Bosnia and Herzegovina - Multiple Indicator Cluster Survey - 2000

Publication date: 2000

d r a f t Household Survey of Women and Children Bosnia and Herzegovina 2000 A Multiple Indicator Cluster Survey B&H MICS 2000 Draft Final Report May 29, 2002 1 d r a f t Contents Lists of Tables .2 List of Figures and Maps.3 Acronyms and Abbreviations .4 Glossary of Terms .6 Foreword . 8 Executive Summary.9 Summary of Indicators, Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000 .13 I. Introduction .15 Background to the Survey .15 Bosnia and Herzegovina Background .16 Survey Objectives.17 II. Survey Methodology .18 Sample Design.18 Fieldwork and Processing.19 III. Sample Characteristics and Data Quality .20 Response Rates.20 Age Distribution and Missing Data .21 Characteristics of the Household Population . 23 IV. Results .25 A. Education.25 B. Water and Sanitation.26 C. Child Malnutrition .27 D. Child Health.29 E. HIV/AIDS.36 F. Reproductive Health.45 G. Child Rights.49 Appendix A: References . 55 Appendix B: List of Personnel Involved in the Bosnia and Herzegovina MICS 2000 Survey .56 Appendix C: Sample Design and Implementation.65 Appendix D: Questionnaires.65 Appendix E: Additional Tables. 103 2 d r a f t Lists of Tables Table 1: Number of households, women and children under 5, and response rates, Bosnia and Herzegovina, MICS 2000. 20 Table 2: Percentage of cases missing information for selected questions, Bosnia and Herzegovina, MICS 2000. 22 Table 3: Percentage distribution of households by background characteristics, Bosnia and Herzegovina, MICS 2000. 23 Table 4: Percentage distribution of household members by background characteristics, Bosnia and Herzegovina, MICS 2000. 23 Table 5: Percentage distribution of women 15-49 by background characteristics, Bosnia and Herzegovina, MICS 2000. 24 Table 6: Percentage distribution of children under 5 by background characteristics, Bosnia and Herzegovina, MICS 2000. 24 Table 7: Percentage of children aged 36-59 months who are attending some form of organised early childhood education programme, Bosnia and Herzegovina MICS 2000 . 25 Table 8: Percentage of children of primary school age attending primary school, Bosnia and Herzegovina, MICS 2000. 26 Table 9: Percentage of children under 5 years of age throughout with missing height or weight data, Bosnia and Herzegovina, MICS 2000. 28 Table 10: Birth weight, Bosnia and Herzegovina, M ICS 2000. 29 Table 11: Percentage of children under 5 with acute respiratory infections in the two weeks before the survey and who have been treated by health providers, Bosnia and Herzegovina MICS 2000. 35 Table 12: Percentage of women aged 15-49 who know the main ways of preventing HIV transmission, Bosnia and Herzegovina, MICS 2000. 37 Table 13: Percentage of women aged 15-19 who know the main ways of preventing HIV/AIDS transmission, Bosnia and Herzegovina MICS 2000. 38 Table 14: Percentage of women aged 20-49 who know the main ways of preventing HIV/AIDS transmission, Bosnia and Herzegovina MICS 2000. 38 Table 15: Percentage of women aged 15-49 who can correctly identify a misconception about HIV/AIDS, Bosnia and Herzegovina MICS 2000 . 39 Table 16: Percentage of women aged 15-49 who can correctly identify means of HIV/AIDS transmission from mother to child, Bosnia and Herzegovina, MICS 2000. 39 Table 17: Percentage of women aged 15-49 who express a discriminatory attitude towards people with HIV/AIDS, Bosnia and Herzegovina, MICS 2000. 40 Table 18: Percentage of women aged 15-19 who have sufficient knowledge of HIV/AIDS transmission, Bosnia and Herzegovina, MICS 2000. 41 Table 19: Percentage of women aged 20 – 49 who have sufficient knowledge of HIV/AIDS transmission, Bosnia and Herzegovina MICS 2000. 41 Table 20: Percentage of married or in union women aged 15-49 who are using (or whose partner is using) a contraceptive method, Bosnia and Herzegovina MICS 2000. 47 Table 21: Percent distribution of women aged 15-49 who gave birth in the last year according to the type of personnel delivering ante-natal care, Bosnia and Herzegovina MICS 2000. 47 3 d r a f t Table 22: Percentage distribution of women aged 15-49 who gave birth in the last year according to the type of personnel assisting at delivery, Bosnia and Herzegovina MICS 2000. 51 Table 23: Percentage distribution of children aged 0-59 months according to whether the birth is registered, and reasons for non-registration, Bosnia and Herzegovina MICS 2000. 51 Table 24: Percentage of children 0-14 years of age in households surveyed who are not living with a biological parent, Bosnia and Herzegovina MICS 2000. 53 List of Figures and Maps Figure 1: Single year age distribution of the household population by sex, Bosnia and Herzegovina 2000. . 21 Figure 2: Total percentage of children aged 12-23 months immunised by 12 months of age, Bosnia and Herzegovina MICS 2000. 30 Figure 3: Total percentage of children aged 18 – 29 months immunised by 18 months of age, Bosnia and Herzegovina MICS 2000. 31 Figure 4: Percentage of women aged 15 – 19 who know the main ways to prevent HIV/AIDS transmission, by level of education, Bosnia and Herzegovina MICS 2000. 42 Figure 5: Percentage of women aged 20-49 who know the main ways of preventing HIV/AIDS transmission, by level of education, Bosnia and Herzegovina MICS 2000. 42 Figure 6: Percentage of women aged 15 – 19 who have sufficient knowledge of HIV/AIDS transmission, Bosnia and Herzegovina 2000 . 43 Figure 7: Percentage of women aged 20 – 49 who have sufficient knowledge of HIV/AIDS transmission, by level of education, Bosnia and Herzegovina MICS 2000. 44 Figure 8: Percentage of married or in union women who are using a method of contraception, by education level, Bosnia and Herzegovina MICS 2000 . 48 4 d r a f t Acronyms and Abbreviations ARI Acute Respiratory Infection B&H MICS 2000 Bosnia and Herzegovina Multiple Indicator Cluster Survey, 2000 B&H Bosnia and Herzegovina BiH Bosna i Herzegovins BCG BacillusCereus-Geuerin (tuberculosis vaccine) CEE/CIS Central and Eastern Europe/Commonwealth of Independent States (UNICEF region) CRC Convention on the Rights of the Child DfID (UK) Department for International Development (United Kingdom) DPT Diptheria-Pertussis-Tetanus EA Enumeration Area(s) EPI Expanded Programme on Immunisation EpiInfo A computer package for data entry and analysis FB&H Federation of Bosnia and Herzegovina FRY Federal Republic of Yugoslavia GDP Gross Domestic Product GNP Gross National Product HH Household(s) HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome IDD Iodine Deficiency Disorders IMCI Integrated Management of Childhood Illnesses IMR Infant Mortality Rate ISSA Integrated System for Survey Analysis (a data entry and analysis package) IUD Intra Uterine Device LAM Lactational Amenorrhoea Method MICS Multiple Indicator Cluster Survey MMR Measles-Mumps-Rubella MoH SW Ministry of Health and Social Welfare MoH Ministry of Health MPM Morbilli-Rubella-Parotitis NA not applicable NCHS National Center for Health Statistics (USA) NK not known OPV Oral Polio Vaccine ORS Oral Re-hydration Solution ORT Oral Re-hydration Therapy OSCE Organization of Security and Co-operation in Europe PHI Public Health Institute PPS Probability Proportional to Size 5 d r a f t RHF Recommended Home Fluid RS Republika Srpska SD standard deviation SOWC State of the World’s Children, an annual UNICEF publication SPSS A computer programme for statistical analysis UNICEF United Nations Children’s Fund WES/WATSAN Water and Environmental Sanitation WHO World Health Organization 6 d r a f t Glossary of Terms Term Definition Ante-natal care Medical care for women during pregnancy. Anthropometry The measurement of weight and height. This was performed using easily portable digital weighing scales measuring to 0.1 kg and locally made height and length measuring boards made according to UNICEF standard specifications. Birth Rate The number of births per year divided by the total population. Cluster In this survey, cluster refers to a group of 20 households obtained from the sampling process Contraception: Prevention of pregnancy through the use of devices or practices Traditional, Modern in sexual intercourse. Traditional methods are related to methods cultural or religious beliefs and vary in different parts of the world. In this survey, the most common traditional method is withdrawal. Modern methods used include contraceptive pills, IUD, condoms and injections. Contraceptive Prevalence The proportion of women (aged 15-49) who are using any form of modern contraception. Enumeration Area B&H was officially divided into geographical sections known as enumeration areas for the purposes of the last demographic survey, and these have been used for this survey. Family planning Conscious control over pregnancy and family size through the use of contraceptives. Infant Mortality The probability of dying before the first birthday, per thousand live births. Internally displaced persons Persons forced to leave their established place of residence and move somewhere else within the boundaries of their home country, usually due to war, civil unrest, natural disasters, etc. Literacy In this survey, literacy is defined as a reported ability to read a newspaper, easily or with difficulty. Maternal mortality Maternal deaths due to pregnancy, birth or puerperium. 7 d r a f t MICS 2000 Indicator An indicator is something that you can measure, for example, birth registration or attendance at school, that can give you useful information about levels of achievement of a set goal or target. The MICS survey measures a globally defined set of indicators. Morbidity Illness; health status below the social norm. Mortality Deaths due to a particular cause. Orphanhood The status of children both of whose biological parents have died. Refugee A person forced to leave his/her own country and to move abroad due to war, civil unrest, natural disasters, etc. Rural As defined in this survey, it refers to areas officially classified as rural, based on the last census in Bosnia and Herzegovina in 1991, plus some areas assessed by field workers on appearance to be so classified – see Sampling Plan Appendix C for further details. Segment An area or section, defined for the purpose of the MICS 2000 survey as a part of an enumeration area from the last census (1991). Stunted A child who is too short for his or her age. Moderate or severe stunting is defined as more than 2 or 3 standard deviations, respectively, below the median height for age of the reference population. Survey Module Modules are sets of questions that relate to a common topic area, such as immunisation, child registration or contraceptive use in the B&H MICS 2000 survey. Underweight A general measure of malnutrition. Moderate or severe underweight is defined as more than 2 or 3 standard deviations, respectively, below the median weight for age of the reference population. Wasted A child who weighs too little for his or her height. Moderate or severe wasting is defined as more than 2 or 3 standard deviations, respectively, below the median weight for height of the reference population. Obese A child who weighs too much for his or her height. Overweight or obese is defined as more than 2 or 3 standard deviations, respectively, above the median weight for height of the reference population. 8 d r a f t Foreword This report represents an outstanding achievement – the largest survey ever conducted on the territory of Bosnia and Herzegovina. We would like to thank all the people of Bosnia and Herzegovina who gave generously of their time to be interviewed. There are many other people to thank since the survey was conducted with input from a large number of people and institutions. We achieved excellent co-operation between the ministries and other organisations. These included: State of Bosnia and Herzegovina - Agency for Statistics; Federation of Bosnia and Herzegovina - Ministry of Health, Public Health Institute, Ministry of Education, Ministry of Social Welfare, Ministry of Finance, Office for Statistics; Republika Srpska - Ministry of Health & Social Welfare, Ministry of Education, Ministry of Finance, Office for Statistics, Public Health Institute, Institute for Geodesics, Banja Luka Clinical Centre, Primary Health Care services; Others – Organisation for Security and Co-operation in Europe. The comprehensive committees that co-ordinated the project are listed in Appendix B and included all relevant ministries. We thank them for their generous support of the survey teams. Over two hundred and fifty people were involved in the technical and field aspects of the survey. 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 in this project. Their new skills and knowledge will be very important for future work of this kind in the country. We would particularly like to thank the United Kingdom Government who provided funding for UNICEF via DfID. UNICEF also contributed funding for training and equipment, and technical support through their offices in Bosnia and Herzegovina, Geneva and New York. The 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 future. The three regional workshops arranged for survey teams from ten countries currently using this methodology were very useful to ensure that the survey met high international standards and increased the skills and knowledge of our survey teams. Bosnia and Herzegovina can now take its place at the UN special session for children in New York in September 2001, bringing substantial new information. Our intention is to use this information to work together for the good of children in Bosnia and Herzegovina. Signed by Dr Zlatko Lagumdziha Minister of Foreign Affairs of Bosnia and Herzegovina 9 d r a f t Foreword by UNICEF Congratulations to all involved in this survey. The commitment of them all has been obvious from the start of the project and I note that all activities were completed on time, using many young and mid-career professionals from Bosnia and Herzegovina. UNICEF is always happy to support local initiatives and in this case there is an achievement to be proud of – some of the first and most useful information on the status of women and children ever produced in this country. The results will be useful for setting the priorities for the next country programme. There is also the possibility for further analyses of the data and follow-up surveys. In December 2000, the End of Decade report on the status of women and children was submitted by the B&H government to the UN, and this drew largely on the results of this survey. UNICEF looks forward to supporting the participation of Bosnia and Herzegovina in the Special Session for Children in September 2001, the National Plan of Action for children for the next decade (currently in progress) and many other exciting and useful projects. Once again, congratulations to all involved. Signed by David Baker Assistant Representative and Head of Office UNICEF Bosnia and Herzegovina Executive Summary The Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000 (B&H MICS 2000) is a nationally representative survey of households, women and children (aged 0 – 18 years). The main objectives of the survey were to provide up-to-date information for assessing the situation of children and women in Bosnia and Herzegovina at the end of the decade, and to furnish the data needed for monitoring progress toward the goals established at the World Summit for Children and as a basis for future action. Data on breast-feeding and salt iodination are available from previous UNICEF supported surveys. 1-4 Data on the remaining End of Decade Goals are available from other sources and are presented in the Bosnia and Herzegovina End of Decade Report. 5 The B&H MICS 2000 survey covered the territory of Bosnia and Herzegovina minus the district of Brèko. This was omitted for sampling and organisational reasons. The survey was carried out in mid 2000 in a joint process with input from two entity field teams, from the Federation of Bosnia and Herzegovina and Republika Srpska. State level and entity level data are presented in this report. The survey sampled 10 772 households across the territory with a very high response rate of 98 percent. A total of 35 571 people lived in the households that responded, making this the largest such survey conducted in Bosnia and Herzegovina in the past ten years. The level of completion of 10 d r a f t the questionnaires was very high, and the data was subjected to multiple quality checks at all stages of the survey. Education · Ninety-four percent of children of primary school age in Bosnia and Herzegovina are attending primary school. School attendance is universally high across both entities and in both rural and urban areas. There is no difference between male and female primary school attendance. · Ninety-nine percent of children who enter the first grade of primary school eventually reach grade five. · The vast majority (95%) of the population over the age of 15 years is literate (as defined by the survey i.e. reported ability to easily read a newspaper). The literate percentage declines slightly after the age of sixty-five years, and there is a bigger drop for women than for men. Water and Sanitation · Ninety-eight percent of the population has access to “safe sources of drinking water”. This is defined by the survey using the global definition of connection to a protected source of water. We note that the actual quality of the water supplied was not tested. Urban areas are slightly more likely to have this access than rural areas. There are variations across the state in the source of drinking water, with rural areas being more likely to have water piped to the yard or plot instead of to the house. This pattern is also seen in RS, which has a more rural population than FB&H. · Ninety-four percent of the population of Bosnia and Herzegovina is living in households with sanitary means of excreta disposal. Urban areas are more likely to have sanitary means of excreta disposal (99%) than rural areas (90%). Child Malnutrition · Four percent of children under the age of five years in Bosnia and Herzegovina are underweight for their age. Ten percent of children are stunted or too short for their age and 6 percent are underweight for their height, although this last figure should be interpreted with caution. · Children, whose mothers have secondary or higher education, are slightly less likely to be underweight and stunted compared to children of mothers with primary or no education. Low Birth weight · Approximately 3 percent of infants are estimated to weigh less than 2500 grams at birth. Immunisation Coverage · Ninety-five percent of children aged 12-23 months receive the BCG vaccination by the age of 12 months and 93 percent the first dose of DPT. The percentage declines very little for subsequent doses of DPT, to 91 percent for the second dose, and 88 percent for the third dose. · Similarly, 93 percent of children receive the first dose of polio vaccine by the age of 12 months and this declines to 90 percent for the second dose and 82 percent for the third dose. · The coverage for measles vaccine (given as MMR in B&H) is lower than for the other vaccines, primarily because only about 25 percent of children are vaccinated before their first birthday. If the local official schedule that has an upper age limit of 18 months for vaccination against measles is included, this figure rises to 79 percent. 