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

Publication date: 2007

BOSNIA AND HERZEGOVINA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Directorate for Economic Planning Bosnia and Herzegovina Ministry of Health and Social Welfare Republika Srpska Ministry of Health of the Federation of Bosnia and Herzegovina UNICEF United Nations Children’s Fund September, 2007 Bosnia and Herzegovina Multiple Indicator Cluster Survey 2006 Publisher: UNICEF Bosnia and Herzegovina Authors: Joki} dr. Irena Loli} dr. Amela Memi} Fahrudin Nik{i} doc. dr. Dragana Pilav dr. Aida Prodanovi} doc. dr Nenad Stijak Miroslav Vukovi} Azemina Design: Branko Veki} Cover photo: Edin Pa{ovi} DTP: Printed by: Print run: 100 The Bosnia and Herzegovina Multiple Indicator Cluster Survey (MICS) was conducted by the Directorate for Economic Planning of Bosnia and Herzegovina, the Ministry of Health and Social Protection of the Republika Srpska and the Ministry of Health of BiH Federation in collaboration with the Public Health Institute of BiH Federation and the Banja Luka Health Centre. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF) and DFID. The survey has been conducted as part of the third round of MICS surveys (MICS3), carried out in more than 50 countries worldwide in 2005-2006, following the first two rounds of MICS surveys that were conducted in 1995 and 2000. Survey tools are based on the models and standards developed by the global MICS project, designed to collect information on the situation of children and women in countries around the world. Additional information on the global MICS project may be obtained from www.childinfo.org. Directorate for Economic Planning of Bosnia and Herzegovina, the Ministry of Health and Social Protection of the Republika Srpska and the Ministry of Health of the Federation of Bosnia and Herzegovina Multiple Indicator Cluster Survey 2006, Final Report. Sarajevo, Bosnia and Herzegovina. Foreword The Bosnia and Herzegovina 2006 MICS 3 Report on the situation of women and children is the second report of its kind prepared by BiH government institutions and represents a significant contribution to the development of policies and programmes for children in Bosnia and Herzegovina. This report is timely in that it comes when BiH is in the process of the preparing a new Development Strategy and Social Inclusion Strategy for the period 2008-2013. This is particularly significant especially because one of the most important goals of these development documents is the improvement of the status of children, women and families in Bosnia and Herzegovina. Data on the health and social status of children and women in both entities as well as on the BiH level forms a basis to asses the progress of the country towards the implementation of the MDGs and CRC goals, as well as the progress made as a part of the country’s responsibility to all its citizens. This report is the result of an exceptional cooperation between ministries, institutions and experts from the whole country, as well as international organizations and donors who provided substantial support to the report’s prepa- ration. We would like to thank UNICEF and DFID for their professional and financial support of this project. Most of all, we would like to thank to all families in Bosnia and Herzegovina who enabled this survey by opening their doors and their homes to MICS3 survey teams. We most sincerely hope that the treasury of the information collected and contained in the Report on the Situation of Children and Women in BiH 2006 will initiate additional - and very much needed - surveys on the issues concerning children and women, and that we will jointly use this data for the well-being of all children and women in BiH. Nikola [piri} Chair of the BiH Council of Ministers MICS 3 FULL TECHNICAL REPORT 3 MICS 3 FULL TECHNICAL REPORT 5 Table of Contents Foreword 3 Table of Contents 5 List of Tables 6 List of Figures 8 List of Abbreviations 9 Summary Table of Findings 11 Acknowledgements 14 Executive Summary 15 I. Introduction 23 Background 23 Survey Objectives 24 II. Sample and Survey Methodology 25 Sample Design 25 Questionnaires 25 Training and Fieldwork 27 Data Processing 27 Report Preparation 27 III. Sample Coverage and the Characteristics of Households and Respondents 28 Sample Coverage 28 Characteristics of Households 28 Characteristics of Respondents 29 IV. Nutrition 31 Nutritional Status 31 Breastfeeding 33 Low Birth Weight 34 V. Child Health 36 Immunization 36 Oral Rehydration Treatment 38 Care Seeking and Antibiotic Treatment of Pneumonia 40 Solid Fuel Use 41 VI. Environment 42 Water and Sanitation 42 Security of Tenure and Durability of Housing 44 VII. Reproductive Health 45 Contraception 45 Unmet Need 46 Antenatal Care 47 Assistance at Delivery 48 VIII. Child Development 49 IX. Education 51 Pre-School Attendance and School Readiness 51 Primary and Secondary School Participation 51 Adult Literacy 53 X. Child Protection 54 Birth Registration 54 Child Labour 55 Child Discipline 55 Early Marriage 56 Domestic Violence 58 Child Disability 58 XI. HIV/AIDS, Sexual Behaviour, and Orphaned and Vulnerable Children 59 Knowledge of HIV Transmission and Condom Use 59 Sexual Behaviour Related to HIV Transmission 60 Orphans and Vulnerable Children 61 Appendix A. Sample Design 139 Appendix B. List of Personnel Involved in the Survey 143 Appendix C. Estimates of Sampling Errors 146 Appendix D. Data Quality Tables 153 Appendix E. MICS Indicators: Numerators and Denominators 166 Appendix F. Questionnaires 172 6 MICS 3 FULL TECHNICAL REPORT List of Tables Table HH.1: Results of household and individual interviews 65 Table HH.2: Household age distribution by sex 66 Table HH.3: Household composition 67 Table HH.4: Women's background characteristics 68 Table HH.5: Children's background characteristics 69 Table NU.1: Child malnourishment 70 Table NU.2: Initial breastfeeding 71 Table NU.3: Breastfeeding 72 Table NU.4: Adequately fed infants 73 Table NU.8: Low birth weight infants 74 Table CH.1: Vaccinations in first year of life 75 Table CH.2: Vaccinations by background characteristics 75 Table CH.1 FBiH: Vaccinations in first year of life 76 Table CH.2FBiH: Vaccinations by background characteristics 76 Table CH.1RS: Vaccinations in first year of life 77 Table CH.2RS: Vaccinations by background characteristics 77 Table CH.4: Oral rehydration treatment 78 Table CH.5: Home management of diarrhoea 79 Table CH.6: Care seeking for suspected pneumonia 80 Table CH.7: Antibiotic treatment of pneumonia 81 Table CH.7A: Knowledge of the two danger signs of pneumonia 82 Table CH.8: Solid fuel use 83 Table CH.9: Solid fuel use by type of stove or hearth 84 Table EN.1: Use of improved water sources 85 Table EN.2: Household water treatment 86 Table EN.3: Time to source of water 87 Table EN.4: Person collecting water 88 Table EN.5: Use of sanitary means of excreta disposal 89 Table EN.6: Disposal of child's faeces 90 Table EN.7: Use of improved water sources and improved sanitation 91 Table EN.8: Security of tenure 92 Table EN.9: Durability of Housing 93 Table EN.10: Slum housing 94 Table RH.1: Use of contraception 95 Table RH.2: Unmet need for contraception 96 Table RH.3: Antenatal care provider 97 Table RH.4: Antenatal care 98 Table RH.5: Assistance during delivery 99 Table CD.1: Family support for learning 100 Table CD.2: Learning materials 101 Table CD.3: Children left alone or with other children 102 Table ED.1: Early childhood education 103 Table ED.2: Primary school entry 104 Table ED.3: Primary school net attendance ratio 105 Table ED.4: Secondary school net attendance ratio 106 Table ED 4W Secondary school age children attending primary school 107 Table ED.5: Children reaching grade 5 108 Table ED.6: Primary school completion and transition to secondary education 109 Table ED.7: Education gender parity 110 Table ED.8: Adult literacy 111 Table ED.2 ISCED: Primary school entry 112 Table ED.3 ISCED: Primary school net attendance ratio 113 Table ED.4 ISCED: Secondary school net attendance ratio 114 Table ED 4W ISCED: Secondary school age children attending primary school 115 MICS 3 FULL TECHNICAL REPORT 7 Table ED.5 ISCED: Children reaching grade 5 116 Table ED.6 ISCED: Primary school completion and transition to secondary education 117 Table ED.7 ISCED: Education gender parity 118 Table CP.1: Birth registration 119 Table CP.2: Child labour 120 Table CP.3: Labourer students and student labourers 121 Table CP.4: Child discipline 122 Table CP.5: Early marriage 123 Table CP.6: Spousal age difference 124 Table CP.9: Attitudes toward domestic violence 125 Table CP.10: Child disability 126 Table HA.1: Knowledge of preventing HIV transmission 127 Table HA.2: Identifying misconceptions about HIV/AIDS 128 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission 129 Table HA.4: Knowledge of mother-to-child HIV transmission 130 Table HA.5: Attitudes toward people living with HIV/AIDS 131 Table HA.6: Knowledge of a facility for HIV testing 132 Table HA.7: HIV testing and counselling coverage during antenatal care 133 Table HA.8: Sexual behaviour that increases risk of HIV infection 134 Table HA.9: Condom use at last high-risk sex 135 Table HA.10: Children's living arrangements and orphanhood 136 8 MICS 3 FULL TECHNICAL REPORT List of Figures Figure HH.1: Age and sex distribution of household population 29 Figure NU.1: Percentage of children under-5 who are undernourished 31 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth 33 Figure NU.3: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group 34 Figure NU.5: Percentage of infants weighing less than 2500 grams at birth 35 Figure CH.4: Percentage of children aged 0-59 months with diarrhoea who received ORT or increased fluids, AND continued feeding 39 Figure EN.1: Percentage distribution of household members by source of drinking water 42 Figure RH.1: Use of Contraception 45 Figure HA.2: Sexual behaviour that increases risk of HIV infection 61 MICS 3 FULL TECHNICAL REPORT 9 List of Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis vaccine) BiH Bosnia and Herzegovina CsPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus vaccine EPI Expanded Programme on Immunization FBiH Federation of Bosnia and Herzegovina FMH Federal Ministry of Health GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorder IQ Intelligence Quotient IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MMR Mumps, Measles and Rubella vaccine NAR Net Attendance Rate ORS Oral Rehydration Solution ORT Oral Rehydration Therapy PPS Probability Proportional to Size RHF Recommended Home Fluid RS Republika Srpska SPSS Statistical Package for Social Sciences UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme 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 PHI FBIH Public Health Institute of FBIH MICS 3 FULL TECHNICAL REPORT 11 Summary Table of Findings, Bosnia and Herzegovina Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, 2006 Topic MICS IndicatorNumber MDG Indicator Number Indicator Value NUTRITION Nutritional status 6 4 Underweight prevalence 0.4 7 Stunting prevalence 2.5 8 Wasting prevalence 0.8 Breastfeeding 45 Timely initiation of breastfeeding 56.7 15 Exclusive breastfeeding rate 17.6 16 Continued breastfeeding rate 12-15 months 25.6 20-23 months 9.6 17 Continued breastfeeding rate 29.0 18 Frequency of complementary feeding 22.7 19 Adequately fed infants 20.4 Low Birth Weight 9 Low birth weight infants 4.5 10 Infants weighed at birth 99.0 CHILD HEALTH Immunization 25 Tuberculosis immunization coverage 95.8 26 Polio immunization coverage 79.0 27 DPT immunization coverage 78.0 28 15 Measles immunization coverage 75.0 BiH 79.4 RS 72.4 FBiH 31 Fully immunized children 61.2BiH 58.5FBiH 64.9RS Care of Illness 33 Use of oral rehydration therapy (ORT) 64.8 34 Home management of diarrhoea 17.3 35 Received ORT or increased fluids, and continued feeding 52.5 23 Care seeking for suspected pneumonia 91.3 22 Antibiotic treatment of suspected pneumonia 73.1 Solid Fuel Use 24 29 Solid fuels 48.7 ENVIRONMENT Water and Sanitation 11 30 Use of improved drinking water sources 98.7 13 Water treatment 6.4 12 31 Use of improved sanitation facilities 93.0 14 Disposal of child’s faeces 35.9 12 MICS 3 FULL TECHNICAL REPORT Topic MICS IndicatorNumber MDG Indicator Number Indicator Value Security of Tenure and Durability of Housing 93 Security of tenure 14.1 94 Durability of housing 0.2 95 32 Slum household 15.8 REPRODUCTIVE HEALTH Contraception and Unmet Need 21 19c Contraceptive prevalence 35.7 98 Unmet need for family planning 23.3 99 Demand satisfied for family planning 60.5 Maternal and Newborn Health 20 Antenatal care 98.9 44 Content of antenatal care 98.9 4 17 Skilled attendant at delivery 99.6 5 Institutional deliveries 99.7 CHILD DEVELOPMENT Child Development 46 Support for learning 75.6 47 Father’s support for learning 73.8 48 Support for learning: children’s books 70.4 49 Support for learning: non-children’s books 75.4 50 Support for learning: materials for play 18.9 51 Non-adult care 6.6 EDUCATION (BiH Standards) Education 52 Pre-school attendance 6.4 53 School readiness 10.7 54 Net intake rate in primary education 90.7 55 6 Net primary school attendance rate 98.4 56 Net secondary school attendance rate 79.3 57 7 Children reaching grade five 99.8 58 Transition rate to secondary school 92.7 59 7b Primary completion rate 86.6 61 9 Gender parity index primary school 1.0 secondary school 1.04 Literacy 60 8 Adult literacy rate 99.6 CHILD PROTECTION Birth Registration 62 Birth Registration 99.5 Child Labour 71 Child Labour 5.3 72 Labourer students 95.3 73 Student labourers 6.0 Child Discipline 74 Child discipline / Any psychological / physical punishment 35.6 Early Marriage 67 Marriage before age 15 1.0 Marriage before age 18 10.1 68 Young women aged 15–19 currently married/in union 7.0 69 Spousal age difference Women aged 15–19 19.4 Women aged 20–24 10.8 Domestic Violence 100 Attitudes towards family violence 4.8 Disability 101 Child disability 6.5 MICS 3 FULL TECHNICAL REPORT 13 Topic MICS IndicatorNumber MDG Indicator Number Indicator Value HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED AND VULNERABLE CHILDREN HIV/AIDS Knowledge and Attitudes 82 19b Comprehensive knowledge about HIV prevention among young people 34.2 89 Knowledge of mother-to-child transmission of HIV 69.1 86 Attitude towards people with AIDS 35.8 87 Women who know where to be tested for HIV 59.1 88 Women who know where to be tested for HIV 2.6 90 Counselling coverage for the prevention of mother-to-child transmission of HIV 18.1 91 Testing coverage for the prevention of mother-to-child transmission of HIV 9.6 Sexual Behaviour 84 Sexual Behaviour 0.6 92 Age-mixing among sexual partners 9.0 83 19a Condom use with non-regular partners 71.0 85 Higher risk sex in the last year 25.7 Support to Orphaned and Vulnerable Children 75 Prevalence of orphaned children 4.5 78 Child’s family circumstances 0.4 This report represents an outstanding achievement, and we would like to thank all the people of Bosnia and Herzegovina who generously provided us with their time to be interviewed. The MICS3 survey was conducted with inputs from a large number of individuals and institutions, and we would like to thank them all. MICS3 has generated excellent co-operation among governments, ministries and other organisations. These included: At the level of the State of Bosnia and Herzegovina: Council of Ministers, Directorate for Economic Planning of the BiH (DEP BiH) Agency for Statistics of Bosnia and Herzegovina Federation of Bosnia and Herzegovina: Ministry of Health, Public Health Institute, Office for Statistics Republika Srpska: Ministry of Health & Social Welfare, Institute for Statistics, Public Health Institute, Banja Luka Primary Health Care Centre The UK Government - DFID (Department for International Development) We would like to thank the committees that co-ordinated the MICS3, including the relevant ministries, for their generous support. The survey teams - including co-ordinators, field staff and data entry staff - carried out their work diligently. We are particularly pleased that so many young and mid–career professionals were involved at all levels of this project. The skills and knowledge they have gained will be of significant importance for similar work in the future. We would particularly like to thank the Government of Great Britain and Northern Ireland that provided funding to UNICEF for the MICS3 implementation through DFID. UNICEF also contributed funding for training and equipment, as well as technical support through their offices in Bosnia and Herzegovina, Geneva and New York. UNICEF country and regional offices and the Global MICS team provided invaluable and ongoing support, and we hope to continue to work in such a productive way in the future. Once again, we would like to thank and congratulate all involved in the MICS3 in BiH. 14 MICS 3 FULL TECHNICAL REPORT Acknowledgements The Multiple Indicator Cluster Survey 3 (MICS3) was implemented in Bosnia and Herzegovina (BiH) during 2006 as a national survey with the primary objective to fill in the data gaps and to create the baseline to assess the status of children and women in the country. MICS3 in BiH has ensured that the country’s institutions now have information on 15 out of 48 MDG indicators, as well as the data responding to the objectives set out in the World Fit for Children (WFfC), the resulting document of the 2002 UN Special Session for Children. In compliance with the complex administrative structure of the country, as well as with its actual accountability for the well being and development of children and women, the MICS3 in Bosnia and Herzegovina was implement- ed by three national partners at state and entity levels: the Directorate for Economic Planning of BiH; the Ministry of Health and Social Welfare of the RS; and the Federal Ministry of Health, Federal Institute for Public Health in FBiH. Nutrition Nutritional status • In BiH, 20.2 percent of children are obese. • The prevalence of child undernourishment in BiH is relatively low: 1.5 percent of children are moderately underweight and 0.4 % are severely underweight. • 7.4 percent of children are moderately stunted and 2.5 severely stunted. 3.2 children are moderately wasted and 0.8 severely wasted. • Wasting and obesity are more prevalent amongst girls and are more frequent in the urban than in the rural regions. • Children whose mothers have secondary or higher education are less likely to be underweight and stunted compared to children of mothers with no education or with just primary education. Breastfeeding • Only 17.6 percent of children under six months in BiH are exclusively breastfed. • The percentage of women in BiH who started breastfeeding within an hour after delivery is 56.7 percent with about a six percent difference between urban and rural areas (61.2 percent in urban areas and 54.9 percent in rural areas). • Only 20.4 percent of children aged 0-11 months in BiH are adequately fed. Low Birth Weight • Almost all newborns in BiH (99 percent) are weighed upon birth. • The percentage of infants with a low birth weight in BiH is at 4.5 percent. MICS 3 FULL TECHNICAL REPORT 15 Summary 16 MICS 3 FULL TECHNICAL REPORT Child Health Immunization • Collection and analysis of data on immunization at the level of BiH was made difficult by differences in the immunization schedules in BiH’s three administrative units (the RS, FBiH and Brcko District), as well as by the differences of the BiH immunization calendars and the global standards used within the MICS3 methodology. In compliance with these differences, the report for BiH presents data for all eight required vaccines as well as the full coverage data, and additionally presents data for Measles and the full coverage for the RS (including Brcko District) and the FBiH. • Overall, 76.7 percent of children in BiH, 81.6 percent of children in the FBiH and 65.4 percent of children in the RS, had health cards. • The percentage of children who received all eight recommended vaccines before their first birthday (18 months for Measles) was 61.2 percent. The percent of children who received all recommended vaccines before their first birthday in the RS was 64.9 percent and 58.5 percent in the FBiH. • The total percentage of children aged 18-29 months who received the eight recommended vaccines at any time before the survey reached 72.1 percent for BiH, specifically 71.2 percent in the FBiH and 75.7 percent in the RS. • Total coverage by the BCG vaccine in BiH was at 95.8 percent whereas the coverage for the Polio vaccines was 79.0 percent. The DPT vaccine’s coverage was 78.0 percent, while 75.0 percent of chil- dren were vaccinated against Measles. Care of Illness Oral Rehydration Treatment • An overall percentage of 4.7 percent of children under five in BiH had diarrhoea within the two-week period before the survey. • The largest prevalence of diarrhoea occurs within the period when the breastfeeding stops, namely within the period of 6-11 months of life, and additional food is introduced. • The recommended oral rehydration therapy was received by 36.9 percent of children, whereas 39.1 percent of children received fluids made at home. 64.8 percent of children received one or more recommended home treatments (e.g. treated with ORS or RFH treatment) whereas 35.2 percent of children did not receive any treatment. Care Seeking and Antibiotic Treatment of Pneumonia • The survey registered a small number of children, around 3.9 percent, who had had symptoms of acute respiratory infection two weeks prior to the survey. • Out of this group, 91.3 percent of children were taken to an appropriate health care provider. Out of the overall percentage of children with symptoms of acute respiratory infection in BiH, 73.1 percent received antibiotic treatment. Solid Fuel Use • Almost half of households in BiH (48.7 percent) use solid fuels for cooking, while a similar percentage (43.5) use electricity for this purpose. There is a significant difference between urban and rural areas, as 67.1 percent of rural and 18.5 percent of urban households use solid fuels for cooking. • Overall, two thirds (63.9 percent) of all households in the RS and more than one third (39.3 percent) in the FBiH are using solid fuels for cooking. MICS 3 FULL TECHNICAL REPORT 17 Environment Water and Sanitation • Overall, access to improved sources of drinking water in BiH is almost universal as 98.7 percent of population uses improved source of drinking water – 99.4 percent in urban and 98.4 percent in rural areas. At BiH level, 88.8 percent of households have a drinking water source on the premises. There are significant differences between urban and rural areas: 95.4 percent of households in urban and 84.9 percent in rural areas have a drinking water source on their premises. • A large portion of the population, about 93.0 percent of households, use sanitary means of excreta disposal. This figure is at 99.0 percent for urban areas and 90.0 percent in rural areas. • A total of 93.0 percent of the population in BiH live in households with improved sanitation facilities (92.6 percent of the population in the RS and 93.0 percent in FBiH). Security of Tenure and Durability of Housing • Approximately five percent of respondents in BiH indicated that they face a risk of eviction and that they do not have security of tenure. • The percentage of survey respondents who have been actually evicted from their dwellings within the last five years is 10.4 percent for BiH. This includes 8.9 of household members in the RS and 10.7 percent of household members in FBiH. • In BiH, 15.8 percent of households, or 17.1 percent of household members, live in dwellings that are considered as non-durable. 