unprotected well or spring 1.5% Overall, 96.5 percent of the population is using an improved source of drinking water – 99.2 percent in urban areas and 94.0 percent in rural areas. The urban-rural disparity is greatest in the use of bottled water – 49.8 and 15.2 percent respectively. The main source of drinking water in Belize is bottled water which is consumed by 32 percent of the population followed by water piped into dwelling (23.1 percent). The district where most of the population drink bottled water is Belize (53 percent). In the other extreme, Toledo is the district where bottled water is consumed the least (5.5 percent). Rain-water and bottled water are very important in Orange Walk and Corozal as these are the main sources there. The education level of the household head shows a direct relationship with access to improved sources, higher education corresponds with better access, especially regarding bottled water. This relationship is even more pronounced when we look at wealth; whereas 58.4 percent of the richest two quintiles drink bottled water only 14.4 percent of the poorest three quintiles do so. Use of in-house water treatment is presented in Table EN.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, and using solar disinfection were considered as proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. The table shows that 78.7 percent of Belizean households drink untreated water and that only 19.9 percent use appropriately treated water. Most households treat the water by boiling it or by adding bleach or chlorine. What is alarming is that merely 22.3 percent of the unimproved water sources are treated appropriately. The amount of time it takes to obtain water is presented in Table EN.3 and the person who usually collect the water in Table EN.4. Note that these results refer to one round trip from home to drinking water source. Information on the number of trips made in one day was not collected. Table EN.3 shows that for 77.3 percent of households, the drinking water source is on the premises. For the households that fetch water from somewhere else, the average amount of time to get to the water source and bring water is around 10 minutes. Out of the 22.7 percent that do not have water on their premises 28 15.4 percent take less than 15 minutes to obtain water, and less than one percent of households spend more than 1 hour for this purpose. Unexpectedly, the time spent in urban areas in collecting water is slightly higher than in rural areas. The percentage of the population having to go to water sources is highest in the northern region (Orange Walk and Corozal Districts) but at the same time these districts have the lowest mean times to get to the source of drinking water. Table EN.4 shows that the overall collection of water when source of drinking water is not on the premises; is shared rather equally between women and men. This is not the case in Toledo where approximately 86 percent of the water is collected by females, six percent being under the age of 15. No children under age 15 collects water in the Cayo District. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities for excreta disposal include: flush or pour flush to a piped sewer system, septic tank, or latrine; ventilated improved pit latrine, pit latrine with slab, and composting toilet. In Belize, improved sanitation coverage is 93.7 percent (Table EN.5). Although there are no considerable disparities regarding access to sanitation between the urban and rural areas, the quality of facilities and health risks to children are different. Whilst 80.9 percent of the urban households have access to a toilet either linked to a sewer system or to a septic tank, only 33.1 percent of the rural households use this type of sanitation facility. Approximately 63 percent of the rural population continue to use pit latrines or less- sanitary facilities. The population in Toledo are less likely to use improved sanitation facilities (81.7 percent) than people in other districts. Additionally, 16.5 of the households in Toledo have no sanitary facilities and use the bush or field to dispose of excreta. The table indicates that the use of improved sanitation facilities is strongly correlated with wealth as 96.5 percent of the richer two quintiles use flush toilet compared to 29.4 of the household in the poorer three quintiles. Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet or by rinsing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table EN.6 Nation- wide, safe disposal of faeces of children 0-2 years of age was found in 23.8 percent of the households with children. Higher rates of safe disposal are observed in the north particularly in Orange Walk (47.0 percent) compared to other districts. In the Belize District, for instance, the rate for safe disposal of children’s faeces is only 13.8 percent. Unexpectedly children whose mothers have at least secondary education are less likely to use a safe disposal method than children whose mothers have not gone beyond primary level. Unsafe disposal are also shown in Table EN.6. The unsafe disposal methods include putting faeces in the garbage, burying it and leaving it in the open. The unsafe disposal method practiced most frequently is putting children’s faeces in the garbage (67 percent). This disposal method is most common in the Belize District (83.5 percent) and least common in Orange Walk (47.3 percent). An overview of the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.7. Overall 96.5 percent of the population of Belize have access to improved drinking water sources and 93.7 percent use improved sanitation facilities for excreta disposal. The percentage of the population having access to both improved drinking water sources and improved sanitation facilities was 90.6 percent. Of these the highest proportion was in Belize District (97.0 percent) while the lowest proportion in Toledo (79.9 percent). 29 VIII. Reproductive Health Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. A World Fit for Children goal is access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. According to the UNFPA’s report on the State of the World Population 2004, contraceptive use varies regionally ranging from 25 percent in Africa to nearly 65 percent in Asia and 70 percent in Latin America and the Caribbean and in the developed regions. In the Caribbean, the prevalence ranges from 74 percent in Trinidad and Tobago to a low of 18 percent in Haiti. In Belize, the percentage of women currently using contraception is 34.3 percent (Table RH.1). The most popular method of contraception is the pill (10.8 percent). The next most popular method is female sterilization, which accounts for 8.9 percent of women. All other contraceptive methods do not exceed five percent. Less than one percent use withdrawal, male sterilization, vaginal methods, or the lactational amenorrhea method (LAM). Differences in contraceptive prevalence are observed between women in urban areas and rural areas (38.8 percent compared to 29.4 percent). Contraceptive prevalence is highest in Belize District at 47.5 percent and lowest in Toledo at 23.4 percent. Adolescents are far less likely to use contraception than older women. No more than 12 percent of women aged 15-19 currently use a method of contraception compared to 32.4 and 48.6 percent of 20-24 and 25-29 year olds respectively. As expected, younger women between 15-19 years don’t use sterilization but older women. Only 13.5 percent of women with no living children are using a contraceptive method as a great percentage of them are seeking a pregnancy. The percentage of women using any method of contraception in Maya speaking households is very low (15.4 percent). Unmet Need Unmet need8 for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth or who wish to stop childbearing altogether. Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Women in unmet need for spacing includes women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to space their births. Pregnant women are considered to want to space their births when they did not want the child at the time they got pregnant. Women who are not pregnant are classified in this category if they want to have another child, but want to have the child at least two years later, or after marriage. Women in unmet need for limiting are those women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to limit their births. The latter group includes women who are currently pregnant 8 Unmet need measurement in MICS is somewhat different than that used in other household surveys, such as the Demographic and Health Surveys (DHS). In DHS, more detailed information is collected on additional variables, such as postpartum amenorrhoea, and sexual activity. Results from the two types of surveys are strictly not comparable. 30 but had not wanted the pregnancy at all, and women who are not currently pregnant but do not want to have another child. Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for limiting. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. Percentage of demand for contraception satisfied is defined as the proportion of women currently married or in union who are currently using contraception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Table RH.2 shows the results of the survey on contraception, unmet need, and the demand for contraception satisfied. Almost one-third of women in Belize have an unmet need for contraception. The demand for contraception is less satisfied among younger women. No major differences exist by background characteristics. 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 (ANC) as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver 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 diseases (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 (e.g., 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. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: • 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 quite high in Belize with 98.1 percent of women receiving antenatal care at least once during the pregnancy. 31 The type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding is presented in Table RH.3. Antenatal care was provided mainly by medical doctors (45.9 percent) and nurses or midwives (46.6 percent). Only 1.9 percent of the pregnant women did not receive ANC during pregnancy. Around 93-100 percent of women in all districts received ANC provided by skilled personnel except in Toledo where it is only 79.5 percent. Higher levels of antenatal care, provided by medical doctors, are found among women living in the urban areas, women with higher levels of education, and women with higher economic status. The types of services pregnant women received are shown in table RH.4. 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 transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal 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 proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target 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. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. Assistance at delivery by professional health personnel is high in Belize as nearly 96 percent of women who gave birth during the two years preceding the MICS survey were assisted by skilled personnel (Table RH.5). This percentage is higher in the urban areas at 99.3 percent and lower in the rural areas at 92.8 percent. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled attendant. 