Belize Multiple Indicator Cluster Survey 2011

Publication date: 2012

Belize Multiple indicator cluster survey 2011 Final report The Belize Multiple Indicator Cluster Survey (MICS) was carried out in 2011 by Statistical Institute of Belize (SIB). Financial and technical support was provided by the United Nations Children’s Fund (UNICEF). MICS is an international household survey programme developed by UNICEF. The Belize MICS was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project may be obtained from www.childinfo.org. Belize Multiple Indicator Cluster Survey 2011 The Statistical Institute of Belize UNICEF United Nations Children’s Fund November, 2012 4 mics f inal report suMMary taBle oF Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Belize, 2011 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1.1 4.1 Under-five mortality rate 17 per 1,000 1.2 4.2 Infant mortality rate 14 per 1,000 NUTRITION Nutritional status 2.1a 2.1b 1.8 Underweight prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 6.2 percent 1.3 percent 2.2a 2.2b Stunting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 19.3 percent 5.4 percent 2.3a 2.3b Wasting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 3.3 percent 1.2 percent Breastfeeding and infant feeding 2.4 Children ever breastfed 91.9 percent 2.5 Early initiation of breastfeeding 61.5 percent 2.6 Exclusive breastfeeding under 6 months 14.7 percent 2.7 Continued breastfeeding at 1 year 62.1 percent 2.8 Continued breastfeeding at 2 years 34.9 percent 2.9 Predominant breastfeeding under 6 months 34.3 percent 2.10 Duration of breastfeeding 16.1 months 2.11 Bottle feeding 57.8 percent 2.12 Introduction of solid, semi-solid or soft foods 67.4 percent 2.13 Minimum meal frequency 67.6 percent 2.14 Age-appropriate breastfeeding 38.2 percent 2.15 At least 2 milk feeds 84.4 percent Vitamin A 2.17 Vitamin A supplementation (children under age 5) 65.1 percent Low birth weight 2.18 Low-birth weight infants 11.1 percent 2.19 Infants weighed at birth 95.0 percent CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage 97.5 percent 3.2 Polio immunization coverage 75.2 percent 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) 67.8 percent 3.4 4.3 Measles immunization coverage 84.9 percent 3.5 Hepatitis B immunization coverage 73.7 percent Tetanus toxoid 3.7 Neonatal tetanus protection 52.4 percent Care of illness 3.8 Oral rehydration therapy with continued feeding 42.5 percent 3.9 Care seeking for suspected pneumonia 82.2 percent 3.10 Antibiotic treatment of suspected pneumonia 70.7 percent Solid fuel use 3.11 Solid fuels 17.7 percent Child Disability 3.21 Child disability 36.4 percent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 97.7 percent 4.2 Water treatment 31.2 percent 4.3 7.9 Use of improved sanitation facilities 89.2 percent 4.4 Safe disposal of child’s faeces 25.6 percent 4.5 Water and soap available 94.4 percent 4.6 Soap anywhere in dwelling 93.2 percent REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.4 Adolescent fertility rate 64 per 1,000 5.2 Early childbearing 16.9 percent 5.3 5.3 Contraceptive prevalence rate 55.2 percent 5.4 5.6 Unmet need 15.9 percent Maternal and newborn health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 96.2 percent 83.1 percent 5.6 Content of antenatal care 96.6 percent 5.7 5.2 Skilled attendant at delivery 96.2 percent 5.8 Institutional deliveries 93.8 percent 5.9 Caesarean section 28.1 percent mics f inal report 5 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value Post-natal health checks 5.10 Post-partum stay in health facility 92.3 percent 5.11 Post-natal health check for the newborn 97.3 percent 5.12 Post-natal health check for the mother 94.6 percent CHILD DEVELOPMENT Child development 6.1 Support for learning 85.6 percent 6.2 Father’s support for learning 50.0 percent 6.3 Learning materials: children’s books 39.6 percent 6.4 Learning materials: playthings 57.3 percent 6.5 Inadequate care 2.4 percent 6.6 Early child development index 87.5 percent 6.7 Attendance to early childhood education 31.7 percent EDUCATION Literacy and education 7.1 2.3 Literacy rate among young women 91.1 percent 7.2 School readiness 32.9 percent 7.3 Net intake rate in primary education 85.3 percent 7.4 2.1 Primary school net attendance rate (adjusted) 94.4 percent 7.5 Secondary school net attendance rate (adjusted) 55.4 percent 7.6 2.2 Children reaching last grade of primary 96.5 percent 7.7 Primary completion rate 92.9 percent 7.8 Transition rate to secondary school 90.9 percent 7.9 Gender parity index (primary school) 1.00 ratio 7.10 Gender parity index (secondary school) 1.23 ratio CHILD PROTECTION Birth registration 8.1 Birth registration 95.2 percent Child labour 8.2 Child labour 10.0 percent 8.3 School attendance among child labourers 90.4 percent 8.4 Child labour among students 9.7 percent Child discipline 8.5 Violent discipline 70.5 percent Early marriage and polygyny 8.6 Marriage before age 15 4.8 percent 8.7 Marriage before age 18 29.4 percent 8.8 Young women age 15-19 currently married or in union 15.2 percent 8.9 Polygyny 3.4 percent 8.10a Spousal age difference - 10+ years older (women age 15 – 19) 17.0 percent 8.10b Spousal age difference - 10+ years older (women age 20 – 24) 15.4 percent Domestic violence 8.14 Attitudes towards domestic violence 8.6 percent HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED AND VULNERABLE CHILDREN HIV/AIDS knowledge and attitudes 9.1 Comprehensive knowledge about HIV prevention 44.5 percent 9.2 6.3 Comprehensive knowledge about HIV prevention among young people 42.9 percent 9.3 Knowledge of mother- to-child transmission of HIV 55.7 percent 9.4 Accepting attitude towards people with HIV 19.3 percent 9.5 Women who know where to be tested for HIV 86.6 percent 9.6 Women who have been tested for HIV and know the results 28.4 percent 9.7 Sexually active young women who have been tested for HIV and know the results 40.8 percent 9.8 HIV counselling during antenatal care 59.4 percent 9.9 HIV testing during antenatal care 71.8 percent Sexual behaviour 9.10 Young women who have never had sex 68.7 percent 9.11 Sex before age 15 among young women 5.3 percent 9.12 Age-mixing among sexual partners 15.9 percent 9.13 Sex with multiple partners 2.1 percent 9.14 Condom use during sex with multiple partners 28.6 percent 9.15 Sex with non-regular partners 41.6 percent 9.16 6.2 Condom use with non-regular partners 64.6 percent 9.18 Prevalence of children with at least one parent dead 3.8 percent SUBJECTIVE WELL-BEING Subjective well- being SW.1 Life satisfaction - women age 15-24 73.7 percent SW.2 Happiness - women age 15-24 91.3 percent SW.3 Perception of a better life - women age 15-24 65.5 percent 6 mics f inal report Table of ConTenTs Summary Table of Findings . 4 Table of Contents . 6 List of Tables . 8 List of Figures .11 List of Abbreviations . 12 Acknowledgements . 15 Executive Summary . 16 I. Introduction . 22 Background . 22 Survey Objectives . 23 II. Sample and Survey Methodology . 24 Sample Design . 24 Questionnaires . 24 Training and Fieldwork . 26 Data Processing . 26 III. Sample Coverage and the Characteristics of Households and Respondents . 27 Sample Coverage. 27 Characteristics of Households . 28 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 . 32 IV. Child Mortality . 35 V. Nutrition Nutritional Status . 37 Breastfeeding and Infant and Young Child Feeding . 41 Children’s Vitamin A Supplementation . 52 Low Birth Weight . 55 VI. Child Health . 58 Vaccinations . 58 Neonatal Tetanus Protection . 61 Oral Rehydration Treatment . 62 Care Seeking and Antibiotic Treatment of Pneumonia . 66 Solid Fuel Use . 69 Child Disability . 72 VII. Water and Sanitation . 75 Use of Improved Water Sources . 75 Use of Improved Sanitation Facilities . 83 Handwashing . 88 VIII. Reproductive Health . 91 Fertility . 91 Contraception . 93 Unmet Need . 96 Antenatal Care .101 Assistance at Delivery .105 Place of Delivery .107 Post-natal Health Checks .109 mics f inal report 7 IX. Child Development .118 Early Childhood Education and Learning .118 Early Childhood Development . 123 X. Literacy and Education . 126 Literacy among Young Women . 126 School Readiness . 127 Primary and Secondary School Participation . 127 XI. Child Protection .141 Birth Registration .141 Child Labour .143 Child Discipline .148 Early Marriage and Polygyny .149 Attitudes toward Domestic Violence . 155 XII. HIV/AIDS, Sexual Behaviour, and Orphans . 157 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS . 157 Attitudes toward People Living with HIV/AIDS . 164 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care 165 Sexual Behaviour Related to HIV Transmission . 169 Orphanhood .174 XIII. Subjective Well-being . 177 Appendix A. Sample Design . 183 Appendix B. Budget . 188 Appendix C. Sensitization Campaign .191 Appendix D. List of Personnel Involved in the Survey .194 Appendix E. Estimates of Sampling Errors .196 Appendix F. Data Quality Tables .210 Appendix G. MICS4 Indicators: Numerators and Denominators . 221 Appendix H. Household Questionnaire . 228 Appendix I. Questionnaire For Individual Women . 244 Appendix J. Questionnaire For Children Under Five . 270 Appendix K. Questionnaire Form For Child Disability . 287 8 mics f inal report lisT of Tables Characteristics of Households Table HH.1: Results of household, women’s, and under-5 interviews. Table HH.2: Household age distribution by sex. Table HH.3: Household composition. Table HH.4: Women’s background characteristics. Table HH.5: Under-5’s background characteristics. Child Mortality Table CM.1: Children ever born, children surviving and proportion dead. Table CM.2: Child mortality. Nutrition Table NU.1: Nutritional status of children. Table NU.2: Initial breastfeeding. Table NU.3: Breastfeeding. Table NU.4: Duration of breastfeeding. Table NU.5: Age-appropriate breastfeeding. Table NU.6: Introduction of solid, semi-solid or soft food. Table NU.7: Minimum meal frequency. Table NU.8: Bottle feeding. Table NU.10: Children’s vitamin A supplementation. Table NU.11: Low birth weight infants. Child Health Table CH.1: Vaccinations in first year of life. Table CH.2: Vaccinations by background characteristics. Table CH.3: Neonatal tetanus protection. Table CH.4: Oral rehydration solutions and recommended homemade fluids. Table CH.5. Feeding practices during diarrhoea. Table CH.6: Oral rehydration therapy with continued feeding and other treatments. Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia Table CH.8: Knowledge of the two danger signs of pneumonia. Table CH.9: Solid fuel use. Table CH.10: Solid fuel use by place of cooking. Table CH.11: Children at increased risk of disability. Water and Sanitation Table WS.1: Use of improved water sources. Table WS.2: Household water treatment. mics f inal report 9 Table WS.3: Time to source of drinking water. Table WS.4: Person collecting water. Table WS.5: Types of sanitation facilities. Table WS.6: Use and sharing of sanitation facilities. Table WS.7: Disposal of child’s faeces. Table WS.8: Drinking water and sanitation ladders. Table WS.9: Water and soap at place for hand washing. Table WS.10: Availability of soap. Reproductive Health Table RH.1: Adolescent birth rate and total fertility rate. Table RH.2: Early childbearing. Table RH.3: Trends in early childbearing. Table RH.4: Use of contraception. Table RH.5: Unmet need for contraception. Table RH.6: Antenatal care provider. Table RH.7: Number of antenatal care visits. Table RH.8: Content of antenatal care. Table RH.9: Assistance during delivery. Table RH.10: Place of delivery. Table RH.11: Post-partum stay in health facility. Table RH.12: Post-natal health checks for newborns. Table RH.13: Post-natal care (PNC) visits for newborns within one week of birth Table RH.14: Post-natal health checks for mothers Table RH.15: Post-natal care (PNC) visits for mothers within one week of birth Table RH.16: Post-natal health checks for mothers and newborns Child Development Table CD.1: Early childhood education. Table CD.2: Support for learning. Table CD.3: Learning materials. Table CD.4: Inadequate care. Table CD.5: Early child development index Education Table ED.1: Literacy among young women. Table ED.2: School readiness. Table ED.3: Primary school entry. Table ED.4A: Primary school attendance. Table ED.4B: Primary school attendance (ISCED). Table ED.5A: Secondary school attendance. Table ED.5B: Secondary school attendance (ISCED). Table ED.6: Children reaching last grade of primary school. 10 mics f inal report Table ED.7A: Primary school completion and transition to secondary school. Table ED.7B: Primary school completion and transition to secondary school (ISCED). Table ED.8A: Education gender parity. Table ED.8B: Education gender parity (ISCED). Child Protection Table CP.1: Birth registration. Table CP.2: Child labour. Table CP.3: Child labour and school attendance. Table CP.4: Child discipline. Table CP.5: Early marriage and polygyny Table CP.6: Trends in early marriage. Table CP.7: Spousal age difference. Table CP.11: Attitudes toward domestic violence. HIV/AIDS Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission. Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young women. Table HA.3: Knowledge of mother-to-child HIV transmission . Table HA.4: Accepting attitudes toward people living with HIV/AIDS. Table HA.5: Knowledge of a place for HIV testing. Table HA.6: Knowledge of a place for HIV testing among sexually active young women. Table HA.7: HIV counselling and testing during antenatal care. Table HA.8: Sexual behaviour that increases the risk of HIV infection. Table HA.9: Sex with multiple partners. Table HA.10: Sex with multiple partners among young women. Table HA.11: Sex with non-regular partners. Table HA.12: Children’s living arrangements and orphanhood. Table HA.13: School attendance of orphans and non-orphans. Life Satisfaction Table SW.1: Domains of life satisfaction. Table SW.2: Life satisfaction and happiness. Table SW.3: Perception of a better life. Sampling Errors Table SE.1: Indicators selected for sampling error calculations Table SE.2: Sampling errors: Total sample Table SE.3: Sampling errors: Urban areas Table SE.4: Sampling errors: Rural areas mics f inal report 11 Table SE.5: Sampling errors: Corozal Table SE.6: Sampling errors: Orange Walk Table SE.7: Sampling errors: Belize Excluding Belize City South Side Table SE.8: Sampling errors: Belize City South Side Table SE.9: Sampling errors: Belize District Table SE.10: Sampling errors: Cayo Table SE.11: Sampling errors: Stann Creek Table SE.12: Sampling errors: Toledo Data Quality Table DQ.1: Age distribution of household population Table DQ.2: Age distribution of eligible and interviewed women Table DQ.3: Age distribution of under-5s in household and under-5 questionnaires Table DQ.4: Women’s completion rates by socio-economic characteristics of households Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households Table DQ.6: Completeness of reporting Table DQ.7: Completeness of information for anthropometric indicators Table DQ.8: Heaping in anthropometric measurements Table DQ.9: Observation of women’s health cards Table DQ.10: Observation of under-5s birth certificates Table DQ.11: Observation of vaccination cards Table DQ.12: Presence of mother in the household and the person interviewed for the under-5 questionnaire Table DQ.13: Selection of children age 2-14 years for the child discipline module Table DQ.14: School attendance by single age Table DQ.15: Sex ratio at birth among children ever born and living lisT of figures Figure HH.1. Population pyramid, MICS, Belize 2011 Figure HH.2. Population pyramid, Belize Census 2011 Figure CM.1. Under-5 mortality rates by sex, region and ethnicity, Belize, 2011 Figure CM.1. Trend in under-5 mortality rates, Belize, 2011 Figure NU.1. Anthropometric indicators by wealth, Belize, 2011 Figure NU.2. Anthropometric indicators by region, Belize, 2011 Figure NU.3. Anthropometric indicators by ethnicity, Belize, 2011 Figure NU.4. Breastfeeding by wealth, Belize, 2011 Figure NU.5. Breastfeeding by ethnicity, Belize, 2011 Figure NU.6. Breastfeeding by place of delivery, Belize, 2011 Figure NU.7. Breastfeeding by region, Belize, 2011 Figure NU.8. Age-appropriate breastfeeding by wealth and education, Belize, 2011 Figure NU.9. Fed with a bottle with nipple by wealth and education, Belize, 2011 Figure NU.10. Infants below 2500 grams at birth by wealth, Belize, 2011 12 mics f inal report Figure CH.1. Polio and DPT vaccinations, Belize, 2011 Figure RH.1. Trends in early childbearing by age and area, Belize, 2011 Figure RH.2. Unmet need for contraception by age and wealth, Belize, 2011 Figure RH.3. Met need for contraception by age and wealth, Belize, 2011 Figure RH.4. Met need for spacing and limiting by age, Belize, 2011 Figure RH.5. Demand for contraception satisfied by wealth, education, age and area, Belize, 2011 Figure ED.1. Primary net attendance ratio by education of mother and sex, Belize, 2011 Figure ED.2. Primary net attendance ratio by wealth and sex, Belize, 2011 Figure ED.3 Secondary net attendance ratio by mother’s education and wealth, Belize, 2011 Figure ED.4. Children reaching last grade of primary school by wealth index, Belize, 2011 Figure CP.1. Child labour by wealth index and education, Belize, 2011 Figure CP.2. Labour force participation by ethnicity, Belize, 2011 Figure CP.3. Child discipline by education, Belize, 2011 Figure CP.4. Trends in early marriage by age and area, Belize, 2011 Figure CP.5. Domestic violence justified by area, age of respondent, education and wealth index, Belize, 2011 Figure HA.1. Percentage of women with comprehensive knowledge of HIV by education and wealth index, Belize 2011 Figure HA.2. Accepting attitudes towards people living with AIDS by education and wealth index, Belize 2011 Figure HA.3. Sexual behavior that increases the risk of HIV infection, Belize 2011 Figure HA.4. Never married women age 14-24 who have never had sex by wealth, Belize, 2011 Figure HA.5. Sex with non-cohabiting partner by wealth index and area, Belize, 2011 Figure HA.6. Children’s living arrangements by ethnicity, Belize, 2011 Figure SW.1. Percentage of women age 15-24 years who are very or somewhat satisfied by age, area and education, Belize, 2011 Figure SW.2. Life improved last year and will get better next year by wealth index, Belize, 2011 lisT of abbreviaTions AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care BCG Bacillis-Cereus-Geuerin (Tuberculosis) CDC Center for Disease Control CRC Convention on the Right of the Child CSPro Census and Survey Processing System deff Design Effect DHS Demographic Health Surveys DPT Diphteria, Pertussis, Tetanus ECDI Early Child Development Index ED Enumeration District EPI Expanded Programme on Immunization mics f inal report 13 FHS Family Health Survey GPI Gender Parity Index HepB Hepetitis HIB Haemophilus Influenzae B HIV Human Immunodeficiency Virus IMR Infant Mortality Rate ISCED International Standard Classification of Education IUD Intrauterine Device JMP Joint Monitoring Programme LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS4 Fourth global round of Multiple Indicator Cluster Survey Programme MoH Ministry of Health NAR Net Attendance Rate NCFC National Committee for Families and Children NCHS National Centre for Health Statistics PNHC Post Natal Health Check NPA National Plan of Action nq0 Probability of Dying Before Year n ORS Oral Rehydration Solution ORT Oral Rehydration Treatment PNC Post Natal Care pps Probability Proportional to Size PSU Primary Sampling Unit RHF Recommended Home Fluid SIB Statistical Institute of Belize STIs Sexually Transmitted Infections SPSS Statistical Package for Social Sciences TSFB Time Since First Birth U5MR Under-5 Mortality Rate UN United Nations 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 14 mics f inal report foreword The Belize Multiple Indicator Cluster Survey (MICS 4) 2011 conducted is part of the UNICEF- GOB Programme of Cooperation to monitor the progress of boys and girls development in Belize. MICS provides updated statistically sound and internationally comparable estimates of a range of indicators in the areas of health, education, child protection (including disabilities), water and sanitation and HIV and AIDS. The survey provides information on the prevalence of child mortality, stunting, wasting, underweight, and obesity; breastfeeding and supplementary feeding practices, including the immunization status of children. Information is also provided on the prevalence of diarrhea and pneumonia among young children and treatment sought. Valuable data on health practices, including access to improved drinking water sources and sanitation, and knowledge about HIV and Aids are made available. Belize would also have data on child development, child protection and life satisfaction. The findings from the MICS are one of the most important sources of data used as a basis for policy decisions and programme interventions, and for influencing public opinion on the situation of children and women. mics f inal report 15 aCknowledgemenT The Multiple Indicator Cluster Survey 2011 is another land mark achievement of Belize and it is with great pride that the Government of Belize and it’s Statistical Institute and UNICEF make public this report. The report provides vital information on a wide range of social indicators related to the situation of children and women of Belize. The Statistical Institute of Belize and the MICS team, head by Director General Glenn Avilez merit special appreciation for their professionalism, dedication, and effort in undertaking this enormous task. We acknowledge the hard work done by the data collection and enumeration teams whose work in the field was vital to the success of this survey. We are indebted to the women of Belize who participated in this initiate and to the men who provided the support when requested. We would also like to convey special gratitude to the Steering Committee who played an instrumental role in the successful completion of the survey and report. We remain thankful for the technical support of Dr.Nathalia Largaespada Beer (Ministry of Health), Ms.Yuvone Flowers ( Ministry of Education, Youth and Sport), Mr. John Flowers, Mark Antrobus ( Ministry of Human Development, Social Transformation and Poverty Alleviation), Ms. Ann Marie Williams (National Aids Commission), Mr. Dylan Williams ( National Committee for Families and Children), Mariana Mansur (UNDP Belize), Joe Hendrix (University of Belize, Policy Observatory) . Special attention goes to the UNICEF MICS Global (Head Quarters, New York) and Regional (TACRO) teams for the technical and financial support. We are highly indebted to Dr. Shane Khan (MICS Regional Coordinator), Dr Attila Hancioglu (Senior Advisor/Global MICS Coordinator), Dr Ivana Bjelic (Statistics Specialist), and Dr. Claudia Cappa (Statistics and Monitoring Specialist) for their unflagging support and guidance to the entire process. Similarly the technical group at UNICEF Belize, Ms Christine Norton (Representative), Ms Paulette Wade (Planning Monitoring and Evaluation Specialist) and Dr. Leopold Perriott (MICS Belize Coordinator) for their untiring support throughout the survey process. Finally to Mr. Peter Wingfield-Digby and Mr. Martin Wulfe who provided technical support and training to SIB for the sample design and data processing phases of the survey. 16 mics f inal report exeCuTive summary MICS is an international household survey programme developed by UNICEF. The Belize MICS was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. The Belize Multiple Indicator Cluster Survey (MICS) was conducted in 2011 by The Statistical Institute of Belize. Fieldwork was carried out between July, 2011 and August, 2011. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF). Findings Child Mortality • MICS 2011 estimated that the infant mortality rate was 14 per thousand, and the under-5 mortality rate (U5MR) was 17 per thousand. Nutritional Status • The key indicators for monitoring the nutritional status of a child under the age of five are underweight (weight-for-age), stunting (height-for- age) and wasting (weight-for-height). In Belize 6.2 percent of children under age five are underweight, 19.3 percent are stunted and 3.3 percent are wasted. • 7.9 percent of children under age five are overweight. Breastfeeding • About 15 percent of 0-1 month old children are exclusively breastfed. • Continued breastfeeding at one year is 62 percent and declines to 34 percent in the second year of life. Vitamin A Supplements • 65.1 percent of children aged 6-59 months received a high dose Vitamin A supplement in the six months prior to the MICS4. Low Birth Weight • 11.1 percent of children who were weighed had a birth weight of less than 2,500 grams at birth. Immunization • 97.5 percent of children have received BCG vaccinations. • Diphteria, Whooping Cough and Tetanus (DPT) immunization are obtained through the Pentavalent and the DTaP – P vaccines: 68.7 percent have received three doses of DPT. mics f inal report 17 • Immunization against Polio is obtained through the Polio and the DTaP – P vaccines: 75.2 percent have received three doses of polio vaccine. • By 18 months of age 84.9 percent of children were immunized against measles. Tetanus Toxoid • Overall, 52.4 percent of the women in Belize received vaccines against tetanus during pregnancy. • 34.5 percent of the women received at least two doses during their last pregnancy. Oral Rehydration Treatment (ORT) • 7.9 percent of the children under age five had diarrhoea in the two weeks preceding the survey. • The recommended treatment for diarrhoea in children is oral rehydration therapy (ORS packet or recommended homemade fluid or increased fluids) with continued feeding: 42.5 percent of children with diarrhoea received this treatment. Care Seeking and Antibiotic Treatment of Pneumonia • About three percent of children under age five had symptoms consistent with pneumonia during the two weeks preceding the survey. • Overall, 70.7 percent of children with suspected pneumonia received antibiotics. • Antibiotic treatment of suspected pneumonia is lower in rural areas than in urban areas, only 63.7 percent, compared to 90.1 percent in urban areas, received antibiotic treatment. • Solid Fuel Use • 17.7 percent of all households in Belize are using solid fuels for cooking. Water and Sanitation • Most of the population of Belize (97.7 %) use an improved source of drinking water. • Both the urban (99.5 percent) and rural (96.2 percent) areas display a high access to improved sources of drinking water. • The main improved source of drinking water in Belize is bottled water (47.8 percent) followed by water piped into dwelling (17.9 percent). • One in ten households (9.7 percent ) in the Toledo District have no sanitary facility but use the bush or field to dispose of excreta. Fertility • Adolescent birth rate is 64 per thousand and twice as high in rural areas (85 per thousand) than in urban areas (39 per thousand). • The percentage of women age 20-24 years who have had a live birth before age 18 is 16.9. Contraception 18 mics f inal report • Use of contraception was reported by 55.2 percent of women currently married or in a union. • The most popular method is female sterilization which is used by 20.7 percent of married women in Belize. The next most popular method is the pill (12.5 percent). • Contraceptive use in urban and rural married women age 15-49 years was 57.7 percent (urban) and 53.3 percent (rural). • Contraceptive prevalence is highest in Corozal District at 61.8 percent. • In the Cayo District, contraceptive use is relatively rare; only 28.3 percent of married women reported using any method. Unmet Need • The unmet need for contraception is 15.9 percent (spacing 8.4% and limiting 7.5%). • Antenatal Care • 96.2 percent of women age 15-49 years with a live birth in the two years preceding the survey received antenatal care (ANC) at least once by skilled personnel and 83.1 percent received ANC at least 4 times by any provider. • The lowest level of antenatal care is found in the Toledo District (91.5 percent) and in the Belize District (91.7 percent). • In the Belize District the lowest level of antenatal care is in the Belize (Excluding Belize City South Side) (86.9 percent). In Belize City South Side the rate is 96.4 percent. Assistance at Delivery • About 96.2 percent of births occurring in the two years preceding the MICS survey were delivered by skilled personnel. • This percentage is highest in Orange Walk at 99.3 percent and lowest in Toledo at 87.8 percent. • Delivery by C-section occurred in 28.1 percent of births. • Doctors delivered almost twice as many babies in private sector health facilities than in public sector health facilities (47.1 percent to 79.2 percent) and were most active in urban areas (urban 56.9 percent, rural 45.3 percent). • Nurses or midwives delivered most frequently in rural areas (urban 41.3 percent to rural 47.9 percent), in public health facilities (public 52.5 percent to private 17.1 percent) and in poorer families (poorest 55.4 percent, richest 33.9 percent). • Both mother and newborn had post natal health checks within 2 days of birth at a rate of 92.7 percent. Child Development • 31.7 percent of children aged 36-59 months are attending pre-school. Urban-rural and regional differentials are observed – the figure is as high as 40.4 percent in urban areas, compared to 26.4 percent in rural areas. • For 85.6 percent of under-five children, an adult household member engaged in more than four activities that promote learning and school readiness during the 3 days preceding the survey. mics f inal report 19 • The average number of activities in the 3 days preceding the survey that adults engaged with children was 5.1. • Father’s involvement with one or more activities was 50.0 percent. • In Belize, 39.6 percent of children 0-59 months old live in households where at least 3 children’s books are present. The percentage of children with 10 or more books declines to 19.5percent. • 57.3 percent of children aged 0-59 months had 2 or more playthings to play with in their homes. • 2.4 percent of children were left with inadequate care during the week preceding the survey, either by being left alone or in the care of another child. • Physical growth, literacy and numeracy skills, socio-emotional development and readiness to learn are vital domains of a child’s overall development. In Belize, 87.5 percent of children aged 36-59 months are developmentally on track. Pre-School Attendance and School Readiness • Overall, 32.9 percent of children who are currently attending the infant 1 of primary school were attending pre-school the previous year. Primary and Secondary School Participation by National Educational Levels • The majority of children of primary school age are attending school (94.4 percent). • In urban areas 98.0 percent of children attend primary school while in rural areas attendance is only 92.2 percent. • The majority of all children starting infant one in primary school (97.6 percent) will eventually reach the last grade (standard 6). • Only half of the children of secondary school age are attending secondary school (55.4 percent). • Gender parity index (GPI) for primary school is 1.00. • Gender parity increases to 1.21 for secondary education. • The disadvantage of boys is particularly pronounced in urban areas and Garifuna headed households. Adult Literacy • Over ninety percent (91.1 percent) of women in Belize are literate and that literacy status varied considerably by place of residence. The most literate women are found in Belize District (98.5 percent) and the least literate in the Orange Walk District (82.0 percent). Birth Registration • The births of 95.2 percent of children under-five years in Belize have been registered. • Only 87.3 percent of children 0 to 11 months have been registered as compared to older children who have been registered at rates in the mid ninety percentages. • Children in the Corozal (93.3 percent) and Cayo (94.8 percent) Districts are somewhat less likely to have their births registered than other children and children from Garifuna households are registered at slightly less rates (91.9 percent) than children from other ethnic backgrounds. 20 mics f inal report Child Labour • In Belize, 10 percent of children age 5 – 14 are involved in child labour. • 12.1 percent of children 5 to 11 years and 4.8 percent of children 12 to 14 years are engaged in child labour. • For the 5 to 11 years group child labour rates are males 14.6 percent and females 9.7 percent while for the 12 to 14 years group 7.0 percent of males and 2.8 percent of females engage in child labour. • Most of the child labour occurs in rural areas. The rates are 4.1 percent urban and 13.8 percent rural. • Of the 93.4 percent of the children 5-14 years of age attending school, 9.7 percent are also involved in child labour activities. • On the other hand, out of the children who are involved in child labour, the majority of them are also attending school (90.4 percent). Child Discipline • In Belize, 70.5 percent of children age 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. • 5.2 percent of children were subjected to severe physical punishment. • 26.2 percent of mothers/caretakers believed that children should be physically punished. Domestic Violence • Overall, 8.6 percent of women in Belize feel that their husband/partner has a right to hit or beat them for at least one of a variety of reasons. • 6.8 percent of women justify violence in instances when they neglect the children. • Acceptance is more present among rural dwellers. • Women living in poorest households, less educated and Mayan households are more accepting of domestic violence. Child Disability • In Belize, 2011 more than a third (36.4 percent) of children 2 to 9 years was at risk for one or more disabilities as reported by the mother or primary caretaker. • The Cayo District recorded the highest at risk percentage (59.3 percent) and the Belize City South Side the lowest (23.0 percent). • Rural children are at higher risk for disabilities than urban children (urban 28.3 percent, rural 41.5 percent). Knowledge of HIV Transmission and Condom Use • 94.7 percent of women in Belize had heard of AIDS. • About eighty percent (77.9 percent) of women know of having one faithful uninfected sex partner, 72.9 percent know of using a condom every time, and 64.4 percent know both main ways of preventing HIV mics f inal report 21 transmission. • Comprehensive knowledge about HIV among women age 15 to 49 years is low at only 44.5. • Only 42.9 percent of women aged 15 to 24 years have comprehensive knowledge of HIV. • Urban women have a higher rate of knowledge (56.4 percent) than rural women (34.0 Percent). • Overall, 90.2 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 55.7 percent, while 4.5 percent of women did not know of any specific means of mother-to-child transmission. • In Belize 96.5 percent of women who have heard of AIDS agree with at least one accepting statement. • The most common accepting attitude is willingness to care for a family member with the AIDS virus in their own home (85.0 percent). • Women in rural areas tend to be less accepting of people with the AIDS virus. In urban areas, 23.4 percent express accepting attitudes on all four indicators while the rate is 15.4 percent in rural areas. • 86.6 percent of women 15 to 49 years knew where to be tested for HIV, while 62.9 percent had actually been tested ever, and only 29.9 percent had been tested in the last year. Sexual Behaviour Related to HIV Transmission • 68.7 percent of women 15 to 24 years had never had sex while 5.3 percent had sex before age 15. • 15.9 percent had sex with a man 10 years or older in the last 12 months. • 2.1 percent of women 15-49 years of age report having sex with more than one partner. Of those women, only 28.6 percent report using a condom the last time they had sex (this is sex in the last 12 months). Orphaned Children • 65.4 percent of children aged 0-17 years in Belize live with both the parents. • About one in fifteen children (6.9 percent) is living with neither parent. • In Belize, 0.4 percent of children aged 10-14 have lost both parents. • Among the children age 10-14 who have not lost a parent and who live with at least one parent, 95.0 percent are attending school. 22 mics f inal report i. inTroduCTion Background This report is based on the Belize Multiple Indicator Cluster Survey (MICS), conducted in 2011 by the Statistical Institute of Belize. 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.” mics f inal report 23 The National Plan of Action (NPA) for children and adolescents in Belize 2004 – 2015 was adopted by the Government of Belize to ensure the wellbeing of Belize’s children. This plan was conceptualized within the framework of national development agencies, the International Convention on the Rights of the Child (CRC) and the Millennium Development goals (MDG). Promoting, monitoring and evaluation of the implementation of the Convention on the Rights of the Child (CRC) are responsibilities assigned to the National Committee for Families and Children (NCFC). The NCFC advocates on behalf of children and adolescents with the Government to meet its obligations as signatory to the Convention and also with local agencies which provide services to families and children. Six main areas are addressed in the NPA: Education, Health, Child Protection, HIV & AIDS, Families and Culture. The Multiple Indicator Cluster Survey (MICS) captures information on many of the MDG indicators and also provides information in many additional areas. The MICS programme is designed to review and monitor targets defined in the NPA and to evaluate the extent to which targets are being realized to achieve compliance with the Convention on the Rights of the Child and with the Millennium Development Goals. This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The 2011 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 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. • To generate data on the situation of children and women, including the identification of vulnerable groups and of disparities, to inform policies and interventions. 24 mics f inal report ii. sample and survey meThodology Sample Design The sample for the Belize Multiple Indicator Cluster Survey (MICS) was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for seven regions: Corozal District, Orange Walk District, Belize District (excluding Belize City South Side), Belize City South Side, Cayo District, Stann Creek District and Toledo District. The tables present figures for all seven regions and a combined figure for Belize District, composed of Belize District (excluding Belize City South Side) and Belize City South Side. The urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, twenty eight census enumeration districts (ED) were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of twenty five households was drawn in each sample enumeration district. Each ED was visited during the fieldwork period. The sample was stratified by region, urban and rural areas, and is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members (usual residents), 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 for all children under 5 living in the household. The questionnaires included the following modules: The Household Questionnaire included the following modules: o Household Information Panel o Household Listing Form o Education o Water and Sanitation o Household Characteristics o Insecticide Treated Nets o Child Labour o Child Discipline o Hand washing The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: o Women Information Panel o Women’s Background mics f inal report 25 o Child Mortality o Desire for Last Birth o Maternal and Newborn Health o Post Natal Health Checks o Illness Symptoms o Contraception o Unmet Need o Attitudes Towards Domestic Violence o Marriage/Union o Sexual Behaviour o HIV/AIDS o Life Satisfaction The Questionnaire for Children Under-Five was administered to mothers or caretakers of children under 5 years of age1 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 Under Five Information Panel o Age o Birth Registration o Early Childhood Development o Breastfeeding o Care of Illness o Immunization o Anthropometry A Questionnaire for Child Disability was also administered to mothers or primary caretakers of children between the ages of 2 and 9 years. This questionnaire contained two modules. o Child Disability Questionnaire Form o Child Disability Questionnaires are based on the MICS4 model questionnaire2. The MICS4 model English versions of the questionnaires were pre-tested in the Orange Walk District in the rural villages of Shipyard, August Pine Ridge and Trinidad and in the urban areas of San Jose Palmar and Orange Walk Town on Wednesday 26th January 2011 and Thursday 27th January 2011. 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 observed the place for handwashing and measured the weights and heights of children age under 5 years. Details and findings of these measurements are provided in the respective sections of the report. 1 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 2 The model MICS4 questionnaires can be found at www.childinfo.org 26 mics f inal report Training and Fieldwork Training for the fieldwork was conducted in two phases. The training of trainers was conducted from 30th May to 8th June, 2011 in Belmopan City and the ten day main training of field staff was conducted from 13th June to 24th June, 2011 in Belize City at a centralized location. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Time was spent becoming familiar with the various vaccination cards in use and all field staff were trained in the use of the anthropomorphic measuring tools. Towards the end of the training period, trainees spent one day in practice interviewing in several enumeration districts in Belize City. The data were collected by seven teams; each was comprised of four interviewers, one driver, one editor and one field supervisor. Even though the MICS programme requires the use of a dedicated Measurer as part of each data collection team, in Belize MICS 2011 measuring was done by the field supervisor with assistance as needed from the editor. One standby interviewer was provided for each team in the event that an interviewer was unable to continue working. Fieldwork began on 13th June, 2011 and concluded on 5th August, 2011. Data Processing Data were entered using the CSPro software. The data were entered on six microcomputers and carried out by six data entry operators and two data entry supervisors. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS4 programme and adapted to the Belize questionnaire were used throughout. Data processing began simultaneously with data collection in June, 2011 and was completed in September, 2011. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose. mics f inal report 27 iii. sample Coverage and The CharaCTerisTiCs of households and respondenTs Sample Coverage Of the 4,900 households selected for the sample, 4,608 were found to be occupied. Of these, 4,424 were successfully interviewed for a household response rate of 96.0 percent. In the interviewed households, 4,485 women (age 15-49 years) were identified. Of these, 4,096 were successfully interviewed, yielding a response rate of 91.3 percent within interviewed households. In addition, 1,982 children under age five were listed in the household questionnaire. Questionnaires were completed for 1,946 of these children, which corresponds to a response rate of 98.2 percent within interviewed households. A total of 3,287 children between the ages of 2 and 11 years were identified and Disability Questionnaires were completed for 3,234 of these children yielding a response rate of 98.4 percent. Overall response rates of 87.8 percent and 94.3 percent are calculated for the women’s and under-5’s interviews respectively (Table HH.1). Table HH.1: Results of household, women’s and under-5 interviews Number of households, womenand children under 5 by results of the household, women’s and under-5’s interviews, and household, women’s and under-5’s response rates, Belize, 2011 AreA region Total Urban rural Corozal orange Walk Belize (excluding Belize City South Side) Cayo Stann Creek Toledo Belize City South Side Belize District Households Sampled 2245 2655 700 699 700 701 700 700 700 1400 4900 Households occupied 2101 2507 655 673 635 651 646 686 662 1297 4608 Households interviewed 2004 2420 642 662 581 626 605 670 638 1219 4424 Household response rate 95.4 96.5 98.0 98.4 91.5 96.2 93.7 97.7 96.4 94.0 96.0 Women eligible 1950 2535 722 738 511 702 547 613 652 1163 4485 Women interviewed 1772 2324 648 688 448 605 493 602 612 1060 4096 Women’s response rate 90.9 91.7 89.8 93.2 87.7 86.2 90.1 98.2 93.9 91.1 91.3 Women’s overall response rate 86.7 88.5 88.0 91.7 80.2 82.9 84.4 95.9 90.5 85.7 87.7 Children under 5 eligible 698 1284 318 329 161 299 256 362 257 418 1982 Children under 5 Mother/Caretaker interviewed 681 1265 314 320 153 295 251 361 252 405 1946 Under-5’s response rate 97.6 98.5 98.7 97.3 95.0 98.7 98.0 99.7 98.1 96.9 98.2 Under-5’s overall response rate 93.1 95.1 96.8 95.7 86.9 94.9 91.8 97.4 94.5 91.1 94.3 Children aged 2-9 eligible for Disability Questionnaire 1147 2140 494 528 293 481 438 647 406 699 3287 Children aged 2-9 Mother/Caretaker interviewed 1121 2113 488 513 281 478 432 643 399 680 3234 Aged 2-9 for Disability Questionnaire response rate 97.7 98.7 98.8 97.2 95.9 99.4 98.6 99.4 98.3 97.3 98.4 Aged 2-9 for Disability Questionnaire overall response rate 93.2 95.3 96.8 95.6 87.7 95.6 92.4 97.1 94.7 91.4 94.5 28 mics f inal report Lowest household response rate occurred in Belize (Excluding Belize City South Side) (91.5 percent) but this is within the design specification of 10 percent non-response allowed by the sample. Non-response rates for the women questionnaire were more than 10 percent for Corozal (10.2 percent), Belize (Excluding Belize City South Side) (12.3 percent) and Cayo (13.8 percent). The response rates for these regions are not excessively higher than the targets set and it is expected that results obtained for these regions should be reliable. Urban and rural response rates are above 90 percent for all questionnaires. 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 pyramids in Figure HH.1 and Figure HH.2. In the 4,424 households successfully interviewed in the survey, 17,288 household members were listed. Of these, 8,582 were males, and 8,705 were females. The average household size of 3.9 obtained from this MICS is precisely that obtained from the Belize 2010 Census. Table HH.2: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Belize, 2011 Males FeMales ToTal Number Percent Number Percent Number Percent age 0-4 961 11.2 941 10.8 1902 11.0 5-9 1016 11.8 988 11.3 2004 11.6 10-14 1002 11.7 1066 12.2 2068 12.0 15-19 919 10.7 939 10.8 1858 10.7 20-24 765 8.9 801 9.2 1565 9.1 25-29 615 7.2 714 8.2 1329 7.7 30-34 604 7.0 587 6.7 1191 6.9 35-39 537 6.3 587 6.7 1125 6.5 40-44 488 5.7 475 5.5 963 5.6 45-49 399 4.6 379 4.4 778 4.5 50-54 348 4.1 376 4.3 724 4.2 55-59 265 3.1 243 2.8 508 2.9 60-64 203 2.4 217 2.5 419 2.4 65-69 143 1.7 121 1.4 264 1.5 70-74 120 1.4 111 1.3 231 1.3 75-79 75 0.9 58 0.7 132 0.8 80-84 62 0.7 46 0.5 108 0.6 85+ 32 0.4 39 0.4 71 0.4 Missing/DK 29 0.3 19 0.2 47 0.3 Dependency age groups 0-14 2979 34.7 2995 34.4 5974 34.6 15-64 5143 59.9 5317 61.1 10460 60.5 65+ 432 5.0 375 4.3 807 4.7 Missing/DK 29 0.3 19 0.2 47 0.3 Children and adult populations Children age 0-17 years 3532 41.2 3561 40.9 7094 41.0 adults age 18+ years 5021 58.5 5125 58.9 10147 58.7 Missing/DK 29 0.3 19 0.2 47 0.3 Total 8582 100.0 8705 100.0 17288 100.0 mics f inal report 29 The population trends obtained from MICS clearly follow the trends as obtained from the Belize Census 2010 (Figure HH.1 and Figure HH.2). In general rates for MICS in the 0 to 14 age group is lower for both males and females than the rates obtained from the census. However, differences are small: for MICS 34.7 percent of the males are 0 – 14 years old while 34.4 percent of the females lie in this age group. Corresponding rates from the 2010 census are males 36 percent and females 35.3 percent. Rates for the 15 to 49 years age group agree well between the MICS and the Belize Census 2010. For the MICS, 50.4 percent of males are 15 to 49 years old while 51.5 percent of females are 15 to 49 years old. 30 mics f inal report Table HH.3 provides basic background information on the households. Within households, the sex of the household head, region, area, number of household members, education of household head, religion and ethnicity of the household head are shown in the table. These background characteristics are 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. There are about three times as many male heads of households as female heads (73.5 percent to 26.5 percent). MICS indicates that there are almost equal numbers of urban and rural households (urban 49.0 percent and rural 51.0 percent). Cayo is the region with the largest number of households (20.7 percent) while the regions with the second largest numbers of households are the Orange Walk and Belize City South Side regions at 13.7 and 13.9 percent respectively. If the two regions of Belize (excluding Belize City South Side) and Belize City South Side are combined then this district, the Belize District, far outstrip the other districts with 33.3 percent of the households. Most household heads are Mestizo (46.5 percent) followed by the Creole at 26.7 percent. The Belize Census 2010 puts the rates of Mestizo and Creole heads at 48.8 percent and 21.1 percent respectively. Most household heads have at least a primary school education (90.5 percent). On average households have about 3.9 members with 17.8 percent of households having 4 members. mics f inal report 31 Table HH.3: Household composition Percent distribution of households by selected characteristics, Belize, 2011 Weighted percent NuMber oF householDs Weighted un-weighted sex of household head Male 73.5 3250 3291 Female 26.5 1174 1133 region Corozal 11.7 519 642 orange Walk 13.7 607 662 belize (excluding belize City south side) 19.4 860 581 belize City south side 13.9 614 638 belize District 33.3 1474 1219 Cayo 20.7 918 626 stann Creek 11.0 488 605 Toledo 9.4 417 670 area urban 49.0 2170 2004 rural 51.0 2254 2420 Number of household members 1 15.1 666 677 2 15.8 699 667 3 16.9 747 737 4 17.8 789 770 5 13.3 589 593 6 8.9 393 410 7 5.2 229 233 8 2.6 117 124 9 2.0 88 92 10+ 2.4 106 121 Education of household head None 7.0 311 349 Primary/Infant 47.6 2104 2201 secondary + 41.8 1851 1722 CeT/ITVeT/VoTeC 1.1 47 41 Missing/DK 1.3 58 50 other 1.2 52 61 ethnicity of household head Creole 26.7 1182 1083 Mestizo 46.5 2058 2010 Garifuna 6.5 286 308 Maya 9.0 399 528 other 9.2 409 409 Missing/DK 2.0 91 86 Total 100.0 4424 4424 Households with at least one child age 0-4 years 31.6 4424 4424 one child age 0-17 years 63.7 4424 4424 one woman age 15-49 years 72.4 4424 4424 Mean household size 3.9 4424 4424 In Table HH.3 the weighted and un-weighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child under 18, at least one child under 5, and at least one eligible woman age 15-49 along with the weighted average household size estimated by the survey. 32 mics f inal report Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 Tables HH.4 and HH5 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. Table HH.4: Women’s background characteristics Percent and frequency distribution of women age 15-49 years by selected characteristics, Belize, 2011 Weighted percent NUMBER OF WOMEN Weighted Un-weighted Region Corozal 13.0 534 648 Orange Walk 15.1 618 688 Belize (Excluding Belize City South Side) 16.8 687 448 Belize City South Side 14.0 573 612 Belize District 30.8 1260 1060 Cayo 22.8 933 605 Stann Creek 9.9 404 493 Toledo 8.5 347 602 Area Urban 47.0 1926 1772 Rural 53.0 2170 2324 Age 15-19 20.6 844 852 20-24 17.6 720 729 25-29 15.9 651 655 30-34 13.3 544 554 35-39 13.1 537 516 40-44 10.8 442 431 45-49 8.8 359 359 Marital/Union status Currently married/in union 58.3 2386 2394 Widowed 1.1 44 43 Divorced 0.8 35 29 Separated 10.0 410 410 Never married/in union 29.8 1219 1219 Missing 0.0 1 1 Motherhood status Ever gave birth 66.6 2728 2735 Never gave birth 33.4 1368 1361 Births in last two years Had a birth in last two years 16.7 685 702 Had no birth in last two years 83.3 3411 3394 Education None 3.6 148 156 Primary/Infant 39.3 1608 1704 Secondary + 55.2 2259 2148 CET/ITVET/VOTEC 0.6 26 22 Other 1.3 55 66 Wealth index quintiles Poorest 15.7 644 799 Second 19.9 815 821 Middle 21.4 877 860 Fourth 21.0 862 824 Richest 21.9 898 792 Ethnicity of household head Creole 24.0 985 900 Mestizo 50.0 2046 1976 Garifuna 6.2 253 267 Maya 9.9 407 550 Other 8.2 335 335 Missing/DK 1.7 70 68 Total 100.0 4096 4096 mics f inal report 33 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 region, area, age, marital status, motherhood status, births in last two years, education1, wealth index quintiles2, and ethnicity of the household head. Some background characteristics of children under 5 years are presented in Table HH.5. These include the distribution of children by several attributes: sex, region and area, age, mother’s or caretaker’s education, wealth, and ethnicity of household head. Male and female under-five children occur in equal numbers in the sample (male 50.6 percent, female 49.4 percent). About twice as many (61.8 percent) of the under-five children are rural dwellers compared with the urban percentage (38.2). Rates for Mestizo children (48.7 percent) follow the ethnic profile as seen in Table HH.3. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, Filmer and Pritchett, 2001, and Gwatkin et. Al., 2000. 1 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 2 Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: Electricity, a radio, a television, a non-mobile telephone, a refrigerator, a fan, a micro wave oven, a security alarm system, a washing machine, a DVD player, a as bar-b-q grill, an air conditioner, a water cooler, a sofa, a dining room table, a clothes closet, a watch, a bicycle, a cell telephone a motorcycle or scooter, a car or truck, a computer, an mp3/mp4 player, a fishing rod, a weight training machine, a boat with a motor. 34 mics f inal report Table HH.5: Under-5’s background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Belize, 2011 Weighted percent Number of children Weighted Un-weighted Sex Male 50.6 984 995 Female 49.4 962 951 Region Corozal 13.5 263 314 Orange Walk 15.5 302 320 Belize (Excluding Belize City South Side) 12.3 240 153 Belize City South Side 13.0 252 252 Belize District 25.3 492 405 Cayo 23.1 450 295 Stann Creek 10.9 212 251 Toledo 11.6 226 361 Area Urban 38.2 743 681 Rural 61.8 1203 1265 Age 0-5 7.6 148 145 6-11 10.7 209 212 12-23 20.8 404 398 24-35 20.2 393 403 36-47 20.3 395 391 48-59 20.4 397 397 Mother’s education* None 5.1 100 108 Primary/Infant 48.6 946 994 Secondary + 43.1 839 778 CET/ITVET/VOTEC 0.7 14 11 Missing/DK 0.0 1 1 Other 2.4 47 54 Wealth index quintiles Poorest 25.2 490 580 Second 23.1 450 437 Middle 20.9 407 388 Fourth 17.0 330 312 Richest 13.8 268 229 Ethnicity of household head Creole 19.5 379 345 Mestizo 48.7 949 912 Garifuna 5.4 105 113 Maya 14.8 288 356 Other 10.0 195 192 Missing/DK 1.6 31 28 Total 100.0 1946 1946 * Mother’s education refers to educational attainment of mothers and caretakers of children under-5. mics f inal report 35 iv. Child morTaliTy One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of 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). For the application of the technique, women are classified into 5-year groups of Time Since First Birth (TSFB), namely 0-4, 5-9, 10-14, 15-19 and 20-24 years. The average numbers of children ever born and proportion dead among these children are calculated for each group of women. The proportions dead calculated for each group are very closely related to mortality risks. The technique converts the proportions dead into conventional mortality risks by using several assumptions in regard to the length of exposure to the risk of dying among children born to each group of women, on the distribution of deaths of children over time, and on the level and pattern of fertility prevalent in the population. Simulations on model data have shown that proportions dead by TSFB groups of women can be converted into probabilities of dying by using modelled relationships, namely into 2q0 (probability of dying before age 2) for proportion dead among children of women in the 0-4 years TSFB group, under-5 mortality rates for the 5-9, 10-14 and 15-19 year TSFB groups, and 15q0 (probability of dying before age 15) for the 20-24 years TSFB group. The technique also time- locates these estimates, again by using several assumptions. This is necessary because children of women who have had their first births long ago have been exposed to mortality risks for a longer period of time, and therefore, their mortality experience refers to farther back in time, compared to that of children born to women who have had their first births recently. The final step in the calculations is the conversion of the estimated mortality risks into comparable probabilities of dying for each estimate derived from different TSFB groups of women. The Coale-Demeny model life tables are used for this purpose. Coale-Demeny model life tables are life table schedules at different levels of mortality, that embody typical age patterns of mortality in human populations, categorized into 4 ‘families’ of such typical patterns – North, South, East and West models. Using typical relationships between 2q0, 5q0 and 15q0 and the infant mortality rate embodied in these model life tables, the initial estimates of mortality 36 mics f inal report are converted into infant mortality rates, while the estimates of 2q0 and 15q0 are converted into estimates of 5q0 (Note that the 5-9, 10-14 and 15-19 year TSFB groups produce estimates of under-5 mortality rates at the initial calculation stage). By expressing mortality risks at different points in time with the same indicator, it then becomes possible to show trends in mortality during the last 15-20 years. Table CM.1: Children ever born, children surviving and proportion dead, Belize, 2011 CHildren ever born CHildren surviving ProPortion dead nuMber of woMen Mean Total Mean Total Time since first birth 0-4 1.3599 750 1.3357 737 0.0178 552 5-9 2.2279 1182 2.1929 1164 0.0157 531 10-14 3.0835 1636 2.9888 1586 0.0307 531 15-19 3.7395 1596 3.5844 1530 0.0415 427 20-24 4.7309 1779 4.5556 1713 0.0370 376 Total 2.8743 6944 2.7856 6729 0.0309 2416 For the calculations in this report, the Coale-Demeny , West model life table was selected as most appropriate, based on previous information on the age pattern of mortality in Belize. Table CM.2 provides estimates of child mortality. The infant mortality rate (IMR) is estimated at 14 per thousand, while the probability of dying under age 5 (U5MR) is around 17 per thousand. These estimates have been calculated using the 5-9 years since first birth and therefore refer to August 2006. table CM.2: Child mortality Infant and under-five mortality rates, based on WEST model, Belize, 2011 InfanT MorTalITy raTE [1] UndEr-fIvE MorTalITy raTE [2] sex Male 16 18 Female 14 16 area urban (17) (19) rural 13 15 Wealth index quintiles Poorest/second/Middle 16 19 Fourth/richest (11) (12) Total 14 17 [1] MICs indicator 1.2; MDG indicator 4.2 [2] MICs indicator 1.1; MDG indicator 4.1 rates refer to august 2006. The West Model was assumed to approximate the age pattern of mortality in Belize. ( ) Figures that are based on less than 250 un-weighted cases Overall, the data show that there are few differences by background characteristics. Differences by sex and place of residence of the child are small. The data do show some differences by wealth; wealthier households tend to have lower mortality rates than poorer households. mics f inal report 37 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 child 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. A reduction in the prevalence of malnutrition will also 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 based on new WHO growth standards1. 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 classified as 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 (www.childinfo.org). Findings in this section are based on the results of these measurements. 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, and mean z-scores for all three anthropometric indicators. 1 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf 38 mics f inal report Ta bl e NU .1 : N ut rit io na l s ta tu s of c hi ld re n Pe rc en ta ge o f c hi ld re n un de r a ge 5 b y nu tr iti on al s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t f or a ge , h ei gh t f or a ge , a nd w ei gh t f or h ei gh t, B el iz e, 2 01 1 W ei gh t f or a ge N um be r of ch ild re n un de r ag e 5 H ei gh t f or a ge N um be r of ch ild re n un de r ag e 5 W ei gh t f or h ei gh t N um be r of ch ild re n un de r ag e 5 U nd er w ei gh t M ea n Z- Sc or e (S D ) St un te d M ea n Z- S co re (S D ) W as te d O ve rw ei gh t M ea n Z- Sc or e (S D ) P er ce nt be lo w -2 s d [1 ] Pe rc en t be lo w -3 s d [2 ] P er ce nt be lo w -2 s d [3 ] Pe rc en t be lo w -3 s d [4 ] Pe rc en t be lo w -2 s d [5 ] Pe rc en t be lo w -3 s d [6 ] P er ce nt a bo ve +2 s d Se x M al e 5. 7 0. 6 -0 .3 91 4 18 .6 5. 7 -0 .8 90 2 3. 2 0. 9 8. 6 0. 2 89 6 Fe m al e 6. 6 2. 0 -0 .4 89 5 20 .0 5. 2 -1 .0 87 8 3. 4 1. 5 7. 1 0. 2 87 2 Ar ea U rb an 5. 4 0. 7 -0 .1 67 8 15 .7 2. 8 -0 .7 66 2 2. 8 1. 2 9. 8 0. 3 66 1 R ur al 6. 6 1. 6 -0 .4 11 32 21 .4 7. 0 -1 .0 11 18 3. 6 1. 2 6. 7 0. 2 11 07 R eg io n C or oz al 7. 0 1. 6 -0 .4 25 1 19 .7 5. 0 -1 .0 24 9 3. 1 0. 3 5. 4 0. 2 24 8 O ra ng e W al k 4. 7 1. 0 -0 .3 28 0 17 .2 3. 1 -1 .0 27 8 2. 4 0. 7 7. 3 0. 4 28 0 B el iz e (E xc lu di ng B el iz e C ity S ou th S id e) 5. 0 0. 0 -0 .2 19 8 13 .9 6. 9 -0 .7 18 6 4. 2 2. 6 14 .1 0. 3 18 6 B el iz e C ity S ou th S id e 5. 6 0. 8 -0 .1 23 5 8. 1 1. 7 -0 .3 23 5 3. 4 1. 3 8. 5 0. 2 23 4 B el iz e D is tri ct 5. 3 0. 4 -0 .1 43 4 10 .7 4. 0 -0 .5 42 1 3. 8 1. 9 11 .0 0. 2 42 0 C ay o 5. 3 1. 6 -0 .3 42 1 18 .6 4. 1 -0 .8 41 3 2. 8 1. 6 6. 0 0. 1 41 0 S ta nn C re ek 9. 5 1. 6 -0 .5 20 7 17 .5 3. 5 -0 .7 20 6 4. 9 1. 2 4. 4 0. 0 20 5 To le do 7. 4 2. 0 -0 .4 21 6 41 .6 16 .1 -1 .6 21 4 3. 3 0. 9 12 .3 0. 5 20 6 Ag e 0- 5 7. 5 2. 7 -0 .1 12 6 13 .6 6. 9 -0 .4 12 3 5. 7 4. 5 12 .6 0. 2 11 9 6- 11 3. 3 1. 8 0. 0 19 1 10 .9 3. 0 -0 .2 18 8 4. 1 0. 8 6. 9 0. 2 18 6 12 -2 3 5. 1 0. 5 -0 .2 38 4 22 .8 4. 3 -1 .0 37 9 1. 7 0. 3 8. 7 0. 4 38 0 24 -3 5 6. 5 0. 8 -0 .3 36 0 19 .5 6. 8 -1 .0 35 1 3. 4 1. 4 7. 2 0. 2 34 7 36 -4 7 7. 5 1. 8 -0 .5 37 5 20 .7 6. 3 -1 .1 37 1 4. 1 0. 9 7. 4 0. 2 37 1 48 -5 9 6. 6 1. 4 -0 .5 37 2 20 .3 5. 1 -1 .0 36 9 2. 8 1. 4 7. 0 0. 1 36 4 M ot he r's ed uc at io n N on e 8. 5 .8 -0 .4 94 28 .4 9. 2 -1 .1 93 1. 8 0. 0 10 .9 0. 4 93 P rim ar y 7. 0 1. 6 -0 .5 90 7 26 .7 7. 5 -1 .2 89 1 2. 8 1. 3 5. 7 0. 2 88 4 S ec on da ry + 5. 2 0. 9 -0 .1 75 7 10 .4 2. 7 -0 .5 74 7 4. 1 1. 3 10 .6 0. 2 74 0 O th er (2 .3 ) (2 .3 ) (0 .0 ) 42 (4 .6 ) (2 .4 ) (-0 .4 ) 41 (2 .1 ) (2 .1 ) (0 .0 ) (0 .2 ) 42 W ea lth in de x qu in til es P oo re st 8. 8 2. 1 -0 .6 46 9 32 .9 11 .1 -1 .3 46 4 3. 8 1. 4 4. 9 0. 2 45 9 S ec on d 7. 0 1. 7 -0 .5 42 1 21 .5 3. 5 -1 .1 41 5 4. 4 0. 6 7. 5 0. 2 41 7 M id dl e 5. 0 0. 5 -0 .2 38 3 12 .3 3. 7 -0 .6 37 3 2. 2 1. 1 8. 9 0. 2 36 9 Fo ur th 4. 7 0. 6 -0 .2 30 5 11 .8 2. 9 -0 .6 30 2 3. 5 2. 3 8. 8 0. 2 30 0 R ic he st 3. 0 1. 1 0. 1 23 0 9. 0 3. 5 -0 .5 22 6 1. 8 0. 7 11 .7 0. 4 22 4 Et hn ic ity o f ho us eh ol d he ad C re ol e 4. 3 1. 0 -0 .2 33 2 9. 9 3. 5 -0 .5 33 3 4. 0 2. 1 7. 5 0. 1 32 6 M es tiz o 5. 9 1. 2 -0 .3 89 5 19 .1 4. 7 -1 .0 87 5 3. 1 0. 7 7. 6 0. 3 87 4 G ar ifu na 8. 4 0. 8 -0 .4 98 8. 5 0. 6 -0 .5 96 5. 1 0. 8 5. 2 0. 0 96 M ay a 9. 1 2. 7 -0 .7 27 8 44 .3 14 .0 -1 .7 27 5 2. 5 1. 8 9. 9 0. 4 27 1 O th er 4. 5 0. 6 -0 .1 17 6 6. 0 1. 9 -0 .4 17 2 3. 7 1. 4 6. 8 0. 1 17 1 M is si ng /D K (1 0. 9) (0 .0 ) (0 .1 ) 29 (1 1. 7) (5 .2 ) (-0 .4 ) 29 (0 .0 ) (0 .0 ) (1 3. 7) (0 .4 ) 29 To ta l 6. 2 1. 3 -0 .3 18 09 19 .3 5. 4 -0 .9 17 80 3. 3 1. 2 7. 9 0. 2 17 68 [1 ] M IC S in di ca to r 2 .1 a an d M D G in di ca to r 1 .8 ; [2 ] M IC S in di ca to r 2 .1 b; [3 ] M IC S in di ca to r 2 .2 a, [4 ] M IC S in di ca to r 2 .2 b; [5 ] M IC S in di ca to r 2 .3 a, [6 ] M IC S in di ca to r 2 .3 b; ( ) F ig ur es th at a re b as ed o n 25 -4 9 un -w ei gh te d ca se s; 7 u n- w ei gh te d ca se s in "C ET /IT VE T/ V O TE C " a nd "M is si ng /D K " o n th e M ot he r's E du ca tio n ar e no t s ho w n mics f inal report 39 Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a plausible range are excluded from Table NU.1. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.6 and DQ.7 in Appendix F. Overall 91.5 percentage of children under 5 years had both their weights and heights measured (Table DQ.7 in Appendix F). Both weights and age were measured in 93.6 percent of children and both height and age were measured in 92.4 percent of children under-5 years. It is seen that the percentages of children under age 6 months excluded from the analysis were about twice as high as the rates for other age groups. This is true for all three anthropomorphic indicators. Table DQ.7 shows that due to incomplete dates of birth, implausible measurements, and missing weight and/or height, 6.4 percent of children have been excluded from calculations of the weight-for-age indicator, while the figures are 7.6 for the height-for-age indicator, and 8.5 for the weight-for-height indicator. About 6 percent of children under age five in Belize are moderately underweight and 1 percent are classified as severely underweight (Table NU.1). Almost 20 percent of children (19.3 percent) are moderately stunted or too short for their age and 3.3 percent are moderately wasted or too thin for their height. About 7.9 percent of children under age 5 years are considered to be obese. Males and females show approximately the same rates for moderate underweight, stunting and wasting. A small difference in rates occur in urban and rural areas with rural children having higher rates than urban children in all three categories (urban/rural percentages are: 5.4/6.6 underweight, 15.7/21.4 stunting and 2.8/3.6 wasting). Generally urban children are more obese than rural children with rates of 9.8 percent urban and 6.7 percent rural. 40 mics f inal report Children from poor households are more likely to be underweight and stunted than other children from wealthier households (Figure NU.1). A clear distinction can not be made between children in different wealth categories with respect to wasting. In contrast, a trend for higher percentages for wealthier households is evident for obesity. Stunting is highest in Toledo District (41.6 Percent) and lowest in Belize City South Side (8.1 percent) (Figure NU.2). Also obesity is most pronounced in Toledo (12.3 percent) and Belize City Excluding Belize City South Side (14.1 percent). In general, Belize City South Side appears to be less disadvantaged with respect to all four anthropomorphic indicators, except for overweight (Figure NU.2). Children from Maya headed households have the highest rates for underweight (9.1 percent), stunting (44.3 percent) and obesity (9.9 percent) when compared to children of other ethnicities. Wasting is least prevalent in children from Maya headed households (2.5 percent) (Figure NU.3). mics f inal report 41 Breastfeeding and Infant and Young Child Feeding 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. WHO/UNICEF have the following feeding recommendations: o Exclusive breastfeeding for first six months o Continued breastfeeding for two years or more o Safe and age-appropriate complementary foods beginning at 6 months o 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 related to recommended child feeding practices are as follows: o Early initiation of breastfeeding (within 1 hour of birth) o Exclusive breastfeeding rate (< 6 months) o Predominant breastfeeding (< 6 months) o Continued breastfeeding rate (at 1 year and at 2 years) o Duration of breastfeeding o Age-appropriate breastfeeding (0-23 months) o Introduction of solid, semi-solid and soft foods (6-8 months) o Minimum meal frequency (6-23 months) o Milk feeding frequency for non-breastfeeding children (6-23 months) o Bottle feeding (0-23 months) Table NU.2 provides the proportion of children born in the last two years who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a pre-lacteal feed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, 61.5 percent of babies are breastfed for the first time within one hour of birth, while 83.1 percent of newborns in Belize start breastfeeding within one day of birth, and 92 percent have ever been breastfed. Mother’s education does not seem to impact rates of early breastfeeding. However, pre-lacteal feeding increases significantly with increasing level of education (none at 9.8 percent to Secondary + at 16.6 percent). Rates of breastfeeding within one hour of birth for urban and rural children do not appear to be significantly different. However, rates for urban children breastfed within one day is 77.4 percent while the rate for rural children is 86.7 percent. 42 mics f inal report Table NU.2: Initial breastfeeding Percentage of last-born children in the 2 years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a pre-lacteal feed, Belize, 2011 Percentage ever breastfed [1] Percentage who were first breastfed: Within one hour of birth [2] Percentage who were first breastfed: Within one day of birth Percentage who received a pre- lacteal feed Number of last- born children in the two years preceding the survey Region Corozal 97.4 56.5 78.4 27.4 95 Orange Walk 90.1 62.9 84.5 18.0 108 Belize (Excluding Belize City South Side) (89.6) (54.7) (83.1) (33.1) 74 Belize City South Side 89.2 69.7 84.1 25.8 77 Belize District 89.4 62.3 83.6 29.4 151 Cayo 88.6 59.1 80.9 22.9 189 Stann Creek 96.8 70.7 88.1 16.3 69 Toledo 96.7 61.7 87.5 3.8 73 Area Urban 87.9 61.1 77.4 22.5 262 Rural 94.5 61.8 86.7 20.9 424 Months since last birth 0-11 months 91.4 59.6 82.2 19.8 313 12-23 months 92.5 63.0 83.9 23.7 357  Assistance at delivery Skilled attendant 92.1 61.4 83.2 22.0 659 Traditional birth attendant (*) (*) (*) (*) 12 Other (*) (*) (*) (*) 8 Missing (*) (*) (*) (*) 6 Place of delivery Public sector health facility 93.7 65.2 86.8 17.8 526 Private sector health facility 84.1 47.0 68.5 38.9 117 Home (98.3) (60.4) (85.4) (21.6) 39 Other/Missing (*) (*) (*) (*) 4 Mother’s education None 92.0 54.4 80.7 9.8 41 Primary 92.8 61.4 85.8 16.6 311 Secondary + 91.1 62.0 81.1 27.6 315 CET/ITVET/VOTEC (*) (*) (*) (*) 3 Other (*) (*) (*) (*) 15 Wealth index quintiles Poorest 93.6 61.8 85.3 9.5 173 Second 91.5 61.5 83.5 22.6 156 Middle 90.9 60.8 85.0 22.7 134 Fourth 92.2 68.8 87.6 22.4 132 Richest 90.6 51.2 69.2 39.6 91 Ethnicity of household head Creole 89.4 63.5 82.6 28.3 113 Mestizo 91.2 59.9 81.5 21.6 355 Garifuna (96.9) (74.7) (89.8) (13.2) 43 Maya 97.9 66.0 88.0 9.3 96 Other 88.8 52.5 82.1 30.6 71 Missing/DK (*) (*) (*) (*) 8 Total 91.9 61.5 83.1 21.5 685 [1] MICS indicator 2.4; [2] MICS indicator 2.5 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 43 Children from the richest families ever breastfed less frequently than children from less wealthy families while pre-lacteal feeding is most pronounced in the richest (39.6 percent) families and least evident in the poorest (9.5 percent) (Figure NU.4). The Maya and Garifuna children seem to be ever breastfed at rates slightly higher than the Creole or Mestizo children. Pre-lacteal feeding is accordingly least pronounced in the Maya and Garifuna (Figure NU.5). Breastfeeding rates are most pronounced for delivery at home or in a public sector hospital. Figure NU.6 indicates that private sector health facilities seem to be linked to reduced rates of early breast feeding and also to increased rates of pre-lacteal feeding. 