18 MICS 3 FULL TECHNICAL REPORT Reproductive Health Contraception, Met and Unmet Needs • Only 35.7 percent of women aged 15-49 years married or in union are using (or their partner is using) some kind of contraceptive method, with significant difference between urban (29.0 percent) and rural (39.3 percent) areas. • Only 11.2 percent of women use modern contraception methods. Antenatal Care • Coverage of antenatal care (by a doctor, nurse, or midwife) is almost universal in BiH, with almost all women receiving antenatal care at least once during the pregnancy: 98.8 percent at BiH level, 98.6 percent in FBiH and 99.4 percent in RS. Assistance at Delivery • Almost all births in BiH (99.7 percent), including 99.6 percent of births in FBiH and 99.8 percent of births in RS, were delivered in health care institutions. 90.9 percent of deliveries were administered by a med- ical doctor. Child Development Child Development • Adult engagement in activities to promote school readiness at BiH level averages 75.6 percent. Engagement of adults is 84.9 percent in RS, while the figure is lower in FBiH, at 70.2 percent. • There is a positive correlation between the level of education and the engagement of parents. More edu- cated mothers and fathers are more engaged in such activities. It is important to emphasize that child’s sex does not significantly affect adult activities with children. • The percentage of children living in households with at least three adult books in BiH is 75.4 percent, whereas 70.4 percent of children have three or more children’s books. • 18.9 percent of children aged 0-59 months own three or more toys. MICS 3 FULL TECHNICAL REPORT 19 Education Pre-School Attendance and School Readiness • Only 6.4 percent of children in BiH aged 36-59 months attend pre-school. Urban-rural differences are significant – the figure is as high as 14.3 percent in urban areas in BiH compared to 2.4 percent in rural areas. • Number of girls attending preschool institutions is almost twice as high (8.0 percent) than the number of boys (4.7 percent). Primary and Secondary School Participation • Overall, 90.7 percent of children of primary/compulsory school entry age in BiH are attending grade one. This percent is at 91.6 for FBiH and 90.8 percent in the RS. • In total, 98.4 percent of children of primary/compulsory school age attend primary school, including 98.3 percent of children in FBiH and 98.7 percent in the RS. A total of 86.6 percent of children complete primary school at an appropriate age. Transition rate to secondary education is 92.7 percent, while the net enrolment rate for secondary school in BiH is 79.3 percent. • Out of the total number of children enrolled in primary/compulsory school, almost 100.0 percent (or 99.8 percent) will reach grade five. • Gender parity for primary school is 1.0, indicating there is no difference between boys and girls. The gender parity index for secondary school rises to 1.04 in favour of girls. Adult literacy • The percent of literate women aged 15-24 years is 99.6 percent at BiH level, as well as for both entities. 20 MICS 3 FULL TECHNICAL REPORT Child Protection Birth Registration • The births of almost all children under five years old in BiH (99.5 percent) are registered in birth registries. There are no significant variations in birth registration across sex, age, or education status of the parents. Child Labour • At the BiH level, 5.3 percent of children aged 5 to 14 years are engaged in some form of child labour. This percent is at 4.7 in the RS and 5.8 in FBiH. Almost one percent of children aged 5-14 in BiH are engaged in some form of labour activity out of their home (paid and unpaid). The percent of boys is much higher (6.6 percent) than that of girls (3.9 percent). There is a significant difference between rural (6.4 percent) and urban (3.2 percent) areas. Child Discipline • In BiH, 35.6 percent of children aged 2-14 were subject to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. This percentage is 39.9 percent in the RS and at 33.6 percent in FBiH. Early Marriage • The percent of young women who married before the age of 15 is a mere 1.0, whereas 10.1 percent of women got married before the age of 18. Of the interviewed women aged 15-19, 7.0 percent live in mar- riage or in union. • In BiH, 19.4 percent of young married or in union women aged 15 are married or in union with a partner 10 or more years older (23.2 percent in FBiH and 14 percent in the RS). Out of all interviewed young women aged 20-24 who are married or living in a union in BiH, 10.8 percent are married to a partner 10 or more years older (6.7 percent in the FBiH and 18.7 percent in the RS). Domestic Violence • Almost five percent (4.8 percent) of women in BiH agree with the statement that husbands/partners are justified in physically punishing their partners for various reasons. • It is worth noting that younger women are less accepting of domestic violence. There are also significant differences in the attitudes of women in rural and urban areas with 3.6 percent of women in urban and 1.8 percent of women in rural areas justifying family violence. MICS 3 FULL TECHNICAL REPORT 21 Disability • Approximately 6.5 percent of children aged two to nine in BiH display one or several forms of disability. • Approximately 9.1 percent of children at the age of two cannot name at least one of the objects presented to him/her. • The information on child disability was collected in the survey for screening purposes, namely to provide an indication of a child’s possible condition, with the assumption that the in-depth examinations would be undertaken by experts. HIV/AIDS, Sexual Behaviour, Orphaned and Vulnerable Children HIV/AIDS Knowledge and Attitudes • Only 2.4 percent of women aged 14 to 49 have never heard of HIV and AIDS. However, the percentage of women who know all three main ways to prevent HIV virus transmission is only 63.8 percent in BiH (57.8 percent in the RS and 67.0 percent in FBiH). • In BiH, 84.3 percent of women know that the use of condom during intercourse is one of the most important methods to prevent transmission of the HIV virus. • It is worrying that 64.2 percent of women in BiH support at least one of the discriminatory attitudes towards people with HIV/AIDS. Sexual Behaviour Related to HIV Transmission • A total of 25.7 percent of women in BiH aged 15-24 had intercourse with an irregular partner or partners within the last 12 months prior to the survey. • Out of all the women who reported having sex with non-regular partner in BiH, 71.0 percent used condom during sex with such partner. Orphans and Vulnerable Children • 91.5 percent of children in BiH live with their family. Children who do not live with their biological parents constitute less than one percent of the child population (0.4 percent), whereas the percent of children living with only one or without both parents in BiH is at 4.5 percent. This figure is 4.3 percent in the RS and 4.6 percent in FBiH. 22 MICS 3 FULL TECHNICAL REPORT Background This report presents the findings of the Multiple Indicator Cluster Survey of the Social and Health Status of Children and Women in Bosnia and Herzegovina in 2006, conducted by the Public Health Institute of the Federation of Bosnia and Herzegovina (PHI FBiH) as the implementing agency under the auspices of the Federal Ministry of Health, and the Ministry of Health and Social Welfare of the Republic of Srpska. Financial and tech- nical support was provided by UNICEF and DFID. In both Entities, as well as in the Br~ko District, the same approach was used in the application of methodology, training for field work, entry of data, and analysis. The BiH Directorate for Economic Planning (DEP) steered the project at the state level. The survey provides information on the situation of children and women in Bosnia and Herzegovina, and was based, in large part, on the need to monitor progress towards goals and targets emanating from the following international agreements: • the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, • 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. Introduction MICS 3 FULL TECHNICAL REPORT 23 Mother and child having a walk - Sarajevo Anthony Asael for UNICEF BiH Commitments defined in these documents 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. 24 MICS 3 FULL TECHNICAL REPORT 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.” Survey objectives The 2006 BiH Multiple Indicator Cluster Survey had as its primary objectives: • To provide basic information for assessing the situation of children and women in Bosnia and Herzegovina; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration, the goals of A World Fit For Children (WFFC), and other internationally agreed upon goals, as a basis for future action; • To contribute to the continuing improvement of the quality of data for the development of the information system. Sample Design The sample for the BiH Multiple Indicator Cluster Survey (MICS) was designed to provide estimates on a large number of indicators of the situation of children and women at the national level, for urban and rural areas, and for two entities: the Federation of Bosnia and Herzegovina (FBiH) and the Republika Srpska (RS)1. In BiH, no population census has been conducted since 1991. Representative samples for social surveys are selected using the Master Sample methodology. The samples for MICS 3 survey were selected from the revised 2006 Master Sample, produced by a statistical system of BiH in 2006 (two months before the start of MICS 3 field work). The revised 2006 Master Sample is a list of about 80,000 households (Master List) obtained after listing carried out in 1500 Census Enumeration Areas selected with equal probability of selection from the total of about 20,000 Census Enumeration Areas in BiH. Sampling was conducted at the state level, and the two entities were identified as the main geographical sampling domains. The sample was selected in two stages. Within both entities and the Br~ko District, a total of 455 Census Enumeration Areas with the same selection probability were selected from 1500 Census Enumeration Areas from the 2006 Master Sample. The Sampling Frame List was stratified into two strata, according to whether the household had children under five-years-of-age (type 1) or not (type 2). In this manner, a total of 6,000 households were selected at the state level. The sample was stratified by type and is not self-weighted. The sample is composed of 3,000 households with children under five (type 1) and 3,000 households of type 2. Sample weights were used for reporting on the national and entity level results. 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, 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-five questionnaire, administered to mothers or caretakers of all children under five living in the household. The Household Questionnaire included the following modules: • Household Listing; • Education; • Water and Sanitation; MICS 3 FULL TECHNICAL REPORT 25 Sample and Survey Methodology 1. Owing to the constraints in the survey budget, the Br~ko District is represented in the same way as other municipalities in BiH. • Household Characteristics; • Child Labour; • Child Discipline; • Disability; and two additional modules: • Household Expenditure; • Household Incomes2. The Questionnaire for Individual Women was completed by all women aged 15-49 living in the households, and included the following modules: • Maternal and Newborn Health; • Marriage/Union; • Contraception and Unmet Need; • Attitudes toward domestic violence; • Sexual behaviour; • HIV education. The Questionnaire for Children Under Five3 was completed by mothers or caretakers of children aged 0-5 living in the households. The interview was usually conducted with mothers of such children; in cases where 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: • Birth Registration and Early Learning; • Child Development; • Breastfeeding; • Care of Illness; • Immunization; • Anthropometry. The questionnaires were based on the MICS3 model questionnaire4. The questionnaires were translated from the English version of the MICS3 model into the local languages of BiH. During April 2006, the question- naires were pre-tested for the Republika Srpska in the Banja Luka region, whereas the pre-testing of the question- naires in FBiH was conducted in April 2006 in house- holds in the Sarajevo Canton. The plan envisaged the conducting of interviews in 55 households obtained ran- domly from the Main Sampling Frame, 41 of which were urban households and 14 “other” households. Based on the results of the aforementioned tests, modifications were made to the wording and translation of the questionnaires. Copies of the questionnaires are provided in Appendix F of the report. 26 MICS 3 FULL TECHNICAL REPORT 2 The data on household income and expenditure are not presented in this report. They will be subject to subsequent analysis and reporting. 3 The terms "children under 5", "children aged 0-4 years", and "children aged 0-59 months" are used interchangeably in this report. 4 The model MICS3 questionnaire can be found at www.childinfo.org, or in UNICEF, 2006. A student of the Primary School D`emaludin ^auševi}, Sarajevo Anthony Asael for UNICEF BiH Training and Fieldwork The fieldwork training lasted for five days and was conducted in May 2006. Training included lectures on interview techniques and the content of the questionnaires, and on the interactive approach of practising interviews between trainees. Fieldwork was implemented by two entity teams. In the RS, the data was collected by four teams. Each team was comprised of three to four interviewers and one supervisor. The fieldwork began on 15 May 2006 and was concluded on 10 July 2006. In FBiH, the data was collected by eight teams (23 interviewers) who were organised at the cantonal level. The teams were comprised of supervisors and interviewers, whose number depended on the number of households to be interviewed in the field. In FBiH, fieldwork began on 20 May 2006 and was concluded on 30 July 2006. Data Processing Data was entered and processed separately for FBiH and the RS. In RS, data was entered using the CSPro software. Data was entered into two microcomputers by two data entry operators, and the process was supervised by one supervisor. In FBiH, data was entered into three microcomputers by three data entry operators, and the process was supervised by one data entry supervisor. Data was analysed using the Statistical Package for Social Sciences (SPSS) software programme, Version 14, and the model syntax and tabulation plans developed by UNICEF for this survey. In order to ensure quality control, all questionnaires were entered twice and internal consistency checks were performed. Procedures and standard programmes developed under the global MICS3 project and adapted to the BiH questionnaire were used throughout. STATA 7.0 software was used to estimate standard errors. Data processing began simultaneously for two entities and was concluded in September 2006 in the RS and in November 2006 for FBiH. Data processing for BiH was concluded in December 2006. Report Preparation The report preparation process in Bosnia and Herzegovina was three-tiered. It included preparation of the entity reports for the Republika Srpska and the Federation of Bosnia and Herzegovina. The report for Bosnia and Herzegovina was prepared as the final step in the national reporting process. Due to the complex administrative structure of the country and respective accountabilities of BiH Entities for development and well-being of women and children, the data and analysis contained in the MICS3 report are presented in such a manner to reflect the national BiH data, as well as the data at the entity level. Due to rela- tively small size of the sample in Brcko District, BiH’s third administrative unit, it was unfortunately impossible to present statistically relevant data for this region in this report. However, the data for Brcko District are presented in the data tables within this report. MICS 3 FULL TECHNICAL REPORT 27 Sample Coverage At the BiH level (Table HH.1), 5,549 households were successfully interviewed and the response rate reached 93.4 percent. In the interviewed households, 4,977 women were identified within the sample range, out of which 4,890 were interviewed. A total of 3,209 children under five years-of-age were listed in the household question- naire, and the questionnaire was completed for 3,188 children. The ratio of responses for children under five dif- fered significantly between rural areas (89.0 percent) and other areas (95.2 percent). In the Republika Srpska, 2,019, out of the 2,129 households selected for the sample, were successfully inter- viewed, yielding a household response rate of 96.0 percent. In the interviewed households, 1,658 women aged 15-49 were identified and 1,620 successfully interviewed (97.7 percent response rate). In addition, out of the 1,086 children under the age of five listed in the household questionnaire, 1,071 had their questionnaires completed, which corresponds to a response rate of 98.6 percent. Overall response rates of 93.8 and 94.7 percent are calculated for the 15-49 women’s and under-fives’ interviews respectively. In the Federation of BiH, of the 3,744 households selected for the sample, 3,710 were available for interview, and 3,413 were successfully interviewed (92.0 percent response rate). In the interviewed households, 3,221 women (aged 15-49) were identified and 3,175 successfully interviewed, yielding a response rate of 98.6 percent. In addition, 2,065 children under the age of five were listed in the household questionnaire and ques- tionnaires were completed for 2,060 of these children (99.8 percent response rate). Overall response rates of 90.7 and 91.8 percent are calculated for the 15-49 women’s and under-fives’ interviews respectively. Characteristics of Households From the 5,549 households interviewed in Bosnia and Herzegovina, there were 17,426 household members registered. Out of this number, 8,524 were men and 8,902 women. Total number of children under five years of age was 953 or 5.5 percent. The total number of children up to 18 years was 3,834 or 22.0 percent, including 3,157 or 18.1 percent of children under 15. The age distribution of the survey sample indicated that the survey included 66.1 percent of the population aged 15-64 and 51.6 percent of the population aged 65+. The estimated mean household size (arithmetic mean) is 3.14 household members per household (Table HH.1). The percentage of children under five is lower than the percentage of children identified within the older age cohorts. The data obtained correspond to the official statistical data on population distribution. The population of BiH appears to be relatively young with 22.0 percent of children under 18 as opposed to 15.6 percent of 65 + population. However, the mean values of the household members per household confirm current and relatively negative population trends. Population distribution by sex does not indicate significant differences, but it is worth noting that in the younger population cohorts there are larger numbers of boys and men than girls and women. In the 3,413 households successfully interviewed in the survey in FBiH, 10,718 household members were listed. Of these, 5,224 (48.7 percent) were male and 5,494 (51.2 percent) were female. The age distribution of the surveyed population shows that the survey included 6.0 percent of children under five, 19.0 percent children under 15, 67.0 percent persons aged 15-64, and 14.0 percent of the population aged 65+. This distribution corre- sponds fully to the latest estimate of the Federal Office of Statistics. The total population aged 0-18 years was 2,530 or 24.0 percent and represents a sizeable sub-group of the whole population. 