98.8 and 96.9 percent of mothers in the Belize and Cayo Districts respectively gave birth in a health facility compared to about half of mothers in the Toledo (52.4 percent) district. Doctors assisted with the delivery of 46 percent of births. The majority of deliveries in Belize, Corozal and Orange Walk were assisted by a medical doctor whereas a nurse or midwife assisted in most of the deliveries in Cayo, Stann Creek and Toledo. Overall less than one percent had traditional birth attendants at delivery (Figure RH.1). The work of nurses or midwives is very important in rural areas with 54.3 percent of deliveries being assisted by them. Assistance at delivery by a medical doctor according to education level and wealth shows some differences between women of primary school level and the ones above and between the poorer three quintiles with the rest. 32 Figure RH.1 Percent Distribution of Women Aged 15-49 with a Birth in Two Years Preceding the Survey by Type of Care at Delivery Belize, 2006 Medical doctor 45.9% Nurse/mid-wife 48.3% Auxiliary mid-wife 1.6% Traditional birth attendant 0.6% Other 2.4% No attendant 1.2% Other 5.8% 33 IX. Child Development It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, adult activities with children, presence of books in the home, for the child, and the conditions of care are important indicators of quality of home care. A World Fit for Children goal is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the survey. These included 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 or yard, playing with children, and spending time with children naming, counting, or drawing things. For seventeen out of every twenty (85.3 percent) children under-five, an adult household member engaged in at least four activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.1). The average number of activities that adults engaged with children was 5.1. The table also indicates that the father’s involvement in such activities was significantly lower at 52 percent and an average number of activities of 2.1. One in four children aged 0-59 months were living in a household without their fathers – lowest among Maya households (6.8 percent) and highest in Garifuna (55.5 percent). There are slight differentials in terms of activities that promote learning with children regarding the level of education of father; however, a larger proportion of fathers with secondary or higher education (74.8 percent) engaged in activities with children than fathers with primary or no education (59.1 percent). The district with the largest proportion of adults engaging in learning and school readiness activities with children was Stann Creek (94.8 percent) and the district with the smallest is Toledo at 69.3 percent. Differentials by age of child and socio-economic status are also observed: Adult engagement in activities with children aged 24-59 months was greater (91.1 percent) than with younger children (76.7 percent), while the proportion was 90 percent for children living in the top two quintiles, as opposed to those living in the poorer three quintiles (82.8 percent). Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance and IQ scores. In Belize, 71.4 percent of children are living in households where at least 3 non-children’s books are present (Table CD.2). However, only 56.7 percent of children aged 0-59 months have 3 or more children’s books. Both the median number of non-children’s books and the median number of children’s books are low (10 and 4 books). While no gender differentials are observed, urban children appear to have more access to both types of books than those living in rural households. Around 78 percent of under-5 children living in urban areas live in households with more than 3 non-children’s books, while the figure is 65.5 percent in rural households. The proportion of under-5 children who have 3 or more children’s books is 64.5 percent in urban areas, compared to 50.2 percent in rural areas. The presence of both non-children’s and children’s books is positively correlated with the child’s age; in the homes of 75.4 percent of children aged 24-59 months, there are 3 or more non-children’s books, while the figure is 65.6 percent for children aged 0-23 months. Similar differentials exist in terms of children’s books. 34 Table CD.2 also shows that one in four children aged 0-59 months had 3 or more playthings to play with in their homes, while 5.7 percent had none of the playthings asked to the mothers/caretakers. The playthings in MICS included household objects, home-made toys, toys that came from a store, and objects and materials found outside the home. It is interesting to note that almost nine out of every ten children play with toys that come from a store. Differentials with respect to background characteristic are small except for age of child which appears to have a stronger correlation with the number of playthings. Home-made toys are more common in Stann Creek and Toledo and among Maya and Garifuna households. As expected, the incidence of these is negatively correlated with mother’s education and economic status of household. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.3 shows that just 2.9 percent of children aged 0-59 months were left in the care of other children, while 2.7 percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that 4 percent of children were left with inadequate care during the week preceding the survey. Major differences were observed by district and language of mother. A child in Toledo was 10 times more likely to be left with inadequate care than a child in Orange Walk or Stann Creek. Inadequate care was also more prevalent among Garifuna households. 35 X. Education Pre-School Attendance and School Readiness Attendance to pre-school education in an organized learning or child education program is important for the readiness of children to school. One of the World Fit for Children goals is the promotion of early childhood education. Less than one third of children of children aged 36-59 months are attending an organized early childhood education programme, such as kindergarten or community childcare with organized learning activities (Table ED.1). Urban-rural and regional differentials are significant – the figure is 43.7 percent in urban areas, compared to 20.7 percent in rural areas. Among children aged 36-59 months, attendance to pre- school is most prevalent in Corozal (50.0 percent) and Belize (46.7 percent) and least in Toledo where only 17.1 percent attend pre-school. Approximately equal percentages of girls and boys attend such programs. Relatively few children (16.7 percent) attend at age three (36-47 months) while a larger proportion (42.7 percent) of children attends at age four (48-59 months). Differentials by education of mother and by socio- economic status are significant. The percentage of children attending early childhood education increases from 21.6 to 49.7 percent as the mother’s education increases to secondary or above (Figure ED.1). Figure ED.1 Percentage of children aged 36-59 months who are attending some form of organised early childhood education program, Belize, 2006 31.4 30.1 50.0 22.5 46.7 20.0 26.4 17.1 43.7 20.7 21.6 49.7 21.6 47.0 30.7 0 10 20 30 40 50 60 M al e Fe m al e C or oz al O ra ng e W al k B el iz e C ay o S ta nn C re ek To le do U rb an R ur al N on e/ P rim ar y S ec on da ry + P oo re st 6 0% R ic he st 4 0% C ou nt ry Selected Characteristics Pe rc en t The table also shows the proportion of children in the first grade of primary school who attended pre- school the previous year (Table ED.1), an important indicator of school readiness. Overall, 32.8 percent of children who are currently age 5 and attending the first grade of primary school were attending pre-school the previous year. There is practically no difference between male and female readiness; however, education of mother and socio-economic status appears to have a positive correlation with school readiness. 36 Primary and Secondary School Participation Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. 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 include: • 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 (or gender parity index - GPI) The indicators of school progression include: • Survival rate to grade five • Transition rate to secondary school • Net primary completion rate Of children who are of primary school entry age (age 5) in Belize, 71 percent are attending grade 1 (ED.2). A higher percentage of boys (74.5 percent) compared to girls (67.8 percent) are attending grade 1. At the urban-rural level, it is higher in urban areas (75.8 percent) than in rural areas (67.1 percent). Significant differentials are also present by region. In Toledo, for instance, the value of the indicator reaches 83.9 percent, while it is only 48.0 percent in Orange Walk. Table ED.3 provides the percentage of children of primary school age attending primary or secondary school. The net primary school attendance rate is high for both males and females (95.2 percent), nevertheless, one in every twenty girls and one in every twenty boys do not attend primary school. At the district level, Orange Walk (91.5 percent) and Stann Creek (92.5 percent) have the lowest net attendance rates and Toledo the highest (97.5 percent). Net attendance is significantly higher for females in Orange Walk and significantly lower in Toledo. When observing the rates by selected characteristics minor differences are found for both boys and girls, by mother’s education and socio-economic status; lower attendance among the poorer and less educated and higher rates among the rich and more educated. The secondary school net attendance ratio is presented in Table ED.4. More dramatic than in primary school where 4.8 percent of the children are not attending school at all, is the fact that merely 58.7 percent of the children of secondary school age are attending secondary school. Of the remaining 41.3 percent, 14.9 percent are still attending primary school (Table ED.4w) and the remaining 26.4 percent are out of school. When age of children is examined, we find that only 11.8 percent of children aged 13 are still in primary school. Major differences in net secondary school attendance are found among districts, and between urban and rural areas. Children of secondary school age, whose mothers have at least a secondary education or are in the richer two quintiles, are more likely to be attending secondary school than those whose mothers have not gone beyond primary or belong to the poorer three quintiles. The percentage of children entering grade one who eventually reach grade 5 is presented in Table ED.5. Of all children starting grade one, the majority of them (98.7 percent) will eventually reach grade 5. Notice that this number includes children that repeat grades and that eventually move up to reach standard five. No other significant differences were observed by selected characteristics 37 The net primary school completion rate and transition rate to secondary education are presented in Table ED.6. At the time of the survey, only 25.2 percent of the children of primary completion age were attending standard six. This value should be distinguished from the gross primary completion ratio which includes children of any age attending the standard six. Similar rates are observed for both boys and girls in net primary school completion rates, however, they differ significantly in the transition rate to secondary education. Children in urban areas and children whose mothers have higher education levels complete primary school earlier than rural or whose have lower levels of education. Fortunately, more than nine of every ten children (92.9 percent) who completed successfully primary school were attending first year of secondary school at the time of the survey. The ratio of girls to boys attending primary and secondary education is provided in Table ED.7. These ratios are better known as the Gender Parity Index (GPI). Notice that the ratios included here are obtained from net attendance ratios rather than gross attendance ratios. The last ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children attending primary education tend to be boys. The table shows that gender parity for primary school is close to 1.00, indicating no difference in the attendance of girls and boys to primary school. The disadvantage of girls is particularly pronounced in the Toledo (0.95) for primary and in Stann Creek for secondary school (0.85. Unlike primary education, the gender gap in secondary education, on the other hand, is little pronounced in favour of girls (1.03) indicating no discrimination or exclusion of girls on the basis of gender from the education system in comparison to boys. However, gender discrimination in secondary education is prevalent among Garifuna and Maya-speaking children whose gender parity index stays at 0.84 and 0.86 respectively. The secondary school attendance rate for girls (69.1percent) in Cayo is relatively high compared to boys (59.0 percent) resulting in a high gender parity index (1.17). Adult Literacy One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s questionnaire was administered, the results are based only on females age 15-24. . Literacy was assessed on the ability of women to read a short simple statement or on school attendance. The percent literate is presented in Table ED.8. Approximately 90 percent of women between 15-24 years are literate nationwide. There are no major variations by residential area or language. However, there are important differences in terms of age and socio-economic status of women. The proportion of women in the age-group 15-19 who are literate is higher (92.7 percent) than that of women in the age-group 20-24 (85.3 percent). Similarly, a lower percentage of literacy is found among women in the poorer three quintiles compared to the richer two quintiles. 