11 d r a f t · One in five children has all eight recommended vaccinations in the first 12 months of life, but this rises to seven in ten, if the local schedule for measles (MMR) is included. · Male and female children are vaccinated at roughly the same rate. · Vaccination coverage is highest among children whose mothers have secondary or higher education. The differences are greatest for the third doses of DPT and Polio, suggesting that drop out rate is higher among children with less educated mothers. Diarrhoea · Approximately eight in ten children with diarrhoea receive one or more of the UNICEF/WHO recommended home treatments (i.e., were treated with ORS or RHF). · Only 11 percent of children with diarrhoea receive increased fluids and continue eating as recommended. Integrated Management of Childhood Infections (IMCI) · Among children under the age of five years who have diarrhoea or some other illness, only 16 percent receive increased fluids and continued eating as recommended by the IMCI programme. · Seven out of ten mothers/carers know at least two of the check number of signs indicating that a child should be taken immediately to a health care facility. It is slightly more likely that mothers/carers with a secondary education or who live in urban areas will know at least two of these signs. HIV/AIDS · Only one in ten women aged 15 – 49 years has never heard of HIV/AIDS. · Only 28 percent of women aged 15-49 years know all three of the main ways to prevent HIV/AIDS transmission – having only one uninfected sexual partner, using a condom every time, and abstaining from sexual intercourse. Urban women are more likely to know all three main ways of preventing HIV/AIDS than rural women. The percentage of women who have sufficient knowledge of HIV/AIDS transmission increases with the level of education. · Sixty-nine percent of women correctly identify a misconception about HIV/AIDS transmission – that a healthy looking person cannot be infected with HIV/AIDS. · Twenty-four percent of women aged 15 – 49 years agree with at least one of two discriminatory statements about people with HIV/AIDS. Contraception · Current use of contraception was reported by 48 percent of married or in union women aged 15 – 49 years. The most popular method is withdrawal, which is used by just over one in four married or in union women followed by intrauterine devices (8%) and the oral contraceptive pill (5%). Prenatal Care · Virtually all women (99%) in Bosnia and Herzegovina receive ante-natal care from skilled personnel (doctor, nurse, midwife). Assistance at Delivery · A doctor, a nurse or a midwife was present at almost all births occurring in the year prior to the B&H MICS 2000 survey. 12 d r a f t Birth Registration · The births of almost all children (98%) under five years of age in B&H have been registered. There are no significant variations in birth registration according to sex, age, urban/rural or education categories. Orphanhood and Living Arrangements of Children · Overall, 93 percent of children aged 0-14 are living with both parents. Children who are not living with a biological parent comprise less than one percent, but children one or both of whose parents are dead amount to almost 5 percent of all children aged 0-14 years. It is more likely that a father will be dead than a mother. Child Labour · Less than 1 percent of children aged 5-14 years engage in paid work. 6 percent participate in unpaid work for someone other than a household member. · Fifteen percent of children are engaged in family work, on the farm or in the family business. Eighteen percent of children aged 5 – 14 years are currently working. · Fifty-five percent of children engage in domestic tasks, such as cooking, fetching water and caring for other children; hardly any children spend more than four hours a day on such tasks. d r a f t Summary of Indicators, Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000 World Summit for Children Indicators B&H FB&H RS Underweight prevalence Proportion of under fives who weigh too litt le for their age 6 % 6 % 2 % Stunting prevalence Proportion of under fives who are too short for their age 13 % 13 % 11% Wasting prevalence Proportion of under f ives who are too thin for their height 8 % 8 % 9 % Safe drinking water Proport ion of population who use a safe source of drinking water 98 % 98 % 97 % Sanitary means of excreta disposal Proportion of population who use a sanitary means of excreta disposal 94 % 99.5 % 84 % Children reaching grade five in school Proportion of children en tering first grade of primary school who eventually reach grade five 100 % 99 % 100% Net primary school attendance rate Proportion of children of primary school age attending primary school 94 % 94 % 95 % Literacy rate Proportion of population aged 15+ years who are able to read a letter or newspaper 95 % 95% 94 % Ante -natal care Proportion of women aged 15-49 attended by skilled personnel at least once during pregnancy 99 % 99 % 100% Contraceptive prevalence Proportion of married women aged 15-49 who are using a method of contraception 48 % 49 % 45 % Childbirth care Proportion of births attended by skil led health personnel 100% 100% 99 % Birth weight below 2.5 kg. Proportion of live births where the baby’s weight is below 2500 grams 3 % 4 % 2 % DPT immunisation coverage Proportion of children immunised against diptheria, pertussis and tetanus by age one year 85 % 86 % 81 % Measles immunisation coverage Proportion of children immunised against measles by age one year 25 % * 28 % * 16 % * Pol io imm unisation coverage Proportion of children immunised against polio by age one year 82 % 84 % 77 % Tuberculosis immunisation coverage Proportion of children immunised against tuberculosis by age one year 95 % 95 % 96 % Use of Oral Re -hydration Therapy (ORT) Proportion of under -fives who had had diarrhoea in the 2 weeks before the survey and had been treated with oral re-hydration salts or an appropriate household solut ion 82 % 79 % 87 % Home management of diarrhoea Proportion of under fives who had had di arrhoea in the 2 weeks before the survey and had received increased fluids and continued feeding during the episode 11 % 10 % 14 % Acute Respiratory Infection Proportion of under fives who had had ARI in the 2 weeks before the survey and were taken to an appropriate health provider 80 % ** 70 % ** 73 % ** 14 d r a f t Pre-school development Proportion of children aged 36-59 months who are attending some form of organised early chi ldhood education programme 9 % 10 % 6 % Indicators for Monitoring Children’s Rights Birth registration Proportion of under -five children whose births are reported registered 98 % 98 % 99 % Children’s l iving arrangements Proportion of children aged 0 -14 years in households who are not l iving with a biological parent 1 % 0.5 % 1 % Orphans in household Proportion of children aged 0 -14 years in households who are orphans 0.1% (both parents) 5 % (one parent) 0.1% (both parents) 4 % (one parent) 0% (both parents) 6 % (one parent) Chi ld labour Proportion of children aged 5 -14 years who are currently working 18 % 16 % 21 % Indicators for Monitoring Integrated Management of Childhood Illnesses (IMCI)and Malaria Home management of i l lness Proportion of under fives reported ill during the last 2 weeks who had received increased fluids and continued feeding 16 % 17 % 14 % Medical assistance Proportion of carers of under fives who know at least 2 signs for seeking medical assistance immediately 68 % 66 % 74 % Indicators for Monitoring HIV/AIDS Knowledge of preventing HIV/AIDS Proportio n of women who correctly state the 3 main ways of avoiding HIV/AIDS infection 28 % 27 % 31 % Knowledge of misconceptions about HIV/AIDS Proportion of women who correctly identify a misconception about HIV/AIDS 69 % 66 % 74 % Knowledge of mother to child t ransmiss ion Proportion of women who correctly identify means of transmission of HIV/AIDS from mother to child 48 % 47% 48 % Attitude to people with HIV//AIDS Proportion of women expressing a discriminatory attitude towards people with HIV/AIDS 24 % 25 % 23 % * the coverage for MMR (measles-mumps -rubella) vaccine by the age of 12 months is lower than for the other vaccines because the B&H schedule of immunisation requires this vaccine to be given between 12 and 18 months of age. Recalculation of immunisation rates for children aged 18 – 29 months according to this schedule shows that the real coverage for MMR is 79 percent, and for all recommended vaccinations 70 percent instead of 18 percent. ** In the MICS questionnaire, children with acute respiratory infection are defined as those who have an illness with a cough accompanied by rapid or difficult breathing, and whose symptoms are due to a problem in the chest, or both a problem in the chest and a blocked nose, or whose mother does not know the source of the problem. This definition is more appropriate for pneumonia and other severe acute lower respiratory infections. As the survey was carried out in August, there were only a few children (10 in RS) under the age of f ive years with such symptoms. 15 d r a f t I. Introduction Background to the Survey At the World Summit for Children held in New York in 1990, many countries in the world, including the Socialist Federal Republic of Yugoslavia , committed themselves to a Declaration and Plan of Action for Children 6. In 1991, war broke out in the region and no National Programme of Action was developed. Bosnia and Herzegovina became an independent country in 1992. The war ended with the Dayton Agreement in 1995, which organised the country into two largely self- governing entities, the Federation of Bosnia and Herzegovina and Republika Srpska. With the support of UNICEF, a National Plan of Action for Children in Bosnia and Herzegovina commenced in 1999, and will be finalised in early 2001. The original global model for the Plan of Action in 1990 called for the establishment of mechanisms for monitoring progress toward the goals and objectives set for the year 2000. Towards this end, UNICEF has developed for global use a core set of 75 indicators for specific aspects of the situation of children, in co-ordination with other international organisations. In 2001, Bosnia and Herzegovina will be presenting an End of Decade report on most of these indicators 5. The B&H MICS 2000 has been implemented to provide end-of-decade information on many of the indicators. Information on the other available and country- relevant indicators will be derived from the existing data collections systems, other UNICEF supported surveys using MICS methodology (breast-feeding and iodine deficiency) 1 - 4 and various disease monitoring systems. A Multiple Indicator Cluster Survey to measure progress at mid-decade (1995) was not conducted, so for many of the indicators, the B&H MICS 2000 survey will provide the first baseline information. Two entity teams conducted the B&H MICS 2000. In the Federation, the Federation Public Health Institute conducted the survey on behalf of the Ministry of Health. In Republika Srpska, the Ministry of Health and Social Welfare conducted the survey. Each entity set up a Steering Committee comprising staff from key Ministries, other organisations and UNICEF, chaired by the relevant lead Ministry. The entire project was organised by a management committee comprising the entity teams and UNICEF staff, chaired by UNICEF. The production of the State level report was overseen by the Agency for Statistics of Bosnia and Herzegovina. Appendix B lists the main contributors to the survey and the organisational arrangements, including the membership and terms of reference for each committee. An identical approach was used in each entity for survey design, methodology, survey tools, fieldwork training, data entry and analysis. UNICEF provided training and management support. Emphasis was placed on building the skills and competences of 16 d r a f t young and mid career level survey technical staff in B&H. Three regional workshops were held with teams from other countries in the region, UNICEF consultants and other professionals in the field to ensure that the survey was carried out to a very high standard and used comparable global methodology. Additional technical support for sampling methodology and report production was provided by UNICEF. UNICEF prepared the final report in close collaboration with the entity teams, using a single set of data created by merging the two sets of entity data. The UK Government provided UNICEF with funding through DfID (Department for International Development) totalling US$ 150 000 and the remaining US $ 40 000 for training came from UNICEF’s regular resources. This report presents results on the principal topics covered in the survey that relate to the World Summit indicators. Further analysis of the B&H MICS 2000 database will be carried out in 2001 and will be presented separately. It is expected that this unique database will be a rich source of information for years to come. Bosnia and Herzegovina Background In 1991, Bosnia and Herzegovina was one of the six republics of the then Federal Republic of Yugoslavia. Its population was 4,377,033, and GDP (1990) was 2,429 US $ per capita. In April 1992, Bosnia and Herzegovina was internationally recognised as an independent country and became a member of the United Nations. War broke out in 1992 and ended with the signing of the Dayton Peace agreement in December 1995. The Peace Agreement established Bosnia and Herzegovina as a country of two entities, the Federation of Bosnia and Herzegovina and Republika Srpska, covering 51 129 km2 (Federation 26 110 km2 and Republika Srpska 25 053 km2) (See map 1)7, 8, 9. The Federation is divided into ten cantons: Bosansko-Podrinjski; Central Bosnia; Herzeg – Bosna; Herzegovina-Neretva; Posavina;, Sarajevo; Tuzla-Podrinja; Una Sana; Western Herzegovina; and Zenica-Doboj. These are subdivided into a total of 83 municipalities. Republika Srpska consists of a total of 64 municipalities. The east and centre of Bosnia and Herzegovina has a distinctly sub-continental climate followed by blazing summers (and this survey was carried out in summer), while the south-west coastal hinterland has a Mediterranean climate. The terrain is hilly with high mountain ranges. Urban settlements are mostly located in the valleys. Much of the country is thickly forested, but in the north along the river Sava lie rich alluvial plains, which provide the most fertile farming land in the country. Three quarters of Bosnia and Herzegovina belongs to the Black Sea basin, an area of rivers feeding the Black Sea, which lies on the Eastern side of the peninsula in which B&H lies. The rivers of the remaining quarter of the country drain into the Adriatic Sea. The estimated population of Bosnia and Herzegovina is given below 7, 9. The last complete census was conducted in 1991, since when there have been massive demographic changes as a result, directly or indirectly, of war and migration both within 17 d r a f t and outside the country. The estimates for refugees and displaced persons in 2000 are also given below 7, 9. Estimated Population of Bosnia and Herzegovina, 2000 Estimated population Estimated refugees/displaced people Federation of Bosnia and Herzegovina 2 297 774 420 000 Republika Srpska 1 448 538 132 298 There are still 305,000 Bosnian refugees living outside the country (two-thirds of whom live in FRY) and an estimated 819,000 internally displaced persons (480,000 in the Federation and 339,000 in RS) 10. Between 1992 and the end of 1995 there was widespread conflict in B&H, leading to significant mortality, morbidity, massive population displacement and destruction of housing and infrastructure. During the war an estimated three percent of the population were killed – 140 000 people of whom up to 16,000 were children. Estimates, however, vary widely. Since the end of the conflict, there has been some reconstruction with the support of the international community. The situation, however, remains difficult and economic recovery is poor. Despite massive population movement, this has been in the nature of population transfer from one house to another one, with relatively little new house building. There has been a loss of household stock due to war damage with recent efforts to repair and rebuild houses 11. Bosnia and Herzegovina is still heavily mined with an estimated 1 million mines in place at the time of the survey (see map 2). The B&H GDP for 1999 was estimated to be USD 3.5 billion 12. Unemployment in 1999 was estimated to be 56 percent of the active population but this figure seems likely to be too high. However, many of those who are nominally employed have not been paid for some time or are paid very little 11. Comprehensive health, education and social welfare services have survived the conflict and are functioning, but are under-funded and cannot meet the needs of the whole population. The health profile of the population reflects many of the trends of Eastern Europe including high morbidity due to cardiovascular causes and cancer. Post war effects on health include high levels of physical and mental disability. The birth rate is declining and so far there is no evidence of a post war birth boom, in fact quite the opposite. Survey Objectives The objectives of the B&H MICS 2000 were: 18 d r a f t · To provide up-to-date information from which to assess the situation of children and women in Bosnia and Herzegovina at the end of the decade and to make predictions for the next decade; · To furnish the data needed to monitor progress toward the goals established at the World Summit for Children and as a basis for future action; · To contribute to the improvement of data and monitoring systems in Bosnia and Herzegovina, and to strengthen technical expertise in the design, implementation, and analysis of such systems. II. Survey Methodology Sample Design The sample for the survey was designed to provide estimates of the indicators at the national level, for urban and rural areas, and for the two entities - the Federation of Bosnia and Herzegovina and Republika Srpska. The district of Brèko in the North East corner of the State was not included in the survey, due to organisational and statistical sampling difficulties. Developing a sampling frame was perhaps the single biggest challenge in this survey. The most recent complete census data were from 1991. Subsequently, there had been widespread conflict and massive population movements both within and from the state. A two stage sampling method was used and this is explained in detail in Appendix C. Stage 1 The geographical area of Bosnia and Herzegovina (with the exception of Brèko district) was selected. The enumeration areas from the 1991 census were taken as the basis for developing the sampling frame. This was updated in the Federation using three additional sources of information, the OSCE voter lists, population estimates from UNHCR and municipality registration data. Additionally, the sampling frame was adjusted in RS using the results of a 1997 census of refugees and displaced people. The entire geographical area of the survey was then divided into segments using probability proportional to size at the municipality level. Each segment covered approximately 110 households. The segments were then randomly selected and an additional number of alternate segments were identified so that in the case of a segment being unusable (empty, mined etc.) an alternate segment could be assigned. Stage 2 The fieldwork teams then went to their allocated segments and made a listing of all households in each segment. From these, the fieldwork supervisors with assistance from the entity statistical institutes updated the old maps if necessary, and in some cases made new maps. Where segments were empty of households, had fewer than 80 households or were heavily mined, they were excluded and an alternate segment selected from the reserve list. Adjustments to the sampling plan are described in detail in Appendix C. 19 d r a f t Finally, the fieldwork supervisors listed all the households in the selected segments on a listing table, and 20 households were randomly selected from this table. Questionnaires The three questionnaires (household, women aged 15 - 49 and children under the age of five) for the B&H MICS 2000 were based on the MICS Model questionnaires with minor modifications and additions. A household questionnaire was administered in each household, which collected information on household members including sex, age, literacy, marital status and orphanhood status. The household questionnaire also included education, child labour and water and sanitation modules. The questionnaire for women contained the following modules: · Child mortality · Maternal and new-born health · Contraceptive use · HIV/AIDS. The questionnaire for children under the age of five was administered to the mother or carer of the child and included modules on: · Birth registration and early learning · Care during illness · Immunisation · Anthropometry1. The MICS Model Questionnaires were translated from English into Bosnian/Croatian (Roman script) and Serbian (Cyrillic script). The questionnaires were then pre-tested in 100 households in each entity during June 2000. Based on the results of these pre-tests, modifications were made to the wording and translation of the questionnaires. For the full questionnaires, see Appendix D. Fieldwork and Processing In the Federation 10 teams collected the data, each comprising four interviewers, one driver and a supervisor. In RS, there were 10 teams, each comprising four or five interviewers, a driver and a supervisor. In each entity, a fieldwork co-ordinator provided overall supervision. The field interviewers in each entity were trained for five days and the field supervisors received additional training. The fieldwork began in July 2000 and concluded in September 2000. The survey took place during the school holidays and during a period of very high day time temperatures (up to forty degrees centigrade). Fieldwork quality was 1 The measurement of weight and height. This was performed using easily portable digital weighing scales measuring to 0.1 kg and locally made height and length measuring boards made according to UNICEF standard specifications. 