28 MICS 3 FULL TECHNICAL REPORT Sample Coverage and Characteristics of Households and Respondents In the 2,019 households successfully interviewed in the RS, 6,324 household members were listed. Of these, 3,099 (49,0 percent) were male, and 3,225 (51,0 percent) were female. In 12.5 percent of the interviewed households lives at least one child under five years of age, and in 48.4 per- cent lives at least one woman of reproductive age. The age distribution puts the total cohort of children under five at 4.9 percent. The number of children under 15 reached 5.6 per- cent and the percent of all children under 18 years of age was 19.2 percent. The survey estimated the average household size at 3.13 persons5. The age distribution of the surveyed population does not deviate significantly from the estimates of the Republic Institute of Statistics of the Republika Srpska. Household age distribution and distribution by sex for BiH is presented in Table HH.2 and was used to develop the population pyramid (figure HH.1). Data on the age and sex distribution are not presented in tables within this report. Characteristics of Respondents Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under the age of five. In both tables, the numbers of weighted and unweighted observations are given. In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the number of observations in each background category. These categories have been used in the subsequent tabulations of this report. 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, urban-rural settlements, age, marital status, moth- erhood status, education6, and according to wealth index quintiles7. MICS 3 FULL TECHNICAL REPORT 29 5. Arithmetic mean 6. Unless otherwise stated, "education" refers to the educational level attended by the respondent throughout this report when it is used as a background variable. 7. Principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to each house- hold asset, and obtain wealth scores for each household in the sample. The assets used in these calculations were as follows: • number of rooms for sleeping • floor, roof and walls material of dwelling • the type of fuel used for cooking • electricity, radio, TV, mobile phone, landline phone, fridge • watch, bicycle, motorcycle, animal-drawn vehicle, car, motorboat • arable land • size of arable land owned • cattle • number of cows and/or oxen, calves, horses, goats, sheep and poultry • source of water for drinking, cooking and washing • type of toilet.) Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. The wealth index is assumed to include 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, and the wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, and Filmer and Pritchett, 2001. Figure HH.1: Age and sex distribution of household population, BiH, 2006 The age distribution of interviewed women in BiH is fairly even, while at the same time their education level varies greatly. Most of the interviewed women have secondary education (57.8 percent), followed by those with primary (28.4 percent) and higher and university education (12.5 percent). Among interviewed women, 64.5 percent were in a marriage/union, and the same percentage applies to women who had given birth. Almost two thirds of inter- viewed women live in rural areas. In both entities, most women of reproductive age fall in the 40-44 age range. Two thirds of women or 64.5 percent (66.2 percent in RS and 63.5 percent in FBiH) are married, while 27.8 percent of women in RS and 31.0 percent in FBiH have never been married, totalling 29.9 percent for BiH. One in seventeen women is either divorced or widowed. Approximately one in every three women of reproductive age has never given birth. The difference between weighted and unweighted figures for almost all categories is small, except for the category of women aged 25-29 years who were over-represented and in the category of unmarried women or women who had never lived in union. The first category of women is over-represented since, as mothers, they are members of the household with children under five years of age. The households with children under five were over-represented due to the specific design of the sample. The second category, single women, was under-represented due to the compensatory effect of weighing factors at the level of the overall sample. Some background characteristics of children under five are presented in Table HH.5. These include distribution of children according to several characteristics: sex, area of residence, age in months, mother’s or caretaker’s education, and wealth index quintiles. At the BiH level, gender distribution of children in interviewed homes is almost even - 50.6 percent boys and 49.4 percent girls. More than two thirds (68.4 percent) of children included in the survey live in rural areas. In both entities, the proportion of male and female children in the under-five sample is approximately the same. As far as mothers’ education is concerned, 0.8 percent of mothers do not have any education, 31.4 percent have primary education whereas the majority, or 59.2 percent, have secondary education and 8.6 percent of mothers have higher or university education. For children whose mother did not live in the household, the educational level of the caretaker was taken into consideration. 30 MICS 3 FULL TECHNICAL REPORT Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to adequate food sup- ply, 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 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, set in 1990, is to reduce by half the proportion of people who suffer from hunger by 2015. The World Fit for Children goal is to reduce the prevalence of malnutrition among children under five years of age by at least one-third (between 2000 and 2010), with special attention to children under two years of age. A reduction in the prevalence of malnutrition will assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is the WHO/CDC/NCHS reference, which was recommended for use by UNICEF and the World Health Organization at the time the survey was implemented. Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. In MICS, the weight and height of all children under five years of age were measured using anthropometric equip- ment recommended by UNICEF (UNICEF, 2006). Findings in this section are based on the results of these measurements8. MICS 3 FULL TECHNICAL REPORT 31 Nutrition Figure NU.1: Percentage of children under five who are undernourished, BiH, 2006 8. 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 con- sidered 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 chron- ic 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 wast- ed, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. 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 two standard deviations above the median of the reference population. In Table NU.1, children who were not weighed and measured and those whose measurements are outside a plausible range are not taken into account. In addition, a small number of children whose birth dates are not known are excluded from the analysis. In the whole of BiH, 0.3 percent of children are lagging in height or weight. There are no significant differences between children living in rural and urban areas. At the BiH level, 1.5 percent of children are moderately underweight. There is a higher percent of boys than girls and more in urban than in rural areas. The percentage of severely underweight children is 0.4 percent with more boys than girls in this category as well. The percentage of severely underweight children is larger in urban than in rural areas. The figure for children moderately stunted is 7.4 percent and 2.5 percent for severely stunted, out of which more are in rural than in urban areas. 3.2 percent children are moderately wasted and 0.8 severely wasted, while 20.2 percent of children are overweight or obese. It is important to note that girls are more likely to be underweight and obese and more frequently in urban than in rural areas. In the Republika Srpska, 0.3 percent of children are moderately underweight and no child was classified as severe- ly underweight. One in thirteen children (7.9 percent) is moderately stunted and one in thirty-seven (2.7 percent) is severely stunted. The percent of children who are moderately wasted is 2.6 percent, whereas 0.3 percent are severely wasted. There is a high percentage (23.3 percent) of children whose weight-for-height is two standard deviations above the median of the reference population (obesity). Percentages of children underweight and stunted in rural or other areas is higher than in urban areas whereas the situation is opposite in the case of children wasted. Nearly one in thirty children (3.0 percent) under five years of age in the FBiH are underweight, 2.0 percent of whom are moderately underweight and 0.7 percent are classified as severely underweight. Approximately 9.0 percent of children are stunted or too short for their age. Around 5.0 percent of children are wasted or too thin for their height. Children whose weight-for-height is two standard deviations above the median of the reference population are classified as overweight. In FBiH, 17.0 percent of under five children are classified as overweight. Generally, there is a positive correlation between the education level of the mother and the nutritional status of children, with children whose mothers have secondary or higher education being less likely to be underweight and stunted compared to children of mothers with no education or with only primary education. 32 MICS 3 FULL TECHNICAL REPORT Breastfeeding Breastfeeding in the first few years of life protects children from infection, provides an ideal source of nutrients and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for six months and continue to be breastfed with safe, appropriate and adequate complementary feeding until they are two years of age and beyond. WHO/UNICEF have the following breastfeeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at six months • Frequency of complementary feeding: two times per day for six to eight-month-olds; three times per day for nine to 11-month-olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators of recommended child feeding practices are as follows: • Exclusive breastfeeding rate (< six months and < four months) • Timely complementary feeding rate (six-nine months) • Continued breastfeeding rate (12-15 and 20-23 months) • Timely initiation of breastfeeding (within one hour of birth) • Frequency of complementary feeding (6-11 months) • Adequately fed infants (0-11 months) Table NU.2 provides the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth (which includes those who started within one hour). At the BiH level, 56.7 percent of women started breastfeeding within one hour after delivery, with about a six percent difference between urban and rural areas (61.2 percent in urban areas and 54.9 percent in rural areas). Most of the inter- viewed women (84.3 percent) started breast- feeding within a day after the delivery. Approximately half the women in the FBiH start- ed breastfeeding their infants within one hour after delivery (51.0 percent). Over two thirds of women (83.0 percent) started breastfeeding within one day after delivery. In the RS, 70.9 percent of women started breastfeeding within one hour after delivery, whereas 89.3 percent of women started breastfeeding within one day after delivery. MICS 3 FULL TECHNICAL REPORT 33 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, BiH, 2006 In Table NU.3, breastfeeding status is based on the reports of mothers/caretakers of children’s food and fluid consumption in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as comple- mentary feeding of six to nine month-aged children and continued breastfeeding of children at 12-15 and 20-23 months of age. At the BiH level, 17.6 percent of children under six months of age have been exclusively breastfed. At the age of six to nine months, 33.6 percent of children are receiving breastmilk and solid/mushy food. At the age of 12-15 months, 25.7 percent of children in BiH are breastfed while at the age of 20-23 months, 10.7 percent of children are still breastfed. In RS, approximately 7.6 percent of children aged less than six months are exclusively breastfed. At six to nine months, 43.2 percent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, 11.0 percent of children are still being breastfed and by age 20-23 months, 5.0 percent are still breastfed. In FBiH, approximately 21.8 percent of children aged less than six months are exclusively breastfed. At age six to nine months, 19.2 percent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, 33.8 percent of children are still being breastfed and by age 20-23 months, 13.1 percent are still breastfed. The data on adequacy of infant feeding amongst children under 12 months are presented in Table NU.4. Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding. Infants aged six to eight months are considered to be adequately fed if they are receiving breastmilk and complementary food at least two times per day, while infants aged 9-11 months are considered to be adequately fed if they are receiving breastmilk and eating complementary food at least three times a day. In the FBiH, adequate feeding among all infants (0-11 months of age) is 19.5 percent whereas this percentage is 22.2 percent in the RS, which amounts to a 20.4 percent total in BiH. Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also of 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 34 MICS 3 FULL TECHNICAL REPORT Figure NU.3: Infant feeding paterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group BiH, 2006 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 later in 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. Low birth weight stems primarily from the mother's poor health and nutrition. Three factors have the 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 pregnancy. Inade- quate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retarda- tion. Cigarette smoking during pregnancy is the leading cause of low birth weight. Teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. The percentage of newborns weighing below 2,500 grams is estimated from two indicators in the questionnaire: the mother’s assessment of the child’s size at birth (i.e. very small, smaller than average, average, larger than aver- age, very large) and the mother’s recollection of the child’s weight or the weight as recorded on a health card if the child was weighed at birth9. The percentage of infants with low birth weight in BiH is at 4.5 percent and 99.0 percent of children were weighed immediately after the birth. In FBiH, 99.0 percent of children were weighed at birth and approximately 5.0 per- cent of infants are estimated to weigh less than 2,500 grams at birth. In the RS, 99.6 percent of children were weighed at birth and approximately 4.5 percent of infants weighed less than 2,500 grams at birth. Having in mind the fact that most deliveries in BiH are administered by medical personnel, the education level of mother does not influence the practice to weigh children upon delivery. However, the mother’s education level does influence the percentage of children who were born with low birth weight; the percent of children with low birth weight is proportional to the education level of the mother (Table NU.8). MICS 3 FULL TECHNICAL REPORT 35 Figure NU.5: Percentage of infants weighing less than 2,500 grams at birth, BiH, 2006 9. For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996 Immunization The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunization has saved the lives of millions of children 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 two million deaths every year. A goal of the World Fit for Children is to ensure full immunization of 90.0 percent of children under one year of age nationally, with at least 80.0 percent coverage in every district or equivalent administra- tive unit. Furthermore, 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 MMR vaccination (measles, mumps, rubella) by the age of 12 months. During the survey in BiH, 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. 36 MICS 3 FULL TECHNICAL REPORT Child Health Immunization of Roma children in Modri~a UNICEF BiH Overall, 76.7 percent of children in BiH - 81.6 percent of children in FBiH and 65.4 percent of children in RS - had health cards10. If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio, how many times.11 Collection and analysis of immunization data at the level of BiH was made difficult by differences in the immu- nization calendars of its three administrative units (the RS, FBiH and Brcko District), and by differences in the BiH immunization calendars and those used in MICS3 methodology. Immunization calendars for BCG, OPV and DTP are almost identical in the two entities. Differences in the calendar occur with the Measles vaccine that is administered in the RS in combination with the Mumps and Rubella (MMR) at the age of 18 months and onwards, whereas in FBiH, the Measles vaccine (in combination with Mumps and Rubella - MMR) is administered during the 13th month of life and onwards during the second year of life. In compliance with the above-described differences, this report presents the immunization data at the level of BiH for all eight recommended vaccines and the full vaccination coverage, and it additionally presents the data for the RS and FBiH. Full vaccination coverage of children before they reach their first birthday (18 months for Measles) for all eight recommended vaccines in BiH was 61.2 percent. The total percent of children aged 18-29 months who received all eight recommended vaccines at any time before the survey was 72.1 percent for BiH. The total coverage for the tuberculosis immunization, or the BCG vaccine, in BiH was 95.8 percent (Table CH.1). Full Polio coverage was at 79.0 percent, the DPT vaccine was 78.0 percent, whereas 75.0 percent of children were vac- cinated against Measles. In RS (Table CH.1 RS), 97.0 percent of children received a BCG vaccine before 12 months and the first DPT dose was given to 97.0 percent of children. The percentage declined for subsequent doses of DPT to 91.0 percent for the second dose, and 82.8 percent for the third dose. Similarly, 97.9 percent of children received Polio1 by the age of 12 months and this declined to 85.4 percent by the third dose. The coverage for the Measles vaccine by 18 months was lower than for the other vaccines, at 79.4 percent. As a result, the percentage of children who had all the recommended vaccinations by their first birthday (18 months for Measles) was low, at only 64.9 percent. Total percentage of children aged 18-29 months who have received all eight recommended vaccines at any time prior to research was 75.7 percent in the RS. In FBiH (Table CH.1 F BiH), 95.0 percent of children received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 91.3 percent of children. The percentage declined for subsequent doses of DPT vaccine to 84.6 percent for the second dose, and 74.7 percent for the third dose. Similarly, 91.3 percent of children received the Polio 1 vaccine by the age of 12 months and this declined to 75.0 percent by the third dose. The coverage for the Measles vaccine by 18 months was lower than for the other vaccines and was 72.4 percent. The percentage of children who received all eight recommended vaccines by their first birthday (18 months for Measles) was 58.5 percent. The total percentage of children aged 18-29 months who have received all eight recommended vaccines at any time prior to research was 71.2 percent in FBiH. Overall, there are no significant correlations between the educational level of the mother and the immunisation coverage or the wealth of the households and the immunization status of children in BiH. MICS 3 FULL TECHNICAL REPORT 37 10. Table CH.2 11. The percentage of children aged 18 to 29 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children aged 18-29 months so that only children who are old enough to be fully vaccinated are counted. For children without vaccination cards, the proportion of vaccinations given before the first bir thday is assumed to be the same as for children with vaccination cards. Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea - either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The treatment goals are to: 1) reduce by one half deaths due to diarrhoea among children under five by 201012 2) reduce by two thirds the mortality rate among children under five by 201513 In addition, the WFfC calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • (ORT or increased fluids) AND continued feeding 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 what the child usually ate and drank. The largest prevalence of diarrhoea in BiH occurs amongst children 6 to 11 months old, in the period when the breastfeeding stops and additional food is introduced. Overall, 4.7 percent of children under five in BiH (Table CH.4) had diarrhoea within a two-week period before the survey. Nineteen percent of children in BiH received the fluids from the ORS packet and 17.9 percent from the pre-packaged ORS fluids. Recommended fluids made at home were administered to 39.1 percent of children (Table CH.4). One or more recommended home treatments (e.g. treated with ORS or RFH treatment) were received by 64.8 percent of children whereas 35.2 percent of children did not receive any treatment. Of children under five who had diarrhoea, 21.8 percent drank more than usual whilst 77.1 percent drank the same or less. The level of children who ate less, the same or more (continued feeding) was 75.4 percent, whereas 24.6 percent ate less or almost nothing. There are significant differences in the home treatment of diarrhoea with regard to the household characteristics. In rural areas, the home treatment of diarrhoea occurs more frequently (21.8 percent) than in urban area (9.4 percent). The frequency of home treatment of diarrhoea increases with the educational level of the mothers. Overall, 3.9 percent of children under five in the RS had diarrhoea in the two weeks preceding the survey. The peak of diarrhoea prevalence occurs in the period when complementary feeding is introduced, among children aged 6-11 months. About 8.3 percent received fluids from ORS packets whereas 37.5 percent received recom- mended homemade fluids. Approximately half of children with diarrhoea received one or more of the recommended home treatments (i.e. were treated with ORS or RHF), while the other half received no treatment. 38 MICS 3 FULL TECHNICAL REPORT 12. compared to 2000 (A World Fit for Children) 13. compared to 1990 (MDGs) Less than one fifth (16.6 percent) of children under five with diarrhoea in the RS drank more than usual, while 83.4 percent drank the same or less. Almost four fifths (83.4 percent) of children ate less, the same, or more (continued feeding) than before the diarrhoea, but 16.6 percent ate much less or ate almost nothing. Given these figures, only 41.6 percent of children received increased fluids and at the same time continued feeding. In FBiH, 5.0 percent of children under five had diarrhoea in the two-week period preceding the survey. The peak of diarrhoea prevalence occurs in the period when complementary feeding is introduced, among children aged 6-11 months (around 13.0 percent), and starts to decline steadily with the age of the child. The lowest diarrhoea occurrence appears with children aged 48-59 months (2.0 percent). Only 18.0 percent of children under five with diarrhoea drank more than usual, while 80.0 percent drank the same or less. Seventy-one percent of children ate somewhat less, the same or more (continued feeding) than before diarrhoea, but 29.0 percent ate much less or ate almost nothing. Given these figures, over half the children with diarrhoea (54.0 percent) received increased fluids and at the same time continued feeding. MICS 3 FULL TECHNICAL REPORT 39 Figure CH.4: Percentage of children aged 0-59 with diarrhoea who recived ORT or increased fluids, and continued feeding, BiH, 2006 Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in children under five with suspected pneumonia is a key intervention. A WFfC 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 or 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 In BiH, (Table CH. 6), around 3.9 percent of children14 have had symptoms of acute respiratory infection two weeks prior to the survey. Of these, 91.3 percent were taken to an appropriate health care provider. There was a large discrepancy between urban and rural areas as 26.2 percent of urban children were taken to a private health care provider while only 1.9 percent of rural children paid a visit to a private health care provider. Out of all the children with symptoms of acute respiratory infections in BiH, 73.1 percent (Table CH.7) received antibiotic treatment. The antibiotic treatment generally increased with the educational level of the mother. The percentage of mothers/caretakers who recognized the two danger signs of pneumonia in BiH is 51.7 and increases with the educational level (Table CH.7A). In the RS, around 3.3 percent of children under five were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 92.5 percent were taken to an appropriate provider, most- ly to the primary health care centre or hospital. Half of the children under five who were reported to have had symptoms of pneumonia during the two weeks preceding the survey received antibiotic treatment. Mothers’ knowledge of the danger signs of respiratory infections is an important determinant of care-seeking behaviour. Overall, 40.1 percent of women know of the two danger signs of respiratory infections - fast and dif- ficult breathing. The most commonly identified symptom for taking a child to a health facility is when the child develops a fever. Around 44.6 percent of mothers identified fast breathing and 60.4 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. Similarly, in the FBiH, 4.0 percent of children aged 0-59 months were reported to have had symptoms of pneu- monia during the two weeks preceding the survey. The peak prevalence of children with pneumonia symptoms was at age 0-11 months (6.0 percent), and started to decline steadily with age. The lowest prevalence was at 48- 59 months. In FBiH, 91.0 percent of the children with symptoms were taken to an appropriate provider. Overall, 67.0 percent of children with the above symptoms were taken to the primary health care centre/outpatient depart- ment, 16.0 percent were taken to hospital and 6.0 percent were taken to private practitioners. In the FBiH, 81.0 percent of children under five with suspected pneumonia received antibiotic treatment during the two weeks pre- ceding the survey. The use of antibiotics declined with the age of the child. 40 MICS 3 FULL TECHNICAL REPORT 14 It is important to note that ARIs represent leading child diseases in Bosnia and Herzegovina. The percentage of children 0-6 having ARIs in comparison to other child diseases is at approximately 50 percent. The small percentage of ARI within MICS may have been determined by the summer season during which the fieldwork was implemented. Overall, 56.0 percent of the women surveyed in the FBiH knew the two danger signs of pneumonia - fast and dif- ficult breathing. The most commonly identified symptom for taking a child to a health facility was when the child develops a fever (96.0 percent). Overall, 59.0 percent of mothers identified fast breathing and 73.0 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. Solid Fuel Use More than three billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is the presence of products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. The use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the propor- tion of the population using solid fuels as the primary source of domestic energy for cooking. Almost half of all households in BiH (48.7 percent) are using solid fuels for cooking, while a similar percentage (43.5 percent) are using electricity for this purpose. There is a significant difference between urban and rural areas, with 67.1 percent of rural and 18.5 percent of urban households using solid fuels for cooking. Overall, approximately two-thirds (63.9 percent) of all households in the RS, and more than one-third (39.0 percent) of households in FBiH use solid fuels for cooking. Solid fuel use alone is a poor proxy for indoor air pollution, since the concentration of the pollutants is different when the same fuel is burnt in different stoves or hearths. Use of closed stoves with chimneys minimizes indoor pollution, while an open stove or hearth without a chimney or hood means that there is no protection from the harm- ful effects of solid fuels. MICS 3 FULL TECHNICAL REPORT 41 Water and Sanitation Drinking water can be tainted with microbiological, chemical, physical and radiological contaminants, which generate 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 WFfC goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS is as follows: Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person collecting drinking water Sanitation • Use of improved sanitation facilities • Sanitary disposal of child’s faeces The distribution of the population by source of drinking water is shown in Table EN.1 and Figure EN.1. Improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, yard or plot), public tap/standpipe, tube well/borehole, protected well and spring, 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. Overall, some 98.7 percent of population in BiH uses improved sources of drinking water - 99.4 percent in urban and 98.4 per- cent in rural areas. In the RS, 97.3 percent of the population uses improved sources of drinking water whereas the level is at 99.5 percent in FBiH. 42 MICS 3 FULL TECHNICAL REPORT Environment Figure EN.1: Percentage distribution of household members by source of drinking water, BiH, 2006 Use of in-house water treatment is presented in Table EN.2.15 Households were asked of the 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. Very few households use appropriate water treatment methods (6.4 percent). The most commonly method used is boiling (93.0 percent). The amount of time it takes to obtain water is presented in Table EN.3 and the data on household members who usually collected the water in Table EN.4.16. Table EN.3 indicates that 88.8 percent of households in BiH, specifically 87.1 percent of households in the RS and 92.7 percent in FBiH, have their drinking water source on the premises. The water source is available on the premises in 95.4 percent of urban households and 84.9 percent of rural households. Excluding those households with water on the premises, the average time to the source in BiH is 12.1 minutes. The average time in the RS is 11.6 minutes and 13 minutes in FBiH. The time spent collecting water in rural areas is slightly higher than in urban areas. Table EN.4 shows that in the majority of households, an adult female is usually the person collecting the water when the source of drinking water is not on the premises. In BiH, adult men collect water in 46.7 percent of the households, compared to women in 51.0 percent of households. For the rest of the households, 0.4 percent of female and 1.1 percent of male children under 15 in BiH collect water. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities for excreta disposal include: flush or pour flush to a piped sewer system, septic tank, or latrine; ventilated improved pit latrine, pit latrine with slab, and composting toilet. At the BiH level (Table EN.5), around 93.0 percent of households use sanitary means of excreta disposal, with around 99.0 percent of households in urban and 90.0 percent in rural areas. Around 92.6 percent of the RS population and 93.0 percent in FBiH live in households with improved sanitation facilities. The difference between urban and rural areas is mostly reflected in the type of toilet used. The most common facilities in urban areas are flush toilets with connection to a sewage system (77.2 percent for BiH, 66.1 percent in RS and 83.0 percent in FBiH), and the most common facilities in rural areas are septic tanks (57.5 percent for BiH, 58.8 percent in the RS and 56.0 percent in FBiH). Safe disposal of a child’s faeces implies disposal of the stool by a child using a toilet, or by rinsing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table EN.6. At the BiH level, 35.9 percent of children are having their stools disposed of safely, with similar percentage for urban and rural areas. An overview of the percentage of households using improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.7. It indicates that 92.0 percent of households in BiH - 90.5 percent of households in RS and 92.6 percent in FBiH - are using improved sources of drinking water and adequate sanitary facilities. The use of improved sources of drinking water is somewhat but insignificantly larger in urban (98.4 percent) than in rural areas (88.5 percent). It slightly increases with the education level of the household head (82.1 percent without any education and 97.5 with higher and university education) as well as with the wealth of the household (82.3 percent of the poorest and 99.8 percent amongst the wealthiest). MICS 3 FULL TECHNICAL REPORT 43 15. The table shows the percentages of population using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. 16. 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. Security of Tenure and Durability of Housing In MICS, three indicators were introduced to measure the quality of life related to slum housing: security of tenure, durability of housing, and proportion of population living in slum households. An urban household is considered a slum in MICS3 if it fulfils one of the following conditions: improved drinking water sources are not used, improved sanitation facilities are not used, living area is not sufficient, housing is not durable, or security of tenure is lack- ing. Lack of security of tenure is defined as the lack of formal documentation for the residence or perceived risk of eviction. Table EN.8 presents data on the security of tenure. A total of 12.6 percent of households in BiH do not posses formal documentation in support of their tenure. The figure is 11.9 percent in the RS and 13.3 percent in FBiH. The lack of formal documentation highly correlates with the wealth index and the level of education: 15.2 percent of households in which the head of household is without formal education do not posses formal documentation, whereas this rate is almost two times lower (8.8 percent) when the head of household has high school or higher education. The lack of formal documen- tation is three times as frequent amongst the poor (27.0 percent) than it is amongst the wealthiest population (8.8 percent). Around 5.0 percent of respondents to the household questionnaire in BiH indicated that there is a risk of eviction and that they do not have security of tenure. Additionally, Table EN.8 also shows that 8.9 percent of household members in the RS and 10.7 percent of household members in the FBiH have been evict- ed from a dwelling they were residing in during the last five years. Structures that households are living in are considered “non-durable” if the floor material is natural and there are two or more bad conditions identified (the dwelling facility is in poor condition), if there exists vulnerability to acci- dents in terms of the dwelling’s surroundings, or if the structure is located in or near a hazardous area. House- holds were asked, or the information was sought by observation, if the dwelling is near a landslide area, a flood area, a riverbank, a steep hill, a rubbish tip, an industrial pollution area, a railway line, power plant or flyover. Table EN.9 provides information on the findings of the survey. Overall, very few households (0.2 percent) are living in dwellings which are considered as non-durable. Table EN.10 presents all five components of slum housing. Overall, 15.8 percent of households in BiH live in slum housing. The analysis of the living conditions of the household members indicates that 17.1 percent of household members in BiH live in slum housing. 44 MICS 3 FULL TECHNICAL REPORT Children included in MICS3 field work UNICEF BiH Contraception Appropriate family planning is important in maintaining the health of women and children by: • preventing pregnancies that are too early or too late • extending the period between births • limiting the number of children A WFfC goal is access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. At the BiH level (Table RH.1 and Figure RH.1), 35.7 percent of women aged 15-49 years married or in union are using (or their partner is using) some kind of contraceptive method, with a significant difference between urban (29.0 percent) and rural (39.3 percent) areas. The most common method of contraception is withdrawal, which is used by 21.4 percent of the respondents. Only 11.2 percent of the women includ- ed in the survey use some of the modern methods of contraception and 64.3 percent of women do not use any contraception methods (66.4 percent in FBiH and 59.3 percent in the RS). In urban areas, this percent reaches 71.0, and in rural areas 60.7 percent. The use of modern and traditional methods of contra- ception significantly correlates with the education level of women. Modern methods of contraception are used by 17.6 percent of women with higher or university education in comparison to only 6.5 percent of women with pri- mary education. The use of modern methods increases in correlation with the wealth index (4.4 percent of the poorest in comparison to 19.9 percent of the wealthiest). Current use of contraception was reported by approximately one-third (33.6 percent) of women aged 15-49 currently married or in union in the FBiH, while this figure is somewhat higher in the RS, at 40.7 percent (Table RH.1). The most popular method is withdrawal, used by 19.0 percent of married or in union women in the FBiH and 25.0 percent of women in the RS. Another method is condom use, which was reported by 5.0 percent of women in the FBiH and 3.0 percent in the RS. It is interesting to note that only 12.0 percent of the respondents in the FBiH and 9.4 percent in the RS are currently using any of the modern methods of contraception. MICS 3 FULL TECHNICAL REPORT 45 Reproductive Health Figure RH.1: Use of contraception, BiH 2006 Unmet Need Unmet need17 for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth or who wish to stop childbearing altogether. Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Women with an unmet need for spacing includes women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to space their births. Pregnant women are considered to want to space their births when they did not want the child at the time they got pregnant. Women who are not pregnant are classified in this category if they want to have a(nother) child, but want to have the child at least two years later, or after getting married. Women with an unmet need for limiting are those women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to limit their births. The latter group includes women who are currently pregnant but had not wanted the pregnancy at all, and women who are not currently pregnant but do not want to have a(nother) child. Total unmet need for contraception is the sum of unmet need for spacing and unmet need for limiting. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data, which is defined as the proportion of women currently married or in union who are currently using contraception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Table RH.2 shows the results of the survey on contraception, unmet need, and the demand for contraception satisfied. According to the survey, 60.5 percent of women aged 15-49 in BiH have their contraception needs satisfied. This figure is 63.6 percent in the RS and 59.0 percent in the FBiH. Out of all interviewed women, 23.3 percent of married or in union women have an unmet need for contraception. Unmet need for contraception mainly mani- fests as unmet need for limiting (21.1 percent), with the exception of younger women, 15-24 years old, whose needs are mainly manifested as a need for spacing. No significant differences were observed in relation to the education level, rural-urban areas or socio-economic status of the household. 46 MICS 3 FULL TECHNICAL REPORT 17. Unmet need measurement in MICS is somewhat different than that used in other household surveys, such as the Demographic and Health Surveys (DHS). In DHS, more detailed information is collected on additional variables, such as postpartum amenorrhoea, and sexual activity. Results from the two types of surveys are strictly not comparable. 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 an 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 danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of 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 of antenatal care visits, which include: Blood pressure measurement • Urine testing for bateriuria and proteinuria • Blood testing to detect syphilis and severe anaemia • Weight/height measurement (optional) Coverage of antenatal care (by a doctor, a nurse, or a midwife) is almost universal in Bosnia and Herzegovina, with almost all women receiving antenatal care at least once during the pregnancy: 98.8 percent at BiH level, 98.6 percent in the FBiH and 99.4 percent in the RS (Table RH.3). The types of services pregnant women received are shown in table RH.4. The percentage of services received (blood testing, blood pressure measurement, urine testing, weight measurement) is very high in BiH at 98.9 percent - 98.6 percent in the FBiH and 99.4 percent in the RS. MICS 3 FULL TECHNICAL REPORT 47 Assistance at Delivery Three quarters of all maternal deaths globally 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 WFfC goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indi- cators are the proportion of births with a skilled attendant and proportion of institutional deliveries.18 The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reduc- ing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS Survey included a number of questions to assess the proportion of births attended by a skilled attendant. Table RH.5 shows that 99.7 percent of babies in BiH were delivered in health care institutions (99.6 percent of births in the FBiH and 99.8 percent of births in the RS). The number of births assisted by a midwife stands at 6.0 percent in the RS and 9.5 percent in the FBiH, with the remainder being assisted by a medical doctor. Overall in BiH, 90.9 percent were deliveries assisted by a medical doctor and 8.5 percent were deliveries assisted by a nurse or a midwife. 48 MICS 3 FULL TECHNICAL REPORT 18. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. It is well recognized that a period of rapid brain development occurs in the first three to four years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, adult activities with children, the presence of books in the home for the child, and the conditions of care are impor- tant indicators of home care quality. Moreover, a WFfC goal is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the survey. This includes the involvement of adults with children in activities such as 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. Table CD.1 shows the engagement of an adult in activities that promote learning and school readiness during the three days preceeding the survey. Adult engagement in activities to promote school readiness in BiH aver- ages 75.6 percent. The table also shows that the engagement of adults is 84.9 percent in the RS, while the fig- ure is somewhat lower for the FBiH, at 70.2 percent. There are no gender differences in terms of adult activities with children, but adult involvement in activities that promote learning and school readiness is strongly influenced by household wealth and the mother’s education. While only 63.9 of parents from the poorest households are involved in activities that promote learning and school readiness, that percentage is as much as 85.1 percent for the richest households. The mother’s education level shows a similar pattern: 65.5 percent of mothers with primary education are involved in these activities, compared to 85.4 percent of mothers with high school or higher education. A larger proportions of adults, 84.7 percent, are engaged in learning and school readiness activities with children in urban areas than in rural areas where the figure is 71.3 percent. The percentage of fathers’ involvement in activities that promote learning and school readiness during the three days preceding the survey is 73.8 percent, with their involvement in, on average, 2.3 activities with the child. The trend pattern is the same as with more edu- cated mothers, more educated fathers are also more engaged in such activities than those with less education. Exposure to books in early years not only provides the child with a 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. The presence of books is important for later school performance and IQ scores. The percentage of children living in the households with at least three non-children books in BiH is 75.4 percent (Table CD.2), whereas 70.4 percent of children possess three or more children's books. In FBiH, 77.3 percent and in RS 72.6 percent of children are living in households where at least three non-children’s books are present. While no gender differences are observed, urban children appear to have more access to books than those living in rural households. In fact, 83.9 percent of children under five living in urban areas live in households with more than three non-children’s books, while 82.1 percent of children had three or more children’s books. In rural areas, 71.4 percent of children lived in households with three or more non-children books and 65.0 percent of children from rural areas live in households where three or more children’s books are present. Exposure to books is also highly influenced by socio-economic status and a mother’s education level. It is found that only 53.5 percent of children whose mothershave primary education have three or more children’s books, while 91.6 percent of children whose mother has higher educa- tion have three or more children’s books. Among the poorest households, only 52.2 percent of childrenhave three or more children’s books in comparison with the children from the richest families, where the figure is 88.1 percent. MICS 3 FULL TECHNICAL REPORT 49 Child Development Immunization of Roma children in Modri~a UNICEF BiH Table CD.2 also shows that 18.9 percent of children aged 0-59 months in BiH had three or more playthings in their homes, while 5.0 percent of children aged 0-59 months in BiH had no playthings. On the entity level, 23.7 percent of children in the FBiH and 10.3 percent in the RS had three or more playthings in their homes. The play- things in MICS include household objects, homemade toys, toys that came from a store, and objects and mate- rials found outside the home. It is interesting that 90.0 percent of children in BiH play with toys that come from a store. Table CD.3 shows that 6.1 percent of children aged 0-59 months in BiH were left in the care of other children (7.3 percent in the FBiH and 4.1 percent in the RS), while 2.0 percent of children in BiH (including 2.5 percent in the FBiH and 1.2 percent in the RS) were left alone during the week preceding the interview. Table CD. 3 also shows that 6.6 percent of children in BiH (8.0 percent of children in the FBiH and 4.3 percent in the RS) were left with inadequate care during the week preceding the survey. No differences were observed in relation to the sex of the child, while there is a significant urban-rural difference. At BiH level, 7.7 percent of children in urban areas were left with inadequate care during the week preceding the survey, compared to 6.1 percent of children in rural areas. 50 MICS 3 FULL TECHNICAL REPORT Pre-School Attendance and School Readiness Attending pre-school education in an organized learning or child education program is important for the readiness of children for school. One of the World Fit for Children goals is the promotion of early childhood education. However, only 6.4 percent of children in BiH, including 6.8 percent of children aged 36-59 months in the FBiH and 6.1 percent in the RS, are attending pre-school (Table ED.1). Urban-rural differences are significant - the fig- ure is as high as 14.3 in urban areas in BiH compared to 2.4 in rural areas. Differences in pre-school education attendance by sex are significant, with 4.7 percent of boys attending pre-school compared to 8.0 percent of girls. There is a significant correlation between pre-school attendance and the educational level of the mother: 29.2 percent of mothers with higher or university education have their children attend pre-school, in contrast to 1.5 percent of mothers with primary education. This correlation may be significantly affected by the employment status of the mother having in mind that the pre-schools in BiH have day care functions as well. 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 the WFfC. Education is a vital prerequisite for com- bating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploita- tion, promoting human rights and democracy, protecting the environment, and influencing population growth. MICS 3 FULL TECHNICAL REPORT 51 Education Primary School in Kiseljak - UNICEF Child-friendly School UNICEF BiH The indicators for primary and secondary school attendance include: • Net intake rate in primary education • Net primary school attendance rate • Net secondary school attendance rate • Net primary school attendance rate of children of secondary school age • Female to male education ratio (or gender parity index - GPI) The indicators of school progression include: • Survival rate to grade five • Transition rate to secondary school • Net primary completion rate The data on primary school participation in the BiH are determined by the complexity of the education system and application of education legislation in BiH. The legislation in BiH prescribes nine years of primary education. This legislation is fully implemented in the RS, whereas nine-year primary education in the FBiH was met by only 7 out of its 10 constituent cantons. Such a diversity of regulations has affected the primary school participation data in the MICS3 Survey. The age for primary school participation was set at six years for the purpose of this survey19. Overall, 90.7 percent of children of the primary school entry age in BiH are attending grade one (91.6 percent in the FBiH and 90.8 percent in the RS) as presented in the Table ED.2. The actual enrolment rates are better presented by the data on the percentage of children of primary school age attending primary school (Table ED.3). Overall, 98.4 percent of children of primary school age attend primary school, including 98.3 percent in the FBiH and 98.7 percent in the RS. The secondary school net attendance ratio is presented in Table ED.4 and is 79.3 percent. Children aged 17 rep- resent the smallest percentage (67.0 percent) of all children of secondary school age attending secondary school. The largest percentage of children attend secondary school at the age of 15 (92.6 percent) but this signifi- cantly drops in subsequent years, specifically to 89.7 percent for 16 year-olds, 67.0 percent for 17 year-old and 67.7 for 18 year-olds. There is a significant difference between rural and urban areas with 88.1 percent of chil- dren in urban areas attending secondary school in comparison to 73.9 percent in rural areas. Boys (77.9 per- cent) are less likely to attend secondary school in comparison to girls (81.1 percent). The primary school net attendance ratio of children of secondary school age is presented in Table ED.4W. Overall, 2.1 percent of the children of secondary school age in BiH are attending primary school when they should be attending secondary school. There is a marked difference between girls and boys: a higher percentage of boys of secondary school age attend primary school (2.7 percent) compared to girls (1.5 percent). Almost 2.3 percent of children of secondary school age in rural areas are attending primary school, compared to 1.8 percent of children in urban areas. Table ED.5. presents the percentage of children in BiH entering grade one who reach grade five. Out of all chil- dren starting grade one, almost 100.0 percent will eventually reach grade five (99.8. percent). It is important to note that this number includes children that repeat grades but still eventually move up to reach grade five. No significant differences with respect to sex, region and mother’s education were observed. The net primary school completion rate and transition rate to secondary education are presented in Table ED.6. Net primary school completion rate is 86.6 percent, while transition rate to secondary school is 92.7 percent. 52 MICS 3 FULL TECHNICAL REPORT A student of the Primary School Modri~ki Lug, Modri~a UNICEF BiH 19. The data are based on the estimated age of children at the beginning of the school year in relation to the time of the Survey. In order to obtain realistic data in relation to the fact that the MICS3 has been implemented at least 6 months after the beginning of the school year, the criteria for enrolment and for school attendance were set as follows: adequate age of the child + 1 year. For this reason, the data indicated in the BiH report may vary from the data presented within the BiH entity preliminary reports. MICS 3 FULL TECHNICAL REPORT 53 Education in BiH according to the International Standard Classification of Education (ISCED) MICS3 methodology was designed so as to respond to the needs and standards of the country in which the survey was implemented and also to respond to the criteria of the global reporting on the situation of women and children. For this reason, the MICS3 Survey in BiH represents the data on education based on the stan- dards for preschool, primary and secondary education that are official in BiH, and also based on the ISCED standards that will enable comparison of the achievements of BiH in the area of education at the global level. In order to present data on the education in BiH, the following ISCED standards were followed: a) Preschool education includes children 3 to 6 years old; b) Primary education includes children 6 to 9 years old; c) Secondary education lasts from the age 10 to age 17. According to ISCED1 standard (Table ED.2 ISCED), 90.7 percent of children in BiH of primary school age were enrolled, including 91.6 percent of children in the FBiH and 90.8 percent in the RS. The net primary school attendance rate according to the ISCED1 standard (Table ED.3 ISCED) indicates that 97.9 percent of children in BiH aged six to nine attend primary school, 97.3 percent in the FBiH and 99.0 per- cent in the RS. There are no significant differences between the boys and girls attending primary school. The secondary school net attendance rate for children aged 10-17 is at 89.3 percent (Table ED.4 ISCED), including 87.4 percent in the FBiH and 93.7 percent in the RS. The percent of children of secondary school age who attend primary school is 5.0 percent in BiH according to ISCED standards (Table ED.4w ISCED), including 6.6 percent in the FBiH and 1.2 percent in the RS). Out of the total number of children enrolled in elementary school, 99.8 percent will reach grade five. The primary school net completion rate and the transition rate to secondary school are presented in the Table ED.6 ISCED. A total of 68.3 percent of children in BiH will complete primary school at an adequate age, where- as 98.8 percent will transition to secondary school. The ratio of girls to boys attending primary and secondary education is presented in Table ED.7 ISCED and indicates that the gender parity index is at 1.01 for primary school and 1.00 for secondary school. The ratio of girls to boys attending primary and secondary education is presented in Table ED.7. These ratios are better known as the Gender Parity Index (GPI). The table shows that gender parity for primary school is 1.01, indicating no difference between boys and girls. However, it is at 1.04 for secondary education in favour of girls. Adult literacy One of the WFfC goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. Since only a women’s questionnaire was administered, the results in MICS are valid only for females aged 15-24. Literacy was assessed based on the ability of women to read a short, simple statement or on school attendance. The percent of literate women in BiH is 99.6 percent, as presented in Table ED.8. The percent of literate women is the same in both entities. There are no differences between the rural and urban areas and the differences based on wealth index are insignificant. Birth Registration The Convention on the Rights of the Child (CRC) 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 WFfC states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his/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 five years-of age-whose birth is registered. Overall, 99.5 percent of children in BiH under five are registered upon birth (Table CP.10). The births of 99.8 per- cent of children in the RS and 99.4 percent in the FBiH have been registered. There are no significant variations in birth registration across sex, age, or education categories. 54 MICS 3 FULL TECHNICAL REPORT Child Protection A student of the Primary School D`emaludin ^au{evi}, Sarajevo Anthony Asael for UNICEF BiH Child Labour Article 32 of the CRC 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 WFfC mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploita- tion. In the MICS questionnaire, a number of questions addressed the issue of child labour, specifically 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 pre- ceding the survey a child was involved in: • 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 BiH, 5.3 percent of children aged 5-14 are involved in child labour, 4.7 percent in the RS and 5.8 percent in the FBiH. Almost 1.0 percent of children aged 5-14 in BiH are engaged in some form of economic activity out of their home (paid or unpaid). This figure is 1.1 percent in FBiH and 0.6 percent in the RS. There is a strong cor- relation between child labour and the type of area a child is living in, as well as with the gender. Children living in rural areas are twice as involved in child labour activities (6.4 percent), than children living in urban areas (3.2 percent). Boys are much more involved in child labour (6.6 percent) than girls (3.9 percent). Table CP.3 presents the percentage of children classified as “student labourers” or as “labourer students”. Student labourers are children attending school who are involved in child labour activities. Out of the 83.7 percent of childrenaged 5-14 attending school in BiH (84.3 percent in the FBiH and 82.5 percent in the RS), 6.0 percent (6.5 percent in FBiH and 5.5 percent in RS) are also involved in child labour activities. The proportion of student labourers is more than two times higher among children living in rural areas than in urban areas - 7.4 percent and 3.5 percent respectively. There is a large correlation of gender and child labour with 7.6 percent boy and 4.5 percent of girl student labourers. Child Discipline As stated in the WFfC, “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 BiH MICS survey, mothers/care- takers of children age 2-14 years were asked a series of questions on the ways parents tend 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. Two indicators were used to describe aspects of the child discipline: • the number of children 2-14 years that experience psychological aggression as punishment or minor physical punishment or severe physical punishment • 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 MICS 3 FULL TECHNICAL REPORT 55 Overall data for BiH (Table CP.4) indicate that 35.6 percent of children aged 2-14 were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. This percentage in the RS is 39.9 percent while the percentage in FBiH is 34.0 percent. The breakdown by abuse type showed that 27.0 percent of children were exposed to psychological punishment, 21.1 percent to minor physi- cal punishment and 3.0 percent were subjected to severe physical punishment. The latter figure is not in corre- lation with the percentage of mothers/caretakers who believe that children should be physically punished, which is almost twice as high (6.4 percent). The correlation with mother’s education status and belief in physical punish- ment is negative. Female children were subjected more to severe physical punishment (3.7 percent) than male children (2.5 percent). Violent disciplining is more practised in urban (4.1 percent) than in rural areas (2.5 percent). More than a half of caregivers (58.1 percent) are using non-violent disciplinary methods (60.0 percent in the FBiH and 54.2 percent in the RS). Only 5.7 percent children have never been exposed to any of disciplinary methods or punishment. Early Marriage Marriage before the age of 18 is a reality for many young girls. According to UNICEF's worldwide estimates, over 60 million women aged 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 • 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 the hope 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 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 (CEDAW) 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 CRC, child marriage is linked to other rights - such as the right to express their views freely, the right to be protected from all forms of abuse and 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. 