44 mics f inal report Rates of early breastfeeding (within one hour or within one day) are lowest in the Corozal District and in Belize (excluding Belize City South Side) and highest in the Districts of Cayo and Toledo and in Belize City South Side (Figure NU.7). Pre-lacteal feeding seems to have a trend opposite to this with highest rates in the Corozal District and in Belize (excluding Belize City South Side) and lowest rates of breastfeeding in the Districts of Cayo and Toledo and in Belize City South Side. mics f inal report 45 In Table NU.3, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids during the previous day or night 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, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Belize, 2011 Children 0-5 months Children 12-15 months Children 20-23 months Percent exclusively breastfed [1]  Percent predominantly breastfed [2] Number of children Percent breastfed (Continued breastfeeding at 1 year) [3] Number of children Percent breastfed (Continued breastfeeding at 2 years) [4] Number of children Sex Male 10.5 30.3 90 63.6 57 37.0 62 Female 21.0 40.4 58 60.7 59 33.4 94 Region Corozal (*) (*) 18 (71.8) 21 (53.8) 26 Orange Walk (15.0) 53.6 28 (*) 17 (*) 23 Belize District (8.0) 13.5 37 (*) 30 (*) 34 Cayo (4.9) 26.0 40 (*) 24 (33.6) 43 Stann Creek (*) (*) 9 (*) 9 (*) 15 Toledo (*) (*) 16 (*) 14 (*) 15 Area Urban 10.9 29.3 61 (49.7) 50 32.3 69 Rural 17.3 37.8 87 71.5 66 36.9 87 Mother’s education Primary 15.3 36.1 62 65.7 54 38.2 71 Secondary + 11.6 30.6 75 60.7 51 30.3 74 Other (*) (*) 11 (*) 11 (*) 11 Wealth index quintiles Poorest (23.7) 62.0 29 (71.8) 26 (33.2) 43 Second (12.9) 40.8 31 (*) 25 (39.0) 43 Middle (22.3) 36.2 36 (*) 26 (*) 27 Fourth (4.6) 11.5 31 (*) 23 (*) 19 Richest (*) (*) 22 (*) 16 (*) 24 Ethnicity of household head Creole (14.1) 33.8 31 (*) 22 (28.7) 29 Mestizo 9.0 27.1 71 57.2 53 42.3 87 Garifuna (*) (*) 11 (*) 8 (*) 4 Maya (*) (*) 14 (*) 18 (36.8) 20 Other (*) (*) 21 (*) 16 (*) 15 Total 14.7 34.3 148 62.1 116 34.9 156 [1] MICS indicator 2.6; [2] MICS indicator 2.9; [3] MICS indicator 2.7; [4] MICS indicator 2.8 ( ) Figures that are based on 25-49 un-weighted cases ; (*) Figures that are based on less than 25 un-weighted cases There is marked difference between the sexes for the rates of exclusively breastfed infants 0 – 5 months of age. Approximately 10.5 percent males and 21.0 percent females aged less than six months are exclusively breastfed. A similar difference is evident for children 0 – 5 months who are predominantly breastfed (males 30.3 and females 40.4 percent). By age 12-15 months rates for continued breastfeeding are approximately equal for males (63.6 percent) and females (60.7 percent). The same applies for continued breastfeeding for children 20 – 23 months (males 36.9 percent and females 33.8 percent). Table NU.3 shows urban/rural differences in the rates of breastfeeding in children 0 – 5 months and 12 – 15 months. Rates for exclusively breastfed 0 – 5 month old children are urban 11.2 percent and rural 17.0 percent. For predominantly breastfed children the rates are urban 30.0 percent and rural 37.1 percent. Differences are even more pronounced for continued breastfeeding in children 12 – 15 months of age (urban 46 mics f inal report 49.7 percent and rural 71.5 percent). At two years the rates for urban and rural children are approximately equal. A detailed examination of breastfeeding for variables other than sex and area can not be justified because the sample size is inadequate. Table NU.4 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 16.0 months for any breastfeeding, 0.9 months for exclusive breastfeeding, and 3.1 months for predominant breastfeeding. The median duration for exclusive and predominant breastfeeding is small for all variables rarely exceeding 3 months. Similarly the median duration for any breastfeeding does not exceed two years. Table NU.4: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Belize, 2011 Median duration (in months) of Number of children age 0-35 months Any breastfeeding [1] Exclusive breastfeeding Predominant breastfeeding Sex Male 15.8 0.4 0.9 591 Female 16.6 0.7 1.4 563 Region Corazal 22.6 1.0 1.5 162 Orange Walk 14.8 0.5 2.8 184 Belize (Excluding Belize City South Side 15.4 na na 125 Belize City South Side 8.7 0.6 1.1 143 Belize District 11.9 0.5 0.6 268 Cayo 15.6 0.4 0.6 283 Stann Creek 16.4 1.4 2.9 121 Toledo 17.8 1.3 4.6 137 Area Urban 12.6 0.5 1.0 443 Rural 18.0 0.5 1.1 711 Mother’s education None 22.9 1.8 1.8 62 Primary 18.6 0.6 1.6 543 Secondary+ 14.8 0.5 0.7 514 CET/ITVET/VOTEC (*) (*) (*) 8 Wealth index quintile Poorest 19.5 0.9 3.5 293 Second 16.6 0.5 2.1 261 Middle 11.7 0.7 1.8 241 Fourth 20.5 0.4 0.4 190 Richest 6.1 0.4 0.5 169 Ethnicity of household head Creole 15.0 0.5 1.2 207 Mestizo 19.0 0.5 0.7 580 Garifuna 13.2 0.9 2.7 65 Maya 17.6 0.5 2.4 167 Other 14.3 0.7 0.7 118 Median 16.1 0.5 1.0 1154 Mean for all children (0-35 months) 16.0 0.9 3.1 1154 [1] MICS indicator 2.10 (*) Figures that are based on less than 25 un-weighted cases; na Not applicable The adequacy of infant feeding in children under 24 months is provided in Table NU.5. Different criteria of feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while infants aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft food. mics f inal report 47 Overall, only 43.9 percent of children aged 6-23 months are being appropriately fed. Age-appropriate feeding among all infants 0-5 months old drops to 14.7 percent. Age-appropriate feeding rates for children 0 – 5 months are considerably different for the sexes (males 10.5 percent and females 21.0 percent) and also for urban/rural areas (urban 10.9 percent and rural 17.3 percent). Small sample sizes prevent comparisons for other variables for the 0 – 5 month old children. For 6 – 23 month old children small difference in age-appropriate feeding rates occur between the sexes (males 45.5 percent and females 42.2 percent) and between urban and rural areas (urban 38.7 percent and rural 47.1 percent). Surprisingly, children of mothers with primary education appropriately feed their children at a rate of 47.7 percent while mothers with a secondary education or better only appropriately feed their children at a rate of 38.1 percent. A similar pattern exists for wealthy families. Children from poor families are appropriately fed at a rate of 50.7 percent while the richest families adequately feed their children at a rate of 28.0 percent. Figure NU.8 clearly shows the decreasing pattern for all children less than 2 years with respect to wealth and educational level. 48 mics f inal report Table NU.5: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Belize, 2011 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed [1] Number of children Percent currently breastfeeding and receiving solid, semi- solid or soft foods Number of children Percent appropriately breastfed [2] Number of children Sex Male 10.5 90 45.5 306 37.6 396 Female 21.0 58 42.2 307 38.9 365 Region Corozal (*) 18 64.6 93 58.0 110 Orange Walk (15.0) 28 40.4 96 34.7 124 Belize (Excluding Belize City South Side) (*) 17 (48.1) 66 38.1 83 Belize City South Side (*) 20 37.2 71 32.3 91 Belize District (8.0) 37 42.4 137 35.1 174 Cayo (4.9) 40 35.1 154 28.8 195 Stann Creek (*) 9 38.3 68 36.1 77 Toledo (41.5) 16 48.9 66 47.5 82 Area Urban 10.9 61 38.7 237 33.0 298 Rural 17.3 87 47.1 376 41.5 463 Mother's education None (*) 7 (59.8) 38 (53.4) 45 Primary 15.3 62 47.7 285 41.9 347 Secondary + 11.6 75 38.9 275 33.0 350 CET/ITVET/VOTEC (*) 1 (*) 3 (*) 3 Missing/DK (*) 0 (*) 0 (*) 0 Other (*) 3 (*) 13 (*) 16 Wealth index quintiles Poorest (23.7) 29 50.7 160 46.6 189 Second (12.9) 31 45.4 141 39.6 172 Middle (22.3) 36 41.1 118 36.7 154 Fourth (4.6) 31 47.6 107 37.9 138 Richest (*) 22 28.0 87 23.8 108 Ethnicity of household head Creole (14.1) 31 36.1 97 30.7 129 Mestizo 9.0 71 46.6 323 39.9 394 Garifuna (*) 11 (33.5) 33 (31.9) 44 Maya (*) 14 47.6 91 45.5 105 Other (*) 19 43.4 60 37.4 80 Missing/DK (*) 2 (*) 8 (*) 10 Total 14.7 148 43.9 613 38.2 761 [1] MICS indicator 2.6; [2] MICS indicator 2.14 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Appropriate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the prevention of under-nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. Appropriate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the prevention of under-nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. mics f inal report 49 About 68.0 percent of infants age 6-8 received solid, semi-solid, or soft foods (Table NU.6). Among currently breastfeeding infants this percentage is 68.5 while it is 67.0 among infants currently not breastfeeding. Females fare better than males in being fed adequate amounts of complementary foods (overall males 65.8 percent and females 70.6 percent). Urban children seem to fare better than rural children (73.0 percent to 65.7 percent). Table NU.6: Introduction of solid, semi-solid or soft food Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day, Belize, 2011 Currently breastfeeding Currently not breastfeeding All Percent re- ceiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods [1] Number of children age 6-8 months Sex Male (66.5) 40 (*) 14 64.6 54 Female (71.0) 30 (*) 15 (70.6) 46 Area Urban (*) 18 (*) 15 (70.8) 33 Rural 64.6 52 (*) 15 65.7 67 Total 68.5 70 (*) 29 67.4 100 [1] MICS indicator 2.12 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Table NU.7 presents the proportion of children age 6-23 months who received semi-solid or soft foods the minimum number of times or more during the previous day according to breastfeeding status (see the note in Table NU.7 for a definition of minimum number of times for different age groups). Overall, over a half of the children age 6-23 months (67.6 percent) were receiving solid, semi-solid and soft foods the minimum number of times. 50 mics f inal report Table NU.7: Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breastfeeding status, Belize, 2011 Currently breastfeeding Currently not breastfeeding All Percent re- ceiving solid, semi-solid and soft foods the minimum number of times Number of children age 6-23 months Percent receiving at least 2 milk feeds [1] Percent re- ceiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Percent with minimum meal fre- quency [2] Num- ber of children age 6-23 months Sex Male 48.6 168 85.3 89.8 138 67.1 306 Female 51.2 157 83.5 85.7 150 68.1 307 Age 6-8 months 43.1 70 (88.3) (88.3) 29 56.4 100 9-11 months 42.3 70 (92.2) (92.2) 39 60.2 109 12-17 months 49.3 102 85.1 89.4 73 66.0 174 18-23 months 62.6 83 81.1 85.4 147 77.2 230 Region Corozal 67.4 62 (85.7) (88.3) 30 74.3 93 Orange Walk (56.9) 47 92.6 94.2 48 75.7 96 Belize (Excluding Belize City South Side) (*) 37 (*) (*) 29 (53.1) 66 Belize City South Side (42.6) 28 (91.1) (95.6) 43 74.4 71 Belize District 37.6 65 83.6 88.4 72 64.2 137 Cayo (44.0) 72 91.9 92.2 82 69.5 154 Stann Creek (45.0) 35 (90.3) (90.3) 32 66.6 68 Toledo (48.9) 42 (34.2) (52.0) 24 50.0 66 Area Urban 51.5 101 90.8 90.7 136 74.0 237 Rural 49.1 224 78.6 84.9 152 63.6 376 Mother’s edu- cation None (58.6) 28 (*) (*) 10 (65.4) 38 Primary 49.7 168 79.8 85.0 117 64.2 285 Secondary + 47.9 124 87.3 89.1 151 70.5 275 CET/ITVET/VOTEC (*) 0 (*) (*) 3 (*) 3 Other (*) 5 (*) (*) 7 (*) 13 Wealth index quintiles Poorest 53.7 103 58.8 73.5 57 60.8 160 Second 53.4 82 88.1 92.2 59 69.6 141 Middle 31.3 53 93.3 93.3 65 65.3 118 Fourth 51.5 61 (92.2) (89.5) 46 67.9 107 Richest (*) 26 89.4 89.1 61 79.7 87 Ethnicity of household head Creole (42.3) 40 91.4 90.1 58 70.6 97 Mestizo 52.5 183 87.6 88.5 140 68.1 323 Garifuna (*) 17 (*) (*) 16 (58.9) 33 Maya 42.1 55 (63.7) (80.1) 36 57.1 91 Other (59.9) 28 (90.8) (95.0) 33 78.8 60 Missing/DK (*) 3 (*) (*) 6 (*) 8 Total 49.8 325 84.4 87.6 288 67.6 613 [1] MICS indicator 2.15; [2] MICS indicator 2.13 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.8 shows that bottle-feeding is still prevalent in Belize. Almost sixty percent (57.8 percent) of children under 6 months of age are fed using a bottle with a nipple. mics f inal report 51 Table NU.8: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Belize, 2011 Percentage of children age 0-23 months fed with a bottle with a nipple [1] Number of children age 0-23 months: Sex Male 63.7 396 Female 51.4 365 Age 0-5 months 54.6 148 6-11 months 63.5 209 12-23 months 55.9 404 Region Corozal 49.0 110 Orange Walk 44.2 124 Belize (Excluding Belize City South Side) 71.7 83 Belize City South Side 75.5 91 Belize District 73.7 174 Cayo 64.0 195 Stann Creek 72.4 77 Toledo 27.6 82 Area Urban 69.9 298 Rural 49.9 463 Mother's education None (43.4) 45 Primary 49.6 347 Secondary + 68.7 350 CET/ITVET/VOTEC (*) 3 Other (*) 16 Wealth index quintiles Poorest 39.0 189 Second 53.3 172 Middle 64.2 154 Fourth 66.5 138 Richest 77.1 108 Ethnicity of household head Creole 71.6 129 Mestizo 56.1 394 Garifuna (73.9) 44 Maya 42.9 105 Other 53.9 80 Missing/DK (*) 10 Total 57.8 761 [1] MICS indicator 2.11 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases In children under 23 months males are more likely than females to be fed from a bottle with a nipple (males 63.7 percent and females 51.4 percent). It is clear that urban children are also more likely to be fed from a bottle (urban 69.9 percent and rural 49.9 percent). In Belize, the prevalence is highest in Belize City South Side (75.5 percent) and the rest of the Belize District (71.7 percent) and in the Stann Creek District (72.4 percent), and it is lowest in the Toledo District (27.6 percent). Rates of bottle feeding increase as the educational level of the mother increases (no education: 43.4 percent to Secondary+: 68.7 percent). A similar trend exists for the index of wealth with poorest families at 39.0 percent and the richest families at 77.1 percent (Figure NU.9). Children with Creole (71.6 percent) and Garifuna (73.9 percent) heads of household display elevated prevalence among ethnic groups for feeding from a bottle with a nipple. In children under 23 months males are more likely than females to be fed from a bottle with a nipple (males 63.7 percent and females 51.4 percent). It is clear that urban children are also more likely to be fed from a bottle (urban 69.9 percent and rural 49.9 percent). In Belize, the prevalence is highest in Belize City South Side (75.5 percent) and the rest of the Belize District (71.7 percent) and in the Stann Creek District (72.4 percent), and it is lowest in the Toledo District (27.6 percent). Rates of bottle feeding increase as the educational level of the mother increases (no education: 43.4 percent to Secondary+: 68.7 percent). A similar trend exists for the index of wealth with poorest families at 39.0 percent and the richest families at 77.1 percent (Figure NU.9). Children with Creole (71.6 percent) and Garifuna (73.9 percent) heads of household display elevated prevalence among ethnic groups for feeding from a bottle with a nipple. 52 mics f inal report Children’s Vitamin A Supplementation 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 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 mics f inal report 53 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 Belize Ministry of Health recommends that children aged 6-11 months be given one high dose Vitamin A capsules and children aged 12-59 months given a vitamin A capsule every 6 months. In some parts of the country, Vitamin A capsules are linked to immunization services and are given when the child has contact with these services after six months of age. It is also recommended that mothers take a Vitamin A supplement within eight weeks of giving birth due to increased Vitamin A requirements during pregnancy and lactation. Within the six months prior to the MICS, 65.1 percent of children aged 6-59 months received a high dose Vitamin A supplement (Table NU.10). Approximately 66.9 percent of females received the supplement in the last 6 months: males received treatment at a rate of 63.1 percent. Children from the Toledo District (51.3 percent) and the Belize City South Side (51.9 percent) were less likely to get Vitamin A supplement within the last 6 months. Maya children (58.2 percent) were least likely to receive Vitamin A supplement within the last 6 months. The age pattern of Vitamin A supplementation shows that supplementation in the last six months rises slowly from 53.3 percent among children aged 6-11 months to 68.0 percent among children aged 48-59 months. Rural children receive Vitamin A supplementation at a rate of 66.9 percent as compared to urban rate of 62.0 percent. 54 mics f inal report Table NU.10: Children’s vitamin A supplementation Percent distribution of children age 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, Belize, 2011 Percentage who received Vitamin A according to: Percentage of children who received Vitamin A during the last 6 months [1] Number of children age 6-59 months Child health book/card/ vaccination card Mother’s report Sex Male 2.8 63.2 63.2 894 Female 4.8 66.9 66.9 904 Region Corozal 10.3 57.0 57.0 246 Orange Walk 3.8 65.9 65.9 274 Belize (Excluding Belize City South Side) 3.5 67.6 67.6 223 Belize City South Side 1.4 51.9 51.9 232 Belize District 2.4 59.6 59.6 455 Cayo 4.4 78.2 78.2 409 Stann Creek 0.0 73.9 73.9 203 Toledo 2.1 51.3 51.3 211 Area Urban 2.7 62.0 62.0 682 Rural 4.5 66.9 66.9 1116 Age 6-11 5.0 53.3 53.3 209 12-23 3.6 65.5 65.5 404 24-35 4.3 66.5 66.5 393 36-47 4.8 66.5 66.5 395 48-59 2.0 68.0 68.0 397 Mother’s education None 3.4 45.5 45.5 93 Primary/Infant 3.7 66.9 66.9 884 Secondary + 4.0 65.3 65.3 764 CET/ITVET/VOTEC (*) (*) (*) 13 Missing/DK (*) (*) (*) 1 Other 2.1 60.3 60.3 43 Wealth index quintiles Poorest 3.6 55.9 55.9 462 Second 5.5 72.6 72.6 420 Middle 3.1 61.2 61.2 371 Fourth 5.1 69.0 69.0 299 Richest 1.0 70.6 70.6 247 Ethnicity of household head Creole 3.7 67.2 67.2 347 Mestizo 5.0 67.9 67.9 878 Garifuna 0.0 69.3 69.3 94 Maya 3.1 58.2 58.2 274 Other 1.0 54.9 54.9 175 Missing/DK 5.6 66.6 66.6 29 Total 3.8 65.1 65.1 1798 [1] MICS indicator 2.17 (*) Figures that are based on less than 25 un-weighted cases mics f inal report 55 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 birth2 . 2 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. 56 mics f inal report Table NU.11: Low birth weight infants Percentage of last-born children in the 2 years preceding the survey that are estimated to have weighed below 2500 grams at birth and percentage of live births weighed at birth, Belize, 2011 Percent of live births: Below 2500 grams [1] Weighed at birth [2] Number of live births in the last 2 years Region Corozal 13.5 98.2 95 Orange Walk 9.4 98.4 108 Belize (Excluding Belize City South Side) 12.9 87.5 74 Belize City South Side 10.2 96.4 77 Belize District 11.5 92.0 151 Cayo 10.4 98.3 189 Stann Creek 12.4 90.7 69 Toledo 10.6 87.8 73 Area Urban 11.4 96.3 262 Rural 11.0 94.3 424 Education None (11.2) (91.6) 41 Primary 12.2 94.5 311 Secondary + 10.5 95.8 315 CET/ITVET/VOTEC (*) (*) 3 Other (*) (*) 15 Wealth index quintiles Poorest 12.1 91.9 173 Second 14.1 96.0 156 Middle 9.6 95.9 134 Fourth 9.7 95.6 132 Richest 8.7 97.3 91 Ethnicity of household head Creole 13.4 95.1 113 Mestizo 10.1 95.6 355 Garifuna (10.1) (92.4) 43 Maya 13.9 91.7 96 Other 9.8 100.0 71 Missing/DK (*) (*) 8 Total 11.1 95.0 685 [1] MICS indicator 2.18; [2] MICS indicator 2.19 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 57 Overall, 95.0 percent of births were weighed at birth and approximately 11.1 percent of infants are estimated to weigh less than 2500 grams at birth (Table NU.11). There was notable variation by wealth (Figure NU.10). Maya (13.9 percent) and Creole (13.4 percent) children show elevated rates low birth weights. Low birth weight infants are most prevalent in the Corozal District (13.5 percent), the Belize area (excluding Belize City South Side) (12.9 percent) and the Stann Creek District (12.4 percent). The percentage of low birth weight does not vary much by urban and rural areas or by mother’s education. 58 mics f inal report vi. Child healTh Vaccinations 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 18 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. 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 (and by 18 months for measles), Belize, 2011 Vaccinated at any time before the survey according to: vaccination card Vaccinated at any time before the survey according to: Mother’s report Vaccinated at any time before the survey according to: either Vaccinated by 12 months of age (18 months for measles) bCG [1] 75.5 22.5 98.0 97.5 Polio 1 75.0 22.4 97.3 95.6 Polio 2 75.6 1.8 77.4 75.2 Polio 3 [2] 69.2 0.8 70.0 65.3 Polio booster 1.5 0.8 2.3 1.4 DTP 1) 77.7 5.8 83.4 81.7 DTP 2) 75.4 1.2 76.6 74.2 DTP 3) [3] 72.3 1.2 73.5 67.8 DPT booster (Diphteria, Whooping Cough, Tetanus) 1.4 1.2 2.6 2.2 HIB 1 Haemophilus Influenzae B) 77.5 6.0 83.5 83.5 HIB 2 Haemophilus Influenzae B) 75.4 1.2 76.6 76.6 HIB 3 Haemophilus Influenzae B) 72.3 1.2 73.5 73.5 HIB 4 Haemophilus Influenzae B) 1.6 1.1 2.8 2.1 hepb 1 77.4 6.1 83.5 83.5 hepb 2 75.3 1.5 76.8 76.8 hepb 3 [5] 72.2 1.5 73.7 73.7 Measles [4] 72.2 17.5 89.8 84.9 all vaccinations 62.9 0.0 62.9 54.3 no vaccinations 0.0 1.7 1.7 1.7 Number of children age 18-29 months 405 405 405 405 [1] MICs indicator 3.1; [2] MICs indicator 3.2; [3] MICs indicator 3.3; [4] MICs indicator 3.4; MDG indicator 4.3; [5] MICs indicator 3.5 mics f inal report 59 Overall, 75.3 percent of children had health cards that were seen by the interviewers (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, Polio, HIB and Heb B, how many times. The percentage of children age 12 to 23 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children age 12-23 months so that only children who are old enough to be fully vaccinated are counted. For measles, the denominator is 18-29 months as the vaccine is administered from age 6 months. 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. Approximately 97.5 percent of children age 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 81.7 percent. The percentage declines for subsequent doses of DPT to 74.2 percent for the second dose, and 67.8 percent for the third dose (Figure CH.1). Similarly, 95.6 percent of children received Polio 1 by age 12 months and this declines to 65.3 percent by the third dose. The coverage for measles vaccine by 18 months is somewhat lower than for the other vaccines at 84.9 percent. In Belize, influenza vaccinations are also recommended as part of the immunization schedule and three doses are provided to the child by age 12 months. These can be seen in Table CH1. Table CH.2 shows vaccination coverage rates among children 12-23 months by background characteristics. The 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. In general, Maya children seem to have the lowest levels of vaccinations followed by Creole children. There were too few cases of Garifuna children to make useable comparisons. Female children overall seem to have slightly higher coverage rates than male children, though the differences are generally small. The Toledo District and Belize City South Side have the lowest vaccination rates of all regions of the country for BCG, Polio 1, DPT 1 and Measles vaccinations. 60 mics f inal report Ta b le C H .2 : V ac ci n at io n s b y b ac kg ro u n d c h ar ac te ri st ic s Pe rc en ta g e o f ch ild re n a g e 18 -2 9 m o n th s cu rr en tl y va cc in at ed a ga in st c h ild h o o d d is ea se s, B el iz e, 2 01 1 P E R C E N TA G E O F C H IL D R E N W H O R E C E IV E D : Pe rc en ta g e w it h v ac ci - n at io n c ar d se en N u m b er o f ch ild re n ag e 18 -2 9 m o n th s B C G Po lio 1 Po lio 2 Po lio 3 D P T 1 D P T 2 D P T 3 D P T B o o st - er H IB 1 H IB 2 H IB 3 H IB 4 H ep B 1 H ep B 2 H ep B 3 M ea - sl es 1 N o n e A ll S ex M al e 99 .0 98 .2 75 .2 67 .4 83 .3 75 .9 73 .0 3. 2 83 .4 75 .9 73 .0 3. 2 83 .4 76 .4 73 .5 88 .7 0. 7 58 .6 72 .7 19 8 Fe m al e 97 .0 96 .4 79 .4 72 .4 83 .5 77 .2 73 .9 2. 1 83 .5 77 .2 73 .9 2. 5 83 .6 77 .3 74 .0 90 .8 2. 7 66 .8 77 .9 20 7 R eg io n C o ro za l 98 .3 96 .7 82 .1 82 .1 82 .3 82 .1 77 .3 3. 1 82 .3 82 .1 77 .3 3. 1 82 .6 82 .4 77 .7 93 .6 1. 7 74 .5 77 .2 56 O ra n g e W al k 10 0. 0 10 0. 0 80 .3 74 .4 85 .7 82 .5 78 .0 2. 1 85 .7 82 .5 78 .0 2. 1 85 .7 82 .5 78 .0 95 .7 0. 0 71 .7 81 .7 67 B el iz e (E xc lu d in g B el iz e C it y S o u th S id e) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 36 B el iz e C it y S o u th S id e 98 .0 98 .0 78 .3 73 .8 92 .2 80 .3 75 .8 6. 4 92 .3 80 .3 75 .8 6. 4 92 .2 80 .3 75 .8 92 .1 2. 0 68 .3 73 .9 52 B el iz e D is tr ic t 98 .8 98 .8 74 .5 64 .7 84 .4 72 .0 69 .5 3. 7 84 .6 72 .0 69 .5 3. 7 84 .4 72 .0 69 .5 93 .5 1. 2 61 .7 73 .8 88 C ay o 96 .9 95 .3 81 .6 69 .9 85 .5 80 .9 77 .8 0. 0 85 .5 80 .9 77 .8 .0 85 .5 80 .9 77 .8 82 .2 3. 1 60 .1 82 .9 99 S ta n n C re ek (1 00 .0 ) (9 7. 9) (8 6. 9) (7 9. 7) (8 8. 0) (8 1. 1) (7 9. 0) (4 .6 ) (8 8. 0) (8 1. 1) (7 9. 0) (6 .9 ) (8 8. 0) (8 3. 2) (8 0. 9) (9 3. 4) (0 .0 ) (7 5. 3) (7 9. 2) 40 .3 To le d o 94 .1 95 .3 58 .8 54 .3 72 .3 58 .4 57 .1 4. 4 72 .3 58 .4 57 .1 4. 4 72 .6 58 .8 57 .6 82 .7 3. 7 38 .3 51 .5 55 A re a U rb an 98 .9 98 .7 77 .1 69 .0 84 .1 75 .0 70 .4 2. 2 84 .2 75 .0 70 .4 2. 2 84 .1 75 .0 70 .4 89 .4 0. 7 61 .7 74 .7 14 5 R u ra l 97 .5 96 .5 77 .6 70 .6 83 .1 77 .5 75 .2 2. 8 83 .1 77 .5 75 .2 3. 2 83 .2 77 .9 75 .7 89 .9 2. 3 63 .5 75 .7 26 0 M o th er ’s ed u ca ti o n N o n e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 22 Pr im ar y/ In fa n t 99 .3 98 .5 80 .7 74 .8 87 .8 81 .1 76 .3 1. 8 87 .8 81 .1 76 .3 2. 3 87 .9 81 .7 76 .9 91 .7 0. 3 67 .0 78 .8 18 7 S ec o n d ar y + 97 .9 97 .8 75 .3 66 .0 81 .7 74 .0 72 .4 3. 2 81 .8 74 .0 72 .4 3. 2 81 .7 74 .0 72 .4 89 .4 1. 7 59 .3 73 .2 18 4 E th n ic it y o f h o u se h o ld h ea d C re o le 99 .2 10 0. 0 81 .2 73 .1 89 .9 81 .7 80 .3 4. 0 90 .0 81 .7 80 .3 4. 0 89 .9 81 .7 80 .3 91 .6 0. 0 65 .2 78 .4 77 M es ti zo 99 .2 99 .2 80 .9 73 .6 84 .5 78 .1 75 .0 2. 4 84 .5 78 .1 75 .0 2. 8 84 .5 78 .6 75 .5 92 .9 0. 8 68 .2 80 .1 20 3 G ar if u n a (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 14 M ay a 96 .9 96 .1 69 .7 62 .8 74 .1 69 .8 68 .8 2. 9 74 .1 69 .8 68 .8 2. 9 74 .4 70 .1 69 .1 79 .3 3. 1 47 .2 59 .9 65 O th er (9 2. 5) (8 8. 0) (6 9. 4) (6 3. 4) (8 5. 2) (7 3. 6) (6 7. 6) (2 .1 ) (8 5. 2) (7 3. 6) (6 7. 6) (2 .1 ) (8 5. 2) (7 3. 6) (6 7. 6) (8 8. 2) (6 .1 ) (6 0. 5) (7 4. 0) 41 M is si n g /D K 10 0. 0 10 0. 0 48 .8 48 .8 48 .8 48 .8 48 .8 0. 0 48 .8 48 .8 48 .8 0. 0 48 .8 48 .8 48 .8 10 0. 0 0. 0 48 .8 48 .8 6 To ta l 98 .0 97 .3 77 .4 70 .0 83 .4 76 .6 73 .5 2. 6 83 .5 76 .6 73 .5 2. 8 83 .5 76 .8 73 .7 89 .8 1. 7 62 .9 75 .3 40 5 ( ) Fi g u re s th at a re b as ed o n 2 5- 49 u n -w ei g h te d c as es ; ( *) F ig u re s th at a re b as ed o n le ss t h an 2 5 u n -w ei g h te d c as es 4 u n -w ei g h te d c as es in “ C E T /IT V E T /V O T E C ” an d 9 u n -w ei g h te d c as es in “ O th er ” o n E d u ca ti o n a n d 6 u n -w ei g h te d c as es in M is si n g /D K ” in E th n ic it y o f th e h ea d o f h o u se h o ld a re n o t sh o w n mics f inal report 61 Neonatal Tetanus Protection 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. • The strategy of preventing maternal and neonatal tetanus is to assure all pregnant women receive at least two doses of tetanus toxoid vaccine. If a woman has not received two doses of the tetanus toxoid during a particular pregnancy, she (and her newborn) are also considered to be protected against tetanus if the woman: • Received at least two doses of tetanus toxoid vaccine, the last within the previous 3 years; • Received at least 3 doses, the last within the previous 5 years; • Received at least 4 doses, the last within the previous 10 years; • Received at least 5 doses anytime during her life. To assess the status of tetanus vaccination coverage, women who gave birth during the two years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this pregnancy were then asked about tetanus toxoid vaccinations they may have received prior to this pregnancy. Interviewers also asked women to present their vaccination card, on which dates of tetanus toxoid are recorded and referred to information from the cards when available. Table CH.3 presents the results. Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 2 years by major background characteristics. Overall, 52.4 percent of women are protected. Belize City South Side (39.0 percent) has the lowest rates of tetanus protection among the other regions. Garifuna women have the lowest rates (47.6 percent) while the Maya have the highest (54.0 percent). Less educated women seem to have lower rates of protection against Tetanus. 62 mics f inal report Table CH.3: Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, Belize, 2011 Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus [1] Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Area Urban 33.0 16.7 0.3 0.0 0.0 50.1 262 Rural 35.5 18.2 0.2 0.0 0.0 53.9 424 Region Corozal 39.5 17.7 0.8 0.0 0.0 58.0 95 Orange Walk 52.8 12.0 0.0 0.0 0.0 64.8 108 Belize (Excluding Belize City South Side) (26.6) (30.8) (0.0) (0.0) (0.0) (57.5) 74 Belize City South Side 24.1 13.7 1.1 0.0 0.0 39.0 77 Belize District 25.4 22.1 0.6 0.0 0.0 48.1 151 Cayo 32.6 16.6 0.0 0.0 0.0 49.1 189 Stann Creek 31.9 19.0 0.0 0.0 0.0 50.9 69 Toledo 27.7 18.3 0.0 0.0 0.0 46.0 73 Education None (16.8) (14.5) (0.0) (0.0) (0.0) (31.3) 46 Primary 36.4 14.3 0.5 0.0 0.0 51.2 306 Secondary + 36.5 20.7 0.0 0.0 0.0 57.2 315 Other (*) (*) (*) (*) (*) (*) 15 Wealth index quintiles Poorest 31.6 16.6 0.4 0.0 0.0 48.6 173 Second 33.2 20.7 0.0 0.0 0.0 53.9 156 Middle 33.0 10.4 0.6 0.0 0.0 44.1 134 Fourth 39.7 21.7 0.0 0.0 0.0 61.4 132 Richest 37.3 19.4 0.0 0.0 0.0 56.7 91 Ethnicity of household head Creole 30.6 21.7 0.8 0.0 0.0 53.0 113 Mestizo 39.2 13.5 0.2 0.0 0.0 52.9 355 Garifuna (24.5) (23.1) (0.0) (0.0) (0.0) (47.6) 43 Maya 30.3 23.6 0.0 0.0 0.0 54.0 96 Other 28.9 21.3 0.0 0.0 0.0 50.3 71 Total 34.5 17.7 0.2 0.0 0.0 52.4 685 [1] MICs indicator 3.7 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 3 un-weighted cases in “CET/ITvET/voTEC” on Education and 8 un-weighted cases in “Missing/dK” on Ethnicity of Household Head are not shown 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. mics f inal report 63 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 • ORT with continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had 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, 7.9 percent of under-five children had diarrhoea in the two weeks preceding the survey (Table CH.4). Diarrhoea prevalence was slightly higher in rural areas (8.8 percent) than in urban areas (4.6 percent). Males had a higher prevalence (9.2 percent) than females (6.5 percent). Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since children may have been given more than one type of liquid, the percentages do not necessarily add to 100. About 22.8 percent received fluids from ORS packets or pre-packaged ORS fluids and 42.7 percent received Pedialyte. Males and females received oral rehydration solution at about the same rates. Approximately 55.2 percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or any recommended homemade fluid). 64 mics f inal report Table CH.4: Oral rehydration solutions and recommended homemade fluids Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solu- tions and recommended homemade fluids, Belize, 2011 Had diar- rhoea in last two weeks Number of children age 0-59 months Children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea ORS (Fluid from ORS packet or pre-pack- aged ORS fluid) Pedialyte ORS or any rec- ommend- ed home- made fluid Sex Male 9.2 984 22.9 44.6 58.1 91 Female 6.5 962 22.8 39.9 50.8 62 Region Corozal 9.2 263 (38.8) (62.3) (72.4) 24 Orange Walk 3.4 302 (*) (*) (*) 10 Belize (Excluding Belize City South Side) 5.4 240 (*) (*) (*) 13 Belize City South Side 4.1 252 (*) (*) (*) 10 Belize District 4.7 492 (*) (*) (*) 23 Cayo 13.6 450 (15.5) (48.5) (61.4) 61 Stann Creek 8.2 212 (*) (*) (*) 18 Toledo 7.5 226 (*) (*) (*) 17 area urban 6.4 743 (13.7) (46.8) (58.5) 48 rural 8.8 1203 27.0 40.9 53.7 106 age 0-11 9.3 357 (17.8) (44.8) (56.1) 33 12-23 14.6 404 27.0 45.4 58.9 59 24-35 7.6 393 (16.4) (34.7) (46.8) 30 36-47 4.5 395 (*) (*) (*) 18 48-59 3.4 397 (*) (*) (*) 14 Mother’s education None 9.5 115 (*) (*) (*) 11 Primary 8.6 931 27.1 32.8 49.0 80 secondary + 7.2 839 19.4 54.3 63.0 61 other (3.2) 47 (*) (*) (*) 1 Wealth index quintiles Poorest 9.6 490 31.9 31.9 54.8 47 second 6.4 450 (20.7) (37.1) (45.2) 29 Middle 9.4 407 (25.2) (47.3) (55.2) 38 Fourth 6.1 330 (*) (*) (*) (*) richest 7.2 268 (*) (*) (*) (*) ethnicity of household head Creole 5.2 379 (*) (*) (*) (*) Mestizo 9.0 949 19.1 37.8 47.8 86 Garifuna 2.5 105 (*) (*) (*) 3 Maya 10.5 288 (29.1) (44.7) (62.4) 30 other 6.5 195 (*) (*) (*) (*) Missing/DK (7.8) 31 (*) (*) (*) (*) Total 7.9 1946 22.8 42.7 55.2 153 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases About 16.7 percent of under-five children with diarrhoea drank more than usual while 80.4 percent drank the same or less (Table CH.5). Seventy-two percent ate somewhat less, same or more (continued feeding), but 27.6 percent ate much less or stopped food or have not ever eaten. It is clear that males were denied drink at a higher rate than females but fared a little better in getting food. Also, rural children were not as likely as urban children to access drink and food. mics f inal report 65 Table CH.5. Feeding practices during diarrhoea Percent distribution of children age 0-59 months with diarrhoea in the last two weeks by amount of liquids and food given during episode of diarrhoea, Belize, 2011 Had diar- rhoea in last two weeks Number of children age 0-59 months Drinking practices during diarrhoea: Given much less to drink Given somewhat less to drink Given about the same to drink Given more to drink Given nothing to drink Miss- ing/DK Total Sex Male 9.2 984 14.1 24.6 40.8 16.1 3.7 0.7 100.0 Female 6.5 962 4.4 39.5 37.6 17.7 0.9 0.0 100.0 Area Urban 6.4 743 (8.1) (20.5) (47.2) (20.9) (2.0) (1.3) 100.0 Rural 8.8 1203 11.1 35.2 36.0 14.8 2.8 0.0 100.0 Total 7.9 1946 10.2 30.7 39.5 16.7 2.6 0.4 100.0 Eating practices during diarrhoea: Number of children aged 0-59 months with diar- rhoea Given much less to eat Given somewhat less to eat Given about the same to eat Given more to eat Stopped food Had never been giv- en food Missing/ DK Total Sex Female Male 16.9 27.7 37.5 3.4 11.0 2.9 0.7 100.0 91 14.4 41.1 34.8 1.0 6.1 2.5 0.0 100.0 62 Area Rural Urban (11.6) (33.8) (43.9) (6.4) (1.7) (1.3) (1.3) 100.0 48 17.8 32.9 33.0 0.6 12.3 3.4 0.0 100.0 106 Total 15.9 33.2 36.4 2.4 9.0 2.7 0.4 100.0 153 ( ) Figures that are based on 25-49 un-weighted cases Table CH.6 provides the proportion of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and percentage of children with diarrhoea who received other treatments. Overall, 34.4 percent of children with diarrhoea received ORS or increased fluids, 58.6 percent received ORT (ORS or recommended homemade fluids or increased fluids) and 42.5 percent received ORT with continued feeding. There are differences in the management of diarrhoea by area. ORT with continued feeding occurred at a higher rate in urban (58.0 percent) than in rural (35.6 percent) areas. Almost twice as many females (25.2 percent) versus males (14.5 percent) were not given any treatment or drug for diarrhoea. 66 mics f inal report Table CH.6: Oral rehydration therapy with continued feeding and other treatments Percentage of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and percentage of children with diarrhoea who received other treatments, Belize, 2011 Children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea Not given any treatment or drug ORS or in- creased fluids ORT (ORS or recommend- ed home- made fluids or increased fluids) ORT with continued feeding [1] Sex Male 34.4 59.5 41.7 91 14.5 Female 34.5 57.5 43.8 62 25.2 Area Urban 27.6 62.1 58.0 48 19.7 Rural 37.5 57.1 35.6 106 18.5 Total 34.4 34.4 42.5 153 18.9 [1] MICS indicator 3.8 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 mics f inal report 67 Ta b le C H .7 : C ar e se ek in g f o r su sp ec te d p n eu m o n ia a n d a n ti b io ti c u se d u ri n g s u sp ec te d p n eu m o n ia Pe rc en ta g e o f ch ild re n a g e 0- 59 m o n th s w it h s u sp ec te d p n eu m o n ia in t h e la st t w o w ee ks w h o w er e ta ke n t o a h ea lt h p ro vi d er a n d p er ce n ta g e o f ch ild re n w h o w er e g iv en an ti b io ti cs , B el iz e, 2 01 1 H ad s u s- p ec te d p n eu m o n ia in t h e la st tw o w ee ks N u m b er o f ch ild re n a g e 0- 59 m o n th s C H IL D R E N W IT H S U S P E C T E D P N E U M O N IA W H O W E R E T A K E N T O : A ny a p p ro - p ri at e p ro vi d - er [ 1] Pe rc en ta g e o f ch il- d re n w it h su sp ec te d p n eu m o n ia w h o r e- ce iv ed a n - ti b io ti cs in th e la st t w o w ee ks [ 2] N u m b er o f ch ild re n ag e 0- 59 m o n th s w it h s u s- p ec te d p n eu m o n ia in t h e la st tw o w ee ks P u b lic se ct o r: G ov - er n m en t h o sp it al Pu b lic se ct o r: G ov er n - m en t h ea lt h ce n te r O th er p u b lic Pr iv at e h o sp it al / cl in ic Pr iv at e p hy si ci an Pr iv at e p h ar m a- cy O th er p ri va te m ed ic al R el a- ti ve / Fr ie n d O th er S ex M al e 3. 2 98 4 (3 3. 7) (1 9. 6) (5 .1 ) (1 1. 3) (4 .9 ) (3 .1 ) (2 .6 ) (5 .0 ) (2 .0 ) (7 7. 3) (6 7. 7) 31 Fe m al e 2. 7 96 2 (3 4. 6) (2 5. 1) (0 .0 ) (2 9. 3) (3 .2 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (8 8. 1) (7 4. 1) 26 A re a U rb an 2. 0 74 3 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 15 R u ra l 3. 5 12 03 32 .8 17 .4 3. 7 16 .7 5. 6 0. 0 1. 9 3. 7 1. 5 78 .2 63 .7 42 To ta l 3. 0 19 46 34 .1 22 .1 2. 8 19 .5 4. 1 1. 7 1. 4 2. 7 1. 1 82 .2 70 .7 57 [1 ] M IC S in d ic at o r 3. 9; [ 2] M IC S in d ic at o r 3. 10 ( ) F ig u re s th at a re b as ed o n 2 5- 49 u n -w ei g h te d c as es ; ( *) F ig u re s th at a re b as ed o n le ss t h an 2 5 u n -w ei g h te d c as es 68 mics f inal report Table CH.7 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. Three 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, 82.2 percent were taken to an appropriate provider. Table CH.7 also presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, age, region, area, age, and socioeconomic factors. In Belize, 70.7 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.8. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, 7.0 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 develops a fever (73.3 percent). 13.0 percent of mothers identified fast breathing and 21.2 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. Mothers in the Stann Creek District recognized the two signs of pneumonia at a higher rate (24.5 percent) than in all other regions (a minimum of 0.4 percent in Orange Walk) (Table CH.8). As expected more educated mothers had a higher rate for recognizing the two signs of pneumonia (no education 5.3 percent, primary 5.3 percent and secondary+ 9.2 percent). Mothers from households with Garifuna heads recognized the two signs of pneumonia at a higher rate (17.2 percent) than in all other ethnicities. The next highest rate occurred in households with Creole heads (8.5 percent). mics f inal report 69 Table CH.8: Knowledge of the two danger signs of pneumonia Percentage of mothers and caretakers of children age 0-59 months by symptoms that would cause them to take the child immedi- ately to a health facility, and percentage of mothers who recognize fast and difficult breathing as signs for seeking care immediately, Belize, 2011 Percentage of mothers/caretakers who think that a child should be taken immediately to a health facility if the child: Mothers/care- takers who recognize the two danger signs of pneu- monia Number of mothers/care- takers of chil- dren age 0-59 months Is not able to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has dif- ficulty breath- ing Has blood in stool Is drinking poorly Has other symp- toms Region Corozal 2.8 9.9 77.1 7.7 22.8 1.9 2.3 36.2 5.4 177 Orange Walk 1.5 5.0 57.6 6.8 18.5 2.5 2.2 5.6 0.4 206 Belize (Ex- cluding Belize City South Side) 5.4 24.8 78.5 11.5 20.6 3.9 0.9 12.0 4.3 166 Belize City South Side 3.6 3.7 67.6 9.9 23.4 5.4 1.5 36.1 5.3 181 Belize Dis- trict 4.4 13.8 72.8 10.7 22.1 4.7 1.3 24.6 4.9 347 Cayo 1.3 4.3 79.5 13.0 21.2 4.4 2.8 21.6 7.2 337 Stann Creek 17.6 28.3 71.6 27.5 33.0 24.5 17.0 46.4 24.5 150 Toledo 1.5 36.6 79.5 18.4 9.2 6.1 3.1 20.8 4.6 145 Area Urban 4.7 9.3 73.0 12.8 22.6 5.8 3.7 28.0 7.4 544 Rural 3.8 16.5 73.5 13.0 20.3 6.5 3.9 22.1 6.6 818 Education None 0.9 13.8 69.7 11.1 12.9 5.1 0.8 20.1 5.3 59 Primary/ Infant 3.0 14.2 73.2 11.2 18.4 5.1 4.1 21.5 5.3 647 Secondary + 5.8 13.5 74.7 15.3 25.1 7.6 3.9 28.5 9.2 625 Wealth index quin- tiles Poorest 1.9 16.3 73.2 13.8 17.5 4.6 3.0 20.3 5.4 306 Second 4.8 11.1 72.6 9.4 20.6 7.1 3.4 26.6 6.4 308 Middle 4.2 14.2 72.9 13.5 22.7 7.6 3.3 27.7 7.2 294 Fourth 5.2 14.3 73.3 15.3 24.9 6.3 6.5 19.9 8.6 254 Richest 5.0 11.7 75.2 13.4 21.1 5.6 3.3 28.8 7.7 201 Ethnicity of household head Creole 4.2 12.0 72.4 15.7 22.3 7.2 3.6 29.4 8.5 288 Mestizo 3.3 10.7 72.2 10.1 22.0 4.4 3.0 23.6 5.6 673 Garifuna 11.1 23.6 75.2 20.5 29.3 18.4 13.0 43.5 17.2 77 Maya 3.7 22.3 83.9 18.8 15.7 6.8 5.0 16.2 7.2 190 Other 5.4 16.1 63.4 7.9 15.0 6.9 2.2 16.2 3.1 113 Total 4.1 13.6 73.3 13.0 21.2 6.3 3.8 24.5 7.0 1362 7 un-weighted cases in “CET/ITVET/VOTEC” and 28 un-weighted cases in “Other” on Education and 21 un-weighted cases in “Missing/DK” on Ethnicity of Household Head are not shown Solid Fuel Use More than 3 billion people around the world rely on solid fuels for their basic energy needs, including cooking and heating. Solid fuels include biomass fuels, such as wood, charcoal, crops or other agricultural waste, dung, shrubs and straw, and coal. Cooking and heating with solid fuels leads to high levels of indoor smoke 70 mics f inal report which contains a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is their incomplete combustion, which produces toxic elements such as carbon monoxide, polyaromatic hydrocarbons, sulphur dioxide (SO2) among others. Use of solid fuels increases the risks of incurring acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, asthma and may contribute to low birth weight of babies born to pregnant women exposed to smoke. The primary indicator for monitoring use of solid fuels is the proportion of the population using solid fuels as the primary source of domestic energy for cooking, shown in Table CH.9. Table CH.9: Solid fuel use Percent distribution of household members according to type of cooking fuel used by the household, and percentage of household members living in households using solid fuels for cooking, Belize, 2011 Percentage of household members in households using: Total Solid fuels for cooking [1] Number of house- hold members Electricity Butane Biogas Kerosene Charcoal Wood No food cooked in house- hold Region Corozal 0.2 66.3 0.1 0.1 0.1 32.6 0.6 100.0 32.7 2296 Orange Walk 0.8 81.1 0.0 0.1 0.2 17.3 0.4 100.0 17.4 2584 Belize (Excluding Belize City South Side) 3.1 92.5 0.0 0.2 0.0 2.9 1.4 100.0 2.9 2799 Belize City South Side 3.1 94.1 0.1 0.3 0.0 0.5 1.8 100.0 0.5 2177 Belize District 3.1 93.2 0.1 0.2 0.0 1.8 1.6 100.0 1.8 4976 Cayo 2.9 83.1 0.0 0.0 0.5 12.8 0.4 100.0 13.3 3865 Stann Creek 1.1 82.6 0.0 0.0 0.0 15.0 1.4 100.0 15.0 1833 Toledo 0.6 40.6 0.0 0.1 0.0 56.6 2.0 100.0 56.6 1733 Area Urban 2.1 92.9 0.0 0.1 0.3 3.0 1.5 100.0 3.3 7536 Rural 1.6 68.6 0.0 0.1 0.1 28.8 0.7 100.0 28.9 9752 Education of house- hold head None 1.8 51.1 0.0 0.2 0.2 45.8 0.9 100.0 46.0 1377 Primary 1.4 73.0 0.1 0.2 0.1 24.1 1.0 100.0 24.2 8782 Secondary + 2.5 92.1 0.0 0.0 0.1 4.0 1.1 100.0 4.1 6412 CET/ITVET/VO- TEC 0.0 98.5 0.0 0.0 0.0 0.5 0.9 100.0 0.5 172 Missing/DK 2.3 93.0 0.0 0.0 2.6 1.7 0.4 100.0 4.3 256 Other 0.0 89.1 0.0 0.0 0.0 10.9 0.0 100.0 10.9 288 Wealth index quintiles Poorest 1.4 31.6 0.0 0.5 0.2 62.5 3.8 100.0 62.8 3458 Second 1.6 79.4 0.1 0.0 0.4 17.7 0.7 100.0 18.1 3457 Middle 1.6 91.5 0.0 0.0 0.1 6.0 0.4 100.0 6.2 3459 Fourth 1.8 96.5 0.1 0.0 0.0 1.5 0.2 100.0 1.5 3456 Richest 2.9 96.8 0.0 0.0 0.0 0.1 0.1 100.0 0.1 3457 Ethnicity of house- hold head Creole 2.8 92.3 0.0 0.2 0.0 3.0 1.7 100.0 3.0 4048 Mestizo 1.2 78.1 0.1 0.1 0.3 19.2 0.9 100.0 19.5 8498 Garifuna 1.1 94.0 0.0 0.0 0.0 3.2 1.6 100.0 3.2 959 Maya 0.7 38.8 0.0 0.0 0.0 60.2 0.4 100.0 60.2 1933 Other 4.9 89.5 0.0 0.2 0.1 4.7 0.6 100.0 4.8 1552 Missing/DK 1.6 92.5 0.0 0.0 0.0 5.4 0.5 100.0 5.4 298 Total 1.8 79.2 0.0 0.1 0.2 17.6 1.0 100.0 17.7 17288 [1] MICS indicator 3.11 Overall, 17.7 percent of all households in Belize use solid fuels for cooking. Use of solid fuels is low in urban areas (3.3 percent) and higher in rural areas (28.9 percent). Solid fuel use is highest in the Toledo District (56.5 percent) and lowest in Belize City South Side (0.5 percent) (Table 9). Differentials with respect to household wealth and the educational level of the household head are also evident. The findings show that use of solid fuels is very common among households with Maya heads (60.2 percent), and very uncommon among the richest households (0.1 percent). mics f inal report 71 Solid fuel use by place of cooking is depicted in Table CH.10. The presence and extent of indoor pollution are dependent on cooking practices, places used for cooking, as well as types of fuel used. In Belize the use of solid fuels occurs in a separate building or outdoors in 63.6 percent of households that use solid fuels. Households with Creole heads seem to use solid fuels outside of the dwelling or in a separate building at a higher rate than other ethnicities (Creole 88.4 percent, Mestizo 72.3 percent and Maya 47.1 percent). Table CH.10: Solid fuel use by place of cooking Percent distribution of household members in households using solid fuels by place of cooking, Belize, 2011 Place of cooking: Number of household members in households using solid fuels for cooking In a sepa- rate room used as kitchen Elsewhere in the house In a separate building Outdoors Other Missing Total Region Corozal 13.8 2.5 52.2 31.6 0.0 0.0 100.0 750 Orange Walk 44.6 3.0 45.0 5.5 1.9 0.0 100.0 451 Belize (Excluding Belize City South Side) 15.1 0.0 63.6 21.2 0.0 0.0 100.0 81 Belize City South Side (*) (*) (*) (*) (*) (*) (*) 10 Belize District 15.5 0.0 56.4 27.0 0.0 1.0 100.0 91 Cayo 17.5 1.2 49.5 31.4 0.0 0.3 100.0 516 Stann Creek 35.9 10.7 34.7 16.3 0.9 1.5 100.0 274 Toledo 23.4 26.6 29.3 17.5 2.2 1.1 100.0 981 Area Urban 26.6 1.7 31.1 39.0 0.0 1.6 100.0 247 Rural 23.8 11.5 42.9 20.2 1.1 0.5 100.0 2817 Education of house- hold head None 23.5 16.5 40.7 15.5 2.4 1.3 100.0 633 Primary 24.0 9.8 42.0 23.2 0.7 0.4 100.0 2125 Secondary + 25.0 6.4 43.7 23.9 0.9 0.0 100.0 262 Wealth index quin- tiles Poorest 23.8 13.7 38.7 21.5 1.5 0.8 100.0 2170 Second 28.4 4.4 46.0 21.2 0.0 0.0 100.0 625 Middle 16.9 1.6 57.2 24.4 0.0 0.0 100.0 213 Fourth (12.3) (2.0) (60.9) (24.8) (0.0) (0.0) 100.0 53 Ethnicity of household head Creole 10.8 0.0 43.7 44.7 0.0 0.8 100.0 121 Mestizo 23.6 3.1 49.3 23.0 0.5 0.5 100.0 1658 Garifuna (6.2) (2.0) (7.5) (79.1) (0.0) (5.1) 100.0 31 Maya 27.1 23.2 31.8 15.3 2.0 0.6 100.0 1163 Other 20.5 8.9 38.1 32.5 0.0 0.0 100.0 75 Total 24.1 10.7 41.9 21.7 1.1 0.6 100.0 3064 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 un-weighted case in “CET/ITVET/VOTEC”, 7 un-weighted cases in “Missing/DK” and 37 cases of “Other” on the Education of the Head of Household are excluded from the table. 3 un-weighted cases in “Richest” category in Wealth Index quintiles and 19 un-weighted cases in the “Missing/DK” category in Ethnicity of household head are excluded from the table. 72 mics f inal report Child Disability Disability is a general term describing impairments, participation restrictions and activity limitations. The term disability describes an interaction between the disabled person and negative attitudes, inaccessible buildings and transportation and limited support in the society. Disability is very diverse requiring in some cases extensive health care interventions. In general, however, all people with disabilities have the same general health care needs as everyone else, and therefore need access to mainstream health care services. MICS was designed to identify children 2 to 9 years at risk for disability in ten areas: walking (gross motor skills), hearing, seeing, understanding, movement (fine motor skills), learning, speaking and mental slowness. Table CH.11 indicates that in Belize, 2011 more than a third (36.4 percent) of children 2 to 9 years was at risk for one or more disabilities as reported by the mother or primary caretaker. The Stann Creek District recorded the highest at risk percentage (59.3 percent) and the Belize City South Side the lowest (23.0 percent). Rural children are at higher risk for disabilities than urban children (urban 28.3 percent, rural 41.5 percent). Increasing mother’s educational levels seems to correlate with decreasing risk of disability. The rate for children whose mothers had no education was 40.4 percent and for children whose mothers had secondary or better education, the rate was 32.2 percent. The three specific impairments that are most frequent are speech is not normal (14.9 percent), appears mentally backward, dull or slow (12.5 percent) and no speaking/ cannot be understood in words (8.4 percent). mics f inal report 73 Ta b le C H .1 1: C h ild re n a t in cr ea se d r is k o f d is ab ili ty Pe rc en ta g e o f ch ild re n a g e 2- 9 ye ar s re p o rt ed t o h av e im p ai rm en ts o r ac ti vi ty li m it at io n s, b y b ac kg ro u n d c h ar ac te ri st ic s, B el iz e, 2 01 1 Pe rc en ta g e o f ch ild re n a g e 2- 9 re p o rt ed t o h av e sp ec ifi ed im p ai rm en ts o r ac ti vi ty li m it at io n s 3- 9 ye ar s N u m - b er o f ch ild re n ag ed 3 -9 ye ar s 2 ye ar s N u m - b er o f ch ild re n ag ed 2 ye ar s Pe rc en ta g e o f ch ild re n ag e 2- 9 ye ar s w it h at le as t o n e re p o rt ed im p ai rm en t [1 ] N u m - b er o f ch ild re n ag ed 2 -9 ye ar s D el ay in si tt in g , st an d in g o r w al ki n g D iffi cu lt y se ei n g , e i- th er in t h e d ay ti m e o r at n ig h t A p p ea rs to h av e d iffi cu lt y h ea ri n g N o u n d er - st an d in g o f in st ru ct io n s D iffi - cu lt y in w al k- in g , m ov in g ar m s, w ea k- n es s o r st iff - n es s H av e fi ts , b ec o m e ri g id , l o se co n sc io u s- n es s N o t le ar n - in g t o d o th in g s lik e o th er c h il- d re n h is / h er a g e N o s p ea ki n g ca n n o t b e u n d er st o o d in w o rd s A p p ea rs m en ta lly b ac kw ar d , d u ll, o r sl o w S p ee ch is n o t n o rm al C an n o t n am e at le as t o n e o b je ct A re a U rb an 2. 1 2. 8 2. 0 4. 1 1. 9 2. 4 3. 2 6. 5 7. 7 11 .9 10 89 13 .6 14 6 28 .3 12 35 R u ra l 3. 9 5. 3 5. 2 7. 7 2. 7 1. 8 6. 5 9. 5 15 .4 16 .7 17 58 16 .8 24 1 41 .5 19 99 R eg io n C o ro za l 2. 9 4. 9 3. 5 3. 4 2. 4 1. 6 3. 4 7. 1 23 .2 9. 1 36 0 1. 7 52 37 .8 41 2 O ra n g e W al k 2. 0 3. 0 2. 4 6. 0 2. 1 1. 3 6. 3 8. 3 6. 5 9. 9 41 6 10 .9 59 29 .3 47 5 B el iz e (E xc lu d - in g B el iz e C it y S o u th S id e) 2. 9 5. 0 5. 1 4. 5 1. 8 2. 2 2. 2 4. 2 6. 2 7. 8 41 0 (7 .9 ) 42 24 .4 45 1 B el iz e C it y S o u th S id e 2. 5 2. 0 0. 8 4. 3 1. 9 1. 5 2. 9 5. 5 4. 0 8. 0 33 4 20 .7 51 23 .0 38 5 B el iz e D is tr ic t 2. 7 3. 6 3. 1 4. 4 1. 9 1. 9 2. 5 4. 8 5. 2 7. 9 74 4 15 .0 93 23 .8 83 7 C ay o 5. 1 4. 6 4. 2 10 .8 3. 8 3. 3 8. 6 12 .7 20 .3 35 .7 67 1 26 .2 91 59 .3 76 2 S ta n n C re ek 3. 2 8. 0 8. 4 3. 5 1. 5 1. 7 4. 3 7. 4 8. 6 10 .7 32 4 16 .8 44 33 .1 36 8 To le d o 2. 7 2. 9 3. 5 7. 9 2. 4 1. 0 6. 2 10 .0 12 .4 4. 9 33 1 16 .3 49 29 .1 37 9 A g e o f ch ild 2- 4 3. 7 3. 2 3. 3 6. 4 2. 6 2. 2 5. 3 12 .1 11 .2 15 .6 79 2 15 .6 38 7 37 .5 11 79 5- 6 2. 9 3. 8 4. 0 5. 9 2. 0 1. 8 4. 9 5. 3 12 .5 13 .8 80 6 n a n a 34 .2 80 6 7- 9 3. 0 5. 8 4. 6 6. 6 2. 6 1. 9 5. 4 6. 8 13 .7 15 .1 12 49 n a n a 36 .9 12 49 M o th er ’s ed u ca ti o n N o n e 7. 7 4. 6 6. 8 8. 7 7. 7 2. 3 7. 9 12 .9 18 .2 20 .0 19 5 (* ) 21 40 .4 21 6 Pr im ar y 3. 1 4. 6 4. 5 6. 6 2. 4 1. 7 5. 6 8. 7 14 .4 14 .7 14 83 17 .0 18 8 39 .2 16 71 S ec o n d ar y + 2. 8 4. 0 2. 8 5. 7 1. 5 2. 3 4. 4 6. 9 9. 4 14 .3 10 97 14 .1 16 2 32 .2 12 59 C E T /IT V E T / V O T E C (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 14 (* ) 4 (* ) 19 M is si n g /D K (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 2 (* ) 0 (* ) 2 O th er 2. 5 1. 4 5. 0 7. 9 3. 8 2. 5 6. 2 14 .9 5. 0 7. 1 56 (* ) 11 34 .5 67 W ea lt h in d ex q u in ti le s Po o re st 4. 3 3. 9 5. 7 8. 9 3. 3 1. 7 6. 2 10 .8 16 .6 15 .6 71 1 15 .9 99 40 .7 81 0 S ec o n d 3. 4 5. 2 4. 2 4. 9 2. 0 1. 9 6. 0 9. 1 13 .7 12 .8 64 7 13 .1 88 36 .2 73 5 M id d le 3. 3 4. 4 2. 8 6. 6 2. 2 1. 4 6. 2 7. 8 11 .1 13 .1 57 1 21 .7 87 35 .4 65 8 Fo u rt h 2. 4 4. 2 4. 1 4. 1 3. 2 3. 2 3. 7 5. 1 10 .9 14 .3 49 5 13 .6 53 32 .3 54 9 R ic h es t 2. 1 3. 9 2. 1 6. 6 1. 1 2. 0 3. 1 7. 7 7. 3 19 .8 42 2 11 .6 60 35 .8 48 2 To ta l 3. 2 4. 3 4. 0 6. 3 2. 4 2. 0 5. 2 8. 4 12 .5 14 .9 28 47 15 .6 38 7 36 .4 32 34 [1 ] M IC S in d ic at o r 3. 21 ( ) Fi g u re s th at a re b as ed o n 2 5- 49 u n -w ei g h te d c as es ; ( *) F ig u re s th at a re b as ed o n le ss t h an 2 5 u n - w ei g h te d c as es , n a = n o t ap p lic ab le 74 mics f inal report The educational level of the mother seems to have a great effect on the perception of disability in the child. As the educational level increased the perception of risk in all areas of disability decreased. In general, also, children from rural areas were perceived to be at higher risk for disabilities than urban children in all areas of disabilities considered. mics f inal report 75 vii. 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 o Use of improved drinking water sources o Use of adequate water treatment method o Time to source of drinking water o Person collecting drinking water Sanitation o Use of improved sanitation facilities o Sanitary disposal of child’s faeces For more details on water and sanitation and to access some reference documents, please visit the UNICEF childinfo website http://www.childinfo.org/wes.html. Use of Improved Water Sources The distribution of the population by source of drinking water is shown in Table WS.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, 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. 76 mics f inal report Table WS.1: Use of improved water sources Percent distribution of household population using improved drinking water sources, Belize, 2011 Main source of drinking water Improved sources Piped into dwelling Piped into compound, yard or plot Piped to neighbour Public tap / stand- pipe Tube well, bore- hole Protect- ed well Protected spring rainwater collection Bottled water* Number of household members region Corozal 7.0 10.8 0.8 0.0 0.0 3.2 0.0 26.1 47.7 2296 orange Walk 8.3 4.7 0.0 0.0 0.0 2.1 0.0 21.2 61.4 2584 belize (exclud- ing belize City south side) 11.7 1.9 0.0 0.0 0.0 0.6 0.0 17.9 67.5 2799 belize City south side 27.7 1.3 0.2 1.4 0.0 0.0 0.0 10.1 59.2 2177 belize District 18.7 1.6 0.1 0.6 0.0 0.4 0.0 14.5 63.9 4976 Cayo 23.1 10.7 2.1 0.0 0.0 1.3 0.3 11.3 46.8 3865 stann Creek 45.4 27.3 1.6 0.1 0.1 0.6 0.0 2.4 22.0 1833 Toledo 3.4 46.0 1.1 14.2 7.0 5.7 0.3 8.1 11.4 1733 area urban 21.5 3.4 0.6 0.7 0.0 0.1 0.0 7.6 65.6 7536 rural 15.1 19.5 1.0 2.3 1.3 3.0 0.2 19.6 34.1 9752 Education of house- hold head None 16.9 25.0 1.7 4.9 1.9 4.0 0.0 21.8 20.5 1507 Primary 19.6 17.1 0.8 2.0 1.0 2.2 0.2 16.1 37.4 8652 secondary + 16.2 4.2 0.8 0.6 0.1 0.7 0.0 8.7 68.2 6412 CeT/ITVeT/ VoTeC 14.8 3.3 0.0 0.0 0.0 0.0 0.0 5.5 76.4 172 Missing/DK 26.4 17.6 0.0 0.0 0.0 3.2 0.0 8.8 41.5 256 other 3.8 0.0 0.0 0.0 0.0 0.0 0.0 65.4 30.8 288 Wealth index quin- tiles Poorest 11.9 37.6 3.8 6.0 3.3 4.3 0.2 18.1 8.9 3458 second 27.8 19.5 0.6 1.2 0.2 2.3 0.4 16.8 29.4 3457 Middle 25.1 4.0 0.0 0.1 0.1 1.5 0.0 16.9 50.4 3459 Fourth 16.8 0.8 0.0 0.3 0.0 0.5 0.0 13.2 67.2 3456 richest 7.8 0.6 0.0 0.3 0.0 0.0 0.0 6.8 83.3 3457 ethnicity of house- hold head Creole 24.9 5.0 0.5 0.8 0.0 0.6 0.0 15.9 51.9 4048 Mestizo 14.3 12.6 1.0 0.4 0.0 2.6 0.1 13.6 52.3 8498 Garifuna 36.4 6.8 0.4 0.5 0.2 0.1 0.0 4.0 51.4 959 Maya 16.1 39.1 2.3 9.9 6.0 2.5 0.3 8.9 10.7 1933 other 10.1 3.8 0.0 0.8 0.2 0.7 0.0 29.4 54.0 1552 Missing/DK 19.0 3.3 0.0 0.0 0.0 0.0 0.0 7.7 63.6 298 Total 17.9 12.5 0.9 1.6 0.7 1.8 0.1 14.4 47.8 17288 mics f inal report 77 Table WS.1: Use of improved water sources [continued] Percent distribution of household population using unimproved drinking water sources, Belize, 2011 Unimproved sources Percent- age using improved sources of drinking water [1] Number of household members Unprotected well Unprotected spring Surface water (riv- er, stream, dam, lake, pond, canal, irrigation channel) Bottled water* Other Region Corozal 3.2 0.0 0.0 1.2 0.0 95.6 2296 Orange Walk 1.1 0.1 0.0 1.2 0.0 97.6 2584 Belize (Exclud- ing Belize City South Side) 0.1 0.0 0.0 0.2 0.0 99.7 2799 Belize City South Side 0.0 0.0 0.0 0.2 0.0 99.8 2177 Belize District 0.0 0.0 0.0 0.2 0.0 99.8 4976 Cayo 0.5 0.6 1.8 1.6 0.0 95.6 3865 Stann Creek 0.0 0.0 0.0 0.1 0.4 99.5 1833 Toledo 1.7 0.2 0.7 0.2 0.1 97.1 1733 Area Urban 0.0 0.0 0.0 0.5 0.0 99.5 7536 Rural 1.5 0.3 0.8 1.0 0.1 96.2 9752 Education of house- hold head None 2.0 0.0 1.3 0.0 0.0 96.7 1377 Primary 1.3 0.3 0.7 1.2 0.1 96.3 8782 Secondary + 0.1 0.1 0.0 0.3 0.0 99.5 6412 CET/ITVET/VO- TEC 0.0 0.0 0.0 0.0 0.0 100.0 172 Missing/DK 0.0 0.0 0.0 2.5 0.0 97.5 256 Other 0.0 0.0 0.0 0.0 0.0 100.0 288 Wealth index quintiles Poorest 3.4 0.4 1.4 0.6 0.2 94.0 3458 Second 0.7 0.0 0.3 0.7 0.1 98.3 3457 Middle 0.3 0.3 0.6 0.5 0.0 98.2 3459 Fourth 0.0 0.0 0.0 1.1 0.0 98.9 3456 Richest 0.0 0.1 0.0 1.0 0.0 98.9 3457 Ethnicity of house- hold head Creole 0.2 0.0 0.0 0.1 0.0 99.6 4048 Mestizo 1.1 0.2 0.8 1.1 0.0 96.8 8498 Garifuna 0.0 0.0 0.0 0.2 0.0 99.8 959 Maya 2.0 0.7 0.6 0.5 0.4 95.8 1933 Other 0.0 0.0 0.0 1.0 0.0 99.0 1552 Missing/DK 3.0 0.0 0.0 3.4 0.0 93.6 298 Total 0.9 0.2 0.5 0.8 0.1 97.7 17288 [1] MICS indicator 4.1; MDG indicator 7.8 * Households using bottled water as the main source of drinking water are classified into improved or unimproved drinking water users according to the water source used for other purposes such as cooking and hand-washing. 78 mics f inal report Overall, 97.7 percent of the population is using an improved source of drinking water – 99.5 percent in urban areas and 96.2 percent in rural areas. Use of improved sources of water is widespread across regions of the country with the lowest rates occurring in the Corozal and Cayo Districts (95.6 percent in both cases). There is a slight reduction in rates of use of improved sources of drinking water for less educated head of households (no education 96.4 percent) and families with wealth index of poorest (94.0 percent). Improved drinking water is obtained mainly from four sources: bottled water (47.8 percent), water piped into dwelling (17.9 percent), collected rainwater (14.4 percent) and water piped into yard or compound (12.5 percent) (Table WS.1). Urban and rural areas exhibit pronounced differences in the sources of improved drinking water: bottled water (urban 65.6 percent, rural 34.1 percent), piped into dwelling (urban 21.5 percent, rural 15.1 percent), collected rainwater ( urban 7.6 percent, rural 19.6 percent) and piped into yard or plot ( urban 3.4 percent, rural 19.5 percent ). Level of education of household head and the wealth index of the family seem to correlate to use of improved sources of drinking water in the same way. Presumably the more educated household heads live in households with higher wealth indices. Bottled water use rises with both increasing education and wealth index, rainwater collection decreases with the increase of wealth and education and water piped into compound is seen to decrease as wealth and education increase. The prevalence of the use of unimproved sources of drinking water is very small (Table WS.1). Unprotected wells are the main source and their use is most pronounced in rural areas, the Corozal (3.2 percent) and Toledo (1.7 percent) Districts, household where the heads have no education, households with the poorest wealth index and in households with Maya heads. Use of in-house water treatment is presented in Table WS.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 water treatment by all households and the percentage of household members living in households using unimproved water sources but using appropriate water treatment methods. About eight in ten (82.1 percent) of households did nothing to make the water safer to drink. About a third (31.2 percent) of household members using unimproved drinking water sources also use an appropriate water treatment measure. The most likely not to use any water treatment are households in the Corozal District (68.3 percent), urban areas (89.0 percent), households with heads having secondary or more education (87.1 percent), households with the richest wealth index (89.5 percent) and households with Garifuna heads (90.7 percent) (Table WS.2). In general the water treatment of choice was adding bleach or chlorine (9.9 percent) followed by boiling at 6.6 percent. mics f inal report 79 Table WS.2: Household water treatment Percentage of household population by drinking water treatment method used in the household, and for household members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Belize, 2011 Water treatment method used in the household Number of household membersNone boil add bleach / chlorine strain through a cloth use water filter solar disin- fection let it stand and set- tle other Don’t know region Corozal 68.3 4.3 27.4 0.8 0.6 0.0 0.0 0.0 0.0 2296 orange Walk 89.6 2.6 7.1 2.5 1.4 0.0 0.0 0.0 0.0 2584 belize (excluding belize City south side) 86.7 2.3 10.1 0.0 1.2 0.0 0.1 0.4 0.1 2799 belize City south side 89.9 5.2 3.0 0.1 1.1 0.0 0.1 1.0 0.0 2177 belize District 88.1 3.6 7.0 0.1 1.2 0.0 0.1 0.7 0.0 4976 Cayo 79.6 9.0 8.4 1.0 2.7 0.0 0.2 0.2 0.0 3865 stann Creek 84.5 7.4 6.6 0.6 1.3 0.0 0.0 0.0 0.0 1833 Toledo 75.0 17.9 6.1 0.9 0.6 0.0 0.2 0.2 0.0 1733 area urban 89.0 5.4 3.8 0.5 1.2 0.0 0.1 0.4 0.0 7536 rural 76.8 7.5 14.6 1.1 1.6 0.0 0.0 0.2 0.0 9752 Education of house- hold head None 74.2 11.8 12.9 2.2 1.1 0.0 0.0 0.0 0.0 1377 Primary 78.9 7.3 12.7 1.1 1.3 0.0 0.1 0.2 0.0 8782 secondary + 87.1 5.1 6.0 0.2 1.6 0.0 0.2 0.4 0.0 6412 CeT/ITVeT/VoTeC 99.6 0.0 0.0 0.0 0.4 0.0 0.0 0.0 0.0 172 Missing/DK 92.3 0.0 7.7 0.0 0.0 0.0 0.0 0.0 0.0 256 other 87.3 4.4 2.5 2.4 3.3 0.0 0.0 0.0 0.0 288 Wealth index quin- tiles Poorest 76.6 12.3 10.9 0.9 0.5 0.0 0.4 0.1 0.0 3458 second 77.3 8.0 13.6 1.5 1.2 0.0 0.0 0.4 0.0 3457 Middle 82.9 4.6 10.8 1.4 1.0 0.0 0.0 0.5 0.0 3459 Fourth 84.2 5.2 9.6 0.5 1.3 0.0 0.1 0.1 0.0 3456 richest 89.5 2.9 4.6 0.1 3.0 0.0 0.0 0.2 0.0 3457 ethnicity of household head Creole 86.0 3.3 8.4 0.3 1.6 0.0 0.1 0.8 0.0 4048 Mestizo 81.3 4.7 13.3 1.3 1.0 0.0 0.0 0.1 0.0 8498 Garifuna 90.7 4.1 3.7 0.2 1.4 0.0 0.1 0.0 0.0 959 Maya 70.4 23.7 5.5 0.6 0.9 0.0 0.6 0.0 0.0 1933 other 85.8 5.3 4.6 0.8 4.2 0.0 0.0 0.0 0.0 1552 Missing/DK 82.1 8.3 9.4 0.0 0.0 0.0 0.0 0.6 0.0 298 Total 82.1 6.6 9.9 0.9 1.4 0.0 0.1 0.2 0.0 17288 80 mics f inal report Table WS.2: Household water treatment [continued] Percentage of household population by drinking water treatment method used in the household, and for household members living in households where an unimproved drinking water source is used, the percentage who are using an appropriate treatment method, Belize, 2011 Percentage of household members in households using unimproved drinking water sources and using an appropriate water treatment method [1] Number of household members in households using unimproved drinking water sources Region Corozal 69.4 101 Orange Walk 27.9 63 Belize (Excluding Belize City South Side) (*) 7 Belize City South Side (*) 4 Belize District (*) 11 Cayo 7.4 171 Stann Creek (*) 9 Toledo (*) 50 Area Urban (0.0) 35 Rural 34.2 371 Education of household head None 32.5 46 Primary 28.9 321 Secondary + (58.6) 33 Missing/DK (*) 6 Wealth index quintiles Poorest 32.6 207 Second 43.8 60 Middle 37.3 61 Fourth (17.0) 39 Richest (9.0) 38 Ethnicity of household head Creole (*) 15 Mestizo 31.7 273 Garifuna (*) 2 Maya 27.2 82 Other (*) 15 Missing/DK (*) 19 Total 31.2 406 [1] MICS indicator 4.2 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collected the water in Table WS.4. Note that these results refer to one roundtrip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that for 94.9 percent of households, the drinking water source is on the premises. In general few households bring water from a distance (1.9 percent for a round trip of less than 30 minutes and 0.7 percent a trip of 30 minutes or more). In households where water is collected from a distance, adult women fetch the water in 37.6 percent of the cases and adult men in 43.9 percent. In 9.1 percent of cases a male child fetches the water while in 6.7 percent it is a female child. mics f inal report 81 Table WS.3: Time to source of drinking water Percent distribution of household population according to time to go to source of drinking water, get water and return, for users of improved and unimproved drinking water sources, Belize, 2011 Time to source of drinking water Total Number of household members Users of improved drinking water sources Users of unimproved drinking water sources Water on premises Less than 30 minutes 30 min- utes or more Missing/DK Water on premises Less than 30 minutes 30 min- utes or more Missing/DK Region Corozal 88.3 4.6 1.9 0.8 3.8 0.6 0.0 0.0 100.0 2296 Orange Walk 96.3 0.9 0.3 0.0 2.1 0.4 0.0 0.0 100.0 2584 Belize (Excluding Belize City South Side) 98.2 1.1 0.4 0.0 0.1 0.2 0.0 0.0 100.0 2799 Belize City South Side 96.2 3.4 0.1 0.0 0.2 0.0 0.0 0.0 100.0 2177 Belize District 97.3 2.1 0.3 0.0 0.1 0.1 0.0 0.0 100.0 4976 Cayo 94.7 0.4 0.4 0.1 2.0 1.8 0.6 0.0 100.0 3865 Stann Creek 99.0 0.3 0.2 0.0 0.0 0.4 0.1 0.0 100.0 1833 Toledo 90.2 4.5 2.1 0.4 1.9 0.7 0.1 0.1 100.0 1733 Area Urban 97.5 1.9 0.1 0.1 0.4 0.0 0.0 0.0 100.0 7536 Rural 92.9 2.0 1.1 0.3 2.4 1.2 0.3 0.0 100.0 9752 Education of house- hold head None 90.9 1.7 3.5 0.5 1.7 0.8 0.9 0.0 100.0 1377 Primary 93.0 2.7 0.5 0.2 2.3 1.2 0.2 0.0 100.0 8782 Secondary + 97.8 1.1 0.4 0.1 0.5 0.0 0.0 0.0 100.0 6412 CET/ITVET/VOTEC 99.5 0.5 0.0 0.0 0.0 0.0 0.0 0.0 100.0 172 Missing/DK 96.4 1.2 0.0 0.0 1.8 0.0 0.6 0.0 100.0 256 Other 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 288 Wealth index quin- tiles Poorest 86.9 4.4 2.1 0.6 3.4 2.5 0.1 0.0 100.0 3458 Second 94.5 2.8 0.7 0.2 0.9 0.5 0.4 0.0 100.0 3457 Middle 96.8 1.2 0.2 0.0 1.0 0.4 0.3 0.0 100.0 3459 Fourth 97.9 0.7 0.2 0.1 1.1 0.0 0.0 0.1 100.0 3456 Richest 98.2 0.4 0.2 0.0 1.1 0.0 0.0 0.0 100.0 3457 Ethnicity of household head Creole 97.2 2.1 0.3 0.1 0.2 0.1 0.0 0.0 100.0 4048 Mestizo 94.5 1.5 0.6 0.2 1.9 1.0 0.3 0.0 100.0 8498 Garifuna 99.2 0.6 0.0 0.0 0.0 0.0 0.0 0.2 100.0 959 Maya 89.6 4.3 1.7 0.2 2.6 1.5 0.1 0.0 100.0 1933 Other 95.3 1.4 1.7 0.6 0.9 0.0 0.0 0.0 100.0 1552 Missing/DK 91.5 2.1 0.0 0.0 6.4 0.0 0.0 0.0 100.0 298 Total 94.9 1.9 0.7 0.2 1.5 0.7 0.2 0.0 100.0 17288 82 mics f inal report Table WS.4: Person collecting water Percentage of households without drinking water on premises, and percent distribution of households without drinking water on premises according to the person usually collecting drinking water used in the household, Belize, 2011 Percentage of households without drinking water on premises Number of households Person usually collecting drinking water Number of households without drinking water on premises adult woman (age 15+ years) adult man (age 15+ years) Female child (under 15) Male child (under 15) DK Missing region Corozal 8.0 519 (40.7) (47.3) (2.0) (9.9) (0.0) (0.0) 42 orange Walk 2.1 607 (*) (*) (*) (*) (*) (*) 13 belize (excluding belize City south side) 1.9 860 (*) (*) (*) (*) (*) (*) 16 belize City south side 3.3 614 (*) (*) (*) (*) (*) (*) 21 belize District 2.5 1474 (18.8) (59.5) (11.9) (9.7) (0.0) (0.0) 37 Cayo 2.5 918 (*) (*) (*) (*) (*) (*) (*) stann Creek 1.3 488 (*) (*) (*) (*) (*) (*) (*) Toledo 7.2 417 (*) (*) (*) (*) (*) (*) 30 area urban 1.9 2170 (20.3) (53.6) (9.0) (10.6) (6.6) (0.0) 42 rural 4.8 2254 (44.2) (40.2) (5.8) (8.5) (0.8) (0.5) 109 Education of household head None 7.0 311 (*) (*) (*) (*) (*) (*) 22 Primary 4.5 2104 35.2 42.6 9.0 9.3 3.9 0.0 94 secondary + 1.7 1851 (31.7) (57.7) (5.0) (5.6) (0.0) (0.0) 32 CeT/ITVeT/VoTeC (1.9) 47 (*) (*) (*) (*) (*) (*) 1 Missing/DK 4.0 58 (*) (*) (*) (*) (*) (*) 2 other (0.0) 52 (*) (*) (*) (*) (*) (*) . Wealth index quintiles Poorest 9.3 885 42.1 40.0 7.1 5.8 4.4 0.7 82 second 4.3 865 (30.5) (45.6) (8.6) (15.3) (0.0) (0.0) 37 Middle 1.9 863 (*) (*) (*) (*) (*) (*) 16 Fourth 1.1 889 (*) (*) (*) (*) (*) (*) 9 richest 0.6 922 (*) (*) (*) (*) (*) (*) 6 ethnicity of household head Creole 2.5 1182 (*) (*) (*) (*) (*) (*) 30 Mestizo 3.4 2058 34.7 46.0 2.4 12.3 3.8 0.8 70 Garifuna 1.2 286 (*) (*) (*) (*) (*) (*) 3 Maya 7.7 399 (*) (*) (*) (*) (*) (*) 31 other 3.3 409 (*) (*) (*) (*) (*) (*) 14 Missing/DK 3.3 91 (*) (*) (*) (*) (*) (*) 3 Total 3.4 4424 37.6 43.9 6.7 9.1 2.4 0.4 151 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 83 Use of Improved Sanitation Facilities Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation can reduce diarrheal disease by more than a third, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. 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. Table WS.5 indicates that use of improved sanitation facilities is linked to wealth and is quite different between urban and rural areas. In rural areas, the population is mostly using septic tanks (43.2 percent) and pit latrines with slabs (43.1 percent). In contrast, the most common facilities in urban areas are flush toilets with connection to a sewage system (22.7 percent) or septic tank (65.2 percent). Rich households mostly flush to septic tank (78.4 percent) while poorest households use a pit latrine with slab (62.8 percent) Table WS.5: Types of sanitation facilities Percent distribution of household population according to type of toilet facility used by the household, Belize, 2011 Improved sanitation facility Total Number of household members Flush to piped sewer system Flush to septic tank Flush to pit (latrine) Ventilated Improved Pit latrine (VIP) Pit latrine with slab Region Corozal 0.0 48.1 0.0 12.4 37.9 100.0 2296 Orange Walk 0.0 47.8 0.3 9.9 41.1 100.0 2584 Belize (Excluding Belize City South Side) 16.4 75.7 0.5 0.1 6.7 100.0 2799 Belize City South Side 47.4 47.1 0.0 0.0 0.6 100.0 2177 Belize District 30.0 63.2 0.3 0.1 4.0 100.0 4976 Cayo 6.7 53.8 0.3 1.9 36.3 100.0 3865 Stann Creek 0.0 64.6 0.7 0.4 28.1 100.0 1833 Toledo 0.2 21.7 1.0 17.6 49.5 100.0 1733 Area Urban 22.7 65.2 0.3 0.8 9.4 100.0 7536 Rural 0.4 43.2 0.4 8.9 43.1 100.0 9752 Education of household head None 1.4 27.9 0.1 7.4 53.3 100.0 1377 Primary 6.4 46.3 0.4 8.0 35.8 100.0 8782 Secondary + 17.4 67.9 0.3 1.5 11.3 100.0 6412 CET/ITVET/VOTEC 21.9 63.3 0.0 0.0 12.5 100.0 172 Missing/DK 6.8 56.1 0.0 2.5 34.6 100.0 256 Other 0.6 24.2 0.0 7.9 67.2 100.0 288 Wealth index quintiles Poorest 2.4 11.7 0.8 11.7 62.8 100.0 3458 Second 7.5 36.8 0.4 6.2 45.6 100.0 3457 Middle 9.8 61.9 0.1 5.9 22.2 100.0 3459 Fourth 12.3 75.0 0.0 2.6 9.8 100.0 3456 Richest 18.7 78.4 0.5 0.5 1.6 100.0 3457 Ethnicity of household head Creole 21.7 63.6 0.1 0.7 11.5 100.0 4048 Mestizo 5.7 50.5 0.4 7.0 34.6 100.0 8498 Garifuna 11.3 76.3 0.5 0.5 9.0 100.0 959 Maya 1.2 20.5 0.8 12.9 52.7 100.0 1933 Other 11.9 61.1 0.6 2.7 23.8 100.0 1552 Missing/DK 25.5 60.3 0.0 3.4 10.8 100.0 298 Total 10.1 52.8 0.4 5.4 28.4 100.0 17288 84 mics f inal report Table WS.5: Types of sanitation facilities [continued] Percent distribution of household population according to type of toilet facility used by the household, Belize, 2011 Number of household members Unimproved sanitation facility Flush to some- where else Pit latrine without slab / Open pit Bucket Other Missing No facili- ty, Bush, Field Region Corozal 0.0 0.7 0.0 0.0 0.0 0.9 2296 Orange Walk 0.0 0.7 0.0 0.0 0.0 0.3 2584 Belize (Excluding Belize City South Side) 0.1 0.0 0.2 0.0 0.0 0.4 2799 Belize City South Side 0.0 0.0 3.1 0.2 0.0 1.6 2177 Belize District 0.0 0.0 1.4 0.1 0.0 0.9 4976 Cayo 0.0 0.6 0.0 0.0 0.0 0.4 3865 Stann Creek 0.0 4.6 0.2 0.1 0.0 1.4 1833 Toledo 0.0 0.1 0.1 0.0 0.1 9.7 1733 Area Urban 0.0 0.0 0.9 0.1 0.0 0.7 7536 Rural 0.0 1.4 0.1 0.0 0.0 2.4 9752 Education of house- hold head None 0.0 0.9 0.1 0.0 0.0 8.9 1377 Primary 0.0 1.2 0.5 0.0 0.0 1.4 8782 Secondary + 0.0 0.4 0.4 0.1 0.0 0.6 6412 CET/ITVET/VOTEC 0.0 0.0 1.8 0.0 0.0 0.5 172 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 256 Other 0.0 0.0 0.0 0.0 0.0 0.0 288 Wealth index quin- tiles Poorest 0.0 2.7 0.9 0.0 0.1 6.9 3458 Second 0.0 0.9 1.3 0.0 0.0 1.2 3457 Middle 0.0 0.0 0.0 0.0 0.0 0.1 3459 Fourth 0.0 0.2 0.0 0.1 0.0 0.0 3456 Richest 0.0 0.2 0.0 0.0 0.0 0.0 3457 Ethnicity of household head Creole 0.0 0.2 1.5 0.1 0.0 0.6 4048 Mestizo 0.0 1.1 0.0 0.0 0.0 0.7 8498 Garifuna 0.0 0.5 1.1 0.1 0.0 0.8 959 Maya 0.0 2.0 0.3 0.0 0.0 9.7 1933 Other 0.0 0.0 0.0 0.0 0.0 0.0 1552 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.0 298 Total 0.0 0.8 0.4 0.0 0.0 1.6 17288 Access to safe drinking-water and to basic sanitation is measured by the proportion of population using an improved sanitation facility. MDGs and WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify households as using an unimproved sanitation facility if they are using otherwise acceptable sanitation facilities but sharing a facility between two or more households or using a public toilet facility. As shown in Table WS.6, 96.9 percent of the household population is using an improved sanitation facility of which 89.2 percent is not shared. Only 7.7 percent of households use an improved toilet facility that is shared with other households. Rural households are more likely than urban households to use a shared improved toilet facility (9.1 percent and 6.0 percent, respectively). Improved sanitation facilities are shared less by more educated households and by households with the richest wealth index. Households in the Corozal District share improved sanitary facilities more than households in other districts (12.2 percent). mics f inal report 85 Table WS.6: Use and sharing of sanitation facilities Percent distribution of household population by use of private and public sanitation facilities and use of shared facilities, by users of improved and unimproved sanitation facilities, Belize, 2011 Users of improved sanitation facilities Users of unimproved sanitation facilities Open defe- cation (no facility, bush field) Number of house- hold members Not shared [1] Public facility Shared by: 5 house- holds or less Shared by: More than 5 house- holds Missing/ DK Not shared Shared by: 5 house- holds or less Shared by: More than 5 house- holds Miss- ing/DK Region Corozal 85.5 0.4 12.2 0.0 0.2 0.4 0.2 0.0 0.0 0.9 2296 Orange Walk 93.5 0.5 3.1 2.0 0.0 0.7 0.0 0.0 0.0 0.3 2584 Belize (Excluding Belize City South Side) 93.3 0.3 5.3 0.5 0.0 0.2 0.0 0.0 0.0 0.4 2799 Belize City South Side 88.3 0.5 4.7 1.3 0.3 2.8 0.5 0.0 0.0 1.6 2177 Belize District 91.1 0.4 5.0 0.8 0.1 1.3 0.2 0.0 0.0 0.9 4976 Cayo 90.3 0.5 6.1 2.2 0.0 0.6 0.0 0.0 0.0 0.4 3865 Stann Creek 86.1 0.0 5.1 2.5 0.0 3.6 0.3 0.8 0.1 1.4 1833 Toledo 82.9 0.8 4.1 1.9 0.2 0.2 0.0 0.1 0.0 9.7 1733 Area Urban 92.2 0.3 4.6 1.1 0.1 0.8 0.2 0.0 0.0 0.7 7536 Rural 86.9 0.5 6.8 1.8 0.1 1.3 0.1 0.2 0.0 2.4 9752 Education of house- hold head None 79.5 0.7 5.5 1.6 0.1 0.7 0.1 0.2 0.0 11.7 1577 Primary 86.7 0.3 7.3 1.8 0.1 1.5 0.2 0.2 0.0 1.9 9242 Secondary + 93.1 0.6 3.7 1.1 0.1 0.7 0.2 0.0 0.0 0.6 6412 CET/ITVET/VOTEC 93.1 0.0 4.6 0.0 0.0 1.8 0.0 0.0 0.0 0.5 172 Missing/DK 84.2 0.0 9.6 6.2 0.0 0.0 0.0 0.0 0.0 0.0 256 Other 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 288 Wealth index quintiles Poorest 74.2 0.4 11.5 3.1 0.1 3.0 0.5 0.2 0.1 6.9 3458 Second 82.6 0.6 10.8 2.4 0.2 1.8 0.2 0.3 0.0 1.2 3457 Middle 92.3 0.9 4.9 1.6 0.1 0.0 0.0 0.0 0.0 0.1 3459 Fourth 98.4 0.0 1.3 0.0 0.0 0.3 0.0 0.0 0.0 0.0 3456 Richest 98.4 0.3 0.7 0.4 0.0 0.2 0.0 0.0 0.0 0.0 3457 Ethnicity of house- hold head Creole 91.2 0.3 4.9 1.0 0.2 1.6 0.2 0.0 0.0 0.6 4048 Mestizo 88.9 0.4 6.8 1.9 0.1 0.9 0.1 0.1 0.0 0.7 8498 Garifuna 91.0 0.1 5.2 1.4 0.0 0.7 0.5 0.2 0.2 0.8 959 Maya 79.1 0.5 6.3 1.8 0.2 1.9 0.0 0.4 0.0 9.7 1933 Other 96.4 0.9 2.4 0.3 0.0 0.0 0.0 0.0 0.0 0.0 1552 Missing/DK 92.6 0.5 6.