20 d r a f t maintained as follows: 10 percent of households were re-interviewed by field supervisors; UNICEF conducted field checks on a number of households; and questionnaires were checked by the fieldwork co-ordinator to ensure completeness of data and those with missing or absent data returned for checking. Workshops were organised in each entity using locally modified and translated UNICEF training materials to train data entry staff. Data were entered on seven microcomputers in the Federation and four in Republika Srpska using the ISSA programme (Integrated System for Survey Analysis) and data was analysed using SPSS. In the Federation, seven data entry staff were employed and in the RS four. All questionnaires were double- entered and internal consistency checks were performed. Data processing began in August 2000 and finished in October 2000. The procedures and standard programmes developed by UNICEF and adapted to the Bosnia and Herzegovina questionnaires were used throughout. The survey was managed using staged contracts, with payment from UNICEF based on meeting agreed quality indicators for all outputs (design, training, fieldwork, data entry, reports, data sets, analysis etc.). III. Sample Characteristics and Data Quality Response Rates Of the 10 772 households selected for the survey sample, 10 742 were found to be occupied (Table 1). Of these, 10 546 were successfully interviewed to give a household response rate of 98 percent. The response rate was slightly higher in rural areas (99 %) than in urban areas (97%). In the interviewed households, 8 912 eligible women aged 15-49 years were identified. Of these, 8 726 were successfully interviewed, yielding a response rate of 98 percent. In addition, 2 642 children under the age of five years were listed in the household questionnaire. Of these, questionnaires were completed for 2 621 children giving a response rate of 99 percent. Table 1: Number of households, women and children under 5, and response rates, Bosnia and Herzegovina, MICS 2000 Area Urban Rural Total Sampled households 4355 6417 10772 Occupied households 4337 6405 10742 Completed households 4207 6339 10546 Household response rate (%) 97.0 99.0 98.2 Eligible women 3530 5382 8912 Interviewed women 3466 5260 8726 Women response rate (%) 98.2 97.7 97.9 Children under 5 875 1767 2642 Interviewed children under 5 868 1753 2621 Child response rate (%) 99.2 99.2 99.2 21 d r a f t Age Distribution and Missing Data As shown in Table 1 in Appendix E and Figure 1, the single year age distribution of household members by sex exhibits some distortions centred around the age of 15 for females and the age of two for males. There appears to be significant heaping of women around the age of 50 and perhaps a slight dearth of women aged 18-19 years. For both sexes, some digit preference is evident for ages ending in 0 and 5. This reflects the normal tendency to round up to whole numbers. Figure 1: Single year age distribution of the household population by sex, Bosnia and Herzegovina 2000. As a basic check on the quality of the survey data, the percentage of cases missing information on selected questions is shown in Table 2. Nobody failed to give information on their level of education or years of education. All female respondents reported a complete birth date (i.e. month and year). The data on weight and height are the most likely of the selected information to be missing. This information is missing for less than 1 percent of children, possibly as the result of the child not being present, of refusal or for some other reason. By international standards, this percentage is very low in comparison to other surveys in which anthropometric measurements were taken. 0 0.5 1 1.5 2 2.5 1 4 7 1 0 1 3 1 6 1 9 2 2 2 5 2 8 3 1 3 4 3 7 4 0 4 3 4 6 4 9 5 2 5 5 5 8 6 1 6 4 6 7 7 0 Age P er ce n t Male Female Linear (Female) 22 d r a f t Table 2: Percentage of cases missing information for selected questions, Bosnia and Herzegovina, MICS 2000 % missing Federation of B&H % missing Republika Srpska Number Level of education .0 .0 29367 Year of education .0 .0 29367 Number of hours worked .0 .0 357 Complete birth date .0 .0 2621 Diarrhoea in last 2 weeks .0 .0 2621 Weight .8 .7 2621 Height .8 .8 2621 23 d r a f t Comparison of data between the two entities shows little unexplained variation, except for two questions relating to the indicators on Integrated Management of Childhood Illness. There may have been differences in training or questionnaire interpretation only for these questions. The others show a very high level of consistency across both entities. These very low levels of missing data suggest that were no significant problems with the questions or the fieldwork. Characteristics of the Household Population Information on the characteristics of the household population and the survey respondents is provided to assist in the interpretation of the survey findings and to serve as a basic check on the sample implementation. Table 3: Percentage distribution of households by background characteristics, Bosnia and Herzegovina, MICS 2000 Percent Number Entity Federation of B&H 60.4 6368 Republika Srpska 39.6 4178 Area Urban 39.9 4207 Rural 60.1 6339 1 11.1 1175 2-3 41.5 4381 4-5 39.1 4123 Number of HH household members 6+ 8.2 867 Total 100.0 10546 Table 3 and Table 4 present the percentage distribution of households in the sample according to background characteristics. Sixty percent of the households (6 368) were in FB&H and 40 percent (4 178) were in RS, as set by the sampling plan. About 40 percent of the households (4 207) were urban and 60 percent (6 339) were rural. Republika Srpska had a larger percentage of rural households than the Federation. Most of the households had between 2 and 3 members. Twenty-one percent of the households contained at least one child under five years of age and 66 percent contained at least one woman aged 15-49. Table 4: Percentage distribution of household members by background characteristics, Bosnia and Herzegovina, MICS 2000 Percent Number At least one child age < 15 44.4 10546 At least one child age < 5 21.2 10546 At least one woman age 15-49 66.1 10546 Table 5 shows the characteristics of female respondents aged 15-49 years. Women aged 35 – 39 years comprised the greatest percentage of the sample at 16 percent. The percentage distribution is fairly steady across all five-year age groups presented. Sixty-six percent of women in the sample were married/in union and 68 percent had given birth at some time. Sixty-four percent of women had had at least some secondary education, 36 percent had had only primary or no 24 d r a f t education. We note that only a handful of women (103 in the Federation and 31 in RS) reported no or non-traditional education and so they have been merged into the primary education data to give a category called primary/no education. Table 5: Percentage distribution of women 15-49 by background characteristics, Bosnia and Herzegovina, MICS 2000 Percent Number Entity Federation of B&H 63.9 5578 Republika Srpska 36.1 3148 Area Urban 39.7 3466 Rural 60.3 5260 Age 15-19 13.6 1189 20-24 14.7 1287 25-29 14.4 1255 30-34 14.5 1263 35-39 15.8 1380 40-44 14.9 1296 45-49 12.1 1056 Marital status Currently married 65.8 5738 Formerly married 7.7 673 Never married 26.5 2315 Ever given birth Yes 68.3 5958 No 31.7 2768 Primary/None 36.3 3166Woman's education level Secondary + 63.7 5560 Total 100.0 8726 Table 6 shows the characteristics of children under the age of five. Fifty-one percent of the children were male and 49 percent were female. On average, 41 percent of mothers had had primary education (73% in FB&H and 27% in RS). Note that for children whose mothers did not live in the household, the education of the child’s carer was used. Table 6: Percentage distribution of children under 5 by background characteristics, Bosnia and Herzegovina, MICS 2000 Percent Number Sex Male 51.4 1347 Female 48.6 1274 Entity Federation of B&H 72.6 1903 Republika Srpska 27.4 718 Area Urban 33.1 868 Rural 66.9 1753 Age < 6 months 9.3 244 6-11 months 8.8 230 12-23 months 18.3 480 24-35 months 18.2 478 36-47 months 23.9 627 48-59 months 21.4 562 Primary/None 41.0 1074Mother's education level Secondary 59.0 1547 Total 100.0 2621 25 d r a f t IV. Results A. Education Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals set by the World Summit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. Early childhood education Only one in ten children aged 36-59 months is attending an organised early childhood education programme, such as kindergarten or community childcare with organised learning activities (Table 7). Slightly more girls than boys are attending these programmes. Children in urban areas (15%) are almost three times as likely to attend early learning activities as children in rural areas (6%). Table 7: Percentage of children aged 36-59 months who are attending some form of organised early childhood education programme, Bosnia and Herzegovina MICS 2000 Attending programme Number of children Sex Male 8.1 620 Female 9.5 569 Entity Federation of B&H 9.8 882 Republika Srpska 5.9 307 Area Urban 15.2 376 Rural 5.8 813 Age 36-47 months 6.9 627 48-59 months 10.9 562 Primary/None 5.9 524Mother's education level Secondary 11.0 665 Total 8.7 1189 World Summit for Children Goal => Number 26 Seven percent of children attend at age 3 – 4 years, and 11 percent of children attend at age 4 – 5 years. The education of the mother is related to the likelihood that a child will attend an early childhood education programme, since 6 percent of children whose mothers have only primary if any education attend these programmes compared to 11 percent of children whose mothers have secondary education. Basic education Overall, 94 percent of children of primary school age in Bosnia and Herzegovina are attending primary school (Table 8). This figure is the same for both entities, urban and rural areas and for boys and girls. Almost all (99%) of children who enter the first grade of primary school eventually reach grade five. There are no urban/rural or entity disparities in children reaching grade five. 26 d r a f t Table 8: Percentage of children of primary school age attending primary school, Bosnia and Herzegovina, MICS 2000 Sex Total Male Female Attending primary school Attending primary school % Number % Number % Number Entity Federation of B&H 93.0 1474 94.3 1413 93.7 2887 Republika Srpska 94.6 701 95.2 662 94.9 1363 Area Urban 93.6 785 95.2 744 94.4 1529 Rural 93.5 1390 94.3 1331 93.9 2721 8 96.8 249 95.5 244 96.1 493 9 97.9 281 96.9 259 97.4 540 Age up to year 10 98.7 303 99.6 272 99.1 575 11 98.3 238 98.7 239 98.5 477 12 98.9 283 99.3 282 99.1 565 13 98.2 272 99.7 291 98.9 563 14 94.4 267 95.1 306 94.8 573 15 66.0 282 61.0 182 64.0 464 Total age up to year 93.5 2175 94.6 2075 94.0 4250 World Summit for Children Goal => Number 6 Literacy The vast majority (95%) of the population over age 15 years in Bosnia and Herzegovina is literate (Table 2 in Appendix E). The literate population as defined by this survey includes those who are reported to read a newspaper ‘easily or with difficulty’. There are minor differences between entities and between urban and rural areas (urban 97%, rural 93%). Overall, women are slightly less likely than men to be literate (91% vs. 98%). There is a slight drop-off in literacy after the age of 65 years for men to 92 percent and a more marked drop-off for women (to 63%). Literacy is lower in older age groups. The percentage literate declines from almost 100 percent among those aged 15-34 years to 76 percent among the population aged 65 years and older. We note that there are many different ways of defining literacy and so comparisons with previous literacy measurements in the country should be made with caution. B. Water and Sanitation Use of drinking water (Table 3 in Appendix E) Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as infectious diarrhoea, hepatitis A, typhoid, giardiasis and other water borne diseases such as polio. Drinking water can also be tainted with chemical, physical and radiological contaminants, which are harmful to human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, particularly in rural areas because they bear the primary responsibility for carrying water, often for long distances. The global definition of safe drinking water was used and this refers to sources of drinking water that are mechanically protected from contamination. The survey asked questions about the source of drinking water, but did not assess the quality of the water itself 27 d r a f t Seventy-one percent of the population use drinking water that is piped into their dwellings. Nine percent of the population used water piped into their yard or plot. Tube well / bore hole with pump, protected spring and protected dug well account for the remainder. The population using safe drinking water sources are defined for this survey as those who use any of the following types of supply: piped water; public tap; bore hole / tube well; protected well; protected spring; or rainwater. Overall, 98 percent of the population has access to safe drinking water – almost 100 percent in urban areas and 96 percent in rural areas. Use of sanitation Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoea diseases and polio. Sanitary means of excreta disposal include: flush toilets connected to sewage systems or septic tanks; other flush toilets; improved pit latrines; and traditional pit latrines. Ninety-four percent of the population of Bosnia and Herzegovina is living in households with sanitary means of excreta disposal (Table 4 in Appendix E). This percentage is 99 percent in urban areas and 90 percent in rural areas. C. Child Malnutrition Nutritional status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply and are not exposed to repeated illness, they reach their growth potential and are considered well nourished. In a well-nourished population, there is a standard distribution of height and weight for children under the age of five years. Under-nourishment in a population can be gauged by comparing children to this standard distribution. The standard or reference population used here is the National Centre for Health Statistics (NCHS) standard, USA, which is recommended for use by UNICEF and the World Health Organisation and which is being used globally for comparisons in MICS surveys. Each of the four nutritional status indicators are expressed in standard deviation units (z-scores) from the median of this reference population. Weight for age is a measure of both acute and chronic malnutrition. Children whose weight for age is more than two standard deviations below the median of the reference population are considered moderately underweight while those whose weight for age is more than three standard deviations below the median are classified as severely underweight. Height for age is a measure of linear growth. Children whose height for age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately stunted. Children whose height for age is more than three standard deviations below the median are classified as severely stunted. Stunting may be a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period or of recurrent or chronic illness. However, other factors may also contribute to high scores on this indicator. Finally, children whose weight for height is more than two standard deviations below the median of the reference population are classified as moderately wasted while those whose weight is more than three standard deviations below the median are severely wasted. Wasting is usually the 28 d r a f t result of a recent nutritional deficiency. This indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children who were not weighed and measured (approximately 1%) and children whose measurements are outside a plausible range are excluded (Table 9). The birth dates of all the children in the survey are known, so all the remaining children have been included. Table 9: Percentage of children under 5 years of age throughout with missing height or weight data, Bosnia and Herzegovina, MICS 2000 Missing height or weight data Number of children Sex Male .7 1347 Female 1.0 1274 Entity Federation of B&H .8 1903 Republika Srpska .8 718 Area Urban .8 868 Rural .9 1753 Age < 6 months .0 244 6-11 months 1.3 230 12-23 months .8 480 24-35 months 1.0 478 36-47 months 1.0 627 48-59 months .7 562 Primary/None .8 1074Mother's education level Secondary .8 1547 Total .8 2621 World Summit for Children Goal => Number 3, 9, 26 Almost 4 percent of children under age five in Bosnia and Herzegovina are underweight and less than 1 percent are classified as severely underweight (Table 5 in Appendix E). Ten percent of children are stunted or too short for their age and 6 percent are wasted or too thin for their height. Children whose mothers have secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with less education. Boys appear to be slightly more likely to be underweight, stunted or wasted than girls. Obesity is also a nutritional concern. Children whose weight for height is more than two standard deviations above the mean are considered overweight and more than three standard deviations above the mean are considered to be obese (Table 6 in Appendix E). Overall, 13 percent of children are overweight and 5 percent obese. Girls are slightly more often overweight (15%) than boys (12%). Low birth weight Infants who weigh less than 2500 grams (2.5 kg.) at birth are categorised as low birth weight babies. Since many infants are not weighed at birth and those who are weighed may be a biased sample of all births, reported birth weight cannot, normally, be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of babies weighing below 2500 grams at birth is estimated from the weight recorded on the health card or from the mother’s recall of the baby’s size at birth (i.e., very small, smaller than average, average, larger than average, very large). First, the two items are cross-tabulated for those children who were weighed at birth to obtain the proportion of babies in each category of size who weighed less than 2500 grams. This proportion is then multiplied by the total number of children falling in the 29 d r a f t size category to obtain the estimated number of children in each size category who were of low birth weight. The numbers for each size category are summed to obtain the total number of low birth weight children. This number is divided by the total number of live births, to obtain the percentage with low birth weight. However, almost 100 percent of babies whose births were reported in this survey were weighed at birth and in almost all cases we have documentary evidence in the form of written records from health care staff at the time of birth. This makes this indicator reliable. We were unable however to go back and check the reliability of the weighing equipment and techniques used to measure the children. We note that this is an uncommonly high percentage of babies to be weighed at birth, in global terms. In Bosnia and Herzegovina, only 3 percent of infants are estimated to weigh less than 2500 grams at birth (Table 10). This percentage is low and the numbers are also very low. It is higher in rural areas (4%) compared to urban areas (2%). We note that these estimates only refer to children under the age of 5 who were low birth weight babies and who are still alive. The methodology therefore underestimates the numbers of low birth weight babies because some of these babies will have died by the age of five. Table 10: Birth weight, Bosnia and Herzegovina, MICS 2000 Birth weight <2500 gms (%) 2500+ gms (%) NK or Missing (%) Not weighted at birth (%) Total Number Entity Federation of B&H 3.8 90.6 5.0 .6 100.0 340 Republika Srpska 2.1 93.8 3.4 .7 100.0 145 Area Urban 2.3 96.0 .6 1.1 100.0 174 Rural 3.9 89.1 6.8 .3 100.0 311 Primary/None 3.7 89.0 6.7 .6 100.0 164Woman's education level Secondary + 3.1 92.8 3.4 .6 100.0 321 Total 3.3 91.5 4.5 .6 100.0 485 D. Child Health Immunisation coverage According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diptheria, pertussis and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. The schedule is slightly different in B&H as the upper age recommendation for measles, mumps and rubella vaccination (MMR) is 18 months. In this survey, mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the B&H MICS 2000 questionnaire. Mothers were also probed to report any vaccinations the child had received that did not appear on the card. Overall, 86 percent of children had vaccination cards. If the child did not have a card, the mother was read a short description of each vaccine and asked to recall whether or not the child had received it and, for DPT and Polio, how many times. 