56 MICS 3 FULL TECHNICAL REPORT 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. Co-habitation - 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 numerous 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 are 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 group. There is evidence to suggest that girls who get married at a young age are more likely to marry older men, which may put 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 young wives to reproduce and the power imbalance resulting from the age difference lead to very low condom use among such couples. Two of the indicators that are used to estimate the early marriage are percentage of women married before 15 years of age and the percentage married before 18 years of age. The percentage of women married at various ages is provided in Table CP.5. A total of 7.0 percent of girls aged 15-19 years live in marriage or in union. Overall, 1.0 percent of women in BiH (1.0 percent in the FBiH and 0.9 percent in the RS) had married before the age of 15. The tendency towards early marriage is sig- nificantly higher in rural (1.2 percent) than in urban areas (0.7 percent).This phenomenon is strongly correlated with poverty and lower education: 1.7 per- cent of girls from the poorest households (0.6 percent from the richest), and 2.4 percent of girls with primary education (0.5 percent with secondary and 0.4 percent with higher education) were married before the age of 15. The percentage of women married before the age of 18 in BiH is 10.1 percent (9.8 in the FBiH and 10.7 percent in the RS). This practice is much more common in rural (13.1 percent) than in urban areas (5.1 percent) and is highly correlat- ed with poverty - 18.1 percent of women from the poorest households were married before the age of 18 in comparison with 4.3 percent of women from the richest households. There is also a correlation with education as 23.1 per- cent of women with primary education were married before the age of 18, while this percentage is only 0.9 percent among women with higher educa- tion. MICS 3 FULL TECHNICAL REPORT 57 A student of the Primary School Modri~ki Lug, Modri~a UNICEF BiH Another component is the spousal age difference with an indicator being the percentage of married/in union women who are 10 or more years younger than their current partner. Table CP.6 presents the results of the age difference between husbands and wives. While 19.4 percent of young married women aged 15 to 19 are married to a partner 10 or more years older (23.2 percent in the FBiH and 14.0 percent in the RS), among young married women aged 20-24 this percentage is much lower - 10.8 percent (6.7 percent in the FBiH and 18.7 percent in the RS). This prac- tice is also mainly correlated with poverty and lower education - 21.8 percent of women aged 20-24 from the poor- est households are married to a partner 10 or more years older in comparison with 6.7 percent from the richest house- holds. The correlation with education is that 19.2 percent of women aged 20-24 with primary education are married to a partner 10 or more years older and 7.9 percent of women with secondary school are married to such a partner. Domestic Violence A number of questions were asked to women age 15-49 years to assess their attitudes towards whether husbands are justified to hit or beat their wives/partners in a variety of scenarios.20 The responses to these questions can be found in Table CP.9. It is interesting to note that 4.8 percent of women in BiH agree with the statement that their husbands or partners are justified to hit or beat their wives/partners in a variety of scenarios. There are no sig- nificant regional differences. Domestic violence is less accepted among younger women. There are significant differences in attitudes towards domestic violence between rural and urban areas with 3.6 percent of women in urban and 5.5 percent of women in rural areas justifying family violence. The correlation of low education status of women and the acceptance of violence is evident as 7.6 percent of woman with primary school believe that it is justified for a husband to beat his wife/partner in comparison with 2.5 percent of woman with higher education. Child Disability One of the WFfC goals is to protect children against abuse, exploitation and violence, including the elimination of discrimination against children with disabilities. For children aged two through nine years, a series of ques- tions were asked to assess a number of disabilities/impairments, such as sight impairment, deafness, and diffi- culties with speech. This approach is based on the concept of “functional disability” developed by WHO and aims to identify the implications of any impairment or disability for the development of the child (e.g. health, nutrition, education, etc.). Table CP.10 presents the results of these questions. According to the parents' or caretakers’ report, approximately 6.5 percent of children aged two to nine years in BiH dis- play one or more of the above disabilities. Child disabilities appear to be more frequent in urban (7.7 percent) than in rural areas (5.9 percent) as well as among children whose mothers are less educated (6.9 percent children whose mothers have only primary education and 5.5 percent of children whose mothers have higher education). Approximately 9.1 percent of children aged two years cannot name at least one of the objects presented to him/her, and this appears to be more frequent among children from rural (9.9 percent) than in urban areas (7.6 percent). However, it is important to note that questions from this module were asked for screening purposes only, with the assumption that thorough examinations will be made by qualified personnel after the screening. 58 MICS 3 FULL TECHNICAL REPORT 20. These questions were asked in order to have an indication of cultural beliefs that tend to be associated with the prevalence of violence against women by their hus- bands/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. Knowledge of HIV Transmission and Condom Use One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. The HIV module was administered to women 15-49 years of age. One indicator, which is both an MDG and UNGASS indicator, is the percentage of young women who have com- prehensive and correct knowledge of HIV prevention and transmission. In MICS, women were asked whether they knew of the three main ways of HIV prevention - having only one faithful uninfected partner, using a con- dom every time, and abstaining from sex. The results are presented in Table HA.1. In BiH, almost all of the interviewed women had heard of AIDS (97.6 percent in BiH, including 97.0 percent in the FBiH and 98.4 percent in the RS). However, the percentage of women who were familiar with all three main ways of preventing HIV transmission was only 63.8 percent for BiH (67.0 percent in the FBiH and 57.9 in the RS). In BiH, 84.3 percent of women (86.5 percent of women in the RS and 83.0 percent in the FBiH) knew that reg- ular condom use was a main way of preventing HIV transmission. While 92.9 percent of women in the RS and 90.0 percent of women in the FBiH knew at least one way, a significant proportion of women (7.1 percent in the RS and 10.0 percent in the FBiH) did not know any of the three ways of prevention. The overall percentage of women in BiH who are knowledgeable of at least one mode of prevention is 91.5 per- cent, whereas 8.5 percent do not know any of the three ways of preventing HIV transmission. Table HA.2 presents the percent of women who could correctly identify HIV misconceptions. Of all interviewed women in BiH, only 37.1 percent (39.9 percent in the FBiH and 32.4 percent in the RS) were aware of the two most common misconceptions and knew that a healthy-looking person could be infected. In BiH, 61.5 percent of women knew that HIV cannot be transmitted by sharing food, 87.2 percent knew that HIV could not be transmitted by supernatural means, while 89.8 knew that HIV could be transmitted by sharing needles. Table HA.3 summarizes information from Tables HA.1 and HA.2 and presents the percentage of women who knew two ways of preventing HIV transmission and rejected three common misconceptions. Comprehensive knowl- edge of HIV prevention methods and transmission is still fairly low. Overall, 34.2 percent of women in BiH (37.5 percent in the FBiH and 28.5 percent in the RS) were found to have comprehensive knowledge, which was high- er in urban areas - 40.9 percent in comparison with 30.1 percent in rural areas. 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 aged 15-49 years con- cerning mother-to-child transmission is presented in Table HA.4. Overall, 87.6 percent of women in BiH (87.3 MICS 3 FULL TECHNICAL REPORT 59 HIV/AIDS, Sexual Behaviour, and Orphaned and Vulnerable Children percent in the FBiH and 88.2 percent in the RS) knew that HIV can be transmitted from mother to child. The per- centage of women who knew all three ways of mother-to-child transmission is 69.1 percent in BiH whereas it amounts to 70.3 percent in the FBiH and 66.0 percent in the RS. Out of all interviewed women, 10.0 percent did not know of any specific mode of transmission. The indicators on attitudes towards 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 4) would not want to keep HIV status of a family member a secret Table HA.5 presents the attitudes of women towards people living with HIV/AIDS. The obtained indicators show a high level of intolerance towards people living with HIV/AIDS - 64.2 percent of women in BiH agree with at least one of the discriminatory attitudes. One half of the interviewed woman would not buy fresh vegetables from a vendor who was HIV positive (50.8 percent) and more than one third (37.9 percent) of them think that a female teacher who is HIV positive should not be allowed to teach in school. Discriminatory attitudes significantly corre- late with lower woman’s education - 74.0 percent of women with primary education agree with at least one of the discriminatory attitudes, while 50.1 percent of women with higher education do not accept any of discriminatory attitudes. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. Almost 59.0 percent of women in BiH (57.6 percent in the FBiH and 62.6 percent in the RS) know where to be tested, while only 2.6 percent of women in BiH (less than 2.0 percent in the FBiH and 3.6 percent in the RS) have actually been tested. Among women who had given birth within the two years preceding the survey, the percent who received coun- selling and HIV testing during antenatal care is presented in Table HA.7. Of women who had given birth within the two years preceding the survey, 18.1 percent in BiH, (11.3 percent in the FBiH and 28.5 percent in the RS) received counselling on HIV prevention during antenatal care, whereas 9.8 percent (4.0 percent in the FBiH and 15.2 percent in the RS) have been tested during pregnancy, and almost all were informed about the test results. Sexual Behaviour Related to HIV Transmission Promoting safer sexual behaviour is critical to reducing HIV prevalence. The use of condoms during sex, espe- cially 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. Hence, 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. 60 MICS 3 FULL TECHNICAL REPORT The frequency of sexual behaviours that increase the risk of HIV infection among women is presented in Table HA.8 and Figure HA.2 . Condom use during sex with men other than husbands or live-in partners (non-marital, non-cohabiting) was assessed in women 15-24 years of age who had sex with such a partner in the previous year (Table HA.9). Over 34.0 percent of women 15-24 years in the RS and 17.6 percent in the FBiH report- ed having sex with a non-regular partner in the 12 months prior to the MICS. The over- all percentage for BiH is 25.7 percent. Out of all women reporting having sex with a non-regular partner in BiH, 71.0 percent used condom during sex with such partner (68.3 percent in the RS and 72.5 in FBiH). Orphans and Vulnerable Children 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. To monitor these variations, a measurable definition of orphaned and vulnerable children needed to be created. The UNAIDS Monitoring and Evaluation Reference Group developed a proxy definition of children who have been affected by adult morbidity and mortality. This definition classifies children as orphaned and vulnerable if they have experienced the death of either parent, if either parent is chronically ill, or if an adult (aged 18-59) in the household either died (after being chronically ill) or was chronically ill in the year prior to the survey. The frequency of children living with neither parent, mother only, or father only is presented in Table HA.10. The survey revealed that 0.4 percent of children in BiH (0.4 percent in the RS and 0.5 percent in the FBiH) do not live with their biological parents and that 4.5 percent of children in BiH, including 4.3 percent of children in the RS and 4.6 percent of children in the FBiH lost one or both parents. MICS 3 FULL TECHNICAL REPORT 61 Figure HA.2: Sexual behaviour that increases risk of HIV infection, BiH, 2006 Boerma, J. T., Weinstein, K. I., Rutstein, S. O., i Sommerfelt, A. E., 1996. „Data on Birth Weight in Developing Countries: Can Surveys Help?” Bulletin of the World Health Organization, 74(2), 209-16. Blanc, A. And Wardlaw, T., 2005. „Monitoring Low Birth Weight: An Evaluation of International Estimates and an Updated Estimation Procedure“. WHO Bulletin, 83(3), 178-185. Filmer, D. And Pritchett, L., 2001. “Estimating wealth effects without expenditure data - or tears: An application to educational enrolments in states of India.” Demography, 38(1): 115-132. Rutstein, S. O. And Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Marzland: ORC Macro. UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation. New York, UN Pop Division. United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN. WHO i UNICEF, 1997. The Sisterhood Method for Estimating Maternal Mortality. Guidance notes for potential users, Geneva. www.childinfo.org The RS Ministry of Health and Social Protection, The Multiple Indicator Cluster Survey 2006 in the Republika Srpska, dr. Amela Loli}, doc. dr. Nenad Prodanovi}, Miroslav Stijak, Banja Luka, 2007. Federal Ministry of Health, Public Health Institute FBiH, The Multiple Indicator Cluster Survey in FBiH, dr. Aida Pilav, dr. Irena Joki}, doc.dr. Dragana Nik{i}, Sarajevo 2007. 62 MICS 3 FULL TECHNICAL REPORT List of References MICS 3 FULL TECHNICAL REPORT 63 Tables Table HH.1: Results of household and individual interviews Numbers of households, women and children under 5 by results of the household, women's and under-five's interviews, and household, women's and under-five's response rates, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 65 Area Administrative regions Total Urban Rural FBiH RS DB Sampled households 2263 3737 3744 2129 127 6000 Occupied households 2231 3707 3710 2103 125 5938 Interviewed households 1995 3554 3413 2019 117 5549 Household response rate 89.4 95.9 92.0 96.0 93.6 93.4 Eligible women 1703 3274 3221 1658 98 4977 Interviewed women 1678 3212 3175 1620 95 4890 Women response rate 98.5 98.1 98.6 97.7 96.9 98.3 Women's overall response rate 88.1 94.1 90.7 93.8 90.7 91.8 Eligible children under 5 1025 2184 2065 1086 58 3209 Mother/Caretaker Interviewed 1020 2168 2060 1071 57 3188 Child response rate 99.5 99.3 99.8 98.6 98.3 99.3 Children's overall response rate 89.0 95.2 91.8 94.7 92.0 92.8 Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, BiH, 2006 66 MICS 3 FULL TECHNICAL REPORT Sex Total Male Female Number Percent Number Percent Number Percent Age 0-4 481 5.6 472 5.3 953 5.5 5-9 521 6.1 543 6.1 1064 6.1 10-14 575 6.7 565 6.3 1140 6.5 15-19 632 7.4 510 5.7 1142 6.6 20-24 620 7.3 606 6.8 1227 7.0 25-29 618 7.3 560 6.3 1178 6.8 30-34 596 7.0 562 6.3 1158 6.6 35-39 555 6.5 524 5.9 1079 6.2 40-44 619 7.3 655 7.4 1274 7.3 45-49 654 7.7 534 6.0 1188 6.8 50-54 593 7.0 711 8.0 1304 7.5 55-59 520 6.1 578 6.5 1099 6.3 60-64 423 5.0 439 4.9 862 4.9 65-69 437 5.1 599 6.7 1036 5.9 70+ 665 7.8 1025 11.5 1690 9.7 Missing/DK 13 * 18 * 31 * Dependency age groups <15 1577 18.5 1580 17.7 3157 18.1 15-64 5832 68.4 5680 63.8 11512 66.1 65+ 1102 12.9 1624 18.2 2726 15.6 Missing/DK 13 * 18 * 31 * Age Children aged 0-17 1974 23.2 1861 20.9 3834 22.0 Adults 18+/Missing/DK 6550 76.8 7041 79.1 13591 78.0 Total 8524 100.0 8902 100.0 17426 100.0 Weighted percent Number of households weighted Number of households unweighted Sex of Household Head Male 76.2 4228 4551 Female 23.8 1321 998 Administrative regions FBiH 60.0 3331 3413 RS 37.7 2094 2019 DB 2.2 124 117 Area Urban 37.9 2103 1995 Rural 62.1 3446 3554 Number of household members 1 17.1 947 565 2-3 42.4 2351 1829 4-5 32.4 1798 2282 6-7 7.1 396 750 8-9 (0.8) 46 99 10+ * 12 24 At least one child aged < 18 years 39.8 5549 5549 At least one child aged < 5 years 14.6 5549 5549 At least one woman aged 15-49 years 55.1 5549 5549 Total 100.0 5549 5549 Table HH.3: Household composition Percent distribution of households by selected characteristics, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 67 Table HH.4: Women's background characteristics Percent distribution of women aged 15-49 years by background characteristics, BiH, 2006 68 MICS 3 FULL TECHNICAL REPORT Weighted percent Number of women weighted Number of women unweighted Administrative regions FBiH 65.4 3199 3175 RS 32.5 1590 1620 DB 2.1 101 95 Area Urban 37.5 1835 1678 Rural 62.5 3055 3212 Age 15-19 12.9 630 432 20-24 15.1 739 821 25-29 14.2 693 1137 30-34 14.4 704 928 35-39 13.4 654 624 40-44 16.6 810 514 45-49 13.5 660 434 Marital/Union status Currently married /In union 64.5 3153 3793 Formerly married/In union 5.6 274 220 Never married/In union 29.9 1463 877 Motherhood status Ever gave birth 64.5 3152 3868 Never gave birth 35.5 1738 1022 Woman's education level None 1.2 59 53 Primary 28.4 1391 1485 Secondary 57.8 2826 2849 Higher and University 12.5 612 501 Non-standard curriculum * 3 2 Wealth index quintiles Poorest 16.1 787 874 Second 18.2 890 972 Middle 20.7 1014 1006 Fourth 21.9 1070 1024 Richest 23.1 1130 1014 Total 100.0 4890 4890 Weighted percent Number of under-5 children weighted Number of under-5 children unweighted Sex Male 50.6 1612 1628 Femle 49.4 1575 1559 Administrative regions FBiH 65.4 2083 2059 RS 32.3 1031 1071 DB 2.3 74 57 Area Urban 31.6 1008 1020 Rural 68.4 2179 2167 Age < 6 months 8.4 269 186 6-11 months 9.9 317 327 12-23 months 20.7 661 681 24-35 months 19.9 634 667 36-47 months 19.8 630 657 48-59 months 21.2 676 669 Mother's education level None (0.8) 27 26 Primary 31.4 1000 974 Secondary 59.2 1886 1904 Higher and University 8.6 273 281 Non-standard curriculum * 2 2 Wealth index quintiles Poorest 18.4 587 617 Second 20.5 654 655 Middle 21.1 671 651 Fourth 21.1 672 640 Richest 18.9 603 624 Total 100.0 3187 3187 Tabela HH.5: Children's background characteristics Percent distribution of children under five years of age by background characteristics, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 69 Table NU.1: Child malnourishment Percentage of under-five children who are severely or moderately undernourished, BiH, 2006 70 MICS 3 FULL TECHNICAL REPORT Weight for age: % below -2 SD Weight for age: % below -3 SD* Height for age: % below -2 SD Height for age: % below -3 SD** Weight for height: % below -2 SD Weight for height: % below -3 SD*** Weight for height: % above +2 SD Number of children Sex Male 1.7 0.6 7.4 2.3 3.1 1.1 19.7 1526 Female 1.2 0.3 7.4 2.7 3.3 0.5 20.6 1491 Administrative regions FBiH 2.1 0.7 6.9 2.4 3.6 1.0 17.4 1953 RS 0.3 0.0 7.9 2.7 2.6 0.3 23.3 994 DB 0.0 0.0 13.4 2.4 0.0 0.0 52.5 69 Area Urban 2.2 1.1 6.3 2.2 4.4 1.4 22.5 948 Rural 1.1 0.2 7.9 2.6 2.7 0.5 19.1 2069 Age < 6 months 0.3 0.0 2.7 0.0 6.4 0.3 6.7 252 6-11 months 1.7 0.6 8.9 2.3 6.1 0.6 19.1 292 12-23 months 1.7 0.1 8.4 2.9 3.0 0.7 27.1 611 24-35 months 1.9 1.1 7.8 2.9 2.8 1.3 19.7 608 36-47 months 1.9 0.1 8.2 3.6 3.3 1.1 20.7 606 48-59 months 0.8 0.5 6.4 1.7 1.2 0.4 19.3 648 Mother's education level None * * * * * * * 25 Primary 1.4 0.3 9.4 3.8 2.8 0.5 17.2 953 Secondary 1.3 0.5 6.9 1.8 3.4 0.9 22.7 1780 Higher and University 2.0 0.7 3.6 2.3 2.6 0.7 15.4 257 Non-standard curriculum * * * * * * * 2 Wealth index quintiles Poorest 2.1 0.3 12.1 4.6 2.9 0.8 20.3 553 Second 1.2 0.3 7.1 2.3 3.1 0.3 17.5 617 Middle 0.3 0.1 5.1 1.8 2.2 0.8 20.4 643 Fourth 0.7 0.1 8.2 2.2 2.1 0.1 22.3 643 Richest 3.5 1.5 4.8 1.7 6.0 2.1 20.3 561 Total 1.5 0.4 7.4 2.5 3.2 0.8 20.2 3017 * MICS indicator 6; MDG indicator 4 ** MICS indicator 7 *** MICS indicator 8 Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with live birth in the two years preceding the survey Administrative regions FBiH 51.2 83.2 290 RS 70.9 89.3 157 DB * * 12 Area Urban 61.2 85.7 134 Rural 54.9 83.7 324 Months since last birth < 6 months 62.2 88.6 97 6-11 months 57.7 83.9 115 12-23 months 54.1 82.7 246 Woman's education level None * * 2 Primary 52.2 83.4 135 Secondary 58.5 84.3 281 Higher and University 59.4 86.8 40 Non-standard curriculum * * 0 Wealth index quintiles Poorest 66.4 87.5 81 Second 56.8 85.9 105 Middle 50.5 85.1 93 Fourth 50.8 76.3 97 Richest 61.3 87.5 83 Total 56.7 84.3 459 * MICS indicator 45 Table NU.2: Initial breastfeeding Percentage of women aged 15-49 years with a birth in the 2 years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 71 Table NU.3: Breastfeeding Percent of living children according to breastfeeding status at each age group, BiH, 2006 72 MICS 3 FULL TECHNICAL REPORT Children 0-3 months Children 0-5 months Children 6-9 months Children 12-15 months Children 20-23 months Percent exclusively breastfed Number of children Percent exclusively breastfed * Number of children Percent receiving breastmilk and solid/mushy food ** Number of children Percent breast- fed*** Number of children Percent breastfed *** Number of chil- dren Sex Male (26.4) 77 17.8 133 33.6 106 25.7 95 10.7 134 Female (21.1) 88 17.4 136 23.6 89 25.4 89 8.4 111 Administrative regions FBiH 29.3 113 21.8 190 19.2 114 33.8 112 13.1 149 RS (11.4) 52 7.6 78 43.2 80 11.0 69 5.0 84 DB * 1 * 1 * 1 * 3 * 12 Area Urban (18.0) 52 16.0 80 (26.7) 38 25.4 56 5.7 90 Rural 26.1 114 18.3 190 29.6 157 25.6 128 11.9 155 Mother's education level None * 0 * 1 * 0 * 1 * 2 Primary (25.7) 56 18.2 93 32.8 54 38.1 53 18.4 55 Secondary (26.6) 92 20.1 151 28.1 129 23.6 104 6.9 172 Higher and University * 17 * 24 * 12 * 27 * 16 Wealth index quintiles Poorest * 33 (36.4) 46 (28.9) 32 (30.8) 33 (25.5) 40 Second * 53 (16.4) 88 (23.6) 46 (28.9) 32 10.2 50 Middle * 33 (8.6) 49 (27.2) 37 (15.2) 50 (5.7) 30 Fourth * 21 (6.1) 41 (32.1) 45 (22.7) 37 6.6 64 Richest * 25 (21.2) 44 (34.2) 35 (35.9) 33 4.1 62 Total 23.6 165 17.6 269 29.0 195 25.6 185 9.6 245 * MICS indicator 15 ** MICS indicator 17 *** MICS indicator 16 0-5 months exclusively breastfed 6-8 months who received breastmilk and complementary food at least 2 times in prior 24 hours 9-11 months who received breastmilk and complementary food at least 3 times in prior 24 hours 6-11 months who received breastmilk and complementary food at least the minimum recom- mended number of times per day* 0-11 months who were appropri- ately fed** Number of infants aged 0-11 months Sex Male 17.8 26.6 23.9 25.3 21.9 290 Female 17.4 11.5 26.2 20.1 18.9 296 Administrative regions FBiH 21.8 12.0 21.9 17.4 19.5 390 RS 7.6 32.9 31.1 31.9 22.2 194 DB * * * * * 2 Area Urban 16.0 10.0 20.9 17.7 16.9 166 Rural 18.3 21.8 27.5 24.6 21.7 420 Mother's education level None * * * * * 2 Primary 18.2 27.1 29.7 28.5 23.1 179 Secondary 20.1 18.1 25.0 21.7 21.0 354 Higher and University (0.0) (0.0) (16.7) (12.5) (6.7) 51 Wealth index quintiles Poorest 36.4 21.4 31.0 26.3 31.3 95 Second 16.4 20.4 11.3 15.9 16.1 162 Middle 8.6 15.1 33.4 25.7 18.4 115 Fourth 6.1 26.3 8.3 18.0 13.4 107 Richest 21.2 12.0 38.9 29.8 26.3 106 Total 17.6 19.8 25.2 22.7 20.4 586 * MICS indicator 18 * MICS indicator 19 Table NU.4: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times 24 hours prior to survey, and percentage of infants adequately fed, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 73 Table NU.8: Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, BiH, 2006 74 MICS 3 FULL