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 298 Total 89.2 0.4 5.8 1.5 0.1 1.1 0.1 0.1 0.0 1.6 17288 [1] MICS indicator 4.3; MDG indicator 7.9 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 WS.7. About a quarter of children’s faeces (25.6 percent) were disposed of safely in Belize. The Toledo District (15.2 percent) and the Belize City South Side (17.7 percent) were the regions with the lowest safety disposal rates. Households in rural areas tended to dispose of children’s faeces safely more often than households in urban areas (urban 17.5 percent, rural 30.7 percent). Also of interest is that households with less educated heads and richer families seem to safely dispose of children’s faeses at higher rates . 86 mics f inal report Table WS.7: Disposal of child’s faeces Percent distribution of children age 0-2 years according to place of disposal of child’s faeces, and the percentage of children age 0-2 years whose stools were disposed of safely the last time the child passed stools, Belize, 2011 Place of disposal of child’s faeces Total Percentage of children whose last stools were disposed of safely [1] Number of children age 0-2 years Child used toilet / latrine Put / rinsed into toilet or latrine Put / rinsed into drain or ditch Thrown into garbage (solid waste) buried left in the open other DK Type of sanitaton facility in dwelling Improved 13.1 12.7 0.7 68.2 1.6 1.1 2.0 0.5 100.0 25.8 1110 unimproved (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 15 open defacation (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 27 region Corozal 14.2 23.0 2.5 57.1 0.0 2.2 1.1 0.0 100.0 37.2 162 orange Walk 15.3 26.8 0.8 50.7 0.5 0.9 3.1 1.9 100.0 42.1 184 belize (excluding belize City south side) 17.5 1.3 0.0 81.1 0.0 0.0 0.0 0.0 100.0 18.9 123 belize City south side 13.8 3.8 0.0 81.0 0.0 0.0 1.3 0.0 100.0 17.7 143 belize District 15.6 2.7 0.0 81.0 0.0 0.0 0.7 0.0 100.0 18.2 266 Cayo 13.8 6.5 0.6 75.8 1.7 0.0 1.7 0.0 100.0 20.3 283 stann Creek 8.0 17.4 0.0 56.9 7.7 2.9 5.6 1.4 100.0 25.4 121 Toledo 5.8 9.3 0.9 71.9 2.2 4.9 4.0 1.0 100.0 15.2 136 area urban 13.5 4.1 0.0 82.1 0.0 0.0 0.4 0.0 100.0 17.5 443 rural 12.7 18.0 1.2 59.1 2.5 2.2 3.5 0.9 100.0 30.7 709 Mother’s education None 17.2 16.5 3.5 51.0 2.2 3.9 4.6 1.2 100.0 33.7 62 Primary 10.6 15.7 0.7 65.8 1.8 1.8 3.0 0.5 100.0 26.4 543 secondary + 15.1 6.2 0.2 75.2 1.3 0.3 1.4 0.3 100.0 21.3 512 CeT/ITVeT/VoTeC (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 8 other (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 27 Wealth index quin- tiles Poorest 10.9 20.5 2.5 50.6 2.7 5.0 6.5 1.3 100.0 31.3 292 second 12.4 16.6 0.0 66.9 1.9 0.3 1.8 0.0 100.0 29.1 261 Middle 12.6 9.7 0.0 76.6 0.3 0.0 0.4 0.4 100.0 22.3 241 Fourth 13.2 5.4 0.4 77.4 2.2 0.0 0.4 0.9 100.0 18.6 190 richest 17.7 5.3 0.0 76.5 0.0 0.0 0.5 0.0 100.0 23.0 168 ethnicity of household head Creole 15.9 4.4 0.0 77.1 1.3 0.0 0.5 0.8 100.0 20.4 207 Mestizo 12.9 15.3 1.0 65.2 1.4 0.9 2.9 0.4 100.0 28.2 579 Garifuna 9.5 14.5 0.0 74.8 0.0 1.3 0.0 0.0 100.0 24.0 65 Maya 10.7 8.2 0.7 67.7 4.3 3.5 4.5 0.4 100.0 18.9 167 other 11.2 21.3 1.3 61.1 0.0 3.0 0.8 1.4 100.0 32.5 118 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 17 Total 13.0 12.6 0.7 67.9 1.6 1.3 2.3 0.6 100.0 25.6 1152 [1] MICS indicator 4.4 (*) Figures that are based on less than 25 un-weighted cases In its 2008 report1, the JMP developed a new way of presenting the access figures, by disaggregating and refining the data on drinking-water and sanitation and reflecting them in “ladder” format. This ladder allows a disaggregated analysis of trends in a three rung ladder for drinking-water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of population with no sanitation facilities at all, of those reliant on technologies defined by JMP as “unimproved,” of those sharing sanitation facilities of otherwise acceptable technology, and those using “improved” sanitation facilities. Table WS.8 presents the percentages of household population by drinking water and sanitation ladders. 1 WHO/UNICEF JMP (2008), MDG assessment report - http://www.wssinfo.org/download?id_document=1279 mics f inal report 87 The table also shows the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal. Almost all households (97.7 percent) have improved drinking water and 89.2 percent have improved sanitation (Table WS.8). Improved sanitation rates differ by area with 92.2 percent in urban areas and 86.9 percent in rural areas. Residents of the Toledo (82.9 percent) and Stann Creek (86.1 percent) Districts are less likely than others to use improved sanitation facilities. Use of improved sanitary facilities increase with increasing education (no education 81.9 percent, secondary + education 93.1 percent). Also, use of improved sanitation increases with increasing wealth (poorest 74.2 percent, richest 98.4 percent). The Maya are the least likely to use improved sanitation (79.1 percent). 88 mics f inal report Table WS.8: Drinking water and sanitation ladders Percentage of household population by drinking water and sanitation ladders, Belize, 2011 Percentage of household population using: Number of house- hold members Improved drinking water [1] Unim- proved drinking water Total Improved sanitation [2] Unimproved sanitation Total Improved drinking water sources and im- proved sanitation Piped into dwelling, plot or yard Other im- proved Shared improved facilities Unim- proved facilities Open defeca- tion Region Corozal 59.2 36.4 4.4 100.0 85.5 12.9 0.7 0.9 100.0 82.4 2296 Orange Walk 72.3 25.3 2.4 100.0 93.5 5.5 0.7 0.3 100.0 92.1 2584 Belize (Excluding Belize City South Side) 77.6 22.2 0.3 100.0 93.3 6.1 0.2 0.4 100.0 93.2 2799 Belize City South Side 88.2 11.6 0.2 100.0 88.3 6.8 3.3 1.6 100.0 88.3 2177 Belize District 82.2 17.5 0.2 100.0 91.1 6.4 1.6 0.9 100.0 91.1 4976 Cayo 76.0 19.6 4.4 100.0 90.3 8.8 0.6 0.4 100.0 85.9 3865 Stann Creek 94.6 4.9 0.5 100.0 86.1 7.6 4.9 1.4 100.0 86.0 1833 Toledo 58.4 38.7 2.9 100.0 82.9 7.1 0.3 9.7 100.0 80.9 1733 Area Urban 89.3 10.3 0.5 100.0 92.2 6.1 1.0 0.7 100.0 91.9 7536 Rural 64.3 31.9 3.8 100.0 86.9 9.2 1.6 2.4 100.0 83.9 9752 Education of house- hold head None 58.2 38.2 3.6 100.0 79.5 7.9 1.0 11.7 100.0 77.0 1577 Primary 71.5 25.2 3.3 100.0 86.7 9.6 1.9 1.9 100.0 84.2 9242 Secondary + 85.2 14.2 0.5 100.0 93.1 5.4 0.9 0.6 100.0 92.7 6412 CET/ITVET/VO- TEC 94.5 5.5 0.0 100.0 93.1 4.6 1.8 0.5 100.0 93.1 172 Missing/DK 82.3 15.3 2.5 100.0 84.2 15.8 0.0 0.0 100.0 81.7 256 Other 27.0 73.0 0.0 100.0 100.0 0.0 0.0 0.0 100.0 100.0 288 Wealth index quintiles Poorest 56.6 37.4 6.0 100.0 74.2 15.1 3.8 6.9 100.0 70.2 3458 Second 74.1 24.1 1.7 100.0 82.6 13.9 2.3 1.2 100.0 81.2 3457 Middle 76.3 21.9 1.8 100.0 92.3 7.6 0.0 0.1 100.0 90.7 3459 Fourth 80.8 18.0 1.1 100.0 98.4 1.3 0.3 0.0 100.0 97.3 3456 Richest 88.1 10.8 1.1 100.0 98.4 1.4 0.2 0.0 100.0 97.4 3457 Ethnicity of house- hold head Creole 80.4 19.3 0.4 100.0 91.2 6.4 1.8 0.6 100.0 90.9 4048 Mestizo 75.0 21.8 3.2 100.0 88.9 9.3 1.1 0.7 100.0 86.3 8498 Garifuna 94.0 5.8 0.2 100.0 91.0 6.6 1.7 0.8 100.0 90.8 959 Maya 65.3 30.4 4.2 100.0 79.1 8.9 2.3 9.7 100.0 76.0 1933 Other 61.7 37.3 1.0 100.0 96.4 3.6 0.0 0.0 100.0 95.5 1552 Missing/DK 85.6 7.9 6.4 100.0 92.6 7.4 0.0 0.0 100.0 89.2 298 Total 75.2 22.5 2.3 100.0 89.2 7.9 1.3 1.6 100.0 87.4 17288 [1] MICS indicator 4.1; MDG indicator 7.8 [2] MICS indicator 4.3; MDG indicator 7.9 Handwashing Handwashing with water and soap is the most cost effective health intervention to reduce both the incidence of diarrhoea and pneumonia in children under five. It is most effective when done using water and soap after visiting a toilet or cleaning a child, before eating or handling food and, before feeding a child. Monitoring correct hand washing behaviour at these critical times is challenging. A reliable alternative to observations or self-reported behaviour is assessing the likelihood that correct hand washing behaviour takes place by observing if a household has a specific place where people most often wash their hands and observing if water and soap (or other local cleansing materials) are present at a specific place for hand washing. mics f inal report 89 Ta b le W S .9 : W at er a n d s o ap a t p la ce f o r h an d -w as h in g Pe rc en ta g e o f h o u se h o ld s w h er e p la ce f o r h an d -w as h in g w as o b se rv ed a n d p er ce n t d is tr ib u ti o n o f h o u se h o ld s b y av ai la b ili ty o f w at er a n d s o ap a t p la ce f o r h an d -w as h in g , B el iz e, 20 11 Pe rc en ta g e o f h o u se - h o ld s w h er e p la ce f o r h an d -w as h in g w as o b se rv ed Pe rc en ta g e o f h o u se h o ld s w h er e p la ce fo r h an d -w as h in g w as n o t o b se rv ed To ta l N u m b er o f h o u se - h o ld s Pe rc en t d is tr ib u ti o n o f h o u se h o ld s w h er e p la ce f o r h an d -w as h in g w as o b se rv ed , a n d : To ta l N u m b er o f h o u se - h o ld s w h er e p la ce f o r h an d -w as h - in g w as o b - se rv ed N o t in d w el l- in g /p lo t/ ya rd N o p er m is - si o n t o s ee O th er re as o n s W at er a n d so ap a re av ai la b le [1 ] W at er is av ai la b le , so ap is n o t av ai l- ab le W at er is n o t av ai l- ab le , s o ap is a va il- ab le W at er an d s o ap ar e n o t av ai la b le R eg io n C o ro za l 69 .5 9. 3 19 .6 1. 6 10 0. 0 51 9 93 .0 3. 6 3. 2 0. 2 10 0. 0 36 1 O ra n g e W al k 84 .5 9. 4 4. 4 1. 8 10 0. 0 60 7 98 .5 0. 7 0. 8 0. 0 10 0. 0 51 3 B el iz e (E xc lu d in g B el iz e C it y S o u th S id e) 78 .6 2. 1 13 .9 5. 4 10 0. 0 86 0 99 .4 0. 4 0. 2 0. 0 10 0. 0 67 6 B el iz e C it y S o u th S id e 49 .7 5. 1 18 .8 26 .5 10 0. 0 61 4 93 .7 1. 3 5. 0 0. 0 10 0. 0 30 5 B el iz e D is tr ic t 66 .5 3. 3 15 .9 14 .2 10 0. 0 14 74 97 .6 0. 7 1. 7 0. 0 10 0. 0 98 1 C ay o 83 .2 8. 8 3. 0 5. 0 10 0. 0 91 8 98 .1 0. 2 1. 3 0. 4 10 0. 0 76 4 S ta n n C re ek 75 .5 10 .1 9. 2 5. 2 10 0. 0 48 8 95 .3 3. 6 0. 4 0. 7 10 0. 0 36 8 To le d o 88 .9 8. 9 0. 3 1. 9 10 0. 0 41 7 73 .2 24 .7 1. 9 A re a U rb an 72 .4 4. 6 12 .2 10 .9 10 0. 0 21 70 97 .5 1. 0 1. 5 0. 0 10 0. 0 15 70 R u ra l 79 .3 9. 9 7. 6 3. 1 10 0. 0 22 54 91 .7 6. 4 1. 5 0. 4 10 0. 0 17 88 E d u ca ti o n o f h o u se - h o ld h ea d N o n e 81 .5 9. 8 7. 1 1. 6 10 0. 0 31 1 87 .6 10 .5 0. 6 1. 3 10 0. 0 25 4 Pr im ar y 75 .6 9. 0 9. 6 5. 9 10 0. 0 21 04 92 .9 5. 1 1. 9 0. 1 10 0. 0 15 90 S ec o n d ar y + 74 .6 5. 2 10 .9 9. 3 10 0. 0 18 51 97 .0 1. 5 1. 4 0. 1 10 0. 0 13 81 C E T /IT V E T /V O T E C (8 7. 0) (0 .0 ) (8 .9 ) (4 .1 ) 10 0. 0 47 (1 00 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) 10 0. 0 41 M is si n g /D K 75 .9 8. 1 9. 4 6. 6 10 0. 0 58 (1 00 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) 10 0. 0 44 O th er 93 .7 4. 5 1. 8 0. 0 10 0. 0 52 98 .5 1. 5 0. 0 0. 0 10 0. 0 49 W ea lt h in d ex q u in - ti le s Po o re st 74 .5 11 .8 7. 8 5. 9 10 0. 0 88 5 84 .0 12 .1 2. 9 1. 0 10 0. 0 65 9 S ec o n d 71 .8 9. 4 11 .6 7. 3 10 0. 0 86 5 93 .5 3. 9 2. 5 0. 1 10 0. 0 62 1 M id d le 75 .6 6. 6 11 .1 6. 7 10 0. 0 86 3 96 .6 2. 3 1. 1 0. 0 10 0. 0 65 2 Fo u rt h 80 .0 4. 2 8. 9 6. 9 10 0. 0 88 9 97 .8 0. 9 1. 3 0. 0 10 0. 0 71 1 R ic h es t 77 .6 4. 6 10 .0 7. 9 10 0. 0 92 2 99 .4 0. 6 0. 0 0. 0 10 0. 0 71 5 E th n ic it y o f h o u se h o ld h ea d C re o le 69 .6 4. 9 13 .1 12 .4 10 0. 0 11 82 95 .6 2. 1 2. 2 0. 0 10 0. 0 82 2 M es ti zo 78 .3 9. 1 8. 3 4. 3 10 0. 0 20 58 95 .5 2. 7 1. 5 0. 3 10 0. 0 16 11 G ar if u n a 74 .8 5. 3 9. 2 10 .8 10 0. 0 28 6 96 .2 2. 4 1. 4 0. 0 10 0. 0 21 4 M ay a 86 .1 7. 1 3. 1 3. 7 10 0. 0 39 9 82 .7 16 .1 0. 6 0. 7 10 0. 0 34 4 O th er 76 .2 6. 3 12 .7 4. 8 10 0. 0 40 9 96 .5 2. 3 1. 2 0. 0 10 0. 0 31 2 M is si n g /D K 62 .8 8. 2 21 .0 8. 1 10 0. 0 91 98 .5 1. 5 0. 0 0. 0 10 0. 0 57 To ta l 75 .9 7. 3 9. 9 6. 9 10 0. 0 44 24 94 .4 3. 9 1. 5 0. 2 10 0. 0 33 59 [1 ] M IC S in d ic at o r 4. 5; ( ) F ig u re s th at a re b as ed o n 2 5- 49 u n -w ei g h te d c as es . 90 mics f inal report In Belize, a specific place for hand washing was observed in 75.9 percent of the households while 7.3 percent households could not indicate a specific place where household members usually wash their hands and 9.9 percent of the households did not give a permission to see the place used for hand washing (Table WS.9). Of those households where place for hand-washing was observed, 94.4 percent had both water and soap present at the designated place. In 3.9 percent of the households only water was available at the designated place, while in 1.5 percent of the households the place only had soap but no water. The remaining 0.2 percent of households had neither water nor soap available at the designated place for hand washing (Table WS.9). Soaps were available at rates in excess of 93 percent in all regions except the Cayo District (73.2 percent). There is tendency for water and soap to be present at higher rates in households with more educated heads. Households with richer wealth indices tend to have higher rates of available water and soap. Households with Maya heads were the least likely to have water and soap available (Table WS.10). Table WS.10: Availability of soap Percent distribution of households by availability of soap in the dwelling, Belize, 2011 Place for hand washing observed Place for hand washing not observed Total Percent- age of house- holds with soap any- where in the dwell- ing [1] Number of households Soap ob- served Soap shown No soap in house- hold Not able/ Does not want to show soap Soap shown No soap in house- hold Not able/ Does not want to show soap Region Corozal 66.9 1.4 1.1 0.2 28.0 0.5 2.0 100.0 96.3 519 Orange Walk 84.0 0.1 0.4 0.0 14.7 0.3 0.5 100.0 98.7 607 Belize (Exclud- ing Belize City South Side) 78.3 0.3 0.0 0.0 4.5 0.3 16.5 100.0 83.1 860 Belize City South Side 49.0 0.5 0.0 0.2 38.3 1.6 10.4 100.0 87.8 614 Belize District 66.1 0.4 0.0 0.1 18.6 0.9 14.0 100.0 85.1 1474 Cayo 82.7 0.2 0.4 0.0 15.8 0.3 0.7 100.0 98.6 918 Stann Creek 72.3 3.0 0.2 0.0 19.7 0.2 4.6 100.0 95.0 488 Toledo 66.8 19.3 2.8 0.0 9.8 1.0 0.3 100.0 95.9 417 Area Urban 71.7 0.6 0.1 0.0 20.1 0.6 6.9 100.0 92.4 2170 Rural 74.0 4.3 1.0 0.0 15.7 0.6 4.4 100.0 94.0 2254 Education of house- hold head None 71.9 6.1 3.5 0.0 14.6 2.8 1.1 100.0 92.6 311 Primary 71.6 3.3 0.6 0.1 19.6 0.6 4.3 100.0 94.5 2104 Secondary + 73.4 1.2 0.1 0.0 17.0 0.2 8.2 100.0 91.6 1851 CET/ITVET/ VOTEC (87.0) (0.0) (0.0) (0.0) (10.1) (0.0) (2.9) 100.0 (97.1) 47 Missing/DK (75.9) (0.0) (0.0) (0.0) (17.0) (0.0) (7.1) 100.0 (92.9) 58 Other (92.4) (1.4) (0.0) (0.0) (6.3) (0.0) (0.0) 100.0 (100.0) 52 Wealth index quintiles Poorest 64.7 7.4 2.3 0.1 18.3 1.8 5.4 100.0 90.5 885 Second 68.9 2.4 0.5 0.0 21.2 0.8 6.2 100.0 92.5 865 Middle 73.8 1.8 0.0 0.0 19.8 0.3 4.3 100.0 95.4 863 Fourth 79.3 0.6 0.0 0.1 14.8 0.0 5.2 100.0 94.7 889 Richest 77.1 0.4 0.0 0.0 15.4 0.0 7.0 100.0 93.0 922 Ethnicity of house- hold head Creole 68.1 1.3 0.1 0.1 18.8 0.7 10.9 100.0 88.2 1182 Mestizo 75.9 1.9 0.4 0.0 18.4 0.5 2.9 100.0 96.2 2058 Garifuna 72.9 1.8 0.0 0.0 18.0 0.7 6.5 100.0 92.8 286 Maya 71.7 10.9 3.5 0.0 12.0 1.0 0.8 100.0 94.6 399 Other 74.5 1.7 0.0 0.0 16.4 0.3 7.1 100.0 92.6 409 Missing/DK 61.9 0.9 0.0 0.0 25.4 0.0 11.8 100.0 88.2 91 Total 72.8 2.5 0.6 0.0 17.9 0.6 5.6 100.0 93.2 4424 [1] MICS indicator 4.6; ( ) Figures that are based on 25-49 un-weighted cases. mics f inal report 91 viii. reproduCTive healTh Fertility In MICS4, adolescent birth rates and total fertility rates are calculated by using information on the date of last birth of each woman and are based on the one-year period (1-12 months) preceding the survey. Rates are underestimated by a very small margin due to absence of information on multiple births (twins, triplets etc) and on women having multiple deliveries during the one year period preceding the survey. Table RH.1 shows adolescent birth rates and total fertility rate. The adolescent birth rate (age-specific fertility rate for women age 15-19) is defined as the number of births to women age 15-19 years during the one year period preceding the survey, divided by the average number of women age 15-19 (number of women-years lived between ages 15 through 19, inclusive) during the same period, expressed per 1000 women. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. Table RH.1: Adolescent birth rate and total fertility rate Adolescent birth rates and total fertility rates, Belize, 2011 Adolescent birth rate [1] (Age- specific fertility rate for women age 15-19) Total Fertility Rate Region Corozal 61 2.3 Orange Walk 79 3.0 Belize (Excluding Belize City South Side) 45 1.7 Belize City South Side 59 1.9 Belize District 51 1.8 Cayo 56 3.1 Stann Creek 84 3.1 Toledo 81 3.4 Area Urban 39 2.1 Rural 85 3.1 Mother’s education None 0 6.0 Primary 145 3.3 Secondary+ 37 2.0 CET/ITVET/VOTEC 0 .0 Wealth index quintile Poorest 96 4.2 Second 88 2.8 Middle 62 2.4 Fourth 53 2.5 Richest 23 1.7 Ethnicity of household head Creole 34 1.4 Mestizo 83 2.8 Garifuna 64 3.1 Maya 74 3.8 Other 23 3.8 Total 64 2.6 [1] MICS indicator 5.1; MDG indicator 5.4 92 mics f inal report Adolescent birth rate is twice as in rural areas (85 per thousand) than in urban areas (39 per thousand). High adolescent birth rates are also found in the Mestizo (83 per thousand) and in the Stann Creek District (84 per thousand). Wealthy families are less likely to have high adolescent birth rates; for poor families the rate is 96 per thousand while for the richest it is 23 per thousand. Sexual activity and childbearing early in life carry significant risks for young people all around the world. Table RH.2 presents some early childbearing indicators for women age 15-19 and 20-24 while Table RH.3 presents the trends for early childbearing. As shown in Table RH.2, 11.4 percent of women age 15-19 have already had a birth, 4.2 percent are pregnant with their first child, 15.6 percent have begun childbearing and 0.6 percent have had a live birth before age 15. The percentage of women age 20-24 years who have had a live birth before age 18 is 16.9. Women with a live birth before age 15 years are slightly more likely to be from rural areas while for live births before age 18 years it is clear that rural women have higher rates (Figure RH.1). There are also some interesting patterns in the percentage of women 20 to 24 who have had a live birth before age 18 years. Richer women seem to have fewer births before age 18 years (TableRH.2). For the poorest index the rate is 32.5 percent and this reduces for the richest index at 6.0 percent. Toledo (27.6 percent) and Stann Creek (21.2 percent) are the districts with highest rates of live births before age 18 years for women 20 to 24 years. Among the ethnic groups, highest rates are observed in the Maya (21.4 percent) and the Mestizo (19.3 Percent) households. Table RH.2: Early childbearing Percentage of women age 15-19 who have had a live birth or who are pregnant with the first child, percentage of women age 15- 19 who have begun childbearing before age 15, and the percentage of women age 20-24 who have had a live birth before age 18, Belize, 2011 Number of women age 15-19 Number of women age 15-19 Percentage of women age 20-24 who have had a live birth before age 18 [1] Number of women age 20-24 Have had a live birth Are preg- nant with first child Have begun childbearing Have had a live birth be- fore age 15 Region Corozal 13.1 5.3 18.4 1.6 107 15.3 87 Orange Walk 13.2 6.2 19.4 0.7 137 17.4 121 Belize (Excluding Belize City South Side) 10.0 2.1 12.1 0.0 139 13.0 116 Belize City South Side 8.1 0.0 8.1 0.8 106 15.8 110 Belize District 9.2 1.2 10.3 0.4 245 14.4 226 Cayo 9.8 5.5 15.3 0.0 196 14.5 151 Stann Creek 11.8 6.6 18.4 2.1 77 21.2 70 Toledo 16.4 3.3 19.7 0.0 82 27.6 65 Area Urban 7.1 3.9 11.0 0.2 383 14.1 343 Rural 15.0 4.5 19.5 0.9 461 19.4 377 Education None (*) (*) (*) (*) 9 (*) 13 Primary 25.5 9.3 34.9 2.0 220 29.4 223 Secondary + 6.6 2.6 9.1 0.1 598 10.8 466 CET/ITVET/VOTEC (*) (*) (*) (*) 4 (*) 6 Other (*) (*) (*) (*) 14 (*) 12 Wealth index quin- tiles Poorest 17.4 6.4 23.9 1.0 160 32.5 111 Second 15.4 6.7 22.1 2.2 167 19.7 163 Middle 9.9 3.2 13.1 0.0 192 14.2 164 Fourth 7.4 3.9 11.3 0.0 159 14.9 149 Richest 7.2 1.2 8.3 0.0 167 6.0 132 Ethnicity of household head Creole 9.4 2.2 11.6 0.5 190 12.2 185 Mestizo 12.9 5.7 18.7 1.0 431 19.3 352 Garifuna 6.2 2.1 8.3 0.0 44 (12.7) 49 Maya 15.9 5.4 21.4 0.0 98 21.4 80 Other 5.1 0.9 6.0 0.0 69 13.0 45 Missing/DK (*) (*) (*) (*) 12 (*) 8 Total 11.4 4.2 15.6 0.6 844 16.9 720 [1] MICS indicator 5.2 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 93 Table RH.3: Trends in early childbearing Percentage of women who have had a live birth by age 15 and 18, by age groups, Belize, 2011 Urban Rural All Percentage of women with a live birth before age 15 Number of wom- en age 15-49 years Percentage of women with a live birth before age 18 Number of wom- en age 20-49 years Percentage of women with a live birth before age 15 Number of wom- en age 15-49 years Percentage of women with a live birth before age 18 Number of wom- en age 20-49 years Percentage of women with a live birth before age 15 Number of wom- en age 15-49 years Percentage of women with a live birth before age 18 Number of wom- en age 20-49 years Age 15-19 0.2 379 (*) 0 0.9 465 (*) 0 0.6 844 (*) 0 20-24 2.2 340 14.3 340 2.0 377 19.2 377 2.1 717 16.8 717 25-29 1.8 301 15.3 301 3.7 351 26.7 351 2.8 653 21.4 653 30-34 2.9 250 23.2 250 3.6 290 27.0 290 3.3 540 25.2 540 35-39 3.9 238 20.6 238 4.2 298 28.1 298 4.0 536 24.7 536 40-44 1.3 228 20.4 228 3.6 214 26.1 214 2.4 442 23.2 442 45-49 2.1 165 22.8 165 2.2 194 26.6 194 2.2 359 24.8 359 Total 1.9 1900 18.8 1521 2.7 2191 25.2 1725 2.4 4091 22.2 3247 (*) Figures that are based on less than 25 un-weighted cases 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. Access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many is critical. Current use of contraception was reported by 55.2 percent of women currently married or in union (Table RH.4). The most popular method is female sterilization which is used by 20.7 percent of married women in 94 mics f inal report Belize. The next most popular method is the pill, which accounts for 12.5 percent of married women and this is followed closely by injectables at 11.4 percent. Male condom use (5.2 percent) and use of IUD (1.6 percent) play a small role. Less than 2.1 percent use periodic abstinence, withdrawal, male sterilization, vaginal methods, or the lactational amenorrhea method (LAM). Table RH.4: Use of contraception Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Belize, 2011 Not using any method Any modern method Any traditional method Any method [1] Number of wom- en currently mar- ried or in union Region Corozal 38.2 55.1 6.7 61.8 346 Orange Walk 41.1 54.1 4.8 58.9 373 Belize (Excluding Belize City South Side) 42.8 55.2 2.0 57.2 369 Belize City South Side 44.8 52.6 2.5 55.2 257 Belize District 43.6 54.2 2.2 56.4 625 Cayo 43.1 53.9 3.0 56.9 601 Stann Creek 43.3 54.8 1.9 56.7 225 Toledo 71.7 26.4 1.8 28.3 217 Area Urban 42.3 54.3 3.4 57.7 991 Rural 46.7 50.0 3.4 53.3 1395 Age 15-19 64.3 33.8 1.9 35.7 128 20-24 50.2 47.9 1.9 49.8 369 25-29 44.2 52.6 3.2 55.8 488 30-34 41.9 54.1 4.0 58.1 407 35-39 41.9 54.8 3.3 58.1 417 40-44 37.0 57.2 5.8 63.0 323 45-49 48.0 49.3 2.8 52.0 254 Number of living children 0 76.3 22.4 1.4 23.7 275 1 48.6 47.6 3.8 51.4 451 2 39.5 57.9 2.5 60.5 522 3 39.6 56.6 3.9 60.4 425 4+ 37.4 58.4 4.2 62.6 713 Educa- tion None 57.8 38.3 3.8 42.2 119 Primary 44.4 52.7 2.9 55.6 1165 Secondary + 42.3 53.7 4.0 57.7 1056 CET/ITVET/VOTEC (*) (*) (*) (*) 13 Other (8.6) (11.4) (0.0) (11.4) 34 Wealth index quintiles Poorest 57.8 40.8 1.4 42.2 409 Second 46.0 50.9 3.0 54.0 498 Middle 46.4 50.5 3.1 53.6 484 Fourth 38.8 57.3 3.9 61.2 494 Richest 37.5 57.3 5.2 62.5 501 Ethnic- ity of house- hold head Creole 43.9 53.8 2.3 56.1 493 Mestizo 40.0 56.1 4.0 60.0 1262 Garifuna 46.8 47.3 5.9 53.2 120 Maya 62.0 36.0 2.0 38.0 272 Other 54.2 42.8 3.1 45.8 198 Missing/DK (41.5) (56.3) (2.2) (58.5) 41 Total 44.8 51.8 3.4 55.2 2386 [1] MICS indicator 5.3; MDG indicator 5.3 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Contraceptive prevalence is highest in Corozal District at 61.8 percent and almost as high in Orange Walk at 58.9 percent. In the Toledo District, contraceptive use is relatively rare; only 28.3 percent of married women reported using any method. Adolescents are less likely to use contraception than older women. About 35.7 percent of married or in union women aged 15-19 currently use a method of contraception compared to 49.8 percent of 20-24 year olds and 55.8 percent of older women. mics f inal report 95 Women’s education level is associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 44.1 percent among those with no education to 55.6 percent among women with primary education, and to 57.7 percent among women with secondary or higher education. In addition to differences in prevalence, the method mix varies by education. About 42.2 percent of contraceptive users with no or primary education are sterilized and 18.8 percent use the pill. In comparison, 14.0 percent of contraceptive users with secondary or higher education use the pill and 18.8 percent are sterilized. Table RH.4: Use of contraception [continued] Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Belize, 2011 Not using any method Female sterilization Male sterilization IUD Injectables Implants Pill Number of women currently married or in union Region Corozal 38.2 22.8 0.5 1.4 12.4 0.0 12.6 346 Orange Walk 41.1 21.3 0.0 1.2 13.4 0.0 13.9 373 Belize (Excluding Belize City South Side) 42.8 24.6 0.0 1.3 8.7 0.0 11.7 369 Belize City South Side 44.8 21.4 0.0 3.2 6.3 0.4 13.3 257 Belize District 43.6 23.3 0.0 2.1 7.7 0.2 12.4 625 Cayo 43.1 21.1 0.0 1.9 13.9 0.0 12.1 601 Stann Creek 43.3 21.0 0.0 1.4 12.7 0.0 15.2 225 Toledo 71.7 8.2 0.0 0.0 8.7 0.3 8.6 217 Area Urban 42.3 21.9 0.0 2.2 10.0 0.2 12.8 991 Rural 46.7 19.9 0.1 1.1 12.4 0.0 12.3 1395 Age 15-19 64.3 0.0 0.0 1.3 16.9 0.0 13.0 128 20-24 50.2 4.5 0.0 1.5 17.5 0.3 16.2 369 25-29 44.2 12.7 0.2 1.0 13.9 0.0 17.6 488 30-34 41.9 21.7 0.0 2.5 10.0 0.1 13.8 407 35-39 41.9 27.8 0.0 1.1 12.1 0.0 9.0 417 40-44 37.0 36.7 0.3 2.6 6.4 0.0 9.0 323 45-49 48.0 37.0 0.0 1.0 2.4 0.0 5.4 254 Number of living children 0 76.3 0.3 0.3 0.0 3.0 0.0 11.7 275 1 48.6 4.0 0.0 2.7 12.8 0.2 18.3 451 2 39.5 20.5 0.0 2.8 15.3 0.0 13.9 522 3 39.6 31.1 0.2 1.0 9.3 0.1 10.9 425 4+ 37.4 33.2 0.0 0.9 12.1 0.0 9.1 713 Education None 57.8 18.7 0.0 2.2 10.4 0.0 5.6 119 Primary 44.4 23.2 0.0 0.8 12.4 0.0 12.2 1165 Secondary + 42.3 18.8 0.2 2.4 10.8 0.1 14.0 1056 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) (*) 13 Other (88.6) (9.3) (0.0) (0.0) (0.0) (0.0) (2.1) 34 Wealth index quintiles Poorest 57.8 15.9 0.0 0.9 15.0 0.0 7.6 409 Second 46.0 18.7 0.0 0.8 12.7 0.2 12.1 498 Middle 46.4 21.2 0.0 1.0 9.0 0.0 12.8 484 Fourth 38.8 23.1 0.2 1.6 12.5 0.1 14.5 494 Richest 37.5 24.0 0.2 3.3 8.3 0.0 14.7 501 Ethnicity of household head Creole 43.9 22.3 0.0 1.9 8.4 0.3 13.6 493 Mestizo 40.0 22.4 0.1 1.4 14.1 0.0 12.6 1262 Garifuna 46.8 19.2 0.0 1.5 7.5 0.0 16.8 120 Maya 62.0 15.6 0.0 0.0 11.4 0.0 7.6 272 Other 54.2 14.5 0.5 3.4 4.9 0.0 12.3 198 Missing/DK (41.5) (20.1) (0.0) (3.9) (6.1) (0.0) (17.9) 41 Total 44.8 20.7 0.1 1.6 11.4 0.1 12.5 2386 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 96 mics f inal report Table RH.4: Use of contraception [continued] Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Belize, 2011 Number of women currently married or in union Male condom Female condom Diaphragm/ foam/jelly Lactational amenorrhoea method (LAM) Periodic abstinence/ Rhythm Withdrawal Other Region Corozal 5.2 0.0 0.2 1.5 3.1 2.1 0.0 346 Orange Walk 3.8 0.5 0.0 0.0 3.3 1.3 0.3 373 Belize (Excluding Belize City South Side) 8.4 0.5 0.0 0.0 1.2 0.8 0.0 369 Belize City South Side 7.0 1.1 0.0 0.0 2.2 0.4 0.0 257 Belize District 7.8 0.7 0.0 0.0 1.6 0.6 0.0 625 Cayo 4.9 0.0 0.0 0.0 2.1 0.8 0.0 601 Stann Creek 3.8 0.8 0.0 0.0 0.7 0.8 0.4 225 Toledo 0.8 0.0 0.0 0.0 0.8 0.5 0.5 217 Area Urban 6.8 0.4 0.0 0.0 2.1 1.1 0.2 991 Rural 3.8 0.2 0.1 0.4 2.0 0.9 0.1 1395 Age 15-19 2.7 0.0 0.0 0.0 0.7 1.2 0.0 128 20-24 7.4 0.7 0.0 0.2 0.9 0.6 0.2 369 25-29 7.1 0.2 0.0 0.2 1.0 1.8 0.3 488 30-34 5.2 0.6 0.2 0.8 2.2 0.9 0.0 407 35-39 4.7 0.0 0.0 0.0 2.9 0.5 0.0 417 40-44 1.9 0.3 0.0 0.0 4.4 1.1 0.3 323 45-49 3.2 0.3 0.0 0.0 1.8 0.9 0.0 254 Number of living children 0 6.7 0.3 0.0 0.0 0.6 0.5 0.2 275 1 8.8 0.8 0.0 0.2 2.1 1.4 0.1 451 2 5.1 0.2 0.2 0.2 1.5 0.7 0.2 522 3 3.8 0.0 0.0 0.0 2.5 1.4 0.0 425 4+ 2.8 0.4 0.0 0.5 2.7 0.9 0.1 713 Education None 1.4 0.0 0.0 2.3 0.8 0.8 0.0 134 Primary 4.0 0.2 0.0 0.1 1.8 0.9 0.0 1150 Secondary + 6.8 0.5 0.1 0.1 2.5 1.2 0.2 1056 CET/ITVET/ VOTEC (*) (*) (*) (*) (*) (*) (*) 13 Other (0.0) (0.0) (0.0) (0.0) (0.0) (0.00 (0.0) 34 Wealth index quintiles Poorest 1.4 0.0 0.0 0.6 0.6 0.0 0.1 409 Second 5.6 0.7 0.0 0.2 1.4 1.4 0.1 498 Middle 5.8 0.7 0.0 0.2 1.6 1.2 0.2 484 Fourth 5.3 0.0 0.2 0.0 3.2 0.7 0.0 494 Richest 6.5 0.2 0.0 0.2 3.3 1.5 0.2 501 Ethnicity of household head Creole 6.8 0.5 0.0 0.0 1.6 0.8 0.0 493 Mestizo 5.2 0.2 0.1 0.2 2.5 1.2 0.1 1262 Garifuna 2.3 0.0 0.0 0.0 3.1 2.1 0.7 120 Maya 0.7 0.6 0.0 0.0 1.4 0.2 0.4 272 Other 6.9 0.4 0.0 1.4 0.8 0.9 0.0 198 Missing/DK (8.3) (0.0) (0.0) (0.0) (2.2) (0.0) (0.0) 41 Total 5.1 0.3 0.0 0.2 2.1 1.0 0.1 2386 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Unmet Need Unmet need for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth (spacing) or who wish to stop childbearing altogether (limiting). 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. mics f inal report 97 Table RH.5 shows the results of the survey on contraception, unmet need, and the demand for contraception satisfied. Unmet need for spacing is defined as percentage of women who are not using a method of contraception AND o are not pregnant and not postpartum amenorrheic1 and are fecund2 and say they want to wait two or more years for their next birth OR o are not pregnant and not postpartum amenorrheic and are fecund and unsure whether they want another child OR o are pregnant and say that pregnancy was mistimed: would have wanted to wait OR o are postpartum amenorrheic and say that the birth was mistimed: would have wanted to wait Unmet need for limiting is defined as percentage of women who are not using a method of contraception AND o are not pregnant and not postpartum amenorrheic and are fecund and say they do not want any more children OR o are pregnant and say they didn’t want to have a child OR o are postpartum amenorrheic and say that they didn’t want the birth Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for limiting. The percentage of women aged 15-49 years currently married or in union with an unmet need for contraception stands at 15.9 percent. Education does not seem to be a factor in determining unmet need for contraception. However, area does show a slight difference in rates (urban 14.1 percent and rural 17.1 percent). Unmet need for contraception is quite dependent on the age of the woman and on the wealth of her family (Figure RH.2). Evidently younger women have a greater unmet need than older women and similarly unmet need for poorer women is higher than for the wealthier women. 1 A women is postpartum amenorrheic if she had a birth in last two years and is not currently pregnant, and her menstrual period has not returned since the birth of the last child 2 A women is considered not fecund if she is neither pregnant nor postpartum amenorrheic, and (1a) has not had menstruation for at least six months, or (1b) never menstruated, or (1c) her last menstruation occurred before her last birth, or (1d) in menopause/has had hysterectomy OR (2) She declares that she has had hysterectomy, or that she has never menstruated or that she is menopausal, or that she has been trying to get pregnant for 2 or more years without result in response to questions on why she thinks she is not physically able to get pregnant at the time of survey OR (3) She declares she cannot get pregnant when asked about desire for future birth OR (4) She has not had a birth in the preceding 5 years, is currently not using contraception and is currently married and was continuously married during the last 5 years preceding the survey 98 mics f inal report Met need for limiting includes women who are using a contraceptive method and who want no more children, are using male or female sterilization or declare themselves as not fecund. Met need for spacing includes women who are using a contraceptive method and who want to have another child or undecided whether to have another child. The total of met need for spacing and limiting add up to the total met need for contraception. Total met need for contraception is 55.2 percent and for limiting it is 38.8 percent. Urban-rural differences in both categories of met need are quite small. Met need for contraception generally correlates positively with increasing age and wealth (Figure RH.3). These trends are perhaps expected since unmet need roughly complements met need. Of interest also is that the met need for spacing and for limiting correlate in different directions with respect to age (Figure RH.4). Evidently, younger women want more children at higher rates than older women and older women want no more children at higher rates than younger women. mics f inal report 99 Table RH.5: Unmet need for contraception Percentage of women aged 15-49 years currently married or in union with an unmet need for family, Belize, 2011 Met need for contra- ception - For spacing Met need for contra- ception - For limiting Met need for contra- ception - Total Unmet need for contra- ception - For spacing Unmet need for contra- ception - For limiting Unmet need for contra- ception - Total [1] Number of wom- en currently mar- ried or in union Region Corozal 17.2 44.9 61.8 4.7 6.7 11.4 346 Orange Walk 15.8 43.1 58.9 7.4 5.6 13.0 373 Belize (Excluding Be- lize City South Side) 15.4 41.7 57.2 9.5 6.4 15.9 369 Belize City South Side 17.5 37.7 55.2 8.0 10.0 18.0 257 Belize District 16.3 40.1 56.4 8.9 7.9 16.8 625 Cayo 17.2 39.7 56.9 6.1 5.7 11.8 601 Stann Creek 19.4 37.3 56.7 10.7 9.0 19.7 225 Toledo 10.7 17.6 28.3 18.3 14.5 32.9 217 Area Urban 18.1 39.7 57.7 7.0 7.1 14.1 991 Rural 15.1 38.3 53.3 9.4 7.8 17.1 1395 Age 15-19 29.6 6.1 35.7 26.4 4.4 30.8 128 20-24 33.4 16.3 49.8 19.4 6.4 25.8 369 25-29 25.9 29.9 55.8 8.7 6.3 15.0 488 30-34 13.7 44.4 58.1 6.2 9.5 15.7 407 35-39 8.1 50.0 58.1 5.5 9.1 14.5 417 40-44 3.3 60.0 63.0 1.0 8.6 9.7 323 45-49 1.0 51.0 52.0 0.3 5.7 6.1 254 Education None 8.9 33.3 42.2 4.2 12.6 16.8 119 Primary 13.9 41.7 55.6 7.5 9.0 16.5 1165 Secondary + 20.4 37.4 57.7 9.7 5.5 15.2 1056 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) 13 Other (2.1) (9.3) (11.4) (10.1) (0.0) (10.1) 34 Wealth index quin- tiles Poorest 13.1 29.0 42.2 11.5 14.5 26.0 409 Second 17.2 36.7 54.0 10.3 7.8 18.1 498 Middle 17.3 36.3 53.6 9.2 7.3 16.4 484 Fourth 17.4 43.8 61.2 5.0 6.1 11.1 494 Richest 16.2 46.5 62.5 6.5 3.1 9.6 501 Ethnicity of household head Creole 13.9 42.2 56.1 8.5 7.0 15.6 493 Mestizo 17.1 42.9 60.0 6.5 7.0 13.5 1262 Garifuna 18.8 34.4 53.2 13.3 12.0 25.4 120 Maya 14.0 24.0 38.0 15.4 11.0 26.4 272 Other 20.3 26.0 45.8 7.2 5.3 12.5 198 Missing/DK (12.5) (46.0) (58.5) (8.4) (4.0) (12.4) 41 Total 16.4 38.8 55.2 8.4 7.5 15.9 2386 [1] MICS indicator 5.4; MDG indicator 5.6 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 100 mics f inal report Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. Percentage of demand satisfied is defined as the proportion of women currently married or in a marital 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. Among women aged 15-49 years currently married or in union 77.6 percent have satisfied their demand for contraception. Satisfied demand for contraception is linked to areas (urban 80.3 percent and rural 75.7 percent), age where younger women are less satisfied than older women, education where less educated women have less satisfied demand than older women and wealth where poorer indices are linked to less satisfied demand (Figure RH.5). Demand for contraception is least satisfied in the Toledo District (46.3 percent) and most satisfied in the Corozal District (84.5 percent). Belize City South Side is found in between at 75.4 percent. In Maya households the demand for contraception is smallest at 59.0 percent and highest in Mestizo households at 81.6 percent. mics f inal report 101 Table RH.5: Unmet need for contraception (c0ntinued) Percentage of women aged 15-49 years currently married or in union with demand for contraception satisfied, Belize, 2011 Percentage of demand for contraception satisfied Number of women currently married or in union with need for contraception region Corozal 84.5 253 orange Walk 82.0 268 belize (excluding belize City south side) 78.2 269 belize City south side 75.4 188 belize District 77.1 457 Cayo 82.8 413 stann Creek 74.2 172 Toledo 46.3 132 area urban 80.3 712 rural 75.7 983 age 15-19 53.7 85 20-24 65.9 279 25-29 78.8 346 30-34 78.7 300 35-39 80.0 303 40-44 86.7 235 45-49 89.5 148 Education None 71.5 70 Primary 77.1 840 secondary + 79.1 770 CeT/ITVeT/VoTeC (*) 8 other (*) 7 Wealth index quintiles Poorest 61.9 279 second 74.9 359 Middle 76.5 339 Fourth 84.7 357 richest 86.6 361 ethnicity of household head Creole 78.3 354 Mestizo 81.6 928 Garifuna 67.7 94 Maya 59.0 175 other 78.5 116 Missing/DK (82.6) 29 Total 77.6 1695 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform 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 102 mics f inal report during pregnancy and treatment of 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: o Blood pressure measurement o Urine testing for bateriuria and proteinuria o Blood testing to detect syphilis and severe anaemia o Weight/height measurement (optional) Table RH.6: Antenatal care provider Percent distribution of women age 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Belize, 2011 Person providing antenatal care Total at least once by skilled personnel [1] Number of women who gave birth in the preceding two yearsDoctor Nurse / Midwife Community health worker other/ missing No antenatal care received region Corozal 39.1 60.0 0.9 0.0 0.0 100.0 99.1 95 orange Walk 26.5 73.5 0.0 0.0 0.0 100.0 100.0 108 belize (excluding belize City south side) 57.2 29.7 8.6 0.0 4.6 100.0 86.9 74 belize City south side 71.8 24.6 0.0 0.0 3.6 100.0 96.4 77 belize District 64.6 27.1 4.2 0.0 4.1 100.0 91.7 151 Cayo 56.8 40.7 0.8 0.0 1.7 100.0 97.5 189 stann Creek 37.4 60.2 2.4 0.0 0.0 100.0 97.6 69 Toledo 4.6 86.9 0.7 1.6 6.2 100.0 91.5 73 area urban 57.9 39.4 0.7 0.0 2.0 100.0 97.3 262 rural 35.0 60.5 2.1 0.3 2.0 100.0 95.5 424 Mother’s age at birth less than 20 36.4 60.2 1.6 0.5 1.3 100.0 96.7 118 20-34 45.2 51.8 1.4 0.1 1.5 100.0 97.0 490 35-49 46.1 44.7 2.6 0.0 6.5 100.0 90.8 78 Education None 29.9 59.4 0.0 0.0 10.7 100.0 89.3 41 Primary 31.6 64.8 1.7 0.2 1.8 100.0 96.4 311 secondary + 57.8 38.9 1.8 0.2 1.3 100.0 96.7 315 CeT/ITVeT/VoTeC (*) (*) (*) (*) (*) 100.0 (*) 3 other (*) (*) (*) (*) (*) 100.0 (*) 15 Wealth index quintiles Poorest 20.3 73.8 1.3 0.3 4.3 100.0 94.1 173 second 50.4 49.0 0.0 0.0 0.6 100.0 99.4 156 Middle 41.9 52.8 2.3 0.0 3.0 100.0 94.7 134 Fourth 51.5 43.3 4.3 0.4 0.4 100.0 94.8 132 richest 68.8 30.2 0.0 0.0 1.0 100.0 99.0 91 ethnicity of household head Creole 60.0 33.2 2.1 0.0 4.7 100.0 93.2 113 Mestizo 42.3 56.3 0.5 0.2 0.7 100.0 98.7 355 Garifuna (49.1) (45.4) (4.2) (0.0) (1.3) 100.0 (94.4) 43 Maya 21.9 71.2 2.1 0.6 4.1 100.0 93.2 96 other 50.5 43.1 4.3 0.0 2.2 100.0 93.5 71 Missing/DK (*) (*) (*) (*) (*) 100.0 (*) 8 Total 43.8 52.5 1.6 0.2 2.0 100.0 96.2 685 [1] MICs indicator 5.5a; MDG indicator 5.5 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 103 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.6. Coverage of antenatal care (by a doctor, nurse, or midwife) is high in Belize with 96.2 percent of women receiving antenatal care at least once during the pregnancy. The lowest level of antenatal care is found in the Toledo District (91.5 percent) and in the Belize District (91.7 percent). In the Belize District the lowest level is in the Belize (Excluding Belize City South Side) (86.9 percent). In Belize City South Side the rate is 96.4 percent. Antenatal care coverage is slightly more in urban areas (97.3 percent) compared to rural areas (95.5 percent). Table RH.6 suggests that mothers who were older at birth were less likely to be seen at least once by skilled medical personnel. There is no clear link between antenatal care coverage and education, wealth and ethnicity because of small sample sizes. Table RH.7: Number of antenatal care visits Percentage of women who had a live birth during the two years preceding the survey by number of antenatal care visits by any provider, Belize, 2011 Percent of women who had: Total Number of women who gave birth in the preceding two years No antenatal care visits One visit Two visits Three visits 4 or more visits [1] Missing/ DK Region Corozal 0.0 1.8 1.9 1.8 84.0 10.4 100.0 95 Orange Walk 0.0 2.4 5.7 6.3 84.8 0.9 100.0 108 Belize (Excluding Belize City South Side) 4.6 0.0 0.0 2.0 81.1 12.3 100.0 74 Belize City South Side 3.6 1.2 0.0 2.2 82.3 10.7 100.0 77 Belize District 4.1 0.6 0.0 2.1 81.7 11.5 100.0 151 Cayo 1.7 0.0 1.9 3.4 90.9 2.2 100.0 189 Stann Creek 0.0 0.0 3.3 2.3 88.5 5.8 100.0 69 Toledo 6.2 0.0 0.0 4.7 57.2 31.8 100.0 73 Area Urban 2.0 0.3 1.0 1.6 87.4 7.7 100.0 262 Rural 2.0 1.0 2.7 4.5 80.5 9.3 100.0 424 Mother’s age at birth Less than 20 1.3 0.7 2.4 4.5 80.5 10.6 100.0 118 20-34 1.5 0.9 1.9 3.5 84.6 7.7 100.0 490 35-49 6.5 0.0 2.3 1.1 78.0 12.1 100.0 78 Education None (9.5) (2.0) (5.9) (5.4) (68.5) (8.7) 100.0 46 Primary 1.8 0.8 1.4 3.1 83.4 9.5 100.0 306 Secondary + 1.3 0.6 1.4 1.7 86.6 8.4 100.0 315 CET/ITVET/ VOTEC (*) (*) (*) (*) (*) (*) 100.0 3 Other (*) (*) (*) (*) (*) (*) 100.0 15 Wealth index quintiles Poorest 4.3 1.0 5.4 7.9 70.3 11.1 100.0 173 Second 0.6 1.7 1.2 1.9 88.1 6.5 100.0 156 Middle 3.0 0.7 0.6 2.9 82.6 10.2 100.0 134 Fourth 0.4 0.0 1.3 0.0 90.6 7.6 100.0 132 Richest 1.0 0.0 0.0 2.8 89.0 7.3 100.0 91 Ethnicity of household head Creole 4.7 0.0 0.0 4.3 76.3 14.7 100.0 113 Mestizo 0.7 1.0 1.7 1.6 90.0 5.0 100.0 355 Garifuna (1.3) (0.0) (1.9) (0.0) (89.5) (7.3) 100.0 43 Maya 4.1 0.9 1.9 6.1 68.5 18.5 100.0 96 Other 2.2 1.3 7.3 9.6 73.3 6.4 100.0 71 Missing/DK (*) (*) (*) (*) (*) (*) 100.0 8 Total 2.0 0.8 2.0 3.4 83.1 8.7 100.0 685 [1] MICS indicator 5.5b; MDG indicator 5.5 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 104 mics f inal report UNICEF and WHO recommend a minimum of at least four antenatal care visits during pregnancy. Table RH.7 shows number of antenatal care visits during the last pregnancy during the two years preceding the survey, regardless of provider by selected characteristics. Almost nine in ten mothers (88.5 percent) receive antenatal care more than once and over three quarters of mothers received antenatal care at least four times (83.1 percent). Mothers from the poorest households and those with primary education are less likely than more advantaged mothers to receive ANC four or more times. For example, 70.3 percent of the women living in poorest households reported four or more antenatal care visits compared with 89.0 percent among those living in richest households. The Toledo District (57.2 percent) recorded the lowest rates for four or more antenatal care visits among the other districts with Cayo posting a high of 90.9 percent . The types of services pregnant women received are shown in table RH.8. Among those women who have given birth to a child during the two years preceding the survey, 97.6 percent reported that a blood sample was taken during antenatal care visits, 97.7 percent reported that their blood pressure was checked, 96.9 percent that urine specimen was taken and in 96.6 percent of cases all three tests were administered. Table RH.8: Content of antenatal care Percentage of women age 15-49 years who had their blood pressure measured, urine sample taken, and blood sample taken as part of antenatal care, Belize, 2011 Percent of pregnant women who had: Blood pressure measured, urine specimen and blood test taken [1] Number of women who gave birth in two years preceding survey Blood pressure measured Urine specimen taken Blood test taken Region Corozal 100.0 98.1 100.0 98.1 95 Orange Walk 98.5 97.8 99.2 97.8 108 Belize (Excluding Belize City South Side) 95.4 91.4 95.4 91.4 74 Belize City South Side 96.4 96.4 95.2 95.2 77 Belize District 95.9 93.9 95.3 93.3 151 Cayo 98.3 98.3 98.3 98.3 189 Stann Creek 100.0 100.0 100.0 100.0 69 Toledo 93.1 93.8 93.0 92.3 73 Area Urban 98.0 97.4 97.7 97.1 262 Rural 97.4 96.6 97.6 96.4 424 Mother’s age at birth Less than 20 98.7 98.7 98.7 98.7 118 20-34 98.1 97.2 98.0 96.8 490 35-49 93.5 92.3 93.5 92.3 78 Education None (90.5) (86.6) (90.5) (86.6) 46 Primary 98.0 98.2 98.0 97.9 306 Secondary + 98.7 97.8 98.4 97.5 315 CET/ITVET/VOTEC (*) (*) (*) (*) 3 Other (*) (*) (*) (*) 15 Wealth index quintiles Poorest 94.5 93.3 94.9 92.7 173 Second 99.4 99.4 98.8 98.8 156 Middle 97.0 95.8 97.0 95.8 134 Fourth 99.6 98.4 99.6 98.4 132 Richest 99.0 99.0 99.0 99.0 91 Ethnicity of household head Creole 95.3 94.0 94.5 93.1 113 Mestizo 99.1 98.9 99.3 98.7 355 Garifuna (98.7) (98.7) (98.7) (98.7) 43 Maya 95.9 95.9 95.3 95.3 96 Other 95.5 91.9 96.6 91.9 71 Missing/DK (*) (*) (*) (*) 8 Total 97.7 96.9 97.6 96.6 685 [1] MICS indicator 5.6 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 105 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. About 96.2 percent of births occurring in the two years preceding the MICS survey were delivered by skilled personnel (Table RH.9). This percentage is highest in Orange Walk at 99.3 percent and lowest in Toledo at 87.8 percent. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled attendant. Delivery by C-section occurred in 28.1 percent of births. Older women tended to have more deliveries by C-section than younger mothers (mothers less than 20 years at 25.8 percent and mothers 35 to 49 at 38.6 percent). Generally richer mothers tended to give birth by C-section more frequently than poor mothers. Private sector hospitals delivered by C-section more frequently than public sector hospitals (37.8 percent and 28.2 percent). Almost a half of the births (45.5 percent) in the two years preceding the MICS survey were delivered with assistance by a midwife (Table RH.9). Doctors assisted with the delivery of 49.7 percent of births and nurses assisted with 45.4 percent. Overall, about 96.2 percent of births were delivered by skilled attendants. In the Toledo District, about 19.7 percent of births are delivered by doctors, 62.5 percent by a nurse or midwife, 5.6 percent by auxiliary midwife and 3.0 percent by a friend or relative. In the other regions, between 27.6 and 73.1 percent of births are delivered by a doctor while 24.8-70.1 percent are delivered with the assistance of a midwife. Traditional birth attendants are most active in the Corozal District (5.4 percent) with Cayo next at 2.5 percent. Doctors delivered almost twice as many babies in private sector health facilities than in public sector health facilities (47.1 percent to 79.2 percent) and were most active in urban areas (urban 56.9 percent, rural 45.3 percent). Babies from families with rich wealth index tended to be delivered more frequently by doctors than babies from poorer families: the richest scored 64.2 percent and the poorest was 31.0 percent. Nurses or midwives delivered most frequently in rural areas (41.3 percent to 47.9 percent), in public health facilities (public 52.5 percent to private 17.1 percent) and in poorer families (poorest 55.4 percent, richest 33.9 percent). Traditional birth attendant plays a small role when compared to doctors and nurses and midwives. The traditional birth attendants operated mainly in rural areas (0.3 percent to rural 2.7 percent), in homes (20.8 percent) and in the poorest families (6.1 percent). 106 mics f inal report Table RH.9: Assistance during delivery Percent distribution of women age 15-49 who had a live birth in the two years preceding the survey by person assisting at delivery and percentage of births delivered by C-section, Belize, 2011 any skilled personnel [1] Percent delivered by C-section [2] Number of women who gave birth in preceding two years region Corozal 94.6 30.2 95 orange Walk 99.3 17.3 108 belize (excluding belize City south side) 97.9 27.1 74 belize City south side 97.5 35.4 77 belize District 97.7 31.3 151 Cayo 96.6 39.6 189 stann Creek 97.8 19.4 69 Toledo 87.8 13.4 73 area urban 98.4 29.7 262 rural 94.8 27.1 424 Mother’s age at birth less than 20 97.2 25.8 118 20-34 96.4 27.0 490 35-49 93.3 38.6 78 Place of delivery Public sector health facility 99.9 28.2 526 Private sector health facility 97.0 37.8 117 home (50.3) (0.0) 39 other (*) (*) 4 Education None (80.4) (19.9) 46 Primary 95.6 25.5 306 secondary + 98.8 32.0 315 CeT/ITVeT/VoTeC (*) (*) 3 other (*) (*) 15 Wealth index quintiles Poorest 89.4 19.3 173 second 98.5 27.7 156 Middle 97.6 32.8 134 Fourth 99.6 26.8 132 richest 98.1 40.6 91 ethnicity of household head Creole 97.8 35.1 113 Mestizo 96.6 28.0 355 Garifuna (96.9) (23.2) 43 Maya 92.0 22.8 96 other 96.2 29.3 71 Missing/DK (*) (*) 8 Total 96.2 28.1 685 [1] MICS indicator 5.7; MDG indicator 5.2 [2] MICS indicator 5.9 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 7 un-weighted cases in “CET/ITVET/VOTEC” and “Missing/DK” on the Mother’s Education are excluded from the table mics f inal report 107 Table RH.9: Assistance during delivery (continued) Percent distribution of women age 15-49 who had a live birth in the two years preceding the survey by person assisting, Belize, 2011 Person assisting at delivery Total Number of women Doctor Nurse / Midwife Auxiliary midwife Traditional birth attendant Community health worker Relative / Friend Other/ missing No attendant Region Corozal 59.8 33.8 0.9 5.4 0.0 0.0 0.0 0.0 100.0 95 Orange Walk 36.8 60.9 1.6 0.0 0.0 0.7 0.0 0.0 100.0 108 Belize (Excluding Belize City South Side) 73.1 24.8 0.0 0.0 0.0 0.0 2.1 0.0 100.0 74 Belize City South Side 61.3 35.2 1.0 1.2 0.0 1.3 0.0 0.0 100.0 77 Belize District 67.1 30.1 0.5 0.6 0.0 0.7 1.0 0.0 100.0 151 Cayo 57.7 38.9 0.0 2.5 0.0 0.9 0.0 0.0 100.0 189 Stann Creek 27.6 70.1 0.0 2.2 0.0 0.0 0.0 0.0 100.0 69 Toledo 19.7 62.5 5.6 0.0 0.8 3.0 6.1 2.4 100.0 73 Area Urban 56.9 41.3 0.3 0.3 0.0 1.0 0.2 0.0 100.0 262 Rural 45.3 47.9 1.6 2.7 0.1 0.7 1.3 0.4 100.0 424 Mother’s age at birth Less than 20 48.2 47.8 1.2 1.4 0.0 0.0 1.4 0.0 100.0 118 20-34 48.8 46.4 1.1 1.7 0.1 1.1 0.5 0.1 100.0 490 35-49 57.5 35.0 0.8 3.1 0.0 0.0 2.2 1.4 100.0 78 Place of delivery Public sector health facility 47.1 52.5 0.3 0.0 0.0 0.0 0.1 0.0 100.0 526 Private sector health facility 79.2 17.1 0.8 3.0 0.0 0.0 0.0 0.0 100.0 117 Home (0.0) (38.4) (11.9) (20.8) (1.4) (14.5) (8.6) (4.4) 100.0 39 Other (*) (*) (*) (*) (*) (*) (*) (*) 100.0 4 Education None (46.2) (31.0) (3.1) (12.8) (0.0) (1.7) (2.5) (2.5) 100.0 46 Primary 44.4 49.6 1.5 1.8 0.2 1.1 1.2 0.2 100.0 306 Secondary + 56.1 42.3 0.4 0.3 0.0 0.5 0.4 0.0 100.0 315 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) (*) (*) 100.0 3 Other (*) (*) (*) (*) (*) (*) (*) (*) 100.0 15 Wealth index quintiles Poorest 31.0 55.4 3.0 6.1 0.3 1.3 1.9 1.0 100.0 173 Second 57.8 40.2 0.4 0.0 0.0 1.2 0.4 0.0 100.0 156 Middle 52.0 44.3 1.3 0.0 0.0 1.2 1.2 0.0 100.0 134 Fourth 52.2 47.3 0.0 0.0 0.0 0.0 0.4 0.0 100.0 132 Richest 64.2 33.9 0.0 1.9 0.0 0.0 0.0 0.0 100.0 91 Ethnicity of household head Creole 55.3 42.5 0.0 0.8 0.0 0.0 1.4 0.0 100.0 113 Mestizo 52.3 43.7 0.7 2.3 0.0 1.0 0.2 0.0 100.0 355 Garifuna (37.0) (58.1) (1.8) (1.7) (0.0) (0.0) (1.3) (0.0) 100.0 43 Maya 37.3 51.7 3.0 0.0 0.6 2.3 3.4 1.8 100.0 96 Other 49.7 44.2 2.2 3.8 0.0 0.0 0.0 0.0 100.0 71 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) 100.0 8 Total 49.7 45.4 1.1 1.8 0.1 0.8 0.9 0.3 100.0 685 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Place of Delivery Increasing the proportion of births that are delivered in health facilities is an important factor in reducing the health risks to both the mother and the baby. Proper medical attention and hygienic conditions during delivery can reduce the risks of complications and infection that can cause morbidity and mortality to either the mother or the baby. Table RH.10 presents the percent distribution of women age 15-49 who had a live birth in the two years preceding the survey by place of delivery and the percentage of births delivered in a health facility, according to background characteristics. 108 mics f inal report Over 90 percent (93.8 percent) of births in Belize are delivered in a health facility; 76.8 percent of deliveries occur in public sector facilities and 17.0 percent occur in private sector facilities. A small percentage (5.6 percent) of delivery occurs at home. By age, women less than 20 are most likely to deliver in a health facility (95.5 percent) while 91.4 percent of women age 35 to 49 years deliver in a health facility. Women in urban areas are likely to deliver in a health facility more frequently than their rural counterparts ([97.5 percent compared with [91.6 percent). The Corozal District has the highest proportion of institutional deliveries (98.2 percent), followed by Belize City South Side (97.5 percent), while the Toledo District has the lowest proportion (80.7 percent). Women with higher levels of educational attainment are more likely to deliver in a health facility than women with less education or no education (no education 83.1 percent, secondary + education 98.6 percent). The proportion of births occurring in a health facility increases with increasing wealth quintile, from 84.2 percent of births in the lowest wealth quintile to 97.1 percent among those in the highest quintile. Table RH.10: Place of delivery Percent distribution of women age 15-49 with a birth in two years preceding the survey by place of delivery, Belize, 2011 Place of delivery Total Delivered in health facility [1] Number of women who gave birth in preceding two years Public sector health facility Private sector health facility Home Other Region Corozal 73.7 24.5 1.8 0.0 100.0 98.2 95 Orange Walk 72.8 18.8 8.4 0.0 100.0 91.6 108 Belize (Excluding Belize City South Side) 67.2 28.3 2.4 2.1 100.0 95.5 74 Belize City South Side 87.3 10.1 1.3 1.2 100.0 97.5 77 Belize District 77.4 19.1 1.9 1.6 100.0 96.5 151 Cayo 75.3 19.4 5.3 0.0 100.0 94.7 189 Stann Creek 88.9 7.9 3.2 0.0 100.0 96.8 69 Toledo 77.7 3.0 17.7 1.6 100.0 80.7 73 Area Urban 79.3 18.2 1.9 0.6 100.0 97.5 262 Rural 75.2 16.3 7.9 0.5 100.0 91.6 424 Mother’s age at birth Less than 20 91.1 4.8 4.1 0.0 100.0 95.9 118 20-34 74.1 19.6 5.5 0.7 100.0 93.7 490 35-49 72.1 19.3 8.6 0.0 100.0 91.4 78 Percent of women who had: None (*) (*) (*) (*) 100.0 (*) 14 1-3 visits (71.6) (22.6) (5.8) (0.0) 100.0 (94.2) 42 4+ visits 77.1 18.0 4.8 0.1 100.0 95.1 570 Missing/DK 85.4 7.6 7.0 0.0 100.0 93.0 60 Education None (51.2) (31.9) (16.9) (0.0) 100.0 (83.1) 46 Primary 81.5 9.7 8.1 0.7 100.0 91.2 306 Secondary + 78.7 19.9 1.0 0.5 100.0 98.6 315 CET/ITVET/VOTEC (*) (*) (*) (*) 100.0 (*) 3 Other (*) (*) (*) (*) 100.0 (*) 15 Wealth index quintiles Poorest 70.6 13.6 15.4 0.3 100.0 84.2 173 Second 88.9 9.9 1.2 0.0 100.0 98.8 156 Middle 81.7 12.6 4.5 1.2 100.0 94.3 134 Fourth 78.5 19.3 1.8 0.4 100.0 97.7 132 Richest 58.1 39.0 1.9 1.0 100.0 97.1 91 Ethnicity of household head Creole 88.0 9.8 .0 2.2 100.0 97.8 113 Mestizo 78.1 16.0 5.7 0.2 100.0 94.1 355 Garifuna (95.1) (1.9) (1.7) (1.3) 100.0 (96.9) 43 Maya 81.5 4.4 14.2 0.0 100.0 85.8 96 Other 37.0 57.4 5.6 0.0 100.0 94.4 71 Missing/DK (*) (*) (*) (*) 100.0 (*) 8 Total 76.8 17.0 5.6 0.5 100.0 93.8 685 [1] MICS indicator 5.8 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 109 Post Natal Health Checks The time of birth and immediately after is a critical window of opportunity to deliver lifesaving interventions for both the mother and newborn. Across the world, approximately 3 million newborns annually die in the first month of life3 and the majority of these deaths occur within a day or two of birth4, which is also the time when the majority of maternal deaths occur5. Despite the importance of the first few days following birth, large-scale, nationally representative household survey programmes have not systematically included questions on the post-natal period and care for the mother and newborn. In 2008, the Countdown to 2015 initiative, which monitors progress on maternal, newborn and child health interventions, highlighted this data gap, and called not only for post-natal care (PNC) programmes to be strengthened, but also for better data availability and quality6. Following the establishment and discussions of an Inter-Agency Group on PNC and drawing on lessons learned from earlier attempts of collecting PNC data, a new questionnaire module for MICS was developed and validated. Named the Post-natal Health Checks (PNHC) module, the objective is to collect information on newborns’ and mothers’ contact with a provider, not content of care. The rationale for this is that as PNC programmes scale up, it is important to measure the coverage of that scale up and ensure that the platform for providing essential services is in place. Content is considered more difficult to measure, particularly because the respondent is asked to recall services delivered up to two years preceding the interview. After delivery, 92.3 percent of women remained in the health facility for 12 hours or more (Table RH.11). About 66.4 percent remained for 1 to 2 days and 25.1 percent remained for 3 days or more. There is little difference between urban and rural areas in the duration of stay at the health facility if the stay is 12 hours or more. However, for stays of 6 to 11 hours rates for rural women is about twice as much as for urban women (1.8 percent to 3.9 percent). For stays less than 6 hours rates for rural women are less than rate for urban women (urban 5.1 percent, rural 4.4 percent). 3 Liu L, Johnson HL, Cousens S, et al. Global, regional, and national causes of child mortality in 2000-2010: an updated systematic analysis. Lancet. 2012;11 May 2012. doi:10.1016/S0140-6736(12)60560-1. 4 Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: When? Where? Why? Lancet 2005; 365:891–900. 5 WHO, UNICEF, UNFPA, The World Bank. Trends in Maternal Mortality: 1990-2010. Geneva: World Health Organization 2012. 6 Countdown to 2015: Tracking Progress in Maternal, Newborn & Child Survival, The 2008 Report. New York: UNICEF 2008. 110 mics f inal report Table RH.11: Post-partum stay in health facility Percent distribution of women age 15-49 years who gave birth in a health facility in the two years preceding the survey by duration of stay in health facility following their last live birth, Belize, 2011 Duration of stay in health facility: Total 12 hours or more [1] Number of women who gave birth in a health facility in the preceding two years Less than 6 hours 6-11 hours 12-23 hours 1-2 days 3 days or more Missing/DK Region Corozal 1.8 6.5 0.9 64.7 26.0 0.0 100.0 91.6 93 Orange Walk 5.2 9.2 0.0 62.5 23.1 0.0 100.0 85.6 99 Belize (Excluding Belize City South Side) (8.5) (4.5) (0.0) (65.3) (21.7) (0.0) 100.0 (87.0) 71 Belize City South Side 5.1 0.0 1.3 69.6 24.0 0.0 100.0 94.9 75 Belize District 6.8 2.2 0.7 67.5 22.9 0.0 100.0 91.1 146 Cayo 5.9 0.7 1.5 66.2 25.6 0.0 100.0 93.3 179 Stann Creek 2.2 0.0 0.0 70.9 26.9 0.0 100.0 97.8 67 Toledo 1.9 0.0 0.0 68.8 29.4 0.0 100.0 98.1 59 Area Urban 5.1 1.8 0.8 66.8 25.6 0.0 100.0 93.2 255 Rural 4.4 3.9 0.6 66.2 24.8 0.0 100.0 91.7 388 Mother’s age at birth Less than 20 2.3 0.0 0.0 63.2 34.5 0.0 100.0 97.7 113 20-34 5.9 4.3 1.0 65.9 22.9 0.0 100.0 89.8 459 35-49 0.0 0.0 0.0 75.1 24.9 0.0 100.0 100.0 71 Percent of women who had: None (*) (*) (*) (*) (*) (*) 100.0 (*) 6 1-3 visits (6.7) (15.2) (0.0) (48.8) (29.3) (0.0) 100.0 (78.1) 40 4+ visits 5.0 2.3 0.8 68.0 23.8 0.0 100.0 92.6 542 Missing/DK (0.0) (1.6) (0.0) (63.8) (34.5) (0.0) 100.0 (98.4) 55 Education None (2.7) (18.9) (0.0) (49.5) (28.8) (0.0) 100.0 (78.4) 33 Primary 4.9 1.2 0.0 65.6 28.4 0.0 100.0 93.9 284 Secondary + 4.3 1.4 1.5 70.7 22.1 0.0 100.0 94.2 310 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) 100.0 (*) 3 Other (*) (*) (*) (*) (*) (*) 100.0 (*) 12 Wealth index quintiles Poorest 4.5 9.3 0.0 57.1 29.1 0.0 100.0 86.2 146 Second 4.7 0.8 1.2 65.1 28.3 0.0 100.0 94.5 154 Middle 5.5 0.0 1.2 72.0 21.3 0.0 100.0 94.5 126 Fourth 6.0 1.3 0.9 71.0 20.8 0.0 100.0 92.7 129 Richest 1.8 3.5 0.0 69.7 25.0 0.0 100.0 94.7 88 Ethnicity of household head Creole 3.2 0.0 0.0 68.9 27.9 0.0 100.0 96.8 110 Mestizo 5.6 2.3 0.9 65.9 25.3 0.0 100.0 92.1 334 Garifuna (0.0) (0.0) (0.0) (75.9) (24.1) (0.0) 100.0 (100.0) 42 Maya 2.4 0.0 0.0 65.9 31.7 0.0 100.0 97.6 82 Other 8.7 17.9 2.3 57.2 13.9 0.0 100.0 73.4 67 Missing/DK (*) (*) (*) (*) (*) (*) 100.0 (*) 8 Total 4.7 3.1 0.7 66.4 25.1 0.0 100.0 92.3 643 [1] MICS indicator 5.10 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Safe motherhood programmes have recently increased emphasis on the importance of post-natal care, recommending that all women and newborns receive a health check within two days of delivery. To assess the extent of post-natal care utilization, women were asked whether they and their newborn received a health check after the delivery, the timing of the first check, and the type of health provider for the woman’s last birth in the two years preceding the survey. Post natal health checks are conducted for both child and mother shortly after birth. A distinction is made whether the checks were made in a health facility or not and also whether the checks were made by the health professionals involved in the delivery. Information is collected on those women with a live birth in the 2 years preceding the date of interview. Table RH.12 shows the percentage of newborns born in the last two years who received health checks and post-natal care visits from any health provider after birth. Please note that health checks following birth while in facility or at home refer to checks provided by any health provider regardless of timing (column 1), whereas post-natal care visits refer to a separate visit to check on the health of the newborn and provide preventive care services and therefore do not include health checks following birth while in facility or at home. The indicator, Post-natal health checks, include any health check after birth received while in the health facility and at home (column 1), regardless of timing, as well as PNC visits within two days of delivery (columns 2, 3, and 4). 112 mics f inal report Table RH.12: Post-natal health checks for newborns Percentage of newborns born in the last two years who received health checks and post-natal care (PNC) visits from any health provider after birth, Belize, 2011 Health check following birth while in facility or at home PNC visit Total Post-natal health check for the new- born [1] Number of last births in the two years pre- ceding the survey Same day 1 day following birth 2 days following birth 3-6 days following birth After the first week following birth No post-na- tal care visit Missing/ DK Region Corozal 99.1 0.9 1.8 5.3 11.0 38.1 35.1 7.7 100.0 99.1 95 Orange Walk 97.7 12.3 3.1 3.0 3.6 7.1 70.9 0.0 100.0 98.4 108 Belize (Excluding Belize City South Side) (95.8) (10.1) (2.0) (2.1) (6.3) (50.3) (25.4) (3.8) 100.0 (95.8) 74 Belize City South Side 96.2 16.1 5.9 2.6 8.5 43.7 23.2 0.0 100.0 96.2 77 Belize District 96.0 13.2 4.0 2.3 7.4 47.0 24.3 1.9 100.0 96.0 151 Cayo 98.3 18.7 5.3 3.9 7.9 28.3 35.9 0.0 100.0 99.1 189 Stann Creek 100.0 5.9 0.9 1.2 9.7 31.7 50.6 0.0 100.0 100.0 69 Toledo 88.4 35.4 3.0 .0 4.0 3.0 47.1 7.5 100.0 88.4 73 Area Urban 97.2 9.8 1.7 2.3 8.8 35.7 40.2 1.5 100.0 97.8 262 Rural 96.7 17.4 4.6 3.3 6.4 23.4 42.2 2.8 100.0 96.9 424 Mother’s age at birth Less than 20 99.1 15.6 2.9 4.4 7.3 23.0 43.7 3.2 100.0 99.1 118 20-34 97.0 14.6 3.7 2.6 7.3 29.4 40.0 2.4 100.0 97.5 490 35-49 93.3 12.0 3.4 3.0 7.1 27.4 47.0 0.0 100.0 93.3 78 Place of birth Public sector health facility 98.9 14.5 3.1 3.0 7.1 28.7 41.2 2.5 100.0 98.9 526 Private sector health facility 99.3 11.9 4.9 3.7 6.0 34.8 36.9 1.8 100.0 99.3 117 Home (71.5) (23.7) (5.0) (0.0) (14.3) (3.0) (52.6) (1.4) 100.0 (77.6) 39 Other (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 4 Education None (90.2) (15.4) (6.1) (0.0) (0.0) (27.8) (49.3) (1.3) 100.0 (92.1) 41 Primary 96.6 14.0 4.0 2.5 6.2 24.9 44.5 4.0 100.0 96.6 311 Secondary + 97.9 13.9 2.8 3.7 9.8 32.5 36.5 0.8 100.0 98.4 315 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 3 Other (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 15 Wealth index quintiles Poorest 94.7 21.1 3.6 2.0 3.5 19.2 46.2 4.5 100.0 94.7 173 Second 97.8 13.4 4.5 2.4 7.5 31.6 38.8 1.9 100.0 98.3 156 Middle 97.0 10.7 5.0 4.3 6.9 28.6 43.4 1.0 100.0 98.2 134 Fourth 98.5 11.6 2.4 5.4 11.0 27.9 39.5 2.1 100.0 98.5 132 Richest 97.3 13.3 0.9 0.0 9.5 38.8 36.6 0.8 100.0 97.3 91 Ethnicity of house- hold head Creole 95.5 17.0 4.6 3.1 11.4 28.5 34.6 0.8 100.0 95.5 113 Mestizo 97.6 11.3 2.8 3.8 6.5 26.8 47.3 1.6 100.0 98.3 355 Garifuna (98.7) (2.6) (0.0) (0.0) (16.7) (45.3) (33.4) (2.0) 100.0 (98.7) 43 Maya 93.6 28.9 4.2 0.9 4.6 15.7 38.5 7.1 100.0 93.6 96 Other 98.7 13.8 6.9 3.2 1.6 38.4 35.3 0.8 100.0 98.7 71 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) 100.0 (*) 8 Total 96.9 14.5 3.5 2.9 7.3 28.1 41.4 2.3 100.0 97.3 685 [1] MICS indicator 5.11 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Note: Health checks following birth while in facility or at home refer to checks provided by any health provider regardless of timing. Post-natal care visits (PNC) refer to a separate visit to check on the health of the newborn and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home (Column 1). Post-natal health checks include any health check after birth performed while in the health facility and at home, regardless of timing, as well as PNC visits with- in two days of delivery mics f inal report 113 96.9 percent of newborns receive a health check following birth while in a facility or at home. With regards to PNC visits, these predominantly occur either after one week following birth or on the first day after the delivery (28.1 percent and 14.5 percent, respectively). As a result, a total of 97.3 percent of all newborns receive a post-natal health check. Almost three quarters of the first PNC visits for newborns occur in a public facility. About 94 percent of the first PNC visits for newborns are provided by a doctor/nurse/midwife in Belize, with few differences across most characteristics (See Table RH 13). Table RH.13: Post-natal care (PNC) visits for newborns within one week of birth Percentage of newborns who were born in the last two years and received a PNC visit within one week of birth by location and provider of the first PNC visit, Belize, 2011 Location of first PNC visit Provider of first PNC visit Number of newborns born in the preceding two years with a PNC visit within the first week of lifeHome Public Sector Private Sector Other location Missing/ DK Total Doctor/ nurse/ midwife Auxiliary midwife Com- munity health worker Tradi- tional birth atten- dant Other/ missing Total Region Corozal (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 18 Orange Walk (17.0) (45.3) (37.7) (0.0) (0.0) 100.0 (94.1) (2.9) (0.0) (2.9) (0.0) 100.0 24 Belize (Excluding Belize City South Side) (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 15 Belize City South Side (3.7) (92.5) (3.8) (0.0) (0.0) 100.0 (100.0) (0.0) (0.0) (0.0) (0.0) 100.0 25 Belize District (6.0) (91.6) (2.4) (0.0) (0.0) 100.0 (96.2) (0.0) (3.8) (0.0) (0.0) 100.0 41 Cayo (9.8) (67.7) (22.5) (0.0) (0.0) 100.0 (93.0) (0.0) (2.3) (4.8) (0.0) 100.0 67 Stann Creek (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 12 Toledo (13.1) (85.2) (1.8) (0.0) (0.0) 100.0 (92.5) (5.7) (1.8) (0.0) (0.0) 100.0 Area Urban 8.8 74.5 16.7 0.0 0.0 100.0 100.0 0.0 0.0 0.0 0.0 100.0 59 Rural 10.5 74.2 15.3 0.0 0.0 100.0 91.3 1.8 2.7 4.2 0.0 100.0 134 Mother’s age at birth Less than 20 (2.4) (87.3) (10.3) (0.0) (0.0) 100.0 (97.6) (0.0) (0.0) (2.4) (0.0) 100.0 35 20-34 11.2 73.0 15.8 0.0 0.0 100.0 93.9 1.8 1.5 2.8 0.0 100.0 138 35-49 (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 20 Place of birth Public sector health facility 4.2 93.4 2.4 0.0 0.0 100.0 98.5 0.5 1.1 0.0 0.0 100.0 146 Private sector health facility 7.3 6.0 86.7 0.0 0.0 100.0 90.5 2.3 5.0 2.3 0.0 100.0 31 Home (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 17 Educa- tion None (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 9 Primary 12.1 73.7 14.2 0.0 0.0 100.0 91.4 2.1 2.5 4.0 0.0 100.0 83 Secondary + 6.5 81.6 11.9 0.0 0.0 100.0 98.4 0.0 1.6 0.0 0.0 100.0 95 Other (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 6 Wealth index quintiles Poorest 17.2 67.2 15.6 0.0 0.0 100.0 86.4 3.4 1.0 9.1 0.0 100.0 52 Second (3.5) (81.0) (15.5) (0.0) (0.0) 100.0 (98.5) (1.5) (0.0) (0.0) (0.0) 100.0 43 Middle (2.4) (84.1) (13.6) (0.0) (0.0) 100.0 (95.7) (0.0) (4.3) (0.0) (0.0) 100.0 36 Fourth (10.4) (77.1) (12.5) (0.0) (0.0) 100.0 (96.1) (0.0) (3.9) (0.0) (0.0) 100.0 40 Richest (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 22 Ethnicity of house- hold head Creole (6.0) (83.1) (10.9) (0.0) (0.0) 100.0 (96.2) (0.0) (3.8) (0.0) (0.0) 100.0 41 Mestizo 10.4 76.7 12.9 0.0 0.0 100.0 94.3 0.0 0.0 5.7 0.0 100.0 86 Garifuna (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 8 Maya 14.2 79.6 6.2 0.0 0.0 100.0 95.5 3.0 1.5 0.0 0.0 100.0 37 Other (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 18 Missing/DK (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 3 Total 10.0 74.3 15.7 0.0 0.0 100.0 93.9 1.3 1.9 2.9 0.0 100.0 193 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Tables RH.14 and RH.15 present information collected on post-natal health checks and visits of the mother and are identical to Tables RH.12 and RH.13 that presented the data collected for newborns. Please be reminded that that health checks following birth while in facility or at home refer to checks provided by any health provider regardless of timing (column 1), whereas post-natal care visits refer to a separate visit to check on the health of the mother and provide preventive care services and therefore do not include health checks following birth while in facility or at home. The indicator, Post-natal health checks, include any health check after birth received while in the health facility and at home (column 1), regardless of timing, as well as PNC visits within two days of delivery (columns 2, 3, and 4). Table RH.14 shows that 94.1percent of mothers have a health check following birth while in a facility. With regards to post natal health checks, 94.6 percent of women have these checks. However, this is lowest in Cayo (86.1 percent). mics f inal report 115 Table RH.14: Post-natal health checks for mothers Percentage of women age 15-49 years who gave birth in the 2 years preceding the survey who received health checks and post-natal care (PNC) visits from any health provider after birth, Belize, 2011 Health check following birth while in facility or at home PNC visit Total Post-natal health check for the moth- er [1] Number of women who gave birth in the two years preceding the sur- vey Same day 1 day following birth 2 days following birth 3-6 days following birth After the first week following birth No post-natal care visit Missing/ DK Region Corozal 95.6 0.0 0.0 4.4 4.9 32.4 54.9 3.4 100.0 95.6 95 Orange Walk 97.9 7.9 2.8 2.5 3.3 2.5 81.1 0.0 100.0 98.6 108 Belize (Exclud- ing Belize City South Side) (87.1) (2.0) (0.0) (0.0) (0.0) (42.0) (54.0) (1.9) 100.0 (87.1) 74 Belize City South Side 91.3 2.6 2.5 1.2 2.3 21.8 69.6 0.0 100.0 92.6 77 Belize District 89.2 2.3 1.3 0.6 1.2 31.7 62.0 0.9 100.0 89.9 151 Cayo 96.6 7.7 7.2 3.5 2.5 19.9 58.1 0.9 100.0 97.4 189 Stann Creek 98.8 3.5 1.2 0.0 4.3 18.5 71.5 0.9 100.0 98.8 69 Toledo 85.3 30.0 3.8 0.0 1.6 0.0 59.3 5.2 100.0 86.1 73 Area Urban 93.3 3.1 1.0 2.0 2.5 21.7 68.9 0.8 100.0 94.3 262 Rural 94.5 10.1 4.6 2.2 2.9 17.7 60.4 2.1 100.0 94.8 424 Mother’s age at birth Less than 20 96.7 5.2 5.4 2.2 3.0 19.8 62.8 1.7 100.0 97.1 118 20-34 93.2 8.0 2.6 1.8 2.7 19.2 63.9 1.8 100.0 93.9 490 35-49 95.5 7.1 4.3 4.2 2.8 18.4 63.1 0.0 100.0 95.5 78 Place of birth Public sector health facility 96.1 7.5 2.4 1.8 2.9 17.1 66.4 1.8 100.0 96.1 526 Private sector health facility 96.5 5.9 3.9 3.5 2.4 35.0 48.6 0.7 100.0 96.5 117 Home (67.7) (12.2) (12.7) (2.2) (1.6) (2.2) (67.7) (1.4) 100.0 (77.9) 39 Other (*) (*) (*) (*) (*) (*) 100.0 (*) 100.0 (*) 4 Type of delivery Vaginal birth 93.0 8.2 3.0 2.2 2.7 16.6 65.6 1.6 100.0 93.8 493 C-section 96.9 5.5 3.8 1.8 3.0 26.0 58.5 1.5 100.0 96.9 193 Education None (85.9) (7.2) (8.2) (0.0) (0.0) (19.3) (64.0) (1.3) 100.0 (87.8) 41 Primary 94.9 9.1 2.5 2.4 3.0 15.1 65.3 2.6 100.0 95.4 311 Secondary + 94.2 5.7 3.1 2.2 3.1 24.4 60.8 0.7 100.0 94.7 315 CET/ITVET/ VOTEC (*) (*) (*) (*) (*) (*) 100.0 (*) 100.0 (*) 3 Other (*) (*) (*) (*) (*) (*) 100.0 (*) 100.0 (*) 15 Wealth index quin- tiles Poorest 91.4 11.3 5.0 1.0 1.4 7.4 70.4 3.6 100.0 91.7 173 Second 94.9 8.1 3.2 2.8 2.8 14.0 68.6 0.5 100.0 96.1 156 Middle 93.6 3.1 1.8 3.9 2.6 22.7 65.9 0.0 100.0 94.8 134 Fourth 96.2 7.6 2.5 0.7 4.2 24.4 58.2 2.4 100.0 96.2 132 Richest 95.3 5.1 3.1 2.7 3.5 38.2 46.7 0.8 100.0 95.3 91 Ethnicity of household head Creole 90.6 6.1 0.9 2.5 1.6 27.5 61.4 0.0 100.0 90.6 113 Mestizo 96.0 5.5 3.3 2.6 3.2 16.6 66.9 1.9 100.0 97.0 355 Garifuna (94.1) (2.6) (1.9) (2.1) (5.8) (29.4) (58.2) (0.0) 100.0 (94.1) 43 Maya 90.3 20.3 6.7 0.0 2.1 5.7 60.9 4.3 100.0 90.8 96 Other 95.3 5.6 3.2 2.2 0.7 29.0 59.3 0.0 100.0 95.3 71 Missing/DK (*) (*) (*) (*) (*) (*) 100.0 (*) 100.0 (*) 8 Total 94.1 7.4 3.2 2.1 2.8 19.2 63.6 1.6 100.0 94.6 685 [1] MICS indicator 5.12 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Note: Health checks following birth while in facility or at home refer to checks provided by any health provider regardless of timing. Post-natal care visits (PNC) refer to a separate visit to check on the health of the mother and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home (Column 1). Post-natal health checks include any health check after birth performed while in the health facility and at home, regardless of timing, as well as PNC visits within two days of delivery 116 mics f inal report Table RH.15: Post-natal care (PNC) visits for mothers within one week of birth Percentage of women age 15-49 years who gave birth in the preceding 2 years and received a PNC visit within one week of birth, by location and provider of the first PNC visit, Belize, 2011 Location of first PNC visit Provider of first PNC visit Number of women who gave birth in the two years preceding survey and received a PNC visit within one week of delivery Home Public Sector Private Sector Other loca- tion Missing/ DK Total Doctor/ nurse/ midwife Auxiliary midwife Com- munity health worker Traditional birth atten- dant Other/ missing Total Type of deliv- ery Vaginal birth 10.2 72.6 15.2 2.0 0.0 100.0 90.7 0.7 2.6 6.0 0.0 100.0 79 C-section (18.0) (58.3) (23.7) (0.0) (0.0) 100.0 100.0 (0.0) (0.0) (0.0) (0.0) 100.0 27 Educa- tion None (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 6 Primary 11.5 74.3 14.2 0.0 0.0 100.0 90.4 1.0 4.0 4.6 0.0 100.0 53 Second- ary + (10.5) (71.9) (14.0) (3.6) (0.0) 100.0 (100.0) (0.0) (0.0) (0.0) (0.0) 100.0 44 Other (*) (*) (*) (*) (*) 100.0 (*) (*) (*) (*) (*) 100.0 3 Total 12.2 68.9 17.4 1.5 0.0 100.0 93.1 0.5 2.0 4.4 0.0 100.0 107 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Table RH.15 matches Table RH.13, but now deals with PNC visits for mothers by location and type of provider. As defined above, a visit does not include a check in the facility or at home following birth. 