30 d r a f t Table 7 in Appendix E shows the percentage of children aged 12 to 23 months who received each of the vaccinations. The denominator for the table is comprised of children aged 12-23 months so that only children who are old enough to be fully vaccinated are counted. In the top three lines, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom two lines, only those who were vaccinated before their first birthday are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. Calculation of immunisation rates at 12 months from the MICS tables is based on the sum of the percentage of children aged 12-23 months vaccinated according to their health card and the percentage of children vaccinated according to their mother’s report. This sum is multiplied by the probability of being vaccinated by 12 months of age, to derive the total percentage vaccinated (Figure 2). All children aged 12-23 months, who have health cards, received a BCG vaccination by the age of 12 months and 99 percent had received the first dose of DPT. The percentage does not decline for subsequent doses of DPT, 98 percent for the second dose, and 97 percent for the third dose.Similarly, 99 percent of children received the first dose of Polio vaccine by the age of 12 months and this only declines to 96 percent by the third dose. Figure 2: Total percentage of children aged 12-23 months immunised by 12 months of age, Bosnia and Herzegovina MICS 2000 0 10 20 30 40 50 60 70 80 90 100 (MMR) BC G DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles Total percentage vaccinated by 12 months The coverage for measles vaccine is lower than that for other vaccines. As per the local schedule, by eighteen months 79 percent of children had received the measles vaccine (Table 8 in 31 d r a f t Appendix E), but by 12 months, only 25 percent had been vaccinated (Table 7 in Appendix E). As a result, the percentage of children who had all eight recommended vaccinations by their first birthday is very low at only 18 percent. However if the local schedule of measles vaccinations by age 18 months is taken into account, this rises to 70 percent (Figure 3). Figure 3: Total percentage of children aged 18 – 29 months immunised by 18 months of age, Bosnia and Herzegovina MICS 2000 70 75 80 85 90 95 100 (MMR) BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles Total percentage vaccinated by 18 months In Table 9 in Appendix E, the percentage of children age 12-23 months currently vaccinated against childhood diseases is shown according to background characteristics. Unlike the previous table, the estimates in this table refer to children who received the vaccinations by the time of the survey, even if they did not occur prior to the age of 12 months. A similar table is presented for children aged 12 – 29 months (Table 10 in Appendix E) There is no variation between male and female, and very little variation between urban and rural areas. Children whose mothers have secondary/higher education are slightly more likely to have lower vaccination rates for polio and measles. Diarrhoea and Acute Respiratory Infections Dehydration caused by diarrhoea is a major cause of mortality and morbidity among the children of the world. Home management of diarrhoea – either through oral re-hydration salts (ORS) or a 32 d r a f t 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. In this survey, mothers/carers were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 9 percent of children under five years of age had had diarrhoea in the two weeks preceding the survey (Table 11 in Appendix E). The peak of diarrhoea prevalence occurred in the weaning period, among children aged 6-23 months. Table 11 in Appendix E also shows the percentage of children receiving various types of recommended liquids during episodes of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add up to 100. One in five children received breast milk while they had diarrhoea. Children under the age of 12 months are especially likely to have received breast milk. About 20 percent of children received gruel and 13 percent received ORS. Children of mothers with secondary education appear to be more likely to receive ORS. Approximately eight in ten children with diarrhoea received one or more of the recommended home treatments (i.e. were treated with ORS or RHF). Slightly less than one fifth of children with diarrhoea drank more than usual while three fifths drank the same or less (Table 12 in Appendix E). About three fifths ate somewhat less, the same, or more than usual while two fifths ate much less than usual or none. Overall, only one in ten children with diarrhoea received increased fluids and continued eating as recommended. Table 11 shows the pattern of medical assistance sought for children with acute respiratory infections (ARI). In the MICS questionnaire, children with ARI are defined as those who have an illness with a cough accompanied by rapid or difficult breathing, and whose symptoms are due to a chest problem, a problem in the chest and a blocked nose, or whose mother did not know the source of the problem. One and a half percent of children had ARIs in the two weeks before the survey, and appropriate medical assistance had been sought in 80 percent of cases. Assistance was most often sought at primary health care centres (40%), hospitals (28%) and private physicians (20%). However, the definition of ARI is more appropriate for pneumonia and other severe acute lower respiratory infections, and as the survey was carried out in August, there were only a few children under the age of five years with such symptoms. Integrated Management of Childhood Illness (IMCI) initiative The Integrated Management of Childhood Illnesses (IMCI) is a programme developed by UNICEF and WHO that combines strategies for control and treatment of five major killers of children – acute lower respiratory tract infections, diarrhoeal dehydration, measles, malaria and malnutrition. Programmes for all of these (excepting malaria) have been implemented in Bosnia and Herzegovina. The programme focuses on the improvement of case management skills by health workers, improvement of the health system, and improvement of family and community practices in the prevention and early management of childhood illnesses. Appropriate home management of illness is one component of IMCI. The approach teaches mothers/carers that appropriate home management of diarrhoea or any other illness requires giving more fluids and continuing to feed sick children as they are normally fed. 33 d r a f t Table 12 in Appendix E presents information on the drinking and eating behaviour of sick children. Almost 19 percent of children were reported to have had diarrhoea or some other illness in the two weeks preceding the survey. Of these, 26 percent drank more liquids during the illness and 65 percent continued eating (i.e., ate somewhat less, the same, or more). Overall, only 16 percent of ill children received increased fluids and continued eating as recommended under the IMCI programmed. 34 d r a f t 35 d r a f t Table 11: Percentage of children under 5 with acute respiratory infections in the two weeks before the survey and who have been treated by health providers, Bosnia and Herzegovina MICS 2000 Had acute respiratory infect ion Number of chi ldren under 5 Hospi ta l Primary Healthcare centre Private physic ian Tradit ional healer Other Any appropriate provider Number of children with ARI Sex Male 1.8 1347 20.8 50.0 20.8 .0 12.5 79.2 24 Female 1.3 1274 37.5 25.0 18.8 .0 6.3 81.3 16 Entity Federation of B&H 1.6 1903 26.7 46.7 20.0 .0 6.7 83.3 30 Republika Srpska 1.4 718 30.0 20.0 20.0 .0 20.0 70.0 10 Area Urban .9 868 25.0 50.0 25.0 .0 25.0 100.0 8 Rural 1.8 1753 28.1 37.5 18.8 .0 6.3 75.0 32 Age < 6 months .4 244 .0 100.0 100.0 .0 .0 100.0 1 6-11 months 1.3 230 33.3 33.3 .0 .0 .0 66.7 3 12-23 months 2.1 480 30.0 10.0 20.0 .0 10.0 60.0 10 24-35 months .0 478 . . . . . . 0 36-47 months 3.0 627 26.3 52.6 26.3 .0 5.3 94.7 19 48-59 months 1.2 562 28.6 42.9 .0 .0 28.6 71.4 7 Primary/None 2.2 1074 37.5 37.5 8.3 .0 8.3 79.2 24Mother's education level Secondary 1.0 1547 12.5 43.8 37.5 .0 12.5 81.3 16 Total 1.5 2621 27.5 40.0 20.0 .0 10.0 80.0 40 World Summit for Children Goal => Number 24 36 d r a f t Promoting knowledge among carers about when it is appropriate to seek medical assistance for ill children is another important component of the IMCI programmed. In the B&H MICS 2000, mothers or carers of children were asked to name all of the symptoms that would cause them to take a child to a health facility right away. The most common response, given by 94 percent of mothers, was that they would take their child to a health facility right away if he/she developed a fever (Table 14 in Appendix E). Thirty-six percent said that the child becoming more ill would cause them to take the child to a health facility and 40 percent mentioned difficulty in breathing. Between 12 percent and 40 percent of mothers cited an inability to breast-feed, fast breathing, blood in stools, and drinking poorly as reasons for taking a child to a health facility right away. Overall, 68 percent of mothers know at least two signs for seeking medical assistance. There is no apparent difference between urban and rural areas and very little in educational level. E. HIV/AIDS AIDS knowledge One of the most important strategies for reducing the rate of HIV/AIDS infection is the promotion of accurate knowledge of how HIV/AIDS is transmitted and how to prevent transmission. Among women aged 15-49 years in Bosnia and Herzegovina, 97 percent have heard of HIV/AIDS (Table 12). This percentage is 98 percent in urban areas and a little lower at 96 percent in rural areas. Women aged 15 – 49 years participating in the B&H MICS 2000 were read three statements about the means of HIV/AIDS transmission and asked to state whether they believed the statements were true. Half believed that having only one uninfected sex partner could prevent HIV/AIDS transmission. Half believed that using a condom every time one had sexual intercourse could prevent HIV/AIDS transmission and 39 percent agreed that abstaining from sexual intercourse prevents HIV/AIDS transmission. However we note that abstaining from sexual intercourse is not a realistic expectation, and therefore not a reliable method of preventing HIV/AIDS transmission. Data is also presented according to the two main ways of preventing HIV/AIDS transmission, and separately for the youngest women (15-19 years old) (Table 13) and women aged 20 –49 years of age (Table 14) 37 d r a f t Table 12: Percentage of women aged 15-49 who know the main ways of preventing HIV transmission, Bosnia and Herzegovina, MICS 2000 Heard of AIDS Have only one faithful uninfected sex partner Using a condom every time Abstaining from sexual intercourse Knows all three ways Knows at least one way Doesn't know any way Number of women Entity Federation of B&H 95.7 47.6 46.6 37.6 26.7 59.3 40.7 5578 Republika Srpska 97.9 58.7 53.3 42.7 31.3 68.6 31.4 3148 Area Urban 98.0 60.0 59.5 44.9 33.5 73.2 26.8 3466 Rural 95.5 46.0 42.2 35.8 24.9 55.7 44.3 5260 Age 15-19 97.4 53.2 50.3 41.4 29.9 65.6 34.4 1189 20-24 97.0 57.2 55.1 42.9 33.3 68.1 31.9 1287 25-29 97.4 53.5 51.6 41.5 29.9 65.2 34.8 1255 30-34 97.5 53.4 50.1 39.4 28.5 62.9 37.1 1263 35-39 96.7 49.2 47.6 37.3 26.4 60.9 39.1 1380 40-44 95.5 49.6 46.1 38.5 26.2 61.0 39.0 1296 45-49 93.4 44.0 41.6 34.3 23.6 53.5 46.5 1056 Primary/None 92.8 35.2 31.1 28.7 18.4 43.7 56.3 3166Woman's education level Secondary + 98.6 60.9 59.3 45.5 34.0 73.4 26.6 5560 Total 96.5 51.6 49.1 39.4 28.3 62.6 37.4 8726 Monitoring HIV/AIDS Indicator 38 d r a f t Table 13: Percentage of women aged 15-19 who know the main ways of preventing HIV/AIDS transmission, Bosnia and Herzegovina MICS 2000 Heard of AIDS Have only one faithful uninfected sexual partner Using a condom every time Abstaining from sexual intercourse Knows all three ways Knows at least one way Does not know any way Number of women Federation of B&H 96.5 47.7 45.6 38.1 26.9 60.0 40.0 723Entity Republika Srpska 98.9 61.8 58.0 46.0 34.6 73.8 26.2 468 Urban 98.7 61.6 62.5 49.6 37.5 76.9 23.1 464 Area Rural 96.7 48.0 42.9 35.9 25.2 58.2 41.8 727 15 96.5 39.0 35.5 33.7 18.0 53.5 46.5 172 16 98.8 53.7 46.3 46.3 32.0 66.0 34.0 244 17 96.9 51.6 50.8 38.8 28.3 65.1 34.9 258 18 98.5 58.6 57.8 42.2 30.4 71.9 28.1 263 Age 19 96.5 59.1 57.1 42.9 37.4 66.9 33.1 254 Primary/None 91.7 38.5 33.3 28.2 19.4 46.4 53.6 252Woman's education level Secondary + 99.0 57.3 55.2 44.7 32.8 70.6 29.4 939 Total 97.5 53.3 50.5 41.2 30.0 65.5 34.5 1191 Monitoring HIV/AIDS Indicator Table 14: Percentage of women aged 20-49 who know the main ways of preventing HIV/AIDS transmission, Bosnia and Herzegovina MICS 2000 Heard of AIDS Have only one faithful uninfected sexual partner Using a condom every time Knows two ways Knows one way Does not know any way Number of women Federation of B&H 95.6 47.6 46.8 38.2 56.2 43.8 4855Entity Republika Srpska 97.8 58.1 52.5 45.7 65.0 35.0 2680 Urban 97.9 59.8 59.0 49.4 69.4 30.6 3002 Area Rural 95.3 45.7 42.1 35.2 52.6 47.4 4533 20-24 97.0 57.3 55.1 46.5 65.9 34.1 1289 25-29 97.4 53.5 51.6 42.9 62.3 37.7 1253 30-34 97.5 53.4 50.1 43.5 60.1 39.9 1263 35-39 96.7 49.2 47.6 39.3 57.5 42.5 1380 40-44 95.5 49.5 46.0 37.5 58.0 42.0 1294 Age 45-49 93.4 44.0 41.6 34.8 50.9 49.1 1056 Primary/None 92.9 34.9 31.0 25.4 40.5 59.5 2914Woman's education level Secondary + 98.5 61.7 60.1 50.6 71.2 28.8 4621 Total 96.3 51.3 48.8 40.8 59.3 40.7 7535 Monitoring HIV/AIDS Indicator 39 d r a f t Differences across age groups are not particularly large; the percentage of women in the 20-49 age group who know both main ways of transmission ranges from 47 percent among 20-24 year olds to 35 percent among 45-49 year olds. Rural women in this group are less likely to know both methods – 35 percent versus 49 percent of urban women. The level of education appears to be important – 25 percent of women with primary/no education know three ways compared to 51 percent of women with secondary/higher education. Seven in ten women aged 15 – 49 correctly believe that a healthy looking person can be infected. This declines from 72 percent aged 15 – 19 years to 61 percent aged 45 – 49 years. Only 49 percent of women with primary/no education knew that a healthy looking person could be infected with HIV/AIDS compared with 80 percent of women with secondary school/higher education (Table 14). Table 15: Percentage of women aged 15-49 who can correctly identify a misconception about HIV/AIDS, Bosnia and Herzegovina MICS 2000 Heard of AIDS A healthy looking person can be infected Number of women Entity Federation of B&H 95.7 66.4 5578 Republika Srpska 97.9 73.5 3148 Area Urban 98.0 78.9 3466 Rural 95.5 62.4 5260 Age 15-19 97.4 71.9 1189 20-24 97.0 75.4 1287 25-29 97.4 74.3 1255 30-34 97.5 69.1 1263 35-39 96.7 67.1 1380 40-44 95.5 63.1 1296 45-49 93.4 60.8 1056 Primary/None 92.8 49.2 3166Woman's education level Secondary + 98.6 80.2 5560 Total 96.5 68.9 8726 Monitoring HIV/AIDS Indicator Seven in ten women in Bosnia and Herzegovina knew that HIV/AIDS can be transmitted from mother to child (Table 15). When asked specifically about the mechanisms through which mother to child transmission can take place, 68 percent said that transmission during pregnancy was possible, 59 percent said that transmission at delivery was possible, and 54 percent agreed that HIV/AIDS can be transmitted through breast milk. Almost half of all women aged 15 – 49 years knew all three modes of transmission. Table 16: Percentage of women aged 15-49 who can correctly identify means of HIV/AIDS transmission from mother to child, Bosnia and Herzegovina, MICS 2000 Knows AIDS can be transmitted from mother to child Transmission during pregnancy possible Transmission at delivery possible Transmission through breast milk possible Knows all three Did not know any specific way Number of women Entity Federation of B&H 72.5 68.2 57.9 53.3 47.1 29.7 5578 Republika Srpska 72.5 67.3 60.2 54.4 48.4 30.1 3148 Area Urban 81.7 77.9 66.5 59.3 53.1 20.3 3466 40 d r a f t Rural 66.5 61.3 53.6 50.0 44.0 36.2 5260 Age 15-19 70.1 63.7 53.6 49.7 43.2 33.7 1189 20-24 75.5 71.4 62.0 55.4 49.0 26.5 1287 25-29 76.3 72.1 62.8 56.5 49.9 25.6 1255 30-34 74.8 71.2 60.3 57.3 50.7 27.2 1263 35-39 72.6 68.6 59.1 53.4 47.5 29.3 1380 40-44 69.5 64.0 56.5 52.9 46.7 33.2 1296 45-49 67.9 63.4 56.1 49.9 45.6 34.7 1056 Primary/None 60.1 55.0 47.7 45.8 40.0 42.5 3166 Woman's education level Secondary + 79.6 75.3 65.0 58.2 51.9 22.7 5560 Total 72.5 67.9 58.7 53.7 47.6 29.9 8726 Monitoring HIV/AIDS Indicator The survey also attempted to measure discriminatory attitudes towards people living with HIV/AIDS. To this end, respondents were asked whether they agreed with two questions. The first asked whether a teacher who has the AIDS virus but is not sick should be allowed to continue teaching in school. The second question asked whether the respondent would buy food from a shopkeeper or food seller whom the respondent knew to be infected with HIV/AIDS. The results are presented in Table 16. Table 17: Percentage of women aged 15-49 who express a discriminatory attitude towards people with HIV/AIDS, Bosnia and Herzegovina, MICS 2000 Believes that a teacher with HIV/AIDS should not be allowed to work Would not buy food from a person with HIV/AIDS Agrees with at least one discriminatory statement Agrees with neither discriminatory statement Number of women Entity Federation of B&H 23.4 13.1 24.9 75.1 5578 Republika Srpska 21.7 8.4 22.6 77.4 3148 Area Urban 31.5 15.1 32.5 67.5 3466 Rural 17.0 9.0 18.6 81.4 5260 Age 15-19 27.8 13.6 29.2 70.8 1189 20-24 28.2 15.7 30.3 69.7 1287 25-29 26.3 12.4 27.7 72.3 1255 30-34 23.2 10.8 24.1 75.9 1263 35-39 19.4 9.6 20.4 79.6 1380 40-44 17.7 9.4 19.1 80.9 1296 45-49 16.5 8.0 17.3 82.7 1056 Primary/None 11.9 6.7 13.3 86.7 3166Woman's education level Secondary + 29.0 14.1 30.3 69.7 5560 Total 22.8 11.4 24.1 75.9 8726 Monitoring HIV/AIDS Indicator Almost one in four women aged 15 –49 years believe that a teacher with HIV/AIDS should not be allowed to work. This percentage does not vary by entity. Urban women, younger women and those with secondary or higher education are more likely to express this discriminatory attitude than older women, rural women and those with no or primary education. Eleven percent of women would not buy food from a person infected with HIV/AIDS and this follows the same pattern as the first question. Overall, 24 percent of women agree with at least one of the discriminatory statements. 