38 XI. Child Protection Birth Registration The Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The indicator is the percentage of children under 5 years of age whose birth is registered. The births of 94.4 percent of children, under five years of age, in Belize have been registered (Table CP.1). The districts which show higher registration percentages are Cayo and Corozal where around 98 out of every hundred children were registered. On the other hand, Stann Creek shows the highest percentage for non-registration (12.4 percent); “must travel too far” is clearly the main reason for non-registration here (48.1 percent). Rural children are to some extent less likely to be registered than their urban peers; 91.8 and 96.5 percent respectively, but this appears to be due primarily to long distances of rural communities to the nearest registration centre (data table not shown).There are no significant variations in birth registration across sex, age, or education categories. Among those whose births are not registered, cost, and travel distance seem to be the main reasons (data table not shown). Child Discipline As stated in A World Fit for Children, “children must be protected against any acts of violence …” and the Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In the Belize MICS survey, mothers/caretakers of children age 2-14 years were asked a series of questions on the ways parents tend to use to discipline their children when they misbehave. Note that for the child discipline module, one child aged 2-14 per household was selected randomly during fieldwork. Out of these questions, the two indicators used to describe aspects of child discipline are: 1) the number of children 2-14 years that experience psychological aggression as punishment or minor physical punishment or severe physical punishment; and 2) the number of parents/caretakers of children 2-14 years of age that believe that in order to raise their children properly, they need to physically punish them. In Belize, 67.7 percent of children aged 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. 25.3 percent of mothers/caretakers believed that children should be physically punished; however, only 6.6 percent of children were reportedly subjected to severe physical punishment. It is very interesting that differentials with respect to most of the background variables were relatively small (Table CP.2). Domestic Violence A number of questions were asked of women age 15-49 years to assess their attitudes towards whether husbands are justified to hit or beat their wives/partners for a variety of scenarios. These questions were asked to have an indication of cultural beliefs that tend to be associated with the prevalence of violence against women by their husbands/partners. The main assumption here is that women that agree with the 39 statements indicating that husbands/partners are justified to beat their wives/partners under the situations described in reality tend to be abused by their own husbands/partners. The responses to these questions can be found in Table CP.3. The percentage of women who justify physical violence under any of the circumstances is 12.2 percent; the situation with the highest justification being when they neglect the children (8.4 percent). The rates of justification vary by district, economic status, education and language of women. Whereas 34.2 percent of the women in Toledo justify physical violence in any of the situations only 6.2 percent do so in Belize District. Likewise, it is 17.0 and 5.9 percent among the poorer three and richer two quintiles respectively. Child Disability One of the World Fit for Children goals is to protect children against abuse, exploitation, and violence, including the elimination of discrimination against children with disabilities. For children age 2 through 9 years, a series of questions were asked to assess a number of disabilities/impairments, such as sight impairment, deafness, and difficulties with speech. This approach rests in the concept of functional disability developed by WHO and aims to identify the implications of any impairment or disability for the development of the child (e.g. health, nutrition, education, etc.). Table CP.4 presents the results of these questions. More than a quarter (26.3 percent) of children aged 2-9 years were reported to have at least one disability, with the highest proportion (50.9 percent) living in Toledo and the lowest in Belize (17.1 percent). Noticeably, there is a high percentage of children aged 3-9 years whose speech is not normal (28.2 percent) with the highest prevalence in Cayo (45.1 percent) and lowest in Stann Creek (7.7 percent). Among two- year-old children who could not name at least one object, the proportion of children living in rural areas almost doubles that of their counterparts in urban areas. Differences by most other background characteristics are minor. 40 XII. HIV/AIDS, Sexual Behaviour, and Orphaned Children Knowledge of HIV Transmission and Condom Use One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. The HIV module was administered to women 15-49 years of age. One indicator which is both an MDG and UNGASS indicator is the percent of young women who have comprehensive and correct knowledge of HIV prevention and transmission. Women were asked whether they knew of the three main ways of HIV transmission – having only one faithful uninfected partner, using a condom every time, and abstaining from sex. The results are presented in Table HA.1. Table HA.1 shows that 96.6 percent of women aged 15-49 years in Belize have heard of AIDS. However, the percentage of women who know of all three main ways of preventing HIV transmission is about half of them (49.7 percent). When asked, 73.1 percent of women knew that transmission of HIV/AIDS could be prevented by having one faithful uninfected sex partner; 71 percent knew that using a condom every time they have sex could prevent HIV/AIDS transmission; and 70.1 percent knew that abstaining from sex could prevent HIV/AID transmission. While 89.9 percent of women know at least one way, one out of every ten women do not know any of the three ways. Accurate knowledge of the means of HIV/AIDS transmission is somewhat less among women in Toledo compared to other districts as only 26.8 percent of women in Toledo know all three ways of preventing HIV/AIDS transmission. Differences across age groups are not particularly large; the percentage of women who know all three ways ranges from 47.3 percent among women 40-44 year olds to 53.6 percent among 45-49 year olds. Women with higher educational level and better socio-economic status were more likely to have accurate knowledge of HIV/AIDS Table HA.2 presents the percent of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Belize, that HIV can be transmitted by sharing food and mosquito bites. The table also provides information on whether women know that HIV cannot be transmitted by supernatural means, and that HIV can be transmitted by sharing needles. Of the interviewed women, 53.8 percent reject the two most common misconceptions and know that a healthy-looking person can be infected. Approximately 85 percent of women know that HIV cannot be transmitted by supernatural means, and 68.4 percent of women know that HIV cannot be transmitted by mosquito bites, while 84.5 percent of women know that a healthy-looking person can be infected. Women in Toledo are more likely to believe misconceptions about AIDS transmission than women in other districts. For instance, less than half (43.9 percent) of the women in Toledo know that HIV cannot be transmitted by mosquito bites, likewise only 60.4 percent know that a healthy-looking person can be 41 infected. Rural women are more likely to believe misconceptions about AIDS transmission than urban women are. Women with higher education level are most likely to recognize all three misconceptions. Socio-economic status seems to be strongly associated with correct identification of all three misconceptions Table HA.3 summarizes information from Tables HA.1 and HA.2 and presents the percentage of women who know 2 ways of preventing HIV transmission and reject three common misconceptions. The table presents the percentage of women 15-49 years who have a comprehensive knowledge of HIV/AIDS transmission. Knowledge of HIV prevention methods is still fairly low with only 58.5 percent of women reporting knowing two prevention methods; this rate is 66.5 percent in urban areas and 49.9 percent in the rural areas. As expected, the percentage of women who know two prevention methods increases with the woman’s education level and socio-economic status. A key indicator used to measure countries’ responses to the HIV epidemic is the proportion of young people 15-24 years who know two methods of preventing HIV/AIDS, reject two misconceptions, and know that a healthy looking person can have HIV. Just 39.7 percent of young women have comprehensive knowledge about HIV transmission; a level comparable to all other age-groups. Levels of education (Figure HA.1) area of residence and socio-economic status are again highly associated with knowledge of HIV. Figure HA.1 Percent of women who have comprehensive knowledge of HIV/AIDS transmission, Belize, 2006 47.2 72.0 58.5 40.8 69.2 53.8 24.7 52.4 37.3 0 10 20 30 40 50 60 70 80 None/Primary Secondary + Country P er ce nt Knows 2 ways to prevent HIV Identify 3 misconceptions Comprehensive knowledge Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeeding. The level of knowledge among women age 15-49 years concerning mother-to-child transmission is presented in Table HA.4. Overall, 91.6 percent of women know that HIV can be transmitted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is 59.7 percent, while 5 percent of women did not 42 know of any specific way. When asked specifically about the means through which mother to child transmission can take place 86.8 percent knew that AIDS can be transmitted during pregnancy, 69.6 percent said that transmission at delivery was possible, and 76.5 percent agreed that AIDS can be transmitted