68.9 percent of the first PNC visits occur in a public facility. This proportion varies across background characteristics. In 93.1 percent of the cases, a doctor, nurse or midwife is the provider of the first PNC visit. Due to the small denominators across the various subgroups, not all usual background characteristics are presented. Details are shown in table RH15. Table RH.16 presents the distribution of women with a live birth in the two years preceding the survey by receipt of health checks or PNC visits within 2 days of birth for the mother and the newborn, thus combining the indicators presented in tables RH.12 and RH.14. mics f inal report 117 Table RH.16: Post-natal health checks for mothers and newborns Percent distribution of women age 15-49 who gave birth in the two years preceding the survey by receipt of health checks and post-natal care (PNC) visits within 2 days of birth, for the mother and newborn, Belize, 2011 Health checks or PNC visits within 2 days of birth for: Total Number of women age 15-49 years who gave birth in the 2 years pre- ceding the survey Both mothers and new- borns Mothers only Newborns only Neither mother nor new- born Missing Region Corozal 91.3 0.9 4.4 0.0 3.4 100.0 95 Orange Walk 97.8 0.8 0.6 0.8 0.0 100.0 108 Belize (Excluding Belize City South Side) (85.2) (0.0) (8.7) (4.2) (1.9) 100.0 74 Belize City South Side 91.3 1.3 4.9 2.5 0.0 100.0 77 Belize District 88.3 0.7 6.7 3.3 0.9 100.0 151 Cayo 96.6 0.9 2.6 0.0 0.0 100.0 189 Stann Creek 98.8 0.0 1.2 0.0 0.0 100.0 69 Toledo 80.8 0.7 3.1 10.8 4.5 100.0 73 Area Urban 93.2 0.4 3.9 1.8 0.8 100.0 262 Rural 92.5 0.9 3.0 2.2 1.4 100.0 424 Mother’s age at birth Less than 20 95.4 0.5 2.4 0.5 1.2 100.0 118 20-34 92.2 0.4 4.0 2.1 1.3 100.0 490 35-49 92.2 3.2 1.0 3.5 0.0 100.0 78 Place of birth Public sector health facility 94.4 0.5 3.3 0.6 1.3 100.0 526 Private sector health facility 95.8 0.0 2.8 0.7 0.7 100.0 117 Home (70.2) (6.3) (6.0) (16.1) (1.4) 100.0 39 Other (*) (*) (*) (*) (*) 100.0 4 Type of delivery Vaginal birth 91.8 0.8 3.6 2.6 1.2 100.0 493 C-section 95.2 0.5 2.6 0.5 1.1 100.0 193 Education None (84.2) (2.2) (6.5) (5.7) (1.3) 100.0 41 Primary 91.9 1.3 2.5 2.1 2.2 100.0 311 Secondary + 94.5 0.0 3.8 1.6 0.2 100.0 315 CET/ITVET/VOTEC (*) (*) (*) (*) (*) 100.0 3 Other (*) (*) (*) (*) (*) 100.0 15 Wealth index quintiles Poorest 88.0 0.8 3.8 4.5 2.9 100.0 173 Second 93.8 1.7 3.9 0.0 0.5 100.0 156 Middle 94.1 0.7 4.1 1.2 0.0 100.0 134 Fourth 95.1 0.0 2.4 1.5 1.0 100.0 132 Richest 94.5 0.0 1.9 2.7 0.8 100.0 91 Ethnicity of house- hold head Creole 90.6 0.0 4.9 4.5 0.0 100.0 113 Mestizo 94.8 1.0 2.3 0.7 1.2 100.0 355 Garifuna (94.1) (0.0) (4.6) (1.3) (0.0) 100.0 43 Maya 86.5 0.6 3.4 5.8 3.7 100.0 96 Other 94.0 1.3 4.7 0.0 0.0 100.0 71 Missing/DK (*) (*) (*) (*) (*) 100.0 8 Total 92.7 0.7 3.4 2.0 1.2 100.0 685 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases The Belize MICS shows that for 92.7 percent of live births, both the mothers and their newborns receive either a health check following birth or a timely PNC visit, whereas for 2 percent of births neither receive health checks or timely visits. Given the high levels of coverage, there are few notable differences. Wealth, however, is one exception where the poorest households are least likely to have both the mother and the child checked (88 percent) compared with the richest households, who have close to 95 percent covered. 118 mics f inal report ix. Child developmenT Early Childhood Education and Learning Attendance to pre-school education in an organized learning or child education program is important for the readiness of children to school. 31.7 percent of children aged 36-59 months are attending pre-school (Table CD.1). Urban-rural and regional differentials are observed – the figure is as high as 40.4 percent in urban areas, compared to 26.4 percent in rural areas. Among children aged 36-59 months, attendance to pre-school is more prevalent in the Belize District (52.9 percent), and lowest in the Toledo District (12.8 percent). A small gender differential exists, but differentials by socioeconomic status are pronounced. 59.1 percent of children living in rich households attend pre-school, while the figure drops to 16.1 percent in poor households. The proportions of children attending pre-school at ages 36-47 months and 48-59 months also show some differentials (36-47 months 18.2 percent and 48-59 months 45.2 percent). Table CD.1: Early childhood education Percentage of children age 36-59 months who are attending some form of organized early childhood education programme, Belize, 2011 Percentage of children age 36-59 months currently attending early childhood education [1] Number of children aged 36-59 months Sex Male 29.5 393 Female 33.9 399 Region Corozal 19.1 101 Orange Walk 16.3 118 Belize (Excluding Belize City South Side) 56.2 115 Belize City South Side 49.5 109 Belize District 52.9 224 Cayo 24.7 167 Stann Creek 45.0 92 Toledo 12.8 90 Area Urban 40.4 300 Rural 26.4 492 Age of child 36-47 months 18.2 395 48-59 months 45.2 397 Mother’s education None (2.3) 38 Primary 23.3 403 Secondary + 46.6 325 Other (*) 19 Wealth index quintiles Poorest 16.1 198 Second 28.5 189 Middle 25.6 166 Fourth 46.0 140 Richest 59.1 99 Ethnicity of household head Creole 51.1 172 Mestizo 27.6 368 Garifuna (52.4) 40 Maya 19.4 121 Other 14.8 77 Total 31.7 792 [1] MICS indicator 6.7 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 4 un-weighted cases in “CET/ITVET/VOTEC” and 1 un-weighted case in “Missing/DK” on the Mother’s Education are excluded from the table mics f inal report 119 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, engagement of adults in 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. 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 almost more than three-quarters (85.6 percent) of under-five children, an adult household member engaged in four or more activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.2). The average number of activities that adults engaged with children was 5.1. Father’s involvement with one or more activities was 50.0 percent. 25.1 percent of children were living in a household without their fathers. In the Belize City South Side, father’s involvement with one or more activities was lower than in other regions (34.0 percent). Cayo had the highest father involvement at 56.3 percent. The percentage of children not living with their fathers was highest in Belize City South Side (43.8 percent) and lowest in Toledo (13.0 percent). There is a small gender differential in terms of engagement of adults in activities with children (male 88.3 percent, female 83.0 percent) and fathers engaged in activities with male children (55.0 percent) than with female children (45.2 percent). Larger proportions of adults engaged in learning and school readiness activities with children in urban areas (88.5 percent) than in rural areas (83.9 percent). Differentials by region and socio-economic status are also observed: adult engagement in activities with children was greatest in the Cayo District (91.2 percent) and lowest in the region of Belize (Excluding Belize City South Side) (80.6 percent), while the proportion was 94.0 percent for children living in the richest households, as opposed to those living in the poorest households (72.5 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. The mother/caretaker of all children under-5 were asked about number of children’s books or picture books they have for the child, household objects or outside objects, and homemade toys or toys that came from a shop that are available at home. 120 mics f inal report Table CD.2: Support for learning Percentage of children age 36-59 months with whom an adult household member engaged in activities that promote learning and school readiness during the last three days, Belize, 2011 Percentage of children aged 36-59 months Mean number of activities Percentage of children not living with their natural father Number of children aged 36-59 months With whom adult household members engaged in four or more activities [1] With whom the father engaged in one or more activities [2] Any adult household member en- gaged with the child The father engaged with the child Sex Male 88.3 55.0 5.2 2.1 22.9 393 Female 83.0 45.2 4.9 1.6 27.3 399 Region Corozal 84.0 55.4 5.0 1.7 17.1 101 Orange Walk 83.1 41.9 5.1 1.6 20.7 118 Belize (Excluding Belize City South Side) 80.6 55.5 4.8 2.0 26.4 115 Belize City South Side 88.2 34.0 5.1 1.1 43.8 109 Belize District 84.3 45.0 4.9 1.5 34.9 224 Cayo 91.2 56.3 5.4 2.6 25.7 167 Stann Creek 86.1 54.2 5.0 1.9 26.6 92 Toledo 83.6 51.3 4.8 1.9 13.0 90 Area Urban 88.5 43.6 5.2 1.7 37.5 300 Rural 83.9 54.0 5.0 2.0 17.6 492 Age 36-47 months 89.4 53.7 5.2 2.1 25.3 395 48-59 months 81.9 46.3 4.9 1.6 25.0 397 Mother’s education None (60.7) (42.6) (3.8) (1.4) (10.7) 38 Primary 82.9 51.9 5.0 1.9 19.2 403 Secondary + 93.6 49.4 5.4 2.0 35.3 325 Father’s education None 58.7 51.0 3.8 1.4 na 44 Primary 84.8 57.6 5.1 2.1 na 276 Secondary + 94.3 68.2 5.4 2.7 na 240 Father not in household 84.3 16.0 4.9 na na 199 Wealth index quin- tiles Poorest 72.5 52.0 4.4 1.9 15.3 198 Second 84.6 41.9 5.1 1.5 28.6 189 Middle 88.9 51.1 5.2 1.8 25.3 166 Fourth 95.8 52.8 5.4 2.1 30.6 140 Richest 94.0 55.9 5.5 2.4 30.1 99 Ethnicity of household head Creole 89.2 43.5 5.1 1.4 38.8 172 Mestizo 85.7 52.3 5.1 2.0 24.0 368 Garifuna (89.6) (45.4) (5.3) (2.1) (42.2) 40 Maya 84.7 51.4 4.9 2.0 10.5 121 Other 74.1 53.1 4.7 2.0 17.2 77 Total 85.6 50.0 5.1 1.9 25.1 792 [1] MICS indicator 6.1 [2] MICS Indicator 6.2 na = Not Applicable ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 5 un-weighted cases in “CET/ITVET/VOTEC” and “Missing/DK” and 22 un-weighted cases of “Other” on the Mother’s Education are excluded from the table 11 un-weighted cases in “CET/ITVET/VOTEC” and “Missing/DK” and 22 un-weighted cases of “Other” on the Father’s Education are excluded from the table 13 un-weighted cases in “Missing/DK” on the Ethnicity of Head of Household are excluded from the table In Belize, 39.6 percent of children age 0-59 months live in households where at least 3 children’s books are present (Table CD.3). The percentage of children with 10 or more books declines to 19.5] percent. Urban children appear to have more access to children’s books than those living in rural households. The proportion of under-5 children who have 3 or more children’s books is 49.9 percent in urban areas, compared to 33.3 percent in rural areas. The presence of children’s books is positively correlated with the child’s age; in the mics f inal report 121 homes of 48.7 percent of children aged 24-59 months, there are 3 or more children’s books, while the figure is 25.5 percent for children aged 0-23 months. When children for whom there are 10 or more children’s books or picture books are considered, the patterns observed for 3 or more children’s books remain and in some instances become more pronounced. For mother’s education at the secondary level the rate is 33.7 percent while it is 4.2 percent for children whose mothers have no education. In the case of the sex of the child, rates are equal at 19.5 percent Table CD.3: Learning materials Percentage of children under age 5 by numbers of children’s books present in the household, and by playthings that child plays with, Belize, 2011 Household has for the child: Child plays with: Two or more types of playthings [2] Number of children under age 5 3 or more children’s books [1] 10 or more children’s books Homemade toys Toys from a shop/ manufactured toys Household objects/objects found outside Sex Male 38.8 19.4 21.6 88.4 56.3 57.4 984 Female 40.5 19.5 19.3 90.4 56.1 57.3 962 Region Corozal 27.7 10.3 22.8 93.6 60.6 63.4 263 Orange Walk 42.8 16.6 26.3 92.3 72.3 73.6 302 Belize (Excluding Belize City South Side) 53.3 37.4 19.9 91.6 55.3 60.1 240 Belize City South Side 42.3 23.1 5.5 88.4 37.3 38.6 252 Belize District 47.6 30.1 12.5 89.9 46.1 49.1 492 Cayo 44.6 21.2 24.4 87.4 60.7 59.0 450 Stann Creek 39.3 20.0 8.5 91.4 65.2 63.4 212 Toledo 22.2 7.0 30.6 81.4 34.1 37.7 226 Area Urban 49.9 27.5 15.2 90.7 51.6 54.1 743 Rural 33.3 14.6 23.7 88.6 59.1 59.4 1203 Age 0-23 months 25.5 11.6 14.4 81.6 42.8 43.0 761 24-59 months 48.7 24.5 24.3 94.4 64.8 66.6 1185 Mother’s education None 8.3 1.9 33.3 75.0 63.9 59.3 108 Primary 25.8 7.9 21.4 87.6 53.8 54.6 994 Secondary + 56.2 33.7 18.1 92.4 54.6 56.7 839 Other (41.2) (8.0) (35.0) (90.9) (63.8) (78.1) 47 Wealth index quintiles Poorest 16.9 3.9 25.3 79.4 57.0 54.8 490 Second 29.7 9.5 18.4 90.6 57.6 59.6 450 Middle 43.5 21.6 17.8 91.8 54.9 58.2 407 Fourth 55.3 27.0 20.1 94.5 54.5 56.6 330 Richest 72.8 52.4 19.5 95.6 56.5 57.8 268 Ethnicity of household head Creole 55.3 29.3 15.2 94.4 53.1 56.2 379 Mestizo 34.9 16.9 19.7 88.6 58.3 57.2 949 Garifuna 43.6 24.4 5.7 88.5 48.2 46.6 105 Maya 26.8 9.8 29.2 83.7 54.2 57.1 288 Other 45.9 21.7 26.8 91.5 59.2 66.2 195 Missing/DK (59.5) (37.7) (36.0) (94.1) (56.9) (60.1) 31 Total 39.6 19.5 20.4 89.4 56.2 57.3 1946 [1] MICS indicator 6.3 [2] MICS indicator 6.4 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 12 un-weighted cases in “CET/ITvET/voTEC” and “Missing/dK” on the Mother’s Education are excluded from the table Table CD.3 also shows that 57.3 percent of children aged 0-59 months had 2 or more playthings to play with in their homes. The playthings in MICS included homemade toys (such as dolls and cars, or other toys made at home), toys that came from a store, and household objects (such as pots and bowls) or objects and materials found outside the home (such as sticks, rocks, animal shells, or leaves). It is interesting to note that 89.4 percent of children play with toys that come from a store as compared to home made toys (20.4 122 mics f inal report percent). The proportion of children who have 2 or more playthings to play with is about 57.4 percent for both male and female children. A small urban-rural differential is observed in this respect (urban 54.1 percent, rural 59.4 percent). No differences are observed in terms of mother’s education and across socioeconomic status of the households. Children who have 2 or more playthings to play appear in equal rates (about 57 percent) for heads of household with different ethnicities except for the Garifuna with a rate of 46.6 percent. 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.4: Inadequate care Percentage of children under age 5 left alone or left in the care of other children under the age of 10 years for more than one hour at least once during the past week, Belize, 2011 Percentage of children under age 5 Number of children under age 5 Left alone in the past week Left in the care of another child younger than 10 years of age in the past week Left with inadequate care in the past week [1] Sex Male 1.4 2.1 2.8 984 Female 0.9 1.6 2.1 962 Region Corozal 0.3 2.2 2.2 263 Orange Walk 0.0 0.3 0.3 302 Belize (Excluding Belize City South Side) 0.0 0.0 0.0 240 Belize City South Side 0.4 1.5 1.5 252 Belize District 0.2 0.8 0.8 492 Cayo 2.5 2.2 4.0 450 Stann Creek 1.2 4.2 5.0 212 Toledo 2.9 2.8 3.7 226 Area Urban 0.1 0.5 0.5 743 Rural 1.8 2.7 3.6 1203 Age 0-23 1.1 1.4 1.9 761 24-59 1.2 2.1 2.8 1185 Mother’s education None 0.9 5.8 5.8 100 Primary 1.2 1.9 2.5 946 Secondary + 1.2 1.4 2.1 839 Wealth index quintiles Poorest 1.5 4.0 4.3 490 Second 1.2 1.1 1.5 450 Middle 2.0 1.4 3.4 407 Fourth 0.5 1.2 1.2 330 Richest 0.0 0.6 0.6 268 Ethnicity of household head Creole 0.7 1.4 1.9 379 Mestizo 1.2 2.1 2.9 949 Garifuna 0.0 0.0 0.0 105 Maya 2.5 3.2 3.9 288 Other 0.5 0.9 0.9 195 Total 1.1 1.8 2.4 1946 [1] MICS indicator 6.5 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 11 un-weighted cases in “CET/ITVET/VOTEC” and 1 un-weighted case in “Missing/DK” on the Mother’s Education are excluded from the table 28 un-weighted cases in “Missing/DK” on the Ethnicity of Household Head are excluded from the table Table CD.4 shows that 1.8 percent of children aged 0-59 months were left in the care of other children, while 1.1 percent were left alone during the week preceding the interview. Combining the two care indicators, it is mics f inal report 123 calculated that 2.4 percent of children were left with inadequate care during the week preceding the survey, either by being left alone or in the care of another child. Children from rural areas tended to be left more frequently without adequate care than children from urban areas (urban 0.5 percent, rural 3.6 percent). Inadequate care was more prevalent among children whose mothers had no education (5.8 percent), as opposed to children whose mothers had at least secondary education (2.1 percent). Children aged 24-59 months were left with inadequate care more (2.8 percent) than those who were aged 0-23 months (1.9 percent). Children with wealth index poorest were more likely to leave children without adequate care (4.3 percent). Early Childhood Development Early child development is defined as an orderly, predictable process along a continuous path, in which a child learns to handle more complicated levels of moving, thinking, speaking, feeling and relating to others. Physical growth, literacy and numeracy skills, socio-emotional development and readiness to learn are vital domains of a child’s overall development, which is a basis for overall human development. A 10-item module that has been developed for the MICS programme was used to calculate the Early Child Development Index (ECDI). The indicator is based on some benchmarks that children would be expected to have if they are developing as the majority of children in that age group. The primary purpose of the ECDI is to inform public policy regarding the developmental status of children in Belize. Each of the 10 items is used in one of the four domains, to determine if children are developmentally on track in that domain. The domains in question are: o Literacy-numeracy: Children are identified as being developmentally on track based on whether they can identify/name at least ten letters of the alphabet, whether they can read at least four simple, popular words, and whether they know the name and recognize the symbols of all numbers from 1 to 10. If at least two of these is true, then the child is considered developmentally on track. o Physical: If the child can pick up a small object with two fingers, like a stick or a rock from the ground and/or the mother/caretaker does not indicate that the child is sometimes too sick to play, then the child is regarded as being developmentally on track in the physical domain. o In the social-emotional domain, children are considered to be developmentally on track if two of the following is true: If the child gets along well with other children, if the child does not kick, bite, or hit other children and if the child does not get distracted easily o Learning: If the child follows simple directions on how to do something correctly and/or when given something to do, is able to do it independently, then the child is considered to be developmentally on track in the learning domain. ECDI is then calculated as the percentage of children who are developmentally on track in at least three of these four domains. 124 mics f inal report Table CD.5: Early child development index Percentage of children age 36-59 months who are developmentally on track in literacy-numeracy, physical, social- emotional, and learning domains, and the early child development index score, Belize, 2011 Percentage of children age 36-59 months who are developmentally on track for indicated domains Early child development index score [1] Number of children age 36-59 monthsLiteracy- numeracy Physical Social- Emotional Learning Sex Male 43.1 98.8 80.1 98.2 87.3 393 Female 48.7 99.2 77.0 98.7 87.8 399 Region Corozal 52.9 99.2 77.6 98.3 87.4 101 Orange Walk 40.7 99.2 81.4 99.2 91.5 118 Belize (Excluding Belize City South Side) 55.3 100.0 70.2 100.0 85.0 115 Belize City South Side 34.4 100.0 87.0 100.0 93.7 109 Belize District 45.1 100.0 78.4 100.0 89.2 224 Cayo 48.2 98.9 72.3 98.0 82.0 167 Stann Creek 49.9 97.2 87.8 98.2 93.3 92 Toledo 38.6 98.0 78.4 94.8 82.6 90 Area Urban 49.1 98.8 79.8 99.7 91.1 300 Rural 44.0 99.1 77.8 97.7 85.3 492 Age 36-47 months 32.5 98.9 78.2 98.2 84.2 395 48-59 months 59.4 99.1 78.9 98.7 90.8 397 Attendance to early childhood education Attending preschool 70.8 99.7 80.2 99.7 93.8 251 Not attending preschool 34.4 98.7 77.8 97.9 84.6 541 Mother’s education None (29.0) (98.0) (70.3) (90.2) (77.3) 38 Primary 44.7 99.1 76.8 98.5 86.7 403 Secondary + 51.0 98.9 81.1 99.2 89.5 325 Other (13.6) (100.0) (94.9) (100.0) (94.9) 19 Wealth index quintiles Poorest 31.6 99.1 75.3 96.4 81.4 198 Second 39.4 99.2 78.1 99.6 86.2 189 Middle 47.9 98.4 79.5 98.4 88.3 166 Fourth 52.0 98.7 81.0 98.8 91.5 140 Richest 75.0 100.0 80.9 100.0 95.2 99 Ethnicity of household head Creole 46.3 98.5 81.3 98.1 88.8 172 Mestizo 46.5 99.3 74.9 98.9 84.0 368 Garifuna (57.3) (97.6) (83.6) (100.0) (95.4) 40 Maya 46.2 98.5 81.4 96.6 90.9 121 Other 35.4 100.0 82.8 98.8 91.8 77 Total 45.9 99.0 78.5 98.4 87.5 792 [1] MICS indicator 6.6 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 5 un-weighted cases in “CET/ITVET/VOTEC” and “Missing/DK” on the Mother’s Education are excluded from the table 13 un-weighted cases in “Missing/DK” on the Ethnicity of Household Head are excluded from the table mics f inal report 125 The results are presented in Table CD.5. In Belize, 87.5 percent of children aged 36-59 months are developmentally on track. ECDI is virtually the same among boys (87.3 percent) and girls (87.8 percent). As expected, ECDI is higher in older age group (90.8 percent among 48-59 months old compared to 84.2 percent among 36-47 months old), since children develop more skills with increasing age. Higher ECDI is seen in children attending an early childhood education programme (93.8 percent compared to 84.6 percent for those who are not attending preschool). Children living in poorest households have lower ECDI (81.4 percent) compared to children living in richest households (95.2 percent of children developmentally on track). The analysis of four domains of child development shows that 98.4 percent of children are on track in the learning domain, 99.0 percent in physical, but 78.5 percent in the social-emotional and only 45.9 percent in the literacy-numeracy domain. In each individual domain the higher score is associated with children living in richest households, and with children from the Belize District. Girls perform better than boys in all domains except in the socio-emotional domain (boys 80.1percent, girls 77.0 percent). 126 mics f inal report x. liTeraCy and eduCaTion Literacy among Young Women 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.1. Table ED.1 indicates that over ninety percent (91.1 percent) of women in Belize are literate and that literacy status varied considerably by area. The most literate women are found in Belize District (98.5 percent) and the least literate in the Orange Walk District (82.0 percent). There is a ten percent gap between urban (96.6 percent) and rural (86.4 percent) women. Literacy is also linked to wealth. Only 74.6 percent of women with poorest wealth index were literate and rates steadily increased to women from the richest wealth quintile at a rate of 99.2 percent. Women from households with Garifuna heads had a 100 percent literacy rate while women from Maya households had a literacy rate of 88.7 percent. Table ED.1: Literacy among young women Percentage of women age 15-24 years who are literate, Belize, 2011 Percentage literate [1] Percentage not known Number of women age 15-24 years Region Corozal 86.0 8.8 194 Orange Walk 82.0 11.5 258 Belize (Excluding Belize City South Side) 98.8 0.6 255 Belize City South Side 98.2 0.0 216 Belize District 98.5 0.3 471 Cayo 91.6 3.7 347 Stann Creek 90.9 4.2 147 Toledo 89.6 1.1 147 Area Urban 96.6 1.0 726 Rural 86.4 7.4 838 Education None (*) (*) 22 Primary/Infant 79.0 7.5 443 Secondary + 100.0 0.0 1064 CET/ITVET/VOTEC (*) (*) 10 Other (0.0) (89.2) 25 Age 15-19 91.6 4.5 844 20-24 90.6 4.3 720 Wealth index quintiles Poorest 74.6 14.4 271 Second 88.8 4.3 330 Middle 95.1 2.1 356 Fourth 96.0 2.1 308 Richest 99.2 0.6 299 Ethnicity of household head Creole 98.1 0.4 376 Mestizo 91.0 3.7 784 Garifuna 100.0 0.0 93 Maya 88.7 1.0 179 Other 65.6 31.5 113 Missing/DK (*) (*) 19 Total 91.1 4.4 1564 [1] MICS indicator 7.1; MDG indicator 2.3 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 127 School Readiness Attendance to pre-school education in an organised learning or child education programme is important for the readiness of children to school. Table ED.2 shows the proportion of children in the first grade of primary school (infant 1) who attended pre-school the previous year. Overall, 32.9 percent of children who are currently attending the infant 1 of primary school were attending pre-school the previous year. The proportion among females is higher (35.5 percent) than males (30.2 percent), and urban rates (39 percent) were higher than rural rates (28.6 percent). By District, rates were lowest in Orange Walk (16.6 percent) and highest in Belize City South Side at 42.5 percent. Table ED.2: School readiness Percentage of children attending first grade of primary school who attended pre-school the previous year, Belize, 2011 Percentage of chil- dren attending first grade who attended preschool in previ- ous year [1] Number of children attending first grade of primary school Sex Male 30.2 425 Female 35.5 418 Region Corozal 32.4 100 Orange Walk 16.6 106 Belize (Excluding Belize City South Side) 37.7 110 Belize City South Side 42.5 105 Belize District 40.0 215 Cayo 35.0 202 Stann Creek 37.8 109 Toledo 26.3 111 Area Urban 39.0 343 Rural 28.6 500 Mother’s education None 10.9 58 Primary 29.6 468 Secondary + 41.9 312 Wealth index quintiles Poorest 23.5 213 Second 33.9 201 Middle 30.1 158 Fourth 42.1 154 Richest 39.6 116 Ethnicity of house- hold head Creole 40.4 185 Mestizo 29.6 436 Garifuna 43.2 53 Maya 29.8 117 Other (26.9) 43 Missing/DK (*) 9 Total 32.9 843 [1] MICS indicator 7.2 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 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: 128 mics f inal report o Net intake rate in primary education o Primary school net attendance ratio (adjusted) o Secondary school net attendance ratio (adjusted) o Female to male education ratio (or gender parity index - GPI) in primary and secondary school The indicators of school progression include: o Children reaching last grade of primary o Primary completion rate o Transition rate to secondary school In Belize formal schooling is divided into three main parts, primary, secondary and tertiary. Students attend primary school for eight years: infant 1 and 2 and standard 1 to 6. Secondary school attendance is for four years and tertiary education is for two or more years. Of children who are of primary school entry age (age 5) in Belize, 85.3 percent of children of school entry age are entering grade 1 (Table ED.3). By region and urban-rural areas, there are notable differentials; (urban 94.5 percent, rural 79.0 percent). In Belize City South Side, for instance, the value of the indicator reaches 100 percent, while it is 80.0 percent in the Toledo District. In rich households, the proportion is around 93.1 percent, while it is 70.8 percent among children living in the poorest households. Table ED.3: Primary school entry Percentage of children of primary school entry age entering grade 1 (net intake rate), Belize, 2011 Percentage of children of primary school entry age entering grade 1 [1] Number of children of primary school entry age Sex Male 85.3 191 Female 85.3 212 Region Corozal 83.2 51 Orange Walk 77.9 74 Belize (Excluding Belize City South Side) 84.9 43 Belize City South Side 100.0 48 Belize District 92.9 91 Cayo 86.1 77 Stann Creek 89.4 52 Toledo 80.0 58 Area Urban 94.5 163 Rural 79.0 239 Mother’s education None (42.6) 29 Primary 89.8 212 Secondary + 92.0 151 CET/ITVET/VOTEC (*) 1 Missing/DK (*) 1 Other (*) 9 Wealth index quin- tiles Poorest 70.8 108 Second 88.6 93 Middle 87.9 69 Fourth 93.6 75 Richest 93.1 57 Ethnicity of household head Creole 97.8 84 Mestizo 86.4 191 Garifuna 86.4 25 Maya 88.2 67 Other (36.8) 32 Missing/DK (*) 4 Total 85.3 403 [1] MICS indicator 7.3 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 129 Table ED.4A provides the percentage of children of primary school age 5 to 12 years who are attending primary or secondary school1. The majority of children of primary school age are attending school (94.4 percent). In urban areas 98.0 percent of children attend school while in rural areas attendance is only 92.2 percent. As the educational level of the mother increases the total net attendance ratio also increases (from 79.0 percent for no education to 98.1 percent for mothers with secondary or better education). This trend is similar for males and females (Figure ED.1). For wealth as the wealth index increases so does the net attendance ratios. This is true for both sexes and for the country in general (Figure ED.2). Table ED.4A: Primary school attendance Percentage of children of primary school age attending primary or secondary school (Net attendance ratio), Belize, 2011 Male Female Total net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) [1] Number of children region Corozal 92.6 214 93.3 207 92.9 421 orange Walk 83.7 250 81.9 223 82.8 473 belize (excluding belize City south side) 97.9 215 97.2 230 97.5 446 belize City south side 97.1 195 98.6 203 97.9 398 belize District 97.5 410 97.9 433 97.7 843 Cayo 97.9 389 97.1 393 97.5 783 stann Creek 97.3 182 96.2 188 96.8 370 Toledo 93.9 198 95.7 198 94.8 396 area urban 97.6 638 98.4 647 98.0 1285 rural 92.4 1005 92.0 996 92.2 2001 age at beginning of school year 5 85.3 191 85.3 212 85.3 403 6 94.9 194 93.7 189 94.3 384 7 96.8 226 96.7 178 96.8 404 8 94.1 213 95.9 203 95.0 416 9 97.6 234 96.8 233 97.2 466 10 94.7 199 97.7 212 96.3 411 11 96.5 197 96.1 209 96.3 406 12 94.1 189 93.7 207 93.9 395 Mother’s education None 79.4 135 78.6 131 79.0 266 Primary 97.8 886 96.9 869 97.4 1756 secondary + 97.7 576 98.5 607 98.1 1183 CeT/ITVeT/VoTeC (*) 6 (*) 5 (*) 11 Missing/DK (*) 8 (*) 3 (*) 11 other (5.2) 31 (2.6) 27 4.0 58 Wealth index quintiles Poorest 87.9 413 87.4 384 87.7 797 second 94.4 347 92.9 374 93.6 721 Middle 96.8 340 97.2 299 97.0 639 Fourth 98.3 303 99.2 311 98.8 614 richest 97.1 240 98.2 275 97.7 515 ethnicity of household head Creole 98.0 359 99.4 383 98.7 742 Mestizo 97.6 837 97.2 784 97.4 1621 Garifuna 94.3 88 96.8 86 95.5 174 Maya 95.9 211 95.3 224 95.6 435 other 61.1 131 64.6 149 63.0 280 Missing/DK (*) 17 (*) 17 (100.0) 34 Total 94.4 1643 94.5 1643 94.4 3286 [1] MICS indicator 7.4; MDG indicator 2.1; ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 Ratios presented in this table are “adjusted” since they include not only primary school attendance, but also secondary school attendance in the numerator. 130 mics f inal report In the report, results are also presented using the International Standard Classification of Education (ISCED) categories, which in the case of Belize, differs from what occurs in-country. These figures are presented mainly for the use of international data comparisons (Table ED.4B) Table ED.4B: Primary school attendance (ISCED) Percentage of children of primary school age attending primary or secondary school (Net attendance ratio), Belize, 2011 Male Female Total Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Net attendance ratio (adjusted) Number of children Region Corozal 90.9 153 93.6 161 92.2 314 Orange Walk 83.5 195 82.9 170 83.2 365 Belize (Excluding Belize City South Side) 98.1 168 96.5 182 97.3 350 Belize City South Side 97.4 149 99.3 145 98.4 294 Belize District 97.8 317 97.7 327 97.8 643 Cayo 97.7 294 96.4 281 97.1 575 Stann Creek 97.7 141 94.9 140 96.3 281 Toledo 93.2 157 96.3 149 94.7 306 Area Urban 97.3 492 98.4 478 97.8 971 Rural 92.1 764 91.8 749 91.9 1514 Age at beginning of school year 5 85.3 191 85.3 212 85.3 403 6 94.9 194 93.7 189 94.3 384 7 96.8 226 96.7 178 96.8 404 8 94.1 213 95.9 203 95.0 416 9 97.6 234 96.8 233 97.2 466 10 94.7 199 97.7 212 96.3 411 Mother’s education None 75.2 96 76.8 95 76.0 191 Primary 97.8 685 96.8 654 97.3 1339 Secondary + 97.2 444 98.4 452 97.8 897 CET/ITVET/ VOTEC (*) 6 (*) 5 (*) 11 Missing/DK (*) 3 (*) 1 (*) 4 Other (3.1) 23 (3.6) 20 3.3 43 Wealth index quintiles Poorest 87.6 318 86.3 290 87.0 607 Second 94.1 267 93.6 281 93.9 548 Middle 96.8 263 97.2 228 97.0 491 Fourth 97.7 221 99.3 221 98.5 441 Richest 97.1 188 98.0 208 97.6 396 Ethnicity of household head Creole 97.8 282 99.5 282 98.6 564 Mestizo 97.6 629 96.7 594 97.2 1222 Garifuna 92.5 67 97.2 64 94.8 132 Maya 95.8 172 96.3 166 96.0 338 Other 56.6 93 61.6 106 59.2 199 Missing/DK (*) 15 (*) 15 (100.0) 30 Total 94.1 1257 94.3 1228 94.2 2484 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 131 132 mics f inal report Table ED.5A: Secondary school attendance Percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio), and percentage of children attending primary school, Belize, 2011 Male Female Total Net attendance ratio (adjusted) Percent attending primary school Number of children Net attendance ratio (adjusted) Percent attending primary school Number of children Net attendance ratio (adjusted) [1] Percent attending primary school Number of children Region Corozal 43.8 18.7 102 46.6 12.6 98 45.2 15.8 201 Orange Walk 41.1 14.4 108 48.2 10.2 107 44.6 12.3 216 Belize (Excluding Belize City South Side) 64.4 25.2 99 73.8 16.7 124 69.6 20.5 223 Belize City South Side 63.7 20.3 77 83.4 9.5 98 74.7 14.2 175 Belize District 64.1 23.0 176 78.1 13.5 222 71.9 17.7 398 Cayo 46.3 28.7 183 61.7 20.4 199 54.3 24.4 382 Stann Creek 51.9 33.5 89 59.4 18.9 84 55.6 26.4 173 Toledo 41.0 27.4 82 48.2 18.8 79 44.6 23.2 161 Area Urban 60.3 25.9 288 76.9 14.3 336 69.2 19.7 625 Rural 42.6 23.3 452 49.2 16.9 454 45.9 20.1 906 Age at beginning of school year 13 37.3 53.6 200 44.8 40.2 217 41.2 46.6 417 14 54.1 28.2 191 65.9 12.2 171 59.7 20.6 361 15 56.1 5.9 190 68.8 6.8 224 62.9 6.4 414 16 51.5 4.9 160 66.3 .9 178 59.3 2.8 338 Mother’s education None 25.4 37.2 77 30.3 25.8 66 27.6 32.0 142 Primary 40.6 29.7 363 53.5 21.1 364 47.1 25.4 727 Secondary + 75.6 18.6 184 84.8 12.4 233 80.7 15.1 416 CET/ITVET/VOTEC (*) (*) 5 (*) (*) 4 (*) (*) 9 Mother not in household 59.0 9.4 95 59.6 2.2 104 59.3 5.6 199 Missing/DK (*) (*) 1 (*) (*) 4 (*) (*) 5 Other (*) (*) 16 (*) (*) 15 (4.8) (0.0) 32 Wealth index quintiles Poorest 22.9 33.8 168 29.4 21.8 144 25.9 28.3 312 Second 37.9 28.9 148 44.6 15.6 150 41.3 22.2 298 Middle 40.8 28.5 123 63.4 19.5 184 54.4 23.1 307 Fourth 67.3 19.8 156 76.4 11.8 158 71.9 15.8 314 Richest 80.4 9.9 145 87.7 10.1 154 84.2 10.0 299 Ethnicity of household head Creole 69.1 17.5 157 80.9 11.5 179 75.3 14.3 336 Mestizo 44.4 25.2 371 56.4 15.7 391 50.5 20.3 761 Garifuna (45.9) (42.0) 35 (80.6) (14.9) 40 64.3 27.6 75 Maya 38.0 33.1 93 38.8 26.4 97 38.4 29.7 190 Other 46.4 14.7 70 54.3 12.9 76 50.5 13.8 146 Missing/DK (*) (*) 14 (*) (*) 7 (*) (*) 21 Total 49.5 24.3 740 61.0 15.8 790 55.4 19.9 1530 [1] MICS indicator 7.5 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 133 The secondary school net attendance ratio is presented in Table ED.5A. Table ED.5A shows that only about half of the children of secondary school age are attending secondary school (55.4 percent). Of the remaining half some of them are either out of school or attending primary school; almost two in five (19.9 percent) of the children of secondary school age are attending primary school when they should be attending secondary school. Differences exist in net rates for males (49.5 percent) and females (61.0 percent) and also for urban (69.2 percent) and rural (45.9 percent) areas. Mother’s education and wealth seem to correlate positively with increasing net ratios (Figure ED.3). It is interesting to note that the largest percentage of secondary age children attending primary school come from Maya households (29.7 percent) and from the Stann Creek District (26.4 percent). 134 mics f inal report Table ED.5B below presents the figures for secondary education according to International Standard Classification of Education (ISCED) categories. Table ED.5B: Secondary school attendance (ISCED) Percentage of children of secondary school age attending secondary school or higher (adjusted net attendance ratio), and percentage of children attending primary school, Belize, 2011 Male Female Total Net attendance ratio (adjusted) Percent attending primary school Number of children Net attendance ratio (adjusted) Percent attending primary school Number of children Net attendance ratio (adjusted) [1] Percent attending primary school Number of children Region Corozal 32.0 42.8 163 33.4 36.5 145 32.6 39.8 308 Orange Walk 28.9 36.3 163 35.1 30.1 160 32.0 33.2 323 Belize (Excluding Belize City South Side) 46.4 45.5 146 54.7 38.5 173 50.9 41.7 319 Belize City South Side 41.5 46.9 123 58.6 35.8 155 51.1 40.7 279 Belize District 44.2 46.1 269 56.6 37.2 328 51.0 41.2 598 Cayo 32.6 50.4 279 41.4 46.3 311 37.3 48.2 590 Stann Creek 39.6 49.2 130 41.0 45.2 132 40.3 47.2 262 Toledo 29.8 48.1 123 33.2 44.1 128 31.5 46.1 250 Area Urban 41.9 48.5 434 55.3 38.0 505 49.1 42.9 939 Rural 31.1 44.2 693 33.8 41.7 700 32.4 42.9 1393 Age at beginning of school year 11 1.8 94.7 197 0.8 94.8 209 1.2 94.8 406 12 14.4 79.2 189 15.8 78.0 207 15.1 78.6 395 13 37.3 53.6 200 44.8 40.2 217 41.2 46.6 417 14 54.1 28.2 191 65.9 12.2 171 59.7 20.6 361 15 56.1 5.9 190 68.8 6.8 224 62.9 6.4 414 16 51.5 4.9 160 66.3 0.9 178 59.3 2.8 338 Mother’s education None 17.5 54.2 116 20.1 45.7 102 18.8 50.2 218 Primary 28.5 51.5 565 35.0 48.0 579 31.8 49.7 1144 Secondary + 49.2 47.1 315 57.5 40.1 388 53.7 43.2 703 CET/ITVET/VOTEC (*) (*) 5 (*) (*) 4 (*) (*) 9 Mother not in household 59.0 9.4 95 59.6 2.2 104 59.3 5.6 199 Missing/DK (*) (*) 6 (*) (*) 5 (*) (*) 11 Other 0.0 3.7 24 6.6 0.0 23 3.2 1.9 47 Wealth index quintiles Poorest 15.6 52.7 264 18.2 48.6 239 16.8 50.8 503 Second 26.0 50.8 227 28.8 43.1 243 27.5 46.8 470 Middle 28.3 51.2 200 48.0 39.0 254 39.3 44.3 454 Fourth 48.6 43.0 239 52.4 39.7 248 50.6 41.3 487 Richest 63.2 29.0 197 68.1 29.5 221 65.8 29.3 418 Ethnicity of household head Creole 48.3 42.2 235 56.5 38.3 281 52.8 40.1 515 Mestizo 31.5 48.1 579 40.4 40.1 580 35.9 44.1 1160 Garifuna 30.2 62.2 56 55.5 40.1 61 43.4 50.6 117 Maya 27.8 50.8 132 25.5 49.8 155 26.6 50.3 287 Other 35.6 29.4 109 36.7 32.2 119 36.2 30.8 228 Missing/DK (*) (*) 15 (*) (*) 9 (*) (*) 25 Total 35.3 45.9 1126 42.8 40.1 1205 39.2 42.9 2332 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 135 The percentage of children entering first grade who eventually reach the last grade of primary school is presented in Table ED.6. Of all children starting infant one in primary school, the majority of them (96.5 percent) will eventually reach the last grade (standard 6). Notice that this number includes children that repeat grades and that eventually move up to reach last grade. There is no difference between boys and girls if completing primary school (males 96.3 percent, females 96.8 percent). The difference between urban and rural areas is small: the percent who reach standard 6 of those who enter infant1 in urban areas is 98.1 percent and in rural areas it is 95.4 percent. There seems to be a small positive correlation between wealth index and increasing completion to standard 6 (Figure ED.4). The majority children from households with Creole heads (97.8 percent) and Mestizo heads (96.3 percent) reach standard 6. 136 mics f inal report Table ED.6: Children reaching last grade of primary school Percentage of children entering first grade of primary school who eventually reach the last grade of primary school (Survival rate to last grade of primary school), Belize, 2011 Percent at- tending grade 1 last year who are in grade 2 this year Percent attending grade 2 last year who are attending grade 3 this year Percent attending grade 3 last year who are attending grade 4 this year Percent attending grade 4 last year who are attending grade 5 this year Percent attending grade 5 last year who are attending grade 6 this year Percent who reach grade 6 of those who enter grade 1 [1] Sex Male 100.0 100.0 100.0 98.9 97.3 96.3 Female 99.6 100.0 99.7 99.6 97.8 96.8 Region Corozal 100.0 100.0 100.0 98.6 98.4 97.1 Orange Walk 100.0 100.0 100.0 100.0 96.6 96.6 Belize (Excluding Belize City South Side) 100.0 100.0 100.0 100.0 97.6 97.6 Belize City South Side 100.0 100.0 100.0 100.0 100.0 100.0 Belize District 100.0 100.0 100.0 100.0 98.8 98.8 Cayo 100.0 100.0 100.0 98.5 97.0 95.6 Stann Creek 98.5 100.0 100.0 100.0 95.2 93.8 Toledo 100.0 100.0 98.8 98.6 98.5 96.0 Area Urban 100.0 100.0 100.0 99.0 99.1 98.1 Rural 99.7 100.0 99.8 99.4 96.5 95.4 Mother’s education None 97.3 100.0 100.0 100.0 93.7 91.2 Primary 100.0 100.0 99.7 99.4 97.1 96.3 Secondary + 100.0 100.0 100.0 100.0 100.0 100.0 Missing/DK 100.0 100.0 100.0 100.0 100.0 100.0 Wealth index quin- tiles Poorest 100.0 100.0 99.4 96.3 98.1 93.9 Second 99.3 100.0 100.0 100.0 95.6 94.9 Middle 100.0 100.0 100.0 100.0 98.6 98.6 Fourth 100.0 100.0 100.0 100.0 96.3 96.3 Richest 100.0 100.0 100.0 100.0 100.0 100.0 Ethnicity of household head Creole 100.0 100.0 100.0 100.0 97.8 97.8 Mestizo 99.7 100.0 100.0 99.6 96.4 95.7 Garifuna 100.0 100.0 100.0 93.5 100.0 93.5 Maya 100.0 100.0 98.7 98.9 98.8 96.4 Other 100.0 100.0 100.0 100.0 100.0 100.0 Missing/DK 100.0 100.0 100.0 100.0 100.0 100.0 Total 99.8 100.0 99.9 99.2 97.6 96.5 [1] MICS indicator 7.6; MDG indicator 2.2 mics f inal report 137 The primary school completion rate and transition rate to secondary education are presented in Table ED.7A. 92.9 percent of the children of primary completion age (12 to 14 years) were attending the last grade of primary education. This value should be distinguished from the gross primary completion ratio which includes children of any age attending the last grade of primary. Females complete at a higher rate than males (males 88.3 percent and females 97.1 percent) and urban children complete at a slightly higher rate than rural children (urban 102.1 percent, rural 87.0 percent). Increasing household wealth is positively associated with increasing primary completion rates (poorest 77.0 percent to richest 84.2 percent). Over ninety percent 90.9 percent of the children that completed successfully the last grade of primary school were found at the moment the survey to be attending the first grade of secondary school. There is a small difference between the rates for boys and girls (males 89.2, females 92.7) and a larger one between areas (urban 94.4 percent, rural 87.4 percent). Increasing mother’s education correlates with increasing transition rates and also increasing wealth correlates with increasing transition rates. Table ED.7A: Primary school completion and transition to secondary school Primary school completion rates and transition rate to secondary school, Belize, 2011 Primary school completion rate [1] Number of children of primary school completion age Transition rate to secondary school [2] Number of children who were in the last grade of primary school the previous year Sex Male 88.3 189 89.2 183 Female 97.1 207 92.7 170 Region Corozal 92.0 54 74.4 45 Orange Walk 54.9 54 (83.3) 33 Belize (Excluding Belize City South Side) (144.8) 40 (93.8) 49 Belize City South Side 89.1 54 98.6 71 Belize District 117.0 93 96.2 120 Cayo 102.0 98 93.7 79 Stann Creek 87.3 48 91.0 44 Toledo 85.4 47 (92.6) 32 Area Urban 102.1 154 94.4 175 Rural 87.0 241 87.4 177 Mother’s education None (74.7) 41 (89.0) 27 Primary 92.8 201 86.9 160 Secondary + 96.3 141 98.0 129 CET/ITVET/VOTEC (*) 0 (*) 2 Mother not in household (*) 0 (*) 25 Missing/DK (*) 4 (*) 0 Other (*) 8 (*) 2 Wealth index quintiles Poorest 77.0 94 (85.0) 36 Second 91.8 78 86.4 62 Middle 112.9 79 87.4 77 Fourth 99.7 81 95.3 87 Richest 84.2 63 94.9 90 Ethnicity of household head Creole 92.2 90 90.3 101 Mestizo 87.1 204 88.5 178 Garifuna (*) 19 (100.0) 24 Maya 133.0 37 (97.5) 22 Other (77.8) 42 (94.5) 26 Missing/DK (*) 4 (*) 2 Total 92.9 395 90.9 352 [1] MICS indicator 7.7; [2] MICS indicator 7.8 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 138 mics f inal report The International Standard Classification of Education (ISCED) comparison is presented below in Table ED.7B. Table ED.7B: Primary school completion and transition to secondary school (ISCED) Primary school completion rates and transition rate to secondary school, Belize, 2011 Primary school completion rate [1] Number of chil- dren of primary school comple- tion age Transition rate to secondary school [2] Number of children who were in the last grade of primary school the previous year Sex Male 83.8 199 89.2 183 Female 94.6 212 92.7 170 Region Corozal 85.7 58 74.4 45 Orange Walk 54.5 55 (83.3) 33 Belize (Excluding Belize City South Side) (108.8) 53 (93.8) 49 Belize City South Side 90.5 53 98.6 71 Belize District 99.6 106 96.2 120 Cayo 115.0 87 93.7 79 Stann Creek 72.5 58 91.0 44 Toledo 84.5 48 (92.6) 32 Area Urban 104.5 150 94.4 175 Rural 80.6 261 87.4 177 Mother’s education None (95.8) 32 (89.0) 27 Primary 79.0 236 86.9 160 Secondary + 103.2 131 98.0 129 CET/ITVET/VOTEC (*) 0 (*) 2 Mother not in household (*) 0 (*) 25 Missing/DK (*) 3 (*) 0 Other (*) 8 (*) 2 Wealth index quin- tiles Poorest 73.8 98 (*) 36 Second 82.7 87 86.4 62 Middle 100.7 89 87.4 77 Fourth 130.8 62 95.3 87 Richest 70.0 76 94.9 90 Ethnicity of household head Creole 78.1 106 90.3 101 Mestizo 94.4 188 88.5 178 Garifuna (73.8) 25 (100.0) 24 Maya 108.9 45 (97.5) 22 Other 80.7 40 (94.5) 26 Missing/DK (*) 6 (*) 2 Total 89.4 411 90.9 352 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases The ratio of girls to boys attending primary and secondary education is provided in Table ED.8A. These 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 1.00 indicating that attendance is same for boys and girls. However, the indicator increases to 1.23 for secondary education indicating that girls outperform boys at the secondary level. The disadvantage of boys is particularly pronounced in urban areas (GPI of 1.28), as well as among children living in the middle wealth households (GPI of 1.55) and Garifuna headed households (GPI of 1.75). mics f inal report 139 Table ED.8A: Education gender parity Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Belize, 2011 Primary school adjusted net attendance ratio (NAR), girls Primary school adjust- ed net atten- dance ratio (NAR), boys Gender parity index (GPI) for pri- mary school adjusted NAR [1] Secondary school ad- justed net attendance ratio (NAR), girls Secondary school ad- justed net attendance ratio (NAR), boys Gender parity in- dex (GPI) for sec- ondary school adjusted NAR [2] Region Corozal 93.3 92.6 1.01 46.6 43.8 1.07 Orange Walk 81.9 83.7 0.98 48.2 41.1 1.17 Belize (Excluding Belize City South Side) 97.2 97.9 0.99 73.8 64.4 1.15 Belize City South Side 98.6 97.1 1.02 83.4 63.7 1.31 Belize District 97.9 97.5 1.00 78.6 64.0 1.23 Cayo 97.1 97.9 0.99 61.7 46.3 1.33 Stann Creek 96.2 97.3 0.99 59.4 51.9 1.14 Toledo 95.7 93.9 1.02 48.2 41.0 1.18 Area Urban 98.4 97.6 1.01 76.9 60.3 1.28 Rural 92.0 92.4 1.00 49.2 42.6 1.15 Education of mother/caretaker None 78.6 79.4 0.99 30.3 25.4 1.20 Primary 96.9 97.8 0.99 53.5 40.6 1.32 Secondary + 98.5 97.7 1.01 84.8 75.6 1.12 CET/ITVET/VOTEC 100.0 100.0 1.00 100.0 100.0 1.00 Mother not in household (*) (*) (*) 59.6 59.0 1.01 Other 2.6 5.2 0.50 9.8 (*) (*) Wealth index quintiles Poorest 87.4 87.9 0.99 29.4 22.9 1.28 Second 92.9 94.4 0.98 44.6 37.9 1.18 Middle 97.2 96.8 1.00 63.4 40.8 1.55 Fourth 99.2 98.3 1.01 76.4 67.3 1.13 Richest 98.2 97.1 1.01 87.7 80.4 1.09 Ethnicity of household head Creole 99.4 98.0 1.01 80.9 69.1 1.17 Mestizo 97.2 97.6 1.00 56.4 44.4 1.27 Garifuna 96.8 94.3 1.03 80.6 45.9 1.75 Maya 95.3 95.9 0.99 38.8 38.0 1.02 Other 64.6 61.1 1.06 54.3 46.4 1.17 Missing/DK 100.0 100.0 1.00 77.9 67.2 1.16 Total 94.5 94.4 1.00 61.0 49.5 1.23 [1] MICS indicator 7.9; MDG indicator 3.1 [2] MICS indicator 7.10; MDG indicator 3.1 (*) Figures that are based on less than 25 un-weighted cases 140 mics f inal report The International Standard Classification of Education (ISCED) comparison is also presented below in Table ED.8B. Table ED.8B: Education gender parity (ISCED) Ratio of adjusted net attendance ratios of girls to boys, in primary and secondary school, Belize, 2011 Primary school adjusted net attendance ratio (NAR), girls Primary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for primary school adjusted NAR [1] Secondary school adjusted net attendance ratio (NAR), girls Secondary school adjusted net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school adjusted NAR [2] Region Corozal 93.6 90.9 1.03 33.4 32.0 1.04 Orange Walk 82.9 83.5 0.99 35.1 28.9 1.21 Belize (Excluding Belize City South Side) 96.5 98.1 0.98 54.7 46.4 1.18 Belize City South Side 99.3 97.4 1.02 58.6 41.5 1.41 Belize District 97.9 97.8 1.00 56.7 44.0 1.30 Cayo 96.4 97.7 0.99 41.4 32.6 1.27 Stann Creek 94.9 97.7 0.97 41.0 39.6 1.04 Toledo 96.3 93.2 1.03 33.2 29.8 1.11 Area Urban 98.4 97.3 1.01 55.3 41.9 1.32 Rural 91.8 92.1 1.00 33.8 31.1 1.09 Education of mother/caretaker None 76.8 75.2 1.02 20.1 17.5 1.15 Primary 96.8 97.8 0.99 35.0 28.5 1.23 Secondary + 98.4 97.2 1.01 57.5 49.2 1.17 Mother not in household (*) (*) (*) 59.6 59.0 1.01 Other 3.6 3.1 1.17 6.6 (*) (*) Wealth index quintiles Poorest 86.3 87.6 0.99 18.2 15.6 1.17 Second 93.6 94.1 0.99 28.8 26.0 1.11 Middle 97.2 96.8 1.00 48.0 28.3 1.69 Fourth 99.3 97.7 1.02 52.4 48.6 1.08 Richest 98.0 97.1 1.01 68.1 63.2 1.08 Ethnicity of household head Creole 99.5 97.8 1.02 56.5 48.3 1.17 Mestizo 96.7 97.6 0.99 40.4 31.5 1.28 Garifuna 97.2 92.5 1.05 55.5 30.2 1.84 Maya 96.3 95.8 1.01 25.5 27.8 0.92 Other 61.6 56.6 1.09 36.7 35.6 1.03 Missing/DK 100.0 100.0 1.00 63.5 59.0 1.08 Total 94.3 94.1 1.00 42.8 35.3 1.21 (*) Figures that are based on less than 25 un-weighted cases mics f inal report 141 xi. Child proTeCTion Birth Registration The International Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The 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 95.2 percent of children under five years in Belize have been registered (Table CP.1). There are no large variations in birth registration across sex, area, or education categories. Only 87.3 percent of children 0 to 11 months have been registered as compared to older children who have been registered at rates in the mid ninety percentages. Children in the Corozal (93.3 percent), Belize City South Side (94.6 percent) and Cayo (94.8 percent) Districts are somewhat less likely to have their births registered than other children and children from Garifuna households are registered at slightly less rates (91.9 percent) than children from other ethnic backgrounds. 142 mics f inal report Table CP.1: Birth registration Percentage of children under age 5 by whether birth is registered and percentage of children not registered whose mothers/caretakers know how to register birth, Belize, 2011 Children under age 5 whose birth is regis- tered with civil authorities Number of chil- dren Children under age 5 whose birth is not registered Has birth certif- icate No birth certificate Total reg- istered [1] Percent of chil- dren whose mother/caretaker knows how to register birth Number of children with- out birth reg- istrationSeen Not seen Sex Male 39.1 50.1 5.9 95.0 984 (95.5) 49 Female 41.6 48.9 4.9 95.4 962 (91.3) 44 Region Corozal 25.0 60.6 7.7 93.3 263 (*) 18 Orange Walk 68.5 21.5 5.3 95.2 302 (*) 14 Belize (Exclud- ing Belize City South Side) 53.3 36.5 6.5 96.2 240 (*) 9 Belize City South Side 27.0 65.9 1.6 94.6 252 (*) 14 Belize District 39.8 51.6 4.0 95.4 492 (*) 23 Cayo 32.7 59.5 2.6 94.8 450 (*) 24 Stann Creek 50.4 36.5 10.8 97.7 212 (*) 5 Toledo 27.6 61.6 6.5 95.8 226 (*) 9 Area Urban 37.3 53.7 3.7 94.6 743 (95.4) 40 Rural 42.2 46.9 6.5 95.6 1203 (92.1) 53 Age 0-11 34.8 44.0 8.5 87.3 357 (94.2) 45 12-23 40.1 50.8 4.6 95.5 404 (*) 18 24-35 44.9 48.4 3.4 96.7 393 (*) 13 36-47 40.2 52.8 5.8 98.7 395 (*) 5 48-59 41.2 50.9 5.0 97.2 397 (*) 11 Mother’s education None 52.7 36.6 4.9 94.2 100 (*) 6 Primary 39.6 49.2 6.6 95.3 946 (91.3) 44 Secondary + 38.8 52.0 4.5 95.3 839 (100.0) 39 CET/ITVET/VO- TEC (*) (*) (*) (*) 14 (*) 4 Other (64.4) (35.6) (0.0) (100.0) 47 (*) 0 Wealth index quintiles Poorest 39.3 49.0 6.8 95.1 490 (*) 24 Second 40.3 48.3 5.9 94.5 450 (*) 25 Middle 39.2 51.0 5.0 95.2 407 (*) 20 Fourth 42.0 49.9 3.5 95.4 330 (*) 15 Richest 41.9 49.6 5.0 96.5 268 (*) 9 Ethnicity of house- hold head Creole 32.3 55.9 5.7 93.9 379 (*) 23 Mestizo 44.4 45.5 5.6 95.4 949 (90.7) 43 Garifuna 39.4 43.5 9.0 91.9 105 (*) 9 Maya 37.8 53.8 5.4 96.9 288 (*) 9 Other 40.2 53.9 1.7 95.8 195 (*) 8 Missing/DK (42.9) (47.1) (7.4) (97.4) 31 (*) 1 Total 40.4 49.5 5.4 95.2 1946 93.5 93 [1] MICS indicator 8.1 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 143 Child Labour Article 32 of the Convention on the Rights of the Child states: “States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development.” The World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions addressed the issue of child labour, that is, children 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: Ages 5-11: at least one hour of economic work or 28 hours of domestic work per week. Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiation between child labour and child work to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the prevalence of child labour since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained above. Table CP.2 presents the results of child labour by the type of work. Percentages do not add up to the total child labour as children may be involved in more than one type of work. In Belize, 10 percent of children age 5 – 14 are involved in child labour. About twelve (12.1) percent of children 5 to 11 years and 4.8 percent of children 12 to 14 years are engaged in child labour. In both age groups males participate in child labour at higher rates than females. For the 5 to 11 years group the rates are males 14.6 percent and females 9.7 percent while for the 12 to 14 years group 7.0 percent of males and 2.8 percent of females engage in child labour. Most of the child labour occurs in rural areas. Overall, for children age 5 – 14, 4.1 percent work in urban areas while 13.8 percent of them work in rural areas. It is clear that for all children 5 to 14 years child labour is linked to the wealth of the family and to the education of the mother (Figure CP.1). Children with more educated mothers and from wealthier families are less likely to engage in child labour. Children from the Corozal and Toledo Districts are more likely to engage in child labour. For children 5-14, child labour rates are 16.6 percent in Corozal District and 15.9 percent in Toledo District. This compares with 4.5 percent in Belize District. Child labour participation rate for children 5 to 14 years is lowest in Belize City South Side at 4.0 percent. Labour force activity is most pronounced for children from Mestizo and Maya households (Figure CP.2) an in either case is more prevalent for the younger children. 144 mics f inal report mics f inal report 145 Table CP.2: Child labour Percentage of children by involvement in economic activity and household chores during the past week, according to age groups, and percentage of children age 5-14 involved in child labour, Belize, 2011 Percentage of children age 5-11 involved in Number of chil- dren age 5-11 Economic activity Economic activity for at least one hour Household chores less than 28 hours Household chores for 28 hours or more Child labour Working outside household Working for family business     Paid work Unpaid work Sex Male 2.6 1.4 12.1 14.3 52.1 0.4 14.6 1448 Female 1.8 1.2 7.6 9.6 59.5 0.1 9.7 1439 Region Corozal 6.4 2.4 15.5 21.2 60.5 0.2 21.5 362 Orange Walk 1.3 0.6 4.3 5.5 58.7 0.4 6.0 423 Belize (Excluding Belize City South Side) 0.8 1.1 3.4 4.8 42.3 0.0 4.8 403 Belize City South Side 3.1 0.0 2.8 5.3 54.4 0.0 5.3 348 Belize District 1.9 0.6 3.1 5.1 47.9 0.0 5.1 751 Cayo 2.1 2.2 11.3 13.3 61.2 0.0 13.3 657 Stann Creek 1.2 0.7 12.9 13.9 61.9 0.9 14.6 334 Toledo 1.2 1.3 19.4 20.2 48.4 0.3 20.4 359 Area Urban 1.4 0.9 2.3 4.3 55.2 0.1 4.4 1122 Rural 2.8 1.5 14.7 16.8 56.2 0.3 17.0 1765 School partici- pation Yes 2.3 1.3 9.8 11.9 56.8 0.3 12.1 2702 No 1.4 0.8 11.4 13.3 41.1 0.0 13.3 184 Mother’s edu- cation None 3.6 1.2 25.2 27.2 59.0 0.7 27.6 219 Primary 3.2 1.2 12.9 15.1 56.7 0.2 15.3 1547 Secondary + 0.7 1.6 2.7 4.9 54.1 0.0 4.9 1052 Other (0.0) (0.0) (0.0) (0.0) (42.6) (3.6) (3.6) 52 Wealth index quintiles Poorest 2.6 1.1 22.2 23.9 52.4 0.6 24.3 710 Second 4.5 0.6 10.6 12.7 55.7 0.3 13.0 633 Middle 1.4 2.3 6.0 8.8 57.7 0.2 9.0 565 Fourth 0.8 1.6 3.1 4.9 62.1 0.0 4.9 514 Richest 1.1 0.9 2.3 4.4 51.5 0.0 4.4 465 Ethnicity of household head Creole 1.0 0.9 3.3 5.1 56.6 0.0 5.1 647 Mestizo 2.6 1.8 10.4 12.9 55.5 0.3 13.1 1407 Garifuna 1.0 0.0 2.9 3.9 59.2 0.0 3.9 159 Maya 2.7 1.1 23.0 23.7 52.5 0.3 23.9 395 Other 2.3 0.7 7.1 10.1 61.7 0.8 10.8 243 Missing/DK (10.0) (0.0) (12.8) (18.0) (31.7) (0.0) (18.0) 36 Total 2.2 1.3 9.9 11.9 55.8 0.2 12.1 2887 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 146 mics f inal report Table CP.2: Child labour [continued] Percentage of children by involvement in economic activity and household chores during the past week, according to age groups, and percentage of children age 5-14 involved in child labour, Belize, 2011 Percentage of children age 12-14 involved in Number of children age 12-14 Total child labour [1] Num- ber of children age 5-14 years Economic activity Econom- ic activity less than 14 hours Econom- ic activity for 14 hours or more House- hold chores less than 28 hours House- hold chores for 28 hours or more Child labour Working outside household Working for family business     Paid work Unpaid work Sex Male 9.0 1.9 29.1 29.2 5.6 71.7 1.5 7.0 570 12.4 2018 Female 3.5 1.6 13.6 15.0 1.5 81.1 1.4 2.8 615 7.6 2054 Region Corozal 12.5 3.5 31.1 34.5 4.4 78.4 1.9 5.8 163 16.6 525 Orange Walk 4.0 0.0 16.7 15.0 3.4 72.6 7.8 11.2 158 7.4 581 Belize (Ex- cluding Belize City South Side) 4.2 1.7 5.0 5.1 5.0 60.3 0.0 5.0 167 4.9 570 Belize City South Side 5.8 1.4 2.7 7.9 0.7 83.2 0.0 0.7 140 4.0 488 Belize District 4.9 1.6 4.0 6.4 3.0 70.7 0.0 3.0 306 4.5 1058 Cayo 5.8 2.1 26.9 30.1 0.5 80.7 0.0 0.5 294 9.4 952 Stann Creek 8.2 0.6 29.4 22.9 10.2 83.4 0.6 10.8 133 13.5 467 Toledo 2.2 2.3 32.2 30.4 3.1 77.1 0.9 3.5 130 15.9 489 Area Urban 4.8 1.7 8.1 10.2 3.0 77.2 0.3 3.3 460 4.1 1582 Rural 7.0 1.7 29.3 29.2 3.7 76.3 2.2 5.8 725 13.8 2489 School par- ticipation Yes 6.1 1.9 20.5 21.5 3.3 77.1 0.7 3.9 1100 9.7 3802 No 6.8 0.0 27.9 26.3 5.3 70.3 11.9 17.2 86 14.5 270 Mother’s education None 15.1 0.5 42.1 41.8 7.3 81.0 0.6 7.9 123 20.5 342 Primary 5.5 2.4 25.9 26.7 3.0 76.7 1.2 4.0 626 12.0 2173 Secondary + 4.5 1.3 7.1 8.4 2.8 76.6 0.6 3.5 399 4.5 1450 CET/ITVET/ VOTEC (*) (*) (*) (*) (*) (*) (*) (*) 5 (*) 18 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) 7 (*) 12 Other 6.7 0.0 20.0 16.6 6.7 50.6 26.5 33.2 25 13.3 77 Wealth index quin- tiles Poorest 8.7 2.1 45.9 42.1 6.0 72.3 3.3 8.7 273 20.0 983 Second 6.0 1.6 24.5 25.3 4.1 75.6 2.0 6.2 248 11.1 882 Middle 7.7 0.7 13.2 16.1 2.3 79.1 0.4 2.7 221 7.2 786 Fourth 4.0 2.9 8.3 12.3 1.6 81.6 1.0 2.6 249 4.1 763 Richest 3.8 1.1 7.0 7.4 2.7 74.8 0.0 2.7 193 3.9 658 Ethnicity of household head Creole 6.6 1.5 9.6 12.1 2.3 77.3 1.0 3.0 265 4.5 913 Mestizo 6.5 1.6 23.2 23.3 3.6 77.1 1.2 4.7 590 10.6 1997 Garifuna 4.9 1.4 12.3 10.2 7.1 73.3 0.0 7.1 58 4.8 217 Maya 3.3 1.7 41.0 39.5 3.5 79.8 0.4 3.5 142 18.5 537 Other 7.9 2.6 16.6 21.0 3.8 70.0 6.0 9.8 122 10.5 364 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) 8 (14.6) 44 Total 6.1 1.7 21.1 21.8 3.5 76.6 1.5 4.8 1185 10.0 4072 [1] MICS indicator 8.2 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Table CP.3 presents the percentage of children age 5-14 years involved in child labour who are attending school and percentage of children age 5-14 years attending school who are involved in child labour. Of the 93.4 percent of the children 5-14 years of age attending school, 9.7 percent are also involved in child labour mics f inal report 147 activities. On the other hand, out of the 10.0 percent of the children who are involved in child labour, the majority of them are also attending school (90.4 percent). The percentage of children attending school who are involved in child labour is higher for males (12.2 percent) than for females (7.2 percent). Profiles for child labourers and school attendance correspond to those for the child labourers discussed in previous sections. Hence, the children attending school who are involved in child labour are predominantly male, from rural areas, younger (5 to 11 years), have mothers that are less educated and from poorer families. Mestizo and Maya stand out as having the highest levels of child labour. Table CP.3: Child labour and school attendance Percentage of children age 5-14 years involved in child labour who are attending school, and percentage of children age 5-14 years attending school who are involved in child labour, Belize, 2011 Percentage of children involved in child labour Percentage of children at- tending school Number of children age 5-14 years Percentage of child labourers who are attend- ing school [1] Number of children age 5-14 years involved in child labour Percentage of children attending school who are involved in child labour [2] Number of children age 5-14 years attending school sex Male 12.4 93.7 2018 92.2 251 12.2 1891 Female 7.6 93.0 2054 87.5 157 7.2 1911 region Corozal 16.6 90.8 525 87.3 87 16.0 477 orange Walk 7.4 85.1 581 67.6 43 5.9 495 belize (excluding belize City south side) 4.9 97.3 570 88.8 28 4.4 555 belize City south side 4.0 97.7 488 100.0 20 4.1 476 belize District 4.5 97.5 1058 93.4 47 4.3 1031 Cayo 9.4 95.2 952 96.7 89 9.5 906 stann Creek 13.5 95.7 467 93.7 63 13.2 447 Toledo 15.9 91.4 489 94.7 78 16.5 447 area urban 4.1 97.0 1582 96.5 65 4.1 1534 rural 13.8 91.1 2489 89.2 342 13.5 2268 age 5-11 years 12.1 93.6 2887 93.0 351 12.1 2702 12-14 years 4.8 92.8 1185 74.3 57 3.9 1100 Mother’s education None 20.5 77.5 342 72.9 70 19.2 265 Primary 12.0 94.1 2173 96.1 261 12.3 2045 secondary + 4.5 97.9 1450 97.4 65 4.4 1420 CeT/ITVeT/VoTeC (*) (*) 18 (*) 1 (*) 18 Missing/DK (*) (*) 12 (*) 0 (*) 12 other (13.3) (54.5) 77 (18.2) 10 (4.4) 42 Wealth index quin- tiles Poorest 20.0 85.9 983 86.3 196 20.1 845 second 11.1 92.8 882 90.8 97 10.8 818 Middle 7.2 95.6 786 100.0 57 7.6 751 Fourth 4.1 97.8 763 97.2 31 4.1 746 richest 3.9 97.5 658 90.2 26 3.6 642 ethnicity of household head Creole 4.5 97.9 913 97.9 41 4.5 894 Mestizo 10.6 94.6 1997 94.8 212 10.7 1889 Garifuna 4.8 96.2 217 100.0 10 4.9 209 Maya 18.5 93.1 537 94.2 99 18.7 500 other 10.5 73.6 364 43.7 38 6.2 268 Missing/DK (14.6) (94.3) 44 (100.0) 6 (15.5) 42 Total 10.0 93.4 4072 90.4 408 9.7 3802 [1] MICs indicator 8.3 [2] MICs indicator 8.4 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 148 mics f inal report 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. Table CP.4: Child discipline Percentage of children age 2-14 years according to method of disciplining the child, Belize, 2011 Percentage of children age 2-14 years who experienced: Number of children age 2-14 years Respondent be- lieves that the child needs to be physi- cally punished Respon- dents to the child discipline Only non-violent discipline Psychological aggression Physical punish- ment Any violent discipline meth- od [1]Any Severe Sex Male 22.5 53.5 58.4 5.2 71.3 2596 26.7 1211 Female 24.5 54.2 55.4 5.2 69.7 2635 25.6 1224 Region Corozal 26.5 42.8 56.0 4.2 66.1 675 10.6 314 Orange Walk 34.6 42.1 48.1 5.3 59.7 755 36.5 352 Belize (Excluding Belize City South Side) 19.8 66.6 53.8 4.4 75.7 723 39.0 377 Belize City South Side 17.7 62.8 65.4 3.9 76.0 646 24.3 332 Belize District 18.8 64.8 59.3 4.2 75.9 1369 32.1 709 Cayo 24.8 46.9 53.5 3.6 65.8 1201 27.0 559 Stann Creek 21.6 51.5 65.0 10.3 74.8 599 19.3 255 Toledo 16.6 71.5 62.2 6.8 81.4 631 19.3 246 Area Urban 23.2 55.0 56.6 5.4 70.2 2022 26.0 1068 Rural 23.7 53.1 57.1 5.1 70.7 3209 26.3 1368 Age 2-4 years 21.0 48.3 61.4 3.3 70.6 1018 22.0 547 5-9 years 23.2 53.7 61.9 5.6 72.1 2129 28.0 917 10-14 years 25.0 56.7 49.7 5.8 68.8 2084 26.7 971 Education of household head None 27.5 48.4 51.7 5.6 60.9 415 na na Primary 22.4 54.8 58.2 5.3 72.0 2692 na na Secondary + 22.2 56.0 58.0 4.7 72.2 1878 na na CET/ITVET/VOTEC (40.4) (37.8) (41.5) (8.9) (59.6) 55 na na Missing/DK 34.6 46.7 51.8 13.2 62.3 82 na na Other 42.4 27.8 37.1 4.3 52.8 109 na na Respondent’s education None na na na na na na 24.2 511 Primary na na na na na na 26.8 1168 Secondary + na na na na na na 26.7 716 Missing/DK na na na na na na (23.1) 41 Wealth index quintiles Poorest 21.1 55.9 63.4 5.7 74.3 1275 28.7 436 Second 22.9 52.5 57.7 6.3 70.6 1151 29.6 499 Middle 21.3 59.6 57.7 5.2 72.0 1032 24.4 497 Fourth 23.3 52.2 55.0 4.9 70.0 954 23.1 509 Richest 31.2 47.3 47.0 3.4 63.0 819 25.3 494 Ethnicity of household head Creole 16.2 67.4 64.7 5.2 80.0 1161 27.8 577 Mestizo 28.2 47.3 52.2 4.0 64.7 2537 24.6 1216 Garifuna 19.5 58.4 65.4 13.6 77.8 275 24.1 130 Maya 15.4 61.5 66.3 8.8 78.5 715 25.3 272 Other 29.3 44.1 44.3 1.9 63.2 478 33.4 203 Missing/DK 34.0 37.4 54.5 1.3 61.7 64 (25.5) 37 Total 23.5 53.9 56.9 5.2 70.5 5231 26.2 2436 [1] MICS indicator 8.5 ( ) Figures that are based on 25-49 un-weighted cases; na refers to variables that are not applicable mics f inal report 149 In Belize, 70.5 percent of children age 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members (Table CP.4). More importantly, 5.2 percent of children were subjected to severe physical punishment. On the other hand, 26.2 percent of mothers/caretakers believed that children should be physically punished. This is an interesting contrast with the actual prevalence of physical discipline (56.9 percent). Male and female children were equally likely to be subjected to both minor and severe physical discipline (males 58.4 and 5.2 percent and female 55.4 and 5.2 percent. It is interesting to note that increased respondent’s education correlates positively with both psychological and physical forms of discipline (Figure CP.3). Also rates for psychological discipline increase with increasing age of the child (48.3 percent for children aged 2 to 4 years up to 56.7 percent for children aged 10 to 14 years). Differentials with respect to many of the background variables were relatively small. Early Marriage and Polygyny Marriage before the age of 18 is a reality for many young girls. According to UNICEF’s worldwide estimates, over 64 million women age 20-24 were married/in union before the age of 18. Factors that influence child marriage rates include: the state of the country’s civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. The right to ‘free and full’ consent to a marriage is 150 mics f inal report recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be ‘free and full’ when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women mentions the right to protection from child marriage in article 16, which states: “The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage.” While marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to other rights - such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices - and is frequently addressed by the Committee on the Rights of the Child. Other international agreements related to child marriage are the Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages and the African Charter on the Rights and Welfare of the Child and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa. Child marriage was also identified by the Pan-African Forum against the Sexual Exploitation of Children as a type of commercial sexual exploitation of children. Young married girls are a unique, though often invisible, group. Required to perform heavy amounts of domestic work, under pressure to demonstrate fertility, and responsible for raising children while still children themselves, married girls and child mothers face constrained decision-making and reduced life choices. Boys are also affected by child marriage but the issue impacts girls in far larger numbers and with more intensity. Cohabitation - when a couple lives together as if married - raises the same human rights concerns as marriage. Where a girl lives with a man and takes on the role of caregiver for him, the assumption is often that she has become an adult woman, even if she has not yet reached the age of 18. Additional concerns due to the informality of the relationship - for example, inheritance, citizenship and social recognition - might make girls in informal unions vulnerable in different ways than those who are in formally recognized marriages. Research suggests that many factors interact to place a child at risk of marriage. Poverty, protection of girls, family honour and the provision of stability during unstable social periods are considered as significant factors in determining a girl’s risk of becoming married while still a child. Women who married at younger ages were more likely to believe that it is sometimes acceptable for a husband to beat his wife and were more likely to experience domestic violence themselves. The age gap between partners is thought to contribute to these abusive power dynamics and to increase the risk of untimely widowhood. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There is evidence to suggest that girls who marry at young ages are more likely to marry older men which puts them at increased risk of HIV infection. Parents seek to marry off their girls to protect their honour, and men often seek younger women as wives as a means to avoid choosing a wife who might already be infected. The demand for this young wife to reproduce and the power imbalance resulting from the age differential lead to very low condom use among such couples. Two of the indicators are to estimate the percentage of women married before 15 years of age and percentage married before 18 years of age. The percentage of women married at various ages is provided in Table CP.5. mics f inal report 151 About one in seven young women age 15-19 years is currently married or in a union (15.2 percent). This proportion also varies between urban (10.8 percent) and rural (18.9 percent). Increasing level of education and wealth both correlate negatively with children married before age 15 years. The percentage of women age 15-19 currently married is highest in poorest families (21.9 percent) and declines with household wealth to 4.8 percent in the richest families. Table CP.5: Early marriage and polygyny Percentage of women age 15-49 years who first married or entered a marital union before their 15th birthday, percentages of women age 20-49 years who first married or entered a marital union before their 15th and 18th birthdays, percentage of women age 15-19 years currently married or in union, and the percentage of women currently married or in union who are in a polygynous marriage or union, Belize, 2011 Percentage married before age 15 [1] Number of women age 15-49 years Percentage married before age 15 Percentage married before age 18 [2] Number of women age 20-49 years Percentage of women 15-19 years current- ly married/in union [3] Number of women age 15-19 years Percentage of women age 15-49 years in polygynous marriage/ union [4] Number of women age 15-49 years currently married/in union region Corozal 5.5 534 6.7 35.2 427 17.0 107 7.7 346 orange Walk 4.4 618 5.1 31.0 481 17.2 137 0.7 373 belize (excluding belize City south side) 5.1 687 6.2 26.5 548 11.7 139 2.0 369 belize City south side 3.4 573 4.1 21.6 467 7.1 106 3.7 257 belize District 4.3 1260 5.2 24.2 1014 9.7 245 2.7 625 Cayo 2.5 933 2.7 27.0 737 17.3 196 5.2 601 stann Creek 7.7 404 8.2 28.0 327 17.3 77 0.7 225 Toledo 9.1 347 11.1 45.5 265 19.0 82 1.8 217 area urban 3.4 1926 4.1 24.3 1542 10.8 383 4.1 991 rural 6.1 2170 7.0 34.0 1710 18.9 461 3.0 1395 age 15-19 1.7 844 na na na 15.2 844 3.3 128 20-24 3.4 720 3.4 25.9 720 na na 4.1 369 25-29 5.8 651 5.8 31.6 651 na na 1.9 488 30-34 7.2 544 7.2 32.1 544 na na 2.9 407 35-39 5.9 537 5.9 29.0 537 na na 4.6 417 40-44 5.8 442 5.8 27.9 442 na na 4.8 323 45-49 6.8 359 6.8 30.7 359 na na 2.9 254 Education None 8.9 148 9.4 46.1 139 (*) 9 0.7 119 Primary 9.3 1608 10.1 43.5 1388 32.9 220 4.0 1165 secondary + 1.5 2259 1.8 17.0 1661 9.1 598 3.2 1056 CeT/ITVeT/VoTeC (*) 26 (*) (*) 22 (*) 4 (*) 13 other 1.3 55 1.7 5.7 41 (*) 14 (0.0) 34 Wealth index quin- tiles Poorest 8.9 644 11.0 44.8 485 21.9 160 2.4 409 second 7.5 815 8.5 39.8 648 28.5 167 4.0 498 Middle 4.0 877 4.9 28.1 684 13.6 192 4.5 484 Fourth 3.5 862 4.3 26.3 704 7.1 159 2.0 494 richest 1.5 898 1.4 14.2 731 4.8 167 4.2 501 ethnicity of household head Creole 2.6 985 3.0 23.4 794 8.2 190 3.4 493 Mestizo 6.0 2046 7.0 33.6 1615 19.4 431 3.1 1262 Garifuna 3.3 253 4.0 19.5 209 4.3 44 7.7 120 Maya 7.7 407 9.4 42.4 309 20.8 98 4.0 272 other 2.5 335 3.2 17.9 266 8.2 69 1.7 198 Missing/DK 1.2 70 1.4 14.0 58 6.6 11 (8.1) 41 Total 4.8 4096 5.6 29.4 3252 15.2 844 3.4 2386 [1] MICs indicator 8.6 [2] MICs indicator 8.7 [3] MICs indicator 8.8 [4] MICs indicator 8.9 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases; na refers to variables that are not applicable 152 mics f inal report The percentage of women in a polygynous union is also provided in Table CP.5. About 3.4 percent of women between the ages of 15 and 49 years are in a polygynous marriage or union. Table CP.6 presents the proportion of women who were first married or entered into a marital union before age 15 and 18 by area and age groups. Examining the percentages married before age 15 and 18 by different age groups allow us to see the trends in early marriage over time (Figure CP.4). Table CP.6: Trends in early marriage Percentage of women who were first married or entered into a marital union before age 15 and 18, by area and age groups, Belize, 2011 Age Urban Rural All Percent- age of women married before age 15 Number of wom- en age 15-49 Percent- age of women married before age 18 Number of wom- en age 20-49 Percent- age of women married before age 15 Number of wom- en age 15-49 Percent- age of women married before age 18 Number of wom- en age 20-49 Percent- age of women married before age 15 Number of wom- en age 15-49 Percent- age of women married before age 18 Number of wom- en age 20-49 15-19 0.4 383 na na 2.8 461 na na 1.7 844 na na 20-24 2.2 343 22.6 343 4.5 377 29.0 377 3.4 720 25.9 720 25-29 3.5 307 25.8 307 7.9 344 36.8 344 5.8 651 31.6 651 30-34 6.2 257 26.8 257 8.0 287 36.9 287 7.2 544 32.1 544 35-39 3.2 242 22.1 242 8.1 295 34.6 295 5.9 537 29.0 537 40-44 3.6 230 23.6 230 8.1 212 32.6 212 5.8 442 27.9 442 45-49 7.6 165 25.5 165 6.1 194 35.1 194 6.8 359 30.7 359 Total 3.4 1926 24.3 1542 6.1 2170 34.0 1710 4.8 4096 29.4 3252 na refers to variables that are not applicable Another component is the spousal age difference with an indicator being the percentage of married/in union women with a difference of 10 or more years younger than their current spouse. Table CP.7 presents the results of the age difference between husbands and wives. The results show that there are some important spousal age differences in Belize. About one in six women age 20-24 is currently married to a man who is older by ten years or more (15.4 percent), and about one in six women age 15-19 are currently married to men who are older by ten years or more (17.0 percent). mics f inal report 153 Table CP.7: Spousal age difference Percent distribution of women currently married/in union age 15-19 according to the age difference with their husband or partner, Belize, 2011 Percentage of currently married/in union women age 15-19 years whose husband or partner is: Number of women age 15-19 years currently married/ in unionYounger 0-4 years older 5-9 years older 10+ years older [1] Husband/partner’s age unknown Total Region Corozal (*) (*) (*) (*) (*) 100.0 18 Orange Walk (*) (*) (*) (*) (*) 100.0 23 Belize (Excluding Belize City South Side) (*) (*) (*) (*) (*) 100.0 16 Belize City South Side (*) (*) (*) (*) (*) 100.0 8 Belize District (*) (*) (*) (*) (*) 100.0 24 Cayo (*) (*) (*) (*) (*) 100.0 34 Stann Creek (*) (*) (*) (*) (*) 100.0 13 Toledo (*) (*) (*) (*) (*) 100.0 16 Area Urban (2.0) (42.6) (31.3) (24.2) (0.0) 100.0 41 Rural 6.1 44.3 32.1 13.6 4.0 100.0 87 Age 15-19 4.8 43.8 31.8 17.0 2.7 100.0 128 Education None (*) (*) (*) (*) (*) 100.0 2 Primary 5.9 40.2 36.0 15.5 2.5 100.0 72 Secondary + (3.4) (49.9) (27.2) (18.1) (1.4) 100.0 54 Wealth index quintiles Poorest (7.3) (44.4) (32.1) (10.1) (6.1) 100.0 35 Second (5.7) (39.3) (28.9) (25.0) (1.2) 100.0 48 Middle (*) (*) (*) (*) (*) 100.0 26 Fourth (*) (*) (*) (*) (*) 100.0 11 Richest (*) (*) (*) (*) (*) 100.0 8 Ethnicity of household head Creole (*) (*) (*) (*) (*) 100.0 16 Mestizo 4.1 47.7 32.5 13.9 1.8 100.0 84 Garifuna (*) (*) (*) (*) (*) 100.0 2 Maya (*) (*) (*) (*) (*) 100.0 20 Other (*) (*) (*) (*) (*) 100.0 6 Total 4.8 43.8 31.8 17.0 2.7 100.0 128 [1] MICS indicator 8.10a ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 154 mics f inal report Table CP.7: Spousal age difference [continued] Percent distribution of women currently married/in union age 20-24 years according to the age difference with their husband or partner, Belize, 2011 Percentage of currently married/in union women age 20-24 years whose hus- band or partner is: Number of wom- en age 20-24 years currently married/in unionYounger 0-4 years older 5-9 years older 10+ years older [2] Husband/ partner’s age unknown Total Region Corozal (8.7) (51.5) (25.3) (13.2) (1.3) 100.0 50 Orange Walk 13.3 51.8 20.8 11.7 2.4 100.0 73 Belize (Excluding Belize City South Side) (14.9) (42.9) (32.8) (9.3) (0.0) 100.0 50 Belize City South Side (18.8) (44.5) (13.6) (23.2) (0.0) 100.0 41 Belize District 16.6 43.6 24.2 15.6 0.0 100.0 91 Cayo 13.2 54.6 17.2 15.0 0.0 100.0 83 Stann Creek (2.9) (51.3) (18.5) (27.3) (0.0) 100.0 33 Toledo (6.9) (53.2) (20.3) (14.9) (4.7) 100.0 38 Area Urban 17.1 50.2 17.5 14.8 0.4 100.0 152 Rural 8.3 50.6 23.7 15.8 1.6 100.0 217 Age 15-19 na na na na na na na 20-24 11.9 50.5 21.2 15.4 1.1 100.0 369 Education None (*) (*) (*) (*) (*) 100.0 10 Primary 8.3 41.8 28.7 19.8 1.3 100.0 156 Secondary + 13.4 56.1 16.8 12.6 1.1 100.0 192 CET/ITVET/VOTEC 45.0 26.1 28.9 0.0 0.0 100.0 3 Other (*) (*) (*) (*) (*) 100.0 7 Wealth index quintiles Poorest 12.7 55.5 17.8 12.3 1.7 100.0 72 Second 8.4 48.2 29.7 12.8 0.8 100.0 104 Middle 18.6 36.3 22.1 22.0 1.0 100.0 88 Fourth 13.1 64.4 11.9 10.7 0.0 100.0 68 Richest (1.5) (55.2) (18.6) (21.4) (3.3) 100.0 37 Ethnicity of household head Creole 14.9 46.9 16.1 22.1 0.0 100.0 72 Mestizo 10.7 49.5 22.7 15.4 1.6 100.0 188 Garifuna (*) (*) (*) (*) (*) 100.0 20 Maya (8.9) (56.9) (24.5) (8.7) (1.0) 100.0 53 Other (18.7) (53.0) (19.7) (6.8) (1.8) 100.0 32 Missing/DK (*) (*) (*) (*) (*) 100.0 3 Total 11.9 50.5 21.2 15.4 1.1 100.0 369 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases na refers to variables that are not applicable[2] MICS indicator 8.10b mics f inal report 155 Attitudes towards 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 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.8. Overall, 8.6 percent of women in Belize feel that their husband/partner has a right to hit or beat them for at least one of a variety of reasons. In the calculation of this indicator, the reasons having sex with another man and wastes money is not included in the indicator to accommodate the standard MICS indicator and global comparisons. Women who approve their partner’s violence, in most cases agree and justify violence in instances when they neglect the children (6.8 percent), or if they demonstrate their autonomy, e.g. go out without telling their husbands or argue with them (1.6 percent). Around 1.1 percent of women believe that their partner has a right to hit or beat them if they refuse to have sex with him or if they burn the food (1.2 percent). Acceptance is more present among rural dwellers (5.5 percent to 11.4 percent), those living in poorest households (17.1 percent), less educated (13.8 percent), and Mayan households (18.1 percent) (see Figure CP.5). 156 mics f inal report Table CP.8: Attitudes toward domestic violence Percentage of women age 15-49 years who believe a husband is justified in beating his wife/partner in various circumstances, Belize, 2011 Percentage of women age 15-49 years who believe a husband is justified in beating his wife/partner: Number of women age 15-49 years If goes out without telling him If she neglects the children If she argues with him If she refuses sex with him If she burns the food If she has sex with another man If she wastes the money For any of these reasons [1] Region Corozal 2.1 7.9 2.8 0.5 1.5 18.3 3.1 10.0 534 Orange Walk 0.7 4.4 1.5 0.7 0.5 10.1 2.3 5.8 618 Belize (Excluding Belize City South Side) 0.2 4.8 0.2 0.2 0.4 9.5 2.6 5.0 687 Belize City South Side 0.3 4.8 0.5 0.3 0.3 8.7 1.3 5.4 573 Belize District 0.3 4.8 0.4 0.3 0.4 9.1 2.0 5.2 1260 Cayo 2.1 7.3 1.4 0.5 0.7 16.0 3.5 9.3 933 Stann Creek 3.1 13.3 2.8 1.1 1.6 24.2 6.4 14.5 404 Toledo 3.9 8.3 7.3 7.5 5.4 21.3 9.0 15.3 347 Area Urban 0.7 4.7 0.6 0.2 0.3 9.4 1.9 5.5 1926 Rural 2.4 8.7 3.1 1.9 1.9 19.2 5.1 11.4 2170 Age 15-19 1.7 9.4 2.9 1.0 2.0 18.7 4.1 11.2 844 20-24 1.1 5.9 1.5 1.7 1.5 14.6 2.1 8.2 720 25-29 1.9 6.2 0.9 1.5 0.4 13.5 4.1 7.9 651 30-34 2.1 8.0 1.9 1.2 1.2 14.8 4.3 9.3 544 35-39 1.7 5.9 1.5 0.2 1.4 13.2 2.5 7.4 537 40-44 1.6 6.5 2.1 1.1 0.5 11.6 5.1 8.8 442 45-49 0.8 4.0 2.4 0.7 0.5 12.0 2.9 5.0 359 Marital/ Union status Currently married/in union 1.7 6.3 1.9 1.2 1.1 15.3 3.6 8.3 2386 Formerly married/in union 0.7 6.7 1.1 1.0 0.8 12.8 3.8 8.0 489 Never married/in union 1.8 7.9 2.2 0.9 1.5 13.8 3.5 9.5 1219 Education None 6.2 11.4 4.9 3.0 3.5 21.9 6.5 13.7 148 Primary 2.4 8.2 3.0 1.8 1.8 20.2 5.0 11.3 1608 Secondary + 0.8 5.7 1.0 0.5 0.6 10.3 2.3 6.6 2259 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) (*) (*) 26 Other (0.0) (3.2) (0.0) (0.0) (0.0) (4.3) (4.4) (3.2) 55 Wealth index quintiles Poorest 4.1 11.7 6.2 4.6 4.0 26.3 7.7 17.1 644 Second 2.0 7.9 2.3 0.8 1.1 16.9 4.6 9.9 815 Middle 1.4 7.3 1.1 0.3 0.7 15.5 3.2 8.3 877 Fourth 0.6 4.9 0.8 0.4 0.6 10.4 1.8 5.4 862 Richest 0.6 3.8 0.3 0.4 0.3 7.1 1.8 4.8 898 Ethnicity of household head Creole 0.4 6.8 0.4 0.6 0.7 10.4 3.0 7.5 985 Mestizo 1.5 6.0 1.9 0.5 0.9 14.7 2.6 7.6 2046 Garifuna 1.3 8.0 0.5 0.3 0.7 14.2 3.7 9.5 253 Maya 4.9 12.4 6.8 6.7 4.4 27.6 9.8 18.1 407 Other 1.2 4.1 1.1 0.4 1.0 9.9 3.4 6.0 335 Missing/DK 4.4 9.1 2.3 0.0 0.0 15.0 5.9 9.1 70 Total 1.6 6.8 1.9 1.1 1.2 14.6 3.6 8.6 4096 [1] MICS indicator 8.14 Note: The reasons sex with another man and wastes the money are not included in the calculation of the indicator ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 un-weighted case in “Missing” on the Marital Status variable is excluded from the table mics f inal report 157 xii. hiv/aids, sexual behaviour, and orphanhood Knowledge about HIV Transmission and Misconceptions about HIV/AIDS 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 who have comprehensive knowledge about HIV prevention include women who know of the two ways of HIV prevention (having only one faithful uninfected partner and using a condom every time, who know that a healthy looking person can have the AIDS virus, and who reject the two most common misconceptions. Tables HA.1 and HA.2 present the percentage of women with comprehensive knowledge. In Belize all women age 15 to 49 years who had heard of AIDS 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 and Table HA.1. Almost all of the interviewed women (94.7 percent) had heard of AIDS. About eighty percent (77.9 percent) of women know of having one faithful uninfected sex partner, 72.9 percent know of using a condom every time, and 64.4 percent know both main ways of preventing HIV transmission. Comprehensive knowledge about HIV among women age 15 to 49 years is low at only 44.5 percent and differs by area. Urban women have a higher rate of knowledge (56.4 percent) than rural women (34.0 Percent). Women with more education and women from families with high wealth index are much more knowledgeable of HIV than less educated and poorer women (Figure HA.1). Among the districts, women of the Belize District have higher rates of HIV knowledge than women of the other districts. The percentages are Belize District 66.0 percent (Belize excluding Belize City South Side at 69.6 percent and Belize City South Side at 61.5 percent) followed by Stann Creek at 51.5 percent and with the Toledo District having the lowest rate at 31.3 percent. Table HA.1 also indicates women who come from a 158 mics f inal report household with a Garifuna or Creole head of household are almost twice as knowledgeable about HIV than women of other ethnicities (Garifuna 64.0 percent, Creole 61.2 percent). mics f inal report 159 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission. Percentage of women age 15-49 years who know the main ways of preventing HIV transmission and percentage who know that a healthy looking person can have the AIDS virus, Belize, 2011 Percentage who have heard of AIDS Percentage who know transmission can be prevented by: Percentage of women who know both ways Percentage who know that a healthy looking person can have the AIDS virus Number of women Having only one faithful uninfected sex partner Using a condom every time Region Corozal 95.6 74.3 68.7 56.4 82.3 534 Orange Walk 93.9 75.5 63.9 56.3 82.1 618 Belize (Excluding Belize City South Side) 98.4 92.4 89.1 85.2 96.1 687 Belize City South Side 99.7 86.2 89.4 80.2 96.6 573 Belize District 99.0 89.6 89.2 82.9 96.3 1260 Cayo 96.2 73.0 65.0 54.9 84.1 933 Stann Creek 98.6 81.7 77.4 69.5 90.4 404 Toledo 70.5 54.8 52.1 43.7 57.8 347 Area Urban 97.9 86.4 82.1 75.5 92.9 1926 Rural 91.8 70.5 64.7 54.6 79.4 2170 Age 15-24 94.0 76.7 70.4 61.4 86.2 1564 25-29 95.4 79.1 74.6 67.1 86.7 651 30-39 95.0 78.9 75.4 67.1 85.3 1081 40-49 95.2 78.1 73.0 64.6 84.7 801 Marital status Ever married/in union 94.5 77.5 73.2 64.5 84.5 2875 Never married/in union 95.2 79.0 72.1 64.1 88.7 1219 Education None 72.4 47.7 43.3 35.4 51.8 148 Primary 92.4 70.2 64.4 53.6 79.2 1608 Secondary + 99.1 87.1 82.3 75.5 94.4 2259 CET/ITVET/VOTEC (*) (*) (*) (*) (*) 26 Other (40.7) (4.9) (8.9) (4.9) (6.1) 55 Wealth index quintiles Poorest 78.2 54.8 49.3 39.3 60.0 644 Second 95.4 75.6 70.8 60.9 84.4 815 Middle 98.4 80.2 76.2 66.3 89.6 877 Fourth 99.3 86.3 79.8 72.4 93.7 862 Richest 97.9 86.5 82.0 76.2 93.9 898 Ethnicity of household head Creole 99.0 85.9 85.9 77.2 95.9 985 Mestizo 97.7 79.9 71.7 62.7 87.4 2046 Garifuna 100.0 87.0 85.8 77.0 98.3 253 Maya 77.4 55.3 50.1 41.7 61.2 407 Other 79.9 63.3 58.3 54.3 63.5 335 Missing/DK 98.8 79.7 79.9 70.5 95.8 70 Total 94.7 77.9 72.9 64.4 85.7 4096 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 un-weighted missing case for Martial Status is excluded from the table 160 mics f inal report Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission (continued) Percentage of women age 15-49 years who reject common misconceptions about HIV transmission, and percentage who have comprehensive knowledge about HIV transmission Belize, 2011 Percentage who know that HIV cannot be transmitted by: Percentage who reject the two most common misconcep- tions and know that a healthy looking person can have the AIDS virus Percentage with comprehensive knowledge [1] Number of wom- en Mosquito bites Supernatural means Sharing food with some- one with AIDS Region Corozal 60.5 81.2 75.4 48.3 31.5 534 Orange Walk 65.2 85.9 71.1 51.8 32.5 618 Belize (Excluding Belize City South Side) 83.4 93.9 90.7 77.8 69.6 687 Belize City South Side 80.9 94.1 91.5 74.0 61.5 573 Belize District 82.3 94.0 91.1 76.1 66.0 1260 Cayo 61.6 84.6 80.9 52.1 33.0 933 Stann Creek 76.4 92.2 88.9 68.8 51.5 404 Toledo 55.7 62.4 56.3 41.3 31.3 347 Area Urban 76.8 92.4 88.0 69.1 56.4 1926 Rural 62.7 80.6 73.9 51.3 34.0 2170 Age 15-24 68.5 85.7 79.7 58.7 42.9 1564 25-29 70.8 86.5 81.8 60.6 45.7 651 30-39 69.3 86.1 82.0 61.0 46.5 1081 40-49 69.8 86.8 79.3 59.0 44.2 801 Marital status Ever married/in union 68.6 85.5 79.5 58.5 44.4 2875 Never married/in union 71.0 87.5 83.0 62.3 44.7 1219 Education None 34.2 52.2 44.7 23.5 15.9 148 Primary 58.5 80.6 72.5 46.0 30.1 1608 Secondary + 80.7 94.1 90.2 72.9 57.7 2259 CET/ITVET/VOTEC (*) (*) (*) (*) (*) 26 Other (7.1) (7.4) (8.9) (4.2) (1.5) 55 Wealth index quin- tiles Poorest 47.8 62.8 57.9 34.2 22.1 644 Second 61.1 84.3 77.6 50.3 35.6 815 Middle 74.1 89.4 84.5 64.7 47.5 877 Fourth 77.5 94.0 87.6 68.9 52.3 862 Richest 79.6 93.8 88.8 72.6 58.5 898 Ethnicity of household head Creole 81.9 93.5 90.0 74.5 61.2 985 Mestizo 67.3 89.2 81.0 56.3 39.1 2046 Garifuna 85.7 95.1 95.1 81.4 64.0 253 Maya 48.5 64.1 62.1 35.9 23.5 407 Other 57.2 66.6 61.7 48.4 39.0 335 Missing/DK 70.9 82.6 78.7 61.9 47.6 70 Total 69.3 86.1 80.5 59.7 44.5 4096 [1] MICS indicator 9.1 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 un-weighted missing case for Martial Status is excluded from the table The results for women age 15-24 are separately presented in Table HA.2. Only 42.9 percent of women aged 15 to 24 years have comprehensive knowledge of HIV. This compares with 45.7 percent for women 25 to 29 years, 46.5 percent for ages 30 to 39 years and 44.2 percent for women aged 40 to 49 years. It is clear that younger women are less knowledgeable about HIV than older ones. For 15 to 19 year old women the rate is 39.1 percent and for women 20 to 24 years the rate is 47.3 percent. In general comprehensive knowledge of HIV follows the same patterns for women 15 to 24 years as was observed in women 15 to 49 years. mics f inal report 161 Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young women Percentage of young women age 15-24 years who know the main ways of preventing HIV transmission, percentage who know that a healthy looking person can have the AIDS virus, Belize, 2011 Percentage who have heard of aIDs Percentage who know transmission can be prevented by: Percentage of women who know both ways Percentage who know that a healthy looking person can have the aIDs virus Number of women age 15-24 having only one faithful uninfected sex partner using a condom every time region Corozal 92.5 69.8 61.4 48.9 82.7 194 orange Walk 91.8 76.9 64.3 55.6 84.4 258 belize (excluding belize City south side) 98.8 94.5 86.5 84.7 96.5 255 belize City south side 100.0 87.4 88.7 79.5 97.4 216 belize District 99.4 91.2 87.5 82.3 96.9 471 Cayo 96.1 67.6 60.1 48.7 84.4 347 stann Creek 97.7 79.6 75.7 66.3 87.9 147 Toledo 73.8 57.7 56.4 46.2 61.7 147 area urban 97.9 85.0 79.5 71.7 93.4 726 rural 90.5 69.5 62.5 52.5 79.8 838 age 15-19 93.5 74.5 66.9 57.5 85.2 844 20-24 94.5 79.3 74.5 66.0 87.2 720 Marital status ever married/in union 92.4 74.6 70.3 60.3 82.4 583 Never married/in union 94.9 78.0 70.4 62.1 88.3 981 Education None (*) (*) (*) (*) (*) 22 Primary 88.3 63.0 57.3 45.4 74.7 443 secondary + 99.0 85.2 78.3 70.5 94.0 1064 CeT/ITVeT/VoTeC (*) (*) (*) (*) (*) 10 other (26.2) (7.5) (7.5) (7.5) (4.1) 25 Wealth index quintiles Poorest 76.1 51.3 46.7 34.8 60.1 271 second 94.4 75.3 70.0 59.9 87.0 330 Middle 98.4 80.0 74.7 65.3 91.1 356 Fourth 99.4 88.5 78.4 72.1 92.8 308 richest 98.8 85.3 78.7 71.5 96.2 299 ethnicity of household head Creole 99.8 85.5 85.0 76.1 96.7 376 Mestizo 97.2 79.2 69.1 59.2 87.7 784 Garifuna 100.0 87.5 84.3 75.7 99.0 93 Maya 79.1 57.1 53.5 44.0 64.5 179 other 69.7 52.9 45.9 43.4 62.1 113 Missing/DK (*) (*) (*) (*) (*) 19 Total 94.0 76.7 70.4 61.4 86.2 1564 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 162 mics f inal report Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young women (continued) Percentage of young women age 15-24 years who reject common misconceptions, and percentage who have comprehensive knowledge about HIV transmission, Belize, 2011 Percentage who know that HIV cannot be transmitted by: Percentage who reject the two most common misconceptions and know that a healthy looking person can have the AIDS virus Percentage with comprehensive knowledge [1] Number of women age 15-24 Mosquito bites Supernatural means Sharing food with someone with AIDS Region Corozal 54.8 77.6 73.4 45.8 26.6 194 Orange Walk 65.3 85.8 72.4 52.2 33.9 258 Belize (Excluding Belize City South Side) 84.5 94.7 89.7 77.3 69.7 255 Belize City South Side 82.1 95.7 93.2 76.0 62.9 216 Belize District 83.4 95.2 91.3 76.7 66.6 471 Cayo 58.5 82.8 76.7 48.3 27.2 347 Stann Creek 75.5 90.7 88.9 67.4 48.9 147 Toledo 60.7 67.4 61.3 45.6 35.0 147 Area Urban 76.8 92.7 88.4 68.8 54.7 726 Rural 61.2 79.5 72.1 49.9 32.7 838 Age 15-19 66.9 84.3 79.2 57.2 39.1 844 20-24 70.3 87.3 80.2 60.4 47.3 720 Marital status Ever married/in union 64.7 83.7 75.2 53.0 41.6 583 Never married/in union 70.7 86.8 82.3 62.1 43.7 981 Education None (*) (*) (*) (*) (*) 22 Primary 50.8 73.5 63.0 37.4 22.4 443 Secondary + 78.5 94.0 89.4 69.9 53.3 1064 CET/ITVET/VOTEC (*) (*) (*) (*) (*) 10 Other (3.4) (7.5) (7.5) (0.0) (0.0) 25 Wealth index quintiles Poorest 47.1 61.4 53.7 33.5 19.7 271 Second 61.0 86.3 78.3 52.7 37.2 330 Middle 74.7 90.3 85.3 63.8 47.2 356 Fourth 79.5 94.4 87.3 70.3 54.6 308 Richest 77.4 92.4 90.1 70.2 52.9 299 Ethnicity of household head Creole 84.2 92.4 91.3 76.3 61.5 376 Mestizo 65.7 89.2 79.9 54.3 36.8 784 Garifuna 85.0 97.2 93.5 80.1 64.9 93 Maya 51.9 66.5 61.8 40.2 27.8 179 Other 47.6 58.5 53.4 40.8 29.1 113 Missing/DK (*) (*) (*) (*) (*) 19 Total 68.5 85.7 79.7 58.7 42.9 1564 [1] MICS indicator 9.2; MDG indicator 6.3 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Table HA.2 also presents the percent of women who can correctly identify misconceptions concerning HIV. The indicator is based on the three most common and relevant misconceptions in Belize, that HIV can be transmitted by supernatural means and mosquito bites. The tables also provide information on whether women know that HIV cannot be transmitted by sharing food with someone with AIDS. Of the interviewed women age 15-49, 59.7 percent reject the two most common misconceptions and know that a healthy- looking person can be infected. 69.3 percent of women know that mosquito bites, and 86.1 percent of women know that supernatural means can not transmit HIV, while 85.7 percent of women know that a healthy-looking person can be infected. mics f inal report 163 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.3. Overall, 90.2 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 55.7 percent, while 4.5 percent of women did not know of any specific way. Knowledge of all three ways that HIV can be transmitted to babies seem to be related to education of the woman (no education 43.2 percent, secondary or more 58.2 percent). There is also a small difference in rates for urban (58.6 percent, rural 53.1 percent). Garifuna women seem to know more about HIV transmission to babies (Garifuna 64.4 percent) than women from other ethnicities. Table HA.3: Knowledge of mother-to-child HIV transmission Percentage of women age 15-49 years who correctly identify means of HIV transmission from mother to child, Belize, 2011 Percentage who know HIV can be transmitted from mother to child Percent who know HIV can be transmitted: Does not know any of the specific means Number of women During pregnancy During delivery By breastfeeding All three means [1] Region Corozal 90.1 83.3 60.7 71.7 48.7 5.5 534 Orange Walk 84.5 77.3 71.2 73.3 59.6 9.3 618 Belize (Excluding Belize City South Side) 98.0 88.2 70.5 85.2 58.2 0.5 687 Belize City South Side 97.0 88.6 71.0 82.1 58.2 2.7 573 Belize District 97.5 88.4 70.7 83.8 58.2 1.5 1260 Cayo 90.8 84.8 66.4 75.3 57.0 5.4 933 Stann Creek 95.1 82.4 61.7 88.8 53.8 3.5 404 Toledo 66.8 62.7 52.5 62.4 49.2 3.6 347 Area Urban 94.8 86.8 69.3 81.8 58.6 3.2 1926 Rural 86.2 78.7 63.2 73.5 53.1 5.6 2170 Age group 15-24 90.3 83.1 64.6 79.1 55.3 3.6 1564 25+ 90.2 82.1 67.0 76.3 56.0 5.0 2532 Age group 15-19 89.9 82.8 63.9 79.0 55.5 3.7 844 20-24 90.9 83.4 65.4 79.2 55.0 3.6 720 25-29 90.1 82.7 69.3 77.5 59.2 5.3 651 30-39 90.7 81.6 67.6 77.7 56.0 4.3 1081 40-49 89.5 82.3 64.2 73.4 53.3 5.7 801 Marital status Ever married/in union 89.8 82.2 66.2 76.9 55.8 4.7 2875 Never married/in union 91.2 83.2 65.7 78.4 55.6 4.0 1219 Education None 62.0 55.7 48.6 53.2 43.2 10.4 148 Primary 86.3 79.6 62.9 74.1 55.0 6.1 1608 Secondary + 96.9 88.0 70.9 83.0 58.2 2.2 2259 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) 26 Other 7.4 7.4 7.4 7.4 7.4 33.4 55 Wealth index quintiles Poorest 70.6 65.5 50.8 62.2 45.0 7.6 644 Second 89.9 83.1 65.8 80.0 58.8 5.5 815 Middle 95.6 86.7 71.6 82.1 59.0 2.8 877 Fourth 94.3 86.6 67.7 81.6 57.9 5.0 862 Richest 95.5 86.0 70.3 77.2 55.4 2.4 898 Ethnicity of household head Creole 97.1 88.2 70.5 84.6 59.2 1.9 985 Mestizo 92.6 85.1 68.1 78.3 57.1 5.1 2046 Garifuna 99.4 86.6 71.3 96.2 64.4 0.6 253 Maya 72.3 67.4 56.7 63.8 50.0 5.1 407 Other 69.5 63.5 47.9 52.9 37.3 10.4 335 Missing/DK 93.9 87.4 66.3 76.2 54.4 5.0 70 Total 90.2 82.5 66.1 77.4 55.7 4.5 4096 [1] MICS indicator 9.3 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 un-weighted missing case for Martial Status is excluded from the table 164 mics f inal report Accepting Attitudes toward People Living with HIV/AIDS 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.4 presents the attitudes of women towards people living with HIV/AIDS. In Belize 96.5 percent of women who have heard of AIDS agree with at least one accepting statement. The most common accepting attitude is willingness to care for a family member with the AIDS virus in their own home (85.0 percent). For all four indicators the more educated women have more accepting attitudes than the ones with lower education (Figure HA.2). A similar pattern exists for the wealth index where more wealthy women also show a higher acceptance for people with AIDS than less wealthy women. Women in rural areas tend to be less accepting of people with the AIDS virus. In urban areas, 23.4 percent express accepting attitudes on all four indicators while the rate is 15.4 percent in rural areas. Younger women tend to be less accepting than older women of persons with the AIDS virus (15 to 24 years at 13.3 percent and 25 + years at 23.0 percent). Women from households with Garifuna heads are more accepting (35.4 percent) with respect to all four indicators than women from other ethnic backgrounds. The least accepting are women from households with Maya heads (8.5 percent). mics f inal report 165 Table HA.4: Accepting attitudes toward people living with HIV/AIDS Percentage of women age 15-49 years who have heard of AIDS who express an accepting attitude towards people living with HIV/ AIDS, Belize, 2011 Percent of women who: Number of women who have heard of AIDS Are willing to care for a family member with the AIDS virus in own home Would buy fresh vegetables from a shopkeeper or vendor who has the AIDS virus Believe that a female teacher with the AIDS virus and is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Agree with at least one accepting attitude Express accepting attitudes on all four indicators [1] Region Corozal 89.9 51.3 59.6 47.7 97.8 19.2 510 Orange Walk 80.6 54.6 63.8 36.8 93.7 13.7 580 Belize (Excluding Belize City South Side) 89.5 65.4 86.5 35.1 98.5 21.8 676 Belize City South Side 85.2 64.5 81.7 37.9 98.4 20.5 571 Belize District 87.5 65.0 84.3 36.4 98.4 21.2 1247 Cayo 84.5 51.2 62.2 43.1 96.5 18.2 898 Stann Creek 87.6 65.4 73.6 51.1 98.2 28.3 399 Toledo 70.3 51.6 52.0 42.3 87.8 12.1 245 Area Urban 87.5 63.3 79.8 40.7 97.9 23.4 1886 Rural 82.7 52.3 60.2 42.0 95.1 15.4 1993 Age group 15-24 85.1 54.2 68.8 34.2 96.2 13.3 1470 25+ 84.9 59.8 70.3 45.7 96.7 23.0 2409 Age group 15-19 86.8 52.2 66.5 33.2 96.3 12.0 789 20-24 83.2 56.5 71.5 35.4 96.1 14.8 680 25-29 82.5 57.9 70.0 43.0 96.5 19.1 621 30-39 84.3 61.1 71.5 46.4 96.4 24.5 1026 40-49 87.9 59.5 68.9 47.1 97.1 24.0 762 Marital status Ever married/in union 84.2 58.6 68.1 44.0 96.2 21.1 2717 Never married/in union 87.0 55.4 73.5 35.3 97.1 15.1 1160 Education None 78.6 41.5 27.3 46.5 89.9 13.1 107 Primary 83.2 50.6 56.1 46.3 95.8 17.0 1485 Secondary + 87.2 63.5 81.2 38.1 97.9 21.2 2238 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) 26 Other (*) (*) (*) (*) (*) (*) 22 Wealth index quintiles Poorest 71.7 39.9 42.5 46.2 90.2 11.5 504 Second 85.4 54.8 63.7 40.6 96.4 16.8 778 Middle 85.1 57.6 71.3 39.5 97.2 18.2 862 Fourth 89.6 65.8 76.8 39.4 97.7 22.0 856 Richest 87.8 62.4 82.2 43.1 98.3 24.3 879 Ethnicity of household head Creole 86.8 65.2 81.8 40.1 99.0 22.2 975 Mestizo 86.3 55.2 66.8 40.4 97.0 17.4 1999 Garifuna 87.8 72.2 87.5 50.8 97.6 35.4 253 Maya 75.1 42.3 43.4 44.9 90.7 8.5 315 Other 77.6 54.1 62.0 41.2 88.6 20.9 267 Missing/DK 85.0 52.3 69.3 38.3 97.6 16.4 69 Total 85.0 57.6 69.7 41.4 96.5 19.3 3879 [1] MICS indicator 9.4 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 un-weighted missing case for Martial Status is excluded from the table Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care Another important indicator is the knowledge of where to be tested for HIV and use of such services. In order to protect themselves and to prevent infecting others, it is important for individuals to know their HIV status. Knowledge of one’s status is also a critical factor in the decision to seek treatment. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.5. 166 mics f inal report Of women 15 to 49 years 86.6 percent knew where to be tested, while 62.9 percent had actually been tested ever, and only 29.9 percent had been tested in the last year. Of those women who were tested in the last year, 28.4 percent had been told the result. Urban women and better educated women know the locations of HIV testing facilities at higher rates than rural or less educated women. The rates are 92.3 percent for urban women and rural 81.5 percent while for richest women the rate is 93.2 percent and for the poorest it is 63.6 percent. Rates for knowledge of HIV testing facilities are highest for Garifuna (96.5 percent) households and lowest in the Maya household (62.8 percent). Table HA.5: Knowledge of a place for HIV testing Percentage of women age 15-49 years who know where to get an HIV test, percentage of women who have ever been tested, percentage of women who have been tested in the last 12 months, and percentage of women who have been tested and have been told the result, Belize, 2011 Percentage of women who: Number of women Know a place to get tested [1] Have ever been tested Have been tested in the last 12 months Have been tested in the last 12 months and have been told result [2] Region Corozal 81.7 59.7 21.3 19.6 534 Orange Walk 86.5 60.8 27.3 26.0 618 Belize (Excluding Belize City South Side) 93.8 67.3 31.7 30.8 687 Belize City South Side 94.4 74.5 42.3 41.3 573 Belize District 94.1 70.6 36.5 35.6 1260 Cayo 86.4 63.3 32.8 30.8 933 Stann Creek 92.3 69.9 30.8 28.5 404 Toledo 60.5 35.1 15.2 13.3 347 Area Urban 92.3 68.2 34.6 33.8 1926 Rural 81.5 58.3 25.8 23.6 2170 Age 15-24 80.2 43.2 26.5 25.1 1564 15-19 74.1 24.1 15.0 13.7 844 20-24 87.4 65.7 40.0 38.5 720 25-29 90.8 80.9 37.8 35.0 651 30-39 90.8 78.5 34.0 32.6 1081 40-49 89.9 65.9 24.7 23.7 801 Marital status Ever married/in union 89.9 76.4 35.2 33.2 2875 Never married/in union 78.7 31.1 17.4 16.9 1219 Education None 61.8 52.7 20.2 18.5 148 Primary 82.5 64.0 28.1 25.7 1608 Secondary + 92.3 63.9 32.2 31.3 2259 CET/ITVET/VOTEC (*) (*) (*) (*) 26 Other 30.0 23.2 12.3 12.3 55 Wealth index quintiles Poorest 63.6 45.7 19.9 17.2 644 Second 86.3 67.2 31.8 30.3 815 Middle 90.6 61.7 28.7 26.8 877 Fourth 93.0 68.5 34.1 33.4 862 Richest 93.2 67.2 32.5 31.4 898 Ethnicity of household head Creole 95.8 72.8 39.5 38.5 985 Mestizo 88.0 63.5 26.9 25.1 2046 Garifuna 96.5 75.8 45.6 44.6 253 Maya 62.8 37.8 16.7 14.5 407 Other 70.7 48.7 20.6 19.2 335 Missing/DK 91.9 75.9 47.0 47.0 70 Total 86.6 62.9 29.9 28.4 4096 [1] MICS indicator 9.5 [2] MICS indicator 9.6 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 un-weighted missing case for Martial Status is excluded from the table Table HA.6 presents the same results for sexually active young women young aged 15 to 24 years. The proportion of young women who have been tested and have been told the result provides a measure of mics f inal report 167 the effectiveness of interventions that promote HIV counselling and testing among young people. This is important to know, because young people may feel that there are barriers to accessing services related to sensitive issues, such as sexual health. Rural and younger women (age 15 to 19 years) are less likely to know the results of the HIV test. Of those tested 44.3 percent urban and 37.4 percent rural women were told the results of the test. For women 15 to 19 years who were tested only 33.3 percent were told the results of the test. In women 20 to 24 years 44.3 percent were told the results of the test. Education and wealth did not seen to be factors in women being informed of the results of HIV tests. Over a half (56.8 percent) of women from Garifuna households were informed of the HIV test results while the rate for Maya households was 23.5 percent. Table HA.6: Knowledge of a place for HIV testing among sexually active young women Percentage of women age 15-24 years who have had sex in the last 12 months, and among women who have had sex in the last 12 months, the percentage who know where to get an HIV test, percentage of women who have ever been tested, percentage of women who have been tested in the last 12 months, and percentage of women who have been tested and have been told the result, Belize, 2011 Percentage who have had sex in the last 12 months Number of women age 15-24 years Percentage of women who: Number of women age 15-24 years who have had sex in the last 12 months Know a place to get tested Have ever been tested Have been tested in the last 12 months Have been tested in the last 12 months and have been told result [1] Region Corozal 46.2 194 82.5 70.0 32.0 31.0 89 Orange Walk 51.8 258 93.7 75.8 44.2 40.3 134 Belize (Excluding Belize City South Side) 57.3 255 98.0 62.9 38.2 38.2 146 Belize City South Side 60.8 216 95.7 80.5 50.6 48.5 131 Belize District 58.9 471 96.9 71.2 44.1 43.1 278 Cayo 49.1 347 84.7 69.7 51.1 46.6 170 Stann Creek 59.0 147 92.0 74.8 50.2 48.3 87 Toledo 42.4 147 64.2 40.8 22.9 19.4 62 Area Urban 55.7 726 93.3 71.4 45.3 44.3 404 Rural 49.6 838 85.3 67.8 41.3 37.4 416 Age 15-19 30.8 844 86.7 57.3 36.9 33.3 260 20-24 77.8 720 90.5 75.3 46.2 44.3 560 Marital status Ever married/in union 95.9 583 87.2 76.5 47.0 43.9 559 Never married/in union 26.6 981 93.8 54.9 35.2 34.1 261 Education None (*) 23 (*) (*) (*) (*) 10 Primary 62.9 443 83.0 72.0 45.3 40.5 279 Secondary + 48.5 1064 94.0 69.2 42.5 41.2 516 CET/ITVET/VOTEC (*) 10 (*) (*) (*) (*) 7 Other (*) 25 (*) (*) (*) (*) 8 Wealth index quintiles Poorest 49.0 271 69.3 56.2 33.0 28.3 133 Second 59.5 330 90.1 80.8 45.9 43.3 196 Middle 55.0 356 93.8 69.1 45.6 43.4 196 Fourth 55.2 308 96.9 67.5 44.7 43.4 170 Richest 41.8 299 91.7 69.8 44.5 42.5 125 Ethnicity of household head Creole 60.4 376 97.2 75.7 50.5 49.7 227 Mestizo 50.0 784 89.1 69.5 42.0 39.0 392 Garifuna 69.3 93 97.9 79.7 59.3 56.8 65 Maya 46.7 179 68.9 52.8 27.2 23.5 83 Other 38.6 113 (75.2) (51.3) (27.7) (24.0) 44 Total 52.4 1564 89.3 69.6 43.3 40.8 820 [1] MICS indicator 9.7 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 9 un-weighted cases in “Missing” on the Ethnicity of the Head of Household variable are excluded from the table Among women who had given birth within the two years preceding the survey, the percent who received counselling and HIV testing during antenatal care is presented in Table HA.7. Antenatal care from a health 168 mics f inal report care professional was received by 96.2 percent of women during their last pregnancy. 59.4 percent received counselling during antenatal care. There were notable differences in the receipt of HIV counselling during antenatal care; in urban areas 66.6 percent received these services compared with 54.9 percent in rural areas. Differences in rates of antenatal care are small for the education and wealth indicators. Table HA.7: HIV counselling and testing during antenatal care Among women age 15-49 who gave birth in the last 2 years, percentage of women who received antenatal care from a health professional during the last pregnancy, percentage who received HIV counselling, percentage who were offered and accepted an HIV test and received the results, Belize, 2011 Percent of women who: Number of women who gave birth in the 2 years preceding the survey Received antenatal care from a health care professional for last pregnancy Received HIV counselling during antenatal care [1] Were offered an HIV test and were tested for HIV during antenatal care Were offered an HIV test and were tested for HIV during antenatal care, and received the results [2] Received HIV counselling, were offered an HIV test, accepted and received the results Region Corozal 99.1 60.5 81.7 74.0 51.7 95 Orange Walk 100.0 58.9 72.1 67.9 48.8 108 Belize (Excluding Belize City South Side) (86.9) (59.8) (81.8) (81.8) (55.9) 74 Belize City South Side 96.4 58.7 88.1 85.8 56.4 77 Belize District 91.7 59.3 85.0 83.8 56.2 151 Cayo 97.5 61.5 76.2 71.1 55.4 189 Stann Creek 97.6 66.5 86.8 80.9 56.9 69 Toledo 91.5 46.6 44.9 42.8 42.0 73 Area Urban 97.3 66.6 87.2 86.2 64.7 262 Rural 95.5 54.9 69.1 62.9 45.4 424 Young women 15-24 97.8 62.4 78.6 73.4 55.9 294 Age 15-19 96.3 67.0 75.8 70.6 59.0 81 20-24 98.4 60.7 79.7 74.4 54.7 214 25-29 97.1 55.2 78.2 74.5 50.7 181 30-34 93.9 61.0 74.5 71.5 53.8 118 35-49 92.2 55.6 65.4 61.8 45.3 92 Marital status Ever married/in union 96.0 58.7 75.1 71.1 52.4 641 Never married/in union (100.0) (69.8) (89.3) (82.1) (57.5) 45 Education None (89.3) (28.2) (49.1) (46.9) (28.2) 41 Primary 96.4 58.4 71.5 66.0 49.7 311 Secondary + 96.7 66.8 87.1 83.6 61.0 315 Other (*) (*) (*) (*) (*) 15 Wealth index quintiles Poorest 94.1 40.0 48.9 43.5 32.1 173 Second 99.4 68.2 82.2 77.6 61.3 156 Middle 94.7 63.7 82.3 79.0 57.1 134 Fourth 94.8 66.3 92.2 89.8 62.6 132 Richest 99.0 64.8 84.5 79.2 56.7 91 Ethnicity of household head Creole 93.2 67.7 88.4 84.7 63.9 113 Mestizo 98.7 65.1 81.3 76.2 56.2 355 Garifuna (94.4) (72.1) (96.7) (95.0) (68.4) 43 Maya 93.2 44.5 49.3 45.6 38.6 96 Other 93.5 29.1 52.8 49.3 25.6 71 Missing/DK (*) (*) (*) (*) (*) 8 Total 96.2 59.4 76.0 71.8 52.7 685 [1] MICS indicator 9.8 [2] MICS indicator 9.9 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 3 un-weighted cases in “CET/ITVET/VOTEC” on the Education are excluded from the table mics f inal report 169 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. Table HA.8: Sexual Behaviour that increases the risk of HIV infection Percentage of never-married young women age 15-24 years who have never had sex, percentage of young women age 15-24 years who have had sex before age 15, and percentage of young women age 15-24 years who had sex with a man 10 or more years older during the last 12 months, Belize, 2011 Percentage of never-married women age 15-24 years who have never had sex [1] Number of never- married women age 15-24 years Percentage of women age 15-24 years who had sex before age 15 [2] Number of women age 15-24 years Percentage of women age 15-24 years who had sex in the last 12 months with a man 10 or more years older [3] Number of women age 15-24 years who had sex in the 12 months preceding the survey Region Corozal 78.7 116 4.7 194 14.0 89 Orange Walk 77.8 152 5.1 258 12.1 134 Belize (Excluding Belize City South Side) 58.2 174 6.0 255 13.6 146 Belize City South Side 47.6 149 6.0 216 19.6 131 Belize District 53.3 323 6.0 471 16.5 278 Cayo 75.9 211 3.1 347 16.8 170 Stann Creek 60.3 92 9.7 147 22.8 87 Toledo 88.7 87 4.6 147 12.8 62 Area Urban 59.0 492 5.0 726 15.6 404 Rural 78.5 489 5.5 838 16.3 416 Age 15-19 80.3 696 4.1 844 13.4 260 20-24 40.5 285 6.7 720 17.1 560 Marital status Ever married/in union na na 11.1 583 17.7 559 Never married/in union 68.7 981 1.8 981 12.1 261 Education None (*) 10 (0.0) 23 (*) 10 Primary 74.9 188 11.4 443 21.8 279 Secondary + 66.6 760 3.0 1064 12.8 516 CET/ITVET/VOTEC (*) 5 (*) 10 (*) 7 Other (*) 18 (*) 25 (*) 8 Wealth index quintiles Poorest 84.7 146 6.5 271 15.3 133 Second 74.6 158 9.1 330 20.6 196 Middle 70.1 223 5.4 356 15.5 196 Fourth 59.4 209 2.0 308 13.3 170 Richest 62.2 245 3.2 299 13.6 125 Ethnicity of household head Creole 50.4 257 5.2 376 19.2 227 Mestizo 75.9 475 5.0 784 15.6 392 Garifuna 39.4 64 9.0 93 16.7 65 Maya 87.7 97 4.1 179 11.3 83 Other (86.4) 73 (6.6) 113 (10.6) 44 Missing/DK (*) 15 (*) 20 (*) 9 Total 68.7 981 5.3 1564 15.9 820 [1] MICS indicator 9.10 [2] MICS indicator 9.11 [3] MICS indicator 9.12 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases na = not applicable The frequency of sexual behaviours that increase the risk of HIV infection among women is presented in Table HA.8 and Figure HA.3. Evidently, 68.7 percent of women 15 to 24 years had never had sex while 5.3 percent had sex before age 15. 15.9 percent had sex with a man 10 years or older in the last 12 months. An 170 mics f inal report urban-rural difference can be seen in the percentage of never-married women age 15-24 years who have never had sex (urban 59.0 percent, rural 78.5 percent). Women 15 to 24 years from richer families seem to have sex less recently than those from poorer families. Sexual behaviour and condom use during sex with more than one partner were assessed in all women and for women age 15-24 years of age who had sex with such a partner in the previous year (Table HA.9 and Table HA.10). 2.1 percent of women 15-49 years of age report having sex with more than one partner. Of those women, only 28.6 percent report using a condom the last time they had sex (in the last 12 months). mics f inal report 171 Table HA.9: Sex with multiple partners Percentage of women age 15-49 years who ever had sex, percentage who had sex in the last 12 months, percentage who have had sex with more than one partner in the last 12 months and among those who had sex with multiple partners, the percentage who used a condom at last sex, Belize, 2011 Percentage of women who: Number of women age 15-49 years Percent of women age 15-49 years who had more than one sexual partner in the last 12 months, who also reported that a condom was used the last time they had sex [2] Number of women age 15-49 years who had more than one sexual partner in the last 12 months Ever had sex Had sex in the last 12 months Had sex with more than one partner in last 12 months [1] Region Corozal 80.9 70.1 1.6 534 (*) 8 Orange Walk 77.1 69.0 1.2 618 (*) 7 Belize (Excluding Belize City South Side) 84.6 75.2 3.4 687 (*) 23 Belize City South Side 87.3 75.1 3.8 573 (*) 22 Belize District 85.8 75.2 3.6 1260 (34.9) 45 Cayo 80.8 71.2 1.6 933 (*) 15 Stann Creek 84.6 76.8 1.4 404 (*) 6 Toledo 74.8 68.5 0.8 347 (*) 3 Area Urban 83.8 72.8 2.9 1926 (30.7) 55 Rural 79.8 71.8 1.3 2170 (24.7) 29 Age 15-24 56.8 52.4 3.1 1564 (25.5) 48 25-29 94.9 87.9 1.9 651 (*) 12 30-39 97.4 85.9 1.9 1081 (*) 21 40-49 98.3 79.9 0.4 801 (*) 4 Marital status Ever married/in union 99.9 90.3 2.0 2875 (19.2) 56 Never married/in union 38.7 29.7 2.3 1219 (47.6) 28 Education None 91.8 73.2 0.0 148 (*) 0 Primary 88.8 79.0 1.3 1608 (*) 21 Secondary + 76.2 67.5 2.7 2259 28.8 62 CET/ITVET/VOTEC (*) (*) (*) 26 (*) 0 Other 67.7 66.2 1.9 55 (*) 1 Wealth index quintiles Poorest 78.5 70.0 1.3 644 (*) 8 Second 83.6 73.5 2.8 815 (*) 23 Middle 80.5 72.9 1.7 877 (*) 15 Fourth 83.6 75.5 2.9 862 (*) 25 Richest 81.5 69.1 1.4 898 (*) 13 Ethnicity of household head Creole 86.3 76.3 3.7 985 (28.4) 37 Mestizo 80.1 70.9 1.4 2046 (22.9) 28 Garifuna 89.0 79.8 2.9 253 (*) 7 Maya 76.5 68.1 0.5 407 (*) 2 Other 78.3 68.0 1.9 335 (*) 6 Missing/DK 85.1 74.0 5.3 70 (*) 4 Total 81.7 72.3 2.1 4096 28.6 84 [1] MICS indicator 9.13 [2] MICS indicator 9.14 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 1 un-weighted cases in the “Missing” on the Marital Status variable is excluded from the table 172 mics f inal report Table HA.10: Sex with multiple partners among young women Percentage of women age 15-24 years who ever had sex, percentage who had sex in the last 12 months, percentage who have had sex with more than one partner in the last 12 months and among those who had sex with multiple partners, the percentage who used a condom at last sex, Belize, 2011 Percentage of women who: Number of women age 15-24 years Percent of women age 15-24 years who had more than one sexual partner in the last 12 months, who also reported that a condom was used the last time they had sex Number of women age 15-24 years who had more than one sexual partner in the last 12 months Ever had sex Had sex in the last 12 months Had sex with more than one partner in last 12 months Region Corozal 53.0 46.2 2.2 194 (*) 4 Orange Walk 54.3 51.8 1.5 258 (*) 4 Belize (Excluding Belize City South Side) 60.3 57.3 5.4 255 (*) 14 Belize City South Side 67.2 60.8 5.3 216 (*) 12 Belize District 63.5 58.9 5.4 471 (*) 25 Cayo 53.8 49.1 3.1 347 (*) 11 Stann Creek 62.3 59.0 1.7 147 (*) 2 Toledo 47.0 42.4 1.1 147 (*) 2 Area Urban 60.0 55.7 3.7 726 (31.7) 26 Rural 54.1 49.6 2.6 838 (*) 21 Age 15-19 33.7 30.8 1.4 844 (*) 12 20-24 84.0 77.8 5.0 720 (26.2) 36 Marital status Ever married/in union 99.9 95.9 4.5 583 (12.0) 26 Never married/in union 31.3 26.6 2.2 981 (*) 22 Education None (62.9) (46.4) (0.0) 22 (*) 0 Primary 68.1 62.9 1.9 443 10.7 9 Secondary + 52.5 48.5 3.6 1064 (26.8) 38 CET/ITVET/VOTEC (*) (*) (*) 10 (*) 0 Other (33.0) (33.0) (4.1) 25 (*) 1 Wealth index quintiles Poorest 54.1 49.0 1.7 271 (*) 5 Second 64.2 59.5 4.2 330 (*) 14 Middle 56.2 55.0 2.4 356 (*) 8 Fourth 59.7 55.2 5.1 308 (*) 16 Richest 48.9 41.8 1.7 299 (*) 5 Ethnicity of household head Creole 65.5 60.4 4.8 376 (*) 18 Mestizo 54.0 50.0 2.8 784 (*) 22 Garifuna 72.8 69.3 3.9 93 (*) 4 Maya 52.1 46.7 0.6 179 (*) 1 Other 44.0 38.6 2.2 113 (*) 3 Missing/DK (*) (*) (*) 19 (*) 1 Total 56.8 52.4 3.1 1564 (25.5) 48 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases Tables HA.11 presents the percentage of women age 15-24 years who ever had sex, percentage who had sex in the last 12 months, percentage who have had sex with a non-marital, non-cohabiting partner in the last 12 months and among those who had sex with a non-marital, non-cohabiting partner, the percentage who used a condom the last time they had sex with such a partner. The percentage of women 15 to 24 years who had sex with a non-marital, non-cohabiting partner in the 12 months before MICS differ by area (urban 55.5 percent, rural 28.0 percent) and wealth quintiles (see Figure HA.5). Evidently, wealthier women tend to have sex with non-cohabiting partners than poorer women. Women from Garifuna households had sex with no- cohabiting partners at a rate of 68.3 percent: this compares to the rate for Maya households of 14.2 percent. mics f inal report 173 Table HA.11: Sex with non-regular partners Percentage of women age 15-24 years who ever had sex, percentage who had sex in the last 12 months, percentage who have had sex with a non-marital, non-cohabiting partner in the last 12 months and among those who had sex with a non-marital, non-cohabiting partner, the percentage who used a condom the last time they had sex with such a partner, Belize, 2011 Percentage of women 15-24 who: Number of women age 15-24 years Percentage who had sex with a non- marital, non- cohabiting partner in the last 12 months [1] Number of women age 15-24 years who had sex in the last 12 months Percentage of women age 15-24 years who had sex with a non-marital, non- cohabiting partner in the last 12 months, who also reported that a condom was used the last time they had sex with such a partner [2] Number of women age 15-49 years who had more than one sexual partner in the last 12 months Ever had sex Had sex in the last 12 months Region Corozal 53.0 46.2 194 26.8 89 (61.8) 24 Orange Walk 54.3 51.8 258 26.5 134 (55.3) 35 Belize (Excluding Belize City South Side) 60.3 57.3 255 56.4 146 72.0 82 Belize City South Side 67.2 60.8 216 69.0 131 70.3 91 Belize District 63.5 58.9 471 62.4 278 71.1 173 Cayo 53.8 49.1 347 34.9 170 (53.2) 59 Stann Creek 62.3 59.0 147 45.0 87 (66.9) 39 Toledo 47.0 42.4 147 15.7 62 (*) 10 Area Urban 60.0 55.7 726 55.5 404 70.0 224 Rural 54.1 49.6 838 28.0 416 54.1 116 Age 15-19 33.7 30.8 844 50.3 260 68.9 131 20-24 84.0 77.8 720 37.5 560 61.9 210 Marital status Ever married/in union 99.9 95.9 583 14.7 559 46.2 82 Never married/in union 31.3 26.6 981 99.1 261 70.4 259 Education None (62.9) (46.4) 22 (*) 10 (*) 0 Primary 68.1 62.9 443 19.8 279 43.5 55 Secondary + 52.5 48.5 1064 54.5 516 68.2 281 CET/ITVET/VOTEC (*) (*) 10 (*) 7 (*) 3 Other (33.0) (33.0) 25 (*) 8 (*) 1 Wealth index quintiles Poorest 54.1 49.0 271 21.2 133 (55.3) 28 Second 64.2 59.5 330 25.8 196 56.1 51 Middle 56.2 55.0 356 43.0 196 62.8 84 Fourth 59.7 55.2 308 55.0 170 71.3 93 Richest 48.9 41.8 299 67.4 125 67.3 84 Ethnicity of household head Creole 65.5 60.4 376 62.8 227 71.9 143 Mestizo 54.0 50.0 784 32.4 392 61.7 127 Garifuna 72.8 69.3 93 68.3 65 (62.7) 44 Maya 52.1 46.7 179 14.2 83 (*) 12 Other 44.0 38.6 113 (23.3) 44 (*) 10 Missing/DK (*) (*) 19 (*) 9 (*) 5 Total 56.8 52.4 1564 41.6 820 64.6 341 [1] MICS indicator 9.15 [2] MICS indicator 9.16; MDG indicator 6.2 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases 174 mics f inal report Orphanhood As the HIV epidemic progresses, more and more children are becoming orphaned and vulnerable because of AIDS. Children who are orphaned or in vulnerable households 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 orphans and vulnerable children and comparing them to their peers gives us a measure of how well communities and governments are responding to their needs. The frequency of children living with neither parent, mother only, and father only is presented in Table HA.12. This table indicates that 65.4 percent of children aged 0-17 years in Belize live with both the parents. About one in fifteen children (6.9 percent) is living with neither parent. Stann Creek District and Belize City South Side stand out as the regions where children 0 to 17 years are not living with a biological parent (Stann Creek 8.2 percent, Belize City South Side 9.6 percent). There does not appear to be any male – female difference among children not living with a parent (male 6.8 percent, female 7.0 percent). Children from Creole households are not living with biological parents at a rate of 9.3 percent (Figure HA.6). mics f inal report 175 Ta b le H A .1 2: C h ild re n’ s liv in g a rr an g em en ts a n d o rp h an h o o d Pe rc en t d is tr ib u ti o n o f ch ild re n a g e 0- 17 y ea rs a cc o rd in g t o li vi n g a rr an g em en ts , p er ce n ta g e o f ch ild re n a g e 0- 17 y ea rs in h o u se h o ld s n o t liv in g w it h a b io lo g ic al p ar en t a n d p er ce n ta g e o f ch ild re n w h o h av e o n e o r b o th p ar en ts d ea d , B el iz e, 2 01 1 Li vi n g w it h b o th p ar en ts Li vi n g w it h n ei th er p ar en t Li vi n g w it h m o th er o n ly Li vi n g w it h f at h er o n ly   To ta l N o t liv in g w it h a b io lo g ic al p ar en t [1 ] O n e o r b o th p ar - en ts d ea d [2 ] N u m - b er o f ch ild re n ag e 0- 17 ye ar s O n ly f at h er al iv e O n ly m o th er al iv e B o th a re al iv e B o th a re d ea d Fa th er al iv e Fa th er d ea d M o th er al iv e M o th er d ea d Im p o ss ib le t o d et er m in e S ex M al e 66 .0 0. 5 0. 2 5. 6 0. 5 21 .5 1. 7 2. 5 0. 3 1. 1 10 0. 0 6. 8 3. 2 35 32 Fe m al e 64 .7 0. 7 0. 2 5. 6 0. 5 22 .1 2. 7 1. 9 0. 3 1. 2 10 0. 0 7. 0 4. 4 35 61 R eg io n C o ro za l 75 .8 0. 8 0. 3 5. 3 0. 4 13 .2 1. 7 1. 5 0. 3 0. 6 10 0. 0 6. 9 3. 6 92 8 O ra n g e W al k 72 .3 0. 2 1. 3 0. 8 1. 1 0. 1 0. 3 0. 8 0. 7 0. 5 0. 0 0. 8 0. 7 1. 0 0. 1 0. 5 1. 2 0. 7 0. 3 1. 4 0. 3 1. 6 0. 2 0. 0 0. 9 0. 6 0. 2 4. 8 0. 7 17 .7 1. 4 1. 3 0. 5 1. 0 10 0. 0 5. 8 3. 1 10 39 B el iz e (E xc lu d - in g B el iz e C it y S o u th S id e) 59 .0 0. 2 4. 4 0. 1 28 .5 2. 0 3. 4 0. 4 0. 6 10 0. 0 6. 0 4. 0 95 6 B el iz e C it y S o u th S id e 41 .8 0. 3 7. 9 0. 6 42 .2 2. 6 2. 3 0. 3 1. 2 10 0. 0 9. 6 4. 6 86 6 B el iz e D is tr ic t 50 .9 0. 2 6. 0 0. 3 35 .0 2. 3 2. 9 0. 4 0. 9 10 0. 0 7. 7 4. 3 18 22 C ay o 69 .3 0. 2 6. 0 0. 0 17 .4 2. 5 2. 6 0. 2 1. 5 10 0. 0 6. 5 3. 2 16 76 S ta n n C re ek 54 .9 0. 4 5. 9 1. 2 28 .1 3. 7 2. 6 0. 4 2. 0 10 0. 0 8. 2 6. 4 80 4 To le d o 79 .3 0. 1 5. 0 0. 8 10 .4 1. 5 1. 5 0. 4 1. 0 10 0. 0 5. 9 A re a U rb an 51 .4 0. 1 6. 3 0. 5 33 .3 3. 0 2. 8 0. 1 1. 7 10 0. 0 7. 7 4. 5 27 80 R u ra l 74 .4 0. 3 5. 1 0. 5 14 .4 1. 7 1. 8 0. 5 0. 8 10 0. 0 6. 3 3. 4 43 14 A g e 0- 4 ye ar s 74 .6 0. 0 3. 2 0. 2 19 .4 1. 3 0. 9 0. 0 0. 5 10 0. 0 3. 4 1. 6 19 02 5- 9 ye ar s 67 .5 0. 2 4. 6 0. 1 21 .1 1. 9 2. 4 0. 2 1. 0 10 0. 0 5. 8 3. 2 20 04 10 -1 4 ye ar s 61 .8 0. 4 6. 5 0. 4 23 .2 3. 0 2. 6 0. 7 0. 8 10 0. 0 7. 9 5. 1 20 68 15 -1 7 ye ar s 52 .4 0. 4 9. 9 1. 8 24 .7 2. 7 3. 4 0. 5 3. 3 10 0. 0 13 .0 6. 4 11 20 W ea lt h in - d ex q u in ti le s Po o re st 77 .4 0. 3 4. 4 0. 9 11 .7 2. 5 1. 1 0. 6 0. 9 10 0. 0 5. 8 4. 4 16 85 S ec o n d 60 .0 0. 3 6. 0 0. 3 26 .1 1. 7 2. 8 0. 1 2. 1 10 0. 0 7. 1 3. 0 15 37 M id d le 62 .2 0. 2 5. 4 0. 4 26 .2 1. 9 1. 9 0. 3 0. 4 10 0. 0 7. 1 3. 9 14 06 Fo u rt h 60 .1 0. 3 6. 7 0. 2 25 .0 2. 1 2. 9 0. 5 1. 3 10 0. 0 8. 0 3. 9 13 17 R ic h es t 64 .7 0. 1 5. 8 0. 6 21 .9 2. 9 2. 6 0. 2 1. 1 10 0. 0 6. 7 4. 0 11 48 E th n ic it y o f h o u se h o ld h ea d C re o le 48 .2 0. 2 7. 5 0. 2 35 .2 2. 6 3. 1 0. 8 0. 9 10 0. 0 9. 3 5. 1 15 27 M es ti zo 68 .8 0. 3 5. 4 0. 4 19 .3 2. 0 1. 9 0. 3 1. 2 10 0. 0 6. 5 3. 4 34 86 G ar if u n a 43 .5 0. 0 4. 8 1. 9 36 .0 4. 9 4. 6 0. 2 2. 5 10 0. 0 8. 3 8. 6 38 0 M ay a 83 .1 0. 1 4. 4 0. 6 7. 1 1. 4 1. 6 0. 1 1. 4 10 0. 0 5. 3 2. 4 95 3 O th er 73 .6 0. 2 4. 5 0. 1 17 .3 2. 1 1. 3 0. 3 0. 6 10 0. 0 4. 8 2. 7 65 3 M is si n g /D K 69 .4 0. 0 6. 0 0. 9 20 .3 0. 0 2. 6 0. 0 0. 0 10 0. 0 7. 8 1. 8 93 To ta l 65 .4 0. 2 5. 6 0. 5 21 .8 2. 2 2. 2 0. 3 1. 2 10 0. 0 6. 9 3. 8 70 94 [1 ] M IC S in d ic at o r 9. 17 [2 ] M IC S in d ic at o r 9. 18 176 mics f inal report 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 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. In Belize, 0.4 percent of children aged 10-14 have lost both parents (Table HA.13). Among the children age 10-14 who have not lost a parent and who live with at least one parent, 95.0 percent are attending school. Total numbers for orphaned children age 10 to 14 years are low (Table HA.13) and this does not allow comparisons between orphans and non-orphans. Table HA.13: School attendance of orphans and non-orphans School attendance of children age 10-14 years by orphanhood, Belize, 2011 Percentage of children whose mother and father have died (orphans) Percentage of children of whom both parents are alive and child is living with at least one parent (non- orphans) Number of children age 10-14 years Percentage of children who are orphans and are attending school Total number of orphan children age 10-14 years Percentage of children who are non- orphans and are attending school [1] Total number of non- orphan children age 10-14 years Orphans to non-orphans school attendance ratio Sex Male 0.3 88.2 1002 (*) 3 96.0 884 1.04 Female 0.4 87.1 1066 (*) 4 94.0 928 0.85 Area Urban 0.6 86.3 811 (*) 5 98.6 700 1.01 Rural 0.2 88.5 1256 (*) 3 92.7 1112 0.71 Total 0.4 87.6 2068 (*) 7 95.0 1812 0.92 [1] MICS indicator 9.20; MDG indicator 6.4 ( ) Figures that are based on 25-49 un-weighted cases; (*) Figures that are based on less than 25 un-weighted cases mics f inal report 177 xiii. subjeCTive well-being It is well-known that the subjective perceptions of individuals of their incomes, health, living environments and the like, play a significant role in their lives and can impact their perception of well-being, irrespective of objective conditions such as actual income and physical health status. In the 2011 Belize MICS a set of questions were asked to women and men between 15- 24 years of age to understand how satisfied this group of young people is in different areas of their lives, such as their family life, friendships, school, current job, health, where they live, how they are treated by others, how they look, and their current income. Life satisfaction is a measure of an individual’s perceived level of well-being. Understanding young women and young men’s satisfaction in different areas of their lives can help to gain a comprehensive picture of young people’s life situations. A distinction can also be made between life satisfaction and happiness. Happiness is a fleeting emotion that can be affected by numerous factors, including day-to-day factors such as the weather, or a recent death in the family. It is possible for a person to be satisfied with her/his job, income, family life, friends, and other aspects of her life, but still be unhappy. In addition to the set of questions on life satisfaction, the 2011 Belize MICS also asked questions about happiness and the respondents’ perceptions of a better life. To assist respondents in answering the set of questions on happiness and life satisfaction they were shown a card with smiling faces (and not so smiling faces) that corresponded to the response categories (see the Questionnaires in Appendix G). The indicators related to subjective well-being that were included in Belize MICS4 are as follows: o Life satisfaction– the proportion of women age 15-24 years who are very or somewhat satisfied with their family life, friendships, school, current job, health, where they live, how they are treated by others, and how they look o Happiness – the proportion of women age 15-24 years who are very or somewhat happy o Perception of a better life– the proportion of women age 15-24 years who think that their lives improved during the last one year and who expect that their lives will be better after one year Tables SW.1 shows the proportion of young women age 15-24 years, who are very or somewhat satisfied in selected domains. Of the different domains, young women are the most satisfied with their family life(95.0 percent),their school (94.0 percent)and their health (93.8 percent).Among the domains, young women are the least satisfied with their current income (82.6 percent), with 71.9 percent of young women not having an income at all. Rural women are more satisfied with their living environment than urban women (urban 88.3 percent, rural 92.8 percent). Women who were never married or in a union were more satisfied with life than all other women for all domains except the way they look and current income. Also women currently married or in a union were more satisfied than separated women in all domains. 178 mics f inal report Generally women with secondary or better education were less satisfied than women with a primary education. For example, 85.0 percent of women with a primary education were satisfied with their current income, while the percentage for women with secondary or better education was 81.5. With the exception of the current income domain, women from Maya households were more satisfied than women from other ethnic households Table SW.1: Domains of life satisfaction Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains, Belize, 2011 Percentage of women age 15-24 who are very or somewhat satisfied with selected domains: Number of women age 15-24 yearsFamily life Friend- ships School Current job Health Living environ- ment Treatment by others The way they look Current income Age 15-19 95.1 92.4 94.9 87.5 95.0 90.7 90.3 96.7 81.0 844 20-24 94.9 90.0 90.2 86.5 92.4 90.7 91.0 96.0 83.5 720 Region Corozal 93.9 89.7 98.4 91.8 94.3 95.5 91.3 96.8 89.5 194 Orange Walk 95.9 92.6 98.8 87.1 95.2 93.9 94.2 93.3 88.4 258 Belize (Excluding Belize City South Side) 92.9 88.1 97.6 81.4 92.0 87.5 88.4 95.2 76.3 255 Belize City South Side 92.2 85.9 89.0 84.2 91.8 82.6 85.1 97.4 81.2 216 Belize District 92.6 87.1 93.5 82.7 91.9 85.2 86.9 96.2 78.4 471 Cayo 98.5 94.5 89.2 92.8 94.3 92.7 93.0 97.8 86.9 347 Stann Creek 93.3 91.3 93.1 88.2 94.4 87.8 86.0 97.1 74.4 147 Toledo 96.3 97.0 100.0 80.9 95.2 94.8 94.4 97.7 79.9 147 Area Urban 94.6 90.0 93.9 87.3 93.4 88.3 90.1 97.0 82.8 726 Rural 95.4 92.4 94.1 86.1 94.2 92.8 91.1 95.8 82.4 838 Marital/Union status Currently married/in union 94.5 90.7 89.4 85.4 93.6 90.8 91.0 97.1 86.3 497 Separated 86.3 84.8 100.0 82.1 93.0 85.3 86.6 91.8 65.8 86 Never married/in union 96.0 92.2 94.3 88.0 94.0 91.2 90.8 96.4 82.8 981 Education None (*) (*) (*) (*) (*) (*) (*) (*) (*) 22 Primary 94.6 91.8 100.0 90.5 94.3 92.1 90.9 95.9 85.0 443 Secondary + 94.9 90.9 93.7 85.6 93.7 89.8 90.2 96.5 81.5 1064 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) (*) (*) (*) 10 Other (*) (*) (*) (*) (*) (*) (*) (*) (*) 25 Wealth index quintiles Poorest 93.2 91.6 89.9 85.7 94.8 89.0 88.9 96.8 81.6 271 Second 94.1 92.0 96.8 89.2 94.5 89.2 91.2 97.2 83.0 330 Middle 95.8 89.0 95.6 87.6 95.0 90.5 88.7 94.6 85.6 356 Fourth 95.1 90.9 92.4 85.4 90.0 91.1 90.6 96.4 72.6 308 Richest 96.6 93.4 94.0 85.0 94.7 93.9 93.8 97.0 89.4 299 Ethnicity of household head Creole 92.5 88.5 90.9 79.6 90.2 85.9 87.2 96.0 77.3 376 Mestizo 95.8 91.8 94.1 88.0 94.7 92.6 91.9 96.2 86.7 784 Garifuna 91.4 83.7 93.6 89.9 92.4 81.6 82.8 97.3 63.1 93 Maya 97.1 96.6 100.0 95.9 94.7 94.0 94.9 97.8 83.0 179 Other 97.2 94.5 100.0 87.1 99.4 95.3 92.6 97.2 88.4 113 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) (*) 19 Total 95.0 91.3 94.0 86.8 93.8 90.7 90.6 96.4 82.6 1564 (*) Figures that are based on less than 25 un-weighted cases Table SW.1 indicates that the percentage of women age 15-24 years who are very or somewhat satisfied with life is 59.9 for those not currently attending school, 78.3 percent for those women who do not have a job and 71.9 percent for women without any income. For these three domains rural women are consistently more satisfied than urban women and similarly women with primary education are more satisfied than women with secondary or better education (Figure SW.1). Women 15-19 years are more satisfied when they do not have a job or any income than women 20-24 years. mics f inal report 179 Table SW.1: Domains of life satisfaction [continued) Percentage of women age 15-24 years who are very or somewhat satisfied in selected domains, Belize, 2011 Percentage of women age 15-24 who: Number of women age 15-24 years Are not currently attending school Do not have a job Do not have any income Age 15-19 41.3 87.3 81.5 844 20-24 81.9 67.8 60.5 720 Region Corozal 72.1 81.6 77.4 194 Orange Walk 71.4 84.3 82.8 258 Belize (Excluding Belize City South Side) 51.3 73.0 68.4 255 Belize City South Side 48.7 73.3 73.3 216 Belize District 50.1 73.1 70.7 471 Cayo 57.2 79.0 67.9 347 Stann Creek 58.6 76.3 75.2 147 Toledo 63.2 80.3 55.1 147 Area Urban 50.2 72.7 68.8 726 Rural 68.4 83.2 74.5 838 Marital/Union status Currently married/in union 90.3 81.1 70.1 497 Separated 95.5 63.6 59.3 86 Never married/in union 41.5 78.2 73.8 981 Education None (*) (*) (*) 22 Primary 94.5 83.7 74.0 443 Secondary + 44.0 75.1 69.9 1064 CET/ITVET/VOTEC (*) (*) (*) 10 Other (*) (*) (*) 25 Wealth index quintiles Poorest 80.6 87.4 71.1 271 Second 74.4 75.4 68.7 330 Middle 60.4 78.1 72.8 356 Fourth 49.6 76.3 73.4 308 Richest 35.5 75.6 73.4 299 Ethnicity of household head Creole 50.0 75.7 73.4 376 Mestizo 63.0 78.9 73.0 784 Garifuna 43.2 71.4 72.0 93 Maya 73.1 81.3 60.8 179 Other 65.6 84.2 76.0 113 Missing/DK (*) (*) (*) 19 Total 59.9 78.3 71.9 1564 (*) Figures that are based on less than 25 un-weighted cases In TableSW.2 the proportion of women age 15-24 years with life satisfaction is presented. “Life satisfaction” is defined as those who are very or somewhat satisfied with their family life, friendships, school, current job, health, where they live, how they are treated by others and how they look. About two thirds (73.7 percent) of 15- 24 year old women are satisfied with life. Of the women living in the richest households 77.0 percent are satisfied 180 mics f inal report with life as opposed to 72.6 percent in the poorest households. The proportion of women satisfied with life is higher in rural areas (76.7percent) than in urban areas (70.2percent). The average life satisfaction score is the arithmetic mean of responses to questions included in the calculation of life satisfaction. Lower scores indicate higher satisfaction levels. Table SW.2 identifies the lowest level of satisfaction in the Belize District (1.5) with Belize (Excluding Belize City South side) at 1.5 and Belize City South Side at 1.6 and the highest level in the Toledo District (1.2). Evidently, highest life satisfaction among ethnicities is found in the Maya households (1.2). Table SW.2: Life satisfaction and happiness Percentage of women age 15-24 years who are very or somewhat satisfied with their family life, friendships, school, current job, health, living environment, treatment by others, and the way they look, the average life satisfaction score, percentage of women with life satisfaction who are also very or somewhat satisfied with their income, and percentage of women age 15-24 years who are very or somewhat happy, Belize, 2011 Percentage of women with life satisfaction [1] Average life sat- isfaction score Missing / Cannot be calculated Women with life satisfaction who are very or some- what satisfied with their income No income / Cannot be calcu- lated Percentage who are very or some- what happy [2] Number of women age 15-24 years Age 15-19 73.8 1.4 0.1 59.2 81.6 92.4 844 20-24 73.6 1.4 1.3 66.4 61.8 90.0 720 Region Corozal 76.6 1.3 0.7 65.2 78.1 89.7 194 Orange Walk 80.2 1.3 1.0 70.7 83.8 92.6 258 Belize (Excluding Belize City South Side) 69.9 1.5 1.2 59.6 69.6 88.1 255 Belize City South Side 60.6 1.6 0.4 49.7 73.7 85.9 216 Belize District 65.6 1.5 0.8 55.4 71.5 87.1 471 Cayo 76.6 1.3 0.0 71.3 67.9 94.5 347 Stann Creek 66.8 1.5 0.0 51.1 75.2 91.3 147 Toledo 84.5 1.2 1.1 70.0 56.3 97.0 147 Area Urban 70.2 1.4 0.6 62.8 69.5 90.0 726 Rural 76.7 1.3 0.6 64.9 75.1 92.4 838 Marital/Union status Currently married/in union 78.0 1.3 1.5 72.0 71.6 90.7 497 Separated 61.9 1.6 0.0 41.8 59.3 84.8 86 Never married/in union 72.6 1.4 0.2 62.3 74.1 92.2 981 Education None (*) (*) (*) (*) (*) (*) 22 Primary 76.3 1.3 0.7 66.8 74.8 91.8 443 Secondary + 71.8 1.4 0.6 62.2 70.5 90.9 1064 CET/ITVET/VOTEC (*) (*) (*) (*) (*) (*) 10 Other (*) (*) (*) (*) (*) (*) 25 Wealth index quin- tiles Poorest 72.6 1.4 0.4 60.7 71.5 91.6 271 Second 73.3 1.4 0.9 66.8 69.6 92.0 330 Middle 72.9 1.4 0.5 66.0 73.3 89.0 356 Fourth 72.8 1.4 1.0 54.3 74.3 90.9 308 Richest 77.0 1.3 0.3 69.8 73.7 93.4 299 Ethnicity of house- hold head Creole 63.2 1.5 0.7 51.1 74.1 88.5 376 Mestizo 75.9 1.3 0.7 67.2 73.7 91.8 784 Garifuna 59.8 1.5 1.0 45.9 72.9 83.7 93 Maya 84.6 1.2 0.3 72.6 61.1 96.6 179 Other 85.7 1.3 0.0 73.7 76.0 94.5 113 Missing/DK (*) (*) (*) (*) (*) (*) 19 Total 73.7 1.4 0.6 63.8 72.5 91.3 1564 [1] MICS Indicator SW.1; [2] MICS indicator SW.2 (*) Figures that are based on less than 25 un-weighted cases mics f inal report 181 According to Table SW.2, 91.3 percent of women age 15-24 years are very or somewhat happy. Women from the Toledo District and the Maya households are most satisfied. Comparing 15-19 year old women to 20-24 year old women, the proportion of women who are very or somewhat happy is roughly the same, 92.4 and 90.0percent, respectively. Table SW.3 shows women’s perceptions of a better life. The proportion of women age 15-24 years who think that their lives improved during the last one year and who expect that their lives will get better after one year is 65.5 percent. There is a small difference between urban (64.7 percent) and rural (66.3 percent) women who perceive a better life. Women in the Toledo District (76.8 percent) and from Maya households (71.0 percent) perceive improved lives when compared with women from other districts and ethnicities. Women with better education (secondary or greater education 68.7 percent) thought that their life improved over the last year and will get better over the next: this compares with women having a primary education (57.6 percent). The perception that life improved over the last year is positively correlated with wealth with richer households perceiving increased improvement (Figure SW.2). 182 mics f inal report Table SW.3: Perception of a better life Percentage of women age 15-24 years who think that their lives improved during the last one year and those who expect that their lives will get better after one year, Belize, 2011 Percentage of women who think that their life Number of women age 15-24 years Improved during the last one year Will get better after one year Both [1] Age 15-19 69.7 86.8 64.4 844 20-24 70.4 89.2 66.9 720 Region Corozal 72.8 89.4 67.7 194 Orange Walk 73.1 88.0 66.9 258 Belize (Excluding Belize City South Side) 63.7 83.9 58.3 255 Belize City South Side 71.5 91.3 69.0 216 BelizeDistrict 67.3 87.3 63.2 471 Cayo 69.1 88.5 65.7 347 Stann Creek 61.5 86.9 56.2 147 Toledo 80.2 87.5 76.8 147 Area Urban 68.4 90.9 64.7 726 Rural 71.5 85.3 66.3 838 Marital/Union status Currently married/in union 73.4 87.7 68.7 497 Formerly married/in union 52.2 84.1 50.6 86 Never married/in union 69.9 88.4 65.2 981 Education None (*) (*) (*) 22 Primary 63.3 82.0 57.6 443 Secondary + 72.7 90.5 68.7 1064 CET/ITVET/VOTEC (*) (*) (*) 10 Other (*) (*) (*) 25 Wealth index quintiles Poorest 66.8 80.1 61.1 271 Second 67.5 87.4 62.7 330 Middle 71.0 90.8 68.0 356 Fourth 70.3 88.3 66.1 308 Richest 74.3 91.7 69.1 299 Ethnicity of household head Creole 68.7 90.6 64.8 376 Mestizo 68.4 86.3 63.7 784 Garifuna 70.9 90.5 65.8 93 Maya 74.0 88.5 71.0 179 Other 78.2 88.9 73.1 113 Missing/DK (*) (*) (*) 19 Total 70.0 87.9 65.5 1564 [1] MICS indicator SW.3 (*) Figures that are based on less than 25 un- weighted cases mics f inal report 183 appendix a. sample design The major features of the sample design are described in this appendix. Sample design features include target sample size, sample allocation, sampling frame and listing, choice of domains, sampling stages, stratification, and the calculation of sample weights. The primary objective of the sample design for the Belize Multiple Indicator Cluster Survey was to produce statistically reliable estimates of most indicators, at the national level, for urban and rural areas, and for the seven regions Corozal, Orange Walk, Belize City South Side, Belize Other, Cayo, Stann Creek and Toledo of the country. Urban and rural areas in each of the seven regions were defined as the sampling strata. A multi-stage, stratified cluster sampling approach was used for the selection of the survey sample. Sample Size and Sample Allocation The target sample size for the Belize MICS was calculated as 4,900 households. For the calculation of the sample size, the key indicator used was the vitamin A supplementation prevalence among children aged 0-4 years . The following formula was used to estimate the required sample size for this indicator: )])(()12.0[( )]1.1)()(1)((4[ _ 2 npr frrn �= where o n is the required sample size, expressed as number of households o 4 is a factor to achieve the 95 percent level of confidence o r is the predicted or anticipated value of the indicator, expressed in the form of a proportion o 1.1 is the factor necessary to raise the sample size by 10 per cent for the expected non-response [the actual factor will be based on the non-response level experienced in previous surveys in the country] o f is the shortened symbol for deff (design effect) o 0.12r is the margin of error to be tolerated at the 95 percent level of confidence, defined as 12 per cent of r (relative margin of error of r) o p is the proportion of the total population upon which the indicator, r, is based o _ n is the average household size (number of persons per household). For the calculation, r (vitamin A supplementation prevalence) was obtained for the national and district levels from the Census 2000 (Table SD.1). The value of deff (design effect) was taken as 1.5 based on estimates from previous surveys, p (percentage of children aged 6 – 59 months in the total population) and _ n (average household size) were obtained for the national and district levels and presented in Table SD.1, and the response rate was assumed to be 90%. 184 mics f inal report Table SD.1. Determining sample size for MICS 4: the example of Vitamin A supplementation for children Prevalence r Design effect deff Relevant group as % of total population p Average household size, nh Relative margin of error Required sample size n National estimate only 0.238 1.5 0.129 4.3 0.09 4,900 Urban 0.295 1.5 0.117 3.9 0.12 2,493 Rural 0.189 1.5 0.140 5.0 0.13 2,483 National estimate & U/R 4,976 Corozal 0.149 1.5 0.118 4.7 0.31 699 Orange Walk 0.223 1.5 0.124 5.1 0.23 701 Belize(Excluding Belize City South Side) 0.374 1.5 0.118 3.5 0.19 730 Belize City South Side 0.374 1.5 0.118 3.6 0.19 708 Cayo 0.220 1.5 0.137 5.2 0.22 699 Stann Creek 0.264 1.5 0.141 4.1 0.21 701 Toledo 0.087 1.5 0.160 5.2 0.34 702 District estimates 4,940 Equal allocation of the total sample size to the seven regions was used. The resulting number of households from this exercise was 700 households which is the sample size needed in each region – thus yielding about 4,900 households in total. The average number of households selected per cluster for the Belize MICS was determined as 25 households, based on a number of considerations, including the design effect, the budget available, and the time that would be needed per team to complete one cluster. Dividing the total number of households by the number of sample households per cluster, it was calculated that 28 sample clusters (enumeration districts or EDs) would need to be selected in each region. Therefore, 28 clusters (EDs) were allocated to each region, with the final sample size calculated at 4,900 households (28 clusters * 7 regions * 25 sample households per cluster). In each region, the clusters (primary sampling units) were distributed to urban and rural domains, proportional to the number of households in the urban and rural areas of that region. The table below shows the allocation of clusters to the sampling strata. Table SD.2. Allocation of Sample Clusters (Primary Sampling Units) to Sampling Strata Region Households (2010 Estimates) Number of Clusters (Enumeration Districts) Total Urban Rural Urban Rural Total Corozal 9,247 2,699 6,548 8 20 28 Orange Walk 10,394 3,361 7,033 10 18 28 Belize (Excluding Belize City South Side) 16,083 8,852 7,231 15 13 28 Belize City South Side 10,078 10,078 0 28 0 28 Cayo 16,897 9,221 7,676 15 13 28 Stann Creek 9,057 2,562 6,495 8 20 28 Toledo 6,516 1,358 5,158 6 22 28 Total 78,272 38,131 40,141 90 106 196 mics f inal report 185 Sampling Frame and Selection of Clusters The 2010 census frame was used for the selection of clusters. Census enumeration districts (ED) were defined as primary sampling units (PSUs), and were selected from each of the sampling strata by using systematic pps (probability proportional to size) sampling procedures, based on the estimated sizes of the enumeration areas from the 2010 Population Census. The first stage of sampling was thus completed by selecting the required number of enumeration areas from each of the 7 regions, separately by urban and rural strata. Listing Activities A new listing of households was conducted in all the sample enumeration districts prior to the selection of households. For this purpose, listing teams were formed, who visited each selected enumeration district, and listed the occupied households. Field work: 5th to 20th May, 2011 Data entry: 23rd May, 2011 to 24th June, 2011. Number of ED: 196 Number of interviewers: 98 (one interviewer for two EDs) Number of supervisors: 6 (one for each district, urban and rural) Selection of Households Lists of households were prepared by the listing teams in the field for each selected enumeration district. The households were then sequentially numbered from 1 to n (the total number of households in each enumeration area) at the Central Statistical Office, where the selection of 25 households in each enumeration area was carried out using random systematic selection procedures. Calculation of Sample Weights The Belize Multiple Indicator Cluster Survey sample is not self-weighting. Essentially, by allocating equal numbers of households to each of the regions, different sampling fractions were used in each region since the size of the regions varied. For this reason, sample weights were calculated and these were used in the subsequent analyses of the survey data. Thirteen primary sampling units (PSU) were used in producing the sample of households: Corozal urban, Corozal rural, Orange Walk urban , Orange Walk rural, Belize other urban, Belize Other rural, Belize City South Side, Cayo urban, Cayo rural, Stann Creek urban, Stann Creek rural, Toledo urban, Toledo rural. Seven strata (regions) were used: Corozal, Orange Walk, Belize District (Excluding Belize City South Side), Belize City South Side, Cayo, Stann Creek and Toledo and enumeration districts (ED) constitute the clusters. 