41 d r a f t Tables 18 and 19 summarise information from the previous tables on HIV/AIDS knowledge (Tables 13 - 17). The second column shows the percentage of women who know both means of preventing HIV/AIDS transmission – having one faithful uninfected partner and using a condom every time. Thirty percent of women aged 15 – 19 know both ways and 41 percent of women aged 20 –49. The third column of the tables shows the percentage of women who correctly identified a misconception about HIV/AIDS transmission – that a healthy looking person cannot be infected. Seventy-two percent of the younger group of women correctly identified this misconception, compared to 69 percent of women aged 20 –49. Finally, the fourth column of the table shows the percentage of women who have ‘sufficient knowledge’ of HIV/AIDS transmission. These are women who know both ways of preventing HIV/AIDS transmission and can correctly identify all the misconceptions. Only 27 percent of women aged 15-19 fall into this category, and 36 percent of the 20 – 49 year olds. Table 18: Percentage of women aged 15-19 who have sufficient knowledge of HIV/AIDS transmission, Bosnia and Herzegovina, MICS 2000 Heard of AIDS Know 2 ways to prevent HIV transmission Correctly identify the misconception about HIV transmission Have sufficient knowledge Number of women Federation of B&H 96.5 26.9 66.0 24.5 723Entity Republika Srpska 98.9 34.2 80.8 30.8 468 Urban 98.7 37.5 81.5 34.9 464 Area Rural 96.7 25.2 65.9 22.3 727 15 96.5 18.0 61.6 16.3 172 16 98.8 32.0 71.3 28.7 244 17 96.9 28.3 69.4 25.2 258 18 98.5 30.4 80.6 28.5 263 Age 19 96.5 37.4 73.2 33.9 254 Primary/None 91.7 19.4 48.4 17.1 252Woman's education level Secondary + 99.0 32.8 78.3 29.9 939 Total 97.5 30.0 72.0 27.2 1191 Monitoring HIV/AIDS Indicator Table 19: Percentage of women aged 20 – 49 who have sufficient knowledge of HIV/AIDS transmission, Bosnia and Herzegovina MICS 2000 Heard of AIDS Know 2 ways to prevent HIV transmission Correctly identify the misconception about HIV transmission Have sufficient knowledge Number of women Federation of B&H 95.6 38.2 66.4 33.5 4855Entity Republika Srpska 97.8 45.7 72.2 40.4 2680 Urban 97.9 49.4 78.5 45.2 3002 Area Rural 95.3 35.2 61.8 29.8 4533 20-24 97.0 46.5 75.3 42.1 1289 25-29 97.4 42.9 74.3 38.8 1253 30-34 97.5 43.5 69.1 37.5 1263 35-39 96.7 39.3 67.1 33.7 1380 40-44 95.5 37.5 63.1 32.6 1294 Age 45-49 93.4 34.8 60.8 30.4 1056 42 d r a f t Primary/None 92.9 25.4 49.3 20.0 2914Woman's education level Secondary + 98.5 50.6 80.5 45.9 4621 Total 96.3 40.8 68.5 35.9 7535 Monitoring HIV/AIDS Indicator Knowledge of HIV/AIDS transmission varies by level of education (Figures 4 and 5). Women with secondary or higher education are almost twice as likely to know both ways to prevent transmission than women with primary/no education, especially among the women aged 20 – 49. They are over one and a half times more likely to correctly identify the misconception about AIDS and twice as likely to have sufficient knowledge of HIV/AIDS transmission. Figure 4: Percentage of women aged 15 – 19 who know the main ways to prevent HIV/AIDS transmission, by level of education, Bosnia and Herzegovina MICS 2000 0 20 40 60 80 100 120 Heard of AIDS Have only one faithful uninfected sexual partner Using a condom every time Abstaining from sexual intercourse Woman's education level : Primary/None Secondary + Figure 5: Percentage of women aged 20-49 who know the main ways of preventing HIV/AIDS transmission, by level of education, Bosnia and Herzegovina MICS 2000 43 d r a f t 0 20 40 60 80 100 120 Heard of AIDS Have only one faithful uninfected sexual partner Using a condom every time Woman's education level: Primary/None Secondary + The level of education is also an important factor in whether a woman has sufficient knowledge about HIV/AIDS (Figures 6 and 7) Figure 6: Percentage of women aged 15 – 19 who have sufficient knowledge of HIV/AIDS transmission, Bosnia and Herzegovina 2000 44 d r a f t Precentage of women aged 15-19 who have sufficient knowledge of HIV/AIDS transmission, by the level of education, B&H MICS 2000 0 20 40 60 80 100 120 Heard of AIDS Know 2 ways to prevent HIV transmission Correctly identify the misconception about HIV transmission Have sufficient knowledge Woman's education level Woman's education level Primary/None Woman's education level Secondary + Figure 7: Percentage of women aged 20 – 49 who have sufficient knowledge of HIV/AIDS transmission, by level of education, Bosnia and Herzegovina MICS 2000 0 20 40 60 80 100 120 Heard of AIDS Know 2 ways to prevent HIV transmission Correctly identify the misconception about HIV transmission Have sufficient knowledge Primary/None Woman's education level Woman's education level Secondary + 45 d r a f t F. Reproductive Health Contraception Current use of contraception was reported by 48 percent of married or in union women (Table 20). The most popular method is withdrawal which is used by just over one in four married women in Bosnia and Herzegovina. The next most popular method is the IUD (full form), used by 8 percent of married women or in union women. Between 2 percent and 5 percent of women reported using the oral contraceptive pill, periodic abstinence or condoms. Less than one percent use any of the following - female or male sterilisation, diaphragm/foam/jelly or the lactational amenorrhoea method (LAM). Implants and female condoms are not used. 47 d r a f t Table 20: Percentage of married or in union women aged 15-49 who are using (or whose partner is using) a contraceptive method, Bosnia and Herzegovina MICS 2000 Current method No method Female sterilizati on Male sterilizati on Pill IUD Implants Condom Female condom Diaphrag m/foam/j elly LAM Periodic abstinen ce Withdraw al Other Total Any modern method Any traditiona l method Any method Number of currently married women Entity Federation of B&H 51.3 .2 .1 5.1 7.3 .0 2.9 .1 .1 .8 5.1 26.9 .1 100.0 15.7 32.9 48.7 3767 Republika Srpska 54.9 .1 .0 3.2 8.9 .0 3.3 .0 .2 .1 2.2 26.8 .3 100.0 15.7 29.4 45.1 1971 Area Urban 54.4 .1 .0 5.0 9.6 .0 4.0 .0 .1 .3 3.3 23.0 .0 100.0 18.9 26.7 45.6 2099 Rural 51.5 .1 .1 4.2 6.8 .0 2.5 .1 .1 .7 4.6 29.1 .2 100.0 13.9 34.6 48.5 3639 Age 15-19 68.1 .0 .0 2.9 .0 .0 4.3 .0 .0 2.9 1.4 20.3 .0 100.0 7.2 24.6 31.9 69 20-24 60.3 .0 .0 3.2 4.1 .0 3.6 .0 .0 2.4 1.0 25.4 .0 100.0 10.8 28.8 39.7 590 25-49 51.4 .1 .0 4.6 8.4 .0 3.0 .0 .1 .3 4.5 27.2 .2 100.0 16.4 32.2 48.6 5079 Primary/None 52.8 .0 .1 3.3 6.8 .0 1.6 .0 .1 .5 3.9 30.6 .2 100.0 12.0 35.2 47.2 2459Woman's education levelSecondary + 52.3 .2 .0 5.3 8.7 .0 4.1 .0 .2 .5 4.3 24.1 .1 100.0 18.6 29.1 47.7 3279 Total 52.5 .1 .0 4.5 7.9 .0 3.1 .0 .1 .5 4.1 26.9 .2 100.0 15.7 31.7 47.5 5738 World Summit for Children Goal => Number 10 Table 21: Percent distribution of women aged 15-49 who gave birth in the last year according to the type of personnel delivering ante-natal care, Bosnia and Herzegovina MICS 2000 Person delivering ante-natal care Doctor Nurse/ midwife Auxiliary midwife Traditional bir th attendant Other/ missing No ante- natal care received Total Any sk i l led personnel Number of women Entity Federation of B&H 95.9 2.6 .3 .3 .6 .3 100.0 98.8 340 Republika Srpska 99.3 .7 .0 .0 .0 .0 100.0 100.0 145 Area Urban 96.6 2.9 .0 .0 .6 .0 100.0 99.4 174 Rural 97.1 1.6 .3 .3 .3 .3 100.0 99.0 311 Primary/None 95.1 3.0 .6 .6 .6 .0 100.0 98.8 164Woman's education level Secondary + 97.8 1.6 .0 .0 .3 .3 100.0 99.4 321 Total 96.9 2.1 .2 .2 .4 .2 100.0 99.2 485 World Summit for Children Goals => Numbers 9, 11 48 d r a f t Contraceptive prevalence is slightly higher in urban than in rural areas. Adolescents are less likely to use contraception than older women. The educational level of women is not strongly associated with the use of contraceptives (Figure 8). Figure 8: Percentage of married or in union women who are using a method of contraception, by education level, Bosnia and Herzegovina MICS 2000 0 10 20 30 40 50 60 Any modern method Any traditional method Any method Woman's education level Primary/None Woman's education level Secondary + Prenatal care High quality prenatal care can contribute to the prevention of maternal mortality by detecting and managing potential complications and risk factors, including pre-eclampsia, anaemia and sexually transmitted diseases. Ante-natal care also provides opportunities for women to learn the danger signs of pregnancy and delivery, to be immunised against tetanus, to learn about infant care, and be treated for existing conditions, such as anaemia. Female respondents who had given birth in the year prior to the B&H MICS 2000 survey were asked whether they had received ante-natal care for the birth and, if so, what type of person provided the care. If the woman saw more than one type of provider, all were recorded in the questionnaire. Table 21 presents the percent distribution of women who had given birth in the year prior to the B&H MICS 2000 according to the type of personnel who delivered the ante- natal care. If more than one provider was mentioned by the respondent, she was categorised as having seen the most skilled person she mentioned. Virtually all women in the survey (99%) receive some type of prenatal care from skilled personnel (doctor, nurse, midwife). The majority (97%) of women who had given birth in the 49 d r a f t year prior to the survey received ante-natal care from a doctor, 2 percent from a nurse, and less than one percent from a midwife or traditional birth attendant. Assistance at delivery The provision of delivery assistance by trained attendants can greatly improve the outcome for mother and child by the use of appropriate technical procedures, and accurate and speedy diagnosis and treatment of complications. Skilled assistance at delivery is defined as assistance provided by a doctor, nurse or midwife. Virtually all births occurring in the year prior to the B&H MICS 2000 survey were attended by skilled personnel (Table 22). More than one in four babies born in this year were delivered with the assistance of a doctor and the remainder were assisted by a nurse. G. Child Rights Birth registration The International Convention on the Rights of the Child states that every child has the right to a name and a nationality, and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The births of 98 percent of children under five years of age in Bosnia and Herzegovina have been registered (Table 23). There are no variations in birth registration according to sex, age or education categories. Orphanhood and living arrangements of children Children who are orphaned or living away from their parents may be at increased risk of impoverishment, discrimination, denial of property rights and rights to inheritance, various forms of abuse, neglect, and exploitation of their labour or sexuality. Monitoring the numbers of orphans and the living arrangements of children assists in identifying those who may be at risk and in tracking changes over time. In Bosnia and Herzegovina, 93 percent of children aged 0-14 are living with both parents (Table 24). About 2 percent are living with their mother only although their father is alive. Less than 1 percent are living with neither parent although both parents are alive. Children who are not living with a biological parent comprise less than 1 percent and children who have one or both parents dead amount to 5 percent of all children aged 0-14 years. Older children are more likely to have one or more parents dead. Only 1 percent of children under the age of five years have one or more parents dead compared to 7 percent of children aged 10-14 years. Child labour It is important to monitor the extent to which children work, and the type of work in which they participate, for several reasons. Children who are working are less likely to attend school and more likely to drop out. This pattern can trap children in a cycle of poverty and disadvantage. Working conditions for children are often unregulated with few safeguards against potential abuse. In addition, many types of work are intrinsically hazardous and others present less obvious hazards to children, such as exposure to pesticides in agricultural work, carrying heavy weights and scavenging in garbage dumps. 51 d r a f t Table 22: Percentage distribution of women aged 15-49 who gave birth in the last year according to the type of personnel assisting at delivery, Bosnia and Herzegovina MICS 2000 Person assisting at delivery Doctor Nurse/midwife Auxiliary midwife Relative/friend Other/NK Total Any skilled personnel Number of women Entity Federation of B&H 85.6 13.8 .6 .0 .0 100.0 100.0 340 Republika Srpska 80.7 17.2 .7 .7 .7 100.0 98.6 145 Area Urban 85.6 13.2 .6 .0 .6 100.0 99.4 174 Rural 83.3 15.8 .6 .3 .0 100.0 99.7 311 Primary/None 78.0 20.1 .6 .6 .6 100.0 98.8 164Woman's education level Secondary + 87.2 12.1 .6 .0 .0 100.0 100.0 321 Total 84.1 14.8 .6 .2 .2 100.0 99.6 485 World Summit for Children Goal => Numbers 11 Table 23: Percentage distribution of children aged 0-59 months according to whether the birth is registered, and reasons for non-registration, Bosnia and Herzegovina MICS 2000 Registration status Birth registered NK if birth registered Must travel too far Did not know it should be registered Does not know where to register Other Reason NK or Missing Total Number of children Sex Male 98.7 .3 .2 .0 .1 .4 .2 100.0 1347 Female 98.1 .4 .2 .2 .2 .5 .2 100.0 1274 Entity Federation of B&H 98.1 .4 .3 .2 .3 .5 .3 100.0 1903 Republika Srpska 99.3 .1 .0 .0 .0 .6 .0 100.0 718 Area Urban 97.9 .6 .2 .1 .1 .9 .1 100.0 868 Rural 98.6 .2 .2 .1 .2 .3 .3 100.0 1753 Age < 6 months 92.6 .4 .4 .8 .8 3.3 1.6 100.0 244 6-11 months 99.1 .0 .4 .0 .4 .0 .0 100.0 230 12-23 months 98.3 .6 .2 .0 .2 .4 .2 100.0 480 24-35 months 98.7 .4 .2 .0 .2 .4 .0 100.0 478 36-47 months 99.5 .3 .2 .0 .0 .0 .0 100.0 627 48-59 months 99.1 .2 .2 .2 .0 .2 .2 100.0 562 Primary/None 97.2 .6 .4 .2 .4 1.0 .3 100.0 1074Mother's education level Secondary 99.2 .2 .1 .1 .1 .1 .2 100.0 1547 Total 98.4 .3 .2 .1 .2 .5 .2 100.0 2621 Monitoring Children's Rights Indicator 53 d r a f t Table 24: Percentage of children 0-14 years of age in households surveyed who are not living with a biological parent, Bosnia and Herzegovina MICS 2000 Living arrangement Living with both parents Living with neither: only father alive Living with neither: only mother alive Living with neither: both are alive Living with neither: both are dead Living with mother only: father alive Living with mother only: father dead Living with father only: mother alive Living with father only: mother dead Impossi ble to determi ne Total Not living with a biologic al parent One or both parents dead Number of children Sex Male 92.8 .1 .1 .4 .0 1.7 4.1 .3 .3 .1 100.0 .6 4.7 4005 Female 92.3 .1 .1 .4 .1 2.1 3.9 .3 .3 .4 100.0 .6 4.5 3880 Entity Federation of B&H 93.9 .1 .1 .3 .1 1.4 3.5 .3 .3 .2 100.0 .5 3.9 5499 Republika Srpska 89.5 .1 .2 .7 .0 3.0 5.3 .4 .5 .3 100.0 1.0 6.1 2386 Area Urban 91.0 .0 .1 .3 .0 3.0 4.9 .1 .2 .3 100.0 .5 5.3 2718 Rural 93.4 .1 .1 .5 .1 1.3 3.6 .5 .4 .2 100.0 .7 4.2 5167 Age 0-4 years 97.2 .0 .0 .2 .0 1.5 .8 .1 .2 .1 100.0 .2 1.0 2642 5-9 years 91.4 .2 .1 .5 .0 1.8 4.9 .3 .4 .3 100.0 .8 5.6 2490 10-14 years 89.1 .0 .2 .5 .1 2.3 6.3 .6 .5 .3 100.0 .9 7.2 2753 Total 92.6 .1 .1 .4 .1 1.9 4.0 .3 .3 .2 100.0 .6 4.6 7885 Monitoring Children's Rights Indicator 54 d r a f t The B&H MICS 2000 survey estimates that less than 1 percent of children aged 5-14 years engage in paid work (Table 15 in Appendix E). About six times as many (6%) participate in unpaid work for someone other than a household member. ‘Domestic work’ is defined as cooking, shopping, cleaning, washing clothes, fetching water, and caring for children. Slightly more than half of the children do these tasks for less than four hours a day while less than 1 percent spend more than four hours a day on such tasks. Overall, girls are somewhat more likely than boys, and older children (aged 10-14 years) are more likely than younger children (aged 5-19 years) to do domestic work. Fifteen percent of children work on the family farm or in the family business. Children who have carried out any paid or unpaid work for someone who is not a member of the household or who did more than four hours of housekeeping chores in the household or who did other family work are considered to be ‘currently working’. Overall, 18 percent of children are so classified. There is some difference between boys and girls – 20 percent of boys and 16 percent of girls are currently working. 55 d r a f t Appendix A: References 1. The progresses report for the Project "The condition of iodine goitre prophylaxis in the region of the Federation of Bosnia and Herzegovina". 2000. 2. Breastfeeding in the Republic of Srpska, Report on Project Realization. 1999. 3. Project: "Prevention of Iodine Deficit Disorder in the Republika Srpska", 2000. 4. Breastfeeding in the Federation of Bosnia and Herzegovina, final report, 1999. 5. Bosnia and Herzegovina End of Decade Report, 2000. 6. Yugoslav Plan of Action for children by the year 2000(and beyond). 7. Statistical Yearbook Federation of Bosnia & Herzegovina, 1999. 8. Federation of Bosnia and Herzegovina in figures - 2000. Federal Office of Statistics. 9. The Republika Srpska Institute for Statistics, Demographic Statistics, 3 – Statistical bulletin, 2000 10. The 1999 Report of the UN Resident Coordinator for Bosnia and Herzegovina. 11. Reconstruction of Houses in Return Areas. 2000 12. BiH Economic Update, 2000. First Quarter, 2000. USAID 56 d r a f t Appendix B: List of Personnel Involved in the Bosnia and Herzegovina MICS 2000 Survey Ministry of Foreign Affairs Agency of Statistics for Bosnia and Herzegovina FEDERATION OF B&H REPUBLIKA SRPSKA (RS) FB&H Steering Committee Ministry of Health Ministry of Education Ministry of Social Welfare Ministry of Finance Health Insurance Fund Public Health Institute Institute of Statistics Paediatric Association UNICEF staff RS Steering Committee Ministry of Health and Social Welfare Ministry of Education Ministry of Finance Health Insurance Fund Public Health Institute Institute of Statistics Institute of Health Informatics Paediatric Association Banja Luka Clinical Centre representative Primary Health care centres representative UNICEF staff FB&H Survey Team Survey Supervisor (1) Survey Co-ordinator (2) Field Work Co-ordinator (1) Data Entry Co-ordinator (2) RS Survey Team Survey Co-ordinator (1) Field Work Co-ordinator (1) Data processing Co-ordinator (2) Data Processing Assistant (1) 57 d r a f t Management Committee UNICEF Entity Survey Teams 58 d r a f t THE PERSONNEL INVOLVED IN THE B&H MICS 2000 Bosnia and Herzegovina MICS 2000 Report preparation: Dr Mary E Black, UNICEF Bosnia and Herzegovina Validation of data: Ms Slavka Popovic, Member of the Management Board of the Agency for Statistics of Bosnia and Herzegovina Editing and translation: Dr Sanja Mandic, UNICEF Bosnia and Herzegovina Editing (English): Ms Anne Hand, Independent consultant Translator (Local language): Ms Svetlana Pavicic Survey Management Committee Chair: Dr. Mary E Black UNICEF 1. Dr Stevan Bajic, Data Processing Co-ordinator, RS 2. Dr Selena Bajraktarevic, UNICEF, Health Programme Officer 3. Mr David Baker, UNICEF, Assistant Representative and Head of Country Office 4. Mr Mladen Cavaljuga, UNICEF, Operation Officer 5. Prof. Vaso Dragovic, UNICEF Sampling Consultant 6. Dr Alma Gusinac-Skopo, Data Processing Co-ordinator, FB&H 7. Dr Irena Jokic, Field Work Co-ordinator, FB&H 8. Mr Miodrag Jungic, UNICEF, Programme Assistant 9. Dr Tatjana Kovacevic, Field Work Co-ordinator, RS 10. Dr Amela Lolic, Survey Co-ordinator, RS 11. Dr Sanja Mandic, UNICEF, Project Assistant 12. Dr Aida Pilav, Survey Co-ordinator, FB&H 13. Mr Aleksandar Preradovic, Data Entry Clerk, RS 14. Mr Zoran Prskalo, Data Processing Manager, FB&H 15. Dr Osman Slipicevic, Survey Co-ordinator, FB&H 16. Mr Miroslav Stijak, Data Processing Co-ordinator, RS 17. Ms Esperanza Vives, UNICEF, Education Programme Officer Survey Technical Consultant Prof. Vaso Dragovic, Professor of Statistics, Economic Faculty, University of Srpsko Sarajevo 59 d r a f t Federation of Bosnia and Herzegovina Survey Co-ordinating team 1. Dr Aida Pilav, Survey Co-ordinator 2. Dr Osman Slipicevic, Survey Co-ordinator 3. Dr Alma Gusinac-Skopo, Data entry Co-ordinator 4. Dr Irena Jokic, Field work Co-ordinator 5. Mr Zoran Prskalo, Data manager Steering Committee President: Prof. Dr. Božo Ljubic, Minister of Health, FB&H Chair: Dr Zlatko Vucina, Director, Federation Public Health Institute, Survey Supervisor Ministry representatives 1. Dr Ivan Bagaric, Assistant Minister, Minister of Health 2. Dr Vildana Doder, Counsellor, Ministry of Health 3. Dr Fariz Gavrankapetanovic, Deputy Minister of Health 4. Ms Azra Hadžibegic, Head of Department for Social Care, Ministry of Social Welfare 5. Dr Boris Hrabac, Deputy Director of the Health Insurance Fund 6. Ms Tidža Mekic, Counsellor, Ministry of Education 7. Dr Alma Mujanovic, Counsellor, Ministry