through breast milk. The percentages of women who have knowledge of mother-to-child transmission of HIV are above 90 percent in all the districts except in Toledo where only 67.2 of the women know that AIDS can be transmitted from mother-to-child. The knowledge of mother-to-child transmission of HIV is positively correlated with women’s education and wealth. The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) would care for family member sick with AIDS; 2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status of a family member a secret. Table HA.5 presents the attitudes of women towards people living with HIV/AIDS. The table shows that 73.2 percent of the women 15-49 years who have heard of AIDS agree with at least one of the discriminatory statements. Around 44 percent of women aged 15-49 years would want to keep the HIV status of a family member a secret, 32.2 percent thought that an HIV positive teacher should not be allowed to work and 42.2 percent would not buy fresh vegetables from a person with HIV/AIDS (Figure HA.2). Overall people having HIV/AIDS are less discriminated and are cared for more in Belize than in other districts. Approximately 29 percent of women in Toledo would not care for a family member who is sick with AIDS. Figure HA.2 Percentage of women aged 15-49 years who have heard of AIDS and express a discriminatory attitude towards people living with HIV/AIDS, Belize,2006 73.2 26.8 42.2 32.2 44.2 10.5 0 10 20 30 40 50 60 70 80 Would not care for a family member who was sick with AIDS If a family member had HIV would want to keep it a secret Believe that a teacher with HIV should not be allowed to work Would not buy fresh vegetables from a person with HIV/AIDS Agree with at least one discriminatory statement Agree with none of the discriminatory statements Pe rc en t o f w om en w ho : Percent The percentage of respondents who believe that a teacher with HIV/AIDS should not be allowed to work is highest in Toledo (55.4 percent) and lowest in Belize District at 13.9 percent. Similarly, the percentage is higher in rural areas at 44.7 percent and lower in urban areas at 21.3 percent. Women in the richest quintiles and those with secondary or higher education are less likely to express this discriminatory attitude than poorer women and those with primary or no education. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever 43 been tested, and the extent to which those tested have been told the result of the test, is presented in Table HA.6. The majority of women (82.3 percent) of reproductive age in Belize know a place to get tested for AIDS but only 48 percent have actually been tested. Of those who were tested for HIV, 91.3 percent were told the result. This is clearly not the case in Toledo where merely 51.5 percent of women knew a place to get tested, 31.5 percent actually got tested and 80.4 actually received the result. Women living in urban areas are more likely to know a place compared to those of rural areas. Variations also occur by education level and socio-economic status and language of household head. Table HA.7 shows that 94 percent of women age 15-49 receive antenatal care from a health care professional during pregnancy, 3 in every 4 are provided with information about HIV prevention during antenatal care visits and 8 in 10 are tested for HIV during their visit. Of women in this age group, 7 in 10 receive the results of their HIV tests; generally, an inverse relation with respect to age and the recorded variables (receipt of HIV test results, provision of HIV information and HIV testing) emerges Sexual Behaviour Related to HIV Transmission Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms during sex, especially with non-regular partners, is especially important for reducing the spread of HIV. In most countries over half of new HIV infections are among young people 15-24 years thus a change in behaviour among this age group will be especially important to reduce new infections. A module of questions was administered to women 15-24 years of age to assess their risk of HIV infection. Risk factors for HIV include sex at an early age, sex with older men, sex with a non-marital non-cohabitating partner, and failure to use a condom. Condom use during sex with men other than husbands or live-in partners (non-marital, non-cohabiting) was assessed in women 15-24 years of age who had sex with such a partner in the previous year (Table HA.8). Over 41 percent of women 15-24 years report having sex with a non-regular partner in the 12 months prior to the MICS. Of those women less than half (49.5 percent) report using a condom when they had sex with the high risk partner. Condom usage during high risk sex was highest in Orange Walk District (100 percent) and lowest in Toledo (33.6 percent). Significant differentials are also observed by residential area, age, economic status and education level of women (Figure HA.3). 44 Figure HA.3 Percentage of young women aged 15-24 years who had high risk sex in the previous year and who used a condom at last high risk sex, Belize, 2006 72.1 100.0 51.7 36.2 45.8 33.6 52.0 35.3 37.0 53.5 56.0 49.5 67.7 34.3 40.8 0 20 40 60 80 100 120 C or oz al O ra ng e W al k Be liz e C ay o S ta nn C re ek To le do U rb an R ur al 15 -1 9 20 -2 4 N on e/ P rim ar y S ec on da ry + P oo re st 6 0% R ic he st 4 0% C ou nt ry District Area Age Education Wealth Index Total Selected Characteristics Pe rc en t 45 Orphaned Children As the HIV epidemic progresses, more and more children are becoming orphaned because of AIDS. Children who are orphaned may be at increased risk of neglect or exploitation if the parents are not available to assist them. Monitoring the variations in different outcomes for orphaned children and comparing them to their peers gives us a measure of how well communities and governments are responding to their needs. To monitor these variations, a measurable definition of orphaned children needed to be created. The UNAIDS Monitoring and Evaluation Reference Group developed proxy definition of children who have been affected by adult morbidity and mortality. This should capture many of the children affected by AIDS in countries where a significant proportion of the adults are HIV infected. This definition classifies children as orphaned if they have experienced the death of either parent, if either parent is chronically ill, or if an adult (aged 18-59) in the household either died (after being chronically ill) or was chronically ill in the year prior to the survey. The frequency of children living with neither parent, mother only, and father only is presented in Table HA.9. Overall, 68.3 percent of children aged 0-17 years are living with both parents. An important percentage of children (18.2 percent) are living with their mother only, even though their father is alive. This percentage is higher in urban areas at 24.7 percent compared to rural areas at 12.9 percent. Children who have one or both parents dead totalled 5.1 percent of all children aged 0-17 years. Older children are more likely to live away without their biological parents than younger children. Approximately 7 percent of children are living with neither parent even though both parents are alive. The situation of children not living with biological parents differs by district and urban-rural. While 3.1 percent of children in Orange Walk are not living with a biological parent, nearly 10 percent in Belize District do so. The percentage of children not living with biological parents is higher in urban areas (8.5 percent) compared to rural areas (5.1 percent). One of the measures developed for the assessment of the status of orphaned children relative to their peers looks at the school attendance of children 10-14 for children who have lost both parents (double orphans) versus children whose parents are alive (and who live with at least one of these parents). If children whose parents have died do not have the same access to school as their peers, then families and schools are not ensuring that these children’s rights are being met. Less than one percent of children aged 10-14 in Belize have lost both parents (Table HA.10). Among those only 62.1 percent are currently attending school. Among the children ages 10-14 who have not lost a parent and who live with at least one parent, 93.6 percent are attending school. This would suggest that double orphans are disadvantaged compared to the non-orphaned children in terms of school attendance. 46 List of References Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. Blanc, A. and Wardlaw, T. 2005. "Monitoring Low Birth Weight: An Evaluation of International Estimates and an Updated Estimation Procedure". WHO Bulletin, 83 (3), 178-185. Filmer, D. and Pritchett, L., 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. Cental Statistical Office, 1991 Belize Family Health Survey. Central Statistical Office, Population Census 2000. Major Findings. UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN www.Childinfo.org. 47 Tables Table HH.1: Results of household and individual interviews Numbers of households, women and children under 5 by results of the household, women's and under-five's interviews, and household, women's and under-five's response rates, Belize, 2006 Area District Total Urban Rural Corozal Orange Walk Belize Cayo Stann Creek Toledo Sampled households 1,320 1,080 240 300 840 480 300 240 2,400 Occupied households 1,123 945 227 249 708 414 257 213 2,068 Interviewed households 967 865 220 225 600 375 226 186 1,832 Household response rate 86.1 91.5 96.9 90.4 84.7 90.6 87.9 87.3 88.6 Eligible women 944 884 256 249 519 412 217 175 1,828 Interviewed women 866 809 246 208 481 388 206 146 1,675 Women response rate 91.7 91.5 96.1 83.5 92.7 94.2 94.9 83.4 91.6 Women's overall response rate 79.0 83.8 93.1 75.5 78.5 85.3 83.5 72.9 81.2 Eligible children under 5 374 461 98 117 190 210 102 118 835 Mother/Caretaker Interviewed 354 442 98 104 180 202 101 111 796 Child response rate 94.7 95.9 100.0 88.9 94.7 96.2 99.0 94.1 95.3 Children's overall response rate 81.5 87.8 96.9 80.3 80.3 87.1 87.1 82.1 84.5 48 Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, Belize, 2006 Sex Total Male Female Number Percent Number Percent Number Percent Age 0-4 413 10.8 413 10.9 826 10.8 5-9 490 12.8 528 14.0 1,018 13.4 10-14 507 13.2 480 12.7 987 13.0 15-19 438 11.4 387 10.2 825 10.8 20-24 341 8.9 306 8.1 648 8.5 25-29 255 6.6 266 7.0 521 6.8 30-34 209 5.4 248 6.6 457 6.0 35-39 255 6.6 236 6.2 491 6.4 40-44 198 5.2 215 5.7 414 5.4 45-49 170 4.4 158 4.2 328 4.3 50-54 136 3.6 163 4.3 299 3.9 55-59 103 2.7 104 2.8 207 2.7 60-64 81 2.1 77 2.0 158 2.1 65-69 80 2.1 73 1.9 153 2.0 70+ 142 3.7 119 3.1 261 3.4 Missing/DK 18 .5 9 .2 26 .3 Dependency age groups <15 1,410 36.8 1,421 37.6 2,831 37.2 15-64 2,186 57.0 2,161 57.1 4,347 57.1 65+ 222 5.8 192 5.1 414 5.4 Missing/DK 18 .5 9 .2 26 .3 Children aged 0-17 1,692 44.1 1,654 43.7 3,346 43.9 Adults 18+/Missing/DK 2,144 55.9 2,128 56.3 4,272 56.1 Total 3,836 100.0 3,782 100.0 7,619 100.0 49 Table HH.3: Household composition Percent distribution of households by selected characteristics, Belize, 2006 Weighted percent Number of households weighted Number of households unweighted Sex of household head Male 73.4 1,344 1,343 Female 26.6 488 489 District Corozal 13.0 238 220 Orange Walk 13.1 241 225 Belize 35.0 642 600 Cayo 19.3 353 375 Stann Creek 11.0 201 226 Toledo 8.6 158 186 Area Urban 53.7 984 967 Rural 46.3 848 865 Number of household members 1 13.8 252 256 2-3 30.6 561 548 4-5 30.4 557 556 6-7 15.8 289 291 8-9 5.9 108 112 10+ 3.6 66 69 First language of head of household English/Creole 42.3 775 765 Spanish 39.7 727 712 Garifuna 5.4 99 112 Maya 8.1 149 163 Other 4.4 81 78 Total 100.0 1,830 1,830 At least one child aged < 18 years 65.9 1,832 1,832 At least one child aged < 5 years 