TECHNICAL REPORT Percent of live births below 2500 grams * Percent of live births weighed at birth ** Number of live births Administrative regions FBiH 3.9 98.7 290 RS 5.2 99.6 157 DB * * 12 Area Urban 3.8 99.3 134 Rural 4.9 98.9 324 Woman's education level None * * 2 Primary 6.4 99.1 135 Secondary 3.6 99.1 281 Higher and University 3.5 99.2 40 Non-standard curriculum * * 0 Wealth index quintiles Poorest 6.5 98.4 81 Second 4.2 97.9 105 Middle 3.8 100.0 93 Fourth 5.3 99.7 97 Richest 3.0 99.2 83 Total 4.5 99.0 459 * MICS Indicator 9 ** MICS Indicator 10 Tabela CH.1 BiH: Vaccinations in first year of life Percentage of children aged 18-29 months immunized against childhood diseases at any time before the survey and before the first birthday (18 months for measles), BiH, 2006 MICS 3 FULL TECHNICAL REPORT 75 BCG * DPT 1 DPT 2 DPT 3 *** Polio 1 Polio 2 Polio 3 ** MMR **** All ***** None Number of children aged 18-29 months Vaccination card 73.9 76.0 74.4 72.0 75.7 7.3 72.2 65.4 62.9 .0 636 Mother's report 22.6 18.0 16.1 14.1 18.8 17.5 14.1 12.6 10.3 2.4 636 Either 96.5 94.0 90.5 86.2 94.5 91.8 86.4 78.0 73.2 2.4 636 Vaccinated by 12 months of age 95.8 93.4 87.0 78.0 93.7 88.3 79.0 75.0 61.2 2.4 636 * MICS Indicator 25 ** MICS Indicator 26 *** MICS Indicator 27 **** MICS Indicator 28 ; MDG Indicator 15 ***** MICS Indicator 31 BCG DPT1 DPT2 DPT3 Polio 1 Polio 2 Polio 3 MMR All None Percent with health card Number of children aged 18-29 months Sex Male 95.9 94.0 88.1 87.6 93.6 91.8 87.4 80.5 73.1 2.8 75.8 334 Female 97.1 94.0 88.8 84.6 95.5 91.8 85.2 75.2 71.0 2.0 77.6 302 Administrative regions FBiH 96.1 92.3 88.0 83.0 92.5 90.8 83.3 76.3 70.6 3.3 81.6 408 RS 97.0 97.0 88.5 91.4 97.9 92.8 91.5 80.0 73.7 .8 65.4 205 DB 100.0 100.0 96.3 96.2 100.0 100.0 96.3 92.0 85.2 .0 88.9 23 Area Urban 96.9 93.6 85.5 83.6 94.8 92.0 85.2 74.1 65.6 2.4 70.7 216 Rural 96.3 94.3 90.0 87.5 94.3 91.7 87.0 80.0 75.5 2.4 79.7 420 Mother's education level None 100.0 80.0 50.0 40.0 80.0 60.0 40.0 20.0 16.7 .0 66.7 5 Primary 93.6 88.8 84.2 80.0 88.9 86.1 79.2 73.0 69.4 5.4 73.8 187 Secondary 97.6 96.5 90.1 88.5 97.2 94.3 89.3 79.2 71.5 1.1 79.9 391 Higher and University 98.4 95.3 95.3 93.8 95.3 95.3 93.8 90.6 90.6 1.6 64.1 54 Wealth index quintiles Poorest 93.0 89.3 82.0 79.3 91.1 87.8 80.5 71.9 65.8 4.7 75.8 108 Second 94.5 91.0 88.4 86.2 90.3 88.2 84.7 77.6 74.7 4.8 78.8 123 Middle 98.0 94.9 91.2 88.5 94.3 91.1 88.0 77.7 71.8 1.3 78.6 134 Fourth 98.1 98.1 91.1 88.9 98.7 98.7 88.5 86.1 76.1 .6 74.1 133 Richest 98.1 95.7 88.3 86.2 96.9 91.9 88.7 75.5 71.0 1.2 76.1 138 Total 94.0 88.5 86.2 94.5 91.8 86.4 78.0 72.1 2.4 76.7 636 Table CH.2 BiH: Vaccinations by background characteristics Percentage of children aged 18-29 months currently vaccinated against childhood diseases, BiH, 2006 BCG DPT1 DPT2 DPT3 Polio 1 Polio 2 Polio 3 MMR All None Percent with health card Number of children aged 18-29 months Sex Male 95.4 91.9 87.6 83.7 91.1 89.6 83.4 79.3 73.0 3.9 79.3 220 Female 96.8 92.8 90.9 82.3 94.1 92.3 83.2 72.8 69.1 2.7 84.3 188 Administrative regions FBiH 96.1 92.3 89.1 83.0 92.5 90.8 83.3 76.3 71.2 3.3 81.6 408 Area Urban 95.5 91.0 85.8 80.6 92.3 92.3 83.2 75.0 67.1 3.8 72.8 133 Rural 96.3 92.9 90.7 84.2 92.6 90.1 83.3 76.9 73.2 3.1 85.9 275 Mother's educa- tion level None 100.0 66.7 66.7 33.3 66.7 66.7 33.3 .0 .0 .0 100.0 3 Primary 92.1 86.1 83.5 74.2 85.5 82.8 72.8 69.3 66.9 7.2 75.8 129 Secondary 97.8 95.7 91.6 86.9 96.4 94.9 88.0 78.2 70.6 1.4 87.8 236 Higher and University 98.0 93.9 93.9 91.8 93.9 93.9 91.8 91.8 91.8 2.0 63.3 41 Wealth index quintiles Poorest 93.0 85.9 84.5 73.2 87.3 85.9 74.6 64.7 63.3 7.0 80.2 60 Second 92.1 87.1 85.2 82.2 86.1 84.2 80.2 73.0 70.3 6.9 81.4 86 Middle 97.9 94.7 91.6 85.3 93.8 89.5 84.2 74.7 68.4 1.0 91.7 81 Fourth 98.9 97.8 90.2 83.7 97.9 97.9 82.8 82.6 72.0 1.1 77.4 79 Richest 97.5 94.2 92.4 87.4 95.8 95.0 90.8 82.4 78.2 1.7 77.9 103 Total 96.1 92.3 89.1 83.0 92.5 90.8 83.3 76.3 71.2 3.3 81.6 408 Table CH.1 FBiH: Vaccinations in first year of life Percentage of children aged 18-29 months immunized against childhood diseases at any time before the survey and before the first birthday (18 months for measles), FBiH, 2006 Table CH.2 FBiH: Vaccinations by background characteristics Percentage of children aged 18-29 months currently vaccinated against childhood diseases, FBiH, 2006 76 MICS 3 FULL TECHNICAL REPORT BCG * DPT 1 DPT 2 DPT3 *** Polio 1 Polio 2 Polio 3 ** MMR **** All ***** None Number of children aged 18-29 months Vaccination card 79.6 79.5 78.7 75.1 79.4 78.9 75.8 65.8 63.7 .0 408 Mother's report 16.4 12.7 10.5 7.9 13.1 11.9 7.5 10.5 7.5 3.3 408 Either 96.1 92.3 89.1 83.0 92.5 90.8 83.3 76.3 71.2 3.3 408 Vaccinated by 12 months of age 95.0 91.3 84.6 74.7 91.3 86.3 75.0 72.4 58.5 3.3 408 * MICS Indicator 25 ** MICS Indicator 26 *** MICS Indicator 27 **** MICS Indicator 28 ; MDG Indicator 15 ***** MICS Indicator 31 MICS 3 FULL TECHNICAL REPORT 77 Table CH.1RS: Vaccinations in first year of life Percentage of children aged 18-29 months immunized against childhood diseases at any time before the survey and before the first birthday (18 months for measles), RS, 2006 BCG * DPT 1 DPT 2 DPT 3 *** Polio 1 Polio 2 Polio 3 ** MMR **** All ***** None Number of children aged 18-29 months Vaccination card 60.6 67.0 63.5 63.5 66.5 63.1 63.1 61.8 58.6 .0 205 Mother's report 36.4 30.0 28.8 27.9 31.4 29.7 28.4 18.2 17.1 .8 205 Either 97.0 97.0 93.3 91.4 97.9 92.8 91.5 80.0 75.7 .8 205 Vaccinated by 12 months of age 97.0 97.0 91.0 82.8 97.9 91.5 85.4 79.4 64.9 .8 205 * MICS Indicator 25 ** MICS Indicator 26 *** MICS Indicator 27 **** MICS Indicator 28; MDG Indicator 15 ***** MICS Indicator 31 BCG DPT1 DPT2 DPT3 Polio 1 Polio 2 Polio 3 MMR All None Percent with health card Number of children aged Sex Male 96.5 98.2 95.4 95.4 98.2 95.5 95.5 81.0 76.0 .9 65.2 97 Female 97.5 96.0 89.5 87.9 97.6 90.4 88.0 79.1 75.4 .8 65.6 108 Administrative regions RS 97.0 97.0 92.3 91.4 97.9 92.8 91.5 80.0 75.7 .8 65.4 205 Area Urban 98.9 97.7 89.7 88.6 98.9 91.0 88.7 72.9 67.4 .0 67.1 77 Rural 95.9 96.6 93.8 93.1 97.3 93.9 93.2 84.4 80.9 1.3 64.5 128 Mother's education level None 100.0 100.0 50.0 50.0 100.0 50.0 50.0 50.0 50.0 .0 33.3 3 Primary 96.7 94.6 92.9 92.9 96.5 93.0 93.0 79.2 77.4 1.7 66.7 51 Secondary 96.9 97.5 91.9 90.7 98.2 92.6 90.8 80.1 74.5 .6 65.7 140 Higher and University 100.0 100.0 100.0 100.0 100.0 100.0 100.0 85.7 85.7 .0 64.3 12 Wealth index quintiles Poorest 92.7 93.8 89.6 87.5 96.0 90.0 88.0 81.3 73.5 1.8 69.1 46 Second 100.0 100.0 97.6 97.6 100.0 97.5 97.5 87.8 87.8 .0 73.2 35 Middle 98.0 94.7 93.0 93.0 94.7 93.0 93.0 85.4 81.3 1.8 57.8 48 Fourth 96.0 97.9 97.9 95.7 100.0 100.0 95.9 88.6 80.0 .0 60.0 42 Richest 100.0 100.0 82.4 82.4 100.0 82.4 82.4 53.8 53.8 .0 70.0 34 Total 97.0 97.0 92.3 91.4 97.9 92.8 91.5 80.0 75.7 .8 65.4 205 Table CH.2 RS: Vaccinations by background characteristics Percentage of children aged 18-29 months currently vaccinated against childhood diseases, RS, 2006 Table CH.4: Oral rehydration treatment Percentage of children aged 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), BiH, 2006 78 MICS 3 FULL TECHNICAL REPORT Had diarrhoea in last two weeks Number of children aged 0-59 months Fluid from ORS packet Recommended homemade fluid Pre - packaged ORS fluid No treatment ORT use rate * Number of children aged 0-59 months with diarrhoea Sex Male 5.9 1612 25.9 44.6 12.5 31.3 68.7 95 Female 3.6 1575 7.5 29.8 26.8 41.8 58.2 57 Administrative regions FBiH 4.9 2083 25.1 43.3 22.5 25.0 75.0 101 RS 3.9 1031 8.3 37.5 8.3 48.0 52.0 41 DB 12.7 74 0.0 0.0 9.1 90.9 9.1 9 Area Urban 5.4 1008 18.8 42.1 17.2 26.6 73.4 54 Rural 4.5 2179 19.2 37.4 18.2 40.0 60.0 97 Age < 6 months 4.7 269 6.6 13.3 6.6 73.4 26.6 13 6-11 months 10.9 317 31.8 51.3 19.5 24.4 75.6 35 12-23 months 6.0 661 12.8 27.6 17.0 44.7 55.3 40 24-35 months 5.1 634 26.4 49.9 15.8 18.4 81.6 32 36-47 months 3.1 630 13.0 39.1 21.7 30.4 69.6 19 48-59 months 1.9 676 6.7 40.0 26.7 46.7 53.3 13 Mother's education level None (9.4) 27 (0.0) (66.7) (0.0) (33.3) (66.7) 3 Primary 4.3 1000 13.7 29.4 25.5 37.3 62.7 43 Secondary 4.8 1886 24.4 45.8 15.9 29.0 71.0 90 Higher and University 5.6 273 5.5 22.2 11.1 66.8 33.2 15 Non-standard curriculum * 2 * * * * * 0 Wealth index quintiles Poorest 3.5 587 16.7 33.3 25.0 33.3 66.7 20 Second 5.5 654 30.3 55.9 11.6 27.9 72.1 36 Middle 4.1 671 9.1 27.3 33.3 39.4 60.6 28 Fourth 5.9 672 10.6 31.8 10.6 53.3 46.7 40 Richest 4.5 603 28.2 43.7 15.6 15.6 84.4 27 Total 4.7 3187 19.0 39.1 17.9 35.2 64.8 151 * MICS Indicator 33 Had diarrhoea in last two weeks Number of children aged 0-59 months Children with diarrhoea who drank more Children with diarrhoea who drank the same or less Children with diarrhoea who ate somewhat less. same or more Children with diarrhoea who ate much less or none Home manage- ment of diarrhoea * Received ORT or increased fluids AND continued feeding ** Number of children aged 0-59 months with diarrhoea Sex Male 5.9 1612 25.9 73.2 77.7 22.3 21.4 59.8 95 Female 3.6 1575 14.9 83.6 71.7 28.3 10.4 40.3 57 Administrative regions FBiH 4.9 2083 18.3 80.0 70.8 29.2 14.2 54.2 101 RS 3.9 1031 16.6 83.4 83.4 16.6 12.5 41.6 41 DB 12.7 74 81.9 18.1 90.9 9.1 72.8 81.9 9 Area Urban 5.4 1008 14.0 86.0 62.5 37.5 9.4 42.1 54 Rural 4.5 2179 26.1 72.2 82.6 17.4 21.8 58.3 97 Age 0-11 months 8.1 586 21.4 78.6 89.3 10.7 19.6 60.7 47 12-23 months 6.0 661 25.6 74.4 83.0 17.0 23.5 59.6 40 24-35 months 5.1 634 23.7 73.7 55.2 44.8 15.8 44.7 32 36-47 months 3.1 630 8.7 91.3 60.9 39.1 4.3 39.1 19 48-59 months 1.9 676 26.7 66.7 73.3 26.7 13.3 40.0 13 Mother's education level None (9.4) 27 (0.0) (100.0) (66.7) (33.3) (0.0) (33.3) 3 Primary 4.3 1000 17.6 80.4 76.5 23.5 11.8 47.1 43 Secondary 4.8 1886 25.2 73.8 74.8 25.2 21.5 61.7 90 Higher and University 5.6 273 16.6 83.4 77.8 22.2 11.1 16.6 15 Non-standard curriculum * 2 * * * * * * 0 Wealth index quintiles Poorest 3.5 587 16.7 79.2 87.5 12.5 8.3 58.3 20 Second 5.5 654 18.6 81.4 81.4 18.6 13.9 62.8 36 Middle 4.1 671 21.2 75.8 75.8 24.2 18.2 48.5 28 Fourth 5.9 672 27.7 72.3 80.9 19.1 25.6 46.8 40 Richest 4.5 603 21.8 78.2 49.9 50.1 15.6 46.8 27 Total 4.7 3187 21.8 77.1 75.4 24.6 17.3 52.5 151 * MICS indicator 34 ** MICS indicator 35 Table CH.5: Home management of diarrhoea Percentage of children aged 0-59 months with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 79 Table CH.6: Care seeking for suspected pneumonia Percentage of children aged 0-59 months in the last two weeks taken to a health provider, BiH, 2006 80 MICS 3 FULL TECHNICAL REPORT Had acute respiratory infection Number of children aged 0-59 months Govt. hospital Govt. health centre Govt. health post Other public Private hospital clinic Private physi- cian Any appropri- ate provider * Number of children aged 0-59 months with suspected pneumonia Sex Male 5.0 1612 15.8 63.2 3.2 2.1 2.1 8.4 91.6 80 Female 2.9 1575 20.4 68.5 1.9 0.0 5.6 0.0 90.7 46 Administrative regions FBiH 4.4 2083 15.7 66.7 2.8 1.9 3.7 5.6 90.7 91 RS 3.3 1031 22.5 60.0 2.5 0.0 2.5 5.0 92.5 34 DB 1.1 74 0.0 100.0 0.0 0.0 0.0 0.0 100.0 1 Area Urban 3.5 1008 19.0 54.8 0.0 0.0 11.9 14.3 95.2 35 Rural 4.1 2179 16.8 69.2 3.7 1.9 0.0 1.9 89.7 90 Age 0-11 months 4.5 586 22.5 74.2 3.2 0.0 0.0 3.2 93.6 26 12-23 months 4.5 661 17.1 68.6 0.0 2.9 2.9 8.6 94.3 30 24-35 months 4.0 634 26.7 43.3 6.7 0.0 6.7 3.3 86.7 25 36-47 months 4.2 630 9.7 77.5 0.0 3.2 3.2 0.0 90.3 26 48-59 months 2.7 676 9.1 59.1 4.5 0.0 4.5 13.6 90.9 19 Mother's education level None (15.6) 27 (20.0) (80.0) (0.0) (0.0) (.0) (0.0) (80.0) 4 Primary 4.8 1000 21.0 63.2 1.8 3.5 1.8 7.0 93.0 48 Secondary 3.2 1886 15.5 64.8 4.2 0.0 2.8 2.8 90.1 60 Higher and University 4.9 273 12.5 68.8 0.0 0.0 12.5 12.5 93.8 13 Non-standard curriculum * 2 * * * * * * * 0 Wealth index quintiles Poorest 4.5 587 16.1 77.4 3.2 0.0 0.0 3.2 96.8 26 Second 5.4 654 11.9 59.6 2.4 4.8 2.4 4.8 83.4 35 Middle 2.8 671 13.6 77.3 4.5 0.0 0.0 0.0 86.4 19 Fourth 3.8 672 23.3 63.3 3.3 0.0 3.3 6.7 96.7 25 Richest 3.4 603 25.0 50.0 0.0 0.0 12.5 12.5 95.8 20 Total 3.9 3187 17.4 65.1 2.7 1.3 3.4 5.4 91.3 126 * MICS indicator 23 Percentage of children aged 0-59 months with suspected pneumonia who received antibiotics in the last two weeks * Number of children aged 0-59 months with suspected pneumonia in the two weeks prior to the survey Sex Male 77.9 80 Female 64.8 46 Administrative regions FBiH 81.5 91 RS (49.9) 34 DB * 1 Area Urban (76.2) 35 Rural 71.9 90 Age 0-11 months (93.6) 26 12-23 months (74.3) 30 24-35 months (76.7) 25 36-47 months (54.8) 26 48-59 months * 19 Mother's education level None * 4 Primary 63.1 48 Secondary 81.7 60 Higher and University * 13 Wealth index quintiles Poorest (80.6) 26 Second (61.9) 35 Middle * 19 Fourth (76.7) 25 Richest * 20 Total 73.1 126 MICS indicator 22 Table CH.7: Antibiotic treatment of pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 81 Table CH.7A: Knowledge of the two danger signs of pneumonia Percentage of mothers/caretakers of children aged 0-59 months by knowledge of types of symptoms for taking a child immediately to a health facility and percentage of mothers/caretakers who recognize fast and difficult breathing as signs for seeking care immediately, BiH, 2006 82 MICS 3 FULL TECHNICAL REPORT Percentage of mothers/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child: Mothers/ caretakers who recognize the two danger signs of pneumonia Number of mothers/ caretakers of children aged 0-59 months Is not able to drink or breast- feed Becomes sicker Develops a fever Has fast breath- ing Has difficulty breath- ing Has blood in stool Is drink- ing poorly Has other symptoms Administrative regions FBiH 46.7 68.9 96.4 59.5 73.1 64.7 40.4 15.9 56.3 2083 RS 27.4 64.0 90.9 44.6 60.4 62.9 25.9 18.7 40.1 1031 DB 45.9 98.9 98.9 82.8 98.9 98.9 67.8 2.3 81.6 74 Area Urban 40.5 67.6 94.1 53.2 67.4 63.7 35.8 15.4 49.7 1008 Rural 40.4 68.2 94.9 56.1 70.6 65.4 36.6 16.9 52.6 2179 Mother's education level None (34.3) (78.2) (84.4) (62.6) (71.9) (65.7) (40.7) (18.7) (62.6) 27 Primary 38.8 70.6 95.4 54.1 67.3 62.7 36.1 18.4 50.1 1000 Secondary 39.8 65.9 94.8 55.0 70.0 65.4 35.8 14.4 51.4 1886 Higher and University 51.7 71.5 92.3 59.7 75.5 69.4 40.9 23.6 58.5 273 Non-standard curriculum * * * * * * * * * 2 Wealth index quintiles Poorest 33.8 62.4 94.4 50.2 65.2 58.3 37.6 10.9 45.9 587 Second 47.1 73.9 96.3 59.0 73.4 67.9 42.3 20.9 55.7 654 Middle 45.1 70.6 92.1 55.5 67.7 67.7 35.6 16.5 52.1 671 Fourth 34.4 63.8 95.4 51.5 69.3 60.8 28.9 16.3 47.0 672 Richest 41.3 68.6 95.2 59.8 72.2 69.6 37.8 17.1 57.7 603 Total 40.5 68.0 94.7 55.2 69.6 64.9 36.3 16.5 51.7 3187 Type of fuel used for cooking Total Solid fuels for cooking * Number of households Electricity Liquid propane gas (LPG) Natural gas Coal/lignite Charcoal Wood Straw/ shrubs/ grass Administrative regions FBiH 51.6 5.5 3.6 1.0 0.3 37.9 0.1 100.0 39.3 3331 RS 29.9 5.9 0.3 0.1 0.2 63.5 0.1 100.0 63.9 2094 DB 53.3 0.0 3.0 0.0 1.6 42.0 0.0 100.0 43.6 124 Area Urban 66.9 9.4 5.2 1.3 0.2 17.0 0.0 100.0 18.5 2103 Rural 29.2 3.2 0.5 0.2 0.4 66.4 0.1 100.0 67.1 3446 Head's education level None 23.1 1.6 0.7 0.0 0.3 74.3 0.0 100.0 74.6 568 Primary 33.1 3.8 1.2 0.2 0.5 61.1 0.1 100.0 61.9 1949 Secondary 51.3 6.5 2.4 1.1 0.2 38.4 0.0 100.0 39.8 2451 Higher and University 66.3 11.7 7.4 0.7 .0 13.6 0.4 100.0 14.7 568 Non-standard curriculum * * * * * * * * * 11 Missing/DK * * * * * * * * * 2 Wealth index quintiles Poorest 4.9 0.6 0.0 0.0 0.3 94.2 0.0 100.0 94.5 1267 Second 17.4 3.1 0.5 0.0 0.7 77.7 0.5 100.0 78.9 1071 Middle 45.4 5.0 1.5 1.3 0.4 46.4 0.0 100.0 48.1 1035 Fourth 73.5 5.8 5.8 1.9 0.2 12.8 0.0 100.0 14.9 1050 Richest 82.0 13.6 4.0 0.2 0.0 0.3 0.0 100.0 0.4 1125 Total 43.5 5.5 2.3 0.6 0.3 47.6 0.1 100.0 48.7 5549 * MICS indicator 24; MDG indicator 29 Table CH.8: Solid fuel use Percent distribution of households according to type of cooking fuel, and percentage of households using solid fuels for cooking, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 83 Table CH.9: Solid fuel use by type of stove or hearth Percent of households using solid fuels for cooking by type of stove or hearth, BiH, 2006 84 MICS 3 FULL TECHNICAL REPORT Percentage of households using solid fuels for cooking: Total Number of households using solid fuels for cooking Closed stove with chimney Open stove or hearth with chimney or hood Open stove or hearth with no chimney or hood Other stove DK stove type/missing Administrative regions FBiH 99.0 1.0 0.0 0.0 0.0 100.0 1309 RS 93.0 6.8 0.1 0.0 0.0 100.0 1338 DB (100.0) (0.0) (0.0) (0.0) (0.0) 100.0 54 Area Urban 93.8 6.1 0.0 0.0 0.1 100.0 388 Rural 96.5 3.5 0.1 0.0 0.0 100.0 2314 Head's education level None 95.3 4.7 0.0 0.0 0.0 100.0 424 Primary 96.3 3.5 0.1 0.0 0.0 100.0 1207 Secondary 96.3 3.7 0.0 0.0 0.0 100.0 976 Higher and University 95.2 4.5 0.0 0.3 0.0 100.0 83 Non-standard curriculum * * * * * * 10 Missing/DK * * * * * * 2 Wealth index quintiles Poorest 94.7 5.1 0.1 0.0 0.0 100.0 1198 Second 97.6 2.4 0.0 0.0 0.0 100.0 845 Middle 95.9 4.1 0.0 0.0 0.1 100.0 497 Fourth 98.9 1.1 0.0 0.0 0.0 100.0 157 Richest * * * * * * 5 Total 96.1 3.8 0.1 0.0 0.0 100.0 2702 Ta bl e EN .1 : Us e of im pr ov ed w at er s ou rc es P er ce nt d is tr ib ut io n of h ou se ho ld p op ul at io n ac co rd in g to m ai n so ur ce o f dr in ki ng w at er a nd p er ce nt ag e of h ou se ho ld m em be rs u si ng im pr ov ed d ri nk in g w at er s ou rc es , B iH , 2 00 6 MICS 3 FULL TECHNICAL REPORT 85 M a in s o u rc e o f d ri n k in g w a te r T o ta l Im p ro v e d s o u rc e o f d ri n k in g w a te r N u m b e r o f h o u s e h o ld m e m b e rs Im p ro v e d s o u rc e s U n im p ro v e d s o u rc e s P ip e d i n to d w e ll in g P ip e d i n to y a rd o r p lo t P u b li c ta p /s ta n d p ip e T u b e w e ll / b o re h o le P ro te c te d w e ll P ro te c te d s p ri n g R a in w a te r c o ll e c ti o n B o tt le d w a te r U n p ro - te c te d w e ll U n p ro - te c te d s p ri n g T a n k e r - tr u c k S u rf a c e w a te r O th e r A dm in is tr at iv e re gi on s FB iH 73 .2 1. 6 .8 .2 3 .4 11 .2 6 .5 2 .6 .1 .2 .1 .0 .1 10 0 .0 9 9 .5 10 71 8 R S 78 .3 3 .1 .8 3 .7 6 .3 4 .3 .0 .7 .2 1. 0 .0 .1 1. 4 10 0 .0 97 .3 6 32 4 D B 12 .7 .0 47 .5 20 .2 10 .1 7. 0 .0 2 .5 .0 .0 .0 .0 .0 10 0 .0 10 0 .0 3 8 3 A re a U rb an 9 0 .0 .4 1. 9 .6 .7 1. 4 .7 3 .8 .0 .2 .0 .0 .4 10 0 .0 9 9 .4 61 61 R ur al 6 4 .8 3 .1 1. 9 2 .7 6 .7 12 .5 5 .8 .9 .2 .7 .1 .0 .7 10 0 .0 9 8 .4 11 2 6 5 H ea d' s ed uc at io n le ve l N on e 6 6 .2 5 .2 3 .9 2 .1 4 .9 9 .0 4 .0 .1 .6 .5 .3 .0 3 .2 10 0 .0 9 5 .4 12 6 0 P ri m ar y 67 .7 3 .0 2 .3 3 .0 6 .9 9 .4 5 .2 1. 2 .2 .8 .0 .1 .2 10 0 .0 9 8 .7 59 79 S ec on da ry 76 .0 1. 5 1. 3 1. 4 3 .6 9 .1 3 .7 2 .4 .0 .3 .0 .0 .6 10 0 .0 9 9 .1 8 4 0 6 H ig he r an d U ni ve rs it y 8 9 .1 .0 1. 2 .5 .7 3 .2 1. 6 3 .2 .0 .0 .0 .0 .4 10 0 .0 9 9 .6 17 4 6 N on -s ta nd ar d cu rr ic ul um (7 5 .9 ) (6 .0 ) (. 0 ) (. 0 ) (. 0 ) (1 8 .1 ) (. 0 ) (. 0 ) (. 0 ) (. 0 ) (. 0 ) (. 0 ) (. 0 ) (1 0 0 .0 ) (1 0 0 .0 ) 2 9 M is si ng / D K * * * * * * * * * * * * * * * 5 w ea lt h in de x qu in ti le s P oo re st 3 3 .1 10 .2 4 .1 5 .6 16 .9 21 .7 5 .2 .5 .3 1. 6 .1 .0 .7 10 0 .0 97 .3 3 4 8 4 S ec on d 6 9 .3 .4 2 .0 1. 7 4 .7 11 .1 8 .7 .6 .1 .2 .1 .1 .8 10 0 .0 9 8 .6 3 4 8 5 M id dl e 78 .8 .1 1. 5 2 .1 .8 7. 0 5 .1 2 .9 .2 .2 .0 .0 1. 4 10 0 .0 9 8 .2 3 4 87 Fo ur th 9 0 .0 .0 1. 3 .2 .1 2 .6 1. 0 4 .4 .0 .4 .0 .0 .1 10 0 .0 9 9 .5 3 4 81 R ic he st 97 .5 .0 .4 .0 .3 .5 .0 1. 2 .0 .0 .0 .0 .0 10 0 .0 10 0 .0 3 4 8 9 To ta l 73 .7 2 .1 1. 9 1. 9 4 .6 8 .6 4 .0 1. 9 .1 .5 .0 .0 .6 10 0 .0 9 8 .7 17 42 6 * M IC S in di ca to r 11 ; M D G in di ca to r 30 Table EN.2: Household water treatment Percentage distribution of household population according to drinking water treatment method used in the household and percentage of household members that applied an appropriate water treatment method, BiH, 2006 86 MICS 3 FULL TECHNICAL REPORT Water treatment method used in the household All drinking water sources: appropriate water treatment method * Number of household members Improved drinking water sources: appropriate water treatment method Number of household members Unimproved drinking water sources: appropriate water treatment method Number of household membersNone Boil Add bleach /chlorine Use water filter Let it stand and settle Other Don't know Administrative regions FBiH 91.5 2.1 4.8 1.4 0.3 0.3 0.0 8.0 10718 8.0 10667 0.0 51 RS 95.7 2.8 0.9 0.1 0.1 0.5 0.1 3.7 6324 3.7 6152 4.4 172 DB 91.2 2.5 4.2 0.9 0.7 2.0 0.0 7.3 383 7.3 383 . 0 Area Urban 95.7 2.6 0.3 0.8 0.4 0.2 0.1 3.6 6161 3.6 6122 5.9 38 Rural 91.6 2.2 5.1 0.9 0.2 0.5 0.0 7.9 11265 8.0 11080 2.8 185 Head's education level None 95.4 3.3 1.5 0.0 0.3 0.3 0.0 4.6 1260 4.5 1202 8.2 59 Primary 93.0 2.3 3.9 0.4 0.4 0.4 0.0 6.4 5979 6.4 5901 1.3 78 Secondary 92.6 2.1 3.9 1.1 0.2 0.3 0.0 6.8 8406 6.8 8326 2.2 80 Higher and University 93.3 3.4 0.8 2.0 0.0 0.6 0.0 6.0 1746 6.0 1739 0.0 7 Non-standard curriculum (100. 0) (0.0) (0.0) (0.0 ) (0.0) (0.0 ) (0.0) (0.0) 29 (0.0) 29 (.) 