186 mics f inal report It was decided that 28 clusters (ED) would be chosen from each stratum and that 25 households would be chosen from each selected ED. The major component of the weight is the reciprocal of the sampling fraction employed in selecting the number of sample households in that particular sampling stratum (h) and PSU (i): hi hi f W 1= The term fhi, the sampling fraction for the i-th sample PSU(district by urban/rural) in the h-th stratum (ED), is the product of probabilities of selection at every stage in each sampling stratum: hihihihi pppf 321 ��= where pshi is the probability of selection of the sampling unit at stage s for the i-th sample PSU in the h-th sampling stratum. Since the estimated number of households in each enumeration district (PSU) in the sampling frame used for the first stage selection and the updated number of households in the enumeration district from the listing exercise were different, individual sampling fractions for households in each sample enumeration district (cluster) were calculated. The sampling fractions for households in each enumeration district (cluster) therefore included the first stage probability of selection of the enumeration area in that particular sampling stratum and the second stage probability of selection of a household in the sample enumeration area (cluster). A second component in the calculation of sample weights takes into account the level of non-response for the household and individual interviews. The adjustment for household non-response is equal to the inverse value of: RRh = Number of interviewed households in stratum h/ Number of occupied households listed in stratum h After the completion of fieldwork, response rates were calculated for each sampling stratum. These were used to adjust the sample weights calculated for each cluster. Response rates in the Belize Multiple Indicator Cluster Survey are shown in Table HH.1 in this report. Similarly, the adjustment for non-response at the individual level (women and under-5 children) for each stratum is equal to the inverse value of: RRh = Completed women’s (or under-5’s) questionnaires in stratum h / Eligible women (or under-5s) in stratum h mics f inal report 187 The non-response adjustment factors for women’s and under-5’s questionnaires are applied to the adjusted household weights. Numbers of eligible women and under-5 children were obtained from the roster of household members in the Household Questionnaire for households where interviews were completed. The design weights for the households were calculated by multiplying the above factors for each enumeration area. These weights were then standardized (or normalized), one purpose of which is to make the weighted sum of the interviewed sample units equal the total sample size at the national level. Normalization is achieved by dividing the full sample weights (adjusted for nonresponse) by the average of these weights across all households at the national level. This is performed by multiplying the sample weights by a constant factor equal to the un-weighted number of households at the national level divided by the weighted total number of households (using the full sample weights adjusted for nonresponse). A similar standardization procedure was followed in obtaining standardized weights for the women’s and under-5’s questionnaires. Adjusted (normalized) weights varied between 0.452178 and 1.768905 in the 196 sample enumeration districts (clusters). Sample weights were appended to all data sets and analyses were performed by weighting each household, woman or under-5 with these sample weights. 188 mics f inal report A pp en di x B. B ud ge t B EL IZ E M IC S 4 24 F EB , 2 01 1 D ET A IL ED B U D G ET a nd F IN A N C IN G R EQ U IR EM EN TS C U R R EN C Y: U S D ol la rs To ta l C os t Ti m e- bo un d E xp en di tu re F or ec as t Sa m pl e si ze : 4 ,9 00 H ou se ho ld s Ja n - M ar A pr - Ju n Ju l - S ep t O ct - D ec da ys / U ni t To t Q rt Q rt Q rt Q rt A ct iv ity D et ai le d C os t I te m un its w ee ks C os t C os t 1 2 3 4 Pr e- te st in g P er so nn el : i nt er vi ew er s 4 2 da ys 15 12 0 12 0 P er so nn el : d riv er (s ) 1 2 da ys 15 30 30 P er so nn el : m on ito rin g st af f 2 2 da ys 15 60 60 P er d ie m s: in te rv ie w er /m on ito rin g st af f/d riv er 8 2 da ys 22 .5 36 0 36 0 Tr an sp or ta tio n: 2 2 da ys 3 12 12 A cc om od at io n: 8 1 ni gh ts 41 .5 33 2 33 2 Fu el : 1 2 da ys 60 12 0 12 0 Su pp lie s 1 1 37 5 37 5 37 5 C om m un ic at io ns 1 1 25 0 25 0 25 0 1, 65 9 Li st in g P er so nn el : P re pa ra tio n of s am pl e fra m e 1 1 4, 90 0 4, 90 0 4, 90 0 Tr ai ni ng o f l is te rs 7 1 re gi on 60 0 4, 20 0 4, 20 0 P er so nn el : l is te rs 98 2 E D 10 0 19 ,6 00 19 ,6 00 P er so nn el : d riv er s 4 10 da ys 17 .5 70 0 70 0 P er d ie m s: m on ito rin g st af f H Q 4 10 da ys 75 3, 00 0 3, 00 0 P er d ie m s: m on ito rin g st af f o th er 21 10 da ys 17 .5 3, 67 5 3, 67 5 P er d ie m s: d riv er s 3 10 da ys 75 2, 25 0 2, 25 0 C ar R en ta l 7 10 da ys 75 5, 25 0 5, 25 0 Fu el 7 10 da ys 75 5, 25 0 5, 25 0 Su pp lie s 7 1 da ys 75 52 5 52 5 mics f inal report 189 C op ie s of m ap s 19 6 1 m ap 5 98 0 98 0 50 ,3 30 Tr ai ni ng o f tr ai ne rs P er d ie m s: tr ai ne rs 7 10 da ys 22 .5 1, 57 5 1, 57 5 A cc om od at io n: 7 9 ni gh ts 45 2, 83 5 2, 83 5 Tr an sp or ta tio n: 7 4 da ys 12 33 6 33 6 C at er in g 17 10 da ys 7. 5 1, 27 5 1, 27 5 Su pp lie s 1 1 50 50 50 6, 07 1 Fi el d Tr ai ni ng P er d ie m s: tr ai ne rs (f or fi el d tra in in g) 7 11 da ys 22 .5 1, 73 3 1, 73 3 P er d ie m s: tr ai ne es 56 11 da ys 17 .5 10 ,7 80 10 ,7 80 A cc om od at io n: 46 10 ni gh ts 50 23 ,0 00 23 ,0 00 P rin tin g qu es tio nn ai re s 10 0 1 2. 5 25 0 25 0 P in tin g of m an ua ls 60 1 4 24 0 24 0 P er d ie m s: S IB d riv er s 2 6 da ys 22 .5 27 0 27 0 Fu el 2 6 da ys 60 72 0 72 0 R en ta l v en ue 1 11 da ys 30 0 3, 30 0 3, 30 0 Su pp lie s 1 11 da ys 50 55 0 55 0 40 ,8 43 Fi el dw or k D at a C ol le ct io n P er so nn el : F ie ld S up er vi so r/D riv er 7 8 w ks 15 5 8, 68 0 8, 68 0 P er so nn el : E di to rs 7 8 w ks 12 8. 5 7, 19 6 7, 19 6 P er so nn el : A ss t E di to rs fo r w k 1 & 2 7 2 w ks 12 8. 5 1, 79 9 1, 79 9 P er so nn el : I nt er vi ew er s 28 8 w ks 15 5 34 ,7 20 34 ,7 20 P er d ie m : S up er vi so rs 7 15 da ys 10 1, 05 0 1, 05 0 P er d ie m : E di to rs 7 15 da ys 10 1, 05 0 1, 05 0 P er d ie m : A ss t E di to rs fo r w k 1 & 2 7 12 da ys 10 84 0 84 0 P er d ie m : M on ito rin g st af f 6 16 da ys 22 .5 2, 16 0 2, 16 0 P er d ie m : D riv er s fo r M on ito rin g 3 16 da ys 22 .5 1, 08 0 1, 08 0 A cc om m od at io n: M on ito rin g st af f an d d riv er s 9 8 ni gh ts 50 3, 60 0 3, 60 0 C ar R en ta l 7 44 da ys 75 23 ,1 00 23 ,1 00 Fu el 7 44 da ys 60 18 ,4 80 18 ,4 80 P rin tin g qu es tio nn ai re s, fo rm s 21 ,0 00 1 0. 75 15 ,7 50 15 ,7 50 S up pl ie s fo r a nt hr op om et ry 6, 00 0 1 0. 5 3, 00 0 3, 00 0 S up pl ie s (s ta tio na ry , I D s, e tc ) 7 1 30 0 2, 10 0 2, 10 0 C om m un ic at io ns 1 1 1, 00 0 1, 00 0 1, 00 0 190 mics f inal report 12 5, 60 5 D at a Pr oc es si ng P er so nn el : D at a en try C le rk s 6 8 w ks 12 5 6, 00 0 6, 00 0 P er so nn el : D at a en try S up er vi so r 1 8 w ks 12 5 1, 00 0 1, 00 0 Q ue st io nn ai re s to H Q 7 1 75 52 5 52 5 C om m un ic at io ns 1 1 11 2. 5 11 3 11 3 7, 63 8 Su b- To ta l 23 2, 14 5 51 ,9 89 17 2, 51 9 7, 63 8 0 M an ag em en t F ee 10 % o f S ub to ta l 23 ,2 15 7, 73 8 7, 73 8 7, 73 8 TO TA L fo r S IB 25 5, 36 0 59 ,7 27 18 0, 25 7 7, 63 8 7, 73 8 D at a A na ly si s & R ep or t W rit in g 3, 00 0 3, 00 0 Pr oc ur em en t 3 D es kt op C om pu te r ( da ta e nt ry ) 5, 00 0 5, 00 0 M IC S 4 C oo rd in at io n Ja n - A ug 24 ,0 00 9, 00 0 9, 00 0 6, 00 0 D is se m in at io n 30 ,0 00 15 ,0 00 15 ,0 00 TO TA L fo r U N IC EF 62 ,0 00 9, 00 0 14 ,0 00 24 ,0 00 15 ,0 00 O VE R A LL TO TA L M IC S 4 31 7, 36 0 68 ,7 27 19 4, 25 7 31 ,6 38 22 ,7 38 C O B EL IZ E C on tr ib ut io n 13 0, 00 0 O TH ER C O N TR IB U TI O N S 18 7, 36 0 mics f inal report 191 appendix C. sensiTizaTion Campaign The sensitization campaign started two weeks prior to the fieldwork and lasted throughout the entire fieldwork. The initial two weeks of the campaign made the public aware of the purpose, goals and duration of the proposed MICS survey. This campaign utilized the slogan “Get in the MICS4 improving the lives of our children” which was reproduced on flyers, banners t-shirts, bags, key rings and pens. All samples can be accessed at: http://www.youtube.com/watch?v=NsTZhiKWHdQ&feature=plcp There was a radio jingle and 3-minute TV animation message which was aired throughout the fieldwork. In addition there were four TV talk show appearances featuring the Statistical Institute of Belize (SIB) and UNICEF which encouraged public participation. Also, a documentary of the entire MICS fieldwork process was aired on the TV show Belize Watch on the TV station LOVE FM. Banners were hung across the major streets in each district town or city and also in the offshore Cayes. Flyers were distributed from the major shopping centers in urban and rural areas of each district and were also placed on street lamp posts at these locations. A flyer is reproduced in Figure 1. Each respondent participating in the survey was given a small gift package consisting of a MICS bag, a pen and a key ring all emblazoned with the MICS slogan. In addition all interviewers and persons from the SIB and UNICEF were issued t-shirts with the MICS slogan on display. These t-shirts identified interviewers with the MICS survey. The Mennonite communities required special attention prior to the start of fieldwork. Each selected Mennonite community was visited and the elders were informed and their approval and help solicited. A detailed monitoring and evaluation calendar along with budget projections is presented in Table 1. Figure 1. MICS4 Flyer, Belize, 2011 192 mics f inal report Ta bl e 1: M IC S4 S EN SI TI ZA TI O N M O N IT O R IN G A N D E VA LU A TI O N C A LE N D A R , 2 01 1 TI M E FR AM E PR O G R AM M E A C TI VI TI ES & D ES C R IP TI O N 20 11 ST A TU S Q U A N TI TY U N IT C O ST TO TA L C O ST M ay Ju ne Ju ly A ug 23 30 6 13 20 27 4 11 18 25 1 8 1. 0 B y J u ly o f 2 0 1 1 , 9 0 % o f a ll H H a w a re o f th e M IC S- 4 . $ 7 0 ,2 2 9 .0 0 1. 1 Conduc t media campa ign thr ough p ress re lease, r adio an d TV A ds, $ 9 ,6 0 0 .0 0 1. 1. 1 Draft C oncept for 3m inute A nimatio n x 1. 1. 2 Contra ct Com pany 1 $4 ,000.00 $4,0 00.00 x 1. 1. 3 Air Ani mation (Unit= 1day x 3), pri metime => afte r news 14 $400.0 0 $5 ,600.00 x x 1. 2 Conduc t media Campa ign thr ough a ppeara nce on Radio a nd TV t alk shows $ 3 ,0 0 0 .0 0 1. 2. 1 Letters sent to media for app roval 1 $0.00 $0.00 x 1. 2. 2 Appear ance on Open Y our Eye s 1 $0.00 $0.00 x 1. 2. 3 Appear ance on Wake Up Bel ize 1 $0.00 $0.00 x 1. 2. 4 Appear ance on Love T V 1 $0.00 $0.00 x 1. 3 Conduc t Awar eness c ampaig n (med ia) $ 3 ,0 0 0 .0 0 1. 3. 1 Contra ct LOVE FM 1 $ 500.00 $5 00.00 x Docum entary 1 $2 ,500.00 $2,5 00.00 x Appear ance on Belize Watch 1 $0.00 $0.00 x 1. 3 Conduc t media campa ign thr ough F aceboo k page , blog a nd txt (Smart and Di gicel) $0.00 1. 3. 1 Facebo ok pag e 1. 3. 1. a Design Facebo ok pag e 1 $0.00 $0.00 x 1. 3. 1. b Approv al $0.00 $0.00 x 1. 3. 1. c Send F riend r equest 1000 $0.00 $0.00 x 1. 3. 2 Sendin g mass Txt 1. 3. 2. a Letters sent to BTL an d SMAR T for approv al 2 $0.00 $0.00 x 1. 3. 2. b Mass T XT sen t 10,000 $0.00 $0.00 x x 1. 4 Conduc t aware ness ca mpaign throug h Jingle compe tition $4,450 .00 1. 4. 1 Advert ise Com pletion 2 $400 $800.0 0 x x 1. 4. 2 Procur e first place p rize 1 $1,500 .00 $1,500 .00 x 1. 4. 3 Procur e secon d place prize 1 $1,000 .00 $1,000 .00 x 1. 4. 4 Procur e third place p rize 1 $800.0 0 $800.0 0 x 1. 4. 5 Selecti on of W inners $0.00 x 1. 4. 6 Media momen t with w inners (UNICE F confere nce roo m) 1 $350.0 0 $350.0 0 x Jingle c omplet ed and aired 1. 5 Conduc t aware ness ca mpaign banne rs $11,55 4.00 1. 5. 1 Design Banne rs 2 $ 200.00 $ 400.00 x 1. 5. 2 Produc e 14 Ba nners 14 $400.0 0 $ 5,600.0 0 x 1. 5. 3 Letters to City and To wn Cou ncils reques ting to hang b anners 7 $0.00 $0.00 x 1. 5. 4 Procur e rope 1/4 inc h (100 ft. per banner ) 1,400 $2.00 $2,800 .00 x 1. 5. 5 Procur e 1/3 s ticks 28 $2.50 $70.00 x 1. 5. 6 Cost to transp ort ban ners to the dis tricts and cay es 6 $14.00 $84.00 x 1. 5. 7 Hang B anners 13 $200.0 0 $ 2,600.0 0 1. 6 Conduc t aware ness ca mpaign throug h flyers and pa rapher nalia (key ri ngs, T S hirts) $35,22 5.00 1. 6. 0a Contra ct Com pany 1 $0.00 $0.00 x mics f inal report 193 1. 3. 1. a Design Facebo ok pag e 1 $0.00 $0.00 x 1. 3. 1. b Approv al $0.00 $0.00 x 1. 3. 1. c Send F riend r equest 1000 $0.00 $0.00 x 1. 3. 2 Sendin g mass Txt 1. 3. 2. a Letters sent to BTL an d SMAR T for approv al 2 $0.00 $0.00 x 1. 3. 2. b Mass T XT sen t 10,000 $0.00 $0.00 x x 1. 4 Conduc t aware ness ca mpaign throug h Jingle compe tition $4,450 .00 1. 4. 1 Advert ise Com pletion 2 $400 $800.0 0 x x 1. 4. 2 Procur e first place p rize 1 $1,500 .00 $1,500 .00 x 1. 4. 3 Procur e secon d place prize 1 $1,000 .00 $1,000 .00 x 1. 4. 4 Procur e third place p rize 1 $800.0 0 $800.0 0 x 1. 4. 5 Selecti on of W inners $0.00 x 1. 4. 6 Media momen t with w inners (UNICE F confere nce roo m) 1 $350.0 0 $350.0 0 x Jingle c omplet ed and aired 1. 5 Conduc t aware ness ca mpaign banne rs $11,55 4.00 1. 5. 1 Design Banne rs 2 $ 200.00 $ 400.00 x 1. 5. 2 Produc e 14 Ba nners 14 $400.0 0 $ 5,600.0 0 x 1. 5. 3 Letters to City and To wn Cou ncils reques ting to hang b anners 7 $0.00 $0.00 x 1. 5. 4 Procur e rope 1/4 inc h (100 ft. per banner ) 1,400 $2.00 $2,800 .00 x 1. 5. 5 Procur e 1/3 s ticks 28 $2.50 $70.00 x 1. 5. 6 Cost to transp ort ban ners to the dis tricts and cay es 6 $14.00 $84.00 x 1. 5. 7 Hang B anners 13 $200.0 0 $ 2,600.0 0 1. 6 Conduc t aware ness ca mpaign throug h flyers and pa rapher nalia (key ri ngs, T S hirts) $35,22 5.00 1. 6. 0a Contra ct Com pany 1 $0.00 $0.00 x 1. 6. 0. b Art Wo rk 1 $ 100.00 $ 100.00 x 1. 6. 1 T Shirt s 1. 6. 1. a Design T Shirt s 1 $ 125.00 $ 125.00 x 1. 6. 1. b Produc e 500 T Shirts 500 $15.00 $7 ,500.00 x 1. 6. 2 Flyers 1. 6. 2. a Design Flyers 1 $0.00 $0.00 x 1. 6. 2. b Print 5 000 co loured flyers 5,000 $0.75 $3,750 .00 x 1. 6. 3 Key rin gs 1. 6. 3. a Design Key rin gs (Ver tical ba r chart -MICS logo)(1 colour 2 side print 1 $0.00 $0.00 x 1. 6. 3. b Produc e 5000 key rin gs 5,000 $2.25 $11,25 0.00 x 1. 6. 4 Pens 1. 6. 4. a Design pens w ith MIC S Logo s/ Tagl ine 1 $0.00 $0.00 x 1. 6. 4. b Produc e 5,000 pens 1. 6. 5 Bags 1. 6. 5. a Design Bags 5,000 $2.50 $12,50 0.00 x 1. 6. 5. b Produc e 5000 bags 1. 7 Commu nity Ou treach Officer s $6,400 .00 1. 7. 1 Identif ication and se lection of Out -Reach Officer s 7 $0.00 $0.00 x 1. 7. 2 DSA fo r office rs 6 $1, 000.00 $6 ,000.00 x x x 1. 7. 3 Travel 6 $50.00 $ 300.00 x x x 1. 7. 4 Sensiti zation session 1 $ 100.00 $ 100.00 x 194 mics f inal report appendix d. lisT of personnel involved in The survey 1. governance structure MICS IV Steering Committee: The Steering Committee is an advising body to UNICEF and the Statistical Institute of Belize on all issues related to the successful implementation of the MICS IV. o The membership is comprised of senior technical representatives from the following entities a. Ministry of Education b. Ministry of Health c. Ministry of Human Development and Social Transformation d. National Committee for Families and Children e. National AIDS Commission f. Statistical Institute of Belize g. UNDP Belize h. UNICEF Belize i. MICS 4 Coordinator (Secretariat) 2. iMpleMenting personnel Implementing Agency: The Belize MICS IV is being implemented by the Statistical Institute of Belize, with the support and technical assistance of UNICEF. The Statistical Institute of Belize Belmopan City Cayo Glenn Avilez Director General Tyrone Boyce Statistician II Miriam Willoughby Statistician II Desmond Gordon Information Technology Manager Robert Marlin Information Technology Tiffani Vasquez Assistant Statistician I Curwen Arthurs Statistician II Javan Chavarria Statistician II Ms Audrey Villafranco Assistant Statistician II Ms Melinda Blancaneaux Assistant Statistician II Ms. Kenesha Richards Assistant Statistician II Robert Griffith Assistant Statistician II Karl Tyndell Assistant Statistician II Javier Romero Assistant Statistician II Andy Morales Assistant Statistician II Rennick Jackson Assistant Statistician II Ms. Wendi Benavides Assistant Statistician III Six data entry operators Twenty four interviewers mics f inal report 195 UNICEF Ms Christine Norton UNICEF Belize Representative Mr Joseph Hendrikx Social Policy Officer Ms. Paulette Wade Planning, Monitoring and Evaluation Specialist MICS IV Coordinator: A consultant has been hired by UNICEF to provide technical support to the Statistical Institute of Belize and to oversee the entire MICS IV process. Leopold L. Perriott Ph. D. Statistical Consultant, UNICEF Belize Sampling expert: A sampling expert is supplied by UNICEF to assist in sample size determination and in sample selection. Peter Wingfield-Digby MICS Sampling Consultant Data Processing expert: A data processing expert is supplied by UNICEF to assist in adjusting the CSPro and SPSS programs for data capture and editing. Martin Wulfe MICS Data Processing Expert Report writing consultant: A consultant to assist in table production and report writing is supplied by UNICEF. Shane Khan Ph.D. MICSIV Report writing consultant 196 mics f inal report appendix e. esTimaTes of sampling errors The sample of respondents selected in the Belize Multiple Indicator Cluster Survey is only one of the samples that could have been selected from the same population, using the same design and size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between the estimates from all possible samples. The extent of variability is not known exactly, but can be estimated statistically from the survey data. The following sampling error measures are presented in this appendix for each of the selected indicators: • Standard error (se): Sampling errors are usually measured in terms of standard errors for particular indicators (means, proportions etc). Standard error is the square root of the variance of the estimate. The Taylor linearization method is used for the estimation of standard errors. • Coefficient of variation (se/r) is the ratio of the standard error to the value of the indicator, and is a measure of the relative sampling error. • Design effect (deff) is the ratio of the actual variance of an indicator, under the sampling method used in the survey, to the variance calculated under the assumption of simple random sampling. The square root of the design effect (deft) is used to show the efficiency of the sample design in relation to the precision. A deft value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a deft value above 1.0 indicates the increase in the standard error due to the use of a more complex sample design. • Confidence limits are calculated to show the interval within which the true value for the population can be reasonably assumed to fall, with a specified level of confidence. For any given statistic calculated from the survey, the value of that statistic will fall within a range of plus or minus two times the standard error (r + 2.se or r – 2.se) of the statistic in 95 percent of all possible samples of identical size and design. For the calculation of sampling errors from MICS data, SPSS Version 18 Complex Samples module has been used. The results are shown in the tables that follow. In addition to the sampling error measures described above, the tables also include weighted and un-weighted counts of denominators for each indicator. Sampling errors are calculated for indicators of primary interest, for the national level, for the regions, and for urban and rural areas. Three of the selected indicators are based on households, 8 are based on household members, 13 are based on women, and 15 are based on children under 5. All indicators presented here are in the form of proportions. Table SE.1 shows the list of indicators for which sampling errors are calculated, including the base population (denominator) for each indicator. Table SE.2 to Table SE.9 show the calculated sampling errors for selected domains. mics f inal report 197 Table SE.1: Indicators selected for sampling error calculations List of indicators selected for sampling error calculations, and base populations (denominators) for each indicator, Belize, 2011 MICS4 Indicator Base Population HOUSEHOLD MEMBERS 4.1 Use of improved drinking water sources All household members 4.3 Use of improved sanitation All household members 7.5 Secondary school net attendance ratio (adjusted) Children of secondary school age 8.5 Violent discipline Children age 2-14 years 9.18 Prevalence of children with one or both parents dead Children age 0-17 years 8.2 Child labour Children age 5-14 years WOMEN - Pregnant women Women age 15-49 years 5.2 Early childbearing Women age 20-24 years 5.3 Contraceptive prevalence Women age 15-49 years who are currently married or in union 5.4 Unmet need Women age 15-49 years who are currently married or in union 5.5a Antenatal care coverage - at least once by skilled personnel Women age 15-49 years with a live birth in the 2 years preceding the survey 5.5b Antenatal care coverage – at least four times by any provider Women age 15-49 years with a live birth in the 2 years preceding the survey 5.7 Skilled attendant at delivery Women age 15-49 years with a live birth in the 2 years preceding the survey 5.8 Institutional deliveries Women age 15-49 years with a live birth in the 2 years preceding the survey 5.9 Caesarean section Women age 15-49 years with a live birth in the 2 years preceding the survey 7.1 Literacy rate among young women Women age 15-24 years 8.7 Marriage before age 18 Women age 20-49 years 8.9 Polygyny Women age 15-49 years who are currently married or in union 9.2 Comprehensive knowledge about HIV prevention among young people Women age 15-24 years 9.3 Knowledge of mother- to-child transmission of HIV Women age 15-49 years 9.4 Accepting attitudes towards people living with HIV Women age 15-49 years 9.6 Women who have been tested for HIV during last 12 months and who have been told the results Women age 15-49 years 9.7 Sexually active young women who have been tested for HIV and know the results Women age 15-24 years who have had sex in the 12 months preceding the survey 9.11 Sex before age 15 among young women Women age 15-24 years 9.16 Condom use with non-regular partners Women age 15-24 years that had a non-marital, non- cohabiting partner in the 12 months preceding the survey 198 mics f inal report UNDER-5s 2.1a Underweight prevalence Children under age 5 2.2a Stunting prevalence Children under age 5 2.3a Wasting prevalence Children under age 5 2.6 Exclusive breastfeeding under 6 months Total number of infants under 6 months of age 2.14 Age-appropriate breastfeeding Children age 0-23 months - Tuberculosis immunization coverage Children age 18-29 months  - Polio or DTaP-P immunization Children age 18-29 months  - DPT (Pentavalent) Children age 18-29 months  - Received measles immunization Children age 18-29 months  - Received Hepatitis B or Pentavalent immunization Children age 18-29 months - Received HiB or Pentavalent immunization Children age 18-29 months - Diarrhoea in the previous 2 weeks Children under age 5 - Illness with a cough in the previous 2 weeks Children under age 5 3.8 Oral rehydration therapy with continued feeding Children under age 5 with diarrhoea in the previous 2 weeks 3.10 Antibiotic treatment of suspected pneumonia Children under age 5 with suspected pneumonia in the previous 2 weeks 6.1 Support for learning Children age 36-59 months 6.7 Attendance to early childhood education Children age 36-59 months 8.1 Birth registration Children under age 5 mics f inal report 199 Ta b le S E .2 : S am p lin g e rr o rs : T o ta l s am p le S ta n d ar d e rr o rs , c o ef fi ci en ts o f va ri at io n , d es ig n e ff ec ts ( d ef f) , s q u ar e ro o t o f d es ig n e ff ec ts ( d ef t) a n d c o n fi d en ce in te rv al s fo r se le ct ed in d ic at o rs , B el iz e, 2 01 1                         M IC S In d ic at o r Va lu e (r ) S ta n d ar d er ro r (s e) C o ef fi ci en t o f va ri at io n (s e/ r) D es ig n ef fe ct (d ef f) S q u ar e ro o t o f d es ig n ef fe ct ( d ef t) W ei g h te d co u n t U nw ei g h te d co u n t C o n fi d en ce li m it s r - 2s e r + 2s e U se o f im p ro ve d d ri n ki n g w at er s o u rc es 4. 1 0. 97 65 0. 00 60 0. 00 6 7. 01 9 2. 64 9 17 28 8 44 24 0. 96 4 0. 98 9 U se o f im p ro ve d s an it at io n 4. 3 0. 91 90 0. 00 41 0. 00 4 0. 96 5 0. 98 2 16 77 9 42 57 0. 91 1 0. 92 7 S ec o n d ar y sc h o o l n et a tt en d an ce r at io ( ad ju st ed ) 7. 5 0. 55 44 0. 01 55 0. 02 8 1. 50 8 1. 22 8 15 30 15 58 0. 52 3 0. 58 5 C h ild la b o u r 8. 2 0. 10 01 0. 00 61 0. 06 1 1. 70 9 1. 30 7 40 72 41 94 0. 08 8 0. 11 2 Pr ev al en ce o f ch ild re n w it h o n e o r b o th p ar en ts d ea d 9. 18 0. 03 83 0. 00 41 0. 10 8 3. 38 2 1. 83 9 70 94 73 21 0. 03 0 0. 04 7 V io le n t d is ci p lin e 8. 5 0. 70 49 0. 01 15 0. 01 6 1. 56 8 1. 25 2 52 31 24 67 0. 68 2 0. 72 8 W O M E N Pr eg n an t w o m en - 0. 05 83 0. 00 43 0. 07 4 1. 39 4 1. 18 1 40 96 40 96 0. 05 0 0. 06 7 E ar ly c h ild b ea ri n g 5. 2 0. 16 89 0. 01 31 0. 07 8 0. 89 1 0. 94 4 72 0 72 9 0. 14 3 0. 19 5 C o n tr ac ep ti ve p re va le n ce 5. 3 0. 55 16 0. 01 32 0. 02 4 1. 69 4 1. 30 1 23 86 23 94 0. 52 5 0. 57 8 U n m et n ee d 5. 4 0. 15 88 0. 00 74 0. 04 7 0. 97 7 0. 98 9 23 86 23 94 0. 14 4 0. 17 4 A n te n at al c ar e co ve ra g e - at le as t o n ce b y sk ill ed p er so n n el 5. 5a 0. 96 22 0. 00 67 0. 00 7 0. 86 4 0. 93 0 68 5 70 2 0. 94 9 0. 97 6 A n te n at al c ar e co ve ra g e - at le as t fo u r ti m es b y an y p ro vi d er 5. 5b 0. 83 12 0. 01 28 0. 01 5 0. 82 5 0. 90 8 68 5 70 2 0. 80 6 0. 85 7 S ki lle d a tt en d an t at d el iv er y 5. 7 0. 96 16 0. 00 94 0. 01 0 1. 67 5 1. 29 4 68 5 70 2 0. 94 3 0. 98 0 In st it u ti o n al d el iv er ie s 5. 8 0. 93 83 0. 01 08 0. 01 1 1. 40 9 1. 18 7 68 5 70 2 0. 91 7 0. 96 0 C ae sa re an s ec ti o n 5. 9 0. 28 11 0. 01 76 0. 06 2 1. 06 9 1. 03 4 68 5 70 2 0. 24 6 0. 31 6 Li te ra cy r at e am o n g y o u n g w o m en 7. 1 0. 90 53 0. 01 08 0. 01 2 2. 14 1 1. 46 3 15 64 15 81 0. 88 4 0. 92 7 M ar ri ag e b ef o re a g e 18 8. 7 0. 29 41 0. 00 99 0. 03 4 1. 52 8 1. 23 6 32 52 32 44 0. 27 4 0. 31 4 Po ly g yn y 8. 9 0. 03 45 0. 00 38 0. 11 0 1. 03 2 1. 01 6 23 86 23 94 0. 02 7 0. 04 2 C o m p re h en si ve k n o w le d g e ab o u t H IV p re ve n ti o n a m o n g y o u n g p eo p le 9. 2 0. 42 87 0. 01 46 0. 03 4 1. 37 2 1. 17 1 15 64 15 81 0. 40 0 0. 45 8 K n o w le d g e o f m o th er -t o -c h ild t ra n sm is si o n o f H IV 9. 3 0. 55 71 0. 00 96 0. 01 7 1. 51 5 1. 23 1 40 96 40 96 0. 53 8 0. 57 6 A cc ep ti n g a tt it u d es t o w ar d s p eo p le li vi n g w it h H IV 9. 4 0. 19 28 0. 00 78 0. 04 0 1. 48 2 1. 21 7 38 79 38 04 0. 17 7 0. 20 8 W o m en w h o h av e b ee n t es te d f o r H IV d u ri n g la st 1 2 m o n th s an d w h o h av e b ee n to ld t h e re su lt s 9. 6 0. 28 38 0. 00 97 0. 03 4 1. 89 6 1. 37 7 40 96 40 96 0. 26 4 0. 30 3 S ex u al ly a ct iv e yo u n g w o m en w h o h av e b ee n t es te d f o r H IV a n d k n o w t h e re su lt s 9. 7 0. 33 92 0. 01 84 0. 05 4 1. 23 2 1. 11 0 82 0 81 7 0. 30 2 0. 37 6 S ex b ef o re a g e 15 a m o n g y o u n g w o m en 9. 11 0. 05 28 0. 00 58 0. 10 9 1. 04 6 1. 02 3 15 64 15 81 0. 04 1 0. 06 4 C o n d o m u se w it h n o n -r eg u la r p ar tn er s 9. 16 0. 64 60 0. 02 66 0. 04 1 0. 98 7 0. 99 3 34 1 32 0 0. 59 3 0. 69 9 U N D E R -5 s U n d er w ei g h t p re va le n ce 2. 1a 0. 06 16 0. 00 49 0. 08 0 0. 77 1 0. 87 8 18 09 18 22 0. 05 2 0. 07 1 S tu n ti n g p re va le n ce 2. 2a 0. 19 30 0. 01 03 0. 05 3 1. 21 9 1. 10 4 17 80 17 98 0. 17 2 0. 21 4 W as ti n g p re va le n ce 2. 3a 0. 03 29 0. 00 44 0. 13 5 1. 09 5 1. 04 6 17 68 17 81 0. 02 4 0. 04 2 E xc lu si ve b re as tf ee d in g u n d er 6 m o n th s 2. 6 0. 14 66 0. 02 25 0. 15 3 0. 58 1 0. 76 2 14 8 14 5 0. 10 2 0. 19 1 A g e- ap p ro p ri at e b re as tf ee d in g 2. 14 0. 38 19 0. 01 72 0. 04 5 0. 95 0 0. 97 5 76 1 75 5 0. 34 7 0. 41 6 Tu b er cu lo si s im m u n iz at io n c ov er ag e - 0. 97 96 0. 00 73 0. 00 7 1. 09 0 1. 04 4 40 3 41 0 0. 96 5 0. 99 4 Po lio o r D Ta P- P im m u n iz at io n - 0. 70 00 0. 02 10 0. 03 0 0. 83 9 0. 91 6 39 5 40 0 0. 65 8 0. 74 2 D P T ( Pe n ta va le n t) - 0. 71 78 0. 02 12 0. 03 0 0. 88 5 0. 94 1 39 6 40 0 0. 67 5 0. 76 0 R ec ei ve d m ea sl es im m u n iz at io n - 0. 89 04 0. 01 97 0. 02 2 1. 56 8 1. 25 2 39 2 39 4 0. 85 1 0. 93 0 R ec ei ve d H ep at it is B o r Pe n ta va le n t im m u n iz at io n - 0. 71 39 0. 02 11 0. 03 0 0. 86 6 0. 93 1 39 4 39 9 0. 67 2 0. 75 6 R ec ei ve d H iB o r Pe n ta va le n t im m u n iz at io n - 0. 71 14 0. 02 09 0. 02 9 0. 84 7 0. 92 1 39 4 39 9 0. 67 0 0. 75 3 D ia rr h o ea in la st t w o w ee ks - 0. 07 88 0. 00 60 0. 07 7 0. 97 6 0. 98 8 19 46 19 46 0. 06 7 0. 09 1 Ill n es s w it h c o u g h in t h e p re vi o u s 2 w ee ks - 0. 02 95 0. 00 48 0. 16 1 1. 53 3 1. 23 8 19 46 19 46 0. 02 0 0. 03 9 O ra l r eh yd ra ti o n t h er ap y w it h c o n ti n u ed f ee d in g 3. 8 0. 42 54 0. 03 09 0. 07 3 0. 57 5 0. 75 9 15 3 14 8 0. 36 4 0. 48 7 A n ti b io ti c tr ea tm en t o f su sp ec te d p n eu m o n ia 3. 10 0. 70 66 0. 01 98 0. 02 8 0. 12 3 0. 35 1 57 66 0. 66 7 0. 74 6 S u p p o rt f o r le ar n in g 6. 1 0. 85 65 0. 01 60 0. 01 9 1. 64 2 1. 28 1 79 2 78 8 0. 82 4 0. 88 8 A tt en d an ce t o e ar ly c h ild h o o d e d u ca ti o n 6. 7 0. 31 72 0. 02 03 0. 06 4 1. 49 8 1. 22 4 79 2 78 8 0. 27 7 0. 35 8 B ir th r eg is tr at io n 8. 1 0. 95 24 0. 00 48 0. 00 5 0. 97 9 0. 98 9 19 46 19 46 0. 94 3 0. 96 2 200 mics f inal report Ta b le S E .3 : S am p lin g e rr o rs : U rb an S ta n d ar d e rr o rs , c o ef fi ci en ts o f va ri at io n , d es ig n e ff ec ts ( d ef f) , s q u ar e ro o t o f d es ig n e ff ec ts ( d ef t) a n d c o n fi d en ce in te rv al s fo r se le ct ed in d ic at o rs , B el iz e, 2 01 1                         M IC S In d i- ca to r Va lu e (r ) S ta n d ar d er ro r (s e) C o ef fi ci en t o f va ri at io n (s e/ r) D es ig n ef fe ct (d ef f) S q u ar e ro o t o f d es ig n ef fe ct ( d ef t) W ei g h te d co u n t U nw ei g h te d co u n t C o n fi d en ce li m it s r - 2s e r + 2s e H O U S E H O LD M E M B E R S U se o f im p ro ve d d ri n ki n g w at er s o u rc es 4. 1 0. 99 54 0. 00 20 0. 00 2 1. 67 8 1. 29 5 75 36 20 04 0. 99 1 0. 99 9 U se o f im p ro ve d s an it at io n 4. 3 0. 93 78 0. 00 53 0. 00 6 0. 95 5 0. 97 7 74 10 19 61 0. 92 7 0. 94 8 S ec o n d ar y sc h o o l n et a tt en d an ce r at io ( ad ju st ed ) 7. 5 0. 69 20 0. 02 07 0. 03 0 1. 16 5 1. 08 0 62 5 57 9 0. 65 1 0. 73 3 C h ild la b o u r 8. 2 0. 04 12 0. 00 56 0. 13 6 1. 18 2 1. 08 7 15 82 14 85 0. 03 0 0. 05 2 Pr ev al en ce o f ch ild re n w it h o n e o r b o th p ar en ts d ea d 9. 18 0. 04 48 0. 00 58 0. 12 9 2. 03 6 1. 42 7 27 80 26 15 0. 03 3 0. 05 6 V io le n t d is ci p lin e 8. 5 0. 70 20 0. 01 53 0. 02 2 1. 12 2 1. 05 9 20 22 10 00 0. 67 1 0. 73 3 W O M E N Pr eg n an t w o m en - 0. 04 96 0. 00 58 0. 11 7 1. 26 8 1. 12 6 19 26 17 72 0. 03 8 0. 06 1 E ar ly c h ild b ea ri n g 5. 2 0. 14 15 0. 02 01 0. 14 2 1. 06 6 1. 03 3 34 3 32 3 0. 10 1 0. 18 2 C o n tr ac ep ti ve p re va le n ce 5. 3 0. 57 75 0. 01 96 0. 03 4 1. 41 3 1. 18 9 99 1 89 6 0. 53 8 0. 61 7 U n m et n ee d 5. 4 0. 14 13 0. 01 08 0. 07 7 0. 86 5 0. 93 0 99 1 89 6 0. 12 0 0. 16 3 A n te n at al c ar e co ve ra g e - at le as t o n ce b y sk ill ed p er so n n el 5. 5a 0. 97 32 0. 00 64 0. 00 7 0. 38 8 0. 62 3 26 2 24 7 0. 96 0 0. 98 6 A n te n at al c ar e co ve ra g e - at le as t fo u r ti m es b y an y p ro vi d er 5. 5b 0. 87 36 0. 01 88 0. 02 2 0. 78 7 0. 88 7 26 2 24 7 0. 83 6 0. 91 1 S ki lle d a tt en d an t at d el iv er y 5. 7 0. 98 43 0. 00 84 0. 00 9 1. 12 8 1. 06 2 26 2 24 7 0. 96 7 1. 00 0 In st it u ti o n al d el iv er ie s 5. 8 0. 97 50 0. 01 11 0. 01 1 1. 24 5 1. 11 6 26 2 24 7 0. 95 3 0. 99 7 C ae sa re an s ec ti o n 5. 9 0. 29 66 0. 03 40 0. 11 5 1. 36 0 1. 16 6 26 2 24 7 0. 22 9 0. 36 4 Li te ra cy r at e am o n g y o u n g w o m en 7. 1 0. 95 82 0. 00 96 0. 01 0 1. 54 5 1. 24 3 72 6 67 0 0. 93 9 0. 97 7 M ar ri ag e b ef o re a g e 18 8. 7 0. 24 31 0. 01 37 0. 05 6 1. 44 6 1. 20 2 15 42 14 25 0. 21 6 0. 27 0 Po ly g yn y 8. 9 0. 04 10 0. 00 64 0. 15 7 0. 93 8 0. 96 8 99 1 89 6 0. 02 8 0. 05 4 C o m p re h en si ve k n o w le d g e ab o u t H IV p re ve n ti o n a m o n g y o u n g p eo p le 9. 2 0. 54 67 0. 01 93 0. 03 5 1. 00 9 1. 00 5 72 6 67 0 0. 50 8 0. 58 5 K n o w le d g e o f m o th er -t o -c h ild t ra n sm is si o n o f H IV 9. 3 0. 58 61 0. 01 29 0. 02 2 1. 21 5 1. 10 2 19 26 17 72 0. 56 0 0. 61 2 A cc ep ti n g a tt it u d es t o w ar d s p eo p le li vi n g w it h H IV 9. 4 0. 23 39 0. 01 19 0. 05 1 1. 36 2 1. 16 7 18 86 17 38 0. 21 0 0. 25 8 W o m en w h o h av e b ee n t es te d f o r H IV d u ri n g la st 1 2 m o n th s an d w h o h av e b ee n t o ld th e re su lt s 9. 6 0. 33 76 0. 01 19 0. 03 5 1. 11 3 1. 05 5 19 26 17 72 0. 31 4 0. 36 1 S ex u al ly a ct iv e yo u n g w o m en w h o h av e b ee n t es te d f o r H IV a n d k n o w t h e re su lt s 9. 7 0. 37 14 0. 02 52 0. 06 8 1. 01 1 1. 00 6 40 4 37 3 0. 32 1 0. 42 2 S ex b ef o re a g e 15 a m o n g y o u n g w o m en 9. 11 0. 05 01 0. 00 83 0. 16 7 0. 98 1 0. 99 0 72 6 67 0 0. 03 3 0. 06 7 C o n d o m u se w it h n o n -r eg u la r p ar tn er s 9. 16 0. 70 04 0. 02 85 0. 04 1 0. 80 2 0. 89 5 22 4 20 8 0. 64 3 0. 75 7 U N D E R -5 s U n d er w ei g h t p re va le n ce 2. 1a 0. 05 39 0. 00 84 0. 15 6 0. 86 2 0. 92 9 67 8 62 6 0. 03 7 0. 07 1 S tu n ti n g p re va le n ce 2. 2a 0. 15 72 0. 01 62 0. 10 3 1. 21 8 1. 10 4 66 2 61 4 0. 12 5 0. 19 0 W as ti n g p re va le n ce 2. 3a 0. 02 82 0. 00 67 0. 23 7 0. 99 8 0. 99 9 66 1 61 2 0. 01 5 0. 04 2 E xc lu si ve b re as tf ee d in g u n d er 6 m o n th s 2. 6 0. 10 93 0. 02 91 0. 26 7 0. 47 1 0. 68 6 61 55 0. 05 1 0. 16 8 A g e- ap p ro p ri at e b re as tf ee d in g 2. 14 0. 33 05 0. 02 60 0. 07 9 0. 82 1 0. 90 6 29 8 27 0 0. 27 9 0. 38 2 Tu b er cu lo si s im m u n iz at io n c ov er ag e - 0. 98 86 0. 00 85 0. 00 9 0. 85 1 0. 92 3 14 5 13 5 0. 97 2 1. 00 0 Po lio o r D Ta P- P im m u n iz at io n - 0. 68 98 0. 03 78 0. 05 5 0. 88 3 0. 94 0 14 3 13 3 0. 61 4 0. 76 5 D P T ( Pe n ta va le n t) - 0. 69 43 0. 03 38 0. 04 9 0. 71 6 0. 84 6 14 3 13 4 0. 62 7 0. 76 2 R ec ei ve d m ea sl es im m u n iz at io n - 0. 88 74 0. 02 93 0. 03 3 1. 14 1 1. 06 8 14 4 13 4 0. 82 9 0. 94 6 R ec ei ve d H ep at it is B o r Pe n ta va le n t im m u n iz at io n - 0. 69 55 0. 03 39 0. 04 9 0. 71 0 0. 84 3 14 2 13 2 0. 62 8 0. 76 3 R ec ei ve d H iB o r Pe n ta va le n t im m u n iz at io n - 0. 69 07 0. 03 45 0. 05 0 0. 73 4 0. 85 7 14 3 13 3 0. 62 2 0. 76 0 D ia rr h o ea in la st t w o w ee ks - 0. 06 41 0. 01 20 0. 18 6 1. 62 0 1. 27 3 74 3 68 1 0. 04 0 0. 08 8 Ill n es s w it h c o u g h in t h e p re vi o u s 2 w ee ks - 0. 02 04 0. 00 58 0. 28 6 1. 15 9 1. 07 7 74 3 68 1 0. 00 9 0. 03 2 O ra l r eh yd ra ti o n t h er ap y w it h c o n ti n u ed f ee d in g 3. 8 * * * * * 48 40 * * A n ti b io ti c tr ea tm en t o f su sp ec te d p n eu m o n ia 3. 10 * * * * * 15 14 * * S u p p o rt f o r le ar n in g 6. 1 0. 88 52 0. 02 09 0. 02 4 1. 17 3 1. 08 3 30 0 27 5 0. 84 4 0. 92 7 A tt en d an ce t o e ar ly c h ild h o o d e d u ca ti o n 6. 7 0. 40 44 0. 03 28 0. 08 1 1. 22 6 1. 10 7 30 0 27 5 0. 33 9 0. 47 0 B ir th r eg is tr at io n 8. 1 0. 94 63 0. 00 83 0. 00 9 0. 92 2 0. 96 0 74 3 68 1 0. 93 0 0. 96 3 (* ): t h e n u m b er o f u n -w ei g h te d o b se rv at io n s is le ss t h an 5 0 mics f inal report 201 Ta b le S E .3 : S am p lin g e rr o rs : U rb an S ta n d ar d e rr o rs , c o ef fi ci en ts o f va ri at io n , d es ig n e ff ec ts ( d ef f) , s q u ar e ro o t o f d es ig n e ff ec ts ( d ef t) a n d c o n fi d en ce in te rv al s fo r se le ct ed in d ic at o rs , B el iz e, 2 01 1                         M IC S In d i- ca to r Va lu e (r ) S ta n d ar d er ro r (s e) C o ef fi ci en t o f va ri at io n (s e/ r) D es ig n ef fe ct (d ef f) S q u ar e ro o t o f d es ig n ef fe ct ( d ef t) W ei g h te d co u n t U nw ei g h te d co u n t C o n fi d en ce li m it s r - 2s e r + 2s e H O U S E H O LD M E M B E R S U se o f im p ro ve d d ri n ki n g w at er s o u rc es 4. 1 0. 99 54 0. 00 20 0. 00 2 1. 67 8 1. 29 5 75 36 20 04 0. 99 1 0. 99 9 U se o f im p ro ve d s an it at io n 4. 3 0. 93 78 0. 00 53 0. 00 6 0. 95 5 0. 97 7 74 10 19 61 0. 92 7 0. 94 8 S ec o n d ar y sc h o o l n et a tt en d an ce r at io ( ad ju st ed ) 7. 5 0. 69 20 0. 02 07 0. 03 0 1. 16 5 1. 08 0 62 5 57 9 0. 65 1 0. 73 3 C h ild la b o u r 8. 2 0. 04 12 0. 00 56 0. 13 6 1. 18 2 1. 08 7 15 82 14 85 0. 03 0 0. 05 2 Pr ev al en ce o f ch ild re n w it h o n e o r b o th p ar en ts d ea d 9. 18 0. 04 48 0. 00 58 0. 12 9 2. 03 6 1. 42 7 27 80 26 15 0. 03 3 0. 05 6 V io le n t d is ci p lin e 8. 5 0. 70 20 0. 01 53 0. 02 2 1. 12 2 1. 05 9 20 22 10 00 0. 67 1 0. 73 3 W O M E N Pr eg n an t w o m en - 0. 04 96 0. 00 58 0. 11 7 1. 26 8 1. 12 6 19 26 17 72 0. 03 8 0. 06 1 E ar ly c h ild b ea ri n g 5. 2 0. 14 15 0. 02 01 0. 14 2 1. 06 6 1. 03 3 34 3 32 3 0. 10 1 0. 18 2 C o n tr ac ep ti ve p re va le n ce 5. 3 0. 57 75 0. 01 96 0. 03 4 1. 41 3 1. 18 9 99 1 89 6 0. 53 8 0. 61 7 U n m et n ee d 5. 4 0. 14 13 0. 01 08 0. 07 7 0. 86 5 0. 93 0 99 1 89 6 0. 12 0 0. 16 3 A n te n at al c ar e co ve ra g e - at le as t o n ce b y sk ill ed p er so n n el 5. 5a 0. 97 32 0. 00 64 0. 00 7 0. 38 8 0. 62 3 26 2 24 7 0. 96 0 0. 98 6 A n te n at al c ar e co ve ra g e - at le as t fo u r ti m es b y an y p ro vi d er 5. 5b 0. 87 36 0. 01 88 0. 02 2 0. 78 7 0. 88 7 26 2 24 7 0. 83 6 0. 91 1 S ki lle d a tt en d an t at d el iv er y 5. 7 0. 98 43 0. 00 84 0. 00 9 1. 12 8 1. 06 2 26 2 24 7 0. 96 7 1. 00 0 In st it u ti o n al d el iv er ie s 5. 8 0. 97 50 0. 01 11 0. 01 1 1. 24 5 1. 11 6 26 2 24 7 0. 95 3 0. 99 7 C ae sa re an s ec ti o n 5. 9 0. 29 66 0. 03 40 0. 11 5 1. 36 0 1. 16 6 26 2 24 7 0. 22 9 0. 36 4 Li te ra cy r at e am o n g y o u n g w o m en 7. 1 0. 95 82 0. 00 96 0. 01 0 1. 54 5 1. 24 3 72 6 67 0 0. 93 9 0. 97 7 M ar ri ag e b ef o re a g e 18 8. 7 0. 24 31 0. 01 37 0. 05 6 1. 44 6 1. 20 2 15 42 14 25 0. 21 6 0. 27 0 Po ly g yn y 8. 9 0. 04 10 0. 00 64 0. 15 7 0. 93 8 0. 96 8 99 1 89 6 0. 02 8 0. 05 4 C o m p re h en si ve k n o w le d g e ab o u t H IV p re ve n ti o n a m o n g y o u n g p eo p le 9. 2 0. 54 67 0. 01 93 0. 03 5 1. 00 9 1. 00 5 72 6 67 0 0. 50 8 0. 58 5 K n o w le d g e o f m o th er -t o -c h ild t ra n sm is si o n o f H IV 9. 3 0. 58 61 0. 01 29 0. 02 2 1. 21 5 1. 10 2 19 26 17 72 0. 56 0 0. 61 2 A cc ep ti n g a tt it u d es t o w ar d s p eo p le li vi n g w it h H IV 9. 4 0. 23 39 0. 01 19 0. 05 1 1. 36 2 1. 16 7 18 86 17 38 0. 21 0 0. 25 8 W o m en w h o h av e b ee n t es te d f o r H IV d u ri n g la st 1 2 m o n th s an d w h o h av e b ee n t o ld th e re su lt s 9. 6 0. 33 76 0. 01 19 0. 03 5 1. 11 3 1. 05 5 19 26 17 72 0. 31 4 0. 36 1 S ex u al ly a ct iv e yo u n g w o m en w h o h av e b ee n t es te d f o r H IV a n d k n o w t h e re su lt s 9. 7 0. 37 14 0. 02 52 0. 06 8 1. 01 1 1. 00 6 40 4 37 3 0. 32 1 0. 42 2 S ex b ef o re a g e 15 a m o n g y o u n g w o m en 9. 11 0. 05 01 0. 00 83 0. 16 7 0. 98 1 0. 99 0 72 6 67 0 0. 03 3 0. 06 7 C o n d o m u se w it h n o n -r eg u la r p ar tn er s 9. 16 0. 70 04 0. 02 85 0. 04 1 0. 80 2 0. 89 5 22 4 20 8 0. 64 3 0. 75 7 U N D E R -5 s U n d er w ei g h t p re va le n ce 2. 1a 0. 05 39 0. 00 84 0. 15 6 0. 86 2 0. 92 9 67 8 62 6 0. 03 7 0. 07 1 S tu n ti n g p re va le n ce 2. 2a 0. 15 72 0. 01 62 0. 10 3 1. 21 8 1. 10 4 66 2 61 4 0. 12 5 0. 19 0 W as ti n g p re va le n ce 2. 3a 0. 02 82 0. 00 67 0. 23 7 0. 99 8 0. 99 9 66 1 61 2 0. 01 5 0. 04 2 E xc lu si ve b re as tf ee d in g u n d er 6 m o n th s 2. 6 0. 10 93 0. 02 91 0. 26 7 0. 47 1 0. 68 6 61 55 0. 05 1 0. 16 8 A g e- ap p ro p ri at e b re as tf ee d in g 2. 14 0. 33 05 0. 02 60 0. 07 9 0. 82 1 0. 90 6 29 8 27 0 0. 27 9 0. 38 2 Tu b er cu lo si s im m u n iz at io n c ov er ag e - 0. 98 86 0. 00 85 0. 00 9 0. 85 1 0. 92 3 14 5 13 5 0. 97 2 1. 00 0 Po lio o r D Ta P- P im m u n iz at io n - 0. 68 98 0. 03 78 0. 05 5 0. 88 3 0. 94 0 14 3 13 3 0. 61 4 0. 76 5 D P T ( Pe n ta va le n t) - 0. 69 43 0. 03 38 0. 04 9 0. 71 6 0. 84 6 14 3 13 4 0. 62 7 0. 76 2 R ec ei ve d m ea sl es im m u n iz at io n - 0. 88 74 0. 02 93 0. 03 3 1. 14 1 1. 06 8 14 4 13 4 0. 82 9 0. 94 6 R ec ei ve d H ep at it is B o r Pe n ta va le n t im m u n iz at io n - 0. 69 55 0. 03 39 0. 04 9 0. 71 0 0. 84 3 14 2 13 2 0. 62 8 0. 76 3 R ec ei ve d H iB o r Pe n ta va le n t im m u n iz at io n - 0. 69 07 0. 03 45 0. 05 0 0. 73 4 0. 85 7 14 3 13 3 0. 62 2 0. 76 0 D ia rr h o ea in la st t w o w ee ks - 0. 06 41 0. 01 20 0. 18 6 1. 62 0 1. 27 3 74 3 68 1 0. 04 0 0. 08 8 Ill n es s w it h c o u g h in t h e p re vi o u s 2 w ee ks - 0. 02 04 0. 00 58 0. 28 6 1. 15 9 1. 07 7 74 3 68 1 0. 00 9 0. 03 2 O ra l r eh yd ra ti o n t h er ap y w it h c o n ti n u ed f ee d in g 3. 8 * * * * * 48 40 * * A n ti b io ti c tr ea tm en t o f su sp ec te d p n eu m o n ia 3. 10 * * * * * 15 14 * * S u p p o rt f o r le ar n in g 6. 1 0. 88 52 0. 02 09 0. 02 4 1. 17 3 1. 08 3 30 0 27 5 0. 84 4 0. 92 7 A tt en d an ce t o e ar ly c h ild h o o d e d u ca ti o n 6. 7 0. 40 44 0. 03 28 0. 08 1 1. 22 6 1. 10 7 30 0 27 5 0. 33 9 0. 47 0 B ir th r eg is tr at io n 8. 1 0. 94 63 0. 00 83 0. 00 9 0. 92 2 0. 96 0 74 3 68 1 0. 93 0 0. 96 3 (* ): t h e n u m b er o f u n -w ei g h te d o b se rv at io n s is le ss t h an 5 0 Ta b le S E .4 : S am p lin g e rr o rs : R u ra l S ta n d ar d e rr o rs , c o ef fi ci en ts o f va ri at io n , d es ig n e ff ec ts ( d ef f) , s q u ar e ro o t o f d es ig n e ff ec ts ( d ef t) a n d c o n fi d en ce in te rv al s fo r se le ct ed in d ic at o rs , B el iz e, 2 01 1                         M IC S In d ic at o r Va lu e (r ) S ta n d ar d er ro r (s e) C o ef fi ci en t o f va ri at io n (s e/ r) D es ig n ef fe ct (d ef f) S q u ar e ro o t o f d es ig n ef fe ct ( d ef t) W ei g h te d co u n t U nw ei g h te d co u n t C o n fi d en ce li m it s r - 2s e r + 2s e H O U S E H O LD M E M B E R S U se o f im p ro ve d d ri n ki n g w at er s o u rc es 4. 1 0. 96 19 0. 01 05 0. 01 1 7. 33 9 2. 70 9 97 52 24 20 0. 94 1 0. 98 3 U se o f im p ro ve d s an it at io n 4. 3 0. 90 41 0. 00 60 0. 00 7 0. 95 2 0. 97 6 93 68 22 96 0. 89 2 0. 91 6 S ec o n d ar y sc h o o l n et a tt en d an ce r at io ( ad ju st ed ) 7. 5 0. 45 94 0. 01 86 0. 04 1 1. 36 7 1. 16 9 90 6 97 9 0. 42 2 0. 49 7 C h ild la b o u r 8. 2 0. 13 75 0. 00 93 0. 06 8 1. 96 9 1. 40 3 24 89 27 09 0. 11 9 0. 15 6 Pr ev al en ce o f ch ild re n w it h o n e o r b o th p ar en ts d ea d 9. 18 0. 03 42 0. 00 56 0. 16 5 4. 52 9 2. 12 8 43 14 47 06 0. 02 3 0. 04 5 V io le n t d is ci p lin e 8. 5 0. 70 68 0. 01 58 0. 02 2 1. 76 8 1. 33 0 32 09 14 67 0. 67 5 0. 73 8 W O M E N Pr eg n an t w o m en - 0. 06 60 0. 00 61 0. 09 3 1. 41 1 1. 18 8 21 70 23 24 0. 05 4 0. 07 8 E ar ly c h ild b ea ri n g 5. 2 0. 19 38 0. 01 74 0. 09 0 0. 78 1 0. 88 4 37 7 40 6 0. 15 9 0. 22 9 C o n tr ac ep ti ve p re va le n ce 5. 3 0. 53 32 0. 01 80 0. 03 4 1. 94 7 1. 39 5 13 95 14 98 0. 49 7 0. 56 9 U n m et n ee d 5. 4 0. 17 13 0. 00 97 0. 05 7 0. 98 9 0. 99 4 13 95 14 98 0. 15 2 0. 19 1 A n te n at al c ar e co ve ra g e - at le as t o n ce b y sk ill ed p er so n n el 5. 5a 0. 95 54 0. 01 00 0. 01 0 1. 06 4 1. 03 1 42 4 45 5 0. 93 5 0. 97 5 A n te n at al c ar e co ve ra g e - at le as t fo u r ti m es b y an y p ro vi d er 5. 5b 0. 80 50 0. 01 72 0. 02 1 0. 85 5 0. 92 5 42 4 45 5 0. 77 1 0. 83 9 S ki lle d a tt en d an t at d el iv er y 5. 7 0. 94 76 0. 01 43 0. 01 5 1. 86 3 1. 36 5 42 4 45 5 0. 91 9 0. 97 6 In st it u ti o n al d el iv er ie s 5. 8 0. 91 57 0. 01 60 0. 01 7 1. 50 4 1. 22 7 42 4 45 5 0. 88 4 0. 94 8 C ae sa re an s ec ti o n 5. 9 0. 27 15 0. 01 81 0. 06 7 0. 75 1 0. 86 6 42 4 45 5 0. 23 5 0. 30 8 Li te ra cy r at e am o n g y o u n g w o m en 7. 1 0. 85 95 0. 01 78 0. 02 1 2. 40 0 1. 54 9 83 8 91 1 0. 82 4 0. 89 5 M ar ri ag e b ef o re a g e 18 8. 7 0. 34 01 0. 01 38 0. 04 1 1. 54 2 1. 24 2 17 10 18 19 0. 31 2 0. 36 8 Po ly g yn y 8. 9 0. 02 99 0. 00 45 0. 15 0 1. 03 4 1. 01 7 13 95 14 98 0. 02 1 0. 03 9 C o m p re h en si ve k n o w le d g e ab o u t H IV p re ve n ti o n a m o n g y o u n g p eo p le 9. 2 0. 32 66 0. 01 89 0. 05 8 1. 48 1 1. 21 7 83 8 91 1 0. 28 9 0. 36 4 K n o w le d g e o f m o th er -t o -c h ild t ra n sm is si o n o f H IV 9. 3 0. 53 14 0. 01 39 0. 02 6 1. 80 6 1. 34 4 21 70 23 24 0. 50 4 0. 55 9 A cc ep ti n g a tt it u d es t o w ar d s p eo p le li vi n g w it h H IV 9. 4 0. 15 39 0. 01 00 0. 06 5 1. 58 8 1. 26 0 19 93 20 66 0. 13 4 0. 17 4 W o m en w h o h av e b ee n t es te d f o r H IV d u ri n g la st 1 2 m o n th s an d w h o h av e b ee n t o ld th e re su lt s 9. 6 0. 23 60 0. 01 43 0. 06 1 2. 64 8 1. 62 7 21 70 23 24 0. 20 7 0. 26 5 S ex u al ly a ct iv e yo u n g w o m en w h o h av e b ee n t es te d f o r H IV a n d k n o w t h e re su lt s 9. 7 0. 30 79 0. 02 70 0. 08 8 1. 51 1 1. 22 9 41 6 44 4 0. 25 4 0. 36 2 S ex b ef o re a g e 15 a m o n g y o u n g w o m en 9. 11 0. 05 52 0. 00 75 0. 13 7 0. 99 5 0. 99 7 83 8 91 1 0. 04 0 0. 07 0 C o n d o m u se w it h n o n -r eg u la r p ar tn er s 9. 16 0. 54 12 0. 04 74 0. 08 8 1. 00 6 1. 00 3 11 6 11 2 0. 44 6 0. 63 6 U N D E R -5 s U n d er w ei g h t p re va le n ce 2. 1a 0. 06 62 0. 00 62 0. 09 3 0. 73 6 0. 85 8 11 32 11 96 0. 05 4 0. 07 9 S tu n ti n g p re va le n ce 2. 2a 0. 21 43 0. 01 35 0. 06 3 1. 27 6 1. 12 9 11 18 11 84 0. 18 7 0. 24 1 W as ti n g p re va le n ce 2. 3a 0. 03 57 0. 00 58 0. 16 4 1. 15 8 1. 07 6 11 07 11 69 0. 02 4 0. 04 7 E xc lu si ve b re as tf ee d in g u n d er 6 m o n th s 2. 6 0. 17 26 0. 03 20 0. 18 6 0. 64 0 0. 80 0 87 90 0. 10 9 0. 23 7 A g e- ap p ro p ri at e b re as tf ee d in g 2. 14 0. 41 51 0. 02 25 0. 05 4 1. 01 2 1. 00 6 46 3 48 5 0. 37 0 0. 46 0 Tu b er cu lo si s im m u n iz at io n c ov er ag e - 0. 97 45 0. 01 03 0. 01 1 1. 17 3 1. 08 3 25 8 27 5 0. 95 4 0. 99 5 Po lio o r D Ta P- P im m u n iz at io n - 0. 70 58 0. 02 52 0. 03 6 0. 81 0 0. 90 0 25 2 26 7 0. 65 6 0. 75 6 D P T ( Pe n ta va le n t) - 0. 73 11 0. 02 75 0. 03 8 1. 01 9 1. 01 0 25 3 26 6 0. 67 6 0. 78 6 R ec ei ve d m ea sl es im m u n iz at io n - 0. 89 22 0. 02 61 0. 02 9 1. 84 0 1. 35 6 24 9 26 0 0. 84 0 0. 94 4 R ec ei ve d H ep at it is B o r Pe n ta va le n t im m u n iz at io n - 0. 72 42 0. 02 71 0. 03 7 0. 98 1 0. 99 0 25 2 26 7 0. 67 0 0. 77 9 R ec ei ve d H iB o r Pe n ta va le n t im m u n iz at io n - 0. 72 31 0. 02 66 0. 03 7 0. 93 7 0. 96 8 25 2 26 6 0. 67 0 0. 77 6 D ia rr h o ea in la st t w o w ee ks - 0. 08 79 0. 00 63 0. 07 2 0. 63 3 0. 79 5 12 03 12 65 0. 07 5 0. 10 1 Ill n es s w it h c o u g h in t h e p re vi o u s 2 w ee ks - 0. 03 52 0. 00 67 0. 19 2 1. 69 2 1. 30 1 12 03 12 65 0. 02 2 0. 04 9 O ra l r eh yd ra ti o n t h er ap y w it h c o n ti n u ed f ee d in g 3. 8 0. 35 60 0. 04 64 0. 13 0 1. 00 7 1. 00 3 10 6 10 8 0. 26 3 0. 44 9 A n ti b io ti c tr ea tm en t o f su sp ec te d p n eu m o n ia 3. 10 0. 63 71 0. 02 35 0. 03 7 0. 12 2 0. 34 9 42 52 0. 59 0 0. 68 4 S u p p o rt f o r le ar n in g 6. 1 0. 83 89 0. 02 26 0. 02 7 1. 93 4 1. 39 1 49 2 51 3 0. 79 4 0. 88 4 A tt en d an ce t o e ar ly c h ild h o o d e d u ca ti o n 6. 7 0. 26 41 0. 02 54 0. 09 6 1. 70 0 1. 30 4 49 2 51 3 0. 21 3 0. 31 5 B ir th r eg is tr at io n 8. 1 0. 95 62 0. 00 54 0. 00 6 0. 88 9 0. 94 3 12 03 12 65 0. 94 5 0. 96 7 202 mics f inal report Ta b le S E .5 : S am p lin g e rr o rs : C o ro za l S ta n d ar d e rr o rs , c o ef fi ci en ts o f va ri at io n , d es ig n e ff ec ts ( d ef f) , s q u ar e ro o t o f d es ig n e ff ec ts ( d ef t) a n d c o n fi d en ce in te rv al s fo r se le ct ed in d ic at o rs , B el iz e, 2 01 1                         M IC S In d ic at o r Va lu e (r ) S ta n d ar d er ro r (s e) C o ef fi ci en t o f va ri at io n (s e/ r) D es ig n ef fe ct (d ef f) S q u ar e ro o t o f d es ig n ef fe ct ( d ef t) W ei g h te d co u n t U nw ei g h te d co u n t C o n fi d en ce li m it s r - 2s e r + 2s e H O U S E H O LD M E M B E R S U se o f im p ro ve d d ri n ki n g w at er s o u rc es 4. 1 0. 95 59 0. 01 47 0. 01 5 3. 27 3 1. 80 9 22 96 64 2 0. 92 7 0. 98 5 U se o f im p ro ve d s an it at io n 4. 3 0. 86 88 0. 01 25 0. 01 4 0. 86 4 0. 93 0 22 60 63 4 0. 84 4 0. 89 4 S ec o n d ar y sc h o o l n et a tt en d an ce r at io ( ad ju st ed ) 7. 5 0. 45 17 0. 04 24 0. 09 4 1. 79 5 1. 34 0 20 1 24 8 0. 36 7 0. 53 6 C h ild la b o u r 8. 2 0. 16 62 0. 01 74 0. 10 5 1. 41 5 1. 18 9 52 5 64 8 0. 13 1 0. 20 1 Pr ev al en ce o f ch ild re n w it h o n e o r b o th p ar en ts d ea d 9. 18 0. 03 55 0. 00 65 0. 18 3 1. 41 5 1. 18 9 92 8 11 46 0. 02 3 0. 04 9 V io le n t d is ci p lin e 8. 5 0. 66 13 0. 02 74 0. 04 1 1. 29 8 1. 13 9 67 5 38 8 0. 60 6 0. 71 6 W O M E N Pr eg n an t w o m en - 0. 05 39 0. 00 76 0. 14 1 0. 73 6 0. 85 8 53 4 64 8 0. 03 9 0. 06 9 E ar ly c h ild b ea ri n g 5. 2 0. 15 26 0. 02 84 0. 18 6 0. 64 9 0. 80 6 87 10 5 0. 09 6 0. 20 9 C o n tr ac ep ti ve p re va le n ce 5. 3 0. 61 80 0. 02 35 0. 03 8 0. 97 9 0. 98 9 34 6 42 0 0. 57 1 0. 66 5 U n m et n ee d 5. 4 0. 11 37 0. 01 24 0. 10 9 0. 64 0 0. 80 0 34 6 42 0 0. 08 9 0. 13 9 A n te n at al c ar e co ve ra g e - at le as t o n ce b y sk ill ed p er so n n el 5. 5a 0. 99 11 0. 00 86 0. 00 9 0. 96 4 0. 98 2 95 11 5 0. 97 4 1. 00 0 A n te n at al c ar e co ve ra g e - at le as t fo u r ti m es b y an y p ro vi d er 5. 5b 0. 84 05 0. 04 50 0. 05 4 1. 71 9 1. 31 1 95 11 5 0. 75 1 0. 93 0 S ki lle d a tt en d an t at d el iv er y 5. 7 0. 94 58 0. 02 34 0. 02 5 1. 21 9 1. 10 4 95 11 5 0. 89 9 0. 99 3 In st it u ti o n al d el iv er ie s 5. 8 0. 98 22 0. 01 30 0. 01 3 1. 09 1 1. 04 5 95 11 5 0. 95 6 1. 00 0 C ae sa re an s ec ti o n 5. 9 0. 30 16 0. 03 55 0. 11 8 0. 68 1 0. 82 5 95 11 5 0. 23 1 0. 37 3 Li te ra cy r at e am o n g y o u n g w o m en 7. 1 0. 84 23 0. 04 44 0. 05 3 3. 47 8 1. 86 5 19 4 23 5 0. 75 3 0. 93 1 M ar ri ag e b ef o re a g e 18 8. 7 0. 35 17 0. 02 06 0. 05 9 0. 96 6 0. 98 3 42 7 51 8 0. 31 0 0. 39 3 Po ly g yn y 8. 9 0. 07 69 0. 01 22 0. 15 8 0. 87 7 0. 93 6 34 6 42 0 0. 05 3 0. 10 1 C o m p re h en si ve k n o w le d g e ab o u t H IV p re ve n ti o n a m o n g y o u n g p eo p le 9. 2 0. 26 56 0. 03 01 0. 11 3 1. 08 6 1. 04 2 19 4 23 5 0. 20 5 0. 32 6 K n o w le d g e o f m o th er -t o -c h ild t ra n sm is si o n o f H IV 9. 3 0. 48 68 0. 02 46 0. 05 1 1. 56 8 1. 25 2 53 4 64 8 0. 43 8 0. 53 6 A cc ep ti n g a tt it u d es t o w ar d s p eo p le li vi n g w it h H IV 9. 4 0. 19 19 0. 02 86 0. 14 9 3. 26 8 1. 80 8 51 0 62 1 0. 13 5 0. 24 9 W o m en w h o h av e b ee n t es te d f o r H IV d u ri n g la st 1 2 m o n th s an d w h o h av e b ee n t o ld th e re su lt s 9. 6 0. 19 60 0. 02 28 0. 11 6 2. 12 8 1. 45 9 53 4 64 8 0. 15 0 0. 24 1 S ex u al ly a ct iv e yo u n g w o m en w h o h av e b ee n t es te d f o r H IV a n d k n o w t h e re su lt s 9. 7 0. 22 65 0. 04 28 0. 18 9 1. 11 7 1. 05 7 89 10 8 0. 14 1 0. 31 2 S ex b ef o re a g e 15 a m o n g y o u n g w o m en 9. 11 0. 04 74 0. 01 26 0. 26 5 0. 81 9 0. 90 5 19 4 23 5 0. 02 2 0. 07 3 C o n d o m u se w it h n o n -r eg u la r p ar tn er s 9. 16 * * * * * 24 29 * * U N D E R -5 s U n d er w ei g h t p re va le n ce 2. 1a 0. 06 95 0. 01 43 0. 20 6 0. 94 8 0. 97 4 25 1 30 0 0. 04 1 0. 09 8 S tu n ti n g p re va le n ce 2. 2a 0. 19 67 0. 03 20 0. 16 3 1. 91 5 1. 38 4 24 9 29 7 0. 13 3 0. 26 1 W as ti n g p re va le n ce 2. 3a 0. 03 06 0. 01 00 0. 32 6 0. 98 9 0. 99 4 24 8 29 6 0. 01 1 0. 05 0 E xc lu si ve b re as tf ee d in g u n d er 6 m o n th s 2. 6 * * * * * 18 21 * * A g e- ap p ro p ri at e b re as tf ee d in g 2. 14 0. 58 03 0. 04 06 0. 07 0 0. 88 1 0. 93 8 11 0 13 1 0. 49 9 0. 66 2 Tu b er cu lo si s im m u n iz at io n c ov er ag e - 0. 98 34 0. 01 65 0. 01 7 1. 08 4 1. 04 1 55 66 0. 95 0 1. 00 0 Po lio o r D Ta P- P im m u n iz at io n - 0. 82 07 0. 03 05 0. 03 7 0. 39 3 0. 62 7 53 63 0. 76 0 0. 88 2 D P T ( Pe n ta va le n t) - 0. 71 32 0. 05 95 0. 08 3 1. 14 1 1. 06 8 56 67 0. 59 4 0. 83 2 R ec ei ve d m ea sl es im m u n iz at io n - 0. 93 62 0. 03 79 0. 04 1 1. 56 6 1. 25 1 55 66 0. 86 0 1. 00 0 R ec ei ve d H ep at it is B o r Pe n ta va le n t im m u n iz at io n - 0. 76 22 0. 04 24 0. 05 6 0. 62 5 0. 79 1 54 64 0. 67 7 0. 84 7 R ec ei ve d H iB o r Pe n ta va le n t im m u n iz at io n - 0. 77 33 0. 03 78 0. 04 9 0. 50 6 0. 71 1 53 63 0. 69 8 0. 84 9 D ia rr h o ea in la st t w o w ee ks - 0. 09 23 0. 01 29 0. 14 0 0. 62 3 0. 78 9 26 3 31 4 0. 06 6 0. 11 8 Ill n es s w it h c o u g h in t h e p re vi o u s 2 w ee ks - 0. 02 19 0. 01 11 0. 50 8 1. 80 8 1. 34 4 26 3 31 4 0. 00 0 0. 04 4 O ra l r eh yd ra ti o n t h er ap y w it h c o n ti n u ed f ee d in g 3. 8 * * * * * 24 30 * * A n ti b io ti c tr ea tm en t o f su sp ec te d p n eu m o n ia 3. 10 * * * * * 6 7 * * S u p p o rt f o r le ar n in g 6. 1 0. 83 95 0. 05 60 0. 06 7 2. 79 1 1. 67 1 10 1 12 1 0. 72 8 0. 95 1 A tt en d an ce t o e ar ly c h ild h o o d e d u ca ti o n 6. 7 0. 19 06 0. 03 92 0. 20 5 1. 19 3 1. 09 2 10 1 12 1 0. 11 2 0. 26 9 B ir th r eg is tr at io n 8. 1 0. 93 33 0. 01 08 0. 01 2 0. 58 2 0. 76 3 26 3 31 4 0. 91 2 0. 95 5 (* ): t h e n u m b er o f u nw ei g h te d o b se rv at io n s is le ss t h an 5 0 mics f inal report 203 Ta b le S E .6 : S am p lin g e rr o rs : O ra n g e W al k S ta n d ar d e rr o rs , c o ef fi ci en ts o f va ri at io n , d es ig n e ff ec ts ( d ef f) , s q u ar e ro o t o f d es ig n e ff ec ts ( d ef t) a n d c o n fi d en ce in te rv al s fo r se le ct ed in d ic at o rs , B el iz e, 2 01 1   M IC S In d ic at o r Va lu e (r ) S ta n d ar d er ro r (s e) C o ef fi ci en t o f va ri at io n (s e/ r) D es ig n ef fe ct (d ef f) S q u ar e ro o t o f d es ig n ef fe ct ( d ef t) W ei g h te d co u n t U nw ei g h te d co u n t C o n fi d en ce li m it s r - 2s e r + 2s e H O U S E H O LD M E M B E R S U se o f im p ro ve d d ri n ki n g w at er s o u rc es 4. 1 0. 97 56 0. 00 88 0. 00 9 2. 17 4 1. 47 5 25 84 66 2 0. 95 8 0. 99 3 U se o f im p ro ve d s an it at io n 4. 3 0. 94 43 0. 00 98 0. 01 0 1. 18 9 1. 09 0 25 59 65 1 0. 92 5 0. 96 4 S ec o n d ar y sc h o o l n et a tt en d an ce r at io ( ad ju st ed ) 7. 5 0. 44 61 0. 04 23 0. 09 5 1. 70 6 1. 30 6 21 6 23 6 0. 36 1 0. 53 1 C h ild la b o u r 8. 2 0. 07 40 0. 00 73 0. 09 9 0. 49 7 0. 70 5 58 1 63 9 0. 05 9 0. 08 9 Pr ev al en ce o f ch ild re n w it h o n e o r b o th p ar en ts d ea d 9. 18 0. 03 09 0. 00 62 0. 20 0 1. 45 1 1. 20 5 10 39 11 45 0. 01 9 0. 04 3 V io le n t d is ci p lin e 8. 5 0. 59 69 0. 02 20 0. 03 7 0. 77 6 0. 88 1 75 5 38 6 0. 55 3 0. 64 1 W O M E N Pr eg n an t w o m en - 0. 05 97 0. 01 06 0. 17 8 1. 37 7 1. 17 3 61 8 68 8 0. 03 9 0. 08 1 E ar ly c h ild b ea ri n g 5. 2 0. 17 44 0. 03 23 0. 18 5 0. 97 1 0. 98 5 12 1 13 5 0. 11 0 0. 23 9 C o n tr ac ep ti ve p re va le n ce 5. 3 0. 58 94 0. 03 23 0. 05 5 1. 80 5 1. 34 4 37 3 41 9 0. 52 5 0. 65 4 U n m et n ee d 5. 4 0. 12 95 0. 01 46 0. 11 3 0. 78 8 0. 88 7 37 3 41 9 0. 10 0 0. 15 9 A n te n at al c ar e co ve ra g e - at le as t o n ce b y sk ill ed p er so n n el 5. 5a 1. 00 00 0. 00 00 0. 00 0 . . 10 8 12 2 1. 00 0 1. 00 0 A n te n at al c ar e co ve ra g e - at le as t fo u r ti m es b y an y p ro vi d er 5. 5b 0. 84 78 0. 01 45 0. 01 7 0. 19 6 0. 44 3 10 8 12 2 0. 81 9 0. 87 7 S ki lle d a tt en d an t at d el iv er y 5. 7 0. 99 28 0. 00 72 0. 00 7 0. 88 5 0. 94 1 10 8 12 2 0. 97 8 1. 00 0 In st it u ti o n al d el iv er ie s 5. 8 0. 91 58 0. 01 49 0. 01 6 0. 34 8 0. 59 0 10 8 12 2 0. 88 6 0. 94 6 C ae sa re an s ec ti o n 5. 9 0. 17 32 0. 03 61 0. 20 9 1. 10 2 1. 05 0 10 8 12 2 0. 10 1 0. 24 5 Li te ra cy r at e am o n g y o u n g w o m en 7. 1 0. 81 36 0. 03 29 0. 04 0 2. 04 6 1. 43 0 25 8 28 7 0. 74 8 0. 87 9 M ar ri ag e b ef o re a g e 18 8. 7 0. 31 02 0. 03 36 0. 10 8 2. 81 6 1. 67 8 48 1 53 6 0. 24 3 0. 37 7 Po ly g yn y 8. 9 0. 00 69 0. 00 39 0. 57 4 0. 95 3 0. 97 6 37 3 41 9 0. 00 0 0. 01 5 C o m p re h en si ve k n o w le d g e ab o u t H IV p re ve n ti o n a m o n g y o u n g p eo p le 9. 2 0. 33 89 0. 03 49 0. 10 3 1. 55 2 1. 24 6 25 8 28 7 0. 26 9 0. 40 9 K n o w le d g e o f m o th er -t o -c h ild t ra n sm is si o n o f H IV 9. 3 0. 59 63 0. 02 09 0. 03 5 1. 24 7 1. 11 7 61 8 68 8 0. 55 5 0. 63 8 A cc ep ti n g a tt it u d es t o w ar d s p eo p le li vi n g w it h H IV 9. 4 0. 13 69 0. 01 17 0. 08 6 0. 74 8 0. 86 5 58 0 64 3 0. 11 3 0. 16 0 W o m en w h o h av e b ee n t es te d f o r H IV d u ri n g la st 1 2 m o n th s an d w h o h av e b ee n t o ld th e re su lt s 9. 6 0. 26 03 0. 01 65 0. 06 3 0. 97 0 0. 98 5 61 8 68 8 0. 22 7 0. 29 3 S ex u al ly a ct iv e yo u n g w o m en w h o h av e b ee n t es te d f o r H IV a n d k n o w t h e re su lt s 9. 7 0. 29 08 0. 03 86 0. 13 3 1. 07 6 1. 03 7 13 4 15 0 0. 21 4 0. 36 8 S ex b ef o re a g e 15 a m o n g y o u n g w o m en 9. 11 0. 05 14 0. 01 33 0. 25 9 1. 04 2 1. 02 1 25 8 28 7 0. 02 5 0. 07 8 C o n d o m u se w it h n o n -r eg u la r p ar tn er s 9. 16 * * * * * 35 39 * * U N D E R -5 s U n d er w ei g h t p re va le n ce 2. 1a 0. 04 68 0. 00 94 0. 20 1 0. 58 7 0. 76 6 28 0 29 6 0. 02 8 0. 06 6 S tu n ti n g p re va le n ce 2. 2a 0. 17 25 0. 02 45 0. 14 2 1. 23 3 1. 11 1 27 8 29 4 0. 12 3 0. 22 1 W as ti n g p re va le n ce 2. 3a 0. 02 37 0. 00 85 0. 35 8 0. 91 9 0. 95 9 28 0 29 6 0. 00 7 0. 04 1 E xc lu si ve b re as tf ee d in g u n d er 6 m o n th s 2. 6 * * * * * 28 29 * * A g e- ap p ro p ri at e b re as tf ee d in g 2. 14 0. 34 74 0. 05 31 0. 15 3 1. 60 7 1. 26 8 12 4 13 0 0. 24 1 0. 45 4 Tu b er cu lo si s im m u n iz at io n c ov er ag e - 1. 00 00 0. 00 00 0. 00 0 . . 67 70 1. 00 0 1. 00 0 Po lio o r D Ta P- P im m u n iz at io n - 0. 74 36 0. 05 16 0. 06 9 0. 96 2 0. 98 1 67 70 0. 64 1 0. 84 7 D P T ( Pe n ta va le n t) - 0. 75 90 0. 05 28 0. 07 0 1. 02 0 1. 01 0 65 68 0. 65 3 0. 86 5 R ec ei ve d m ea sl es im m u n iz at io n - 0. 95 75 0. 02 32 0. 02 4 0. 89 7 0. 94 7 66 69 0. 91 1 1. 00 0 R ec ei ve d H ep at it is B o r Pe n ta va le n t im m u n iz at io n - 0. 73 88 0. 05 63 0. 07 6 1. 13 2 1. 06 4 67 70 0. 62 6 0. 85 1 R ec ei ve d H iB o r Pe n ta va le n t im m u n iz at io n - 0. 73 88 0. 05 63 0. 07 6 1. 13 2 1. 06 4 67 70 0. 62 6 0. 85 1 D ia rr h o ea in la st t w o w ee ks - 0. 03 41 0. 00 87 0. 25 4 0. 72 5 0. 85 2 30 2 32 0 0. 01 7 0. 05 1 Ill n es s w it h c o u g h in t h e p re vi o u s 2 w ee ks - 0. 00 89 0. 00 68 0. 76 0 1. 65 6 1. 28 7 30 2 32 0 0. 00 0 0. 02 2 O ra l r eh yd ra ti o n t h er ap y w it h c o n ti n u ed f ee d in g 3. 8 * * * * * 10 11 * * A n ti b io ti c tr ea tm en t o f su sp ec te d p n eu m o n ia 3. 10 * * * * * 3 3 * * S u p p o rt f o r le ar n in g 6. 1 0. 83 09 0. 02 62 0. 03 2 0. 61 2 0. 78 2 11 8 12 6 0. 77 8 0. 88 3 A tt en d an ce t o e ar ly c h ild h o o d e d u ca ti o n 6. 7 0. 16 33 0. 02 34 0. 14 3 0. 50 1 0. 70 8 11 8 12 6 0. 11 7 0. 21 0 B ir th r eg is tr at io n 8. 1 0. 95 25 0. 00 85 0. 00 9 0. 50 9 0. 71 3 30 2 32 0 0. 93 5 0. 96 9 (* ): t h e n u m b er o f u nw ei g h te d o b se rv at io n s is le ss t h an 5 0 204 mics f inal report Ta b le S E .7 : S am p lin g e rr o rs : B el iz e (E xc lu d in g B el iz e C it y S o u th S id e) S ta n d ar d e rr o rs , c o ef fi ci en ts o f va ri at io n , d es ig n e ff ec ts ( deff ), s q u ar e ro o t o f d es ig n e ff ec ts ( d ef t) a n d c o n fi d en ce in te rv al s fo r se le ct ed in d ic at o rs , B el iz e, 2 01 1 M IC S In di ca to r Va lu e (r ) S ta nd ar d er ro r ( se ) C oe ffi ci en t of v ar ia tio n (s e/ r) D es ig n ef fe ct (d ef f) S qu ar e ro ot of d es ig n ef fe ct (d ef t) W ei gh te d co un t U nw ei gh te d co un t C on fid en ce lim its r - 2 se r + 2 se H O U S E H O LD M E M B E R S u se o f i m pr ov ed d ri nk in g w at er s ou rc es 4. 1 0. 99 74 0. 00 13 0. 00 1 0. 40 7 0. 63 8 27 99 58 1 0. 99 5 1. 00 0 U se o f i m pr ov ed s an it ati on 4. 3 0. 93 86 0. 01 16 0. 01 2 1. 34 0 1. 15 8 27 83 57 3 0. 91 5 0. 96 2 Se co nd ar y sc ho ol n et a tt en da nc e ra ti o (a dj us te d) 7. 5 0. 69 62 0. 03 69 0. 05 3 0. 97 4 0. 98 7 22 3 15 2 0. 62 2 0. 77 0 Ch ild la bo ur 8. 2 0. 04 87 0. 00 91 0. 18 7 0. 69 9 0. 83 6 57 0 39 0 0. 03 0 0. 06 7 Pr ev al en ce o f c hi ld re n w ith o ne o r bo th p ar en ts d ea d 9. 18 0. 04 04 0. 01 54 0. 38 1 3. 99 4 1. 99 8 95 6 65 5 0. 01 0 0. 07 1 Vi ol en t d is ci pl in e 8. 5 0. 75 72 0. 01 23 0. 01 6 0. 21 1 0. 45 9 72 3 25 7 0. 73 3 0. 78 2 W O M E N Pr eg na nt w om en - 0. 06 27 0. 01 40 0. 22 4 1. 50 0 1. 22 5 68 7 44 8 0. 03 5 0. 09 1 ea rl y ch ild be ar in g 5. 2 0. 13 01 0. 03 15 0. 24 2 0. 65 0 0. 80 6 11 6 75 0. 06 7 0. 19 3 Co nt ra ce pti ve p re va le nc e 5. 3 0. 57 17 0. 03 46 0. 06 1 1. 18 1 1. 08 7 36 9 24 2 0. 50 2 0. 64 1 u nm et n ee d 5. 4 0. 15 94 0. 02 40 0. 15 0 1. 03 3 1. 01 6 36 9 24 2 0. 11 1 0. 20 7 a nt en at al c ar e co ve ra ge - at le as t o nc e by s ki lle d pe rs on ne l 5. 5a * * * * * 74 48 * * a nt en at al c ar e co ve ra ge - at le as t fo ur ti m es b y an y pr ov id er 5. 5b * * * * * 74 48 * * Sk ill ed a tt en da nt a t de liv er y 5. 7 * * * * * 74 48 * * In sti tu ti on al d el iv er ie s 5. 8 * * * * * 74 48 * * Ca es ar ea n se cti on 5. 9 * * * * * 74 48 * * li te ra cy ra te a m on g yo un g w om en 7. 1 0. 98 21 0. 00 99 0. 01 0 0. 93 1 0. 96 5 25 5 16 7 0. 96 2 1. 00 0 M ar ri ag e be fo re a ge 1 8 8. 7 0. 26 54 0. 03 07 0. 11 6 1. 71 9 1. 31 1 54 8 35 6 0. 20 4 0. 32 7 Po ly gy ny 8. 9 0. 01 96 0. 00 69 0. 35 4 0. 60 3 0. 77 6 36 9 24 2 0. 00 6 0. 03 3 Co m pr eh en si ve k no w le dg e ab ou t H Iv p re ve nti on a m on g yo un g pe op le 9. 2 0. 69 66 0. 03 53 0. 05 1 0. 97 6 0. 98 8 25 5 16 7 0. 62 6 0. 76 7 Kn ow le dg e of m ot he r- to -c hi ld tr an sm is si on o f h IV 9. 3 0. 58 22 0. 02 58 0. 04 4 1. 22 1 1. 10 5 68 7 44 8 0. 53 1 0. 63 4 a cc ep ti ng a tti tu de s to w ar ds p eo pl e liv in g w it h H Iv 9. 4 0. 21 80 0. 02 00 0. 09 2 1. 03 4 1. 01 7 67 6 44 1 0. 17 8 0. 25 8 W om en w ho h av e be en te st ed fo r h IV d ur in g la st 1 2 m on th s an d w ho h av e be en to ld th e re su lts 9. 6 0. 30 78 0. 02 84 0. 09 2 1. 69 5 1. 30 2 68 7 44 8 0. 25 1 0. 36 5 Se xu al ly a cti ve y ou ng w om en w ho h av e be en t es te d fo r H Iv a nd k no w t he r es ul ts 9. 7 0. 32 01 0. 05 80 0. 18 1 1. 45 3 1. 20 5 14 6 95 0. 20 4 0. 43 6 se x be fo re a ge 1 5 am on g yo un g w om en 9. 11 0. 05 95 0. 01 53 0. 25 6 0. 69 0 0. 83 1 25 5 16 7 0. 02 9 0. 09 0 Co nd om u se w ith n on -r eg ul ar p ar tn er s 9. 16 0. 72 03 0. 05 20 0. 07 2 0. 69 7 0. 83 5 82 53 0. 61 6 0. 82 4 U N D E R -5 s u nd er w ei gh t p re va le nc e 2. 1a 0. 04 98 0. 01 83 0. 36 7 0. 88 0 0. 93 8 19 8 12 6 0. 01 3 0. 08 6 St un ti ng p re va le nc e 2. 2a 0. 13 92 0. 03 07 0. 22 1 0. 92 3 0. 96 1 18 6 11 8 0. 07 8 0. 20 1 W as ti ng p re va le nc e 2. 3a 0. 04 25 0. 01 38 0. 32 4 0. 54 4 0. 73 8 18 6 11 8 0. 01 5 0. 07 0 Ex cl us iv e br ea stf ee di ng u nd er 6 m on th s 2. 6 * * * * * 17 11 * * a ge -a pp ro pr ia te b re as tf ee di ng 2. 14 0. 38 07 0. 06 09 0. 16 0 0. 80 1 0. 89 5 83 52 0. 25 9 0. 50 2 Tu be rc ul os is im m un iz ati on c ov er ag e - * * * * * 36 23 * * Po lio o r d Ta P- P im m un iz ati on - * * * * * 36 23 * * D PT (P en ta va le nt ) - * * * * * 36 23 * * re ce iv ed m ea sl es im m un iz ati on - * * * * * 36 23 * * re ce iv ed H ep ati ti s B or P en ta va le nt im m un iz ati on - * * * * * 36 23 * * re ce iv ed H iB o r Pe nt av al en t im m un iz ati on - * * * * * 36 23 * * D ia rr ho ea in la st tw o w ee ks - 0. 05 37 0. 02 13 0. 39 6 1. 35 3 1. 16 3 24 0 15 3 0. 01 1 0. 09 6 Ill ne ss w ith c ou gh in th e pr ev io us 2 w ee ks - 0. 00 65 0. 00 68 1. 05 6 1. 10 3 1. 05 0 24 0 15 3 0. 00 0 0. 02 0 o ra l r eh yd ra ti on t he ra py w it h co nti nu ed fe ed in g 3. 8 * * * * * 13 8 * * a nti bi oti c tr ea tm en t of s us pe ct ed p ne um on ia 3. 10 * * * * * 2 1 * * su pp or t f or le ar ni ng 6. 1 0. 80 58 0. 04 48 0. 05 6 0. 93 5 0. 96 7 11 5 74 0. 71 6 0. 89 5 a tt en da nc e to e ar ly c hi ld ho od e du ca ti on 6. 7 0. 56 20 0. 06 88 0. 12 2 1. 40 5 1. 18 5 11 5 74 0. 42 4 0. 70 0 Bi rt h re gi st ra ti on 8. 1 0. 96 24 0. 01 68 0. 01 7 1. 18 1 1. 08 7 24 0 15 3 0. 92 9 0. 