31.8 1,832 1,832 At least one woman aged 15-49 years 70.9 1,832 1,832 50 Table HH.4: Women's background characteristics Percent distribution of women aged 15-49 years by background characteristics, Belize, 2006 Number of women Weighted percent weighted unweighted District Corozal 15.0 252 246 Orange Walk 14.6 245 208 Belize 30.3 507 481 Cayo 21.2 355 388 Stann Creek 10.6 178 206 Toledo 8.2 138 146 Area Urban 52.1 872 866 Rural 47.9 803 809 Age 15-19 21.0 352 358 20-24 16.7 280 281 25-29 14.6 244 242 30-34 14.0 235 232 35-39 13.4 225 223 40-44 11.4 191 191 45-49 8.8 148 148 Motherhood status Ever gave birth 68.7 1,150 1,145 Never gave birth 31.3 525 530 Education None/Primary 54.3 909 910 Secondary+ 45.7 766 765 Wealth index Poorest 60% 56.5 947 957 Richest 40% 43.5 728 718 Language English/Creole 38.3 641 637 Spanish 43.7 731 717 Garifuna 4.8 80 91 Maya 9.0 151 162 Other 4.2 71 67 Total 100.0 1,674 1,674 51 Table HH.5: Children's background characteristics Percent distribution of children under five years of age by background characteristics, Belize, 2006 Number of under-5 children Weighted percent weighted unweighted Sex Male 49.7 395 394 Female 50.3 401 402 District Corozal 12.9 103 98 Orange Walk 15.2 121 104 Belize 24.3 193 180 Cayo 24.2 192 202 Stann Creek 11.1 88 101 Toledo 12.4 99 111 Area Urban 45.2 360 354 Rural 54.8 436 442 Age < 6 months 11.1 89 88 6-11 months 9.4 75 72 12-23 months 20.9 166 167 24-35 months 20.0 159 162 36-47 months 17.8 142 139 48-59 months 20.8 165 168 Mother's education level None/Primary 65.0 517 525 Secondary+ 34.2 273 264 Missing/DK 0.8 6 7 Wealth index Poorest 60% 66.9 533 540 Richest 40% 33.1 263 256 Language English/Creole 32.2 256 252 Spanish 43.5 346 338 Garifuna 4.2 34 37 Maya 13.4 107 117 Other 6.7 53 51 Total 100.0 795 795 52 Table CM.1: Child mortality Infant and under-five mortality rates, Belize, 2006 Infant mortality rate* Under-five mortality rate** Sex Male 28 35 Female 16 19 Area Urban 21 26 Rural 22 27 Mother’s education None/Primary 24 30 Secondary + 14 17 Wealth index Poorest 60% 28 36 Richest 40% 5 6 Total 22 27 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 53 Table CM.2: Children ever born and proportion dead Mean number of children ever born and proportion dead by age of women, Belize, 2006 Mean number of children ever born Proportion dead Number of women Age 15-19 0.135 0.023 352 20-24 1.060 0.034 280 25-29 2.254 0.026 244 30-34 3.088 0.027 235 35-39 3.923 0.042 225 40-44 4.528 0.055 191 45-49 5.475 0.078 148 Total 2.495 0.046 1,675 54 Table NU.1: Child malnourishment Percentage of children aged 0-59 months who are severely or moderately malnourished, Belize, 2006 Weight for age Height for age Weight for height % below % below % below % below % below % below % above - 2 SD* - 3 SD - 2 SD** - 3 SD - 2 SD*** - 3 SD + 2 SD Number of children aged 0-59 months Sex Male 5.3 0.6 17.6 4.2 1.0 0.3 10.6 321 Female 6.8 0.8 17.6 5.7 1.7 0.0 9.9 352 District Corozal 2.9 0.0 10.6 1.9 1.0 0.0 12.3 99 Orange Walk 5.7 0.0 6.0 1.4 0.0 0.0 3.0 80 Belize 6.2 0.7 9.5 3.5 4.2 0.0 18.2 144 Cayo 6.6 1.2 18.7 5.1 1.2 0.6 6.8 179 Stann Creek 3.2 1.1 22.1 3.3 0.0 0.0 7.3 82 Toledo 11.2 1.0 42.7 15.3 0.0 0.0 11.2 88 Area Urban 3.8 0.0 10.9 1.5 1.4 0.0 11.6 300 Rural 7.9 1.3 23.0 7.7 1.4 0.3 9.2 373 Age < 6 months 1.9 1.9 5.2 1.9 0.0 0.0 18.5 59 6-11 months 3.4 0.0 4.3 0.0 1.6 0.0 11.6 62 12-23 months 6.1 0.0 24.9 8.5 0.7 0.0 11.2 144 24-35 months 10.3 1.5 21.2 4.3 3.1 0.8 6.8 132 36-47 months 5.0 0.7 12.6 4.4 1.5 0.0 11.5 130 48-59 months 6.0 0.6 22.3 5.9 0.7 0.0 7.5 144 Mother’s education None/Primary 7.1 1.1 21.6 5.9 1.3 0.2 8.7 450 Secondary + 3.7 0.0 9.4 2.8 1.4 0.0 13.8 217 Wealth index Poorest 60% 7.5 1.1 22.3 6.5 1.5 0.2 9.5 464 Richest 40% 2.9 0.0 7.2 1.4 1.0 0.0 12.0 209 Language English/Creole 5.1 1.0 12.1 3.9 2.5 0.5 14.5 207 Spanish 5.9 0.7 14.0 4.6 1.4 0.0 9.3 296 Garifuna (11.7) (0.0) (11.7) (2.9) (0.0) (0.0) (2.9) 31 Maya 8.3 0.9 49.5 11.1 0.0 0.0 10.8 98 Other (2.7) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) 41 Total 6.1 0.7 17.6 5.0 1.4 0.2 10.3 673 * MICS indicator 6; MDG indicator 4 ** MICS indicator 7 *** MICS indicator 8 ( ) Figures that are based on 25-49 unweighted cases 55 Table NU.2: Initial breastfeeding Percentage of women aged 15-49 years with a birth in the two years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, Belize, 2006 Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with a live birth in the two years preceding the survey District Corozal (41.5) (68.2) 45 Orange Walk (59.4) (78.5) 49 Belize 41.1 78.6 83 Cayo 51.0 84.2 67 Stann Creek (74.1) (85.1) 30 Toledo (50.0) (72.8) 41 Area Urban 45.2 77.7 146 Rural 55.0 78.5 169 Months since birth < 6 months 53.5 88.7 83 6-11 months 38.3 65.0 78 12-23 months 55.2 79.6 154 Mother’s education None/Primary 56.5 80.8 195 Secondary + 40.5 73.9 120 Wealth index Poorest 60% 55.9 79.9 212 Richest 40% 39.1 74.7 103 Language English/Creole 43.1 78.6 105 Spanish 49.2 73.0 137 Garifuna (*) (*) 7 Maya (55.5) (83.5) 40 Other (74.9) (92.6) 25 Total 50.6 78.1 314 * MICS indicator 45 (*) Figures that are based on less than 25 unweighted cases 56 Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at each age group, Belize, 2006 Children 0-3 months Children 0-5 months Children 6-9 months Children 12-15 months Children 20-23 months Percent exclusively breastfed Number of children Percent exclusively breastfed* Number of children % receiving breastmilk & solid/ mushy food** Number of children Percent breastfed*** Number of children Percent breastfed*** Number of children Sex Male (2.8) 27 (4.1) 49 (*) 22 (*) 20 (31.1) 29 Female (*) 23 (17.6) 40 (36.5) 26 (*) 17 (22.3) 27 Area Urban (*) 19 (15.5) 33 (41.2) 27 (*) 12 24.0 33 Rural (9.3) 31 6.9 56 (*) 21 (44.8) 26 (*) 22 Mother’s education None/Primary (12.4) 29 11.6 57 (57.9) 26 (45.1) 30 (26.9) 26 Secondary + (*) 20 (7.7) 31 (*) 22 (*) 7 (27.7) 29 Wealth index Poorest 60% (10.5) 34 8.9 60 (42.9) 29 (52.1) 27 (29.3) 33 Richest 40% (*) 15 (12.6) 29 (*) 19 (*) 10 (*) 22 Total (12.3) 49 10.2 88 (44.0) 48 (41.6) 37 26.8 56 * MICS indicator 15 ** MICS indicator 17 *** MICS indicator 16 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 57 ( ) Figures that are based on 25-49 unweighted cases Table NU.4: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times yesterday and percentage of infants adequately fed, Belize, 2006 Percent of infants 0-5 months exclusively breastfed 6-8 months who received breastmilk and complementary food at least 2 times in prior 24 hours 9-11 months who received breastmilk and complementary food at least 3 times in prior 24 hours 6-11 months who received breastmilk and complementary food at least the minimum recommended number of times per day* 0-11 months who were appropriately fed** Number of infants aged 0-11 months Sex Male (4.1) 64.7 10.3 36.2 18.1 87 Female (17.6) 17.0 54.6 37.4 27.2 77 Area Urban (15.5) 41.8 31.9 36.3 27.0 74 Rural 6.9 41.1 33.8 37.4 18.5 89 Mother’s education None/Primary 11.6 59.0 41.0 49.4 27.6 99 Secondary + (7.7) 19.4 22.1 20.8 14.5 64 Wealth index Poorest 60% 8.9 43.1 31.9 37.1 21.1 105 Richest 40% (12.6) 38.9 34.1 36.4 24.6 58 Total 10.2 41.5 32.8 36.8 22.5 163 * MICS indicator 18 ** MICS indicator 19 58 Table NU.5: Children's vitamin A supplementation Percent distribution of children aged 6-59 months by whether they have received a high dose vitamin A supplement in the last 6 months, Belize, 2006 Percent of children who received vitamin A: Within last 6 months* Prior to last 6 months Not sure when Not sure if received vitamin A Never received vitamin A Total Number of children aged 6-59 months Sex Male 24.6 13.2 21.2 4.2 36.8 100.0 346 Female 23.1 10.1 20.8 6.3 39.7 100.0 361 District Corozal 14.9 9.9 15.9 6.4 53.0 100.0 91 Orange Walk 22.3 22.1 17.9 4.4 33.3 100.0 104 Belize 37.4 16.8 24.5 6.9 14.5 100.0 172 Cayo 22.0 8.3 17.1 3.5 49.1 100.0 176 Stann Creek 26.4 6.1 42.1 4.5 20.9 100.0 81 Toledo 8.7 2.2 10.8 6.4 71.9 100.0 83 Area Urban 29.5 11.6 22.0 5.9 30.9 100.0 327 Rural 18.9 11.6 20.1 4.8 44.6 100.0 381 Age 6-11 months 33.9 3.1 7.6 0.0 55.5 100.0 75 12-23 months 29.4 11.4 16.2 5.8 37.1 100.0 166 24-35 months 23.9 11.9 19.2 5.0 40.1 100.0 159 36-47 months 19.0 17.2 22.0 8.9 32.9 100.0 142 48-59 months 17.6 10.8 32.8 4.3 34.5 100.0 165 Mother’s education None/Primary 20.3 10.7 21.0 3.1 44.9 100.0 460 Secondary + 30.9 13.3 21.2 9.5 25.1 100.0 242 Wealth index Poorest 60% 22.1 12.1 20.2 5.0 40.6 100.0 473 Richest 40% 27.3 10.6 22.6 5.9 33.5 100.0 234 Language English/Creole 31.5 13.8 22.4 6.7 25.6 100.0 229 Spanish 24.8 11.6 17.6 4.7 41.3 100.0 308 Garifuna (22.0) (7.0) (50.6) (3.3) (17.1) 100.0 31 Maya 8.9 6.3 24.1 5.7 55.0 100.0 96 Other (10.4) (14.9) (10.5) (2.5) (61.7) 100.0 44 Total 23.8 11.6 21.0 5.3 38.3 100.0 707 * MICS indicator 42 ( ) Figures that are based on 25-49 unweighted cases 59 Table NU.6: Post-partum mothers' vitamin A supplementation Percentage of women aged 15-49 years with a live birth in the 2 years preceding the survey by whether they received a high dose vitamin A supplement before the infant was 8 weeks old, Belize, 2006 Received vitamin A supplement* Not sure if received vitamin A Number of women aged 15-49 years District Corozal (13.6) (3.0) 45 Orange Walk (35.6) (2.4) 49 Belize 72.1 2.7 83 Cayo 57.5 2.2 67 Stann Creek (40.4) (3.1) 30 Toledo (22.8) (2.3) 41 Area Urban 54.5 4.3 146 Rural 37.7 1.1 169 Education None/Primary 38.4 2.3 195 Secondary + 57.1 2.9 120 Wealth index Poorest 60% 43.7 2.1 212 Richest 40% 49.2 3.4 103 Language English/Creole 59.9 2.1 105 Spanish 38.4 2.9 137 Garifuna (*) (*) 7 Maya (37.0) (2.4) 40 Other (*) (*) 25 Total 45.3 2.6 314 *MICS indicator 43 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 60 Table NU.7: Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Belize, 2006 Percent of live births: Below 2500 grams* Weighed at birth** Number of live births District Corozal (5.8) (94.9) 45 Orange Walk (9.6) (95.2) 49 Belize 10.2 94.1 83 Cayo 6.6 97.3 67 Stann Creek (6.1) (96.9) 30 Toledo (8.0) (72.8) 41 Area Urban 8.1 94.2 146 Rural 8.0 91.1 169 Mother’s education None/Primary 7.8 90.4 195 Secondary + 8.4 96.0 120 Wealth index Poorest 60% 7.9 89.8 212 Richest 40% 8.3 98.1 103 Language English/Creole 8.0 94.2 105 Spanish 8.2 95.5 137 Garifuna (*) (*) 7 Maya (8.4) (76.4) 40 Other (6.2) (96.2) 25 Total 8.1 92.5 314 * MICS indicator 9 ** MICS indicator 10 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 61 Table CH.1: Vaccinations in first year of life Percentage of children age 18-29 months immunized against childhood diseases at any time before the survey and before the first birthday (18 months for measles), Belize, 2006 Percentage of children who received: BCG* DPT/H epB/Hi b 1 DPT/H epB/Hi B 2 DPT/He pB/HiB 3 ** Polio1 Polio2 Polio3 *** Measles **** All ***** None Number of children aged 18- 29 months Vaccinated at any time before the survey According to: Vaccination card 64.3 65.5 68.9 66.8 64.9 68.5 66.6 60.5 61.4 0.0 169 Mother’s report 25.9 25.1 18.5 9.4 24.1 18.3 5.7 24.4 4.5 9.2 169 Either 90.2 90.6 87.4 76.1 89.0 86.8 72.3 85.0 65.8 9.2 169 Vaccinated by 12 months of age 90.2 89.0 84.5 74.6 88.3 84.6 68.6 81.9 56.3 9.2 169 * MICS indicator 25 ** MICS indicator 27 *** MICS indicator 26 **** MICS indicator 28; MDG indicator 15 ***** MICS indicator 31 62 Table CH.2: Vaccinations by background characteristics Percentage of children aged 18-29 months currently vaccinated against childhood diseases, Belize, 2006 Percentage of children who received: BCG DPT/HepB/ Hib 1 DPT/HepB/ HiB 2 DPT/HepB/ HiB 3 Polio1 Polio2 Polio 3 Measles All None Percent with health card Number of children aged 18-29 months Sex Male 94.3 94.2 92.8 81.0 93.1 91.6 79.3 89.3 72.5 5.7 73.2 91 Female 85.4 86.4 80.9 70.2 84.0 80.9 63.7 79.8 57.7 13.4 53.9 77 Area Urban 95.3 95.3 92.4 75.5 93.5 90.9 73.0 90.9 68.3 4.7 65.3 87 Rural 84.8 