of Health 8. Dr Zdravko Pandža, Chief of Paediatric Department, Clinical Centre, Mostar 9. Ms Munira Zahiragic, Director, Federation Statistical Institute Translator Ms Gordana Vuk Field Supervisors Chair: Prof. Dr Zijah Bešlagic 1. Dr Sabaha Dracic 2. Dr Senad Huseinovic 3. Dr Munira Mihelcic 4. Dr Mirsada Mulaomerovic 5. Dr Elmir Šator 6. Dr Senada Tahirovic 7. Dr Ivan Vasilj 8. Dr Marija Željko 9. Dr Amra Živanovic Field Interviewers 1. Babic Ivona 2. Babic Jelena 3. Bandra Manda 4. Becirevic Jasmina 5. Bešic Azemina 6. Bicakcic Anesa 7. Blaževic Ivana 8. Bošnjak Azra 9. Ceric Alma 10. Culic Hasija 11. Eljšani Amira 12. Girotic Dženita 60 d r a f t 13. Goran Selma 14. Halilovic Sevleta 15. Hasanica Mirela 16. Hasanica Samra 17. Hasovic Emina 18. Hrustanovic Azra 19. Huskic Zumreta 20. Kahrimanovic Jasmina 21. Komadaric Sandra 22. Lojo Naida 23. Lugavic Mevlida 24. Mahmutovic Azra 25. Mahmutovic Nesiba 26. Martinovic Julijana 27. Mehic Senada 28. Mikulic Slavica 29. Miljkovic Sabaheta 30. Mujcinovic Sanela 31. Mujkic Melita 32. Mulic Maida 33. Petrovic Marija 34. Petrovic Zdenka 35. Pirija Sabina 36. Pupic Mira 37. Redzepagic-Gavran Larisa 38. Sadžak Azra 39. Sadžak Samra 40. Silajdžija Selma 41. Šator Adisa 42. Šatrovic Lejla 43. Škrebo Mirela 44. Toplic-Berberovic Suzana 45. Tufekcic Maida 46. Vrljak Jasmina 47. Vujic Amela 48. Zjakic Amra 49. Zubic Elvira Data entry clerks 1. Cato Amela 2. Cedovic Nedžada 3. Culjak Vinka 4. Dedajic Zumrata 5. Gusinac Mirsada 6. Priganica Aida 7. Repovac Sanela Finance Assistant Ms Novka Agic 61 d r a f t Republika Srpska Survey co-ordinating team 1. Dr Amela Lolic, Survey Co-ordinator 2. Dr Stevan Bajic, Data Processing Co-ordinator 3. Dr Tatjana Kovacevic, Fieldwork Co-ordinator 4. Mr Miroslav Stijak, Data Processing Co-ordinator Steering Committee President: Dr Zeljko Rodic, Minister of Health and Social Welfare Chair: Dr Miloš Bajic, Deputy Minister of Health and Social Welfare, Survey Supervisor Ministry Representatives 1. Dr Milorad Balaban, Director, Public Health Institute 2. Prof. Petar Dakovic, Assistant Minister of Education 3. Dr Živana Gavric, Head of Department for Social Medicine, Organisation and Economics of Health Care at the Public Health Institute 4. Mr Goran Kljajcin, Director, Health Insurance Fund 5. Dr Branislav Lolic, Chairman, Association of Paediatricians, Director of the Clinical Centre in Banja Luka 6. Mr Slavko Šobot, Director, Institute of Statistics 7. Dr Stanimir Stamenkovic, Head of Department of Epidemiology, Public Health Institute 8. Dr Gordana Tešanovic, Head of Department for Children and Youth Health Care, Primary Health Care Centre, Banja Luka Translator Mr Aleksandar Šulan Field Supervisors 1. Adamovic Rade 2. Arsenovic Svetlana 3. Bajic Ljubiša 4. Despotovic Slobodanka 5. Ðonlaga Mirjana 6. Kasapovic Gojko 7. Kasapovic Marijana 8. Kasapovic Radmila 9. Miloševic Slaðana 10. Radman Jadranka Field Interviewers 1. Adamovic Lidija 2. Adic Vesna 62 d r a f t 3. Akšam Marina 4. Aleksic Milijana 5. Arsenovic Leposava 6. Beric Drenka 7. Cirkovic Snežana 8. Dakic Zorica 9. Dmidic Stanka 10. Dražic Jasmina 11. Durdevic Verica 12. Durdevic Zdenka 13. Gaceša Daliborka 14. Gaceša Dosta 15. Isakovic Ljubica 16. Kasapovic Milka 17. Kedovic Draga 18. Kekovic Vera 19. Kuzmanovic Danijela 20. Kuzmanovic Marijana 21. Mardeta Bojana 22. Mardeta Radmila 23. Matijaševic Brankica 24. Miholjcic Bojan 25. Miloševic Dragica 26. Miloševic Milijana 27. Moraca Jelena 28. Pastir Marica 29. Pilipovic Mira 30. Piljak Radenka 31. Ratkovic Dragana 32. Šeranic Anka 33. Šeranic Vanja 34. Štrbac Slaðana 35. Šuvakovic Gordana 36. Tadic Ljiljana 37. Vergic Sanja 38. Vukasinovic Ljubinka 39. Vukovic Rada 40. Vukovic Slavica 41. Vukovic Zorica 42. Vuletic Marija 43. Žigic Dušanka Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 63 d r a f t Computer programmer Mr Zoran Šopka Data editor Ms Sladana Miloševic Data entry clerks 1. Bajic Duško, 2. Kasapovic Milka 3. Preradovic Aleksandar 4. Vujicic Dražen Finance Assistant Ms Radmila Štrbac Survey Management Committee The Management Committee met at monthly intervals and consisted of selected members of the entity survey teams, UNICEF staff and other survey members co-opted as necessary. The main function of the management committee was to ensure that the project was well co-ordinated between the two survey teams and that urgent management or technical issues are addressed. Terms of Reference for the Entity Survey Teams Terms of reference for Entity Survey Coordinating Teams and Entity Steering Committees Entity Survey Coordinating Teams will worked closely together to ensure that methodology and data analysis were the same in each entity and that the single report could be produced, and to: · Ensure the survey was completed according to plan · Oversee all aspects of the survey · Assign responsibilities of key staff · Ensure recruitment of adequate staff at all stages of the survey · Authorise narrative and financial reports Each entity team would have co-ordination and technical staff who would · Prepared sampling frame according to MICS methodology Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 64 d r a f t · Produced actual list of clusters including their geographical locations and produced a final listing of households (This was in addition to an sampling consultant with extensive experience in sampling) · Modified and translated tools for local use (tasks shared between two entities) · Trained field staff together with the sampling consultant · Oversee field work and ensured that procedures were followed and the data collected is consistent and of good quality · Ensured training of data entry staff · Oversee data entry and ensured quality of data · Produced tables of results · Prepared draft final reports The steering committee in each entity included representatives of the relevant entity institutions, the entity survey teams, UNICEF and others. The terms of reference of the Steering Committee in each entity were to: · Guide planning and implementation; · Ensure that the project is in line with data needs and Government reporting requirements; Ensured that the data arising from B&H MICS 2000 would be officially accepted and used. Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 65 d r a f t Appendix C: Sample Design and Implementation Contents This Annex is presented in two parts: I. The sampling plan (this sets out the sampling plan as designed for the survey); II. The implementation of the Sampling plan (this describes what happened in the field). I. SAMPLING PLAN Introduction This sampling plan was prepared by a UNICEF consultant in collaboration with survey teams from both entities and UNICEF staff. The methodology is based on the Global Multiple Indicator Cluster Survey (MICS) methodology which has been developed by UNICEF in collaboration with international consultants and agencies for use world-wide. Modifications for the B&H survey were made to this Global MICS methodology based on pre-testing in 100 households in each entity of B&H and on locally available data from a variety of sources. The sampling plan was reviewed and approved by UNICEF's Global MICS support group in New York, the B&H entity level steering committees and the B&H project management committee, all of whom found it to be ambitious but technically correct. Background Planning a large survey sample in post-war Bosnia and Herzegovina was a challenging task. A sample plan should ideally have firm grounds in the official data, routinely collected and presented by statistical institutes, or similar organisations involved in official statistics and censuses. Such data in Bosnia and Herzegovina are, for a variety of reasons, incomplete, unreliable or unavailable. The last complete population census was carried out in April 1991. Since then, the demographic situation has dramatically changed. The population losses as a result of the war – both directly and indirectly – are huge. More than one third of the total population has moved, and many people are still living abroad or are displaced within the country. Vital statistics indicators have also changed: an increase in most indicators of mortality and morbidity has been accompanied by a decline in birth rates. The total number of the population reveals the gravity and extent of these changes: Table 1 Population estimates, B&H Population 19811 Population 19912 Expected population 1999 3 Estimated population 1999 4 4,124.256 4,364.649 4,520.000 3,746.3125 Sources 1 1981 Census, Bosnia and Herzegovina 2 1991 Census, Bosnia and Herzegovina 3 Estimate, based on demographic trends, prepared by UNICEF 4 Population Estimates for 1999, Statistical Institute of Bosnia and Herzegovina 5 UNHCR figures 1999. An estimated 800, 000 of this number are internally displaced – not living in their own homes, neighbourhoods or even regions. Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 66 d r a f t A population census was carried out in Republika Srpska in 1996. Basic demographic data for the Federation remain unavailable. As expected, abundant, updated and accurate statistical data were not available. The situation was further complicated by changes in organisation of the geographical territory. The country is divided into two entities – the Federation of Bosnia and Herzegovina (FB&H) and Republika Srpska (RS). FB&H consists of ten cantons, with 81 municipalities, while RS consists of 64 municipalities. The number of municipalities has thus increased from the pre- war 109 to the current figure of 145. In addition, there is the separately administered district of Brèko which is not sub-divided into municipalities. The entities have established independent statistical institutes, but they collaborate with the State Statistical Institute for the collation of state level data. The list of unavailable statistical information related to MICS sampling is long and includes: · Number of households in the country; · Population of inhabited urban and rural settlements; · Detailed age structure of the population; · Socio-economic structure of the population; · Recent maps and definitions of census enumeration areas. The MICS sample plan has utilised currently available data and data estimates, including: · Results of the 1996 population census in Republika Srpska; · Population estimates for 1999 at the municipality level, provided by the statistical institutes of both entities; · Census enumeration areas and maps from the 1991 population census; · Lists of voters, provided by the Organisation for Security and Co-operation in Europe (OSCE); · Results of previous UNICEF supported surveys (1999 breast feeding surveys in both entities, MICS pre-tests). · Results of the 1991 Bosnia and Herzegovina population census; · List of inhabited settlements produced by the B&H Statistical Institute 1998. SAMPLE SIZE This is based on Annex VII of the UNICEF End-Decade MICS Manual. The required sample size has been derived by applying the following equation: n = 4 (r) (1-r) (f) (c) / (e2) (p) (nh) n = 4 (0.6) (1-0.6) (1.75) (1.12) / (0.052) (0.02) (3.40) = 11.068, where Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 67 d r a f t n (11.068 – rounded down to 11.000) is the required sample size (number of households at national level) and is calculated from: · 4 is the normal distribution factor required to achieve a 95 percent level of confidence; · r (0.6) is the indicator rate; · f (1.75) is the design effect factor; · c (1.12) is the non-response constant; · e (0.05) is the margin of error to be tolerated; · p (0.02) is the proportion of the target population group (one-year-old children); · nh (3.40) is the average household size. Explanation of the data used to estimate each part of this equation 4 = Normal Distribution Factor The distance of the variances on either sides of the median, so that approximately 95% of the area under the normal distribution curve is enclosed. r = Indicator Rate The DPT coverage rate has been selected as the key indicator, because DPT immunisation is the least prevalent, and it relates to the smallest target group. The DPT coverage rate is officially estimated to be over 90%. The empirical data, however, indicate that the actual coverage rate may be much lower, as explained next. Sarajevo Canton immunisation results show that 4.590 out of 6.662 (68.9%) children received DPT vaccine in 1999. As Sarajevo Canton – compared to the rest of the country – is well served with public health facilities, the immunisation rate for the country can only be lower. The figure of 60% has been taken to be representative of the country as a whole, although it is possible that the real figure may be even lower. An alternative method would have been to select BCG coverage. The official data indicate that the coverage rate for Sarajevo Canton was 74.2% in 1999. From the birth rate, it can be calculated that the actual percentage of newborn babies who were immunised may be as low as 40.4%. The BCG coverage figures, therefore, are less reliable than those for DPT. As it was important for this survey to take a conservative but realistic estimate for the indicator rates, the figure of 60% was selected. f = Sample Design Effect Factor The variance increase factor required to compensate for sample design in comparison with a simple random sample. c = Non-response constant The non-response constant was reviewed at the pre-testing stage of this survey and in a number of recent UNICEF supported surveys in B&H. Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 68 d r a f t Three percent of households surveyed in the Federation were non responders, and 14% in Republika Srpska. In the 1999 RS Breast-feeding survey, (sample size 2.800 households), the non-response was found to be 8% of households surveyed. As the MICS sample plan and questionnaires are much more complex, with countrywide coverage, a conservative non-response factor of 12 % was used. e = Margin of Error A standard statistical margin of error of 5% (or 0.05) was used, as is also recommended by the global MICS methodology. It gives an acceptable confidence interval around estimates from the sample. n = Average household size The precise size of the average household in Bosnia and Herzegovina is not known. Available estimates of average household size include: 2.27 in RS (RS MICS pre-testing); 3.37 in RS (RS 1999 UNICEF supported Breast feeding survey); 3.50 in the Federation (Federation MICS pre-testing). The official demographic trends are quite reliable with respect to this factor, and indicate that the RS 1999Breast feeding survey results are likely to be accurate for Republika Srpska household size. The average household has traditionally been slightly bigger in the geographical area of the Federation. Therefore, the average household size for the country was estimated to be 3.40. p = Proportion of the target population There are no official data on the proportion of one-year-old children in the population. The available estimates include: 1.12% (derived from vital statistics indicators); 1.50% (unofficial estimate of the RS Statistics Institute); 1.70% (results of the RS Breast feeding survey); 1.42% (Federation MICS pre-testing) to 2.82% (RS MICS pre-testing). Therefore a conservative figure of 2% (i.e. p =0.02) was used. SAMPLE PLAN The survey was carried out by two entity teams (Federation and Republika Srpska), for the geographical area of Bosnia and Herzegovina minus the District of Brèko, which was omitted for organisational reasons. Population estimates were obtained from the entity Statistical Institutes. The total national sample (minus Brèko) was divided into two parts, in proportion with the population figures, and then rounded, as follows: Table 2: sample size in relation to estimated population. Estimated Population 1999* % of Estimated population Sample size and proportion (%) Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 69 d r a f t Federation 2,259,902 61.6 6,580 (61 %) Republika Srpska 1,410,727 38.4 4,200 (39 %) Total Survey 3,670,629 100.0 10,780 (100 %) *Brèko District not included. The national sample would be designed as a two-stage stratified sample. The two-stage design is recommended since it makes the final sample more representative of the population, and allows wider and more accurate statistical methods to be used in the analysis for Global Reporting and for further analysis of data. The sample is designed to be self-weighting. The strata are defined as follows: Stratum 1 – Urban population This is defined as the population living in the cities and pre-war municipal centres. (Note: the official statistics institutes in Bosnia and Herzegovina are currently using this definition, except that the term 'pre-war' is not stated); Stratum 2 – Rural population This is defined as the population living outside the cities and pre-war municipal centres. Some municipalities have recently been formed for political reasons only, and it is difficult to accept the population of their 'centres' as urban. For example, Petrovac municipality in RS, registered only 2 (two) inhabitants in 1997. Most of the newly formed municipalities consist of a few villages, and none has an urban settlement as its centre. The modification below will take this into account. Stratification Stratification should be carried out at the municipality level. The urban/rural ratio has not changed in a major way at the municipality level since the 1991 population census (approximately 35:65 urban:rural). All the new municipalities are defined as completely rural, for the reasons mentioned above. Their share of the population is then subtracted from the total population of their 'mother-municipalities' whose territory and population has been used to form the new administrative units. The resulting population of 'mother municipalities', as estimated for 1999, is stratified in accordance with the structure obtained from the population censuses 1971, 1981 and 1991. The results of the stratification are shown in Table 1. Segment and cluster size The primary sampling unit – the segment – has been, for this sample plan, defined as an area unit containing 110 households or approximately 374 persons. This size of segment has been chosen because there would be the need to make lists of households at the second sampling stage. The smaller the segment, the easier the household list production will be. Secondly, as the rural stratum is likely to have settlements of small size, it will be more convenient to have small segments. The inhabited areas of the country would – at the recommended segment size – be divided up into segments of 9.820 areas. Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 70 d r a f t The cluster size has been determined as 20 households because small clusters will allow for more reliable estimates from the sample. An acceptable ratio between the overall cost of the survey and reliability of estimates should be sought. Very small clusters (10 households) cannot be recommended for reasons of cost-effectiveness, and big clusters (40 or more households) for reasons of errors in estimates. A cluster size of 20 households should ensure a reasonable degree of homogeneity. Sampling First stage The urban and rural strata in each municipality have to be segmented. The number of segments to be included in the sample is determined using the probability proportionate to size (PPS) method, as recommended in the Global MICS methodology, i.e. the number of segments in each municipality is selected in proportion to the estimated population size of the municipality in 1999 and the distribution of households in urban and rural areas. Some municipalities in both entities are clustered together for this exercise, due to their size. An estimated result is shown in the section on implementing the sampling plan. The segmentation will be based on 1991 census enumeration areas and carried out by the entity Statistical Institutes. The voter lists and demographic information available to the institutes (municipality estimates, UNHCR demographic estimates, results from field visits by the staff of the statistical institutes) will be used for correction. The segments will then be coded with a 3-digit number, starting from 001 for each municipality (for example, the biggest municipality, Banja Luka, will be segmented into 600 segments, with codes from 001 to 600). The statistical institutes will also, in close co-operation with both survey teams and representatives of the MICS Management Committee, select the segments for the sample, using the random numbers method. The number of segments to be selected for each municipality is shown in Table 3. As some areas are depopulated as a consequence of war-time population losses and migrations, at least one reserve segment will be randomly selected from the rural stratum of each municipality. The number of reserve segments will depend on the size of the municipality and the number of deserted villages as estimated by the statistical institutes. Information on reserve segments will be made available only to the entity survey co- ordinators. The initial segment maps (for the selected segments), or maps of corresponding census enumeration areas will be prepared by the statistical institutes. Second stage The survey teams will receive tables showing the codes and detailed geographical attributes of the selected segments, and reference numbers that will correspond to the maps for the segments. The field supervisors will then assign the segments to the interviewers, with instructions to (a) make corrections to the maps by adding local information, and (b) make a Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 71 d r a f t list of households (family name, address etc. according to the household listing form) within the segment. The selection of families to be interviewed will be carried out by the field supervisors. A random selection from the lists of households made by the interviewers should result in a cluster of 20 families from each selected segment. If field visits by the interviewers indicate that a selected segment is totally depopulated, the field supervisor will inform the entity survey co-ordinator, who will assign a new segment from the list of reserve segments. If the actual number of households found and listed within a segment is less than 100, the entity survey co-ordinator will decide either to allow additional listing in the neighbouring non-selected segment from the same stratum or, when the actual number of households found is less than 80, to assign a reserve segment. II Sampling Implementation According to the Sampling Plan, a total of 545 segments were to be selected for the whole territory of Bosnia and Herzegovina, 329 in the Federation and 216 in Republika Srpska. The recommended urban:rural ratio was 40%:60% for the Federation and 37%:63% in RS. The sample plan prescribed 20 households in each cluster, to be chosen from the list of 110 households in each segment. In both entities some problems were encountered in the implementation of the Sampling Plan. In the Federation, the sample plan predicted a cluster size of 10 households in 18 municipalities, which was contrary to the recommended cluster size of 20 households. In order to have the same number of segments and the recommended urban:rural ratio in the segmentation, as well as the recommended cluster size of twenty households, the cluster size was expanded from 10 households to 20 households in these municipalities. The number of selected segments was the same as dictated by the Sampling Plan (329), but the number of listed households in urban and rural areas was slightly changed, to give a final urban:rural ratio of 43%:57%. In RS, the Sampling Plan called for the selection of certain numbers of half-clusters (10 households) and clusters (20 households). Some mistakes were made in the selection process so that one less half- cluster was selected in urban areas (10 households) and one and a half more clusters (30 households) were selected in rural areas, than dictated by the Sampling Plan. The final urban:rural ratio of interviewed households was 36%:64%. During the fieldwork, 24 segments could not be used (13 in FB&H; 11 in RS), because they were empty or in a minefield. Reserve segments were used instead. The total number of sampled households was 10 772, out of which 10 742 were occupied. Of these households, 10 546 were interviewed (6368 in FB&H; 4178 in RS). Of these interviewed households, 4207 (39.89%) were urban households and 6339 (60.11%) were rural households. Table of Selected segments Urban Rural Total Total Type of Segment No. % No. % No. % Sampling Plan. Bosnia and Herzegovina Multiple Indicator Cluster Survey 2000. 72 d r a f t First use 212 38.90 309 56.70 521 95.60 Reserve 0 0 24 4.40 24 4.40 Bosnia and Herzegovina Total 212 38.90 333 61.10 545 100 Table of interviewed families Urban Rural Total Total Type of segment No. % No. % No. % First use 4207 39.89 5859 55.56 10066 95.45 Reserve 0 0 480 4.55 480 4.55 Republika Srpska Total 4207 39.89 6339 60.11 10546 100 73 d r a f t Table 3. MUNICIPALITIES, POPULATION AND SAMPLE PLAN FEDERATION MUNICIPALITY ESTIMATED POPULATION 1999 SEGMENTS TOTAL URBAN SEGMENTS RURAL SEGMENTS SELECT SEGMENTS BIHAC 59,352 159 88 71 9 BANOVICI 28,384 76 19 57 4 BOSANSKA KRUPA 28,343 76 19 57 4 BOSANSKI PETROVAC 6,788 18 6 12 1 BUSOVACA + DOBRETICI 14,691 39 13 26 2 BREZA 13,651 37 9 28 2 BUGOJNO 32,729 88 35 53 5 BUZIM 17,468 47 - 47 3 CAZIN 59,473 159 32 127 9 CENTAR 66,044 177 172 5 10 CAPLJINA 19,199 51 10 41 3 CELIC 15,228 40 - 40 2 CITLUK 16,241 43 11 32 2 DOBOJ-ISTOK 10,073 27 - 27 1 DOBOJ-JUG 4,627 12 - 12 1 DOMALJEVAC SAMAC 4,978 13 - 13 1 DONJI VAKUF 13,120 35 9 26 2 DRVAR + BOS. GRAHOVO + GLAMOC 19,256 51 16 35 3 FOJNICA 10,462 28 7 21 1 GORAZDE + FOCA + PALE 34,865 93 37 56 5 GORNJI VAKUF 19,510 52 10 42 3 GRACANICA 52,440 140 18 122 8 GRADACAC 46,137 123 18 105 7 GRUDE 13,380 36 9 27 2 HADZICI 19,401 52 17 35 3 74 d r a f t ILIDZA + TRNOVO 45,250 121 104 17 7 ILIJAS 14,471 39 9 30 2 JABLANICA 13,046 35 8 27 2 JAJCE 18,910 51 17 34 3 KAKANJ 43,276 116 38 78 6 KALESIJA 33,983 91 4 87 5 KISELJAK 20,442 55 9 46 3 KLADANJ 15,485 41 10 31 2 KLJUC 15,524 42 10 32 2 KONJIC 29,533 79 20 59 4 KRESEVO 6,131 16 3 13 1 LIVNO + KUPRES 36,031 96 18 78 5 LUKAVAC 51,098 137 39 98 7 LJUBUSKI 22,345 60 10 50 3 MAGLAJ 22,979 61 10 51 3 MOSTAR 103,751 277 166 111 15 NEUM + RAVNO 6,686 18 7 11 1 NOVI GRAD 110,086 294 294 - 16 NOVI TRAVNIK 24,543 66 16 50 4 NOVO SARAJEVO 69,436 186 177 9 10 ODZAK 16,020 43 9 34 2 OLOVO 12,754 34 8 26 2 ORASJE 22,470 60 10 50 3 POSUSJE 15,973 43 11 32 2 PROZOR 16,992 45 11 34 2 SANSKI MOST 61,967 166 55 111 9 SAPNA 13,991 37 - 37 2 SREBRENIK 41,196 110 18 92 6 STARI GRAD 37,396 100 96 4 5 STOLAC 9,627 26 8 18 1 SIROKI BRIJEG 29,530 79 19 60 4 75 d r a f t TEOCAK 6,712 18 0 18 1 TESANJ 47,329 127 18 109 7 TOMISLAVGRAD 28,144 75 19 56 4 TRAVNIK 50,314 135 38 97 7 TUZLA 134,879 361 217 144 20 USORA 5,906 16 - 16 1 VARES 10,184 27 12 15 2 VELIKA KLADUSA 48,572 130 19 111 7 VISOKO 39,591 106 35 71 6 VITEZ 20,318 54 18 36 3 VOGOSCA 18,799 50 22 28 3 ZAVIDOVICI 37,653 101 34 67 6 ZENICA 127,563 341 180 161 19 ZEPCE 26,278 70 18 52 4 ZIVINICE 50,898 136 19 117 7 TOTAL 2,259.902 6.043 2.418 3.625 329 REPUBLIKA SRPSKA MUNICIPALITY ESTIMATED POPULATION 1999 SEGMENTS TOTAL URBAN SEGMENTS RURAL SEGMENTS SELECT SEGMENTS HOUSEHOLDS BANJA LUKA 224,594 601 437 164 33 BIJELJINA 108,273 290 109 181 16 BILECA 12,236 33 19 14 2 BRATUNAC 20,013 54 18 36 3 CAJNICE 4,539 12 4 8 1 CELINAC 17,502 47 12 35 3 DERVENTA 39,110 105 35 70 6 DOBOJ 79,158 212 53 159 12 GACKO 10,261 27 11 16 2* GRADISKA 61,322 164 55 109 9 76 d r a f t HAN PIJESAK 4,891 13 4 9 1 KALINOVIK 4,774 13 4 9 1 KNEZEVO 12,171 33 8 25 3* KOTOR VAROS 17,255 46 7 39 4* KOZARSKA DUBICA 34,412 92 37 55 5 LAKTASI 40,369 108 18 90 6 LOPARE 16,987 45 2 73 3 LJUBINJE + BERKOVICI 6,970 19 10 9 2* MILICI 9,995 27 - 27 1 MODRICA 28,045 75 23 52 4 MRKONJIC GRAD + JEZERO 17,860 48 15 33 3 NEVESINJE + S. MOSTAR 19,242 51 14 37 3 NOVI GRAD + KRUPA NA UNI 31,427 84 24 60 5 OSMACI 4,688 13 - 13 1 PALE + S. STARI GRAD 30,028 80 36 44 4 PELAGICEVO 5,235 14 - 14 1 PETROVO 11,866 32 14 18 2 PRIJEDOR + S. SANSKI MOST 96,530 258 80 178 14 PRNJAVOR 49,770 133 23 110 7 RIBNIK + PETROVAC + S. DRVAR 8,300 22 - 22 1 ROGATICA 13,148 35 14 21 2 RUDO 9,211 25 5 20 1 S. NOVO SARAJEVO + TRNOVO 10,936 29 10 19 2* SOKOLAC 17,397 47 18 29 3 SRBAC 24,773 66 9 57 4 SRBINJE + S. GORAZDE 26,003 70 23 47 4 SREBRENICA + SKELANI 17,713 47 6 41 3 SRPSKA ILIDZA 16,707 45 - 45 2 SRPSKA KOSTAJNICA 7,723 21 - 21 1 SRPSKI BROD 14,616 39 16 23 2 SAMAC+VUKOSAVLJE + S. ORASJE 27,997 75 13 62 4 SEKOVIÆI 9,947 27 5 22 1 77 d r a f t SIPOVO + SRPSKI KUPRES 8,648 23 8 15 1 TESLIC 45,483 122 18 104 7 TREBINJE 31,061 83 59 24 5 UGLJEVIK 16,695 45 5 40 3* VISEGRAD 18,559 50 16 34 3 VLASENICA 20,001 53 12 41 3 ZVORNIK 46,283 124 22 102 7 TOTAL 1,410.272 3.777 1.331 2.446 216* BOSNA AND HERCEGOVINA ESTIMATED POPULATION 1999 SEGMENTS TOTAL URBAN SEGMENTS RURAL SEGMENTS SELECT SEGMENTS HOUSEHOLDS IN THE SAMPLE FEDERATION 2,259,902 6,043 2,418 3,625 329 6,580 REPUBLIKA SRPSKA 1,410,272 3,777 1,331 2,446 216* 4,200 BOSNIA AND HERCEGOVINA * 3,670,174 9,820 3,749 6,071 539 10,780 *Brèko District not included. 78 d r a f t APPENDIX D: QUESTIONNAIRES HOUSEHOLD QUESTIONNAIRE WE ARE FROM THE PUBLIC HEALTH INSTITUTE OF THE FEDERATION OF BOSNIA AND HERZEGOVINA ON BEHALF OF THE FEDERATION MINISTRY OF HEALTH / THE REPUBLIKA SRPSKA MINISTRY OF HEALTH AND SOCIAL WELFARE. WE ARE WORKING ON A PROJECT CONCERNED WITH FAMILY HEALTH AND EDUCATION. I WOULD LIKE TO TALK TO YOU ABOUT THIS. THE INTERVIEW WILL TAKE ABOUT 45 MINUTES. ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND YOUR ANSWERS WILL NEVER BE IDENTIFIED. DURING THIS TIME I WOULD LIKE TO SPEAK WITH ALL MOTHERS OR OTHERS WHO TAKE CARE OF CHILDREN IN THE HOUSEHOLD. MAY I START NOW? If permission is given, begin the interview. HOUSEHOLD INFORMATION PANEL 1. Cluster number: 2. Household number: ___ ___ ___ ___ ___ ___ 3. Day/Month/Year of interview: 4. Interviewer number: ___ ___ / ___ ___ / ___ ___ ___ ___ ___ ___ 5. Name of head of household: __________________________________________________________ 6. Area: 1. Urban………………………………………………1 2. Rural………….……………………………………2 7. Geographical Area 10. Result of HH interview: Completed.1 Refused .2 Not at home.3 HH not found/destroyed.4 Other (specify) _____________________ 5 11. No. of women eligible for interview: 12. No. of women interviews completed: ___ ___ ___ ___ 13. No. of children under age 5: 14. No. of child interviews completed: ___ ___ ___ ___ 15. Data entry clerk: ___ ___ 16. Total number of household members __ __ Interviewer/supervisor notes: Use this space to record notes about the interview with this household, such as call- back times, incomplete individual interview forms, number of attempts to re-visit, etc. 79 d r a f t Cluster no. __ __ __ Household no. __ __ __ HOUSEHOLD LISTING FORM FIRST, PLEASE TELL ME THE NAME OF EACH PERSON WHO USUALLY LIVES HERE, STARTING WITH THE HEAD OF THE HH. (Use survey definition of HH member). List the first name in line 01. List adult HH members first, then list children. Then ask: ARE THERE ANY OTHERS WHO LIVE HERE, EVEN IF THEY ARE NOT AT HOME NOW? (THESE MAY INCLUDE CHILDREN IN SCHOOL OR AT WORK). If yes, complete listing. Then, ask and record answers to questions as described in Instructions for Interviewers. Add a continuation sheet if there is not enough room on this page. Tick here if continuation sheet used ¨ Eligible for: WOMEN ’S MODULES CHILD LABOUR MODULE CHILD HEALTH MODULES For persons age 15 or over ask Qs. 8 and 9 For children under age 15 years ask Qs. 10-13 1. Line no. 2. Name 3. IS (name) MALE OR FEMALE ? 1 MALE 2 FEM. 4. HOW OLD IS (name)? HOW OLD WAS (name) ON HIS/HER LAST BIRTHDAY? Record in completed years 99=NK* 5. Circle Line no. if woman is age 15-49 6. For each child age 5-14: WHO IS THE MOTHER OR PRIMARY CARER OF THIS CHILD? Record Line no. of mother/ carer 7. For each child under 5: WHO IS THE MOTHER OR PRIMARY CARER OF THIS CHILD? Record Line no. of mother/ carer 8. CAN HE/SHE READ A LETTER OR NEWSPAPER EASILY , WITH DIFFICULTY OR NOT AT ALL? 1 EASILY 2 DIFFICULT 3 NOT AT ALL 9 NK 9. WHAT IS THE MARITAL STATUS OF (name)? 1 CURRENTLY MARRIED / IN UNION 2 WIDOWED 3 DIVORCED 4 SEPARATED 5 NEVER MARRIED 10. IS (name’s) NATURAL MOTHER ALIVE? 1 YES 2 NO 9 NK 11. If alive: DOES (name’s) NATURAL MOTHER LIVE IN THIS HOUSE- HOLD? 1 YES 2 NO 12. IS (name’s) NATURAL FATHER ALIVE? 1 YES 2 NO 9 NK 13. If alive: DOES (name’s) NATURAL FATHER LIVE IN THIS HOUSE- HOLD? 1 YES 2 NO LINE NAME M F AGE 15-49 MOTHER MOTHER E D N NK M W D S N Y N NK Y N Y N NK Y N 01 1 2 ____ ____ 01 ___ ___ ___ ___ 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 02 1 2 ____ ____ 02 ___ ___ ___ ___ 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 03 1 2 ____ ____ 03 ___ ___ ___ ___ 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 04 1 2 ____ ____ 04 ___ ___ ___ ___ 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 05 1 2 ____ ____ 05 ___ ___ ___ ___ 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 06 1 2 ____ ____ 06 ___ ___ ___ ___ 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 07 1 2 ____ ____ 07 ___ ___ ___ ___ 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 ARE THERE ANY OTHER CHILDREN LIVING HERE – EVEN IF THEY ARE NOT MEMBERS OF YOUR FAMILY OR DO NOT HAVE PARENTS LIVING IN THIS HOUSEHOLD? INCLUDING CHILDREN AT WORK OR AT SCHOOL? If yes, insert child’s name and complete form. * See instructions: to be used only for elderly household members (code meaning “do not know/over age 50”). 80 d r a f t Cluster no. __ __ __ Household no. __ __ __ EDUCATION MODULE If interview takes place between two school years, use alternative wording found in Appendix One. For persons age 5 or over ask Qs. 15 and 16 For children age 5 through 18 years, continue on, asking Qs. 17-22 14. Line no. 15. HAS (name) EVER ATTENDED SCHOOL? 1 YES ð Q.16 2 NO ø NEXT LINE 16. WHAT IS THE HIGHEST LEVEL OF SCHOOL (name) ATTENDED? WHAT IS THE HIGHEST GRADE (name) COMPLETED AT THIS LEVEL? LEVEL: 1.PRESCHOOL 2. PRIMARY 3. SECONDARY 4. HIGHER 5 HIGH 6. NON-STANDARD CURRICULUM 9 NK GRADE: 99 NK If less than 1 grade, enter 00. 18. DURING THE SCHOOL YEAR 1999/2000, DID (name) ATTEND SCHOOL AT ANY TIME? 1 YES 2 NO ð Q.21 19. SINCE LAST (day of the week), HOW MANY DAYS DID (name) ATTEND SCHOOL? Insert 88 .(school year ended) 20. WHICH LEVEL AND GRADE IS/WAS (name) ATTENDING? LEVEL: 1 PRESCHOOL 2 PRIMARY 3 SECONDARY 4 NON-STANDARD CURRICULUM 9 NK GRADE: 99 NK 21. DID (name) ATTEND SCHOOL IN THE SCHOOL YEAR 1998/99 ? 1 YES 2 NO ø NEXT LINE 9 NK ø NEXT LINE 22. WHICH LEVEL AND GRADE DID (name) ATTEND IN THE SCHOOL YEAR 1998/99? LEVEL: 1 PRESCHOOL 2 PRIMARY 3 SECONDARY 4 NON-STANDARD CURRICULUM 9 NK GRADE: 99 NK LINE Y NO LEVEL GRADE YES NO DAYS LEVEL GRADE Y N N K LEVEL GRADE 01 1 2ðNEXT LINE 1 2 3 4 5 6 9 ___ ___ 1 2 ____ 1 2 3 4 9 ___ ___ 1 2 9 1 2 3 4 9 ___ ___ 02 1 2ðNEXT LINE 1 2 3 4 5 6 9 ___ ___ 1 2 ____ 1 2 3 4 9 ___ ___ 1 2 9 1 2 3 4 9 ___ ___ 03 1 2ðNEXT LINE 1 2 3 4 5 6 9 ___ ___ 1 2 ____ 1 2 3 4 9 ___ ___ 1 2 9 1 2 3 4 9 ___ ___ 04 1 2ðNEXT LINE 1 2 3 4 5 6 9 ___ ___ 1 2 ____ 1 2 3 4 9 ___ ___ 1 2 9 1 2 3 4 9 ___ ___ 05 1 2ðNEXT LINE 1 2 3 4 5 6 9 ___ ___ 1 2 ____ 1 2 3 4 9 ___ ___ 1 2 9 1 2 3 4 9 ___ ___ 06 1 2ðNEXT LINE 1 2 3 4 5 6 9 ___ ___ 1 2 ____ 1 2 3 4 9 ___ ___ 1 2 9 1 2 3 4 9 ___ ___ 07 1 2ðNEXT LINE 1 2 3 4 5 6 9 ___ ___ 1 2 ____ 1 2 3 4 9 ___ ___ 1 2 9 1 2 3 4 9 ___ ___ Now for each woman age 15-49 years, write her name and line number at the top of each page in the Women’s Questionnaire. For each child under age 5, write his/her name and line number AND the line number of his/her mother or carer at the top of each page in the Children’s Questionnaire. You should now have a separate questionnaire for each eligible woman and child in the household. 81 d r a f t Cluster no. __ __ __ Household no. __ __ __ CHILD LABOUR MODULE To be administered to carer of each child resident in the household age 5 through 14 years. Copy line number of each eligible child from household listing. NOW I WOULD LIKE TO ASK ABOUT ANY WORK CHILDREN IN THIS HOUSEHOLD MAY DO. 1. Line no. 2. Name 3. DURING THE PAST WEEK, DID (name) DO ANY KIND OF WORK FOR SOMEONE WHO IS NOT A MEMBER OF THIS HOUSEHOLD? If yes: FOR PAY? 1 YES, FOR PAY (CASH OR KIND) 2 YES, UNPAID 3 NO ðTO Q.5 4. If yes: SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE DO THIS WORK FOR SOMEONE WHO IS NOT A MEMBER OF THIS HOUSEHOLD? If more than one job, include all hours at all jobs. Record response then ð Q.6 5. AT ANY TIME DURING THE PAST YEAR, DID (name) DO ANY KIND OF WORK FOR SOMEONE WHO IS NOT A MEMBER OF THIS HOUSEHOLD? If yes: FOR PAY? 1 YES, FOR PAY (CASH OR KIND) 2 YES, UNPAID 3 NO 6. DURING THE PAST WEEK, DID (name) HELP WITH HOUSEKEEPING CHORES SUCH AS COOKING, SHOPPING, CLEANING, WASHING CLOTHES, FETCHING WATER, OR CARING FOR CHILDREN? 1 YES 2 NO ð TO Q.8 7. If yes: SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE SPEND DOING THESE CHORES? 8. DURING THE PAST WEEK, DID (name) DO ANY OTHER FAMILY WORK (ON THE FARM OR IN A BUSINESS)? 1 YES 2 NO ø NEXT LINE 9. If yes: SINCE LAST (day of the week), ABOUT HOW MANY HOURS DID HE/SHE DO THIS WORK? LINE YES YES NO. NAME PAID UNPAID NO NO. HOURS PAID UNPAID NO YES NO NO. HOURS YES NO NO. HOURS ___ ___ 1 2 3 ____ ____ 1 2 3 1 2 ____ ____ 1 2 ____ ____ ___ ___ 1 2 3 ____ ____ 1 2 3 1 2 ____ ____ 1 2 ____ ____ ___ ___ 1 2 3 ____ ____ 1 2 3 1 2 ____ ____ 1 2 ____ ____ ___ ___ 1 2 3 ____ ____ 1 2 3 1 2 ____ ____ 1 2 ____ ____ ___ ___ 1 2 3 ____ ____ 1 2 3 1 2 ____ ____ 1 2 ____ ____ ___ ___ 1 2 3 ____ ____ 1 2 3 1 2 ____ ____ 1 2 ____ ____ ___ ___ 1 2 3 ____ ____ 1 2 3 1 2 ____ ____ 1 2 ____ ____ 82 d r a f t When all children in the age range have been covered, GO TO WATER AND SANITATION MODULE ðð 83 d r a f t Cluster no. __ __ __ Household no. __ __ __ WATER AND SANITATION MODULE This module is to be administered once for each household visited. Record only one response for each question. If more than one response is given, record the most usual source or facility. 1. WHAT IS THE MAIN SOURCE OF DRINKING WATER FOR MEMBERS OF YOUR HOUSEHOLD? Piped into dwelling .01 Piped into yard or plot .02 Public tap .03 Tube well/bore hole with pump .04 Protected dug well .05 Protected spring .06 Rainwater collection .07 Bottled water .08 Unprotected dug well .09 Unprotected spring .10 Pond, river or stream .11 Tanker-truck, vendor .12 Other (specify) ______________________ 13 No answer or NK .99 2. HOW LONG DOES IT TAKE TO GO THERE, GET WATER, AND COME BACK? No. of minutes .__ __ __ Water on premises . 888 NK . 999 3. WHAT KIND OF TOILET FACILITY DOES YOUR HOUSEHOLD USE? Flush to sewage system or septic tank .1 Pour flush latrine (water seal type) .2 Improved pit latrine (e.g., VIP) .3 Traditional pit latrine.4 Open pit .5 Bucket .6 Other (specify) _______________________ 7 No facilities or bush or field.98 98ðQ.5 4. IS THIS FACILITY LOCATED WITHIN YOUR DWELLING, OR YARD OR COMPOUND? Yes, in dwelling/yard/compound.1 No, outside dwelling/yard/compound .2 NK .9 5. WHAT HAPPENS WITH THE STOOLS OF YOUNG CHILDREN (0-3 YEARS) WHEN THEY DO NOT USE THE LATRINE OR TOILET FACILITY? Children always use toilet or latrine.1 Thrown into toilet or latrine .2 Thrown outside the yard .3 Buried in the yard .4 Not disposed of or left on the ground.5 Other (specify) _______________________ 6 No young children in household .98 GO TO NEXT MODULE ðð 84 d r a f t 85 d r a f t Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ QUESTIONNAIRE FOR INDIVIDUAL WOMEN WOMEN’S INFORMATION PANEL This module is to be administered to all women age 15 through 49 (see column 5 of HH listing). Fill in one form for each eligible woman. 1. Woman’s line number (from HH listing). Line number . __ __ 2. Woman’s name. Name _______________________________ 3A. IN WHAT MONTH AND YEAR WERE YOU BORN? Or: 3B. HOW OLD WERE YOU AT YOUR LAST BIRTHDAY? Date of birth Month/Year . __ __ / __ __ __ __ NK date of birth .999999 Or: Age (in completed years). __ __ NKð3B GO TO NEXT MODULE ðð 86 d r a f t 87 d r a f t Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ CHILD MORTALITY MODULE This module is to be administered to all women age 15-49. All questions refer only to LIVE births. Follow instructions as provided in training. See Instructions for Interviewers. 