99 6 (* ): t h e n u m b er o f u nw ei g h te d o b se rv at io n s is le ss t h an 5 0 mics f inal report 205 Table SE.8: Sampling errors: Belize City, South Side Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Belize, 2011   MICS Indicator Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.9981 0.0020 0.002 1.255 1.120 2177 638 0.994 1.000 Use of improved sanitation 4.3 0.9283 0.0101 0.011 0.929 0.964 2071 604 0.908 0.949 Secondary school net attendance ratio (adjusted) 7.5 0.7474 0.0249 0.033 0.596 0.772 175 182 0.698 0.797 Child labour 8.2 0.0401 0.0131 0.327 2.257 1.502 488 506 0.014 0.066 Prevalence of children with one or both parents dead 9.18 0.0460 0.0085 0.185 1.481 1.217 866 900 0.029 0.063 Violent discipline 8.5 0.7600 0.0261 0.034 1.287 1.134 646 345 0.708 0.812 WOMEN Pregnant women - 0.0438 0.0086 0.196 1.074 1.037 573 612 0.027 0.061 Early childbearing 5.2 0.1582 0.0341 0.216 1.015 1.007 110 117 0.090 0.226 Contraceptive prevalence 5.3 0.5518 0.0250 0.045 0.689 0.830 257 274 0.502 0.602 Unmet need 5.4 0.1800 0.0252 0.140 1.173 1.083 257 274 0.130 0.230 Antenatal care coverage - at least once by skilled personnel 5.5a 0.9641 0.0202 0.021 0.951 0.975 77 82 0.924 1.000 Antenatal care coverage - at least four times by any provider 5.5b 0.8225 0.0406 0.049 0.913 0.956 77 82 0.741 0.904 Skilled attendant at delivery 5.7 0.9749 0.0179 0.018 1.060 1.029 77 82 0.939 1.000 Institutional deliveries 5.8 0.9749 0.0179 0.018 1.060 1.029 77 82 0.939 1.000 Caesarean section 5.9 0.3537 0.0675 0.191 1.615 1.271 77 82 0.219 0.489 Literacy rate among young women 7.1 0.9778 0.0049 0.005 0.248 0.498 216 230 0.968 0.987 Marriage before age 18 8.7 0.2157 0.0210 0.097 1.299 1.140 467 499 0.174 0.258 Polygyny 8.9 0.0365 0.0109 0.297 0.916 0.957 257 274 0.015 0.058 Comprehensive knowledge about HIV prevention among young people 9.2 0.6292 0.0291 0.046 0.834 0.913 216 230 0.571 0.688 Knowledge of mother-to-child transmission of HIV 9.3 0.5819 0.0236 0.041 1.404 1.185 573 612 0.535 0.629 Accepting attitudes towards people living with HIV 9.4 0.2047 0.0112 0.055 0.470 0.686 571 610 0.182 0.227 Women who have been tested for HIV during last 12 months and who have been told the results 9.6 0.4128 0.0213 0.052 1.149 1.072 573 612 0.370 0.455 Sexually active young women who have been tested for HIV and know the results 9.7 0.4165 0.0416 0.100 0.984 0.992 131 139 0.333 0.500 Sex before age 15 among young women 9.11 0.0605 0.0136 0.225 0.744 0.863 216 230 0.033 0.088 Condom use with non-regular partners 9.16 0.7034 0.0427 0.061 0.831 0.912 91 96 0.618 0.789 UNDER-5s Underweight prevalence 2.1a 0.0560 0.0114 0.204 0.579 0.761 235 235 0.033 0.079 Stunting prevalence 2.2a 0.0815 0.0181 0.222 1.022 1.011 235 235 0.045 0.118 Wasting prevalence 2.3a 0.0336 0.0111 0.331 0.886 0.941 234 234 0.011 0.056 Exclusive breastfeeding under 6 months 2.6 * * * * * 20 20 * * Age-appropriate breastfeeding 2.14 0.3234 0.0429 0.133 0.749 0.866 91 90 0.238 0.409 Tuberculosis immunization coverage - 0.9800 0.0205 0.021 1.095 1.046 52 52 0.939 1.000 Polio or DTaP-P immunization - * * * * * 49 49 * * DPT (Pentavalent) - 0.7299 0.0569 0.078 0.821 0.906 51 51 0.616 0.844 Received measles immunization - 0.9013 0.0330 0.037 0.611 0.782 51 51 0.835 0.967 Received Hepatitis B or Pentavalent immunization - * * * * * 48 48 * * Received HiB or Pentavalent immunization - * * * * * 49 49 * * Diarrhoea in last two weeks - 0.0409 0.0138 0.338 1.219 1.104 252 252 0.013 0.068 Illness with cough in the previous 2 weeks - 0.0411 0.0147 0.356 1.368 1.169 252 252 0.012 0.070 Oral rehydration therapy with continued feeding 3.8 * * * * * 10 10 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 10 10 * * Support for learning 6.1 0.8816 0.0418 0.047 1.810 1.345 109 109 0.798 0.965 Attendance to early childhood education 6.7 0.4953 0.0683 0.138 2.013 1.419 109 109 0.359 0.632 Birth registration 8.1 0.9456 0.0139 0.015 0.937 0.968 252 252 0.918 0.973 (*): the number of unweighted observations is less than 50 206 mics f inal report Table SE.9: Sampling errors: Belize District Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for se- lected indicators, Belize, 2011   MICS Indicator Value (r) Standard error (se) Coeffi- cient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.9977 0.0011 0.001 0.693 0.833 4976 1219 0.995 1.000 Use of improved sanitation 4.3 0.9342 0.0079 0.008 1.200 1.095 4854 1177 0.918 0.950 Secondary school net attendance ratio (adjusted) 7.5 0.7188 0.0235 0.033 0.911 0.954 398 334 0.672 0.766 Child labour 8.2 0.0448 0.0078 0.173 1.258 1.122 1058 896 0.029 0.060 Prevalence of children with one or both parents dead 9.18 0.0431 0.0090 0.210 3.084 1.756 1822 1555 0.025 0.061 Violent discipline 8.5 0.7585 0.0139 0.018 0.637 0.798 1369 602 0.731 0.786 WOMEN Pregnant women - 0.0541 0.0086 0.160 1.546 1.243 1260 1060 0.037 0.071 Early childbearing 5.2 0.1438 0.0232 0.162 0.837 0.915 226 192 0.097 0.190 Contraceptive prevalence 5.3 0.5635 0.0228 0.041 1.092 1.045 625 516 0.518 0.609 Unmet need 5.4 0.1678 0.0174 0.104 1.116 1.056 625 516 0.133 0.203 Antenatal care coverage - at least once by skilled personnel 5.5a 0.9173 0.0165 0.018 0.464 0.681 151 130 0.884 0.950 Antenatal care coverage - at least four times by any provider 5.5b 0.8170 0.0283 0.035 0.692 0.832 151 130 0.760 0.874 Skilled attendant at delivery 5.7 0.9769 0.0138 0.014 1.085 1.042 151 130 0.949 1.000 Institutional deliveries 5.8 0.9651 0.0187 0.019 1.336 1.156 151 130 0.928 1.000 Caesarean section 5.9 0.3130 0.0427 0.136 1.092 1.045 151 130 0.228 0.398 Literacy rate among young women 7.1 0.9801 0.0058 0.006 0.682 0.826 471 397 0.969 0.992 Marriage before age 18 8.7 0.2425 0.0191 0.079 1.695 1.302 1014 855 0.204 0.281 Polygyny 8.9 0.0265 0.0061 0.230 0.742 0.861 625 516 0.014 0.039 Comprehensive knowledge about HIV prevention among young people 9.2 0.6657 0.0232 0.035 0.955 0.977 471 397 0.619 0.712 Knowledge of mother-to-child transmission of HIV 9.3 0.5821 0.0177 0.030 1.363 1.168 1260 1060 0.547 0.617 Accepting attitudes towards people living with HIV 9.4 0.2119 0.0121 0.057 0.914 0.956 1247 1051 0.188 0.236 Women who have been tested for HIV during last 12 months and who have been told the results 9.6 0.3555 0.0185 0.052 1.583 1.258 1260 1060 0.319 0.393 Sexually active young women who have been tested for HIV and know the results 9.7 0.3658 0.0362 0.099 1.317 1.148 278 234 0.293 0.438 Sex before age 15 among young women 9.11 0.0600 0.0104 0.173 0.753 0.868 471 397 0.039 0.081 Condom use with non-regular partners 9.16 0.7114 0.0336 0.047 0.813 0.902 173 149 0.644 0.779 UNDER-5s Underweight prevalence 2.1a 0.0532 0.0104 0.195 0.770 0.878 434 361 0.032 0.074 Stunting prevalence 2.2a 0.1069 0.0165 0.155 1.009 1.004 421 353 0.074 0.140 Wasting prevalence 2.3a 0.0375 0.0087 0.231 0.730 0.855 420 352 0.020 0.055 Exclusive breastfeeding under 6 months 2.6 0.0797 0.0037 0.046 0.006 0.075 37 31 0.072 0.087 Age-appropriate breastfeeding 2.14 0.3507 0.0361 0.103 0.809 0.899 174 142 0.278 0.423 Tuberculosis immunization coverage - 0.9882 0.0120 0.012 0.911 0.954 88 75 0.964 1.000 Polio or DTaP-P immunization - 0.6474 0.0497 0.077 0.768 0.877 85 72 0.548 0.747 DPT (Pentavalent) - 0.6794 0.0414 0.061 0.575 0.758 87 74 0.597 0.762 Received measles immunization - 0.9238 0.0259 0.028 0.693 0.832 87 74 0.872 0.975 Received Hepatitis B or Pentavalent immunization - 0.6909 0.0416 0.060 0.568 0.754 84 71 0.608 0.774 Received HiB or Pentavalent immunization - 0.6828 0.0429 0.063 0.604 0.777 85 72 0.597 0.769 Diarrhoea in last two weeks - 0.0471 0.0125 0.265 1.399 1.183 492 405 0.022 0.072 Illness with cough in the previous 2 weeks - 0.0242 0.0081 0.334 1.119 1.058 492 405 0.008 0.040 Oral rehydration therapy with continued feeding 3.8 * * * * * 23 18 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 12 11 * * Support for learning 6.1 0.8428 0.0293 0.035 1.179 1.086 224 183 0.784 0.901 Attendance to early childhood education 6.7 0.5295 0.0483 0.091 1.704 1.305 224 183 0.433 0.626 Birth registration 8.1 0.9537 0.0108 0.011 1.077 1.038 492 405 0.932 0.975 (*): the number of unweighted observations is less than 50 mics f inal report 207 Table SE.10: Sampling errors: Cayo Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Belize, 2011   MICS Indica- tor Value (r) Stan- dard error (se) Coeffi- cient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Un- weighted count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.9556 0.0243 0.025 8.723 2.954 3865 626 0.907 1.000 Use of improved sanitation 4.3 0.9114 0.0080 0.009 0.491 0.701 3829 620 0.895 0.927 Secondary school net attendance ratio (adjusted) 7.5 0.5434 0.0347 0.064 1.284 1.133 382 266 0.474 0.613 Child labour 8.2 0.0937 0.0163 0.174 2.033 1.426 952 650 0.061 0.126 Prevalence of children with one or both parents dead 9.18 0.0318 0.0102 0.320 3.869 1.967 1676 1148 0.011 0.052 Violent discipline 8.5 0.6576 0.0364 0.055 2.238 1.496 1201 381 0.585 0.730 WOMEN Pregnant women - 0.0599 0.0104 0.173 1.156 1.075 933 605 0.039 0.081 Early childbearing 5.2 0.1453 0.0380 0.262 1.142 1.069 151 99 0.069 0.221 Contraceptive prevalence 5.3 0.5686 0.0362 0.064 2.057 1.434 601 387 0.496 0.641 Unmet need 5.4 0.1180 0.0151 0.128 0.844 0.919 601 387 0.088 0.148 Antenatal care coverage - at least once by skilled person- nel 5.5a 0.9751 0.0179 0.018 1.572 1.254 189 120 0.939 1.000 Antenatal care coverage - at least four times by any pro- vider 5.5b 0.9088 0.0213 0.023 0.651 0.807 189 120 0.866 0.951 Skilled attendant at delivery 5.7 0.9660 0.0271 0.028 2.664 1.632 189 120 0.912 1.000 Institutional deliveries 5.8 0.9474 0.0307 0.032 2.245 1.498 189 120 0.886 1.000 Caesarean section 5.9 0.3960 0.0413 0.104 0.851 0.922 189 120 0.313 0.479 Literacy rate among young women 7.1 0.9096 0.0273 0.030 2.046 1.431 347 226 0.855 0.964 Marriage before age 18 8.7 0.2698 0.0172 0.064 0.718 0.847 737 478 0.235 0.304 Polygyny 8.9 0.0517 0.0109 0.211 0.940 0.969 601 387 0.030 0.074 Comprehensive knowledge about HIV prevention among young people 9.2 0.2724 0.0319 0.117 1.152 1.073 347 226 0.209 0.336 Knowledge of mother-to-child transmission of HIV 9.3 0.5704 0.0245 0.043 1.485 1.219 933 605 0.521 0.619 Accepting attitudes towards people living with HIV 9.4 0.1824 0.0180 0.099 1.266 1.125 898 584 0.146 0.218 Women who have been tested for HIV during last 12 months and who have been told the results 9.6 0.3081 0.0268 0.087 2.041 1.429 933 605 0.254 0.362 Sexually active young women who have been tested for HIV and know the results 9.7 0.4172 0.0431 0.103 0.834 0.913 170 110 0.331 0.503 Sex before age 15 among young women 9.11 0.0313 0.0137 0.439 1.396 1.182 347 226 0.004 0.059 Condom use with non-regular partners 9.16 * * * * * 59 38 * * UNDER-5s Underweight prevalence 2.1a 0.0526 0.0107 0.204 0.636 0.798 421 276 0.031 0.074 Stunting prevalence 2.2a 0.1857 0.0265 0.142 1.245 1.116 413 270 0.133 0.239 Wasting prevalence 2.3a 0.0278 0.0108 0.388 1.151 1.073 410 268 0.006 0.049 Exclusive breastfeeding under 6 months 2.6 * * * * * 40 28 * * Age-appropriate breastfeeding 2.14 0.2885 0.0263 0.091 0.424 0.651 195 127 0.236 0.341 Tuberculosis immunization coverage - 0.9690 0.0220 0.023 1.067 1.033 99 67 0.925 1.000 Polio or DTaP-P immunization - 0.6986 0.0512 0.073 0.823 0.907 99 67 0.596 0.801 DPT (Pentavalent) - 0.7779 0.0517 0.066 1.006 1.003 98 66 0.674 0.881 Received measles immunization - 0.8042 0.0650 0.081 1.772 1.331 99 67 0.674 0.934 Received Hepatitis B or Pentavalent immunization - 0.7684 0.0514 0.067 0.981 0.990 99 67 0.666 0.871 Received HiB or Pentavalent immunization - 0.7684 0.0514 0.067 0.981 0.990 99 67 0.666 0.871 Diarrhoea in last two weeks - 0.1356 0.0158 0.116 0.624 0.790 450 295 0.104 0.167 Illness with cough in the previous 2 weeks - 0.0280 0.0121 0.433 1.586 1.259 450 295 0.004 0.052 Oral rehydration therapy with continued feeding 3.8 * * * * * 61 40 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 13 8 * * Support for learning 6.1 0.9121 0.0403 0.044 2.164 1.471 167 108 0.832 0.993 Attendance to early childhood education 6.7 0.2472 0.0569 0.230 1.863 1.365 167 108 0.133 0.361 Birth registration 8.1 0.9477 0.0126 0.013 0.948 0.973 450 295 0.922 0.973 (*): the number of unweighted observations is less than 50 208 mics f inal report Table SE.11: Sampling errors: Stann Creek Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Belize, 2011    MICS Indicator Value (r) Stan- dard error (se) Coeffi- cient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weight- ed count Unweight- ed count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.9951 0.0038 0.004 1.794 1.340 1833 605 0.988 1.000 Use of improved sanitation 4.3 0.9187 0.0136 0.015 1.395 1.181 1718 565 0.892 0.946 Secondary school net attendance ratio (adjusted) 7.5 0.5557 0.0567 0.102 2.774 1.665 173 214 0.442 0.669 Child labour 8.2 0.1349 0.0169 0.125 1.405 1.185 467 575 0.101 0.169 Prevalence of children with one or both parents dead 9.18 0.0644 0.0164 0.254 4.405 2.099 804 993 0.032 0.097 Violent discipline 8.5 0.7481 0.0346 0.046 1.999 1.414 599 315 0.679 0.817 WOMEN Pregnant women - 0.0630 0.0128 0.204 1.373 1.172 404 493 0.037 0.089 Early childbearing 5.2 0.2123 0.0296 0.139 0.439 0.662 70 85 0.153 0.271 Contraceptive prevalence 5.3 0.5668 0.0292 0.051 0.949 0.974 225 275 0.508 0.625 Unmet need 5.4 0.1974 0.0217 0.110 0.817 0.904 225 275 0.154 0.241 Antenatal care coverage - at least once by skilled per- sonnel 5.5a 0.9760 0.0161 0.017 0.944 0.971 69 86 0.944 1.000 Antenatal care coverage - at least four times by any provider 5.5b 0.8855 0.0299 0.034 0.750 0.866 69 86 0.826 0.945 Skilled attendant at delivery 5.7 0.9779 0.0113 0.012 0.503 0.709 69 86 0.955 1.000 Institutional deliveries 5.8 0.9677 0.0148 0.015 0.600 0.774 69 86 0.938 0.997 Caesarean section 5.9 0.1935 0.0445 0.230 1.080 1.039 69 86 0.104 0.283 Literacy rate among young women 7.1 0.9089 0.0256 0.028 1.407 1.186 147 179 0.858 0.960 Marriage before age 18 8.7 0.2797 0.0291 0.104 1.670 1.292 327 399 0.222 0.338 Polygyny 8.9 0.0074 0.0053 0.719 1.051 1.025 225 275 0.000 0.018 Comprehensive knowledge about HIV prevention among young people 9.2 0.4889 0.0506 0.104 1.824 1.350 147 179 0.388 0.590 Knowledge of mother-to-child transmission of HIV 9.3 0.5377 0.0240 0.045 1.136 1.066 404 493 0.490 0.586 Accepting attitudes towards people living with HIV 9.4 0.2831 0.0280 0.099 1.871 1.368 399 486 0.227 0.339 Women who have been tested for HIV during last 12 months and who have been told the results 9.6 0.2850 0.0244 0.086 1.438 1.199 404 493 0.236 0.334 Sexually active young women who have been tested for HIV and know the results 9.7 0.4237 0.0504 0.119 1.082 1.040 87 105 0.323 0.524 Sex before age 15 among young women 9.11 0.0967 0.0235 0.243 1.122 1.059 147 179 0.050 0.144 Condom use with non-regular partners 9.16 * * * * * 39 47 * * UNDER-5s Underweight prevalence 2.1a 0.0948 0.0173 0.182 0.850 0.922 207 245 0.060 0.129 Stunting prevalence 2.2a 0.1748 0.0271 0.155 1.232 1.110 206 243 0.121 0.229 Wasting prevalence 2.3a 0.0488 0.0171 0.351 1.524 1.234 205 242 0.015 0.083 Exclusive breastfeeding under 6 months 2.6 * * * * * 9 11 * * Age-appropriate breastfeeding 2.14 0.3610 0.0526 0.146 1.104 1.051 77 93 0.256 0.466 Tuberculosis immunization coverage - * * * * * 39 46 * * Polio or DTaP-P immunization - * * * * * 38 44 * * DPT (Pentavalent) - * * * * * 40 47 * * Received measles immunization - * * * * * 38 45 * * Received Hepatitis B or Pentavalent immunization - * * * * * 37 43 * * Received HiB or Pentavalent immunization - * * * * * 38 44 * * Diarrhoea in last two weeks - 0.0824 0.0118 0.143 0.458 0.677 212 251 0.059 0.106 Illness with cough in the previous 2 weeks - 0.0370 0.0148 0.400 1.537 1.240 212 251 0.007 0.067 Oral rehydration therapy with continued feeding 3.8 * * * * * 18 21 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 8 10 * * Support for learning 6.1 0.8608 0.0464 0.054 1.904 1.380 92 107 0.768 0.954 Attendance to early childhood education 6.7 0.4496 0.0280 0.062 0.337 0.580 92 107 0.394 0.506 Birth registration 8.1 0.9766 0.0082 0.008 0.745 0.863 212 251 0.960 0.993 (*): the number of unweighted observations is less than 50 mics f inal report 209 Table SE.12: Sampling errors: Toledo Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for se- lected indicators, Belize, 2011   MICS Indicator Value (r) Stan- dard error (se) Coeffi- cient of variation (se/r) Design effect (deff) Square root of de- sign effect (deft) Weight- ed count Unweight- ed count Confidence limits r - 2se r + 2se HOUSEHOLD MEMBERS Use of improved drinking water sources 4.1 0.9712 0.0075 0.008 1.356 1.164 1733 670 0.956 0.986 Use of improved sanitation 4.3 0.9216 0.0114 0.012 1.103 1.050 1560 610 0.899 0.945 Secondary school net attendance ratio (adjust- ed) 7.5 0.4457 0.0309 0.069 1.004 1.002 161 260 0.384 0.508 Child labour 8.2 0.1591 0.0231 0.145 3.143 1.773 489 786 0.113 0.205 Prevalence of children with one or both parents dead 9.18 0.0283 0.0076 0.268 2.799 1.673 825 1334 0.013 0.044 Violent discipline 8.5 0.8137 0.0122 0.015 0.384 0.620 631 395 0.789 0.838 WOMEN Pregnant women - 0.0675 0.0103 0.153 1.015 1.008 347 602 0.047 0.088 Early childbearing 5.2 0.2759 0.0415 0.150 0.965 0.982 65 113 0.193 0.359 Contraceptive prevalence 5.3 0.2828 0.0327 0.115 1.977 1.406 217 377 0.218 0.348 Unmet need 5.4 0.3285 0.0241 0.073 0.991 0.995 217 377 0.280 0.377 Antenatal care coverage - at least once by skilled personnel 5.5a 0.9155 0.0149 0.016 0.368 0.607 73 129 0.886 0.945 Antenatal care coverage - at least four times by any provider 5.5b 0.5724 0.0334 0.058 0.585 0.765 73 129 0.506 0.639 Skilled attendant at delivery 5.7 0.8776 0.0262 0.030 0.819 0.905 73 129 0.825 0.930 Institutional deliveries 5.8 0.8073 0.0337 0.042 0.935 0.967 73 129 0.740 0.875 Caesarean section 5.9 0.1339 0.0272 0.203 0.815 0.903 73 129 0.080 0.188 Literacy rate among young women 7.1 0.8956 0.0196 0.022 1.051 1.025 147 257 0.856 0.935 Marriage before age 18 8.7 0.4547 0.0237 0.052 1.036 1.018 265 458 0.407 0.502 Polygyny 8.9 0.0176 0.0081 0.461 1.432 1.197 217 377 0.001 0.034 Comprehensive knowledge about HIV preven- tion among young people 9.2 0.3497 0.0277 0.079 0.861 0.928 147 257 0.294 0.405 Knowledge of mother-to-child transmission of HIV 9.3 0.4920 0.0256 0.052 1.574 1.255 347 602 0.441 0.543 Accepting attitudes towards people living with HIV 9.4 0.1211 0.0209 0.173 1.721 1.312 245 419 0.079 0.163 Women who have been tested for HIV during last 12 months and who have been told the results 9.6 0.1332 0.0165 0.124 1.413 1.189 347 602 0.100 0.166 Sexually active young women who have been tested for HIV and know the results 9.7 0.1559 0.0389 0.249 1.253 1.119 62 110 0.078 0.234 Sex before age 15 among young women 9.11 0.0460 0.0121 0.263 0.857 0.926 147 257 0.022 0.070 Condom use with non-regular partners 9.16 * * * * * 10 18 * * UNDER-5s Underweight prevalence 2.1a 0.0740 0.0136 0.184 0.927 0.963 216 344 0.047 0.101 Stunting prevalence 2.2a 0.4160 0.0264 0.063 0.974 0.987 214 341 0.363 0.469 Wasting prevalence 2.3a 0.0328 0.0095 0.290 0.931 0.965 206 327 0.014 0.052 Exclusive breastfeeding under 6 months 2.6 * * * * * 16 25 * * Age-appropriate breastfeeding 2.14 0.4746 0.0536 0.113 1.510 1.229 82 132 0.367 0.582 Tuberculosis immunization coverage - 0.9409 0.0242 0.026 0.893 0.945 54 86 0.893 0.989 Polio or DTaP-P immunization - 0.5426 0.0409 0.075 0.560 0.748 53 84 0.461 0.624 DPT (Pentavalent) - 0.5714 0.0418 0.073 0.550 0.742 49 78 0.488 0.655 Received measles immunization - 0.8266 0.0353 0.043 0.627 0.792 46 73 0.756 0.897 Received Hepatitis B or Pentavalent immuniza- tion - 0.5079 0.0421 0.083 0.588 0.767 53 84 0.424 0.592 Received HiB or Pentavalent immunization - 0.5026 0.0397 0.079 0.516 0.718 52 83 0.423 0.582 Diarrhoea in last two weeks - 0.0754 0.0130 0.172 0.867 0.931 226 361 0.049 0.101 Illness with cough in the previous 2 weeks - 0.0734 0.0179 0.244 1.702 1.305 226 361 0.038 0.109 Oral rehydration therapy with continued feeding 3.8 * * * * * 17 28 * * Antibiotic treatment of suspected pneumonia 3.10 * * * * * 17 27 * * Support for learning 6.1 0.8356 0.0401 0.048 1.662 1.289 90 143 0.755 0.916 Attendance to early childhood education 6.7 0.1282 0.0176 0.137 0.392 0.626 90 143 0.093 0.163 Birth registration 8.1 0.9581 0.0126 0.013 1.421 1.192 226 361 0.933 0.983 (*): the number of unweighted observations is less than 50 210 mics f inal report appendix f. daTa QualiTy Tables Table DQ.1: Age distribution of household population Single-year age distribution of household population by sex, Belize, 2011 Male Female Number Percent Number Percent Age 0 199 2.3 149 1.7 1 188 2.2 207 2.4 2 190 2.2 194 2.2 3 205 2.4 185 2.1 4 178 2.1 206 2.4 5 182 2.1 203 2.3 6 197 2.3 206 2.4 7 194 2.3 186 2.1 8 228 2.7 182 2.1 9 214 2.5 212 2.4 10 228 2.7 227 2.6 11 204 2.4 223 2.6 12 190 2.2 205 2.3 13 189 2.2 202 2.3 14 191 2.2 209 2.4 15 194 2.3 185 2.1 16 192 2.2 212 2.4 17 168 2.0 169 1.9 18 189 2.2 192 2.2 19 176 2.1 181 2.1 20 157 1.8 177 2.0 21 155 1.8 144 1.7 22 148 1.7 159 1.8 23 146 1.7 165 1.9 24 159 1.8 156 1.8 25 128 1.5 142 1.6 26 119 1.4 133 1.5 27 135 1.6 142 1.6 28 123 1.4 151 1.7 29 110 1.3 146 1.7 30 120 1.4 136 1.6 31 115 1.3 99 1.1 32 113 1.3 110 1.3 33 135 1.6 127 1.5 34 121 1.4 115 1.3 35 99 1.2 132 1.5 36 103 1.2 117 1.3 37 110 1.3 105 1.2 38 108 1.3 118 1.4 39 118 1.4 116 1.3 40 118 1.4 115 1.3 41 87 1.0 99 1.1 42 117 1.4 86 1.0 43 97 1.1 81 0.9 44 68 0.8 93 1.1 45 88 1.0 85 1.0 46 78 0.9 78 0.9 47 94 1.1 82 0.9 48 75 0.9 70 0.8 49 65 0.8 63 0.7 50 84 1.0 91 1.0 51 65 0.8 76 0.9 52 65 0.8 67 0.8 53 75 0.9 79 0.9 54 59 0.7 63 0.7 55 39 0.5 54 0.6 56 60 0.7 58 0.7 57 60 0.7 41 0.5 58 52 0.6 42 0.5 59 53 0.6 47 0.5 60 42 0.5 48 0.6 61 34 0.4 45 0.5 62 36 0.4 40 0.5 63 45 0.5 42 0.5 64 45 0.5 42 0.5 65 23 0.3 27 0.3 66 37 0.4 24 0.3 67 31 0.4 28 0.3 68 26 0.3 23 0.3 69 26 0.3 19 0.2 70 22 0.3 32 0.4 71 32 0.4 16 0.2 72 25 0.3 22 0.2 73 23 0.3 15 0.2 74 18 0.2 26 0.3 75 10 0.1 11 0.1 76 26 0.3 12 0.1 77 18 0.2 9 0.1 78 9 0.1 17 0.2 79 12 0.1 9 0.1 80+ 95 1.1 85 1.0 DK/missing 29 0.3 19 0.2 Total 8582 100.0 8705 100.0 mics f inal report 211 Table DQ.2: Age distribution of eligible and interviewed women Household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed, by five-year age groups, Belize, 2011 Household population of women age 10-54 Interviewed women age 15-49 Percentage of eligible women interviewed (Completion rate) Number Number Percent   Age 10-14 1066 na na na 15-19 939 836 20.6 89.1 20-24 801 715 17.6 89.2 25-29 714 644 15.9 90.1 30-34 587 540 13.3 92.0 35-39 587 529 13.0 90.1 40-44 475 437 10.8 91.9 45-49 379 355 8.8 93.8 50-54 376 na na na Total (15-49) 4482 4055 100.0 90.5 na: not applicable Weights used for both household population of women (Column B) and interviewed women (Column D) are household weights. Age is based on the household schedule. Table DQ.3: Age distribution of under-5s in household and under-5 questionnaires Household population of children age 0-7, children age 0-4 whose mothers/caretakers were interviewed, and percentage of under-5 children whose mothers/ caretakers were interviewed, by single ages, Belize, 2011 Household population of children 0-7 years Interviewed under-5 children Percentage of eligible under-5s interviewed (Completion rate) Number Number Percent   Age 0 348 340 18.3 97.9 1 395 388 20.8 98.0 2 384 376 20.2 98.1 3 391 381 20.4 97.5 4 384 379 20.3 98.7 5 386 na na na 6 403 na na na 7 380 na na na Total (0-4) 1902 1865 100.0 98.0 Ratio of 5 to 4 1.003 na: not applicable Weights used for both household population of children and under-5 interviews are household weights. Age is based on the household schedule. 212 mics f inal report Table DQ.4: Women’s completion rates by socio-economic characteristics of households Household population of women age 15-49, interviewed women age 15-49, and percentage of eligible women who were interviewed, by selected so- cial and economic characteristics of the household, Belize, 2011 Household population of women age 15-49 years Interviewed women age 15-49 years Percent of eligible women interviewed (Completion rates) Region Corozal 585 13.0 525 12.9 89.7 Orange Walk 677 15.1 631 15.6 93.2 Belize (Excluding Belize City South Side) 751 16.8 659 16.3 87.7 Belize City South Side 627 14.0 589 14.5 93.8 Belize District 1379 30.8 1248 30.8 90.8 Cayo 1023 22.8 880 21.7 86.1 Stann Creek 439 9.8 399 9.8 90.4 Toledo 380 8.5 373 9.2 98.3 Area Urban 2115 47.2 1904 46.9 90.0 Rural 2367 52.8 2151 53.1 90.8 Household size 1-3 1102 24.6 1013 25.0 91.9 4-6 2248 50.2 2023 49.9 90.0 7+ 1132 25.3 1018 25.1 89.9 Education of household head None 318 7.1 297 7.3 93.3 Primary 2165 48.3 1974 48.7 91.1 Secondary + 1818 40.6 1626 40.1 89.4 CET/ITVET/VOTEC 48 1.1 44 1.1 91.7 Missing/DK 66 1.5 55 1.4 83.4 Other 65 1.5 58 1.4 89.8 Wealth index quintiles Poorest 689 15.4 653 16.1 94.7 Second 866 19.3 808 19.9 93.3 Middle 954 21.3 866 21.4 90.8 Fourth 961 21.4 849 20.9 88.4 Richest 1012 22.6 879 21.7 86.7 Ethnicity of household head Creole 1099 24.5 975 24.1 88.6 Mestizo 2219 49.5 2012 49.6 90.7 Garifuna 270 6.0 251 6.2 92.6 Maya 443 9.9 417 10.3 94.1 Other 374 8.4 331 8.2 88.5 Missing/DK 76 1.7 69 1.7 90.6 Total 4482 100.0 4055 100.0 90.4 mics f inal report 213 Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households Household population of under-5 children, under-5 questionnaires completed, and percentage of under-5 children for whom interviews were completed, by selected socio-economic characteristics of the household, Belize, 2011 Household population of under-5 children Interviewed under-5 children Percent of eligible under-5s with completed under-5 questionnaires (Completion rates) Region Corozal 257 13.5 254 13.6 98.8 Orange Walk 295 15.5 287 15.4 97.2 Belize (Excluding Belize City South Side) 234 12.3 223 11.9 95.0 Belize City South Side 247 13.0 242 13.0 98.1 Belize District 481 25.3 465 24.9 96.6 Cayo 439 23.1 434 23.3 98.8 Stann Creek 208 10.9 204 10.9 98.2 Toledo 221 11.6 221 11.8 99.7 Area Urban 728 38.3 710 38.1 97.5 Rural 1174 61.7 1155 61.9 98.3 Household size 1-3 248 13.0 243 13.1 98.3 4-6 1034 54.4 1009 54.1 97.6 7+ 621 32.6 613 32.8 98.7 Education of household head None 145 7.6 145 7.8 100.0 Primary 931 48.9 915 49.1 98.3 Secondary + 730 38.4 713 38.2 97.6 CET/ITVET/VOTEC 29 1.5 28 1.5 94.6 Missing/DK 21 1.1 20 1.0 93.0 Other 46 2.4 45 2.4 98.1 Wealth index quintiles Poorest 476 25.0 472 25.3 99.2 Second 436 22.9 432 23.2 99.0 Middle 394 20.7 389 20.9 98.6 Fourth 326 17.1 316 16.9 96.9 Richest 269 14.2 256 13.7 95.0 Ethnicity of household head Creole 375 19.7 361 19.4 96.2 Mestizo 922 48.5 909 48.7 98.6 Garifuna 103 5.4 101 5.4 97.8 Maya 280 14.7 279 14.9 99.5 Other 191 10.0 186 10.0 97.5 Missing/DK 31 1.6 30 1.6 95.4 Total 1902 100.0 1865 100.0 98.0 214 mics f inal report Table DQ.6: Completeness of reporting Percentage of observations that are missing information for selected questions and indicators, Belize, 2011 Questionnaire and type of missing information Reference group Percent with missing/ incomplete information* Number of cases Household   Age All household members 0.3 17538 Starting time of interview All households interviewed 0.0 4424 Ending time of interview All households interviewed 0.0 4424     Women   Woman’s date of birth All women age 15-49   Only month 0.0 4096 Both month and year 0.1 4096 Date of first birth All women age 15-49 with at least one live birth   Only month 0.2 2728 Both month and year 1.1 2728 Completed years since first birth All women age 15-49 with at least one live birth with year of first birth unknown 16.1 53 Date of last birth All women age 15-49 with a live birth in last 2 years   Only month 0.2 2728 Both month and year 0.4 2728 Date of first marriage/union All ever married women age 15-49   Only month 11.5 2877 Both month and year 21.1 2877 Age at first marriage/union All ever married women age 15-49 with year of first marriage not known 0.6 2877 Age at first intercourse All women age 15-24 who have ever had sex 2.6 889 Time since last intercourse All women age 15-24 who have ever had sex 1.6 889 Starting time of interview All women interviewed 0.0 4096 Ending time of interview All women interviewed 0.0 4096     Under-5   Date of birth All under-5 children   Only month 0.0 1946 Both month and year 0.0 1946 Anthropometric measurements All under-5 children 7.0 1946 Weight 7.5 1946 Height 6.7 1946 Both weight and height   Starting time of interview All under-5 children 0.0 1946 Ending time of interview All under-5 children 0.0 1946         * Includes “Don’t know” responses mics f inal report 215 Table DQ.7: Completeness of information for anthropometric indicators Distribution of children under 5 by completeness of information for anthropometric indicators, Belize, 2011 Valid weight and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured Incomplete date of birth Weight not measured, incomplete date of birth Flagged cases (outliers) Weight by age <6 months 86.9 13.1 0.0 0.0 0.0 100.0 13.1 145 6-11 months 92.9 7.1 0.0 0.0 0.0 100.0 7.1 212 12-23 months 95.2 4.8 0.0 0.0 0.0 100.0 4.8 398 24-35 months 92.3 7.4 0.0 0.0 0.2 100.0 7.7 403 36-47 months 95.1 4.9 0.0 0.0 0.0 100.0 4.9 391 48-59 months 94.7 5.3 0.0 0.0 0.0 100.0 5.3 397 Total 93.6 6.3 0.0 0.0 0.1 100.0 6.4 1946 Valid height and date of birth Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 height not measured Incomplete date of birth height not measured, incomplete date of birth Flagged cases (outliers) Height by age <6 months 84.1 14.5 0.0 0.0 1.4 100.0 15.9 145 6-11 months 91.0 7.1 0.0 0.0 1.9 100.0 9.0 212 12-23 months 93.7 5.0 0.0 0.0 1.3 100.0 6.3 398 24-35 months 90.8 8.7 0.0 0.0 0.5 100.0 9.2 403 36-47 months 94.6 4.6 0.0 0.0 0.8 100.0 5.4 391 48-59 months 94.2 5.3 0.0 0.0 0.5 100.0 5.8 397 Total 92.4 6.7 0.0 0.0 0.9 100.0 7.6 1946 Valid weight and height Reason for exclusion from analysis Total Percent of children excluded from analysis Number of children under 5 Weight not measured height not measured Weight not measured, incomplete date of birth Flagged cases (outliers) Weight by height <6 months 80.7 0.7 2.1 12.4 4.1 100.0 19.3 145 6-11 months 90.1 0.0 0.0 7.1 2.8 100.0 9.9 212 12-23 months 94.0 0.0 0.3 4.7 1.0 100.0 6.0 398 24-35 months 89.8 0.0 1.2 7.5 1.5 100.0 10.2 403 36-47 months 94.4 0.5 0.3 4.3 0.5 100.0 5.6 391 48-59 months 92.7 0.3 0.3 4.9 1.8 100.0 7.3 397 Total 91.5 0.2 0.6 6.0 1.6 100.0 8.5 1946 216 mics f inal report Table DQ.8: Heaping in anthropometric measurements Distribution of weight and height/length measurements by digits reported for decimals, Belize, 2011 Weight Height Number Percent Number Percent Digits 0 191 10.5 505 27.6 1 168 9.2 118 6.5 2 202 11.1 198 10.8 3 201 11.0 182 10.0 4 178 9.8 146 8.0 5 183 10.0 301 16.5 6 189 10.4 132 7.2 7 163 8.9 105 5.7 8 164 9.0 77 4.2 9 184 10.1 63 3.4 0 or 5 374 20.5 806 44.1 Total 1823 100.0 1827 100.0 Table DQ.9: Observation of women’s health cards Percent distribution of women with a live birth in the last 2 years by presence of a health card, and the percentage of health cards seen by the interviewers, Belize, 2011 Woman does not have health card Woman has health card Missing/DK Total Percent of health cards seen by the interviewer (1)/(1+2)*100 Number of women with a live birth in the last two years Seen by the inter- viewer (1) Not seen by the inter- viewer (2) Region Corozal 17.4 22.6 60.0 0.0 100.0 27.4 115 Orange Walk 2.5 20.5 76.2 0.8 100.0 21.2 122 Belize (Excluding Belize City South Side) 27.1 25.0 45.8 2.1 100.0 35.3 48 Belize City South Side 23.2 25.6 50.0 1.2 100.0 33.9 82 Belize District 24.6 25.4 48.5 1.5 100.0 34.4 130 Cayo 4.2 27.5 68.3 0.0 100.0 28.7 120 Stann Creek 11.6 32.6 54.7 1.2 100.0 37.3 86 Toledo 27.1 24.8 45.7 2.3 100.0 35.2 129 Area Urban 17.0 20.6 61.5 0.8 100.0 25.1 247 Rural 13.8 27.7 57.4 1.1 100.0 32.6 455 Wealth index quintiles Poorest 20.8 23.1 54.7 1.4 100.0 29.7 212 Second 13.9 31.1 54.3 0.7 100.0 36.4 151 Middle 15.0 27.8 56.4 0.8 100.0 33.0 133 Fourth 9.5 20.6 69.0 0.8 100.0 23.0 126 Richest 10.0 22.5 66.3 1.3 100.0 25.4 80 Total 15.0 25.2 58.8 1.0 100.0 30.0 702 mics f inal report 217 Table DQ.10: Observation of under-5s birth certificates Percent distribution of children under 5 by presence of birth certificates, and percentage of birth calendar seen, Belize, 2011 Child does not have birth certif- icate Child has birth certificate Missing/ DK Total Percent of birth certificates seen by the interview- er (1)/(1+2)*100 Number of children un- der age 5 Seen by the interviewer (1) Not seen by the inter- viewer (2) Region Corozal 14.3 24.8 60.8 0.0 100.0 29.0 314 Orange Walk 10.0 68.4 21.6 0.0 100.0 76.0 320 Belize (Excluding Be- lize City South Side) 10.5 53.6 35.9 0.0 100.0 59.9 153 Belize City South Side 7.1 26.6 66.3 0.0 100.0 28.6 252 Belize District 8.4 36.8 54.8 0.0 100.0 40.2 405 Cayo 7.8 32.9 59.3 0.0 100.0 35.7 295 Stann Creek 13.1 49.8 37.1 0.0 100.0 57.3 251 Toledo 10.5 27.7 61.8 0.0 100.0 31.0 361 Area Urban 9.4 36.4 54.2 0.0 100.0 40.2 681 Rural 11.1 41.1 47.7 0.0 100.0 46.3 1265 Child’s age 0 21.4 33.2 45.4 0.0 100.0 42.3 355 1 9.5 39.4 51.0 0.0 100.0 43.6 398 2 6.9 44.4 48.6 0.0 100.0 47.7 403 3 7.4 39.7 52.9 0.0 100.0 42.9 393 4 8.6 39.8 51.6 0.0 100.0 43.5 397 Total 10.5 39.5 50.0 0.0 100.0 44.1 1946 Table DQ.11: Observation of vaccination cards Percent distribution of children under 5 by presence of a vaccination card, and the percentage of vaccination cards seen by the interviewers, Belize, 2011 Child does not have vaccination card Child has vaccination card Missing/ DK Total Percent of vaccination cards seen by the interviewer (1)/(1+2)*100 Number of children under age 5 Had vaccination card previously Never had vaccination card Seen by the interviewer (1) Not seen by the interviewer (2) Region Corozal 3.2 4.1 74.5 18.2 0.0 100.0 80.4 314 Orange Walk 0.6 2.8 79.1 17.5 0.0 100.0 81.9 320 Belize (Excluding Belize City South Side) 2.0 3.9 63.4 30.7 0.0 100.0 67.4 153 Belize City South Side 4.4 4.0 65.1 26.6 0.0 100.0 71.0 252 Belize District 3.5 4.0 64.4 28.1 0.0 100.0 69.6 405 Cayo 4.4 5.1 74.6 15.9 0.0 100.0 82.4 295 Stann Creek 7.6 1.6 74.1 16.7 0.0 100.0 81.6 251 Toledo 11.1 2.5 53.2 33.2 0.0 100.0 61.5 361 Area Urban 4.8 3.1 68.3 23.8 0.0 100.0 74.2 681 Rural 5.1 3.6 69.6 21.7 0.0 100.0 76.3 1265 Child’s age 0 2.8 10.4 74.4 12.4 0.0 100.0 85.7 355 1 2.5 3.0 73.6 20.9 0.0 100.0 77.9 398 2 4.0 0.7 73.2 22.1 0.0 100.0 76.8 403 3 6.4 2.3 65.9 25.4 0.0 100.0 72.1 393 4 9.3 1.3 59.2 30.2 0.0 100.0 66.2 397 Total 5.0 3.4 69.2 22.4 0.0 100.0 75.5 1946 218 mics f inal report Table DQ.12: Presence of mother in the household and the person interviewed for the under-5 questionnaire Distribution of children under five by whether the mother lives in the same household, and the person interviewed for the under-5 questionnaire, Belize, 2011 Mother in the household Mother not in the household Total Number of children under 5 Mother inter- viewed Father inter- viewed Other adult female inter- viewed Father inter- viewed Other adult female inter- viewed Other adult male inter- viewed Age 0 97.6 0.0 0.3 0.2 1.8 0.0 100.0 348 1 96.7 0.4 0.0 0.0 2.4 0.4 100.0 395 2 95.3 0.0 0.5 0.4 3.8 0.0 100.0 384 3 94.1 0.0 0.7 0.2 5.0 0.0 100.0 391 4 92.0 0.0 0.0 0.2 7.4 0.4 100.0 384 Total 95.1 0.1 0.3 0.2 4.1 0.2 100.0 1902 Table DQ.13: Selection of children age 2-14 years for the child discipline module Percent of households with at least two children age 2-14 years where correct selection of one child for the child discipline module was performed, Belize, 2011 Percent of households where cor- rect selection was performed Number of households with 2 or more children age 2-14 years Region Corozal 97.4 234 Orange Walk 88.8 232 Belize (Excluding Belize City South Side) 96.6 145 Belize City South Side 91.7 180 Belize District 93.8 325 Cayo 91.9 235 Stann Creek 90.8 206 Toledo 86.8 280 Area Urban 93.2 531 Rural 90.7 981 Number of households by number of children 2-14 2 94.6 701 3 90.3 435 4 90.9 220 5+ 82.7 156 Total 91.6 1512 mics f inal report 219 Table DQ.14: School attendance by single age Distribution of household population age 5-24 by educational level and grade attended in the current (or most recent) school year, Belize, 2011 Not at- tending school Preschool Primary Secondary 1 2 3 4 5 6 DK 1 2 3 4 Age at beginning of school year 5 10.7 2.5 6.7 1.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 6 4.2 0.0 29.1 5.5 0.0 0.0 0.0 0.0 0.0 0.2 0.2 0.0 0.0 7 1.6 0.0 47.1 27.3 3.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 8 3.6 0.0 22.9 45.8 22.2 1.6 0.0 0.0 0.0 0.0 0.2 0.0 0.0 9 2.3 0.0 7.4 24.3 40.0 23.4 1.1 0.3 0.0 0.0 0.0 0.3 0.0 10 1.7 0.0 2.8 8.6 24.2 42.3 17.2 0.9 0.0 0.3 0.0 0.0 0.0 11 2.4 0.0 0.0 4.4 9.7 26.7 41.4 12.6 0.0 0.7 0.1 0.0 0.4 12 5.1 0.0 0.8 0.7 2.4 15.8 27.5 31.4 0.0 14.1 1.0 0.0 0.0 13 11.8 0.0 0.0 0.0 0.7 4.6 15.4 25.9 0.0 28.5 11.7 1.0 0.0 14 19.5 0.0 0.6 0.6 0.4 0.4 4.2 14.4 0.0 23.5 25.1 9.5 0.8 15 29.8 0.0 0.0 0.1 0.3 0.6 1.0 4.3 0.0 13.9 20.2 20.0 7.2 16 40.7 0.0 0.0 0.0 0.3 0.5 0.0 2.0 0.0 6.4 10.6 18.4 14.8 17 49.1 0.0 0.0 0.2 0.2 0.0 0.2 0.1 0.0 1.9 6.0 13.0 13.4 18 66.4 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.2 0.7 1.2 2.2 8.2 19 71.0 0.0 0.0 0.4 0.0 0.0 0.0 0.0 0.0 0.7 0.8 1.8 5.2 20 80.9 0.0 0.0 0.0 0.3 0.5 0.0 0.0 0.0 0.0 0.9 1.1 2.4 21 83.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.4 1.1 22 90.4 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.0 0.8 0.7 23 91.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.5 0.7 24 94.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 220 mics f inal report Table DQ.14: School attendance by single age (continued) Distribution of household population age 5-24 by educational level and grade attended in the current (or most recent) school year, Belize, 2011 Associates Bachelors and higher CET/ITVET/VOTEC Infant DK Total Number of household members Age at beginning of school year 5 0.0 0.0 0.0 76.8 1.5 100.0 403 6 0.0 0.0 0.0 59.3 1.5 100.0 384 7 0.0 0.0 0.0 18.9 1.6 100.0 404 8 0.0 0.0 0.0 2.3 1.4 100.0 416 9 0.0 0.0 0.0 0.3 0.5 100.0 466 10 0.0 0.2 0.0 0.0 1.9 100.0 411 11 0.0 0.0 0.0 0.3 1.3 100.0 406 12 0.0 0.0 0.0 0.0 1.2 100.0 395 13 0.0 0.0 0.0 0.0 0.4 100.0 417 14 0.3 0.0 0.5 0.0 0.3 100.0 361 15 0.9 0.0 0.7 0.0 0.8 100.0 414 16 4.0 0.3 1.9 0.0 0.2 100.0 338 17 12.9 0.4 2.6 0.0 0.0 100.0 379 18 17.2 1.7 1.6 0.0 0.3 100.0 362 19 13.9 5.3 0.9 0.0 0.0 100.0 343 20 10.6 3.3 0.0 0.0 0.0 100.0 304 21 9.5 5.3 0.5 0.0 0.0 100.0 297 22 3.9 3.6 0.3 0.0 0.0 100.0 310 23 5.5 1.7 0.0 0.0 0.0 100.0 323 24 4.2 1.5 0.0 0.0 0.0 100.0 286 Table DQ.15: Sex ratio at birth among children ever born and living Sex ratio (number of males per 100 females) among children ever born (at birth), children living, and deceased children, by age of women, Belize, 2011 Children Ever Born Children Living Children Deceased Number of women Number of sons ever born Number of daughters ever born Sex ratio Number of sons living Number of daughters living Sex ratio Number of de- ceased sons Number of deceased daughters Sex ratio Age 15-19 53 59 0.90 53 59 0.90 0 0 na. 852 20-24 330 360 0.92 326 355 0.92 4 5 0.80 729 25-29 642 632 1.02 625 618 1.01 17 14 1.21 655 30-34 830 793 1.05 796 769 1.04 34 24 1.42 554 35-39 890 897 0.99 846 876 0.97 44 21 2.10 516 40-44 916 910 1.01 865 876 0.99 51 34 1.50 431 45-49 817 764 1.07 746 729 1.02 71 35 2.03 359 Total 4478 4415 0.99 4257 4282 0.98 221 133 1.51 4096 na Not applicable mics f inal report 221 appendix g. miCs4 indiCaTors: numeraTors and denominaTors MICS4 INDICATOR Module1 Numerator Denominator MDG2 1. MORTALITY 1.1 Under-five mortality rate3 CM Probability of dying by exact age 5 years MDG 4.1 1.2 Infant mortality rate4 CM Probability of dying by exact age 1 year MDG 4.2 2. NUTRITION 2.1a 2.1b Underweight preva- lence AN Number of children under age 5 who (a) fall below minus two standard deviations (moderate and severe) (b) fall below minus three standard deviations (severe) from the median weight for age of the WHO standard Total number of children under age 5 MDG 1.8 2.2a 2.2b Stunting prevalence AN Number of children under age 5 who (a) fall below minus two standard deviations (moderate and severe) (b) fall below minus three standard deviations (severe) from the median height for age of the WHO standard Total number of children under age 5 2.3a 2.3b Wasting prevalence AN Number of children under age 5 who (a) fall below minus two standard deviations (moderate and severe) (b) fall below minus three standard deviations (severe) from the median weight for height of the WHO standard Total number of children under age 5 2.4 Children ever breastfed MN Number of women with a live birth in the 2 years preceding the survey who breastfed the child at any time Total number of women with a live birth in the 2 years preceding the survey 2.5 Early initiation of breastfeeding MN Number of women with a live birth in the 2 years preceding the survey who put the newborn infant to the breast within 1 hour of birth Total number of women with a live birth in the 2 years preceding the survey 2.6 Exclusive breastfeed- ing under 6 months BF Number of infants under 6 months of age who are exclusively breastfed5 Total number of infants under 6 months of age 2.7 Continued breastfeed- ing at 1 year BF Number of children age 12-15 months who are currently breast- feeding Total number of children age 12-15 months 2.8 Continued breastfeed- ing at 2 years BF Number of children age 20-23 months who are currently breast- feeding Total number of children age 20-23 months 2.9 Predominant breast- feeding under 6 months BF Number of infants under 6 months of age who received breast milk as the predominant source of nourishment6 during the previous day Total number of infants under 6 months of age 2.10 Duration of breast- feeding BF The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 2.11 Bottle feeding BF Number of children age 0-23 months who were fed with a bottle during the previous day Total number of children age 0-23 months 2.12 Introduction of solid, semi-solid or soft foods BF Number of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day Total number of infants age 6-8 months 2.13 Minimum meal fre- quency BF Number of children age 6-23 months receiving solid, semi-solid and soft foods (plus milk feeds for non-breast- fed children) the minimum times7 or more, according to breastfeeding status, during the previous day Total number of children age 6-23 months 2.14 Age-appropriate breastfeeding BF Number of children age 0-23 months appropriately fed8 during the previ- ous day Total number of children age 0-23 months 2.15 Milk feeding frequen- cy for non-breastfed children BF Number of non-breastfed children age 6-23 months who received at least 2 milk feedings during the pre- vious day Total number of non-breastfed children age 6-23 months 222 mics f inal report MICS4 INDICATOR Module1 Numerator Denominator MDG2 2.17 Vitamin A supplemen- tation (children under age 5) IM Number of children age 6-59 months who received at least one high- dose vitamin A supplement in the 6 months preceding the survey Total number of children age 6-59 months 2.18 Low-birthweight in- fants MN Number of last live births in the 2 years preceding the survey weighing below 2,500 grams at birth Total number of last live births in the 2 years preceding the survey 2.19 Infants weighed at birth MN Number of last live births in the 2 years preceding the survey who were weighed at birth Total number of last live births in the 2 years preceding the survey 3. CHILD HEALTH 3.1 Tuberculosis immuni- zation coverage IM Number of children age 18-29 months who received BCG vaccine before their first birthday Total number of children age 12-23 months 3.2 Polio immunization coverage IM Number of children age 18-29 months who received OPV3 vaccine before their first birthday Total number of children age 12-23 months 3.3 Immunization cov- erage for diphtheria, pertussis and tetanus (DPT) IM Number of children age 18-29 months who received DPT3 vaccine before their first birthday Total number of children age 12-23 months 3.4 Measles immunization coverage IM Number of children age 18-29 months who received measles vac- cine before their first birthday Total number of children age 12-23 months MDG 4.3 3.5 Hepatitis B immuniza- tion coverage IM Number of children age 18-29 months who received the third dose of Hepatitis B vaccine before their first birthday Total number of children age 12-23 months 3.7 Neonatal tetanus pro- tection MN Number of women age 15-49 years with a live birth in the 2 years preceding the survey who were given at least two doses of tetanus toxoid vaccine within the appropriate interval9 prior to giving birth Total number of women age 15-49 years with a live birth in the 2 years preceding the survey 3.8 Oral rehydration ther- apy with continued feeding CA Number of children under age 5 with diarrhoea in the previous 2 weeks who received ORT (ORS packet or recommended homemade fluid or increased fluids) and continued feed- ing during the episode of diarrhoea Total number of children under age 5 with diar- rhoea in the previous 2 weeks 3.9 Care-seeking for sus- pected pneumonia CA Number of children under age 5 with suspected pneumonia in the previ- ous 2 weeks who were taken to an appropriate health provider Total number of children under age 5 with sus- pected pneumonia in the previous 2 weeks 3.10 Antibiotic treatment of suspected pneumonia CA Number of children under age 5 with suspected pneumonia in the previ- ous 2 weeks who received antibiotics Total number of children under age 5 with sus- pected pneumonia in the previous 2 weeks 3.11 Solid fuels HC Number of household members in households that use solid fuels as the primary source of domestic ener- gy to cook Total number of household members 3.21 Child at increased risk of disability DA Number of children age 2-9 years reported by mothers/caretakers to have at least one of the specified impairments or activity limitations10 Total number of children age 2-9 years 4. WATER AND SANITATION 4.1 Use of improved drink- ing water sources WS Number of household members using improved sources of drinking water Total number of household members MDG 7.8 4.2 Water treatment WS Number of household members using unimproved drinking water who use an appropriate treatment method Total number of household members in house- holds using unimproved drinking water sources 4.3 Use of improved san- itation WS Number of household members using improved sanitation facilities which are not shared Total number of household members MDG 7.9 4.4 Safe disposal of child’s faeces CA Number of children age 0-2 years whose last stools were disposed of safely Total number of children age 0-2 years mics f inal report 223 MICS4 INDICATOR Module1 Numerator Denominator MDG2 4.5 Place for hand washing HW Number of households with a spe- cific place for hand washing where water and soap are present Total number of households 4.6 Availability of soap HW Number of households with soap anywhere in the dwelling Total number of households 5. REPRODUCTIVE HEALTH 5.1 Adolescent birth rate11 CM - BH Age-specific fertility rate for women age 15-19 years for the one year period preceding the survey MDG 5.4 5.2 Early childbearing CM - BH Number of women age 20-24 years who had at least one live birth before age 18 Total number of women age 20-24 years 5.3 Contraceptive preva- lence rate CP Number of women age 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contracep- tive method Total number of women age 15-49 years who are currently married or in union MDG 5.3 5.4 Unmet need12 UN Number of women age 15-49 years who are currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception Total number of women age 15-49 years who are currently married or in union MDG 5.6 5.5a 5.5b Antenatal care cov- erage MN Number of women age 15-49 years who were attended during preg- nancy in the 2 years preceding the survey (a) at least once by skilled personnel (b) at least four times by any pro- vider Total number of women age 15-49 years with a live birth in the 2 years preceding the survey MDG 5.5 5.6 Content of antenatal care MN Number of women age 15-49 years with a live birth in the 2 years preceding the survey who had their blood pressure measured and gave urine and blood samples during the last pregnancy Total number of women age 15-49 years with a live birth in the 2 years preceding the survey 5.7 Skilled attendant at delivery MN Number of women age 15-49 years with a live birth in the 2 years preceding the survey who were attended during childbirth by skilled health personnel Total number of women age 15-49 years with a live birth in the 2 years preceding the survey MDG 5.2 5.8 Institutional deliveries MN Number of women age 15-49 years with a live birth in the 2 years preceding the survey who delivered in a health facility Total number of women age 15-49 years with a live birth in the 2 years preceding the survey 5.9 Caesarean section MN Number of last live births in the 2 years preceding the survey who were delivered by caesarean section Total number of last live births in the 2 years preceding the survey 5.10 Post-partum stay in health facility PN Number of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their last live birth in the 2 years preceding the survey Total number of women age 15-49 years with a live birth in the 2 years preceding the survey 5.11 Post-natal health check for the newborn PN Number of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after birth Total number of last live births in the last 2 years 5.12 Post-natal health check for the mother PN Number of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery Total number of women age 15-49 years with a live birth in the 2 years preceding the survey 6. CHILD DEVELOPMENT 6.1 Support for learning EC Number of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readi- ness in the past 3 days Total number of children age 36-59 months 224 mics f inal report MICS4 INDICATOR Module1 Numerator Denominator MDG2 6.2 Father’s support for learning EC Number of children age 36-59 months whose father has engaged in one or more activities to promote learning and school readiness in the past 3 days Total number of children age 36-59 months 6.3 Learning materials: children’s books EC Number of children under age 5 who have three or more children’s books Total number of children under age 5 6.4 Learning materials: playthings EC Number of children under age 5 with two or more playthings Total number of children under age 5 6.5 Inadequate care EC Number of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the past week Total number of children under age 5 6.6 Early child develop- ment index EC Number of children age 36-59 months who are developmentally on track in literacy-numeracy, phys- ical, social-emotional, and learning domains Total number of children age 36-59 months 6.7 Attendance to early childhood education EC Number of children age 36-59 months who are attending an early childhood education programme Total number of children age 36-59 months 7. LITERACY AND EDUCATION 7.1 Literacy rate among young women WB Number of women age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education Total number of women age 15-24 years MDG 2.3 7.2 School readiness ED Number of children in first grade of primary school who attended pre- school during the previous school year Total number of children attending the first grade of primary school 7.3 Net intake rate in pri- mary education ED Number of children of school-entry age who enter the first grade of pri- mary school Total number of children of school-entry age 7.4 Primary school net attendance ratio (ad- justed) ED Number of children of primary school age currently attending prima- ry or secondary school Total number of children of primary school age MDG 2.1 7.5 Secondary school net attendance ratio (ad- justed) ED Number of children of secondary school age currently attending sec- ondary school or higher Total number of children of secondary school age 7.6 Children reaching last grade of primary ED Proportion of children entering the first grade of primary school who eventually reach last grade MDG 2.2 7.7 Primary completion rate ED Number of children attending the last grade of primary school (excluding repeaters) Total number of children of primary school com- pletion age (age appropriate to final grade of primary school) 7.8 Transition rate to sec- ondary school ED Number of children attending the last grade of primary school during the previous school year who are in the first grade of secondary school dur- ing the current school year Total number of children attending the last grade of primary school during the previous school year 7.9 Gender parity index (primary school) ED Primary school net attendance ratio (adjusted) for girls Primary school net attendance ratio (adjusted) for boys MDG 3.1 7.10 Gender parity index (secondary school) ED Secondary school net attendance ratio (adjusted) for girls Secondary school net attendance ratio (adjusted) for boys MDG 3.1 8. CHILD PROTECTION 8.1 Birth registration BR Number of children under age 5 whose births are reported registered Total number of children under age 5 8.2 Child labour CL Number of children age 5-14 years who are involved in child labour Total number of children age 5-14 years 8.3 School attendance among child labourers ED - CL Number of children age 5-14 years who are involved in child labour and are currently attending school Total number of children age 5-14 years involved in child labour 8.4 Child labour among students ED - CL Number of children age 5-14 years who are involved in child labour and are currently attending school Total number of children age 5-14 years attending school mics f inal report 225 MICS4 INDICATOR Module1 Numerator Denominator MDG2 8.5 Violent discipline CD Number of children age 2-14 years who experienced psychological aggression or physical punishment during the past month Total number of children age 2-14 years 8.6 Marriage before age 15 MA Number of women age 15-49 years who were first married or in union by the exact age of 15 Total number of women age 15-49 years 8.7 Marriage before age 18 MA Number of women age 20-49 years who were first married or in union by the exact age of 18 Total number of women age 20-49 years 8.8 Young women age 15-19 years currently married or in union MA Number of women age 15-19 years who are currently married or in union Total number of women age 15-19 years 8.9 Polygyny MA Number of women age 15-49 years who are in a polygynous union Total number of women age 15-49 years who are currently married or in union 8.10a 8.10b Spousal age difference MA Number of women currently married or in union whose spouse is 10 or more years older, (a) for women age 15-19 years, (b) for women age 20-24 years Total number of women currently married or in union (a) age 15-19 years, (b) age 20-24 years 8.14 Attitudes towards do- mestic violence DV Number of women who state that a husband/partner is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food Total number of women age 15-49 years 9. HIV/AIDS, SEXUAL BEHAVIOUR AND ORPHANS 9.1 Comprehensive knowl- edge about HIV pre- vention HA Number of women age 15-49 years who correctly identify two ways of preventing HIV infection13, know that a healthy looking person can have HIV, and reject the two most common misconceptions about HIV transmission Total number of women age 15-49 years 9.2 Comprehensive knowl- edge about HIV pre- vention among young people HA Number of women age 15-24 years who correctly identify two ways of preventing HIV infection12, know that a healthy looking person can have HIV, and reject the two most common misconceptions about HIV transmission Total number of women age 15-24 years MDG 6.3 9.3 Knowledge of mother- to-child transmission of HIV HA Number of women age 15-49 years who correctly identify all three means14 of mother-to-child transmis- sion of HIV Total number of women age 15-49 years 9.4 Accepting attitudes towards people living with HIV HA Number of women age 15-49 years expressing accepting attitudes on all four questions15 toward people living with HIV Total number of women age 15-49 years who have heard of HIV 9.5 Women who know where to be tested for HIV HA Number of women age 15-49 years who state knowledge of a place to be tested for HIV Total number of women age 15-49 years 9.6 Women who have been tested for HIV and know the results HA Number of women age 15-49 years who have been tested for HIV in the 12 months preceding the survey and who know their results Total number of women age 15-49 years 9.7 Sexually active young women who have been tested for HIV and know the results HA Number of women age 15-24 years who have had sex in the 12 months preceding the survey, who have been tested for HIV in the 12 months preceding the survey and who know their results Total number of women age 15-24 years who have had sex in the 12 months preceding the survey 9.8 HIV counselling during antenatal care HA Number of women age 15-49 years who gave birth in the 2 years preced- ing the survey and received antena- tal care, reporting that they received counselling on HIV during antenatal care Total number of women age 15-49 years who gave birth in the 2 years preceding the survey 226 mics f inal report MICS4 INDICATOR Module1 Numerator Denominator MDG2 9.9 HIV testing during antenatal care HA Number of women age 15-49 years who gave birth in the 2 years preced- ing the survey and received ante- natal care, reporting that they were offered and accepted an HIV test during antenatal care and received their results Total number of women age 15-49 years who gave birth in the 2 years preceding the survey 9.10 Young women who have never had sex SB Number of never married women age 15-24 years who have never had sex Total number of never married women age 15-24 years 9.11 Sex before age 15 among young women SB Number of women age 15-24 years who have had sexual intercourse before age 15 Total number of women age 15-24 years 9.12 Age-mixing among sexual partners SB Number of women age 15-24 years who had sex in the 12 months preceding the survey with a partner who was 10 or more years older Total number of women age 15-24 years who have had sex in the 12 months preceding the survey 9.13 Sex with multiple partners SB Number of women age 15-49 years who have had sexual intercourse with more than one partner in the 12 months preceding the survey Total number of women age 15-49 years 9.14 Condom use during sex with multiple partners SB Number of women age 15-49 years who report having had more than one sexual partner in the 12 months preceding the survey who also re- ported that a condom was used the last time they had sex Total number of women age 15-49 years who re- ported having had more than one sexual partner in the 12 months preceding the survey 9.15 Sex with non-regular partners SB Number of sexually active women age 15-24 years who have had sex with a non-marital, non-cohabitating partner in the 12 months preceding the survey Total number of women age 15-24 years who have had sex in the 12 months preceding the survey 9.16 Condom use with non-regular partners SB Number of women age 15-24 years reporting the use of a condom dur- ing sexual intercourse with their last non-marital, non-cohabiting sex partner in the 12 months preceding the survey Total number of women age 15-24 years who had a non-marital, non-cohabiting partner in the 12 months preceding the survey MDG 6.2 9.17 Children’s living ar- rangements HL Number of children age 0-17 years not living with a biological parent Total number of children age 0-17 years 9.18 Prevalence of children with one or both par- ents dead HL Number of children age 0-17 years with one or both parents dead Total number of children age 0-17 years 9.19 School attendance of orphans HL - ED Number of children age 10-14 years who have lost both parents and are attending school Total number of children age 10-14 years who have lost both parents MDG 6.4 9.20 School attendance of non-orphans HL - ED Number of children age 10-14 years, whose parents are alive, who are living with one or both parents, and who are attending school Total number of children age 10-14 years, whose parents are alive, and who are living with one or both parents MDG 6.4 11. SUBJECTIVE WELL-BEING SW.1 Life satisfaction LS Number of women age 15-24 years who are very or somewhat satisfied with their family life, friendships, school, current job, health, where they live, how they are treated by others, and how they look Total number of women age 15-24 years SW.2 Happiness LS Number of women age 15-24 years who are very or somewhat happy Total number of women age 15-24 years SW.3 Perception of a better life LS Number of women age 15-24 years whose life improved during the last one year, and who expect that their life will be better after one year Total number of women age 15-24 years mics f inal report 227 (Footnotes) 1 Some indicators are constructed by using questions in several modules. In such cases, only the module(s) which contains most of the necessary information is indicated. 2 MDG indicators as of February 2010 3 Indicator is defined as “Probability of dying between birth and fifth birthday, during the 5-year period preceding the survey” when estimated from the birth history 4 Indicator is defined as “Probability of dying between birth and the first birthday, during the 5-year period preceding the survey” when estimated from the birth history 5 Infants receiving breast milk, and not receiving any other fluids or foods, with the exception of oral rehydration solution, vitamins, mineral supplements and medicines 6 Infants who receive breast milk and certain fluids (water and water-based drinks, fruit juice, ritual fluids, oral rehydration solution, drops, vitamins, minerals, and medicines), but do not receive anything else (in particular, non-human milk and food-based fluids) 7 Breastfeeding children: Solid, semi-solid, or soft foods, two times for infants age 6-8 months, 3 times for children 9-23 months; Non-breastfeeding children: Solid, semi-solid, or soft foods, or milk feeds, four times for children age 6-23 months 8 Infants age 0-5 who are exclusively breastfed, and children age 6-23 months who are breastfed and ate solid, semi-solid or soft foods 9 See MICS4 manual for a detailed description 10 Impairments/activity limitations specified in the questionnaire are: (1) delay in sitting, standing or walking, (2) difficulty seeing, either in the daytime or at night, (3) appearing to have difficulty hearing, (4) difficulty in understanding instructions, (5) difficulty walking or moving arms or weakness or stiffness of limbs, (6) has fits, becomes rigid, loses consciousness, (7) does not learn to do things like other children of the same age, (8) cannot speak or cannot be understood in words, (9) appearing mentally backward, dull or slow, (10) cannot name at least an object (for children age 2 years) or whose speech is not normal (age 3-9 years) 11 Indicator is defined as “Age-specific fertility rate for women age 15-19 years, for the 3-year period preceding the survey” when estimated from the birth history 12 See MICS4 manual for a detailed description 13 Using condoms and limiting sex to one faithful, uninfected partner 14 Transmission during pregnancy, during delivery, and by breastfeeding 15 Women (1) who think that a female teacher with the AIDS virus should be allowed to teach in school, (2) who would buy fresh vegetables from a shopkeeper or vendor who has the AIDS virus, (3) who would not want to keep it as a secret if a family member became infected with the AIDS virus, and (4) who would be willing to care for a family member who became sick with the AIDS virus 228 mics f inal report A HOU HH1. HH3. Nam HH5. HH6. Ur Ru Ap WE ARE FRO HEALTH A INFORMAT IDENTIFIE MAY I START …Ye …No After all ques HH8. Name HH9. Result Completed No house resp Entire hou perio Refused . Dwelling v Dwelling d Dwelling n Other (spe HH12. Numb age 1 HH14. Numb under HH15A. Num age 2 USEHOLD INF . Cluster num . Interviewer n e _________ . Day/Month/Y . Area: rban . ural . ppen OM THE STATIS AND EDUCATIO TION WE OBT ED. T NOW? es, permission No, permission i tionnaires for of head of ho of household d . hold member pondent at ho usehold absen od of time . . vacant / Addre destroyed . not found . ecify) _______ ber of women 5-49 years: ber of children r age 5: mber of childr 2-9 years: FORMATION mber name and nu ____________ Year of interv . . ndix STICAL INSTITU ON WITH UNIC TAIN WILL RE is givenÖGo t is not givenÖC the household ousehold: d interview . r or no compe me at time of nt for extende . . ess not a dwe . . ___________ n n en N PANEL ___ ___ __ mber: ______ __ view: . . F UTE OF BELIZE. CEF. I WOULD EMAIN STRICT to HH18 to rec Complete HH9. have been com . 01 etent f visit . 02 ed . 03 . 04 elling . 05 . 06 . 07 _______ 96 ___ ___ ___ ___ ___ ___ __ HH HH __ ___ Na . 1 . 2 HH C O B C S T B . WE ARE WOR D LIKE TO TAL LY CONFIDEN cord the time an .Discuss this re mpleted, fill in t _________ HH10. Res Name: ___ Line Numb HH11. Tot me HH13. Num questionna HH15. Num com HH15B. N com HOUSE H2. Household H4. Superviso ame________ _ H7. Region: Corozal . Orange Walk Belize (Exclu Cayo ………… Stann Creek . Toledo ……… Belize City So RKING ON A PR LK TO YOU ABO TIAL AND YO nd then begin t esult with your the following in ___________ spondent to h ___________ ber: tal number of embers: mber of wome aires complet mber of unde mpleted: umber of que mpleted for ch EHOLD Q d number: or name and n ___________ ___ ___ / ___ . k . ding Belize C ……………… . ………………… outh Side . ROJECT CONCE OUT THESE SU OUR ANSWERS the interview. r supervisor. nformation: ___________ household qu ____________ household en’s ted: er-5 questionn estionnaires hildren age 2- QUESTION ___ number: _________ _ ___ / ___ __ . . City South Sid ……………… . ……………… . Final: Ju ERNED WITH FA UBJECTS. ALL S WILL NEVER ___________ estionnaire: ___________ ___ _ ___ _ ___ _ naires ___ _ -9: ___ _ NNAIRE BELIZE HH _ ___ ___ ___ ___ __ ___ ___ . 1 . 2 e) . 3 ……….….4 . 5 ……….….6 . 7 une, 2011 AMILY L THE R BE ____ ___ ___ ___ ___ ___ ___ Final: June, 2011 HOUSEHOLD.Page2 HH16. Field edited by (Name and number): Name _________________________ ___ ___ HH17. Data entry clerk (Name and number): Name ___________________________ ___ ___ appendix h. household QuesTionnaire mics f inal report 229 Fin al: Ju ne , 2 01 1 HO US EH OL D. Pa ge 3 H H 18 . Re co rd th e tim e. H ou r . . . . ._ _ __ M in ut es . . ._ _ __ am /p m … . __ m H O U SE H O LD L IS TI N G F O RM FI R ST , P LE A SE T EL L M E TH E N A M E O F EA C H P E R SO N W H O U SU A LL Y L IV E S H E R E AN D S H AR E S A M EA L IN T H E H O U SE H O LD , S TA R TI N G W IT H T H E H E AD O F H O U S EH O LD Li st th e he ad o f t he h ou se ho ld in H L2 , l in e 01 . L is t a ll ot he r h ou se ho ld m em be rs (H L2 ), th ei r r el at io ns hi p to th e ho us eh ol d he ad (H L3 ), an d th ei r s ex (H L4 ) Th en a sk : A R E T H E R E A N Y O TH ER S W H O L IV E H ER E , E VE N IF T H EY A R E N O T AT H O M E N O W ? TH ES E M AY IN C LU D E C H IL D R EN IN S C H O O L O R A D U LT S A T W O R K. If ye s, co m pl et e lis tin g fo r q ue st io ns H L2 -H L4 . T he n, a sk q ue st io ns st ar tin g w ith H L5 fo r e ac h pe rs on a t a ti m e. U se a n ad di tio na l q ue sti on na ire if a ll ro w s in th e ho us eh ol d lis tin g fo rm h av e be en u se d. Fo r w om en ag e 15 -4 9 Fo r ch ild re n ag e 5- 14 Fo r ch ild re n un de r a ge 5 Fo r ch ild re n ag e 2- 9 Fo r c hi ld re n ag e 0- 17 y ea rs H L1 . Li ne nu m be r H L2 . N am e H L3 . W H AT IS TH E R EL AT IO N -S H IP O F (n am e) T O TH E H E AD O F H O U SE - H O LD ? H L4 . IS (n am e) M A LE O R FE M AL E ? 1 M al e 2 Fe m al e H L5 . W H AT IS (n am e) ’S D AT E O F BI R TH ? H L6 . H O W O LD IS (n am e) ? Re co rd in co m pl et ed ye ar s. If ag e is 9 5 or a bo ve , re co rd ‘9 5’ H L7 . C irc le lin e nu m be r if w om an is a ge 15 -4 9 H L8 . W H O IS T H E M O TH E R O R PR IM A R Y C AR ET AK ER O F TH IS C H IL D ? Re co rd lin e nu m be r of m ot he r/ ca re ta ke r H L9 . W H O IS T H E M O TH E R O R PR IM A R Y C AR ET A KE R O F TH IS C H IL D ? Re co rd lin e nu m be r of m ot he r/ ca re ta ke r H L9 A . W H O IS T H E M O TH ER O R PR IM AR Y C AR ET AK E R O F TH IS C H IL D ? Re co rd lin e nu m be r of m ot he r/ ca re ta ke r H L1 1. IS (n am e) ’S N AT U R A L M O TH ER AL IV E? 1 Ye s 2 N oÞ H L1 3 8 D K Þ H L1 3 H L1 2. D O ES (n am e) ’S N AT U R AL M O TH E R L IV E IN T H IS H O U S EH O LD ? Re co rd lin e nu m be r of m ot he r o r 00 fo r “ N o” H L1 3. IS (n am e) ’S N AT U R A L FA TH ER AL IV E? 1 Ye s 2 N oÞ N ex t L in e 8 D K Þ N ex t L in e H L1 4. D O ES (n am e) ’S N AT U R AL FA TH E R L IV E IN T H IS H O U SE H O LD ? Re co rd lin e nu m be r of fa th er o r 00 fo r “ N o” 98 D K 99 98 D K Li ne N am e R el at io n* M F M on th Ye ar A ge 15 -4 9 M ot he r M ot he r M ot he r Y N D K M ot he r Y N D K Fa th er 01 0 1 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 01 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 02 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 02 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 03 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 03 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 04 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 04 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 05 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 05 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 06 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 06 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 07 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 07 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 08 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 08 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 09 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 09 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 230 mics f inal report Fin al: Ju ne , 2 01 1 HO US EH OL D. Pa ge 4 H L1 . Li ne nu m be r H L2 . N am e H L3 . W H AT IS TH E R EL AT IO N -S H IP O F (n am e) T O TH E H E AD O F H O U SE - H O LD ? H L4 . IS (n am e) M A LE O R FE M AL E ? 1 M al e 2 Fe m al e H L5 . W H AT IS (n am e) ’S D AT E O F BI R TH ? H L6 . H O W O LD IS (n am e) ? Re co rd in co m pl et ed ye ar s. If ag e is 9 5 or a bo ve , re co rd ‘9 5’ H L7 . C irc le lin e nu m be r if w om an is a ge 15 -4 9 H L8 . W H O IS T H E M O TH E R O R PR IM A R Y C AR ET AK ER O F TH IS C H IL D ? Re co rd lin e nu m be r of m ot he r/ ca re ta ke r H L9 . W H O IS T H E M O TH E R O R PR IM A R Y C AR ET A KE R O F TH IS C H IL D ? Re co rd lin e nu m be r of m ot he r/ ca re ta ke r H L9 A . W H O IS T H E M O TH ER O R PR IM AR Y C AR ET AK E R O F TH IS C H IL D ? Re co rd lin e nu m be r of m ot he r/ ca re ta ke r H L1 1. IS (n am e) ’S N AT U R A L M O TH ER AL IV E? 1 Ye s 2 N oÞ H L1 3 8 D K Þ H L1 3 H L1 2. D O ES (n am e) ’S N AT U R AL M O TH E R L IV E IN T H IS H O U S EH O LD ? Re co rd lin e nu m be r of m ot he r o r 00 fo r “ N o” H L1 3. IS (n am e) ’S N AT U R A L FA TH ER AL IV E? 1 Ye s 2 N oÞ N ex t L in e 8 D K Þ N ex t L in e H L1 4. D O ES (n am e) ’S N AT U R AL FA TH E R L IV E IN T H IS H O U SE H O LD ? Re co rd lin e nu m be r of fa th er o r 00 fo r “ N o” 98 D K 99 98 D K Li ne N am e R el at io n* M F M on th Ye ar A ge 15 -4 9 M ot he r M ot he r M ot he r Y N D K M ot he r Y N D K Fa th er 10 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 10 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 11 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 11 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 12 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 12 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 13 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 13 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 14 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 14 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ 15 __ _ _ __ 1 2 __ _ _ __ _ _ __ _ _ __ _ _ __ 15 __ _ _ __ __ _ _ __ __ _ _ __ 1 2 8 __ _ _ __ 1 2 8 __ _ _ __ Co de s f or H L3 : R el at io ns hi p to h ea d of h ou se ho ld : 01 H ea d 02 W ife / H us ba nd 03 S on / D au gh te r 04 S on -in -L aw /D au gh te r- in -L aw 05 G ra nd ch ild 06 P ar en t 07 P ar en t-i n- La w 1 0 U nc le /A un t 1 3 A do pt ed /F os te r/S te pc hi ld 08 B ro th er /S is te r 1 1 N ie ce /N ep he w 14 N ot re la te d 09 B ro th er -in -L aw /S is te r- in -L aw 12 O th er re la tiv e 98 D on ’t kn ow T ic k he re if a dd iti on al q ue st io nn ai re is u se d … N ow fo r e ac h w om an a ge 1 5- 49 y ea rs , w rit e he r n am e an d lin e nu m be r a nd o th er id en tif yi ng in fo rm at io n in th e in fo rm at io n pa ne l o f a se pa ra te In di vi du al W om en ’s Q ue sti on na ir e. Fo r e ac h ch ild u nd er 5 ye ar s, w rit e hi s/h er n am e an d lin e nu m be r A N D th e lin e nu m be r o f h is /h er m ot he r o r c ar et ak er in th e in fo rm at io n pa ne l o f a se pa ra te U nd er -5 Q ue st io nn ai re . Fo r e ac h ch ild a ge 2 – 9 y ea rs , w ri te h is /h er n am e an d lin e nu m be r A N D th e na m e an d lin e nu m be r o f h is/ he r m ot he r o r c ar et ak er in th e in fo rm at io n pa ne l o f a se pa ra te C hi ld D is ab ili ty Q ue st io nn ai re . Yo u sh ou ld n ow h av e a se pa ra te q ue sti on na ire fo r e ac h el ig ib le w om an , e ac h ch ild u nd er fi ve a nd e ac h ch ild a ge 2 – 9 y ea rs in th e ho us eh ol d. mics f inal report 231 Fin al: Ju ne , 2 01 1 HO US EH OL D. Pa ge 5 ED U CA TI O N ED Fo r h ou se ho ld m em be rs a ge 5 a nd a bo ve Fo r h ou se ho ld m em be rs a ge 5 -2 4 ye ar s E D 1. Li ne nu m be r ED 2. N am e an d ag e C op y fr om H ou se ho ld L ist in g Fo rm , H L2 a nd H L6 E D 3. H AS (n am e) E VE R AT TE N D ED S C H O O L O R P R E- S C H O O L? 1 Ye s 2 N O Þ N ex t Li ne ED 4A . W H AT IS T H E H IG H ES T LE VE L O F SC H O O L (n am e) AT TE N D E D ? Le ve l: 0 Pr es ch oo l 7 In fa nt 1 Pr im ar y 2 S ec on da ry 4 As so ci at es 5 B ac he lo rs & H ig he r 6 C E T/ IT V E T/ V O TE C 8 D K 9 O th er If le ve l= 0, sk ip to E D 5 E D 4B . W H AT IS T H E H IG H E ST ST AN D AR D /F O R M /Y E AR (n am e) C O M P LE TE D AT T H IS LE VE L? 98 D K If le ss th an 1 ye ar , e nt er 00 . E D 5. D U R IN G T H E 20 10 -20 11 SC H O O L YE AR , D ID (n am e) AT TE N D SC H O O L O R PR E- SC H O O L AT A N Y TI M E ? 1 Ye s 2 N oÞ E D 7 E D 6. D U R IN G T H IS S C H O O L YE A R , W H IC H LE VE L AN D S TA N D AR D /F O R M /Y E AR IS (n am e) A TT E N D IN G ? E D 7. D U R IN G T H E P R EV IO U S S C H O O L YE AR , TH AT IS 20 09 - 20 10 , D ID (n am e) A TT EN D S C H O O L O R P R ES C H O O L AT A N Y TI M E ? 1 Ye s 2 N o Þ Ne xt L in e 8 D K Þ N ex t L in e ED 8. D U R IN G T H AT P R E VI O U S SC H O O L YE AR , W H IC H L EV EL A N D S TA N D AR D /F O R M /Y E AR D ID (n am e) A TT EN D ? Le ve l: 0 Pr es ch oo l 7 In fa nt 1 Pr im ar y 2 S ec on da ry 4 As so ci at es 5 B ac he lo rs & H ig he r 6 E T/ IT V E T/ V O TE C 8 D K 9 O th er If le ve l= 0, sk ip to E D 7 St an da rd /F or m /Y ea r: 98 D K Le ve l: 0 Pr es ch oo l 7 In fa nt 1 Pr im ar y 2 S ec on da ry 4 A ss oc ia te s 5 B ac he lo rs & H ig he r 6 C E T/ IT V E T/ V O TE C 8 D K 9 O th er If le ve l= 0, g o to n ex t lin e. S ta nd ar d /F or m /Y ea r: 98 D K Li ne N am e A ge Y es N o Le ve l S td /F or m / Ye ar Y es N o Le ve l S td /F or m / Ye ar Y N D K Le ve l S td /F or m / Ye ar 01 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 02 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 03 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 04 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 05 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 06 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 07 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 08 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 09 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 10 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 11 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 12 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 13 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 14 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 15 __ _ __ _ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 0 1 2 4 5 6 7 8 9 __ _ _ __ 1 2 8 0 1 2 4 5 6 7 8 9 __ _ _ __ 232 mics f inal report Final: June, 2011 HOUSEHOLD. Page 6 WATER AND SANITATION WS WS1. WHAT IS THE MAIN SOURCE OF DRINKING WATER FOR MEMBERS OF YOUR HOUSEHOLD? Piped water Piped into dwelling . 11 Piped into compound, yard or plot . 12 Piped to neighbour . 13 Public tap/standpipe . 14 Hand pump . 21 Dug well Protected well . 31 Unprotected well . 32 Water from spring Protected spring . 41 Unprotected spring . 42 Rainwater collection . 51 Tanker-truck . 61 Cart with small tank/drum . 71 Surface water (river, stream, dam, lake, pond, canal, irrigation channel) . 81 Bottled water . 91 Other (specify) _____________________ 96 11ÖWS6 12ÖWS6 13ÖWS6 14ÖWS3 21ÖWS3 31ÖWS3 32ÖWS3 41ÖWS3 42ÖWS3 51ÖWS3 61ÖWS3 71ÖWS3 81ÖWS3 96ÖWS3 WS2. WHAT IS THE MAIN SOURCE OF WATER USED BY YOUR HOUSEHOLD FOR OTHER PURPOSES SUCH AS COOKING AND HAND WASHING? Piped water Piped into dwelling . 11 Piped into compound, yard or plot . 12 Piped to neighbour . 13 Public tap/standpipe . 14 Hand pump . 21 Dug well Protected well . 31 Unprotected well . 32 Water from spring Protected spring . 41 Unprotected spring . 42 Rainwater collection . 51 Tanker-truck . 61 Cart with small tank/drum . 71 Surface water (river, stream, dam, lake, pond, canal, irrigation channel) . 81 Other (specify) _____________________ 96 11ÖWS6 12ÖWS6 13ÖWS6 WS3. WHERE IS THAT WATER SOURCE LOCATED? In own dwelling . 1 In own yard / plot . 2 Elsewhere . 3 1ÖWS6 2ÖWS6 WS4. HOW LONG DOES IT TAKE TO GO THERE, GET WATER, AND COME BACK? Number of minutes .__ __ __ DK . 998 mics f inal report 233 Final: June, 2011 HOUSEHOLD. Page 7 WS5. WHO USUALLY GOES TO THIS SOURCE TO FETCH THE WATER FOR YOUR HOUSEHOLD? Probe: IS THIS PERSON UNDER AGE 15? WHAT SEX? Female (age 15+ years) . 1 Male (age 15+ years) . 2 Female (under 15) . 3 Male (under 15) . 4 DK . 8 WS6. DO YOU DO ANYTHING TO THE WATER TO MAKE IT SAFER TO DRINK? Yes . 1 No . 2 DK . 8 2ÖWS8 8ÖWS8 WS7. WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? Probe: ANYTHING ELSE? Record all items mentioned. Boil . A Add bleach / chlorine . B Strain it through a cloth . C Use water filter (ceramic, sand, composite, etc.) . D Solar disinfection . E Let it stand and settle . F Other (specify) ______________________ X DK . Z WS8. WHAT KIND OF TOILET FACILITY DO MEMBERS OF YOUR HOUSEHOLD USUALLY USE? If “flush” or “pour flush”, probe: WHERE DOES IT FLUSH TO? If necessary, ask permission to observe the facility. Flush / Pour flush Flush to piped sewer system . 11 Flush to septic tank . 12 Flush to pit (latrine) . 13 Flush to somewhere else . 14 Flush to unknown place / Not sure / DK where . 15 Pit latrine Ventilated Improved Pit latrine (VIP) . 21 Pit latrine with slab . 22 Pit latrine without slab / Open pit . 23 Composting toilet . 31 Bucket . 41 Hanging toilet, Hanging latrine . 51 No facilities, Bush, Field . 95 Other (specify) _____________________ 96 95ÖNext Module WS9. DO YOU SHARE THIS FACILITY WITH OTHERS WHO ARE NOT MEMBERS OF YOUR HOUSEHOLD? Yes . 1 No . 2 2ÖNext Module WS10. DO YOU SHARE THIS FACILITY ONLY WITH MEMBERS OF OTHER HOUSEHOLDS THAT YOU KNOW, OR IS THE FACILITY OPEN TO THE USE OF THE GENERAL PUBLIC? Other households only (not public) . 1 Public facility . 2 2ÖNext Module WS11. HOW MANY HOUSEHOLDS IN TOTAL USE THIS TOILET FACILITY, INCLUDING YOUR OWN HOUSEHOLD? Number of households (if less than 10) 0 __ Ten or more households . 10 DK . 98 234 mics f inal report Final: June, 2011 HOUSEHOLD. Page 8 HOUSEHOLD CHARACTERISTICS HC1A. WHAT IS THE RELIGION OF THE HEAD OF THIS HOUSEHOLD? Anglican.01 Baptist.02 Jehovah’s Witness.03 Mennonite.04 Methodist.05 Nazarene.06 Pentecostal.07 Roman Catholic.08 Seventh-Day Adventist.09 None.95 Other (specify) _____________________ 96 Don’t Know.98 HC1B. WHAT IS THE FIRST LANGUAGE OF THE HEAD OF THIS HOUSEHOLD? English.01 Spanish.02 Garifuna.03 Ketchi/Mopan/Yucatecan.04 German.05 Indian.06 Chinese/Taiwanese.07 Creole.08 Other (specify) _____________________ 96 HC1C. TO WHAT ETHNIC GROUP DOES THE HEAD OF THIS HOUSEHOLD BELONG? Creole.01 East Indian.02 Garifuna.03 Maya (Ketchi/Mopan/Yucatecan).04 Mennonite.05 Mestizo/Spanish/Latino/Hispanic.06 Asian (China/Hong Kong/Taiwan).07 Caucasian/White.08 Other (specify) _____________________ 96 DK/NS.98 HC2. HOW MANY ROOMS IN THIS DWELLING UNIT ARE USED FOR SLEEPING BY THE MEMBERS OF THIS HOUSEHOLD? Number of rooms . __ __ HC3. Main material of the dwelling unit floor. Record observation. If there is more than one kind of material, record the main flooring material. Natural floor Earth/ Sand . 11 Rudimentary floor Wood planks . 21 Plywood . 23 Finished floor Parquet or polished wood . 31 Concrete. 34 Other (specify) _____________________ 96 mics f inal report 235 Final: June, 2011 HOUSEHOLD. Page 9 HC4. Main material of the roof. Record observation. Natural roofing Thatch/Bay leaf . 12 Rudimentary Roofing Rubber rye . 25 Finished roofing Sheet metal/corrugated zinc . 31 Concrete . 35 Roofing shingles . 36 Other (specify) _____________________ 96 HC5. Main material of the exterior walls. Record observation. Natural walls No walls . 11 Palmetto/Wildcane/Sticks . 12 Rudimentary walls Bamboo with mud . 21 Stone with mud . 22 Plywood . 24 Carton . 25 Reused wood . 26 Finished walls Concrete . 31 Stone with lime/concrete . 32 Bricks . 33 Cement blocks . 34 Wood planks/shingles . 36 Wood and concrete…………………….37 Stucco . 38 Other(specify) ______________________ 96 HC6. WHAT TYPE OF FUEL DOES YOUR HOUSEHOLD MAINLY USE FOR COOKING? Electricity . 01 Butane . 02 Biogas . 04 Kerosene . 05 Charcoal . 07 Wood . 08 Agricultural crop residue . 11 No food cooked in household . 95 Other (specify) _____________________ 96 01ÖHC8 02ÖHC8 04ÖHC8 05ÖHC8 95ÖHC8 HC7. IS THE COOKING USUALLY DONE IN THE HOUSE, IN A SEPARATE BUILDING, OR OUTDOORS? If ‘In the house’, probe: IS IT DONE IN A SEPARATE ROOM USED AS A KITCHEN? In the house In a separate room used as kitchen . 1 Elsewhere in the house . 2 In a separate building . 3 Outdoors . 4 Other (specify) ______________________ 6 HC8. DOES YOUR HOUSEHOLD HAVE: [A] ELECTRICITY? [B] A RADIO? Yes No Electricity . 1 2 Radio . 1 2 236 mics f inal report Final: June, 2011 HOUSEHOLD. Page 10 [C] A TELEVISION? [D] A NON-MOBILE TELEPHONE? [E] A REFRIGERATOR? [F] A FAN? [G] A MICRO WAVE OVEN? [H] A SECURITY ALARM SYSTEM? [I] A WASHING MACHINE? [J] A DV D PLAYER? [K] A GAS BAR-B-Q GRILL? [L] AN AIR CONDITIONER? [M] A WATER COOLER? [N] A SOFA? [O] A DINING ROOM TABLE? [P] A CLOTHES CLOSET? Yes No Television . 1 2 Non-mobile telephone . 1 2 Refrigerator . 1 2 Fan . 1 2 Micro Wave Oven . 1 2 Security Alarm System . 1 2 Washing Machine . 1 2 DVD Player . 1 2 Gas Bar-B-Q Grill . 1 2 Air Conditioner . 1 2 Water Cooler . 1 2 Sofa . 1 2 Dining Room Table . 1 2 Clothes Closet . 