85.6 82.0 76.8 84.2 82.2 71.5 78.7 63.1 14.1 63.3 82 Mother’s education None/Primary 86.5 87.4 85.6 77.8 84.6 84.1 73.8 80.7 66.3 12.6 67.0 102 Secondary + 95.8 95.6 90.0 73.2 95.7 90.8 69.7 91.3 64.6 4.2 60.5 65 Wealth index Poorest 60% 88.5 89.0 87.6 77.9 86.7 84.8 73.0 83.3 65.6 10.7 66.8 118 Richest 40% 94.2 94.2 87.1 72.1 94.2 91.4 70.8 88.8 66.4 5.8 58.5 51 Total 90.2 90.6 87.4 76.1 89.0 86.8 72.3 85.0 65.8 9.2 64.3 169 63 Table CH.3: Neonatal tetanus protection Percentage of mothers with a birth in the last 24 months protected against neonatal tetanus, Belize, 2006 Percent of mothers with a birth in the last 24 months who: Received at least 2 doses during last pregnancy Received at least 2 doses, the last within prior 3 years Received at least 3 doses, last within prior 5 years Received at least 4 doses, last within prior 10 years Received at least 5 doses during lifetime Protected against tetanus* Number of mothers District Corozal (52.5) (5.1) (0.0) (0.0) (0.0) (57.6) 45 Orange Walk (50.1) (16.6) (0.0) (0.0) (0.0) (66.8) 49 Belize 60.3 14.8 0.0 0.0 0.0 75.1 83 Cayo 41.8 11.4 0.0 1.6 0.0 54.9 67 Stann Creek (39.0) (9.2) (0.0) (0.0) (0.0) (48.1) 30 Toledo (22.7) (6.8) (0.0) (0.0) (0.0) (29.5) 41 Area Urban 51.0 12.0 0.0 0.7 0.0 63.7 146 Rural 43.1 10.9 0.0 0.0 0.0 53.9 169 Education None/Primary 42.1 11.1 0.0 0.6 0.0 53.7 195 Secondary + 54.2 12.0 0.0 0.0 0.0 66.2 120 Wealth index Poorest 60% 43.0 11.9 0.0 0.0 0.0 54.8 212 Richest 40% 54.4 10.5 0.0 1.1 0.0 65.9 103 Language English/Creole 50.5 12.1 0.0 1.0 0.0 63.6 105 Spanish 52.6 9.4 0.0 0.0 0.0 62.0 137 Garifuna (*) (*) (*) (*) (*) (*) 7 Maya (22.8) (9.2) (0.0) (0.0) (0.0) (32.0) 40 Other (33.1) (22.9) (0.0) (0.0) (0.0) (56.0) 25 Total 46.6 11.4 0.0 0.3 0.0 58.3 314 * MICS indicator 32 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 64 Table CH.4: Oral rehydration treatment Percentage of children aged 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Belize, 2006 Children with diarrhoea who received: Had diarrhoea in last two weeks Number of children aged 0- 59 months Fluid from ORS packet Recommended homemade fluid Pre- packaged ORS fluid No treatment ORT Use Rate * Number of children aged 0-59 months with diarrhoea Sex Male 12.4 395 (23.1) (34.4) (34.1) (36.5) (63.5) 49 Female 11.9 401 (31.2) (31.6) (17.2) (42.3) (57.7) 48 Area Urban 12.5 360 (24.0) (28.1) (16.5) (42.7) (57.3) 45 Rural 11.9 436 29.7 37.2 33.8 36.5 63.5 52 Mother’s education None/Primary 13.0 517 22.7 38.0 24.8 44.9 55.1 67 Secondary + 10.2 273 (36.1) (19.8) (26.4) (28.4) (71.6) 28 Total 12.1 795 27.1 33.0 25.8 39.4 60.6 97 * MICS indicator 33 ( ) Figures that are based on 25-49 unweighted cases 65 Table CH.5: Home management of diarrhoea Percentage of children aged 0-59 months with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode, Belize, 2006 Children with diarrhoea who: Had diarrhoea in last two weeks Number of children aged 0- 59 months Drank more Drank the same or less Ate somewhat less, same or more Ate much less or none Home manage- ment of diarrhoea* Received ORT or increased fluids AND continued feeding** Number of children aged 0-59 months with diarrhoea Sex Male 12.4 395 (23.9) (73.9) (43.5) (52.8) (12.1) (26.4) 49 Female 11.9 401 (20.8) (73.1) (39.8) (58.3) (6.4) (25.4) 48 Area Urban 12.5 360 (23.2) (76.8) (53.9) (46.1) (9.9) (32.8) 45 Rural 11.9 436 21.7 70.6 31.0 63.7 8.7 19.9 52 Mother’s education None/Primary 13.0 517 20.6 73.4 39.9 56.0 10.0 23.0 67 Secondary + 10.2 273 (28.1) (71.9) (48.5) (51.5) (8.2) (34.6) 28 Total 12.1 795 22.4 73.5 41.7 55.5 9.3 25.9 97 * MICS indicator 34 ** MICS indicator 35 ( ) Figures that are based on 25-49 unweighted cases 66 Table CH.6: Knowledge of the two danger signs of pneumonia Percentage of mothers/caretakers of children aged 0-59 months by knowledge of types of symptoms for taking a child immediately to a health facility, and percentage of mothers/caretakers who recognize fast and difficult breathing as signs for seeking care immediately, Belize, 2006 Percentage of mothers/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child: Is not able to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has difficult breathing Has blood in stool Is drinking poorly Has other symptoms Mothers/caretakers who recognize the two danger signs of pneumonia* Number of mothers/caretakers of children aged 0- 59 months District Corozal 22.8 44.7 83.1 54.7 60.6 64.3 28.7 24.7 43.1 103 Orange Walk 20.1 21.7 65.8 20.1 43.4 25.9 10.7 30.9 12.3 121 Belize 7.2 29.6 79.2 33.4 55.5 28.6 12.7 37.0 20.6 193 Cayo 3.1 19.5 78.6 9.6 16.5 19.1 3.5 49.7 2.9 192 Stann Creek 0.9 27.9 75.5 10.0 39.8 7.7 0.0 34.6 5.8 88 Toledo 0.0 19.9 80.5 18.0 14.3 24.6 0.0 51.4 8.2 99 Area Urban 9.2 28.3 79.8 26.9 41.5 31.5 9.8 35.6 16.9 360 Rural 8.0 25.0 75.2 21.4 35.2 24.6 8.8 42.0 13.0 436 Education of Household Head None/Primary 9.1 23.6 75.0 20.8 34.9 25.2 8.4 40.4 12.0 517 Secondary + 7.7 31.4 82.0 30.2 44.2 33.1 11.1 37.2 20.5 273 Wealth index Poorest 60% 9.0 25.6 74.1 23.3 35.5 25.7 8.8 40.9 14.5 533 Richest 40% 7.7 28.4 83.6 25.1 43.1 31.7 10.2 35.5 15.4 263 Language English/Creole 8.3 29.2 78.5 28.7 44.0 28.5 9.7 39.4 18.5 256 Spanish 12.2 27.7 81.1 24.9 40.7 33.4 13.5 35.7 17.3 346 Garifuna (0.0) (11.2) (64.4) (13.9) (43.3) (20.3) (3.1) (47.9) (5.8) 34 Maya 2.4 22.7 83.4 16.2 17.6 22.8 0.0 45.4 6.3 107 Other 4.1 23.5 42.4 14.0 28.3 2.1 2.0 42.3 2.0 53 Total 8.6 26.5 77.2 23.8 38.0 27.7 9.3 39.1 14.7 795 ( ) Figures that are based on 25-49 unweighted cases 67 Table CH.7: Solid fuel use Percent distribution of households according to type of cooking fuel, and percentage of households using solid fuels for cooking, Belize, 2006 Percentage of households using: Electricity Butane Biogas Kerosene Charcoal Wood Other source Total Solid fuels for cooking* Number of households District Corozal 1.5 68.4 0.0 0.4 0.0 27.8 1.8 100.0 27.8 238 Orange Walk 0.4 82.1 0.0 1.8 0.4 14.3 0.9 100.0 14.8 241 Belize 1.6 91.6 0.0 1.1 0.0 1.6 4.0 100.0 1.6 642 Cayo 0.7 88.0 0.7 0.0 0.0 9.3 1.2 100.0 9.3 353 Stann Creek 0.5 81.9 0.0 1.3 0.0 10.6 5.6 100.0 10.6 201 Toledo 0.6 44.1 0.5 1.6 0.0 53.3 0.0 100.0 53.3 158 Area Urban 1.3 92.3 0.2 0.9 0.0 2.1 3.2 100.0 2.1 984 Rural 0.8 69.0 0.1 1.1 0.1 27.0 1.9 100.0 27.1 848 Education of household head None/Primary 0.5 75.5 0.1 1.1 0.1 19.5 3.1 100.0 19.6 1,179 Secondary + 2.2 93.1 0.2 0.7 0.0 1.9 1.9 100.0 1.9 607 Wealth index Poorest 60% 0.7 68.2 0.1 1.7 0.1 24.7 4.4 100.0 24.8 1,009 Richest 40% 1.5 97.8 0.3 0.0 0.0 0.0 0.4 100.0 0.0 823 Language English/Creole 1.3 91.5 0.1 0.6 0.0 3.2 3.2 100.0 3.2 775 Spanish 0.8 79.1 0.2 1.1 0.1 16.6 2.0 100.0 16.7 727 Garifuna 0.0 88.8 0.0 2.9 0.0 5.5 2.8 100.0 5.5 99 Maya 0.0 36.3 0.7 0.6 0.0 60.0 2.4 100.0 60.0 149 Other 4.2 81.6 0.0 1.1 0.0 10.4 2.7 100.0 10.4 81 Total 1.1 81.5 0.2 1.0 0.1 13.6 2.6 100.0 13.6 1,830 * MICS indicator 24; MDG Indicator 29 68 Table CH.8: Solid fuel use by type of stove or fire Percentage of households using solid fuels for cooking by type of stove or fire, Belize, 2006 Percentage of households using solid fuels for cooking: Closed stove with chimney Open stove or fire with chimney or hood Open stove or fire with no chimney or hood Total Number of households using solid fuels for cooking Area Urban (*) (*) (*) 100.0 20 Rural 2.7 4.1 93.2 100.0 230 Education of household head None/Primary 3.7 3.6 92.7 100.0 231 Secondary + (*) (*) (*) 100.0 11 Wealth index Poorest 60% 3.8 4.5 91.7 100.0 250 Richest 40% (*) (*) (*) 100.0 0 Total 3.8 4.5 91.7 100.0 250 69 Table EN.1: Use of improved water sources Percent distribution of household members according to main source of drinking water and percentage of household members using improved drinking water sources, Belize, 2006 Main source of drinking water Improved sources Unimproved sources Piped into dwelling Piped into yard/ plot Public tap/ stand- pipe Hand pump Pro- tected well Pro- tected spring Rain- water Bottled water1 Unpro- tected well Unpro- tected spring Cart with tank/ drum Surface water Bottled water1 Other Total Improved source of drinking water* Number of house hold members District Corozal 10.0 14.3 0.0 3.5 3.7 0.0 25.5 38.9 2.6 0.6 0.0 0.0 0.9 0.0 100.0 96.0 1,124 Orange Walk 9.7 6.6 0.0 0.0 4.1 0.0 37.4 34.2 6.0 0.0 0.0 0.1 0.9 1.1 100.0 91.9 1,132 Belize 22.6 3.0 0.5 0.3 1.1 0.0 19.0 53.0 0.1 0.0 0.0 0.1 0.1 0.2 100.0 99.5 2,173 Cayo 37.7 23.8 0.2 0.1 1.0 0.1 14.6 19.8 0.0 0.5 0.3 0.3 0.0 1.5 100.0 97.4 1,628 Stann Creek 41.9 20.0 1.6 3.6 9.5 0.0 6.7 12.0 0.0 0.0 0.0 4.0 0.0 0.7 100.0 95.3 803 Toledo 12.4 35.8 0.9 18.0 4.5 0.2 17.6 5.5 0.4 0.0 1.2 3.5 0.0 0.0 100.0 94.9 758 Area Urban 28.5 9.1 0.4 0.0 0.4 0.0 11.0 49.8 0.0 0.2 0.0 0.0 0.1 0.5 100.0 99.2 3,693 Rural 17.9 20.0 0.5 5.4 5.7 0.1 29.1 15.2 2.6 0.2 0.3 1.7 0.4 0.7 100.0 94.0 3,926 Education of household head None/Primary 23.5 18.4 0.6 3.4 4.1 0.1 23.1 22.4 1.9 0.2 0.3 1.3 0.4 0.5 100.0 95.5 5,235 Secondary + 22.8 5.0 0.2 1.0 0.9 0.0 12.6 56.8 0.1 0.3 0.0 0.0 0.0 0.3 100.0 99.3 2,174 Wealth index Poorest 60% 22.4 23.9 0.7 4.7 4.9 0.1 23.4 14.4 2.2 0.3 0.3 1.5 0.3 1.0 100.0 94.4 4,571 Richest 40% 24.0 0.9 0.0 0.0 0.5 0.0 15.8 58.4 0.0 0.0 0.0 0.0 0.3 0.1 100.0 99.6 3,047 Language English/Creole 28.7 4.5 0.4 0.7 2.0 0.0 19.7 42.5 0.1 0.2 0.1 0.3 0.2 0.8 100.0 98.4 2,812 Spanish 20.6 17.4 0.4 1.2 4.0 0.0 19.4 32.4 2.9 0.0 0.2 0.1 0.5 0.8 100.0 95.5 3,245 Garifuna 43.5 22.4 0.5 0.3 0.7 0.0 6.2 26.2 0.0 0.0 0.0 0.0 0.0 0.3 100.0 99.7 373 Maya 12.2 41.9 1.1 16.4 4.1 0.2 14.9 1.0 0.4 0.0 0.7 7.0 0.0 0.0 100.0 91.9 804 Other 5.8 1.9 0.0 5.3 4.3 0.6 58.8 21.1 0.0 2.2 0.0 0.0 0.0 0.0 100.0 97.8 377 Total 23.1 14.7 0.4 2.8 3.1 0.1 20.3 32.0 1.3 0.2 0.2 0.9 0.3 0.6 100.0 96.5 7,610 * MICS indicator 11; MDG indicator 30 1 For households using bottled water as the main source of drinking water, the source used for other purposes such as cooking and hand washing is used to determine whether to classify the source as improved. 70 Table EN.2: Household water treatment Percent distribution of household population according to drinking water treatment method used in the household, and percentage of household population that applied an appropriate water treatment method, Belize, 2006 Water treatment method used in the household All drinking water sources Improved drinking water sources Unimproved drinking water sources None Boil Add bleach/ chlorine Strain through a cloth Use water filter Solar dis- infection Let it stand and settle Other Don't know Appropriate water treatment method* Number of household members Appropriate water treatment method Number of household members Appropriate water treatment method Number of household members District Corozal 74.8 7.2 15.4 0.0 1.4 0.0 0.0 1.1 0.4 23.7 1,124 23.4 1,079 (30.9) 45 Orange Walk 83.5 5.1 7.4 0.3 4.0 0.0 0.0 1.8 0.0 15.1 1,132 15.5 1,040 10.6 92 Belize 83.9 8.8 7.0 0.2 0.5 0.3 0.0 0.5 0.0 15.5 2,173 15.4 2,162 (*) 11 Cayo 75.7 15.2 5.9 0.4 2.4 0.0 0.0 0.8 0.0 23.1 1,628 22.7 1,585 (40.6) 43 Stann Creek 63.8 19.8 10.3 0.0 1.4 0.0 5.4 1.0 0.0 31.0 803 31.4 766 (22.3) 38 Toledo 84.3 8.3 9.5 0.1 0.0 0.0 0.1 0.2 0.0 15.7 758 15.6 720 (16.3) 38 Area Urban 82.2 11.3 6.0 0.2 0.5 0.2 0.1 1.0 0.0 16.7 3,693 16.7 3,663 (23.3) 30 Rural 75.4 9.7 11.2 0.2 2.7 0.0 1.0 0.7 0.1 22.9 3,926 23.0 3,689 22.2 237 Education of household head None/Primary 77.7 10.3 9.4 0.3 1.6 0.0 0.8 1.0 0.1 20.5 5,235 20.4 4,997 21.3 238 Secondary + 81.4 10.7 6.6 0.0 1.7 0.3 0.0 0.6 0.0 18.0 2,174 17.7 2,159 (*) 16 Wealth index Poorest 60% 76.0 11.7 10.5 0.1 1.5 0.0 0.8 0.6 0.1 22.7 4,571 22.7 4,317 23.1 254 Richest 40% 82.7 8.7 5.9 0.4 1.8 0.2 0.2 1.2 0.0 15.7 3,047 15.8 3,035 (*) 13 Language English/Creole 79.6 9.5 9.4 0.2 1.1 0.3 0.0 1.2 0.0 19.0 2,812 18.9 2,766 (26.0) 46 Spanish 81.0 9.2 9.1 0.1 0.9 0.0 0.1 0.6 0.1 18.3 3,245 17.9 3,099 25.6 146 Garifuna 75.7 16.6 6.6 1.3 0.0 0.0 1.9 0.4 0.0 23.2 373 23.3 372 (*) 1 Maya 71.4 18.0 8.6 0.0 0.0 0.0 2.9 0.0 0.0 25.6 804 26.5 739 15.5 65 Other 70.1 7.4 1.7 0.0 16.5 0.0 2.7 2.8 0.0 25.6 377 26.1 369 (*) 8 Total 78.7 10.5 8.7 0.2 1.6 0.1 0.6 0.9 0.1 19.9 7,610 19.8 7,344 22.3 267 * MICS indicator 13 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 71 Table EN.3: Time to source of water Percent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, Belize, 2006 Time to source of drinking water 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 Total Mean time to source of drinking water* Number of households District Corozal 58.5 30.9 6.3 2.3 0.0 2.1 100.0 7.4 238 Orange Walk 57.3 34.4 0.0 0.0 0.7 7.6 100.0 4.7 241 Belize 84.8 8.8 2.3 1.0 0.7 2.4 100.0 16.5 642 Cayo 90.8 5.0 2.9 0.3 0.3 0.8 100.0 11.0 353 Stann Creek 82.3 9.9 2.8 1.1 1.1 2.8 100.0 18.4 201 Toledo 69.7 19.5 6.0 2.4 0.6 1.7 100.0 10.2 158 Area Urban 84.8 9.9 1.6 1.1 0.6 2.0 100.0 13.2 984 Rural 72.4 18.9 4.1 1.0 0.5 3.0 100.0 9.2 848 Education of household head None/Primary 75.7 16.1 3.4 1.1 0.7 2.9 100.0 11.0 1,179 Secondary + 83.5 11.2 2.6 0.8 0.0 2.0 100.0 7.9 607 Wealth index Poorest 60% 73.4 18.1 3.6 1.5 0.8 2.6 100.0 11.0 1,009 Richest 40% 86.9 8.6 2.0 0.0 0.0 2.6 100.0 5.5 823 Language English/Creole 81.5 11.5 2.7 1.2 0.4 2.7 100.0 10.8 775 Spanish 74.6 18.8 2.8 0.6 0.2 3.0 100.0 7.1 727 Garifuna 87.3 3.9 3.7 1.4 1.4 2.3 100.0 40.0 99 Maya 68.5 20.5 6.7 1.8 1.8 0.6 100.0 13.0 149 Other 77.1 19.1 0.0 0.0 0.0 3.7 100.0 3.0 81 Total 77.3 15.4 3.2 1.0 0.6 2.6 100.0 10.2 1,830 * The mean time to source of drinking water is calculated based on those households that do not have water on the premises. 