0 Missing/DK * * * * * * * * 5 * 5 * 0 Wealth index quintiles Poorest 88.7 3.2 7.5 0.2 0.4 0.9 0.0 10.6 3484 10.7 3391 6.2 93 Second 90.9 2.4 5.7 1.0 0.2 0.1 0.1 8.7 3485 8.8 3435 3.5 50 Middle 93.1 2.7 2.7 1.1 0.1 0.4 0.0 6.5 3487 6.6 3423 0.0 64 Fourth 96.8 0.8 0.8 1.2 0.3 0.3 0.0 2.5 3481 2.5 3465 0.0 16 Richest 95.7 2.7 0.4 0.9 0.3 0.2 0.0 3.7 3489 3.7 3488 0.0 1 Total 93.0 2.3 3.4 0.9 0.3 0.4 0.0 6.4 17426 6.4 17202 3.4 223 * MICS indicator 13 Time to source of drinking water Total Mean time to source of drinking water (excluding those on premises) Number of householdsWater on premises Less than 15 minutes 15 minutes to less than 30 minutes 30 minutes to less than 1 hour 1 hour or more DK Administrative regions FBiH 92.7 4.7 2.1 0.3 0.1 0.1 100.0 12.7 3331 RS 87.1 9.2 2.1 1.1 0.5 0.0 100.0 11.6 2094 DB 12.5 57.1 19.5 9.4 1.4 0.0 100.0 12.1 124 Area Urban 95.4 2.9 1.3 0.5 0.0 0.0 100.0 12.2 2103 Rural 84.9 10.4 3.2 1.0 0.5 0.1 100.0 12.1 3446 Head's education level None 83.3 10.3 3.2 2.2 0.3 0.7 100.0 13.6 568 Primary 84.8 11.0 3.0 0.6 0.5 0.0 100.0 11.2 1949 Secondary 91.8 5.4 1.9 0.7 0.2 0.0 100.0 12.5 2451 Higher and University 95.6 2.2 1.5 0.6 0.0 0.0 100.0 13.1 568 Non-standard curriculum * * * * * * * * 11 Missing/DK * * * * * * * * 2 Wealth index quintiles Poorest 68.6 21.6 6.4 2.2 1.0 0.3 100.0 12.1 1267 Second 90.8 6.6 2.0 0.5 0.2 0.0 100.0 10.9 1071 Midle 92.9 5.2 1.0 0.8 0.2 0.0 100.0 12.6 1035 Fourth 96.6 1.3 1.8 0.4 0.0 0.0 100.0 15.1 1050 Richest 99.1 0.5 0.4 0.0 0.0 0.0 100.0 12.4 1125 Total 88.8 7.6 2.5 0.8 0.3 0.1 100.0 12.1 5549 Table EN.3: Time to source of water Percent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 87 Table EN.4: Person collecting water Percent distribution of households according to the person collecting water used in the household, BiH, 2006 88 MICS 3 FULL TECHNICAL REPORT Person collecting drinking water Total Number of householdsAdult woman Adult man Female child (under 15) Male child (under 15) DK Missing Administrative regions FBiH 40.8 56.5 0.1 1.8 0.7 0.0 100.0 236 RS 57.2 40.8 0.7 0.0 0.0 1.3 100.0 268 DB 57.7 39.9 0.2 2.1 0.0 0.0 100.0 107 Area Urban 54.2 45.0 0.0 0.8 0.0 0.0 100.0 94 Rural 50.4 47.0 0.4 1.1 0.3 0.7 100.0 518 Head's education level None 67.9 26.5 1.9 1.9 1.9 0.0 100.0 95 Primary 50.7 48.4 0.1 0.2 0.0 0.6 100.0 293 Secondary 45.3 51.5 0.1 2.2 0.0 0.9 100.0 196 Higher and University * * * * * * * 24 Non-standard curriculum * * * * * * * 4 Wealth index quintiles Poorest 50.8 46.8 0.6 0.5 0.4 0.9 100.0 398 Second 56.5 39.4 0.0 4.1 0.0 0.0 100.0 98 Middle 53.2 46.1 0.0 0.7 0.0 0.0 100.0 71 Fourth (40.9) (59.1) (0.0) (0.0) (0.0) (0.0) (100.0) 34 Richest * * * * * * * 10 Total 51.0 46.7 0.4 1.1 0.3 0.6 100.0 611 MICS 3 FULL TECHNICAL REPORT 89 Ta bl e EN .5 : Us e of s an ita ry m ea ns o f e xc re ta d is po sa l P er ce nt d is tr ib ut io n of h ou se ho ld p op ul at io n ac co rd in g to t yp e of t oi le t us ed b y th e ho us eh ol d an d th e pe rc en ta ge o f ho us eh ol d m em be rs u si ng s an ita ry m ea ns o f ex cr et a di sp os al , B iH , 2 00 6 T y p e o f to il e t fa c il it y u s e d b y h o u s e h o ld T o ta l P e rc e n ta g e o f p o p u la ti o n u s in g s a n i- ta ry m e a n s o f e x c re ta d is p o s a l * N u m b e r o f h o u s e h o ld s m e m b e rs Im p ro v e d s a n it a ti o n f a c il it y U n im p ro v e d s a n it a ti o n f a c il it y F lu s h t o p ip e d s e w e r s y s te m F lu s h t o s e p ti c ta n k F lu s h t o p it (l a tr in e ) V e n ti la te d Im p ro v e d P it l a tr in e (V IP ) P it l a tr in e w it h s la b C o m p o s ti n g to il e t F lu s h t o s o m e w h e re e ls e F lu s h t o u n k n o w n p la c e / n o t s u re / D K w h e re P it l a tr in e w it h o u t s la b /o p e n p it H a n g in g to il e t/ h a n g in g la tr in e N o fa c il it ie s o r b u s h o r fi e ld O th e r A dm in is tr at iv e re gi on s FB iH 47 .6 42 .3 .8 .0 1. 0 1. 2 5 .2 .7 .3 .1 .1 .6 10 0 .0 9 3 .0 10 71 8 R S 30 .4 49 .4 .3 .1 1. 8 10 .7 5 .7 .3 1.1 .2 .1 .0 10 0 .0 9 2 .6 6 32 4 D B 6 5 .7 13 .7 .0 .0 .0 20 .3 .3 .0 .0 .0 .0 .0 10 0 .0 9 9 .7 3 8 3 A re a U rb an 7 7. 2 20 .1 .2 .0 .3 1. 0 .6 .5 .0 .0 .1 .0 10 0 .0 9 8 .9 61 61 R ur al 2 2 .4 57 .5 .8 .1 1. 8 7. 2 7. 8 .6 .9 .2 .1 .6 10 0 .0 8 9 .8 11 2 6 5 H ea d' s ed uc at io n le ve l N on e 2 2 .5 5 0 .1 1. 0 .0 1. 6 11 .2 9 .9 .4 .8 .8 .2 1. 4 10 0 .0 8 6 .5 12 6 0 P ri m ar y 27 .5 52 .1 .9 .0 1. 9 7.7 7. 2 .8 .9 .1 .2 .7 10 0 .0 9 0 .3 59 79 Se co nd ar y 4 8 .2 42 .2 .4 .1 .9 3 .0 4 .0 .4 .5 .1 .0 .1 10 0 .0 9 4 .9 8 4 0 6 H ig he r an d U ni ve rs it y 73 .6 23 .5 .0 .0 .1 .7 1. 4 .7 .0 .0 .0 .0 10 0 .0 97 .9 17 4 6 N on -s ta nd ar d cu rr ic ul um (4 8 .3 ) (3 2 .7 ) (. 0 ) (. 0 ) (6 .0 ) (1 2 .9 ) (. 0 ) (. 0 ) (. 0 ) (. 0 ) (. 0 ) (. 0 ) (1 0 0 .0 ) (1 0 0 .0 ) 2 9 M is si ng /D K * * * * * * * * * * * * * * 5 w ea lt h in de x qu in ti le s P oo re st 6 .7 49 .3 1. 4 .2 4 .3 2 2 .3 11 .5 .6 2 .2 .1 .5 .9 10 0 .0 8 4 .2 3 4 8 4 S ec on d 16 .6 6 6 .9 1. 2 .2 1.1 2 .0 9 .6 .8 .4 .6 .0 .7 10 0 .0 87 .9 3 4 8 5 M id dl e 32 .5 6 0 .2 .5 .0 .3 .9 4 .8 .8 .0 .0 .0 .0 10 0 .0 9 4 .3 3 4 87 Fo ur th 5 6 .8 41 .3 .1 .0 .6 .0 .4 .4 .3 .0 .0 .2 10 0 .0 9 8 .7 3 4 81 R ic he st 9 6 .2 3 .7 .0 .0 .0 .0 .0 .2 .0 .0 .0 .0 10 0 .0 9 9 .8 3 4 8 9 To ta l 41 .8 4 4 .3 .6 .1 1. 2 5 .0 5 .3 .5 .6 .1 .1 .4 10 0 .0 9 3 .0 17 42 6 * M IC S In di ca to r 12 ; M D G In di ca to r 31 Table EN.6: Disposal of child's faeces Percent distribution of children aged 0-2 years according to place of disposal of child's faeces, and the percentage of children aged 0-2 years whose stools are disposed of safely, BiH, 2006 90 MICS 3 FULL TECHNICAL REPORT What was done to dispose of the stools Total Proportion of children whose stools are disposed of safely Number of children aged 0-2 years Child used toilet/ latrin Put /rinsed into toilet or latrine Put/rinsed into drain or ditch Thrown into garbage (solid waste) Burried Left in the open Other Missing Administrative regions FBiH 8.0 21.8 2.9 64.9 0.2 0.3 2.0 0.1 100.0 29.7 1250 RS 8.8 41.7 1.0 47.0 0.0 1.5 0.0 0.0 100.0 50.4 615 DB (.0) (6.5) (0.0) (93.5) (0.0) (0.0) (0.0) (0.0) (100.0) (6.5) 39 Area Urban 7.6 27.2 2.0 61.6 0.0 0.0 1.5 0.0 100.0 34.8 577 Rural 8.3 28.2 2.3 58.9 0.2 1.0 1.2 0.1 100.0 36.4 1327 Mother's education level None * * * * * * * * * * 11 Primary 5.8 28.3 4.6 56.1 0.4 1.8 2.8 0.1 100.0 34.1 569 Secondary 8.4 29.1 1.3 60.3 0.0 0.2 0.7 0.0 100.0 37.4 1139 Higher and University 13.4 17.1 0.0 69.1 0.0 0.0 0.5 0.0 100.0 30.4 183 Non-standard curriculum * * * * * * * * * * 1 Wealth index quintiles Poorest 6.0 33.3 4.8 50.2 0.2 2.9 2.2 0.2 100.0 39.3 350 Second 6.0 26.5 2.1 62.9 0.4 0.4 1.7 0.0 100.0 32.6 405 Middle 9.8 27.2 2.6 59.5 0.0 0.2 0.6 0.0 100.0 37.0 394 Fourth 7.2 29.0 1.5 60.7 0.0 0.0 1.5 0.0 100.0 36.3 387 Richest 11.3 23.7 0.2 64.4 0.0 0.0 0.5 0.0 100.0 34.9 367 Total 8.1 27.9 2.2 59.7 0.1 0.7 1.3 0.0 100.0 35.9 1903 * MICS indicator 14 Percentage of house- hold population using improved sources of drinking water * Percentage of house- hold population using sanitary means of excreta disposal ** Percentage of house- hold population using improved sources of drinking water and using sanitary means of excreta disposal Number of household members Administrative regions FBiH 99.5 93.0 92.6 10718 RS 97.3 92.6 90.5 6324 DB 100.0 99.7 99.7 383 Area Urban 99.4 98.9 98.4 6161 Rural 98.4 89.8 88.5 11265 Head's education level None 95.4 86.5 82.1 1260 Primary 98.7 90.3 89.5 5979 Secondary 99.1 94.9 94.0 8406 Higher and University 99.6 97.9 97.5 1746 Non-standard curriculum (100.0) (100.0) (100.0) 29 Missing/DK * * * 5 Wealth index quintiles Poorest 97.3 84.2 82.3 3484 Second 98.6 87.9 86.9 3485 Middle 98.2 94.3 92.5 3487 Fourth 99.5 98.7 98.3 3481 Richest 100.0 99.8 99.8 3489 Total 98.7 93.0 92.0 17426 * MICS indicator 11; MDG indicator 30 ** MICS indicator 12; MDG indicator 31 Table EN.7: Use of improved water sources and improved sanitation Percentage of household population using both improved drinking water sources and sanitary means of excreta disposal, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 91 Table EN.8: Security of tenure Percentage of household members living in households in urban areas (or in capital city) which lack formal documentation for their residence in the dwelling or who feel at risk of eviction from the dwelling, and the percentage of respondents who have been evicted from their home in the 5 years preceding the survey, BiH, 2006 92 MICS 3 FULL TECHNICAL REPORT Household does not have formal documentation for the residence Respondent feels there is a risk of eviction Household does not have security of tenure * Household members evicted from any dwelling prior 5 years Numbers of households members Administrative regions FBiH 13.3 5.3 14.5 10.7 3854 RS 11.9 5.0 13.9 8.9 2131 DB 4.9 4.3 7.9 23.5 175 Area Urban 12.6 5.1 14.1 10.4 6161 Head's education level None 15.2 2.8 16.9 14.6 199 Primary 13.9 7.9 15.9 12.7 1116 Secondary 13.5 5.1 14.7 9.7 3518 Higher and University 8.8 3.2 10.7 9.5 1314 Non-standard curriculum * * * * 14 Wealth index quintiles Poorest 27.0 23.2 33.0 17.5 220 Second 16.8 8.2 20.9 25.3 411 Middle 17.9 5.9 18.4 14.9 910 Fourth 13.5 5.7 14.8 8.8 1807 Richest 8.6 2.6 9.8 7.3 2812 Total 12.6 5.1 14.1 10.4 6161 * MICS Indicator 93 Dwelling has natural floor material Dwelling is in poor condition Dwelling is vulnerable to accidents Percent of households living in dwellings considered non durable * Number of households Percent of household members living in dwelling considered non-durable Number of household members Head's education level None 0.0 8.8 0.0 0.0 103 . 199 Primary 0.1 4.5 0.0 0.0 404 . 1116 Secondary 0.0 1.7 0.4 0.4 1141 0.3 3518 Higher and University 0.0 0.4 0.0 0.0 451 . 1314 Non-standard curriculum * * * * * * 14 Wealth index quintiles Poorest 0.3 16.6 0.0 0.0 85 . 220 Second 0.0 9.5 0.0 0.0 159 . 411 Middle 0.0 1.8 0.0 0.0 313 . 910 Fourth 0.0 1.2 0.3 0.3 624 0.3 1807 Richest 0.0 0.8 0.2 0.2 922 0.1 2812 Number of households 0.0 2.4 0.2 0.2 2103 0.1 6161 * MICS Indicator 94 Table EN.9: Durability of housing Percentage of households and household members living in dwellings in urban areas (or capital city) that are not considered durable by background characteristics, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 93 Table EN.10: Slum housing Percentage of households and household members in urban areas (or capital city) that are considered as living in slum housing, by background characteristics, BiH, 2006 94 MICS 3 FULL TECHNICAL REPORT Dwelling considered non durable Lack of security of tenure Over- crowding: more than three persons per bedroom Lack of use of improved water source Lack of use of improved sanitation Percent of households considered to be living in slum housing * Number of households Percent of households members considered to be living in slum housing Number of household members Head's education level None 0.0 14.2 2.0 0.0 0.2 16.4 103 23.2 199 Primary 0.0 14.8 1.9 0.6 0.9 15.6 404 17.4 1116 Secondary 0.4 13.7 2.7 0.5 1.4 16.8 1141 18.2 3518 Higher and University 0.0 11.9 1.3 0.0 1.2 13.5 451 12.9 1314 Non-standard curriculum * * * * * * * * 14 Wealth index quintiles Poorest 0.0 30.6 3.9 1.2 6.2 34.4 85 38.0 220 Second 0.0 18.5 1.6 2.2 2.5 20.9 159 25.0 411 Middle 0.0 17.7 3.1 1.1 3.2 22.0 313 23.7 910 Fourth 0.3 13.7 2.0 0.0 0.7 15.8 624 17.6 1807 Richest 0.2 9.6 2.1 0.0 0.2 11.2 922 11.8 2812 Number of households 0.2 13.5 2.2 0.4 1.2 15.8 2103 17.1 6161 *MICS Indicator 95; MDG Indicator 32 MICS 3 FULL TECHNICAL REPORT 95 Ta bl e RH .1 : Us e of c on tr ac ep tio n P er ce nt ag e of w om en a ge d 15 -4 9 ye ar s m ar ri ed o r in u ni on w ho a re u si ng (o r w ho se p ar tn er is u si ng ) a co nt ra ce pt iv e m et ho d, B iH , 2 00 6 P e rc e n t o f w o m e n ( c u rr e n tl y m a rr ie d o r in u n io n ) w h o a re u s in g : T o ta l A n y m o d e rn m e th o d A n y tr a d it io n a l m e th o d A n y m e th o d * N u m b e r o f w o m e n c u rr e n tl y m a rr ie d o r in u n io n N o t u s in g a n y m e th o d F e m a le s te ri li za ti o n P il l IU D C o n d o m F e m a le c o n d o m D ia p h ra g m /f o a m / je ll y L A M P e ri o d ic a b s ti n e n c e W it h d ra w a l O th e r A dm in is t ra ti ve re gi on s FB iH 6 6 .4 .1 4 .5 2 .7 4 .8 .0 .0 .1 1. 5 19 .4 .5 10 0 .0 12 .1 21 .5 3 3 .6 20 30 R S 59 .3 .0 1. 4 4 .8 2 .9 .2 .0 .0 5 .1 2 6 .1 .0 10 0 .0 9 .4 31 .2 4 0 .7 10 52 D B 76 .9 .0 1. 8 10 .9 .0 .0 .0 .9 .0 9 .5 .0 10 0 .0 12 .7 10 .4 23 .1 70 A re a U rb an 71 .0 .2 4 .5 4 .7 6 .8 .0 .0 .0 1. 5 10 .8 .4 10 0 .0 16 .2 12 .7 2 9 .0 10 9 3 R ur al 6 0 .7 .0 2 .8 3 .0 2 .6 .1 .0 .1 3 .3 27 .0 .3 10 0 .0 8 .5 30 .7 39 .3 20 6 0 A ge 15 -1 9 67 .7 .0 5 .1 .0 6 .5 .0 .0 .0 .0 20 .8 .0 10 0 .0 11 .5 20 .8 32 .3 4 4 20 -2 4 6 9 .3 .0 3 .4 1.1 3 .3 .0 .0 .2 1. 5 21 .0 .1 10 0 .0 7. 9 2 2 .8 30 .7 27 5 25 -2 9 6 3 .7 .0 4 .0 1. 4 5 .3 .1 .1 .2 2 .5 2 2 .3 .5 10 0 .0 10 .8 25 .5 3 6 .3 47 7 30 -3 4 61 .6 .0 5 .4 3 .5 4 .5 .0 .0 .2 1. 3 23 .4 .0 10 0 .0 13 .5 24 .9 3 8 .4 57 8 3 5 -3 9 5 8 .7 .1 3 .6 4 .5 4 .2 .0 .1 .0 3 .4 24 .7 .8 10 0 .0 12 .4 28 .9 41 .3 5 5 3 4 0 -4 4 57 .6 .0 3 .0 6 .7 4 .3 .3 .0 .0 2 .6 25 .0 .4 10 0 .0 14 .4 28 .0 42 .4 6 8 6 4 5 -4 9 79 .0 .4 .8 2 .2 2 .1 .0 .0 .0 4 .4 10 .9 .1 10 0 .0 5 .6 15 .3 21 .0 5 4 0 W om an 's ed uc a- ti on le ve l N on e (7 7. 0 ) (. 0 ) (. 0 ) (1 .9 ) (. 9 ) (. 0 ) (. 0 ) (. 0 ) (. 0 ) (2 0 .1 ) (. 0 ) (1 0 0 .0 ) (2 .8 ) (2 0 .1 ) (2 3 .0 ) 3 3 P ri m ar y 62 .2 .1 1. 7 2 .2 2 .5 .0 .0 .1 2 .9 27 .9 .4 10 0 .0 6 .5 31 .3 37 .8 11 3 4 Se co nd ar y 6 4 .1 .0 4 .7 4 .3 4 .3 .1 .0 .1 2 .8 19 .4 .1 10 0 .0 13 .5 2 2 .4 3 5 .9 17 3 8 H ig he r an d U ni ve rs it y 74 .1 .9 2 .4 4 .7 9 .5 .0 .1 .0 1. 3 6 .1 .9 10 0 .0 17 .6 8 .3 25 .9 24 8 N on -s ta n- da rd c ur - ri cu lu m * * * * * * * * * * * * * * * 0 w ea lt h in de x qu in ti le s P oo re st 6 5 .1 .0 2 .6 1. 2 .6 .1 .0 .1 2 .9 27 .0 .4 10 0 .0 4 .4 30 .4 3 4 .9 5 4 3 S ec on d 59 .2 .0 2 .9 3 .7 3 .1 .4 .1 .1 3 .1 27 .5 .0 10 0 .0 10 .1 30 .7 4 0 .8 5 6 5 M id dl e 61 .6 .0 2 .4 2 .9 2 .0 .0 .0 .1 2 .7 28 .2 .0 10 0 .0 7. 4 31 .0 3 8 .4 6 6 3 Fo ur th 6 9 .7 .0 2 .9 4 .2 5 .3 .0 .0 .1 3 .4 13 .9 .4 10 0 .0 12 .5 17 .8 30 .3 6 97 R ic he st 6 4 .9 .4 5 .9 5 .4 8 .3 .0 .0 .0 1. 3 13 .1 .7 10 0 .0 19 .9 15 .2 3 5 .1 6 8 5 To ta l 6 4 .3 .1 3 .4 3 .6 4 .1 .1 .0 .1 2 .7 21 .4 .3 10 0 .0 11 .2 24 .5 3 5 .7 31 5 3 * M IC S Table RH.2: Unmet need for contraception Percentage of women aged 15-49 years currently married or in union with an unmet need for family planning and percentage of demand for contraception satisfied, BiH, 2006 96 MICS 3 FULL TECHNICAL REPORT Current use of contraception* Unmet need for contraception - for spacing** Unmet need for contraception - for limiting*** Unmet need for contraception - Total **** Number of women currently married or in union Percentage of demand for contraception satisfied ***** Number of women currently married or in union with need for contraception Administrative regions FBiH 33.6 2.4 20.9 23.3 2030 59.0 1155 RS 40.7 1.7 21.6 23.3 1052 63.6 674 DB 23.1 2.7 18.6 21.3 70 52.0 31 Area Urban 29.0 1.8 22.6 24.4 1093 54.3 583 Rural 39.3 2.4 20.3 22.7 2060 63.4 1277 Age 15-19 32.3 4.3 0.7 5.0 44 86.6 16 20-24 30.7 8.9 2.7 11.7 275 72.5 117 25-29 36.3 4.8 14.8 19.5 477 65.0 266 30-34 38.4 2.4 21.9 24.3 578 61.3 362 35-39 41.3 1.1 31.9 33.0 553 55.6 411 40-44 42.4 0.0 23.4 23.4 686 64.4 452 45-49 21.0 0.0 22.8 22.8 540 47.9 236 Woman's education level None (23.0) (0.0) (30.8) (30.8) 33 (42.7) 18 Primary 37.8 2.0 22.4 24.5 1134 60.8 706 Secondary 35.9 2.2 20.2 22.4 1738 61.6 1013 Higher and University 25.9 3.4 19.9 23.3 248 52.7 122 Non-standard curriculum * * * * 0 * 0 Wealth index quintiles Poorest 34.9 1.6 21.3 22.9 543 60.4 314 Second 40.8 2.7 20.1 22.9 565 64.1 360 Middle 38.4 2.9 20.8 23.7 663 61.9 412 Fourth 30.3 1.7 23.5 25.1 697 54.6 386 Richest 35.1 2.1 19.6 21.7 685 61.8 389 Total 35.7 2.2 21.1 23.3 3153 60.5 1860 * MICS indicator 21; MDG indicator 19C **** MICS indicator 98 ***** MICS indicator 99 Person providing antenatal care Total Any skilled personnel * Number of women who gave birth in the preceding two years Medical doctor Nurse/midwife No antenatal care received Administrative regions FBiH 61.8 0.5 0.9 63.2 98.6 290 RS 34.0 0.0 0.2 34.2 99.4 157 DB * * * * * 12 Area Urban 28.5 0.0 0.8 29.3 97.4 134 Rural 69.9 0.5 0.3 70.7 99.5 324 Age 15-19 (98.4) (0.0) (1.6) (100.0) (98.4) 20 20-24 98.8 0.5 0.7 100.0 99.3 127 25-29 97.7 0.4 1.9 100.0 98.1 165 30-34 98.4 1.0 0.6 100.0 99.4 98 35-39 100.0 0.0 0.0 100.0 100.0 38 40-44 (100.0) (0.0) (0.0) (100.0) (100.0) 11 45-49 * * * * * 0 Woman's education level None * * * * * 2 Primary 95.8 0.9 3.3 100.0 96.7 135 Secondary 99.4 0.3 0.2 100.0 99.8 281 Higher and University 100.0 0.0 0.0 100.0 100.0 40 Non-standard curriculum * * * * * 0 Wealth index quintiles Poorest 98.4 0.0 1.6 100.0 98.4 81 Second 97.3 1.5 1.2 100.0 98.8 105 Middle 99.0 0.7 0.3 100.0 99.7 93 Fourth 97.7 0.0 2.3 100.0 97.7 97 Richest 100.0 0.0 0.0 100.0 100.0 83 Total 98.4 0.5 1.1 100.0 98.9 459 * MICS indicator 20 Table RH.3: Antenatal care provider Percent distribution of women aged 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, BiH, 2006 MICS 3 FULL TECHNICAL REPORT 97 Table RH.4: Antenatal care content Percentage of pregnant women receiving antenal care among women aged 15-49 years who gave birth in two years preceding the survey and percentage of pregnant women receiving specific care as part of the antenatal care received, BiH, 2006 98 MICS 3 FULL TECHNICAL REPORT Percent of pregnant women receiving ANC one or more times during pregnancy* Percent of pregnant women who had: Number of women who gave birth in two years preceding surveyBlood sample taken Blood pressure measured Urine specimen taken Weight measured Administrative regions FBiH 98.6 97.0 94.5 96.7 93.7 290 RS 99.4 99.0 99.2 98.6 97.0 157 DB * * * * * 12 Area Urban 97.4 96.5 96.9 96.7 96.2 134 Rural 99.5 98.3 95.9 97.8 94.5 324 Age 15-19 (98.4) (96.8) (96.8) (96.8) (96.8) 20 20-24 99.3 98.5 98.0 98.3 97.3 127 25-29 98.1 96.4 95.4 96.0 93.1 165 30-34 99.4 98.7 93.9 98.4 93.2 98 35-39 100.0 99.2 98.3 99.2 97.5 38 40-44 (100.0) (97.1) (100.0) (97.1) (100.0) 11 45-49 * * * * * 0 Woman's education level None * * * * * 2 Primary 96.7 94.2 90.9 93.9 90.7 135 Secondary 99.8 99.1 98.3 98.8 96.4 281 Higher and University 100.0 100.0 99.2 100.0 99.2 40 Non-standard curriculum * * * * * 0 Wealth index quintiles Poorest 98.4 96.9 96.5 96.9 96.9 81 Second 98.8 97.6 95.2 97.0 94.3 105 Middle 99.7 98.3 94.2 97.0 92.2 93 Fourth 97.7 96.7 96.4 97.1 96.1 97 Richest 100.0 99.2 99.2 99.6 95.8 83 Total 98.9 97.7 96.2 97.5 95.0 459 * MICS indicator 44 Table RH.5: Assistance during delivery Percent distribution of women aged 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery, BiH, 2006 Person assisting at delivery Total Any skilled personnel * Delivered in health facility ** Number of women who gave birth in preceding two years Medical doctor Nurse/ midwife Auxiliary midwife Other/ missing No attendant Administrative regions FBiH 89.8 9.5 0.2 0.3 0.2 100.0 99.5 99.6 290 RS 93.8 6.0 0.0 0.0 0.2 100.0 99.8 99.8 157 DB * * * * * * * * 12 Area Urban 92.5 6.6 0.5 0.2 0.2 100.0 99.5 99.8 134 Rural 90.3 9.3 0.0 0.2 0.2 100.0 99.6 99.6 324 Age 15-19 (96.8) (3.2) (0.0) (0.0) (0.0) (100.0) (100.0) (100.0) 20 20-24 91.8 7.4 0.2 0.0 0.5 100.0 99.5 99.8 127 25-29 89.1 10.1 0.2 0.6 0.0 100.0 99.4 99.4 165 30-34 91.9 7.8 0.0 0.0 0.3 100.0 99.7 99.7 98 35-39 88.3 11.7 0.0 0.0 0.0 100.0 100.0 100.0 38 40-44 97.1 2.9 0.0 0.0 0.0 100.0 100.0 100.0 11 45-49 * * * * * * * * 0 Woman's education level None * * * * * * * * 2 Primary 86.0 12.8 0.0 0.7 0.5 100.0 98.8 98.8 135 Secondary 94.4 5.3 0.2 0.0 0.1 100.0 99.9 100.0 281 Higher and University 82.7 17.3 0.0 0.0 0.0 100.0 100.0 100.0 40 Non-standard curriculum * * * * * * * * 0 Wealth index quintiles Poorest 91.4 7.8 0.0 0.4 0.4 100.0 99.2 99.2 81 Second 90.1 9.9 0.0 0.0 0.0 100.0 100.0 100.0 105 Middle 86.0 14.0 0.0 0.0 0.0 100.0 100.0 100.0 93 Fourth 91.9 6.8 0.3 0.6 0.3 100.0 99.0 99.0 97 Richest 95.8 3.4 0.4 0.0 0.4 100.0 99.6 100.0 83 Total 90.9 8.5 0.1 0.2 0.2 100.0 99.6 99.7 459 * MICS indicator 4; MDG indicator 17 ** MICS indicator 5 MICS 3 FULL TECHNICAL REPORT 99 Table CD.1: Family support for learning Percentage of children aged 0-59 months for whom household members are engaged in activities that promote learning and school readiness, BiH, 2006 100 MICS 3 FULL TECHNICAL REPORT Percentage of children aged 0-59 months Number of children aged 0-59 months For whom household members engaged in four or more activities that promote learning and school readiness * Mean number of activities household members engage in with the child For whom the father engaged in one or more activities that promote learning and school readiness ** Mean number of activities the father engage in with the child Living in a household without their nat- ural father Sex Male 75.3 4.6 76.0 2.4 2.4 1612 Female 75.9 4.6 71.6 2.3 3.4 1575 Administrative regions FBiH 70.2 4.4 75.3 2.2 2.7 2083 RS 84.9 5.0 73.1 2.7 2.9 1031 DB 96.6 5.2 41.4 0.8 9.2 74 Area Urban 84.7 5.0 78.5 2.8 3.9 1008 Rural 71.3 4.4 71.6 2.1 2.4 2179 Age 0-23 months 66.7 4.2 72.8 2.1 1.7 1247 24-59 months 81.3 4.9 74.5 2.5 3.7 1941 Mother's education level None (46.8) (3.8) (71.9) (1.9) (15.6) 27 Primary 65.5 4.2 67.6 2.0 3.1 1000 Secondary 79.8 4.8 76.8 2.5 2.7 1886 Higher and University 85.4 5.0 76.1 2.8 2.2 273 Non-standard curriculum * * * * * 2 Father's education level None * * * * * 6 Primary 70.6 4.3 71.6 2.0 0.0 681 Secondary 76.1 4.6 75.9 2.4 0.0 2149 Higher and University 84.6 5.1 85.9 3.2 0.0 257 Non-standard curriculum * * * * * 3 Father not at home 69.0 4.5 8.3 0.2 100.0 71 Wealth index quintiles Poorest 63.9 4.1 75.8 2.1 3.9 587 Second 71.3 4.3 67.2 1.9 2.1 654 Middle 79.2 4.7 68.2 2.1 1.3 671 Fourth 77.6 4.8 73.2 2.3 5.0 672 Richest 85.1 5.2 86.0 3.3 2.2 603 Total 75.6 4.6 73.8 2.3 2.9 3187 * MICS indicator 46 ** MICS indicator 47 3 or more adult books * Median number of adult books 3 or more children's books ** Median number of children's books Child plays with: 3 or more types of play- things *** Number of children aged 0-59 months Household objects Objects and materials

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