1 2 HC9. DOES ANY MEMBER OF YOUR HOUSEHOLD OWN: [A] A WATCH? [B] A CELL TELEPHONE? [C] A BICYCLE? [D] A MOTORCYCLE OR SCOOTER? [F] A CAR OR TRUCK? [G] A BOAT WITH A MOTOR? [H] AN MP3/MP4 PLAYER? [I] A FISHING ROD? [J] A WEIGHT TRAINING MACHINE? [K] A COMPUTER Yes No Watch .1 2 Cell telephone .1 2 Bicycle .1 2 Motorcycle/Scooter .1 2 Car/Truck .1 2 Boat with motor .1 2 Mp3/mp4 player .1 2 Fishing Rod .1 2 Weight Training Machine .1 2 Computer…………………………….1 2 mics f inal report 237 Final: June, 2011 HOUSEHOLD. Page 11 HC10. DO YOU OR SOMEONE LIVING IN THIS HOUSEHOLD OWN THIS DWELLING? If “No”, then ask: DO YOU RENT THIS DWELLING FROM SOMEONE NOT LIVING IN THIS HOUSEHOLD? If “Rented from someone else”, circle “2”. For other responses, circle “6”. Own . 1 Rent . 2 Other (Not owned or rented) . 6 HC11. DOES ANY MEMBER OF THIS HOUSEHOLD OWN ANY LAND THAT CAN BE USED FOR AGRICULTURE? Yes . 1 No . 2 2ÖHC13 HC12. HOW MANY ACRES OF AGRICULTURAL LAND DO MEMBERS OF THIS HOUSEHOLD OWN? If less than 1, record “00”.If 95 or more, record ‘95’.If unknown, record ‘98’. Acres . ___ ___ HC13. DOES THIS HOUSEHOLD OWN ANY LIVESTOCK, HERDS, OTHER FARM ANIMALS, OR POULTRY? Yes . 1 No . 2 2ÖHC15 HC14. HOW MANY OF THE FOLLOWING ANIMALS DOES THIS HOUSEHOLD OWN? [A] CATTLE, MILK COWS, OR BULLS? [B] HORSES, DONKEYS, OR MULES? [C] GOATS? [D] SHEEP? [E] CHICKENS? [F] PIGS? If none, record ‘00’. If 95 or more, record ‘95’. If unknown, record ‘98’. Cattle, milk cows, or bulls . ___ ___ Horses, donkeys, or mules . ___ ___ Goats . ___ ___ Sheep . ___ ___ Chickens . ___ ___ Pigs . ___ ___ HC15. DOES ANY MEMBER OF THIS HOUSEHOLD HAVE A BANK ACCOUNT, A BANK BOOK OR CREDIT UNION BOOK? Yes . 1 No . 2 238 mics f inal report Final: June, 2011 HOUSEHOLD. Page 12 CHILD LABOUR CL To be administered for children in the household age 5-14 years. For household members below age5 or above age 14, leave rows blank. NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN AGE 5-14 IN THIS HOUSEHOLD MAY DO. CL1. Line number CL2. Name and Age Copy from Household Listing Form, HL2 and HL6 CL3. DURING THE PAST WEEK, DID (name) DO ANY KIND OF WORK FOR SOMEONE WHO IS NOT A MEMBER OF THIS HOUSEHOLD? If yes: FOR PAY IN CASH OR KIND? 1 Yes, for pay (cash or kind) 2 Yes, unpaid 3 NoÞ CL5 CL4. SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE DO THIS WORK FOR SOMEONE WHO IS NOT A MEMBER OF THIS HOUSEHOLD? If more than one job, include all hours at all jobs. CL5. DURING THE PAST WEEK, DID (name) FETCH WATER OR COLLECT FIREWOOD FOR HOUSEHOLD USE? 1 Yes 2 NoÞ CL7 CL6. SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE FETCH WATER OR COLLECT FIREWOOD FOR HOUSEHOLD USE? CL7. DURING THE PAST WEEK, DID (name) DO ANY PAID OR UNPAID WORK FOR A HOUSEHOLD MEMBER ON A FAMILY FARM OR IN A FAMILY BUSINESS OR SELLING GOODS IN THE STREET? Include work for a business run by the child, alone or with one or more partners. 1 Yes 2 NoÞ CL9 CL8. SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE DO THIS WORK FOR HIS/HER FAMILY OR HIMSELF/ HERSELF? CL9. DURING THE PAST WEEK, DID (name) HELP WITH HOUSEHOLD CHORES SUCH AS SHOPPING, CLEANING, WASHING CLOTHES, COOKING; OR CARING FOR CHILDREN, OLD OR SICK PEOPLE? 1 Yes 2 NoÞ Next Line CL10. SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE SPEND DOING THESE CHORES? CL11. DURING THE PAST WEEK, WHEN DID (name) CARRY OUT THESE HOUSEHOLD CHORES? Circle all that apply Times: A .Morning B. Afternoon C. Evening D. Night CL12. DURING THE PAST WEEK, WHICH HOUSEHOLD CHORES WAS (name) MAINLY CARRYING OUT? Circle all that apply Chores: A. Cooking/Serving Food B. Shopping for H. hold C. Cleaning Utensils/ house D .Washing clothes E. Minor household repairs F. Caring for children G. Caring for elderly or sick H. Other Yes No Number Number Number Number Line Name Age Paid Unpaid of hours Yes No of hours Yes No of hours Yes No of hours Times Chores 01 __ __ 1 2 3 ____ ____ 1 2 ___ ___ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 02 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 03 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H Final: June, 2011 HOUSEHOLD. Page 13 04 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 05 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 06 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 07 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 08 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 09 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 10 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 11 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 12 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 13 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 14 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H 15 __ __ 1 2 3 ____ ____ 1 2 ____ ____ 1 2 ____ ____ 1 2 ____ ____ A B C D A B C D E F G H mics f inal report 239 Final: June, 2011 HOUSEHOLD. Page 14 CHILD DISCIPLINE CD Table 1: Children Aged 2-14 Years Eligible for Child Discipline Questions o List each of the children aged 2-14 years below in the order they appear in the Household Listing Form. Do not include other household members outside of the age range 2-14 years. o Record the line number, name, sex, and age for each child. o Then record the total number of children aged 2-14 in the box provided (CD6). CD1. Rank number CD2. Line number from HL1 CD3. Name from HL2 CD4. Sex from HL4 CD5. Age from HL6 Rank Line Name M F Age 1 __ __ 1 2 ___ ___ 2 __ __ 1 2 ___ ___ 3 __ __ 1 2 ___ ___ 4 __ __ 1 2 ___ ___ 5 __ __ 1 2 ___ ___ 6 __ __ 1 2 ___ ___ 7 __ __ 1 2 ___ ___ 8 __ __ 1 2 ___ ___ CD6. Total children age 2-14 years ___ ___ o If there is only one child age 2-14 years in the household, then skip Table 2 and go to CD8; write down’1’ and continue with CD9 Table 2: Selection of Random Child for Child Discipline Questions o Use Table 2 to select one child between the ages of 2 and 14 years, if there is more than one child in that age range in the household. o Check the last digit of the household number (HH2) from the cover page. This is the number of the row you should go to in the table below. o Check the total number of eligible children (2-14) in CD6 above. This is the number of the column you should go to. o Find the box where the row and the column meet and circle the number that appears in the box. This is the rank number of the child (CD1) about whom the questions will be asked. CD7. Total Number of Eligible Children in the Household (CD6) Last digit of household number (HH2) 1 2 3 4 5 6 7 8+ 0 1 2 2 4 3 6 5 4 1 1 1 3 1 4 1 6 5 2 1 2 1 2 5 2 7 6 3 1 1 2 3 1 3 1 7 4 1 2 3 4 2 4 2 8 5 1 1 1 1 3 5 3 1 6 1 2 2 2 4 6 4 2 7 1 1 3 3 5 1 5 3 8 1 2 1 4 1 2 6 4 9 1 1 2 1 2 3 7 5 CD8.Record the rank number of the selected child . ____ 240 mics f inal report Final: June, 2011 HOUSEHOLD. Page 15 CD9.Write the name and line number of the child selected for the module from CD3 and CD2, based on the rank number in CD8. Name _____________________________ Line number . ___ ___ CD10. ADULTS USE CERTAIN WAYS TO TEACH CHILDREN THE RIGHT BEHAVIOUR OR TO ADDRESS A BEHAVIOUR PROBLEM. I WILL READ VARIOUS METHODS THAT ARE USED AND I WANT YOU TO TELL ME IF YOU OR ANYONE ELSE IN YOUR HOUSEHOLD HAS USED THIS METHOD WITH (name)IN THE PAST MONTH. CD11. TOOK AWAY PRIVILEGES, FORBADE SOMETHING (name) LIKED OR DID NOT ALLOW HIM/HER TO LEAVE HOUSE. Yes . 1 No. 2 CD12. EXPLAINED WHY (name)’S BEHAVIOUR WAS WRONG. Yes . 1 No. 2 CD13. SHOOK HIM/HER. Yes . 1 No. 2 CD14. SHOUTED, YELLED AT OR SCREAMED AT HIM/HER. Yes . 1 No. 2 CD15. GAVE HIM/HER SOMETHING ELSE TO DO. Yes . 1 No. 2 CD16. SPANKED, HIT OR SLAPPED HIM/HER ON THE BOTTOM WITH BARE HAND. Yes . 1 No. 2 CD17. HIT HIM/HER ON THE BOTTOM OR ELSEWHERE ON THE BODY WITH SOMETHING LIKE A BELT, HAIRBRUSH, STICK OR OTHER HARD OBJECT. Yes . 1 No. 2 CD18. CALLED HIM/HER STUPID, LAZY, OR ANOTHER NAME LIKE THAT. Yes . 1 No. 2 CD19. HIT OR SLAPPED HIM/HER ON THE FACE, HEAD OR EARS. Yes . 1 No. 2 CD20. HIT OR SLAPPED HIM/HER ON THE HAND, ARM, OR LEG. Yes . 1 No. 2 CD21. BEAT HIM/HER UP, THAT IS HIT HIM/HER OVER AND OVER AS HARD AS ONE COULD. Yes . 1 No. 2 CD22. DO YOU BELIEVE THAT IN ORDER TO BRING UP, RAISE, OR EDUCATE A CHILD PROPERLY, THE CHILD NEEDS TO BE PHYSICALLY PUNISHED? Yes . 1 No. 2 Don’t know/No opinion . 8 mics f inal report 241 Final: June, 2011 HOUSEHOLD. Page 16 HANDWASHING HW HW1. PLEASE SHOW ME WHERE MEMBERS OF YOUR HOUSEHOLD MOST OFTEN WASH THEIR HANDS. Observed . 1 Not observed Not in dwelling / plot / yard . 2 No permission to see . 3 Other reason . 6 2 ÖHW4 3 ÖHW4 6 ÖHW4 HW2. Observe presence of water at the specific place for hand washing. Verify by checking the tap/pump, or basin, bucket, water container or similar objects for presence of water. Water is available . 1 Water is not available . 2 HW3. Record if soap or detergent is present at the specific place for hand washing. Circle all that apply. Skip to HH19 if any soap or detergent code (A, B, C or D) is circled. If “None” (Y) is circled, continue with HW4. Bar soap . A Detergent (Powder / Liquid / Paste) . B Liquid soap . C Ash / Mud / Sand . D None . Y AÖHH19 BÖHH19 CÖHH19 DÖHH19 HW4. DO YOU HAVE ANY BAR SOAP, SOAP POWDER OR LIQUID SOAP IN YOUR HOUSEHOLD FOR WASHING HANDS? Yes . 1 No . 2 2ÖHH19 HW5. CAN YOU PLEASE SHOW IT TO ME? Record observation. Circle all that apply. Bar soap . A Detergent (Powder / Liquid / Paste) . B Liquid soap . C Ash / Mud / Sand . D Not able / Does not want to show . Y 242 mics f inal report Final: June, 2011 HOUSEHOLD. Page 17 HH19. Record the time. Hour, minutes and am/pm . __ __ : __ __ ___ m HH20. Does any eligible woman age 15-49 reside in the household? Check Household Listing Form, column HL7 for any eligible woman. You should have a questionnaire with the Information Panel filled in for each eligible woman. … Yes Ö Go to QUESTIONNAIRE FOR INDIVIDUAL WOMEN to administer the questionnaire to the first eligible woman. … NoÖ Continue. HH21. Does any child under the age of 5 reside in the household? Check Household Listing Form, columnHL9 for any eligible child under age 5. You should have a questionnaire with the Information Panel filled in for each eligible child. …Yes Ö Go to QUESTIONNAIRE FOR CHILDREN UNDER FIVE to administer the questionnaire to mother or caretaker of the first eligible child. … No Ö Continue. HH22. Does any child age 2-9 reside in the household? Check Household Listing Form, column HL9A for any eligible child. You should have a questionnaire with the Information Panel filled in for each eligible child age 2-9. … Yes Ö Go to QUESTIONNAIRE FOR CHILD DISABILITY to administer the questionnaire for the first eligible child. … No Ö End the interview by thanking the respondent for his/her cooperation. Gather together all questionnaires for this household and complete HH8 to HH15B on the cover page. mics f inal report 243 Final: June, 2011 HOUSEHOLD. Page 18 Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations 244 mics f inal report Repeat greetin WE ARE FRO WE ARE W FAMILY HE WOULD L SUBJECTS 20MINUTES REMAIN ANSWERS MAY I START … … N WM7. Resul WM8. Field e Name _____ WOMAN’S This questionn Fill in a separ WM1. Cluste WM3. Woma Name WM5.Intervie Name ng if not alread OM THE STATIS WORKING ON A EALTH AND ED LIKE TO TALK . THE INTER S. ALL THE IN STRICTLY C WILL NEVER BE NOW? Yes, permissio No, permission lt of woman’s edited by (Na ____________ INFORMAT naire is to be a rate questionna er number an’s name: ewer name a dy read to this STICAL INSTITU A PROJECT CO DUCATION WIT K TO YOU RVIEW WILL FORMATION W CONFIDENTIAL E IDENTIFIED. n is given Ö G n is not given interview ame and num ___________ ION PANEL administered to aire for each e __ nd number: woman: UTE OF BELIZE NCERNED WIT TH UNICEF. ABOUT THES TAKE ABOU WE OBTAIN WIL AND YOU Go to WM10 to Ö Complete W ber): _ ___ ___ QUESTIO o all women ag eligible woman __ ___ ___ ___ ___ E. TH I SE UT LL R If greeting questi then r NOW I WO HEALT TAKE INFOR CONF IDENT o record the tim WM7. Discuss Complete Not at ho Refused . Partly com Incapacit Other (sp WM9. Da Name ___ ONNAIRE ge 15 through 4 . WM2. Hou WM4. Wom WM6. Day g at the beginni ionnaire has a read the follow OULD LIKE TO T TH AND OTHER ABOUT 20 RMATION WE FIDENTIAL AND TIFIED. me and then be this result with ed . me . . mpleted . ated . ecify) ______ ata entry clerk ___________ E FOR IN 49 (see Househ usehold numb man’s line nu y/Month/Year ___ __ Fina ing of the hous lready been re wing: TALK TO YOU M R TOPICS. TH MINUTES. A OBTAIN WILL YOUR ANSWE egin the intervie h your supervis . . . . . ___________ k (Name and ___________ NDIVIDUA hold Listing Fo ber umber: of interview: __ / ___ ___ / al: June, 201 sehold ead to this wom MORE ABOUT Y IS INTERVIEW AGAIN, ALL REMAIN STRI ERS WILL NEVE ew. sor. . . . . . ____________ number): _____ ___ _ AL WOM BE W orm, column HL ___ ___ ___ / ___ ___ ___ 11 man, YOUR WILL THE CTLY ER BE . 01 . 02 . 03 . 04 . 05 _ 96 ___ MEN ELIZE WM HL7). ___ ___ _ ___ appendix i. QuesTionnaire for individual women mics f inal report 245 Final: June, 2011 WOMEN. Page 2 WM10. Record the time. Hour, minutes and am/pm __ __ : __ __/ __ m WOMAN’S BACKGROUND WB WB1. IN WHAT MONTH AND YEAR WERE YOU BORN? Date of birth Month . __ __ DK month . 98 Year . __ __ __ __ DK year . 9998 WB2. HOW OLD ARE YOU? Probe: HOW OLD WERE YOU AT YOUR LAST BIRTHDAY? Compare and correct WB1 and/or WB2 if inconsistent Age (in completed years) . __ __ WB3. HAVE YOU EVER ATTENDED SCHOOL OR PRESCHOOL? Yes . 1 No . 2 2ÖWB7 WB4. WHAT IS THE HIGHEST LEVEL OF SCHOOL YOU ATTENDED? Preschool . 0 Infant . 7 Primary. 1 Secondary . 2 Associates . 4 Bachelors and higher . 5 CET/ITVET . 6 Other…………………………………………….9 DK …………………………………………….8 0ÖWB7 WB5. WHAT IS THE HIGHEST STANDARD/FORM/YEARYOU COMPLETED AT THAT LEVEL? If less than Standard 1, Form 1 or Year 1, enter “00” Standard/Form/Year . __ __ DK ………………………………………. 98 WB6. Check WB4: … Secondary or higher. Ö Go toNext Module … Infant, Primary, other or DKÖ Continue with WB7 WB7. NOW I WOULD LIKE YOU TO READ THIS SENTENCE TO ME. Show sentence on the card to the respondent. If respondent cannot read whole sentence, probe: CAN YOU READ PART OF THE SENTENCE TO ME? Cannot read at all . 1 Able to read only parts of sentence . 2 Able to read whole sentence . 3 No sentence in required language _________________ 4 (specify language) Blind/mute, visually/speech impaired . 5 246 mics f inal report Final: June, 2011 WOMEN. Page 3 CHILD MORTALITY CM All of the following questions refer only to LIVE births CM1. NOW I WOULD LIKE TO ASK ABOUT ALL THE LIVE BIRTHS YOU HAVE HAD DURING YOUR LIFE. HAVE YOU EVER GIVEN BIRTH? Yes………………………………….1 No…………………………………….2 2ÖCM8 CM2. WHAT WAS THE DATE OF YOUR FIRST BIRTH? I MEAN THE VERY FIRST TIME YOU GAVE BIRTH, EVEN IF THE CHILD IS NO LONGER LIVING OR WHOSE FATHER IS NOT YOUR CURRENT PARTNER. Skip to CM4 only if year of first birth is given. Otherwise, continue with CM3. Date of first birth Day __ __ DK day………………………….98 Month………………………… __ __ DK month……………………….98 Year ……………………__ __ __ __ DK year……………………….9998 ÖCM4 CM3. HOW MANY YEARS AGO DID YOU HAVE YOUR FIRST BIRTH? Completed years since first birth………………………….__ __ CM4. DO YOU HAVE ANY SONS OR DAUGHTERS TO WHOM YOU HAVE GIVEN BIRTH WHO ARE NOW LIVING WITH YOU? Yes……………………………………1 No…………………………………….2 2ÖCM6 CM5. HOW MANY SONS LIVE WITH YOU? HOW MANY DAUGHTERS LIVE WITH YOU? If none, record ‘00’. Sons at home……………………__ __ Daughters at home…………….__ __ CM6. DO YOU HAVE ANY SONS OR DAUGHTERS TO WHOM YOU HAVE GIVEN BIRTH WHO ARE ALIVE BUT DO NOT LIVE WITH YOU? Yes…………………………………….1 No………………………………………2 2ÖCM8 CM7. HOW MANY SONS ARE ALIVE BUT DO NOT LIVE WITH YOU? HOW MANY DAUGHTERS ARE ALIVE BUT DO NOT LIVE WITH YOU? If none, record ‘00’. Sons elsewhere……………….__ __ Daughters elsewhere………….__ __ CM8. HAVE YOU EVER GIVEN BIRTH TO A BOY OR GIRL WHO WAS BORN ALIVE BUT LATER DIED? If “No” probe by asking: I MEAN, TO A CHILD WHO EVER BREATHED OR CRIED OR SHOWED OTHER SIGNS OF LIFE – EVEN IF HE OR SHE LIVED ONLY A FEW MINUTES OR HOURS? Yes…………………………………….1 No………………………………………2 2ÖCM10 CM9. HOW MANY BOYS HAVE DIED? HOW MANY GIRLS HAVE DIED? If none, record ‘00’. Boys dead……………………….__ __ Girls dead……………………….__ __ CM10.Sum answers to CM5, CM7, and CM9. Sum………………………………__ __ mics f inal report 247 Final: June, 2011 WOMEN. Page 4 CM11. JUST TO MAKE SURE THAT I HAVE THIS RIGHT, YOU HAVE HAD IN TOTAL (total number in CM10) LIVE BIRTH/S DURING YOUR LIFE. IS THIS CORRECT? … Yes. Check below: … No live births Ö Go to ILLNESS SYMPTOMS Module. … One or more live birthsÖ Continue with CM12 … No Ö Check responses to CM1-CM10 and make corrections as necessary before proceeding. CM12. OF THESE (total number in CM10) BIRTHS YOU HAVE HAD, WHEN DID YOU DELIVER THE LAST ONE (EVEN IF HE OR SHE HAS DIED)? Month and year must be recorded. Date of last birth Day…………………………….__ __ DK day………………………….98 Month………………………… __ __ Year ………………….__ __ __ __ CM13. Check CM12: Last birth occurred within the last 2 years, that is, since (day and month of interview) in 2009 No … No live birth in last 2 years. Ö Go to ILLNESS SYMPTOMS Module Yes… One or more live births in last 2 years. Ö Ask for the name of the child Name of child_______________________ If child has died, take special care when referring to this child by name in the following modules. If more than one live birth in last 2 years record the number here. ____ Go to the next module DESIRE FOR LAST BIRTH. 248 mics f inal report Final: June, 2011 WOMEN. Page 5 DESIRE FOR LAST BIRTH DB This module is to be administered to all women with a live birth in the 2 years preceding date of interview. Check child mortality module CM13 and record name of last-born child here _____________________. Use this child’s name in the following questions, where indicated. DB1. WHEN YOU GOT PREGNANT WITH (name), DID YOU WANT TO GET PREGNANT AT THAT TIME? Yes . 1 No . 2 1ÖNext Module DB2. DID YOU WANT TO HAVE A BABY LATER ON, OR IS IT THAT YOU DID NOT WANT ANY (MORE) CHILDREN? Later . 1 No more . 2 2ÖNext Module DB3. HOW MUCH LONGER DID YOU WANT TO WAIT? Months . 1 __ __ Years . 2 __ __ DK . 998 mics f inal report 249 Final: June, 2011 WOMEN. Page 6 MATERNAL AND NEWBORN HEALTH MN This module is to be administered to all women with a live birth in the 2 years preceding date of interview. Check child mortality module CM13 and record name of last-born child here _____________________. Use this child’s name in the following questions, where indicated. MN1. DID YOU SEE ANYONE FOR PRENATAL CARE DURING YOUR PREGNANCY WITH (name)? Yes . 1 No . 2 2ÖMN5 MN2. WHOM DID YOU SEE? Probe: ANYONE ELSE? Probe for the type of person seen and circle all answers given. Health professional: Doctor . A Nurse / Midwife . B Auxiliary midwife . C Other person Traditional birth attendant . F Community health worker . G Other (specify) ______________________ X MN3. HOW MANY TIMES DID YOU RECEIVE PRENATAL CARE DURING THIS PREGNANCY? Number of times . __ __ DK . 98 MN4. AS PART OF YOUR PRENATAL CARE DURING THIS PREGNANCY, WERE ANY OF THE FOLLOWING DONE AT LEAST ONCE: [A] WAS YOUR BLOOD PRESSURE MEASURED? [B] DID YOU GIVE A URINE SAMPLE? [C] DID YOU GIVE A BLOOD SAMPLE? Yes No Blood pressure . 1 2 Urine sample . 1 2 Blood sample . 1 2 MN5. DO YOU HAVE A PRENATAL CLINIC CARD OR OTHER DOCUMENT WITH YOUR OWN IMMUNIZATIONS LISTED? MAY I SEE IT PLEASE? If a card is presented, use it to assist with answers to the following questions. Yes (card seen) . 1 Yes (card not seen) . 2 No . 3 DK . 8 MN6. WHEN YOU WERE PREGNANT WITH (name), DID YOU RECEIVE ANY INJECTION IN THE ARM OR SHOULDER TO PREVENT THE BABY FROM GETTING TETANUS, THAT IS CONVULSIONS AFTER BIRTH? Yes . 1 No . 2 DK . 8 2ÖMN9 8ÖMN9 MN7. HOW MANY TIMES DID YOU RECEIVE THIS TETANUS INJECTION DURING YOUR PREGNANCY WITH (name)? If 7 or more times, record ‘7’. Number of times . __ DK . 8 8ÖMN9 MN8. How many tetanus injections during last pregnancy were reported in MN7? … Two or more tetanus injections during last pregnancy. Ö Go to MN17 … Fewer than two tetanus injections during last pregnancy. Ö Continue with MN9 250 mics f inal report Final: June, 2011 WOMEN. Page 7 MN9. DID YOU RECEIVE ANY TETANUS INJECTION AT ANY TIME BEFORE YOUR PREGNANCY WITH (name), EITHER TO PROTECT YOURSELF OR ANOTHER BABY? Yes . 1 No . 2 DK . 8 2ÖMN17 8ÖMN17 MN10. HOW MANY TIMES DID YOU RECEIVE A TETANUS INJECTION BEFORE YOUR PREGNANCY WITH (name)? If 7 or more times, record ‘7’. Number of times . __ DK . 8 8ÖMN17 MN11. HOW MANY YEARS AGO DID YOU RECEIVE THE LAST TETANUS INJECTION BEFORE YOUR PREGNANCY WITH (name)? Years ago . __ __ MN17. WHO ASSISTED WITH THE DELIVERY OF (name)? Probe: ANYONE ELSE? Probe for the type of person assisting and circle all answers given. If respondent says no one assisted, probe to determine whether any adults were present at the delivery. Health professional: Doctor . A Nurse/ Midwife . B Auxiliary midwife . C Other person Traditional birth attendant . F Community health worker . G Relative/Friend . H Other (specify) ______________________ X No one . Y MN18. WHERE DID YOU GIVE BIRTH TO(name)? Probe to identify the type of source. Write the name or description of the place below. (Name of place) Home Your home . 11 Other home . 12 Public sector Govt. hospital . 21 Govt. clinic/health centre . 22 Govt. health post . 23 Other public (specify) ______________ 26 Private Medical Sector Private hospital . 31 Private clinic . 32 Private maternity home . 33 Other private medical (specify) _______________ 36 Other (specify) _____________________ 96 11ÖMN20 12ÖMN20 96ÖMN20 MN19. WAS (name) DELIVERED BY CAESAREAN SECTION (C-SECTION)? THAT IS, DID THEY CUT YOUR BELLY OPEN TO TAKE THE BABY OUT? Yes . 1 No . 2 MN20. WHEN (name) WAS BORN, WAS HE/SHE VERY LARGE, LARGER THAN AVERAGE, AVERAGE, SMALLER THAN AVERAGE, OR VERY SMALL? Very large . 1 Larger than average . 2 Average . 3 Smaller than average . 4 Very small . 5 DK . 8 MN21. WAS (name) WEIGHED AT BIRTH? Yes . 1 No . 2 DK . 8 2ÖMN23 8ÖMN23 mics f inal report 251 Final: June, 2011 WOMEN. Page 8 MN22. HOW MUCH DID (name) WEIGH? Record weight from health card, if available. Write the weight: Lbs ______ Oz _____ . From card .1 (lbs) __ __ . __ __ From recall . 2 (lbs) __ __ . __ __ DK . 99998 MN23. HAS YOUR MENSTRUAL PERIOD RETURNED SINCE THE BIRTH OF (name)? Yes . 1 No . 2 MN24. DID YOU EVER BREASTFEED (name)? Yes . 1 No . 2 2ÖNext Module MN25. HOW LONG AFTER BIRTH DID YOU FIRST PUT (name) TO THE BREAST? If less than 1 hour, record ‘00’ hours. If less than 24 hours, record hours. Otherwise, record days. Immediately . 000 Hours . 1 __ __ Days . 2 __ __ Don’t know/remember . 998 MN26. INTHE FIRST THREE DAYS AFTER DELIVERY, WAS (name) GIVEN ANYTHING TO DRINK OTHER THAN BREAST MILK?? Yes . 1 No . 2 2ÖNext Module MN27. WHAT WAS (name) GIVEN TO DRINK? (Circle all responses given) Probe: ANYTHING ELSE? Milk (other than breast milk) . A Plain water . B Sugar or glucose water . C Gripe water . D Sugar-salt-water solution . E Fruit juice . F Infant formula . G Tea / Infusions . H Honey . I Other (specify) ______________________ X 252 mics f inal report Final: June, 2011 WOMEN. Page 9 POST-NATAL HEALTH CHECKS PN This module is to be administered to all women with a live birth in the 2 years preceding the date of interview. Check child mortality module CM13 and record name of last-born child here _____________________. Use this child’s name in the following questions, where indicated. PN1. Check MN18: Was the child delivered in a health facility? … Yes, the child was delivered in a health facility (MN18=21-26 or 31-36) Ö Continue with PN2 … No, the child was not delivered in a health facility (MN18=11-12 or 96) Ö Go to PN6 PN2. NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT WHAT HAPPENED IN THE HOURS AND DAYS AFTER THE BIRTH OF (name). YOU HAVE SAID THAT YOU GAVE BIRTH IN (name or type of facility in MN18). HOW LONG DID YOU STAY THERE AFTER THE DELIVERY? If less than one day, record hours. If less than one week, record days. Otherwise, record weeks. Hours . 1 __ __ Days . 2 __ __ Weeks . 3 __ __ Don’t know / remember . 998 PN3. I WOULD LIKE TO TALK TO YOU ABOUT CHECKS ON (name)’S HEALTH AFTER DELIVERY – FOR EXAMPLE, SOMEONE EXAMINING (name), CHECKING THE CORD, OR SEEING IF (name) IS OK. BEFORE YOU LEFT THE (name or type of facility in MN18), DID ANYONE CHECK ON (name)’S HEALTH? Yes . 1 No . 2 PN4. AND WHAT ABOUT CHECKS ON YOUR HEALTH – I MEAN, SOMEONE ASSESSING YOUR HEALTH, FOR EXAMPLE ASKING QUESTIONS ABOUT YOUR HEALTH OR EXAMINING YOU. DID ANYONE CHECK ON YOUR HEALTH BEFORE YOU LEFT (name or type or facility in MN18)? Yes . 1 No . 2 PN5. NOW I WOULD LIKE TO TALK TO YOU ABOUT WHAT HAPPENED AFTER YOU GAVE BIRTH AT (name or type of facility in MN18). DID ANYONE CHECK ON (name)’S HEALTH AFTER YOU LEFT (name or type of facility in MN18)? Yes . 1 No . 2 1ÖPN11 2ÖPN16 PN6. Check MN17: Did a health professional, traditional birth attendant, or community health worker assist with the delivery? … Yes, delivery assisted by a health professional or other health worker (MN17 = A-G) Ö Continue with PN7 … No, delivery not assisted by a health professional or other health worker (A-G not circled in MN17) Ö Go to PN10 mics f inal report 253 Final: June, 2011 WOMEN. Page 10 PN7. YOU HAVE ALREADY SAID THAT (person or persons in MN17) ASSISTED WITH THE BIRTH. NOW I WOULD LIKE TO TALK TO YOU ABOUT CHECKS ON (name)’S HEALTH AFTER DELIVERY, FOR EXAMPLE EXAMINING (name), CHECKING THE CORD, OR SEEING IF (name) IS OK. AFTER THE DELIVERY WAS OVER AND BEFORE (person or persons in MN17) LEFT YOU, DID (person or persons in MN17) CHECK ON (name)’S HEALTH? Yes . 1 No . 2 PN8. AND DID (person or persons in MN17) CHECK ON YOUR HEALTH BEFORE LEAVING? BY CHECK ON YOUR HEALTH, I MEAN ASSESSING YOUR HEALTH, FOR EXAMPLE ASKING QUESTIONS ABOUT YOUR HEALTH OR EXAMINING YOU. Yes . 1 No . 2 PN9. AFTER THE (person or persons in MN17) LEFT YOU, DID ANYONE CHECK ON THE HEALTH OF (name)? Yes . 1 No . 2 1ÖPN11 2ÖPN18 PN10. I WOULD LIKE TO TALK TO YOU ABOUT CHECKS ON (name)’S HEALTH AFTER DELIVERY – FOR EXAMPLE, SOMEONE EXAMINING (name), CHECKING THE CORD, OR SEEING IF THE BABY IS OK. AFTER (name) WAS DELIVERED, DID ANYONE CHECK ON HIS/HER HEALTH? Yes . 1 No . 2 2ÖPN19 PN11. DID SUCH A CHECK HAPPEN ONLY ONCE, OR MORE THAN ONCE? Once . 1 More than once . 2 1ÖPN12A 2ÖPN12B PN12A. HOW LONG AFTER DELIVERY DID THAT CHECK HAPPEN? PN12B. HOW LONG AFTER DELIVERY DID THE FIRST OF THESE CHECKS HAPPEN? If less than one day, record hours. If less than one week, record days. Otherwise, record weeks. Hours . 1 __ __ Days . 2 __ __ Weeks . 3 __ __ Don’t know / remember . 998 PN13. WHO CHECKED ON (name)’S HEALTH AT THAT TIME? Health professional Doctor . A Nurse/ Midwife . B Auxiliary midwife . C Other person Traditional birth attendant . F Community health worker . G Relative/Friend . H Other (specify) ______________________ X 254 mics f inal report Final: June, 2011 WOMEN. Page 11 PN14. WHERE DID THIS CHECK TAKE PLACE? Probe to identify the type of source. Write the name of the place below. (Name of place) Home Your home . 11 Other home . 12 Public sector Govt. hospital . 21 Govt. clinic/health centre . 22 Govt. health post . 23 Other public (specify) ______________ 26 Private medical sector Private hospital . 31 Private clinic . 32 Private maternity home . 33 Other private medical (specify) _______________ 36 Other (specify) _____________________ 96 PN15. Check MN18: Was the child delivered in a health facility? … Yes, the child was delivered in a health facility (MN18=21-26 or 31-36) Ö Continue with PN16 … No, the child was not delivered in a health facility (MN18=11-12 or 96) Ö Go to PN17 PN16. AFTER YOU LEFT (name or type of facility in MN18), DID ANYONE CHECK ON YOUR HEALTH? Yes . 1 No . 2 1ÖPN20 2ÖNext Module PN17. Check MN17: Did a health professional, traditional birth attendant, or community health worker assist with the delivery? … Yes, delivery assisted by a health professional or other health worker (MN17=A-G) ÖContinue with PN18 … No, delivery not assisted by a health professional or other health worker (A-G not circled in MN17) Ö Go to PN19 PN18. AFTER THE DELIVERY WAS OVER AND (person or persons in MN17) LEFT, DID ANYONE CHECK ON YOUR HEALTH? Yes . 1 No . 2 1ÖPN20 2ÖNext Module PN19. AFTER THE BIRTH OF (name), DID ANYONE CHECK ON YOUR HEALTH? I MEAN SOMEONE ASSESSING YOUR HEALTH, FOR EXAMPLE ASKING QUESTIONS ABOUT YOUR HEALTH OR EXAMINING YOU. Yes . 1 No . 2 2ÖNext Module PN20. DID SUCH A CHECK HAPPEN ONLY ONCE, OR MORE THAN ONCE? Once . 1 More than once . 2 1ÖPN21A 2ÖPN21B mics f inal report 255 Final: June, 2011 WOMEN. Page 12 PN21A. HOW LONG AFTER DELIVERY DID THAT CHECK HAPPEN? PN21B. HOW LONG AFTER DELIVERY DID THE FIRST OF THESE CHECKS HAPPEN? If less than one day, record hours. If less than one week, record days. Otherwise, record weeks. Hours . 1 __ __ Days . 2 __ __ Weeks . 3 __ __ Don’t know / remember . 998 PN22. WHO CHECKED ON YOUR HEALTH AT THAT TIME? Health professional Doctor . A Nurse/ Midwife . B Auxiliary midwife . C Other person Traditional birth attendant . F Community health worker . G Relative/Friend . H Other (specify) ______________________ X PN23. WHERE DID THIS CHECK TAKE PLACE? Probe to identify the type of source. If unable to determine whether public or private, write the name of the place. (Name of place) Home Your home . 11 Other home . 12 Public sector Govt. hospital . 21 Govt. clinic/health centre . 22 Govt. health post . 23 Other public (specify) ______________ 26 Private medical sector Private hospital . 31 Private clinic . 32 Private maternity home . 33 Other private medical (specify) _______________ 36 Other (specify) _____________________ 96 Final: June, 2011 WOMEN. Page 13 ILLNESS SYMPTOMS IS IS1. Check Household Listing, column HL9 Is the respondent the mother or caretaker of any child under age 5? … Yes Ö Continue with IS2. … No Ö Go to Next Module. IS2. SOMETIMES CHILDREN HAVE SEVERE ILLNESSES AND SHOULD BE TAKEN IMMEDIATELY TO A HEALTH FACILITY. WHAT TYPES OF SYMPTOMS WOULD CAUSE YOU TO TAKE YOUR CHILD TO A HEALTH FACILITY RIGHT AWAY? Probe: ANY OTHER SYMPTOMS? Keep asking for more signs or symptoms until the mother/caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions Child not able to drink or breastfeed . A Child becomes sicker . B Child develops a fever . C Child has fast breathing . D Child has difficult breathing . E Child has blood in stool . F Child is drinking poorly . G Child has diarrhoea .……………………….H Child has vomiting …………………………. I Other (specify) ______________________ X Other (specify) ______________________ Y Other (specify) ______________________ Z 256 mics f inal report Final: June, 2011 WOMEN. Page 14 CONTRACEPTION CP CP1. I WOULD LIKE TO TALK WITH YOU ABOUT ANOTHER SUBJECT – FAMILY PLANNING. ARE YOU PREGNANT NOW? Yes, currently pregnant . 1 No . 2 Unsure or DK . 8 1ÖNext Module CP2. SOME PEOPLEUSE VARIOUS WAYS OR METHODS TO DELAY OR AVOID A PREGNANCY. ARE YOU CURRENTLY DOING SOMETHING OR USING ANY METHOD TO DELAY OR AVOID GETTING PREGNANT? Yes . 1 No . 2 2ÖNext Module CP3. WHICH METHOD ARE YOUUSING? Do not prompt. Do not read methods. If more than one method is mentioned, circle each one. Female sterilization (tie-off) . A Male sterilization (vasectomy) . B IUD/Coil . C Injections . D Implants . E Pill . F Male condom . G Female condom . H Diaphragm . I Foam/ Jelly . J Lactational amenorrhoea method (LAM) . K Periodic abstinence/Rhythm/Calendar . L Withdrawal . M Other (specify) ______________________ X mics f inal report 257 Final: June, 2011 WOMEN. Page 15 UNMET NEED UN UN1. Check CP1. Currently pregnant? … Yes, currently pregnant Ö Continue with UN2 … No, unsure or DK Ö Go to UN5 UN2. NOW I WOULD LIKE TO TALK TO YOU ABOUT YOUR CURRENT PREGNANCY. WHEN YOU GOT PREGNANT, DID YOU WANT TO GET PREGNANT AT THAT TIME? Yes . 1 No . 2 1ÖUN4 UN3. DID YOU WANT TO HAVE A BABY LATER ON OR IS IT THAT YOU DID NOT WANT ANY (MORE) CHILDREN? Later . 1 No more . 2 UN4. NOW I WOULD LIKE TO ASK SOME QUESTIONS ABOUT THE FUTURE. AFTER THE CHILD YOU ARE NOW EXPECTING, WOULD YOU LIKE TO HAVE ANOTHER CHILD, OR WOULD YOU PREFER NOT TO HAVE ANY MORE CHILDREN? Have another child . 1 No more / No . 2 Undecided / Don’t know . 8 1ÖUN7 2ÖUN13 8ÖUN13 UN5. Check CP3. Currently using “Female sterilization”? … Yes Ö Go to UN13 … No Ö Continue with UN6 UN6. NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE FUTURE. WOULD YOU LIKE TO HAVE (A/ANOTHER) CHILD, OR WOULD YOU PREFER NOT TO HAVE ANY (MORE) CHILDREN? Have (a/another) child . 1 No more / None . 2 Says she cannot get pregnant . 3 Undecided / Don’t know . 8 2ÖUN9 3ÖUN11 8ÖUN9 UN7. HOW LONG WOULD YOU LIKE TO WAIT BEFORE THE BIRTH OF (A/ANOTHER) CHILD? Months . 1 __ __ Years . 2 __ __ Soon / Now . 993 Says she cannot get pregnant . 994 After marriage . 995 Other . 996 Don’t know . 998 994ÖUN11 UN8. Check CP1. Currently pregnant? … Yes, currently pregnant Ö Go to UN13 … No, unsure or DKÖ Continue with UN9 258 mics f inal report Final: June, 2011 WOMEN. Page 16 UN9. Check CP2. Currently using a method? … Yes Ö Go to UN13 … No Ö Continue with UN10 UN10. DO YOU THINK YOU ARE PHYSICALLY ABLE TO GET PREGNANT AT THIS TIME? Yes . 1 No . 2 DK . 8 1 ÖUN13 8 ÖUN13 UN11. WHY DO YOU THINK YOU ARE NOT PHYSICALLY ABLE TO GET PREGNANT? Circle all codes that apply. Infrequent sex / No sex . A Menopausal . B Never menstruated . C Hysterectomy (surgical removal of uterus) . D Has been trying to get pregnant for 2 years or more without result . E Postpartum amenorrheic . F Breastfeeding . G Too old . H Fatalistic . I Other (specify) ______________________ X Don’t know . Z UN12. Check UN11. “Never menstruated” mentioned? … Mentioned Ö Go to Next Module … Not mentioned Ö Continue with UN13 UN13. WHEN DID YOUR LAST MENSTRUAL PERIOD START? Days ago . 1 __ __ Weeks ago. 2 __ __ Months ago . 3 __ __ Years ago . 4 __ __ In menopause / Has had hysterectomy . 994 Before last birth . 995 Never menstruated . 996 mics f inal report 259 Final: June, 2011 WOMEN. Page 17 ATTITUDES TOWARD DOMESTIC VIOLENCE DV DV1. SOMETIMES A HUSBAND IS ANNOYED OR ANGERED BY THINGS THAT HIS WIFE DOES.IN YOUR OPINION, IS A HUSBAND JUSTIFIED IN HITTING OR BEATING HIS WIFE IN THE FOLLOWING SITUATIONS: [A] IF SHE GOES OUT WITHOUT TELLING HIM? [B] IF SHE NEGLECTS THE CHILDREN? [C] IF SHE QUARRELS WITH HIM? [D] IF SHE REFUSES TO HAVE SEX WITH HIM? [E] IF SHE BURNS THE FOOD? [F] IF SHE HAS SEX WITH ANOTHER MAN? [G] IF SHE WASTES THE MONEY? Yes No DK Goes out without telling . 1 2 8 Neglects children. 1 2 8 Quarrels with him . 1 2 8 Refuses sex . 1 2 8 Burns food . 1 2 8 Sex with another man . 1 2 8 Wastes the money . 1 2 8 260 mics f inal report Final: June, 2011 WOMEN. Page 18 MARRIAGE/UNION MA MA1. ARE YOU CURRENTLY MARRIED OR LIVING WITH A MAN AS IF MARRIED? Yes, currently married . 1 Yes, living with a man . 2 No, not in union . 3 3ÖMA5 MA2. HOW OLD IS YOUR CURRENT HUSBAND/ PARTNER? Probe: HOW OLD WAS YOUR HUSBAND / PARTNER ON HIS LAST BIRTHDAY? Age in years . __ __ DK . 98 MA3. BESIDES YOURSELF, DOES YOUR HUSBAND/PARTNER HAVE ANY OTHER WIVES OR PARTNERS OR DOES HE LIVE WITH OTHER WOMEN AS IF MARRIED? Yes . 1 No . 2 DK . 98 2ÖMA7 98ÖMA7 MA4. HOW MANY OTHER WIVES OR PARTNERS DOES HE HAVE? Number . __ __ DK . 98 ÖMA7 98ÖMA7 MA5. HAVE YOU EVER BEEN MARRIED OR LIVED TOGETHER WITH A MAN AS IF MARRIED? Yes, formerly married . 1 Yes, formerly lived with a man . 2 No . 3 3 ÖNext Module MA6. WHAT IS YOUR MARITAL STATUS NOW: ARE YOU WIDOWED, DIVORCED OR SEPARATED? Widowed . 1 Divorced . 2 Separated. 3 MA7. HAVE YOU BEEN MARRIED OR LIVED WITH A MAN ONLY ONCE OR MORE THAN ONCE? Only once . 1 More than once . 2 MA8. IN WHAT MONTH AND YEAR DID YOU FIRST MARRY OR START LIVING WITH A MAN AS IF MARRIED? Date of first marriage/union Month . __ __ DK month . 98 Year . __ __ __ __ DK year . 9998 ÖNext Module MA9. HOW OLD WERE YOU WHEN YOU STARTED LIVING WITH YOUR FIRST HUSBAND/PARTNER? Age in years . __ __ mics f inal report 261 Final: June, 2011 WOMEN. Page 19 SEXUAL BEHAVIOUR SB Check for the presence of others. Before continuing, ensure privacy. SB1. NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT SEXUAL ACTIVITY IN ORDER TO GAIN A BETTER UNDERSTANDING OF SOME IMPORTANT LIFE ISSUES. THE INFORMATION YOU SUPPLY WILL REMAIN STRICTLY CONFIDENTIAL. HOW OLD WERE YOU WHEN YOU HAD SEXUAL INTERCOURSE FOR THE VERY FIRST TIME? Never had intercourse . 00 Age in years . __ __ First time when started living with (first) husband/partner . 95 DK/Don’t remember…………………………98 00ÖNext Module SB2. THE FIRST TIME YOU HAD SEXUAL INTERCOURSE, WAS A CONDOM USED? Yes . 1 No . 2 DK / Don’t remember . 8 SB3. WHEN WAS THE LAST TIME YOU HAD SEXUAL INTERCOURSE? Record ‘years ago’ only if last intercourse was one or more years ago. If 12 months or more the answer must be recorded in years. Days ago . 1 __ __ Weeks ago . 2 __ __ Months ago . 3 __ __ Years ago . 4 __ __ 4ÖSB15 SB4. THE LAST TIME YOU HAD SEXUAL INTERCOURSE, WAS A CONDOM USED? Yes . 1 No . 2 DK / Don’t remember . 8 SB5. WHAT WAS YOUR RELATIONSHIP TO THISPERSON WITH WHOM YOU LAST HAD SEXUAL INTERCOURSE? Probe to ensure that the response refersto the relationship at the time of sexual intercourse If ‘boyfriend’, then ask: WERE YOU LIVING TOGETHER AS IF MARRIED? If ‘yes’, circle ‘2’.If ‘no’, circle‘3’. Husband . 1 Cohabiting partner . 2 Boyfriend . 3 Casual acquaintance . 4 Other (specify) _______________________6 3ÖSB7 4ÖSB7 6ÖSB7 SB6. Check MA1: … Currently married or living with a man (MA1 = 1 or 2) Ö Go to SB8 … Not married / Not in union (MA1 = 3) Ö Continue with SB7 SB7. HOW OLD IS THIS PERSON? If response is DK, probe: ABOUT HOW OLD IS THIS PERSON? Age of sexual partner . __ __ DK . 98 SB8. HAVE YOU HAD SEXUAL INTERCOURSE WITH ANY OTHER PERSON IN THE LAST 12 MONTHS? Yes . 1 No . 2 2ÖSB15 SB9. THE LAST TIME YOU HAD SEXUAL INTERCOURSE WITH THIS OTHER PERSON, WAS A CONDOM USED? Yes . 1 No . 2 262 mics f inal report Final: June, 2011 WOMEN. Page 20 SB10. WHAT WAS YOUR RELATIONSHIP TO THIS PERSON? Probe to ensure that the response refers to the relationship at the time of sexual intercourse If ‘boyfriend’ then ask: WERE YOU LIVING TOGETHER AS IF MARRIED? If ‘yes’, circle ‘2’.If ‘no’, circle’3’. Husband . 1 Cohabiting partner . 2 Boyfriend . 3 Casual acquaintance . 4 Other (specify) _______________________6 3ÖSB12 4ÖSB12 6ÖSB12 SB11. Check MA1 and MA7: … Currently married or living with a man (MA1 = 1 or 2) AND Married only once or lived with a man only once (MA7 = 1) Ö Go to SB13 … Else Ö Continue with SB12 SB12. HOW OLD IS THIS PERSON? If response is DK, probe: ABOUT HOW OLD IS THIS PERSON? Age of sexual partner . __ __ DK . 98 SB13. OTHER THAN THESE TWO PERSONS, HAVE YOU HAD SEXUAL INTERCOURSE WITH ANY OTHER PERSON IN THE LAST 12 MONTHS? Yes . 1 No . 2 2ÖSB15 SB14. IN TOTAL, WITH HOW MANY DIFFERENT PEOPLE HAVE YOU HAD SEXUAL INTERCOURSE IN THE LAST 12 MONTHS? Number of partners . __ __ SB15. IN TOTAL, WITH HOW MANY DIFFERENT PEOPLE HAVE YOU HAD SEXUAL INTERCOURSE IN YOUR LIFETIME? If a non-numeric answer is given, probe to get an estimate. If number of partners is 95 or more, write ‘95’. Number of lifetime partners . __ __ DK . 98 mics f inal report 263 Final: June, 2011 WOMEN. Page 21 HIV/AIDS HA HA1. NOW I WOULD LIKE TO TALK WITH YOU ABOUT SOMETHING ELSE. HAVE YOU EVER HEARD OF AN ILLNESS CALLED AIDS? Yes . 1 No . 2 2Ö NEXT MODULE HA2. CAN PEOPLE REDUCE THEIR CHANCE OF GETTING THE AIDS VIRUS BY HAVING JUST ONE UNINFECTED SEX PARTNER WHO HAS NO OTHER SEX PARTNERS? Yes . 1 No . 2 DK . 8 HA3. CAN PEOPLE GET THE AIDS VIRUS BECAUSE OF OBEAH OR OTHER SUPERNATURAL MEANS? Yes . 1 No . 2 DK. 8 HA4. CAN PEOPLE REDUCE THEIR CHANCE OF GETTING THE AIDS VIRUS BY USING A CONDOM EVERY TIME THEY HAVE SEX? Yes . 1 No . 2 DK . 8 HA5. CAN PEOPLE GET THE AIDS VIRUS FROM MOSQUITO BITES? Yes . 1 No . 2 DK . 8 HA6. CAN PEOPLE GET THE AIDS VIRUS BY SHARING FOOD WITH A PERSON WHO HAS THE AIDS VIRUS? Yes . 1 No . 2 DK . 8 HA7. IS IT POSSIBLE FOR A HEALTHY-LOOKING PERSON TO HAVE THE AIDS VIRUS? Yes . 1 No . 2 DK . 8 HA8. CAN THE VIRUS THAT CAUSES AIDS BE TRANSMITTED FROM A MOTHER TO HER BABY: [A] DURING PREGNANCY? [B] DURING DELIVERY? [C] BY BREASTFEEDING? Yes No DK During pregnancy . 1 2 8 During delivery . 1 2 8 By breastfeeding . 1 2 8 HA9. IN YOUR OPINION, IF A FEMALE TEACHER HAS THE AIDS VIRUS BUT IS NOT SICK, SHOULD SHE BE ALLOWED TO CONTINUE TEACHING IN SCHOOL? Yes . 1 No . 2 DK/Not sure/Depends . 8 HA10. WOULD YOU BUY FRESH VEGETABLES FROM A SHOPKEEPER OR VENDOR IF YOU KNEW THAT THIS PERSON HAD THE AIDS VIRUS? Yes . 1 No . 2 DK/Not sure/Depends . 8 HA11. IF A MEMBER OF YOUR FAMILY GOT INFECTED WITH THE AIDS VIRUS, WOULD YOU WANT IT TO REMAIN A SECRET? Yes . 1 No . 2 DK/Not sure/Depends . 8 HA12. IF A MEMBER OF YOUR FAMILY BECAME SICK WITH AIDS, WOULD YOU BE WILLING TO CARE FOR HER OR HIM IN YOUR OWN HOUSEHOLD? Yes . 1 No . 2 DK/Not sure/Depends . 8 264 mics f inal report Final: June, 2011 WOMEN. Page 22 HA13. Check CM13: Any live birth in last 2 years? … No live birth in last 2 years Ö Go to HA24 … One or more live births in last 2 years Ö Continue with HA14 HA14. Check MN1: Received prenatal care? … Received prenatal careÖ Continue with HA15 … Did not receive prenatal care Ö Go to HA24 HA15. DURING ANY OF THE PRENATAL VISITS FOR YOUR PREGNANCY WITH (name), WERE YOUGIVEN ANY INFORMATION ABOUT: [A] BABIES GETTING THE AIDS VIRUS FROM THEIR MOTHER? [B] THINGS THAT YOU CAN DO TO PREVENT GETTING THE AIDS VIRUS? [C] GETTING TESTED FOR THE AIDS VIRUS? WERE YOU: [D] OFFERED A TEST FOR THE AIDS VIRUS? Y N DK AIDS from mother . 1 2 8 Things to do . 1 2 8 Tested for AIDS . 1 2 8 Offered a test . 1 2 8 HA16. I DON’T WANT TO KNOW THE RESULTS, BUT WERE YOU TESTED FOR THE AIDS VIRUS AS PART OF YOUR PRENATAL CARE? Yes . 1 No . 2 DK . 8 2ÖHA19 8ÖHA19 HA17. I DON’T WANT TO KNOW THE RESULTS, BUT DID YOU GET THE RESULTS OF THE TEST? Yes . 1 No . 2 DK . 8 2ÖHA22 8ÖHA22 HA18. REGARDLESS OF THE RESULT, ALL WOMEN WHO ARE TESTED ARE SUPPOSED TO RECEIVE COUNSELING AFTER GETTING THE RESULT. AFTER YOU WERE TESTED, DID YOU RECEIVE COUNSELLING? Yes . 1 No . 2 DK . 8 1ÖHA22 2ÖHA22 8ÖHA22 HA19. Check MN17: Birth delivered by health professional (A, B or C)? … Yes, birth delivered by health professionalÖ Continue with HA20 … No, birth not delivered by health professionalÖ Go to HA24 HA20. I DON’T WANT TO KNOW THE RESULTS, BUT WERE YOU TESTED FOR THE AIDS VIRUS BETWEEN THE TIME YOU WENT FOR DELIVERY BUT BEFORE THE BABY WAS BORN? Yes . 1 No . 2 2ÖHA24 HA21. I DON’T WANT TO KNOW THE RESULTS, BUT DID YOU GET THE RESULTS OF THE TEST? Yes . 1 No . 2 HA22. HAVE YOU BEEN TESTED FOR THE AIDS VIRUS SINCE THAT TIME YOU WERE TESTED DURING YOUR PREGNANCY? Yes . 1 No . 2 1ÖHA25 mics f inal report 265 Final: June, 2011 WOMEN. Page 23 HA23. WHEN WAS THE MOST RECENT TIME YOU WERE TESTED FOR THE AIDS VIRUS? Less than 12 months ago. 1 12-23 months ago . 2 2 or more years ago . 3 1, 2 & 3 ÖNEXT MODULE HA24. I DON’T WANT TO KNOW THE RESULTS, BUT HAVE YOU EVER BEEN TESTED TO SEE IF YOU HAVE THE AIDS VIRUS? Yes . 1 No . 2 2ÖHA27 HA25. WHEN WAS THE MOST RECENT TIME YOU WERE TESTED? Less than 12 months ago . 1 12-23 months ago . 2 2 or more years ago . 3 HA26. I DON’T WANT TO KNOW THE RESULTS, BUT DID YOU GET THE RESULTS OF THE TEST? Yes . 1 No . 2 DK . 8 1, 2 & 8 ÖNEXT MODULE HA27. DO YOU KNOW OF A PLACE WHERE PEOPLE CAN GO TO GET TESTED FOR THE AIDS VIRUS? Yes . 1 No . 2 266 mics f inal report Final: June, 2011 WOMEN. Page 24 LIFE SATISFACTION LS LS1.Check WB2: Age of respondent is between 15 and 24? … Age 25-49Ö Go to WM11 … Age 15-24 Ö Continue with LS2 LS2. I WOULD LIKE TO ASK YOU SOME SIMPLE QUESTIONS ON HAPPINESS AND SATISFACTION. FIRST, TAKING ALL THINGS TOGETHER, WOULD YOU SAY YOU ARE VERY HAPPY, SOMEWHAT HAPPY, NEITHER HAPPY NOR UNHAPPY, SOMEWHAT UNHAPPY OR VERY UNHAPPY? YOU CAN ALSO LOOK AT THESE PICTURES TO HELP YOU WITH YOUR RESPONSE. Show side 1 of response card and explain what each symbol represents. Circle the response code pointed to by the respondent. Very happy . 1 Somewhat happy . 2 Neither happy nor unhappy . 3 Somewhat unhappy . 4 Very unhappy . 5 LS3. NOW I WILL ASK YOU QUESTIONS ABOUT YOUR LEVEL OF SATISFACTION IN DIFFERENT AREAS. IN EACH CASE, WE HAVE FIVE POSSIBLE RESPONSES: PLEASE TELL ME, FOR EACH QUESTION, WHETHER YOU ARE VERY SATISFIED, SOMEWHAT SATISFIED, NEITHER SATISFIED NOR UNSATISFIED, SOMEWHAT UNSATISFIED OR VERY UNSATISFIED. AGAIN, YOU CAN LOOK AT THESE PICTURES TO HELP YOU WITH YOUR RESPONSE. Showside 2 of response card and explain what each symbol represents. Circle the response code shown by the respondent, for questions LS3 to LS13. HOW SATISFIED ARE YOU WITH YOUR FAMILY LIFE? Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS4. HOW SATISFIED ARE YOU WITH YOUR FRIENDSHIPS? Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS5. DURING THE CURRENT (2010-2011) SCHOOL YEAR, DID YOU ATTEND SCHOOL AT ANY TIME? Yes . 1 No . 2 2ÖLS7 mics f inal report 267 Final: June, 2011 WOMEN. Page 25 LS6. HOW SATISFIED ARE/WERE YOU WITH YOUR SCHOOL? Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS7. HOW SATISFIED ARE YOU WITH YOUR CURRENT JOB? If the respondent says that he/she does not have a job, circle “0” and continue with the next question. Do not probe to find out how she feels about not having a job, unless she tells you herself. Does not have a job . 0 Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS8. HOW SATISFIED ARE YOU WITH YOUR HEALTH? Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS9. HOW SATISFIED ARE YOU WITH WHERE YOU LIVE? If necessary, explain that the question refers to the living environment, including the neighbourhood and the dwelling. Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS10. HOW SATISFIED ARE YOU WITH HOW PEOPLE AROUND YOU GENERALLY TREAT YOU? Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS11. HOW SATISFIED ARE YOU WITH THE WAY YOU LOOK? Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS12. HOW SATISFIED ARE YOU WITH YOUR LIFE, OVERALL? Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS13. HOW SATISFIED ARE YOU WITH YOUR CURRENT INCOME? If the respondent responds that he/she does not have any income, circle “0” and continue with the next question. Do not probe to find out how she feels about not having any income, unless she tells you herself. Does not have any income . 0 Very satisfied . 1 Somewhat satisfied . 2 Neither satisfied nor unsatisfied . 3 Somewhat unsatisfied . 4 Very unsatisfied . 5 LS14. COMPARED TO THIS TIME LAST YEAR, WOULD YOU SAY THAT YOUR LIFE HAS IMPROVED, STAYED MORE OR LESS THE SAME, OR WORSENED, OVERALL? Improved . 1 More or less the same . 2 Worsened . 3 268 mics f inal report Final: June, 2011 WOMEN. Page 26 LS15. AND IN ONE YEAR FROM NOW, DO YOU EXPECT THAT YOUR LIFE WILL BE BETTER, WILL BE MORE OR LESS THE SAME, OR WILL BE WORSE, OVERALL? Better . 1 More or less the same . 2 Worse . 3 WM11. Record the time. Hour, minutes and am/pm . __ __ : __ __ __ m WM12.Check Household Listing Form, columnHL9. Is the respondent the mother or caretaker of any child age 0-4 living in this household? … Yes Ö Go to QUESTIONNAIRE FOR CHILDREN UNDER FIVE for that child and start the interview with this respondent. … NoÖ Continue. WM13. Check Household Listing Form, columnHL9. Is the respondent the mother or caretaker of any child age 2 - 9 living in this household? … Yes Ö Go to QUESTIONNAIRE FOR CHILD DISABILITY for that child and start the interview with this respondent. … NoÖ End the interview with this respondent by thanking her for her cooperation. Check for the presence of any other eligible woman or children under-5 in the household. mics f inal report 269 Final: June, 2011 WOMEN. Page 27 Field Editor’s Observations Interviewer’s Observations Supervisor’s Observations 270 mics f inal report A Repeat greetin WE ARE FROM WE ARE W FAMILY H WOULD L INTERVIE INFORMA CONFIDE IDENTIFIE MAY I START … … N UF9. Result Codes refer UF10. Field Name _____ UNDER-F This questi care for a c A separate UF1. Clus UF3. Child Name UF5. Moth Name UF7. Inter Name Appe ng if not alread M THE STATIST WORKING ON A EALTH AND ED IKE TO TALK TO EW WILL TAKE A ATION WE OBTA NTIAL AND YOU ED. NOW? Yes, permissio No, permission of interview fo to mother/care edited by (Na ____________ FIVE CHILD I ionnaire is to b child that lives e questionnaire ster number: d’s name: her’s / Careta rviewer name endix dy read to this TICAL INSTITUT A PROJECT CO DUCATION WITH O YOU ABOUT T ABOUT 20 MINU AIN WILL REMAI UR ANSWERS W n is given Ö G n is not given or children un etaker. ame and num ___________ Q NFORMATIO be administered s with them and e should be use ___ aker’s name: e and number x H respondent: TE OF BELIZE. NCERNED WITH H UNICEF. I THIS. THE UTES. ALL THE N STRICTLY WILL NEVER BE Go to UF12 to Ö Complete U nder 5 mber): _ ___ ___ QUESTIO ON PANEL d to all mother d is under the a ed for each elig _ ___ ___ r: ___ ___ H E E If greeting questi then r NOW I WO (child TOPIC MINUT WILL R ANSW record the tim UF9. Discuss th Complete Not at ho Refused . Partly com Incapacit Other (sp UF11. Da Name ___ ONNAIRE rs or caretakers age of 5 years gible child. UF2. Hous UF4. Child UF6. Moth UF8. Day / g at the beginni ionnaire has a read the follow OULD LIKE TO T d’s name fro CS. THIS INTER TES. AGAIN, AL REMAIN STRICT WERS WILL NEV me and then beg his result with y ed . me . . mpleted . ated . ecify) ______ ata entry clerk ___________ E FOR CH rs (see Househo (see Household sehold numbe d’s line numbe er’s / Caretak / Month / Yea ___ Fina ing of the hous lready been re wing: TALK TO YOU M om UF3)’S HEA RVIEW WILL TAK LL THE INFORM TLY CONFIDEN VER BE IDENTIF gin the intervie your superviso . . . . . ___________ k (Name and ___________ HILDREN old Listing For d Listing Form er: er: ker’s line num ar of interview ___ / ___ __ al: June, 201 sehold ead to this wom ORE ABOUT ALTH AND OTH KE ABOUT 20 MATION WE OBT TIAL AND YOUR FIED. ew. or. . . . . . ____________ number): _____ ___ _ UNDER F B rm, column HL m, column HL6) ___ __ __ mber: __ w: __ / ___ ___ _ 11 man, ER TAIN R . 01 . 02 . 03 . 04 . 05 _ 96 ___ FIVE BELIZE UF L9) who 6). __ ___ __ ___ __ ___ ___ ___ appendix j. QuesTionnaire for Children under five mics f inal report 271 Final: June, 2011 CHILDREN UNDER 5. Page 2 UF12. Record the time. Hour, minutes and am/pm . __ __ : __ __ __ m AGE AG AG1. NOW I WOULD LIKE TO ASK YOU ABOUT THE AGE OF (name). IN WHAT MONTH AND YEAR WAS (name) BORN? Probe: WHAT IS HIS / HER BIRTHDAY? If the mother/caretaker knows the exact birth date, also enter the day; otherwise, circle 98 for day Month and year must be recorded. Date of birth Day . __ __ DK day . 98 Month . __ __ Year . __ __ __ __ AG2. HOW OLD IS (name)? Probe: HOW OLD WAS (name) AT HIS / HER LAST BIRTHDAY? Record age in completed years. Record ‘0’ if less than 1 year. Compare and correct AG1 and/or AG2 if inconsistent. Age (in completed years) . __ 272 mics f inal report Final: June, 2011 CHILDREN UNDER 5. Page 3 BIRTH REGISTRATION BR BR1. DOES (name) HAVE A BIRTH CERTIFICATE? If yes, ask: MAY I SEE IT? Yes, seen . 1 Yes, not seen . 2 No . 3 DK . 8 1ÖNext Module 2ÖNext Module BR2. HAS (name)’S BIRTH BEEN REGISTERED WITH THE VITAL STATISTICS UNIT (REGISTRY), MAGISTRATE’S COURT, VILLAGE REGISTRAR OR HOSPITAL? Yes . 1 No . 2 DK . 8 1ÖNext Module BR3. DO YOU KNOW HOW TO REGISTER YOUR CHILD’S BIRTH? Yes . 1 No . 2 mics f inal report 273 Final: June, 2011 CHILDREN UNDER 5. Page 4 EARLY CHILDHOOD DEVELOPMENT EC EC1. HOW MANY CHILDREN’S BOOKS OR PICTURE BOOKS DO YOU HAVE FOR (name)? None . 00 Number of children’s books . 0__ Ten or more books . 10 EC2. I AM INTERESTED IN LEARNING ABOUT THE THINGS THAT (name) PLAYS WITH WHEN HE/SHE IS AT HOME. WHAT DOES (name) PLAY WITH? DOES HE/SHE PLAY WITH: [A] HOMEMADE TOYS (SUCH AS DOLLS, CARS, OR OTHER TOYS MADE AT HOME)? [B] TOYS FROM A SHOP OR MANUFACTURED TOYS? [C] HOUSEHOLD OBJECTS (SUCH AS BOWLS OR POTS) OR OBJECTS FOUND OUTSIDE (SUCH AS STICKS, ROCKS, ANIMAL SHELLS OR LEAVES)? If the respondent says “YES” to the categories above, then probe to learn specifically what the child plays with to confirm the response Y N DK Homemade toys . 1 2 8 Toys from a shop . 1 2 8 Household objects or outside objects . 1 2 8 EC3. SOMETIMES ADULTS TAKING CARE OF CHILDREN HAVE TO LEAVE THE HOUSE TO GO SHOPPING, WASH CLOTHES, OR FOR OTHER REASONS AND HAVE TO LEAVE YOUNG CHILDREN. ON HOW MANY DAYS IN THE PAST WEEK WAS (name): [A] LEFT ALONE FOR MORE THAN AN HOUR? [B] LEFT IN THE CARE OF ANOTHER CHILD, THAT IS, SOMEONE LESS THAN 10 YEARS OLD, FOR MORE THAN AN HOUR? If ‘none’ enter’ 0’. If ‘don’t know’ enter’8’ Number of days left alone for more than an hour . ___ Number of days left with other child for more than an hour . ___ EC4. Check AG2: Age of child … Child age 3 or 4 Ö Continue with EC5 … Child age 0, 1 or 2 Ö Go to Next Module EC5. DOES (name) ATTEND ANY ORGANIZED LEARNING OR EARLY CHILDHOOD EDUCATION PROGRAMME, SUCH AS A PRIVATE OR GOVERNMENT FACILITY, INCLUDING KINDERGARTEN OR COMMUNITY CHILD CARE? Yes . 1 No . 2 DK . 8 2ÖEC7 8ÖEC7 274 mics f inal report Final: June, 2011 CHILDREN UNDER 5. Page 5 EC6. WITHIN THE LAST SEVEN DAYS, ABOUT HOW MANY HOURS DID (name) ATTEND? Number of hours . __ __ EC7. IN THE PAST 3 DAYS, DID YOU OR ANY HOUSEHOLD MEMBER OVER 15 YEARS OF AGE ENGAGE IN ANY OF THE FOLLOWING ACTIVITIES WITH (name): If yes, ask: WHO ENGAGED IN THIS ACTIVITY WITH (name)? – THE MOTHER, THE CHILD’S FATHER OR ANOTHER ADULT MEMBER OF THE HOUSEHOLD (INCLUDING THE CARETAKER/RESPONDENT). Circle all that apply. Mother Father Other No one [A] READ BOOKS TO OR LOOKED AT PICTURE BOOKS WITH (name)? Read books A B X Y [B] TOLD STORIES TO (name)? Told stories A B X Y [C] SANG SONGS TO (name) OR WITH (name), INCLUDING LULLABIES? Sang songs A B X Y [D] TOOK (name) OUTSIDE THE HOME, COMPOUND, YARD OR ENCLOSURE? Took outside A B X Y [E] PLAYED WITH (name)? Played with A B X Y [F] NAMED, COUNTED, OR DREW THINGS TO OR WITH (name)? Named/counted A B X Y EC8. I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH AND DEVELOPMENT OF YOUR CHILD. CHILDREN DO NOT ALL DEVELOP AND LEARN AT THE SAME RATE. FOR EXAMPLE, SOME WALK EARLIER THAN OTHERS. THESE QUESTIONS ARE RELATED TO SEVERAL ASPECTS OF YOUR CHILD’S DEVELOPMENT. CAN (name) IDENTIFY OR NAME AT LEAST TEN LETTERS OF THE ALPHABET? Yes . 1 No . 2 DK . 8 EC9. CAN (name) READ AT LEAST FOUR SIMPLE, POPULAR WORDS? Yes . 1 No . 2 DK . 8 EC10. DOES (name) KNOW THE NAME AND RECOGNIZE THE SYMBOL OF ALL NUMBERS FROM 1 TO 10? Yes . 1 No . 2 DK . 8 EC11. CAN (name) PICK UP A SMALL OBJECT WITH TWO FINGERS, LIKE A STICK OR A ROCK FROM THE GROUND? Yes . 1 No . 2 DK . 8 EC12. IS (name) SOMETIMES TOO SICK TO PLAY? Yes . 1 No . 2 DK . 8 mics f inal report 275 Final: June, 2011 CHILDREN UNDER 5. Page 6 EC13. DOES (name) FOLLOW SIMPLE DIRECTIONS ON HOW TO DO SOMETHING CORRECTLY? Yes . 1 No . 2 DK . 8 EC14. WHEN GIVEN SOMETHING TO DO, IS (name) ABLE TO DO IT INDEPENDENTLY? Yes . 1 No . 2 DK . 8 EC15. DOES (name) GET ALONG WELL WITH OTHER CHILDREN? Yes . 1 No . 2 DK . 8 EC16. DOES (name) KICK, BITE, OR HIT OTHER CHILDREN OR ADULTS? Yes . 1 No . 2 DK . 8 EC17. DOES (name) GET DISTRACTED EASILY? Yes . 1 No . 2 DK . 8 276 mics f inal report Final: June, 2011 CHILDREN UNDER 5. Page 7 BREASTFEEDING BF BF1. HAS (name) EVER BEEN BREASTFED? Yes . 1 No . 2 DK . 8 2ÖBF3 8ÖBF3 BF2. IS HE/SHE STILL BEING BREASTFED? Yes . 1 No . 2 DK . 8 BF3. I WOULD LIKE TO ASK YOU ABOUT LIQUIDS THAT (name) MAY HAVE HAD YESTERDAY DURING THE DAY OR THE NIGHT. I AM INTERESTED IN WHETHER (name) HAD THE ITEM EVEN IF IT WAS COMBINED WITH OTHER FOODS. DID (name) DRINK PLAIN WATER YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 BF4. DID (name) DRINK INFANT FORMULA YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 2ÖBF6 8ÖBF6 BF5. HOW MANY TIMES DID (name) DRINK INFANT FORMULA? Number of times . __ __ BF6. DID (name) DRINK MILK, SUCH AS TINNED, POWDERED OR FRESH ANIMAL MILK YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 2ÖBF8 8ÖBF8 BF7. HOW MANY TIMES DID (name) DRINK TINNED, POWDERED OR FRESH ANIMAL MILK? Number of times . __ __ BF8. DID (name) DRINK JUICE OR JUICE DRINKS YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 BF9. DID (name) DRINK WATERY SOUP YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 BF10. DID (name) DRINK OR EAT VITAMIN OR MINERAL SUPPLEMENTS OR ANY MEDICINES YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 BF11. DID (name) DRINK ORS (ORAL RE- HYDRATION SOLUTION) YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 mics f inal report 277 Final: June, 2011 CHILDREN UNDER 5. Page 8 BF12. DID (name) DRINK ANY OTHER LIQUIDS YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 BF13. DID (name) DRINK OR EAT YOGURT YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 2ÖBF15 8ÖBF15 BF14. HOW MANY TIMES DID (name) DRINK OR EAT YOGURT YESTERDAY, DURING THE DAY OR NIGHT? Number of times . __ __ BF15. DID (name) EAT PORRIDGE/LAB YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 BF16. DID (name) EAT SOLID OR SEMI-SOLID (SOFT, MUSHY) FOOD YESTERDAY, DURING THE DAY OR NIGHT? Yes . 1 No . 2 DK . 8 2ÖBF18 8ÖBF18 BF17. HOW MANY TIMES DID (name) EAT SOLID OR SEMI-SOLID (SOFT, MUSHY) FOOD YESTERDAY, DURING THE DAY OR NIGHT? Number of times . __ __ BF18. YESTERDAY, DURING THE DAY OR NIGHT, DID (name) DRINK ANYTHING FROM A BOTTLE WITH A NIPPLE? Yes . 1 No . 2 DK . 8 278 mics f inal report Final: June, 2011 CHILDREN UNDER 5. Page 9 CARE OF ILLNESS CA CA1. HAS (name) HAD DIARRHOEA IN THE LAST TWO WEEKS, THAT IS, SINCE (day of the week) OF THE WEEK BEFORE LAST? Diarrhoea is determined as perceived by mother or caretaker, or as three or more loose or watery stools per day, or blood in stool. Yes . 1 No . 2 DK . 8 2ÖCA7 8ÖCA7 CA2. I WOULD LIKE TO KNOW HOW MUCH (name) WAS GIVEN TO DRINK DURING THE DIARRHOEA (INCLUDING BREAST MILK). DURING THE TIME (name) HAD DIARRHOEA, WAS HE/SHE GIVEN LESS THAN USUAL TO DRINK, ABOUT THE SAME AMOUNT, MORE THAN USUAL OR NOTHING TO DRINK? If less, probe: WAS HE/SHE GIVEN MUCH LESS THAN USUAL TO DRINK, OR SOMEWHAT LESS? Much less . 1 Somewhat less . 2 About the same . 3 More . 4 Nothing to drink . 5 DK . 8 CA3. DURING THE TIME (name) HAD DIARRHOEA, WAS HE/SHE GIVEN LESS THAN USUAL TO EAT, ABOUT THE SAME AMOUNT, MORE THAN USUAL, OR NOTHING TO EAT? If “less”, probe: WAS HE/SHE GIVEN MUCH LESS THAN USUAL TO EAT OR SOMEWHAT LESS? Much less . 1 Somewhat less . 2 About the same . 3 More . 4 Stopped food . 5 Never gave food . 6 DK . 8 CA4. DURING THE EPISODE OF DIARRHOEA, WAS (name) GIVEN TO DRINK ANY OF THE FOLLOWING: Read each item aloud and record response before proceeding to the next item. [A] A FLUID MADE FROM ORAL REHYDRATION SALT? [B] A PRE-PACKAGED ORS FLUID FOR DIARRHOEA? [C] PEDIALYTE? Y N DK Fluid from ORS . 1 2 8 Pre-packaged ORS fluid . 1 2 8 Pedialyte . 1 2 8 CA5. WAS ANYTHING (ELSE) GIVEN TO TREAT THE DIARRHOEA? Yes . 1 No . 2 DK . 8 2ÖCA7 8ÖCA7 mics f inal report 279 Final: June, 2011 CHILDREN UNDER 5. Page 10 CA6. WHAT (ELSE) WAS GIVEN TO TREAT THE DIARRHOEA? Probe: ANYTHING ELSE? Record all treatments given. Write brand name(s) of all medicines mentioned. (Name) Pill or Syrup Antibiotic. A Antimotility (anti-diarrhoea) . B Zinc . C Other (Not antibiotic, Antimotility or zinc) . G Unknown pill or syrup . H Injection Antibiotic. L Non-antibiotic . M Unknown injection . N Intravenous/drip . O Home remedy / Herbal medicine . Q Other (specify) ______________________ X CA7. AT ANY TIME IN THE LAST TWO WEEKS, HAS (name) HAD AN ILLNESS WITH A COUGH? Yes . 1 No . 2 DK . 8 2ÖCA14 8ÖCA14 CA8. WHEN (name) HAD AN ILLNESS WITH A COUGH, DID HE/SHE BREATHE FASTER THAN USUAL WITH SHORT, RAPID BREATHS OR HAVE DIFFICULTY BREATHING? Yes . 1 No . 2 DK . 8 2ÖCA14 8ÖCA14 CA9. WAS THE FAST OR DIFFICULT BREATHING DUE TO A PROBLEM IN THE CHEST OR A BLOCKED OR RUNNY NOSE? Problem in chest only . 1 Blocked or runny nose only . 2 Both . 3 Other (specify) ______________________ 6 DK . 8 2ÖCA14 6ÖCA14 CA10. DID YOU SEEK ANY ADVICE OR TREATMENT FOR THE ILLNESS FROM ANY SOURCE? Yes . 1 No . 2 DK . 8 2ÖCA12 8ÖCA12 CA11. FROM WHERE DID YOU SEEK ADVICE OR TREATMENT? Probe: ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Probe to identify each type of source. If source is hospital, health centre, or clinic, write the name of the place below. If unable to determine if public or private sector, write the name of the place below. (Name of place) Public sector Govt. hospital . A Govt. health centre . B Govt. health post . C Village health worker . D Mobile / Outreach clinic . E Other public (specify) _______________ H Private medical sector Private hospital / clinic . I Private physician . J Private pharmacy . K Mobile clinic . L Other private medical (specify) ________ O Other source Relative / Friend . P Shop . Q Traditional practitioner . R Other (specify) ______________________ X 280 mics f inal report Final: June, 2011 CHILDREN UNDER 5. Page 11 CA12. WAS (name) GIVEN ANY MEDICINE TO TREAT THIS ILLNESS? Yes . 1 No . 2 DK . 8 2ÖCA14 8ÖCA14 CA13. WHAT MEDICINE WAS (name) GIVEN? Probe: ANY OTHER MEDICINE? Circle all medicines given. Write brand name(s) of all medicines mentioned. (Names of medicines) Antibiotic Pill / Syrup . A Injection . B Anti-malarial . M Paracetamol / Panadol / Acetaminophen . P Aspirin . Q Ibuprofen . R Other (specify) ______________________ X DK . Z CA14. Check AG2: Child aged under 3? … Yes Ö Continue with CA15 … No Ö Go to Next Module CA15. THE LAST TIME (name) PASSED STOOLS, WHAT WAS DONE TO DISPOSE OF THE STOOLS? Child used toilet / latrine . 01 Put into toilet or latrine . 02 Put into drain or ditch . 03 Thrown into garbage (solid waste) . 04 Buried . 05 Left in the open . 06 Other (specify) _____________________ 96 DK . 98 mics f inal report 281 Final: June, 2011 CHILDREN UNDER 5. Page 12 IMMUNIZATION IM If an immunization card is available, copy the dates in IM3 for each type of immunization recorded on the card. IM6-IM16A are for registering vaccinations that are not recorded on the card. IM6-IM16A will only be asked when a card is not available. IM1. DO YOU HAVE A CARD WHERE (name)’S VACCINATIONS ARE WRITTEN DOWN? (If yes) MAY I SEE IT PLEASE? Yes, seen . 1 Yes, not seen . 2 No card . 3 1ÖIM3 2ÖIM6 IM2. DID YOU EVER HAVE A VACCINATION CARD FOR (name)? Yes . 1 No . 2 1ÖIM6 2ÖIM6 IM3. (a) Copy dates for each vaccination from the card. (b) Write ‘44’ in day column if card shows that vaccination was given but no date recorded. Date of Immunization Day Month Year BCG BCG POLIO 1 OPV1 POLIO 2 OPV2 POLIO 3 OPV3 POLIO 4 (BOOSTER) OPV4 PENTAVALANT 1 DPT/HEP/HIB 1 PENTAVALANT 2 DPT/HEP/HIB 2 PENTAVALANT 3 DPT/HEP/HIB 3 DPT DIPHTERIA, WHOOPING COUGH, TETANUS) BOOSTER DTaP-P1 (DIPHTERIA, WHOOPING COUGH, TETANUS, POLIO) DTaP-P1 DTaP-P2 DTaP-P2 DTaP-P3 DTaP-P3 DTaP-P4 DTaP-P4 HAEMOPHILUS INFLUENZAE B 1 (FLU) Hib1 HAEMOPHILUS INFLUENZAE B 2 Hib2 HAEMOPHILUS INFLUENZAE B 3 Hib3 HAEMOPHILUS INFLUENZAE B 4 Hib4 HBV1 (HEPATITIS B) HBV1 HBV2 (HEPATITIS B) HBV2 HBV3 (HEPATITIS B) HBV3 MEASLES, MUMPS, RUBELLA 1 MMR1 282 mics f inal report Final: June, 2011 CHILDREN UNDER 5. Page 13 MEASLES, MUMPS, RUBELLA 2 MMR2 VITAMIN A (MOST RECENT) VITA IM4. Check IM3. Are all vaccines (BCG to Measles (or MMR)) recorded? … YesÖ Go to IM18 … No Ö Continue with IM5 IM5. IN ADDITION TO WHAT IS RECORDED ON THIS CARD, DID (name) RECEIVE ANY OTHER VACCINATIONS – INCLUDING VACCINATIONS RECEIVED IN CAMPAIGNS OR IMMUNIZATION DAYS? Record ‘Yes’ only if respondent mentions vaccines shown in the table above. Yes . 1 (Probe for vaccinations and write ‘66’ in the corresponding day column for each vaccine mentioned. Then skip to IM18) No . 2 DK . 8 2ÖIM18 8ÖIM18 IM6. HAS (name) EVER RECEIVED ANY VACCINATIONS TO PREVENT HIM/HER FROM GETTING DISEASES, INCLUDING VACCINATIONS RECEIVED IN A CAMPAIGN OR IMMUNIZATION DAY? Yes . 1 No . 2 DK . 8 2ÖIM18 8ÖIM18 IM7. HAS (name) EVER RECEIVED A BCG VACCINATION AGAINST TUBERCULOSIS – THAT IS, AN INJECTION IN THE ARM OR SHOULDER THAT USUALLY CAUSES A SCAR? Yes . 1 No . 2 DK . 8 IM8. HAS (name) EVER RECEIVED ANY “VACCINATION DROPS IN THE MOUTH” TO PROTECT HIM/HER FROM GETTING DISEASES – THAT IS, POLIO? Yes . 1 No . 2 DK . 8 2ÖIM11A 8ÖIM11A IM10. HOW MANY TIMES WAS HE/SHE GIVEN THESE DROPS? Number of times . __ IM11A. HAS (name) EVER RECEIVED A PENTAVALENT VACCINATION – THAT IS, AN INJECTION TO PREVENT HIM/HER FROM GETTING DIPHTERIA, WHOOPING COUGH, TETANUS, HEPATITIS B, INFLUENZAE B? Probe by indicating that Pentavalent vaccination is sometimes given at the same time as Polio. Yes . 1 No . 2 DK . 8 2ÖIM12A 8ÖIM12A IM11B. HOW MANY TIMES WAS A PENTAVALENT VACCINE RECEIVED? Number of times . __ IM11. HAS (NAME) EVER RECEIVED A DPT VACCINATION – THAT IS, AN INJECTION IN THE THIGH OR BUTTOCKS – TO PREVENT HIM/HER FROM GETTING TETANUS, WHOOPING COUGH, OR DIPHTHERIA? Probe by indicating that DPT vaccination is sometimes given at the same time as polio Yes . 1 No . 2 DK . 8 1ÖIM16 2ÖIM12A 8ÖIM12A mics f inal report 283 Final: June, 2011 CHILDREN UNDER 5. Page 14 IM12A. HAS (name) EVER RECEIVED A DTaP-P1 VACCINATION – THAT IS, AN INJECTION TO PREVENT HIM/HER FROM GETTING DIPHTERIA, WHOOPING COUGH, TETANUS, POLIO? Yes . 1 No . 2 DK . 8 2ÖIM12C 8ÖIM12C IM12B. HOW MANY TIMES WAS A DTaP-P1 VACCINE RECEIVED? Number of times . __ IM12C. HAS (NAME) EVER RECEIVED A HIB1 VACCINATION – THAT IS, AN INJECTION TO PREVENT HIM/HER FROM GETTING HAEMOPHILUS INFLUENZAE TYPE B (FLU)? Yes . 1 No . 2 DK . 8 2ÖIM13 8ÖIM13 IM12D. HOW MANY TIMES WAS A HIB1 VACCINE RECEIVED? Number of times . __ IM13. HAS (name) EVER BEEN GIVEN A HEPATITIS B VACCINATION – THAT IS, AN INJECTION IN THE THIGH OR BUTTOCKS – TO PREVENT HIM/HER FROM GETTING HEPATITIS B? Probe by indicating that the hepatitis B vaccine is sometimes given at the same time as polio and DPT vaccines Yes . 1 No . 2 DK . 8 2ÖIM16 8ÖIM16 IM14. WAS THE FIRST HEPATITIS B VACCINE RECEIVED WITHIN 24 HOURS AFTER BIRTH, OR LATER? Within 24 hours . 1 Later . 2 DK . 8 IM15. HOW MANY TIMES WAS A HEPATITIS B VACCINE RECEIVED? Number of times . __ IM16. HAS (name) EVER RECEIVED A MEASLES INJECTION OR AN MMR INJECTION – THAT IS, A SHOT IN THE ARM AT THE AGE OF 9 MONTHS OR OLDER - TO PREVENT HIM/HER FROM GETTING MEASLES? Yes . 1 No . 2 DK . 8 2ÖIM18 8ÖIM18 IM16A. HOW MANY TIMES WAS A MEASLES INJECTION OR AN MMR INJECTION VACCINE RECEIVED? Number of times . __ IM18. HAS (name) RECEIVED A VITAMIN A DOSE WITHIN THE LAST 6 MONTHS? Show picture of common types of ampules / capsules / syrups Yes . 1 No . 2 DK . 8 284 mics f inal report Final: June, 2011 CHILDREN UNDER 5. Page 15 UF13. Record the time. Hour, minutes and am/pm . __ __ : __ __ __ m UF14. Is the respondent the mother or caretaker of another child age 0-4 living in this household? … Yes Ö Indicate to the respondent that you will need to measure the weight and height of the child later. Go to the next QUESTIONNAIRE FOR CHILDREN UNDER FIVE to be administered to the same respondent and tell her/him that you will need to measure the weight and height of the child … No Ö Continue UF15. Does any child age 2- 9 years reside in the household? Check Household Listing Form, column HL9A for any eligible child age 2- 9 years. … Yes Ö Go to QUESTIONNAIRE FOR CHILD DISABILITY for that child and start the interview with this respondent. … No Ö End the interview with this respondent by thanking him/her for his/her cooperation and tell her/him that you will need to measure the weight and height of the child Check to see if there are other woman’s or under-5 questionnaires to be administered in this household. Move to another woman’s or under-5 questionnaire, or start making arrangements for anthropometric measurements of all eligible children in the household. mics f inal report 285 Final: June, 2011 CHILDREN UNDER 5. Page 16 ANTHROPOMETRY AN After the household questionnaire is complete the field supervisor weighs and measures each child under 5. Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child’s name and line number on the household listing before recording measurements. AN1. Measurer’s name and number: Name ___ ___ AN2. Result of height / length and weight measurement Either or both measured . 1 Child not present . 2 Child or caretaker refused . 3 Other (specify) ______________________ 6 2ÖAN6 3ÖAN6 6ÖAN6 AN3. Child’s weight Kilograms (kg) . __ __ . __ Weight not measured . 99.9 AN4. Child’s length or height Check age of child in AG2: … Child under 2 years old. Ö Measure length (lying down). … Child age 2 or more years. Ö Measure height (standing up). Length (cm) Lying down . 1 __ __ __ . __ Height (cm) Standing up . 2 __ __ __ . __ Length / Height not measured . 9999.9 AN6. Is there another child in the household who is eligible for measurement? … Yes Ö Record measurements for next child. … No Ö Continue with the interviews. 286 mics f inal report Final: June, 2011 CHILDREN UNDER 5. Page 17 Interviewer’s Observations Field Editor’s Observations Supervisor’s Observations mics f inal report 287 A CHILD DISA This questionn care for a chi A separate qu DA1.Cluster ___ DA3. Child’s Name DA5. Mother Name DA7. Intervie Name Repeat greetin WE ARE FROM WE ARE W WITH FAM UNICEF (name)’S A FEW MI ME WILL R YOUR AN ANYONE O WRITTEN MAY I START … … N Appe ABILITY QUES naire is to be a ld that lives wi uestionnaire sh number s name: r’s / Caretake ewer name an ng if not alread M THE STATIST WORKING ON A MILY HEALTH AN F. I WOULD LIKE HEALTH COND NUTES. ALL TH REMAIN STRICT SWERS WILL N OUTSIDE OF TH PERMISSION. NOW? Yes, permissio No, permission endi QUE STIONNAIRE administered to ith them and is ould be used fo __ er’s name: nd number: dy read to this TICAL INSTITUT A PROJECT CO ND EDUCATION E TO TALK TO Y DITION. THIS W HE INFORMATIO TLY CONFIDEN NEVER BE SHAR HE TEAM WITHO n is given Ö G n is not given x I STIONNA CHILD D E FORM o all mothers o s age 2 through for each eligibl __ ___ ___ ___ ___ respondent: TE OF BELIZE. NCERNED N WITH YOU ABOUT ILL TAKE ONLY ON YOU GIVE TIAL AND RED WITH OUT YOUR Go to DA12 to Ö Complete D AIRE FOR DISABILI or caretakers (s h 9 years (see H le child. DA2. Ho _______ DA4. Ch DA6. Mo DA8. Da Y If greeting questio respon NOW I WOU (child THIS W THE IN STRICT NEVER TEAM W begin the inter DA9. Discuss th RM FOR ITY see Household Household List ousehold num ____________ ild’s line num other’s / Caret ay / Month / Ye ___ __ at the beginnin onnaire has alr ndent, then rea ULD LIKE TO TA d’s name from WILL TAKE ONLY NFORMATION YO TLY CONFIDEN R BE SHARED W WITHOUT YOUR rview. his result with y Fi DISABILIT Listing Form, ting Form, colu ber: ___ mber: taker’s line nu ear of intervie __ / ___ ___ / ng of the house ready been rea ad the followin ALK TO YOU MO m HL2)’S HEA Y A FEW MINUT OU GIVE ME W TIAL AND YOUR WITH ANYONE O R WRITTEN PER your superviso inal: June, 201 TY. Page BE column HL9) umn HL6). ___ ___ ___ umber: ___ ew: / ___ ___ ___ ehold ad to this ng: ORE ABOUT ALTH CONDITIO TES. AGAIN, AL ILL REMAIN R ANSWERS W OUTSIDE OF TH RMISSION. or 11 1 ELIZE DA who _ ___ ___ ___ _ ___ N. LL ILL HE appendix k. QuesTionnaire form for Child disabiliTy 288 mics f inal report Final: June, 2011 DISABILITY. Page 2 DA9. Result of interview for child disability Codes refer to mother/caretaker. Completed . 01 Not at home . 02 Refused . 03 Partly completed . 04 Incapacitated . 05 Other (specify) ________________________________ 96 DA10. Field edited by (Name and number): Name ______________________________ ___ ___ DA11. Data entry clerk (Name and number): Name ______________________________ ___ ___ DA11A. Record the time. Hour, minutes and am/pm . __ __ : __ __ __ m mics f inal report 289 Final: June, 2011 DISABILITY. Page 3 CHILD DISABILITY DA To be administered to mothers or caretakers of children age 2-9 years. DA12. Copy child’s name and age from HL2 and HL6, from Household Listing Form. Name . __________________________ Age . ___ ___ DA13. COMPARED WITH OTHER CHILDREN, DOES OR DID (name) HAVE ANY SERIOUS DELAY IN SITTING, STANDING, OR WALKING? Yes . 1 No . 2 DA14. COMPARED WITH OTHER CHILDREN, DOES (name) HAVE DIFFICULTY SEEING, EITHER IN THE DAYTIME OR AT NIGHT? Yes . 1 No . 2 DA15. DOES (name) APPEAR TO HAVE ANY DIFFICULTY HEARING? (USES HEARING AID, HEARS WITH DIFFICULTY OR COMPLETELY DEAF)? Yes . 1 No . 2 DA16. WHEN YOU TELL (name) TO DO SOMETHING, DOES HE/SHE SEEM TO UNDERSTAND WHAT YOU ARE SAYING? Yes . 1 No . 2 DA17. DOES (name) HAVE DIFFICULTY IN WALKING OR MOVING HIS/HER ARMS OR DOES HE/SHE HAVE WEAKNESS AND/OR STIFFNESS IN THE ARMS OR LEGS? Yes . 1 No . 2 DA18. DOES (name) SOMETIMES HAVE FITS, BECOME RIGID, OR LOSE CONSCIOUSNESS? Yes . 1 No . 2 DA19. DOES (name) LEARN TO DO THINGS LIKE OTHER CHILDREN HIS/HER AGE? Yes . 1 No . 2 DA20. DOES (name) SPEAK AT ALL (CAN HE/SHE MAKE HIM OR HERSELF UNDERSTOOD IN WORDS; CAN HE/SHE SAY ANY RECOGNIZABLE WORDS)? Yes . 1 No . 2 DA21. Check DA12: Age of child … Child age 3 through 9 Ö Continue with DA22 … Child age 2 Ö Go to DA23 DA22. IS (name)’S SPEECH IN ANY WAY DIFFERENT FROM NORMAL (NOT CLEAR ENOUGH TO BE UNDERSTOOD BY PEOPLE OTHER THAN THE IMMEDIATE FAMILY)? Yes . 1 No . 2 1ÖDA24 2ÖDA24 DA23. CAN (name) NAME AT LEAST ONE OBJECT (FOR EXAMPLE, AN ANIMAL, A TOY, A CUP, A SPOON)? Yes . 1 No . 2 290 mics f inal report Final: June, 2011 DISABILITY. Page 4 DA24. COMPARED WITH OTHER CHILDREN OF THE SAME AGE, DOES (name) APPEAR IN ANY WAY SLOW? Yes . 1 No . 2 DA25. AS PART OF THIS SURVEY, OTHERS IN OUR TEAM MAY VISIT YOU AGAIN TO COLLECT MORE INFORMATION ON SOME OF THE TOPICS WE HAVE JUST TALKED ABOUT, CONCERNING (name). MAY I PROCEED AND NOTE THAT YOU WOULD BE FINE WITH SUCH A VISIT, IF IT OCCURS AT ALL? AGAIN, YOU MAY CHANGE YOUR MIND AND DECLINE TO SPEAK TO OUR TEAM IF AND WHEN THE VISIT HAPPENS. Respondent has no objections to additional visit . 1 Respondent uncertain about additional visit/Depends . 2 Refused additional visit . 3 DA28. Does any eligible woman age 15-49 reside in the household? Check Household Listing Form, column HL7 for any eligible woman. You should have a questionnaire with the Information Panel filled in for each eligible woman. … Yes Ö Go to QUESTIONNAIRE FOR INDIVIDUAL WOMEN to administer the questionnaire to the first eligible woman. … NO Ö End the interview by thanking the respondent for his/her cooperation. Gather together all questionnaires for this household and complete HH8 to HH15 on the cover page of the Household Questionnaire DA26. Record the time. Hour, minutes and am/pm __ __ : __ __ : __ m DA27. Does any other child age of 2- 9 years reside in the household? Check Household Listing Form, column HL9A for any eligible child age 2- 9 years. … Yes Ö Go to QUESTIONNAIRE FOR CHILD DISABILITY for that child and start the interview with this respondent. … No Ö Continue mics f inal report 291 Final: June, 2011 DISABILITY. Page 5 Field Editor’s Observations Supervisor’s Observations Interviewer’s Observations _GoBack OLE_LINK1 OLE_LINK2

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