72 Table EN.4: Person collecting water Percent distribution of households according to the person collecting drinking water used in the household, Belize, 2006 Person collecting drinking water Adult woman Adult man Female child under age 15 Male child under age 15 Don't know Total Number of households District Corozal 57.5 32.4 1.7 6.7 1.7 100.0 60 Orange Walk 32.4 50.0 1.6 1.6 14.5 100.0 66 Belize (27.8) (54.6) (0.0) (4.3) (13.3) 100.0 45 Cayo (52.9) (47.1) (0.0) (0.0) (0.0) 100.0 26 Stann Creek (27.8) (56.5) (6.3) (0.0) (9.4) 100.0 30 Toledo (79.8) (14.1) (6.0) (0.0) (0.0) 100.0 44 Area Urban 30.9 54.2 1.5 2.9 10.5 100.0 71 Rural 51.8 37.0 2.8 2.5 6.0 100.0 200 Education of Household head None/Primary 48.3 38.9 2.1 3.2 7.5 100.0 216 Secondary + (35.3) (52.9) (4.6) (0.0) (7.2) 100.0 43 Wealth index Poorest 60% 47.8 41.7 2.5 2.6 5.4 100.0 226 Richest 40% (38.9) (40.5) (2.1) (2.3) (16.2) 100.0 44 Language English/Creole 33.3 50.6 2.4 2.4 11.3 100.0 81 Spanish 47.7 40.5 0.8 4.2 6.8 100.0 120 Garifuna (*) (*) (*) (*) (*) 100.0 9 Maya 73.5 18.6 7.8 0.0 0.0 100.0 46 Other (*) (*) (*) (*) (*) 100.0 13 Total 46.2 41.6 2.4 2.6 7.2 100.0 270 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 73 Table EN.5: Use of sanitary means of excreta disposal Percent distribution of household members according to type of toilet facility used by the household, and the percentage of household members using sanitary means of excreta disposal, Belize, 2006 Improved sanitation facility Unimproved sanitation facility Flush/pour flush to: Piped sewer system Septic tank Pit latrine Ventilated improved pit latrine Pit latrine with slab Compos- ting toilet Pit latrine without slab/ open pit Bucket Hanging toilet/ hanging latrine Other No facilities/ bush/field Total Percentage of population using sanitary means of excreta disposal* Number of house- hold members District Corozal 0.0 37.5 0.0 14.0 41.9 0.0 6.2 0.0 0.0 0.0 0.4 100.0 93.4 1,124 Orange Walk 0.3 43.3 2.2 3.9 49.0 0.7 0.7 0.0 0.0 0.0 0.0 100.0 99.3 1,132 Belize 36.7 54.9 1.7 0.5 3.7 0.0 0.5 1.8 0.0 0.0 0.2 100.0 97.5 2,173 Cayo 5.8 41.3 5.0 0.3 37.4 0.0 7.6 0.0 0.8 0.4 1.5 100.0 89.8 1,628 Stann Creek 0.6 55.4 0.2 1.9 36.8 0.0 4.0 0.4 0.0 0.6 0.1 100.0 94.9 803 Toledo 0.2 21.0 0.8 31.2 28.4 0.0 1.4 0.5 0.0 0.0 16.5 100.0 81.7 758 Area Urban 24.2 56.7 2.1 1.4 11.4 0.2 1.9 1.2 0.2 0.1 0.5 100.0 96.1 3,693 Rural 0.2 32.8 1.9 10.6 46.0 0.0 4.7 0.1 0.1 0.2 3.6 100.0 91.4 3,926 Education of household head None/Primary 7.0 37.4 2.5 7.4 37.3 0.1 4.7 0.6 0.2 0.2 2.6 100.0 91.6 5,235 Secondary + 24.5 62.1 0.3 3.1 9.1 0.0 0.2 0.7 0.0 0.0 0.0 100.0 99.1 2,174 Wealth index Poorest 60% 6.4 23.0 3.0 9.8 47.2 0.2 5.6 0.9 0.2 0.2 3.5 100.0 89.6 4,571 Richest 40% 20.0 76.5 0.4 0.6 2.3 0.0 0.0 0.1 0.1 0.0 0.0 100.0 99.8 3,047 Language English/Creole 25.8 55.6 2.5 1.4 11.6 0.3 1.2 1.3 0.2 0.0 0.2 100.0 97.2 2,812 Spanish 3.1 40.1 2.2 6.5 41.7 0.0 5.5 0.1 0.2 0.2 0.4 100.0 93.6 3,245 Garifuna 6.8 64.6 0.0 4.0 19.5 0.0 1.4 2.2 0.0 1.3 0.3 100.0 94.9 373 Maya 2.0 8.6 1.1 25.3 42.6 0.0 3.8 0.0 0.0 0.0 16.7 100.0 79.5 804 Other 9.0 53.2 0.0 0.7 34.0 0.0 1.9 0.0 0.0 0.0 1.2 100.0 96.9 377 Total 11.8 44.4 2.0 6.2 29.2 0.1 3.3 0.6 0.2 0.1 2.1 100.0 93.7 7,610 * MICS indicator 12; MDG indicator 31 74 Table EN.6: Disposal of child's faeces Percent distribution of children aged 0-2 years according to place of disposal of child's faeces, and the percentage of children aged 0-2 years whose stools are disposed of safely, Belize, 2006 Place of disposal of child's faeces Child used toilet Put/rinsed into toilet or latrine Put/rinsed into drain or ditch Thrown into garbage Buried Left in the open Other Don't know Total Proportion of children whose stools are disposed of safely* Number of children aged 0-2 years District Corozal 6.3 19.5 0.0 74.2 0.0 0.0 0.0 0.0 100.0 25.8 61 Orange Walk 13.8 33.2 3.0 47.3 0.0 0.0 1.4 1.4 100.0 47.0 80 Belize 12.3 1.6 1.2 83.5 0.0 0.0 0.0 1.5 100.0 13.8 127 Cayo 13.4 7.3 5.0 67.0 0.0 0.0 4.0 3.4 100.0 20.6 109 Stann Creek 9.4 10.8 0.0 63.2 5.4 0.0 7.5 3.8 100.0 20.1 49 Toledo 8.3 12.6 4.1 55.4 0.0 14.0 1.4 4.2 100.0 20.9 64 Area Urban 12.0 5.9 1.6 79.0 0.3 0.0 0.0 1.2 100.0 17.9 226 Rural 10.6 18.3 3.2 56.8 0.7 3.4 3.8 3.3 100.0 28.8 264 Mother’s education None/Primary 12.0 15.4 3.0 61.1 0.6 2.9 2.9 2.3 100.0 27.3 315 Secondary + 9.6 7.3 1.5 78.3 0.5 0.0 0.5 2.3 100.0 16.9 171 Wealth index Poorest 60% 10.6 17.4 2.5 60.3 0.8 2.7 3.0 2.7 100.0 28.0 335 Richest 40% 12.5 2.1 2.2 81.7 0.0 0.0 0.0 1.4 100.0 14.7 155 Language English/Creole 11.1 3.2 1.8 81.5 0.5 0.0 0.0 1.8 100.0 14.3 153 Spanish 12.7 16.3 2.4 65.5 0.0 0.4 1.8 0.8 100.0 29.0 224 Garifuna (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 18 Maya 5.9 16.1 4.3 50.3 3.0 11.8 3.0 5.7 100.0 22.0 61 Other (12.0) (29.3) (3.3) (36.4) (0.0) (2.7) (9.8) (6.5) 100.0 (41.3) 33 Total 11.2 12.6 2.4 67.0 0.5 1.8 2.0 2.3 100.0 23.8 489 * MICS indicator 14 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 75 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, Belize, 2006 Percentage of household population: Using improved sources of drinking water* Using sanitary means of excreta disposal** Using improved sources of drinking water and using sanitary means of excreta disposal Number of household members District Corozal 96.0 93.4 89.4 1,124 Orange Walk 91.9 99.3 91.6 1,132 Belize 99.5 97.5 97.0 2,173 Cayo 97.4 89.8 87.2 1,628 Stann Creek 95.3 94.9 90.4 803 Toledo 94.9 81.7 79.9 758 Area Urban 99.2 96.1 95.3 3,693 Rural 94.0 91.4 86.1 3,926 Education of household head None/Primary 95.5 91.6 87.7 5,235 Secondary + 99.3 99.1 98.3 2,174 Wealth index Poorest 60% 94.4 89.6 84.7 4,571 Richest 40% 99.6 99.8 99.4 3,047 Language English/Creole 98.4 97.2 95.5 2,812 Spanish 95.5 93.6 89.3 3,245 Garifuna 99.7 94.9 94.6 373 Maya 91.9 79.5 74.6 804 Other 97.8 96.9 94.7 377 Total 96.5 93.7 90.6 7,610 * MICS indicator 11; MDG indicator 30 ** MICS indicator 12; MDG indicator 31 76 Table RH.1: Use of contraception Percentage of women aged 15-49 who are using (or whose partner is using) a contraceptive method, Belize, 2006 Percent of women (currently married or in union) who are using: Not using any method Female sterili- zation Male sterili- zation Pill IUD Injections Implants Condom Diaph- ragm/ foam/ jelly LAM Periodic abstin- ence With- drawal Other Any modern method Any tradi- tional method Any method* No. of women District Corozal 69.1 10.5 0.0 10.4 2.4 2.9 0.0 0.4 0.0 0.0 3.9 0.0 0.4 26.6 4.3 30.9 252 Orange Walk 69.2 7.2 0.5 11.6 2.4 3.4 0.0 2.4 0.0 0.0 3.4 0.0 0.0 27.4 3.4 30.8 245 Belize 52.5 13.8 0.0 14.7 2.8 5.0 0.2 8.9 0.0 0.0 1.4 0.8 0.0 45.3 2.1 47.5 507 Cayo 75.2 4.5 0.2 8.0 0.8 4.4 0.0 2.5 0.5 0.8 0.7 0.2 2.2 20.9 3.9 24.8 355 Stann Creek 65.9 8.6 0.0 7.0 2.6 8.5 0.5 3.6 0.0 1.0 0.0 0.0 2.3 30.8 3.3 34.1 178 Toledo 76.6 2.0 0.0 7.6 0.7 8.9 0.0 1.4 0.0 0.0 0.7 0.0 2.1 20.6 2.8 23.4 138 Area Urban 61.2 8.7 0.1 12.6 2.3 5.2 0.0 6.6 0.1 0.1 1.5 0.4 1.3 35.5 3.4 38.8 872 Rural 70.6 9.0 0.1 8.8 1.8 4.8 0.2 1.5 0.1 0.5 1.9 0.1 0.5 26.4 3.0 29.4 803 Age 15-19 88.5 0.0 0.0 3.6 0.3 1.6 0.0 5.5 0.0 0.3 0.0 0.0 0.3 11.0 0.6 11.5 352 20-24 67.6 1.2 0.0 13.4 1.4 8.1 0.0 5.3 0.4 0.0 1.0 0.3 1.2 29.8 2.6 32.4 280 25-29 51.4 5.9 0.0 21.2 2.8 8.7 0.0 5.6 0.0 0.4 3.2 0.4 0.4 44.2 4.3 48.6 244 30-34 55.4 10.9 0.0 15.8 2.3 7.2 0.4 3.8 0.0 0.4 2.3 0.4 1.2 40.4 4.3 44.6 235 35-39 54.3 18.1 0.5 8.4 4.5 5.7 0.0 3.8 0.0 0.3 3.3 0.8 0.4 41.0 4.7 45.7 225 40-44 59.1 21.2 0.0 8.0 3.2 1.4 0.5 1.6 0.4 0.5 1.6 0.0 2.5 36.2 4.7 40.9 191 45-49 73.5 16.1 0.5 4.6 0.6 1.4 0.0 0.7 0.0 0.0 1.3 0.0 1.2 23.9 2.6 26.5 148 Number of living children 0 86.5 0.2 0.0 4.8 0.2 1.3 0.0 5.5 0.0 0.0 0.4 0.2 0.9 12.0 1.5 13.5 525 1 55.8 2.8 0.0 19.5 3.3 9.8 0.0 5.1 0.0 0.5 2.9 0.4 0.0 40.5 3.8 44.2 222 2 54.4 9.6 0.3 16.9 3.1 6.9 0.0 3.9 0.7 0.4 2.3 0.4 1.1 41.4 4.2 45.6 245 3 52.3 14.5 0.0 16.0 3.5 6.2 0.4 2.7 0.0 0.0 3.1 0.0 1.2 43.3 4.4 47.7 221 4+ 59.1 18.4 0.3 7.5 2.4 5.4 0.2 2.9 0.0 0.6 1.6 0.4 1.2 37.2 3.7 40.9 462 Education None/Primary 67.8 9.0 0.1 9.5 2.1 5.5 0.2 2.6 0.1 0.3 1.7 0.2 1.0 29.0 3.2 32.2 909 Secondary + 63.2 8.7 0.1 12.2 2.0 4.4 0.0 6.0 0.1 0.2 1.7 0.4 0.8 33.6 3.2 36.8 766 Wealth index Poorest 60% 69.3 8.5 0.0 8.9 1.8 5.3 0.1 2.8 0.1 0.5 1.8 0.3 0.6 27.5 3.1 30.7 947 Richest 40% 60.9 9.3 0.3 13.1 2.4 4.7 0.1 5.9 0.1 0.0 1.6 0.3 1.4 35.8 3.2 39.1 728 Language English/Creole 55.8 12.4 0.3 14.6 2.2 4.7 0.0 6.8 0.1 0.0 1.7 0.6 0.8 41.1 3.1 44.2 641 Spanish 69.5 7.6 0.0 9.8 2.3 5.6 0.1 2.2 0.1 0.1 2.1 0.1 0.4 27.8 2.7 30.5 731 Garifuna 67.9 7.9 0.0 3.5 1.2 2.2 0.0 9.9 0.0 2.3 0.0 0.0 5.1 24.7 7.4 32.1 80 Maya 84.6 1.8 0.0 5.4 0.0 6.2 0.6 0.0 0.0 0.7 0.0 0.0 0.6 14.1 1.3 15.4 151 Other 71.6 6.0 0.0 4.8 3.3 3.0 0.0 2.9 0.0 1.0 3.3 0.0 4.2 19.9 8.5 28.4 71 Total 65.7 8.9 0.1 10.8 2.1 5.0 0.1 4.1 0.1 0.3 1.7 0.3 0.9 31.2 3.2 34.3 1,674 * MICS indicator 21; MDG indicator 19C 77 Table RH.2: Unmet need for contraception Percentage of women aged 15-49 years with an unmet need for family planning and percentage of demand for contraception satisfied, Belize, 2006 Unmet need for contraception Current use of contraception* For spacing For limiting Total** Number of women Percentage of demand for contraception satisfied*** Number of women with need for contraception District Corozal 30.9 17.4 10.1 27.5 252 52.9 147 Orange Walk 30.8 18.3 15.9 34.1 245 47.4 159 Belize 47.5 13.5 18.9 32.3 507 59.5 405 Cayo 24.8 14.8 16.4 31.1 355 44.3 198 Stann Creek 34.1 13.7 15.2 28.9 178 54.1 112 Toledo 23.4 16.5 14.4 30.9 138 43.1 75 Area Urban 38.8 15.0 15.5 30.6 872 56.0 605 Rural 29.4 15.7 16.1 31.8 803 48.1 491 Age 15-19 11.5 34.9 10.5 45.4 352 20.3 200 20-24 32.4 28.6 13.0 41.5 280 43.8 207 25-29 48.6 12.0 11.8 23.8 244 67.1 177 30-34 44.6 7.4 17.5 24.9 235 64.2 163 35-39 45.7 1.3 19.7 21.0 225 68.5 150 40-44 40.9 1.6 25.5 27.1 191 60.2 130 45-49 26.5 0.8 19.3 20.1 148 56.8 69 Education None/Primary 32.2 11.9 17.0 28.9 909 52.7 556 Secondary + 36.8 19.3 14.4 33.7 766 52.2 540 Wealth index Poorest 60% 30.7 15.5 16.1 31.7 947 49.2 590 Richest 40% 39.1 15.0 15.4 30.4 728 56.2 506 Language English/Creole 44.2 13.9 16.2 30.1 641 59.4 476 Spanish 30.5 16.5 15.2 31.7 731 49.0 455 Garifuna 32.1 16.0 18.3 34.3 80 48.4 53 Maya 15.4 15.8 17.2 32.9 151 31.9 73 Other (28.4) (14.6) (12.5) (27.1) (71) (51.2) 39 Total 34.3 15.3 15.8 31.2 1,674 52.4 1,097 * MICS indicator 21; MDG indicator 19C ** MICS indicator 98 *** MICS indicator 99 ( ) Figures that are based on 25-49 unweighted cases 78 Table RH.3: Antenatal care provider Percent distribution of women aged 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Belize, 2006 Person providing antenatal care Medical doctor Nurse/ midwife Auxiliary midwife Community health worker Other No antenatal care received Total Any skilled personnel* Number of women who gave birth in the preceding two years District Corozal (61.9) (36.0) (2.1) (0.0) (0.0) (0.0) 100.0 (100.0) 45 Orange Walk (57.1) (28.5) (7.2) (4.8) (0.0) (2.4) 100.0 (92.7) 49 Belize 62.6 33.9 0.0 1.2 1.2 1.2 100.0 96.5 83 Cayo 34.6 62.2 0.0 3.2 0.0 0.0 100.0 96.8 67 Stann Creek (29.0) (64.9) (0.0) (3.1) (0.0) (3.1) 100.0 (93.9) 30 Toledo (11.5) (68.1) (0.0) (13.6) (0.0) (6.9) 100.0 (79.5) 41 Area Urban 56.7 36.4 1.6 2.4 0.7 2.2 100.0 94.8 146 Rural 36.3 55.7 1.2 5.0 0.0 1.6 100.0 93.3 169 Age 15-19 (41.9) (51.5) (0.0) (6.6) (0.0) (0.0) 100.0 (93.4) 35 20-24 42.2 52.6 0.0 4.1 0.0 1.1 100.0 94.8 92 25-29 48.1 45.3 1.3 2.1 0.0 3.2 100.0 94.7 89 30-34 57.9 38.1 0.0 4.0 0.0 0.0 100.0 96.0 50 35-39 (43.1) (41.9) (6.8) (2.6) (2.8) (2.7) 100.0 (91.8) 35 40-44 (*) (*) (*) (*) (*) (*) 100.0 (*) 12 45-49 (*) (*) (*) (*) (*) (*) 100.0 (*) 3 Education None/Primary 35.9 55.4 2.3 5.0 0.0 1.4 100.0 93.6 195 Secondary + 61.8 32.9 0.0 1.9 0.8 2.6 100.0 94.7 120 Wealth index Poorest 60% 38.4 53.6 1.6 4.7 0.0 1.8 100.0 93.5 212 Richest 40% 61.0 32.8 1.2 2.0 1.0 2.1 100.0 95.0 103 Language English/Creole 50.2 42.8 0.0 2.3 0.9 3.8 100.0 93.0 105 Spanish 50.7 43.2 2.4 3.6 0.0 0.0 100.0 96.4 137 Garifuna (*) (*) (*) (*) (*) (*) 100.0 (*) 7 Maya (4.9) (78.6) (0.0) (11.7) (0.0) (4.7) 100.0 (83.5) 40 Other (76.6) (18.7) (4.7) (0.0) (0.0) (0.0) 100.0 (100.0) 25 Total 45.9 46.6 1.4 3.8 0.3 1.9 100.0 94.0 314 * MICS indicator 20 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 79 Table RH.4: Antenatal care Percentage of pregnant women receiving antenatal care among women aged 15-49 years who gave birth in two years preceding the survey and percentage of pregnant women receiving specific care as part of the antenatal care received, Belize, 2006 Percent of pregnant women who had: Percent of pregnant women receiving ANC one or more times during pregnancy Blood test taken* Blood pressure measured* Urine specimen taken* Weight measured* Number of women who gave birth in two years preceding survey District Corozal (100.0) (97.9) (100.0) (86.4) (100.0) 45 Orange Walk (97.6) (92.8) (95.2) (88.0) (92.8) 49 Belize 98.8 96.4 96.4 95.2 97.6 83 Cayo 100.0 98.9 98.9 95.8 100.0 67 Stann Creek (96.9) (93.9) (96.9) (79.0) (93.9) 30 Toledo (93.1) (84.1) (81.7) (68.2) (86.3) 41 Area Urban 97.8 95.2 94.5 90.8 96.4 146 Rural 98.4 94.3 96.1 85.4 95.5 169 Age 15-19 (100.0) (97.2) (100.0) (78.3) (100.0) 35 20-24 98.9 95.1 97.1 86.8 98.0 92 25-29 96.8 95.8 95.8 91.5 95.8 89 30-34 100.0 97.6 93.8 89.9 97.6 50 35-39 (97.3) (85.7) (89.0) (89.0) (85.7) 35 40-44 (*) (*) (*) (*) (*) 12 45-49 (*) (*) (*) (*) (*) 3 Education None/Primary 98.6 95.2 95.7 85.9 95.9 195 Secondary + 97.4 94.0 94.9 91.1 95.8 120 Wealth index Poorest 60% 98.2 95.1 95.1 86.5 95.4 212 Richest 40% 97.9 93.9 96.0 90.7 96.9 103 Language English/Creole 96.2 94.3 93.4 91.0 95.2 105 Spanish 100.0 97.2 98.6 88.6 99.1 137 Garifuna (*) (*) (*) (*) (*) 7 Maya (95.3) (90.6) (88.2) (81.2) (90.6) 40 Other (*0) (*) (*) (*) (*) 25 Total 98.1 94.7 95.4 87.8 95.9 314 * MICS indicator 44 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 80 Table RH.5: Assistance during delivery Percent distribution of women aged 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery, Belize, 2006 Person assisting at delivery Medical doctor Nurse/ midwife Auxiliary midwife Traditional birth attendant Other No attendant Total Any skilled personnel* Delivered in health facility** Number of women who gave birth in preceding two years District Corozal (55.5) (39.4) (5.1) (0.0) (0.0) (0.0) 100.0 (100.0) (89.8) 45 Orange Walk (54.8) (42.8) (2.4) (0.0) (0.0) (0.0) 100.0 (100.0) (92.7) 49 Belize 75.2 23.6 0.0 0.0 1.2 0.0 100.0 98.8 98.8 83 Cayo 16.8 83.2 0.0 0.0 0.0 0.0 100.0 100.0 96.9 67 Stann Creek (34.7) (53.5) (5.7) (6.1) (0.0) (0.0) 100.0 (93.9) (79.8) 30 Toledo (22.8) (52.3) (0.0) (0.0) (15.8) (9.1) 100.0 (75.1) (52.4) 41 Area Urban 56.8 41.1 1.5 0.0 0.6 0.0 100.0 99.3 93.4 146 Rural 36.7 54.3 1.8 1.1 3.9 2.2 100.0 92.8 83.9 169 Age 15-19 (39.2) (56.9) (3.8) (0.0) (0.1) (0.0) 100.0 (100.0) (94.5) 35 20-24 41.5 56.5 0.0 0.0 2.0 0.0 100.0 98.0 93.6 92 25-29 54.5 37.4 3.0 1.0 4.1 0.0 100.0 94.8 89.6 89 30-34 59.7 40.3 0.0 0.0 0.0 0.0 100.0 100.0 89.6 50 35-39 (37.2) (43.1) (3.4) (2.6) (5.6) (8.1) 100.0 (83.7) (71.9) 35 40-44 (*) (*) (*) (*) (*) (*) 100.0 (*) (*) 12 45-49 (*) (*) (*) (*) (*) (*) 100.0 (*) (*) 3 Education None/Primary 38.8 53.4 1.5 0.9 3.5 1.9 100.0 93.8 84.6 195 Secondary + 57.8 39.6 1.8 0.0 0.8 0.0 100.0 99.2 94.3 120 Wealth index Poorest 60% 37.6 55.2 1.4 0.9 3.1 1.8 100.0 94.3 85.4 212 Richest 40% 63.3 33.7 2.1 0.0 0.9 0.0 100.0 99.0 94.3 103 Language English/Creole 54.3 42.7 2.0 0.0 1.0 0.0 100.0 99.1 96.3 105 Spanish 47.5 50.5 1.4 0.0 0.0 0.7 100.0 99.3 92.8 137 Garifuna (*) (*) (*) (*) (*) (*) 100.0 (*) (*) 7 Maya (9.6) (66.9) (0.0) (4.6) (14.2) (4.7) 100.0 (76.5) (50.4) 40 Other (54.7) (33.1) (4.7) (0.0) (3.7) (3.8) 100.0 (92.5) (89.3) 25 Total 45.9 48.3 1.6 0.6 2.4 1.2 100.0 95.8 88.2 314 * MICS indicator 4; MDG indicator 17 ** MICS indicator 5 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 81 Table CD.1: Family support for learning Percentage of children aged 0-59 months for whom household members are engaged in activities that promote learning and school readiness, Belize, 2006 Percentage of children aged 0-59 months For whom household members engaged in four or more activities that promote learning and school readiness* Mean number 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 number of activities the father engaged in with the child Living in a household without their natural father Number of children aged 0-59 months Sex Male 83.8 5.0 51.2 2.0 25.5 395 Female 86.5 5.1 52.7 2.1 25.8 401 District Corozal 80.0 5.0 62.2 2.2 16.6 103 Orange Walk 81.9 5.0 37.3 1.3 12.1 121 Belize 89.4 5.2 45.6 2.0 39.5 193 Cayo 89.5 5.2 56.4 2.4 26.2 192 Stann Creek 94.8 5.6 71.6 3.2 34.2 88 Toledo 69.3 4.4 45.4 1.4 15.8 99 Area Urban 88.1 5.2 50.2 2.1 33.6 360 Rural 82.7 5.0 53.4 2.0 19.0 436 Age 0-23 months 76.7 4.6 51.8 2.0 24.0 330 24-59 months 91.1 5.4 52.0 2.1 26.8 466 Mother's education None/Primary 82.2 5.0 50.6 1.9 21.8 517 Secondary + 90.5 5.3 54.1 2.3 33.4 273 Father's education None/Primary 83.1 5.1 59.1 2.3 na 379 Secondary + 88.2 5.3 74.8 3.1 na 196 Father not in HH 86.0 5.0 na na na 204 Wealth index Poorest 60% 82.8 5.0 49.6 1.9 24.8 533 Richest 40% 90.0 5.3 56.7 2.3 27.3 263 Language English/Creole 89.6 5.2 52.3 2.2 34.3 256 Spanish 86.4 5.2 53.4 2.1 25.8 346 Garifuna (91.5) (5.3) (41.0) (1.6) (55.5) 34 Maya 70.0 4.5 54.9 2.0 6.8 107 Other 83.1 5.1 42.4 1.8 0.0 53 Total 85.3 5.1 52.0 2.1 25.5 795 * MICS indicator 46 ** MICS Indicator 47 ( ) Figures that are based on 25-49 unweighted cases na: Not applicable 82 ( ) Figures that are based on 25-49 unweighted cases Table CD.2: Learning materials Percentage of children aged 0-59 months living in households containing learning materials, Belize, 2006 Children living in households with: Child has: Child plays with: 3 or more non- child- ren's books* Median number of non- child- ren's books 3 or more child- ren's books** Median number of child- ren's books House- hold objects Objects and materials found outside the home Home- made toys Toys that came from a store No play- things mentioned 3 or more types of play- things *** Number of children aged 0- 59 months Sex Male 71.7 10 56.2 3 25.5 42.8 25.3 91.9 4.2 26.3 395 Female 71.1 10 57.0 4 29.5 35.7 26.9 87.3 7.4 24.8 401 District Corozal 71.6 10 68.5 6 35.0 54.4 15.0 95.6 3.4 28.1 103 Orange Walk 84.1 10 69.3 5 32.4 40.5 17.9 91.5 7.6 26.4 121 Belize 81.9 10 69.2 6 27.9 31.2 16.2 92.3 6.4 20.8 193 Cayo 73.5 10 52.8 3 29.5 41.5 23.1 88.7 7.1 29.7 192 Stann Creek 58.7 5 45.8 2 18.7 44.6 56.9 79.5 3.9 27.5 88 Toledo 42.1 2 21.4 0 17.1 28.2 45.3 86.5 4.5 21.7 99 Area Urban 78.4 10 64.5 5 30.0 36.9 18.1 91.6 6.5 23.7 360 Rural 65.5 10 50.2 3 25.5 41.1 32.7 88.0 5.3 27.1 436 Age 0-23 months 65.6 10 46.9 2 26.7 25.7 20.0 84.3 12.6 20.0 330 24-59 months 75.4 10 63.5 5 28.1 48.7 30.4 93.3 1.1 29.6 466 Mother’s education None/Primary 66.2 10 48.9 2 26.9 39.9 30.2 89.3 5.2 26.4 517 Secondary + 81.4 10 71.9 10 29.3 38.2 17.3 89.9 7.3 24.0 273 Wealth index Poorest 60% 66.6 10 47.0 2 26.5 42.8 28.6 88.3 5.8 27.2 533 Richest 40% 80.9 10 76.2 10 29.7 32.0 21.0 92.3 6.0 22.3 263 Language English/Creole 81.7 10 70.0 7 29.0 36.6 21.0 90.9 6.7 22.4 256 Spanish 68.1 10 51.8 3 28.6 42.1 20.0 90.9 5.9 27.8 346 Garifuna (77.9) 10 (62.9) 5 (21.6) (32.2) (38.4) (91.8) (2.7) (26.7) 34 Maya 46.9 2 25.0 0 24.4 40.6 53.9 80.7 4.9 27.9 107 Other 89.0 10 84.3 10 23.9 35.1 27.0 92.9 3.6 21.8 53 Total 71.4 10 56.7 4 27.6 39.2 26.1 89.7 5.7 25.6 795 * MICS indicator 49 ** MICS indicator 48 *** MICS indicator 50 83 Table CD.3: Children left alone or with other children Percentage of children aged 0-59 months left in the care of other children under the age of 10 years or left alone in the past week, Belize, 2006 Percentage of children aged 0-59 months Left in the care of children under the age of 10 years in past week Left alone in the past week Left with inadequate care in past week* Number of children aged 0-59 months Sex Male 2.6 3.0 4.2 395 Female 3.3 2.3 3.7 401 District Corozal 0.9 5.9 5.9 103 Orange Walk 0.0 1.1 1.1 121 Belize 1.6 1.6 1.6 193 Cayo 4.4 0.5 4.9 192 Stann Creek 1.0 1.0 1.0 88 Toledo 9.9 9.0 10.7 99 Area Urban 2.5 2.1 3.8 360 Rural 3.2 3.2 4.1 436 Age 0-23 months 1.7 2.5 3.1 330 24-59 months 3.8 2.8 4.6 466 Mother’s education None/Primary 2.7 2.8 3.6 517 Secondary + 3.5 2.4 4.7 273 Wealth index Poorest 60% 3.3 3.7 4.6 533 Richest 40% 2.1 0.5 2.6 263 Language English/Creole 1.2 1.2 2.4 256 Spanish 3.3 3.3 4.8 346 Garifuna (9.2) (9.2) (9.2) 34 Maya 4.2 3.4 4.2 107 Other 2.1 0.0 2.1 53 Total 2.9 2.7 4.0 795 * MICS indicator 51 ( ) Figures that are based on 25-49 unweighted cases 84 Table ED.1: Early childhood education Percentage of children aged 36-59 months who are attending some form of organized early childhood education programme and percentage of first graders 1 who attended pre-school, Belize, 2006 Percentage of children aged 36-59 months currently attending early childhood education* Number of children aged 36- 59 months Percentage of children attending first grade who attended preschool program in previous year** Number of children attending first grade Sex Male 31.4 144 32.2 50 Female 30.1 163 33.4 57 District Corozal (50.0) 42 (*) 5 Orange Walk (22.5) 43 (*) 11 Belize 46.7 66 (*) 20 Cayo 20.0 83 (44.6) 32 Stann Creek (26.4) 42 (*) 20 Toledo (17.1) 31 (*) 20 Area Urban 43.7 134 38.8 50 Rural 20.7 172 27.6 58 Age of child 36-47 months 16.7 142 na na 48-59 months 42.7 165 na na 5 years na na 32.8 108 Mother's education None/Primary 21.6 204 26.6 77 Secondary + 49.7 101 (46.7) 29 Wealth index Poorest 60% 21.6 196 31.4 70 Richest 40% 47.0 110 (35.6) 37 Language English/Creole 43.1 102 (42.1) 38 Spanish 26.7 125 (39.2) 39 Garifuna (*) 16 (*) 9 Maya (15.1) 45 (*) 19 Other (*) 20 (*) 3 Total 30.7 307 32.8 108 * MICS indicator 52 ** MICS indicator 53 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases na: Not applicable 85 Table ED.2: Primary school entry Percentage of children of primary school entry age attending grade 1, Belize, 2006 Percentage of children of primary school entry age currently attending grade

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