10. JUST TO MAKE SURE THAT I HAVE THIS RIGHT, YOU HAVE HAD IN TOTAL (total number) BIRTHS DURING YOUR LIFE. IS THIS CORRECT? ¨ Yes ð Go to Q.11 ¨ No ð Check responses and make corrections before proceeding to Q.11 11. OF THESE (total number) BIRTHS YOU HAVE HAD, WHEN DID YOU DELIVER THE LAST ONE (EVEN IF HE OR SHE HAS DIED)? Date of last birth Day/Month/Year. __ __/__ __/__ __ __ __ Did the woman’s last birth occur within the last year, that is, since July 1999? ¨ Yes, live birth in last year. ð GO TO MATERNAL AND NEWBORN HEALTH MODULE ¨ No live birth in last year. ð GO TO CONTRACEPTIVE USE MODULE 88 d r a f t 89 d r a f t Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ MATERNAL AND NEWBORN HEALTH MODULE This module is to be administered to all women with a live birth in the year preceding date of interview. 2. DID YOU SEE ANYONE FOR ANTENATAL CARE FOR THIS PREGNANCY? If yes: WHOM DID YOU SEE? ANYONE ELSE? Probe for the type of person seen and circle all answers given. Health professional: Doctor .1 Nurse/midwife.2 Auxiliary midwife .3 Other person Traditional birth attendant .4 Other (specify) _______________________ 6 No one .0 3. WHO ASSISTED WITH THE DELIVERY OF YOUR LAST CHILD (or name)? ANYONE ELSE? Probe for the type of person assisting and circle all answers given. Health professional: Doctor .1 Nurse/midwife.2 Auxiliary midwife .3 Other person Traditional birth attendant .4 Relative/friend .5 Other (specify) _______________________ 6 No one .0 5. WAS (name) WEIGHED AT BIRTH? Yes .1 No .2 NK .9 6. HOW MUCH DID (name) WEIGH? Record weight from health card, if available. From card .1 (grams) __ , __ __ __ From recall .2 (grams) __ , __ __ __ NK .99999 GO TO NEXT MODULE ðð 90 d r a f t Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ CONTRACEPTIVE USE MO DULE Ask Q.1 for all women age 15-49 and then follow the skip instruction carefully. Questions on pregnancy and contraception are to be asked only of women who are currently married or in union. 1. ARE YOU CURRENTLY MARRIED OR LIVING WITH A MAN? Yes . 1 No, widowed, divorced, separated . 2 No, never married . 3 2ðNEXT MODULE 3ðNEXT MODULE 2. NOW I AM GOING TO CHANGE TOPICS. I WOULD LIKE TO TALK WITH YOU ABOUT ANOTHER SUBJECT – FAMILY PLANNING – AND YOUR REPRODUCTIVE HEALTH. I KNOW THIS IS A DIFFICULT SUBJECT TO TALK ABOUT, BUT IT IS IMPORTANT THAT WE OBTAIN THIS INFORMATION. OF COURSE, ALL THE INFORMATION YOU SUPPLY WILL REMAIN STRICTLY CONFIDENTIAL. YOU WILL NEVER BE IDENTIFIED WITH THE ANSWERS TO THESE QUESTIONS. ARE YOU PREGNANT NOW? Yes, currently pregnant . 1 No . 2 Unsure or NK . 3 1ðNEXT MODULE 3. SOME COUPLES USE VARIOUS WAYS OR METHODS TO DELAY OR AVOID A PREGNANCY . ARE YOU CURRENTLY DOING SOMETHING OR USING ANY METHOD TO DELAY OR AVOID GETTING PREGNANT? Yes . 1 No . 2 3.A.CAN YOU TELL ME FOR WHICH CONTRACEPTIVE METHOD YOU KNOW? Do not prompt. If more than one method is mentioned, circle each one. Female sterilization . 01 Male sterilization . 02 Pill. 03 IUD . 04 Injections . 05 Implants. 06 Condom. 07 Female condom . 08 Diaphragm . 09 Foam/jelly . 10 Lactational amenorrhoea method (LAM) . 11 Periodic abstinence . 12 Withdrawal. 13 Other (specify) _______________________14 4. WHICH METHOD ARE YOU USING? Ask this question only if women's answer to question number 3 is "yes". Do not prompt. If more than one method is mentioned, circle each one. Female sterilization . 01 Male sterilization . 02 Pill. 03 IUD . 04 Injections . 05 Implants. 06 Condom. 07 Female condom . 08 Diaphragm . 09 Foam/jelly . 10 Lactational amenorrhoea method (LAM) . 11 Periodic abstinence . 12 Withdrawal. 13 Other (specify) _________________________ GO TO NEXT MODULE ðð 91 d r a f t 92 d r a f t Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ HIV/AIDS MODULE This module is to be administered to all women age 15-49. See Instructions for Interviewers for further discussion of these questions. 1. NOW I WOULD LIKE TO TALK WITH YOU ABOUT WHAT YOU KNOW ABOUT SERIOUS ILLNESS, IN PARTICULAR, ABOUT HIV AND AIDS. HAVE YOU EVER HEARD OF THE VIRUS HIV OR AN ILLNESS CALLED AIDS? Yes . 1 No . 2 2ðQ.18 2. IS THERE ANYTHING A PERSON CAN DO TO AVOID GETTING HIV, THE VIRUS THAT CAUSES AIDS? Yes . 1 No . 2 NK . 9 2ðQ.8 9ðQ.8 3. NOW I WILL READ SOME QUESTIONS ABOUT HOW PEOPLE CAN PROTECT THEMSELVES FROM THE AIDS VIRUS. THESE QUESTIONS INCLUDE ISSUES RELATED TO SEXUALITY WHICH SOME PEOPLE MIGHT FIND DIFFICULT TO ANSWER. HOWEVER, YOUR ANSWERS ARE VERY IMPORTANT TO HELP UNDERSTAND THE NEEDS OF PEOPLE IN BOSNIA AND HERZEGOVINA . AGAIN, THIS INFORMATION IS ALL COMPLETELY PRIVATE AND ANONYMOUS. PLEASE ANSWER YES OR NO TO EACH QUESTION. CAN PEOPLE PROTECT THEMSELVES FROM GETTING INFECTED WITH THE AIDS VIRUS BY HAVING ONE UNINFECTED SEX PARTNER WHO ALSO HAS NO OTHER PARTNERS? Yes . 1 No . 2 NK . 9 5. CAN PEOPLE PROTECT THEMSELVES FROM THE AIDS VIRUS BY USING A CONDOM CORRECTLY EVERY TIME THEY HAVE SEX? Yes . 1 No . 2 NK . 9 7. CAN PEOPLE PROTECT THEMSELVES FROM GETTING INFECTED WITH THE AIDS VIRUS BY NOT HAVING SEX AT ALL? Yes . 1 No . 2 NK . 9 8. IS IT POSSIBLE FOR A HEALTHY -LOOKING PERSON TO HAVE THE AIDS VIRUS? Yes . 1 No . 2 NK . 9 93 d r a f t 9. CAN THE AIDS VIRUS BE TRANSMITTED FROM A MOTHER TO A CHILD? Yes .1 10. CAN THE AIDS VIRUS BE TRANSMITTED FROM A MOTHER TO A CHILD DURING PREGNANCY? Yes .1 No .2 NK .9 11. CAN THE AIDS VIRUS BE TRANSMITTED FROM A MOTHER TO A CHILD AT DELIVERY? Yes .1 No .2 NK .9 12. CAN THE AIDS VIRUS BE TRANSMITTED FROM A MOTHER TO A CHILD THROUGH BREAST MILK? Yes .1 No .2 NK .9 13. IF A TEACHER HAS THE AIDS VIRUS BUT IS NOT SICK, SHOULD HE OR SHE BE ALLOWED TO CONTINUE TEACHING IN SCHOOL? Yes .1 No .2 NK .9 14. IF YOU KNEW THAT A SHOPKEEPER OR FOOD SELLER HAD AIDS OR THE VIRUS THAT CAUSES IT, WOULD YOU BUY FOOD FROM HIM OR HER? Yes .1 No .2 NK .9 18. Is the woman a carer of any children under five years of age? ¨ Yes. ð GO TO QUESTIONNAIRE FOR CHILDREN UNDER FIVE and administer one questionnaire for each child under five for whom she is the carer. ¨ No. ð CONTINUE WITH Q.19 19. Does another eligible woman reside in the household? ¨ Yes. ð End the current interview by thanking the woman for her cooperation and GO TO QUESTIONNAIRE FOR INDIVIDUAL WOMEN to administer the questionnaire to the next eligible woman. ¨ No. ð End the interview with this woman by thanking her for her cooperation. Gather together all questionnaires for this household and tally the number of interviews completed on the cover page. 94 d r a f t 95 d r a f t Cluster no. __ __ __ Household no. __ __ __ Carer line no. __ __ Child line no. __ __ QUESTIONNAIRE FOR CHILDREN UNDER FIVE This questionnaire is to be administered to all women who care for a child that lives with them and is under the age of 5 years (see Q.4 of the HH listing). A separate form should be used for each eligible child. Questions should be administered to the mother or carer of the eligible child (see Q.7 of the HH listing). Fill in the line number of each child, the line number of the child’s mother or carer, and the household and cluster numbers in the space at the top of each page. BIRTH REGISTRATION AND EARLY LEARNING MO DULE 1. Child’s name. Name _______________________________ 2. Child’s age (copy from Q.4 of HH listing). Age (in completed years). __ __ 3. NOW I WOULD LIKE TO ASK YOU SOME QUESTIONS ABOUT THE HEALTH OF EACH CHILD UNDER THE AGE OF 5 IN YOUR CARE, WHO LIVES WITH YOU NOW. NOW I WANT TO ASK YOU ABOUT (name). IN WHAT MONTH AND YEAR WAS (name) BORN? Probe: WHAT IS HIS/HER BIRTHDAY? If the mother knows the exact birth date, also enter the day; otherwise, enter 99 for day. Date of birth Day/Month/Year. __ __/__ __/__ __ __ __ 4. DOES (name) HAVE A BIRTH CERTIFICATE? MAY I SEE IT? If certificate is presented, verify reported birth date. If no birth certificate is presented, try to verify date using another document (health card, etc.). Correct stated age, if necessary. Yes, seen.1 Yes, not seen .2 No .3 NK .9 1ðQ.8 5. If no birth certificate is shown, ask: HAS (name’s) BIRTH BEEN REGISTERED? Yes .1 No .2 NK .9 1ðQ.8 9ðQ.7 6. WHY IS (name’s) BIRTH NOT REGISTERED? Costs too much .1 Must travel too far.2 Did not know it should be registered.3 Late, and did not want to pay fine .4 Does not know where to register .5 Other (specify)________________________ 6 NK .9 7. DO YOU KNOW HOW TO REGISTER YOUR CHILD’S BIRTH? Yes .1 No .2 No answer.8 96 d r a f t 8. Check age. If child is 3 years old or more, ask: DOES (name) ATTEND ANY ORGANIZED LEARNING OR EARLY CHILDHOOD EDUCATION PROGRAMME, SUCH AS A PRIVATE OR GOVERNMENT FACILITY, INCLUDING KINDERGARTEN OR COMMUNITY CHILD CARE? Yes . 1 No. 2 NK . 9 2ðNEXT MODULE 9ðNEXT MODULE 9. WITHIN THE LAST SEVEN DAYS, ABOUT HOW MANY HOURS DID (name) ATTEND? Number of hours . __ __ GO TO NEXT MODULE ðð 97 d r a f t Cluster no. __ __ __ Household no. __ __ __ Carer line no. __ __ Child line no. __ __ CARE OF ILLNESS MODULE 1. HAS (name) HAD DIARRHOEA IN THE LAST TWO WEEKS, THAT IS, SINCE (day of the week) OF THE WEEK BEFORE LAST? Diarrhoea is determined as perceived by mother or carer, or as three or more loose or watery stools per day, or blood in stool. Yes . 1 No . 2 NK . 9 1ðQ.3 2. IN THE LAST TWO WEEKS, HAS (name) HAD ANY OTHER ILLNESS, SUCH AS COUGH OR FEVER, OR ANY OTHER HEALTH PROBLEM? Yes . 1 No . 2 NK . 9 1ðQ.4 2ðQ.11 9ðQ.11 3. DURING THIS LAST EPISODE OF DIARRHOEA , DID (name) DRINK ANY OF THE FOLLOWING: Y N NK A. Breast milk.1 2 9 B. Gruel .1 2 9 C. yogurt drink, fruit juce without sugar .1 2 9 D. ORS packet .1 2 9 E. Other milk or formula.1 2 9 F. Water with feeding.1 2 9 G. Water alone.1 2 9 H. (coca cola, fruit juce with sugar).1 2 9 I. Nothing .1 2 9 1ðQ.5 4. DURING (name’s) ILLNESS, DID HE/SHE DRINK MUCH LESS, ABOUT THE SAME, OR MORE THAN USUAL? Much less or none . 1 About the same (or somewhat less). 2 More. 3 NK . 9 5. DURING (name’s) ILLNESS, DID HE/SHE EAT LESS, ABOUT THE SAME, OR MORE FOOD THAN USUAL? If “less”, probe: MUCH LESS OR A LITTLE LESS? None . 1 Much less . 2 Somewhat less. 3 About the same . 4 More. 5 NK . 9 6. HAS (name) HAD AN ILLNESS WITH A COUGH AT ANY TIME IN THE LAST TWO WEEKS, THAT IS, SINCE (day of the week) OF THE WEEK BEFORE LAST? Yes . 1 No . 2 NK . 9 2ðQ.11 9ðQ.11 98 d r a f t 7. WHEN (name) HAD AN ILLNESS WITH A COUGH, DID HE/SHE BREATHE FASTER THAN USUAL WITH SHORT, QUICK BREATHS OR HAVE DIFFICULTY BREATHING? Yes .1 No .2 NK .9 2ðQ.11 9ðQ.11 8. WERE THE SYMPTOMS DUE TO A PROBLEM IN THE CHEST OR A BLOCKED NOSE? Blocked nose.1 Problem in chest.2 Both.3 Other (specify)________________________ 4 NK .9 1ðQ.11 4ðQ.11 9. DID YOU SEEK ADVICE OR TREATMENT FOR THE ILLNESS OUTSIDE THE HOME? Yes .1 No .2 NK .9 2ðQ.11 9ðQ.11 10. FROM WHERE DID YOU SEEK CARE? ANYWHERE ELSE? Circle all providers mentioned, but do NOT prompt with any suggestions. Hospital.01 Health centre .02 Dispensary .03 Village health worker.04 MCH clinic.05 Mobile/outreach clinic.06 Private physician .07 Traditional healer .08 Pharmacy or drug seller .09 Relative or friend .10 Other (specify)_______________________ 11 Ask this question (Q.11) only once for each carer. 11. SOMETIMES CHILDREN HAVE SEVERE ILLNESSES AND SHOULD BE TAKEN IMMEDIATELY TO A HEALTH FACILITY. WHAT TYPES OF SYMPTOMS WOULD CAUSE YOU TO TAKE YOUR CHILD TO A HEALTH FACILITY RIGHT AWAY? Keep asking for more signs or symptoms until the carer cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions. Child not able to drink or breastfeed .01 Child becomes sicker.02 Child develops a fever.03 Child has fast breathing.04 Child has difficult breathing.05 Child has blood in stool .06 Child is drinking poorly .07 Other (specify)_______________________ 08 Other (specify)_______________________ 09 Other (specify)_______________________ 10 GO TO NEXT MODULE ðð 99 d r a f t Cluster no. __ __ __ Household no. __ __ __ Carer line no. __ __ Child line no. __ __ IMMUNIZATION MODULE If an immunization card is available, copy the dates in Qs.2-5 for each type of immunization recorded on the card. Qs.7-15 are for recording vaccinations that are not recorded on the card. Qs.7-15 will only be asked when a card is not available. 1. IS THERE A VACCINATION RECORD FOR (name)? Yes, seen . 1 Yes, not seen. 2 No . 3 2ðQ.7 3ðQ.7 (a) Copy dates of all vaccinations from the card. (b) Write ‘44’ in day column if card shows that vaccination was given but no date recorded. Date of Immunization DAY MONTH YEAR 2. BCG BCG 3B. OPV1 OPV1 3C. OPV2 OPV2 3D. OPV3 OPV3 4A. DPT1 DPT1 4B. DPT2 DPT2 4C. DPT3 DPT3 5. MMR (MEASLES , MUMPS, RUBELLA) 6. IN ADDITION TO THE VACCINATIONS SHOWN ON THIS CARD, DID (name) RECEIVE ANY OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN A NATIONAL IMMUNIZATION DAY? Record ‘Yes’ only if respondent mentions BCG, OPV 0-3, DPT 1-3, and/or MMR vaccine(s). Go to Q.15 after you finish. Yes . 1 (Probe for vaccinations and write ‘66’ in the corresponding day column on Q. 2 to Q. 5.) No . 2 NK . 9 1ðQ.15 2ðQ.15 9ðQ.15 7. HAS (name) EVER RECEIVED ANY VACCINATIONS TO PREVENT HIM/HER FROM GETTING DISEASES, INCLUDING VACCINATIONS RECEIVED IN A NATIONAL IMMUNIZATION DAY CAMPAIGN? Yes . 1 No . 2 NK . 9 2ðQ.15 9ðQ.15 8. HAS (name) EVER BEEN GIVEN A BCG VACCINATION AGAINST TUBERCULOSIS – THAT IS, AN INJECTION IN THE LEFT SHOULDER THAT CAUSED A SCAR? Yes . 1 No . 2 NK . 9 100 d r a f t 9. HAS (name) EVER BEEN GIVEN ANY “VACCINATION DROPS IN THE MOUTH” TO PROTECT HIM/HER FROM GETTING DISEASES – THAT IS, POLIO? Yes . 1 No . 2 NK . 9 2ðQ.12 9ðQ.12 10. HOW OLD WAS HE/SHE WHEN THE FIRST DOSE WAS GIVEN – JUST AFTER BIRTH OR LATER? Just after birth. 1 Later. 2 11. HOW MANY TIMES HAS HE/SHE BEEN GIVEN THESE DROPS? No. of times .__ __ 12. HAS (name) EVER BEEN GIVEN “VACCINATION INJECTIONS” – THAT IS, AN INJECTION IN THE THIGH OR BUTTOCKS – TO PREVENT HIM/HER FROM GETTING TETANUS, WHOOPING COUGH, DIPHTHERIA? (SOMETIMES GIVEN AT THE SAME TIME AS POLIO) Yes . 1 No . 2 NK . 9 2ðQ.14 9ðQ.14 13. HOW MANY TIMES? No. of times .__ __ 14. HAS (name) EVER BEEN GIVEN “VACCINATION INJECTIONS” – THAT IS, A SHOT IN THE ARM AT THE AGE OF 9 MONTHS OR OLDER - TO PREVENT HIM/HER FROM GETTING MEASLES, RUBEOLA AND PAROTITIS Yes . 1 No . 2 NK . 9 15. PLEASE TELL ME IF (name) HAS PARTICIPATED IN ANY OF THE FOLLOWING IMMUNIZATION CAMPAIGNS: CAMPAIGN A: (POLIO) 1997 CAMPAIGN B: (POLIO) 1998 CAMPAIGN C: (POLIO) 2000 Y N NK Campaign A .1 2 9 Campaign B.1 2 9 Campaign C.1 2 9 GO TO NEXT MODULE ðð 101 d r a f t Cluster no. __ __ __ Household no. __ __ __ Carer line no. __ __ Child line no. __ __ ANTHROPOMETRY MODULE After questionnaires for all children are complete, the measurer weighs and measures each child. Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child’s name and line number on the HH listing before recording measurements. 1. Child’s weight. Kilograms (kg). ___ ___ . ___ 2. Child’s length or height. Check age of child: ¨ Child under 2 years old. ð Measure length (lying down). ¨ Child age 2 or more years. ð Measure height (standing up). Length (cm) Lying down . 1 ___ ___ ___ . ___ Height (cm) Standing up . 2 ___ ___ ___ . ___ 3. Measurer’s identification code. Measurer code . ___ ___ ___ 4. Result. Measured . 1 Not present . 2 Refused. 3 Other (specify) _______________________ 4 5. Is there another child in the household who is eligible for measurement? ¨ Yes. ð Record measurements for next child. ¨ No. ð End the interview with this household by thanking all participants for their cooperation. Gather together all questionnaires for this household and check that identification numbers are at the top of each page. Tally on the Household Information Panel the number of interviews completed. 102 d r a f t 103 d r a f t Appendix E: Tables Table 1: Single year age distribution of household population by sex, Bosnia and Herzegovina MICS 2000 Sex Male Female NumberPercent NumberPercent Age 0 264 1.5 227 1.3 1 234 1.3 247 1.4 2 250 1.4 248 1.4 3 323 1.9 298 1.6 4 289 1.7 262 1.4 5 253 1.4 232 1.3 6 278 1.6 244 1.3 7 221 1.3 229 1.3 8 249 1.4 244 1.3 9 281 1.6 259 1.4 10 303 1.7 272 1.5 11 238 1.4 239 1.3 12 283 1.6 282 1.6 13 272 1.6 291 1.6 14 267 1.5 306 1.7 15 282 1.6 182 1.0 16 321 1.8 250 1.4 17 288 1.7 278 1.5 18 279 1.6 276 1.5 19 242 1.4 264 1.5 20 322 1.8 306 1.7 21 255 1.5 239 1.3 22 263 1.5 258 1.4 23 255 1.5 256 1.4 24 278 1.6 253 1.4 25 290 1.7 287 1.6 26 229 1.3 256 1.4 27 241 1.4 240 1.3 28 261 1.5 260 1.4 29 243 1.4 246 1.4 30 293 1.7 271 1.5 31 208 1.2 246 1.4 32 248 1.4 246 1.4 33 287 1.6 235 1.3 34 235 1.3 273 1.5 35 329 1.9 296 1.6 36 250 1.4 286 1.6 37 249 1.4 262 1.4 38 296 1.7 286 1.6 39 256 1.5 270 1.5 40 314 1.8 308 1.7 41 240 1.4 259 1.4 42 282 1.6 252 1.4 43 242 1.4 252 1.4 44 224 1.3 236 1.3 45 274 1.6 282 1.6 46 238 1.4 247 1.4 47 247 1.4 238 1.3 48 225 1.3 234 1.3 49 176 1.0 83 .5 50 285 1.6 404 2.2 51 193 1.1 219 1.2 52 189 1.1 215 1.2 53 170 1.0 207 1.1 54 151 .9 157 .9 55 161 .9 212 1.2 56 127 .7 146 .8 57 103 .6 133 .7 58 136 .8 188 1.0 59 162 .9 185 1.0 60 223 1.3 299 1.7 61 154 .9 182 1.0 62 188 1.1 210 1.2 63 197 1.1 221 1.2 64 156 .9 196 1.1 65 205 1.2 244 1.3 66 176 1.0 199 1.1 67 157 .9 155 .9 68 141 .8 187 1.0 69 120 .7 128 .7 70+ 884 5.1 1230 6.8 Missing/DK 8 .0 8 .0 Total 17453 100.0 18118 100.0 104 d r a f t Table 2: Percentage of the population aged 15 years and older that is literate, Bosnia and Herzegovina, MICS 2000 Sex Total Male Female Literate % Not known Number Literate % Not known Number Literate % Not known Number Entity Federation of B&H 98.5 1.0 8136 91.5 5.3 8503 95.0 3.2 16639 Republika Srpska 98.1 .2 5304 90.5 .6 5727 94.1 .4 11031 Area Urban 99.2 .3 4920 95.6 1.8 5622 97.3 1.1 10542 Rural 97.9 .9 8520 88.2 4.5 8608 93.0 2.7 17128 Age 15-24 99.6 .2 2785 99.7 .2 2562 99.6 .2 5347 25-34 99.8 .1 2535 99.6 .4 2560 99.7 .2 5095 35-44 99.4 .3 2682 99.1 .3 2707 99.3 .3 5389 45-54 99.3 .3 2148 95.2 2.1 2286 97.2 1.2 4434 55-64 97.3 1.1 1607 84.0 6.7 1972 89.9 4.2 3579 65+ 92.4 3.0 1683 62.9 13.4 2143 75.8 8.8 3826 Total 98.4 .7 13440 91.1 3.4 14230 94.6 2.1 27670 World Summit for Children Goal => Number 7 105 d r a f t Table 3: Percentage of the population using various sources of drinking water, Bosnia and Herzegovina MICS 2000 Main source of water Piped into dwelling Piped into yard or plot Public tap Tubewell/ bore hole with pump Protected dug well Protected spring Rainwater collection Bottled water Unprotect ed dug well Unprotect ed spring Pond, river or stream Tanker truck vendor Other Total Total with safe drinking water Number of persons Entity Federation of B&H 85.4 3.0 1.8 .7 4.1 2.8 .2 .1 .2 .6 .0 .9 .1 100.0 98.1 22152 Republika Srpska 47.0 18.8 2.0 11.6 7.9 9.1 .2 .0 .9 2.0 .2 .0 .4 100.0 96.5 13419 Area Urban 97.2 .6 .6 .2 .4 .6 .0 .1 .0 .1 .0 .0 .1 100.0 99.7 13263 Rural 55.4 13.9 2.5 7.6 8.6 7.9 .3 .0 .8 1.8 .1 .9 .2 100.0 96.2 22308 Total 70.9 9.0 1.8 4.8 5.6 5.2 .2 .0 .5 1.1 .1 .5 .2 100.0 97.5 35571 World Summit for Children Goal => Number 4 Table 4: Percentage of the population using sanitary means of excreta disposal, Bosnia and Herzegovina MICS 2000 Toilet facility Flush to sewage system or septic tank Pour flush latrine (water seal type) Improved pit latrine (VIP) Traditional pit latrine Open pit Bucket Other No facilities, bush, field Total Total with sanitary means of excreta disposal Number of persons Entity Federation of B&H 84.5 4.4 7.1 3.4 .4 .0 .1 .0 100.0 99.5 22152 Republika Srpska 78.3 2.5 .6 2.2 16.2 .0 .0 .1 100.0 83.7 13419 Area Urban 97.3 1.0 .5 .3 .9 .0 .0 .0 100.0 99.0 13263 Rural 73.2 5.3 7.2 4.5 9.6 .0 .1 .1 100.0 90.2 22308 Total 82.2 3.7 4.7 2.9 6.4 .0 .1 .1 100.0 93.5 35571 World Summit for Children Goal => Number 5 106 d r a f t Table 5: Percentage of children under 5 who are moderately or severely undernourished, Bosnia and Herzegovina, MICS 2000 Weight for age: -2 SD Weight for age: -3 SD Height for age: -2 SD Height for age: -3 SD Weight for height: -2 SD Weight for height: -3 SD Number of children Sex Male 4.7 .8 10.3 3.1 6.7 2.1 1323 Female 3.5 .3 9.1 2.7 5.8 1.7 1246 Entity Federation of B&H 4.8 .7 10.0 3.2 6.1 1.9 1887 Republika Srpska 2.1 .3 8.8 2.2 6.6 1.9 682 Area Urban 3.6 .7 9.1 2.2 6.7 2.0 854 Rural 4.3 .5 10.0 3.3 6.1 1.9 1715 Age < 6 months 4.1 .4 10.0 1.7 8.7 .8 241 6-11 months 4.5 .5 8.6 1.4 10.4 3.6 221 12-23 months 4.7 .4 11.7 3.4 5.7 1.7 470 24-35 months 3.6 .6 10.0 4.1 4.1 1.3 468 36-47 months 3.4 .3 9.6 2.8 5.8 1.8 617 48-59 months 4.5 1.1 8.2 2.9 6.3 2.5 552 Primary/None 4.7 .8 10.7 2.9 6.6 2.2 1053Mother's education level Secondary 3.6 .5 9.0 2.9 6.0 1.7 1516 Total 4.1 .6 9.7 2.9 6.3 1.9 2569 World Summit for Children Goal => Number 3, 9, 26 Table 6: Percentage of children under 5 who are overweight or obese, Bosnia and Herzegovina, MICS 2000 Weight for height: +2 SD Weight for height: +3 SD Number of children Sex Male 11.8 4.3 1323 Female 14.7 5.4 1246 Entity Federation of B&H 12.2 4.6 1887 Republika Srpska 16.0 5.4 682 Area Urban 14.1 6.3 854 Rural 12.8 4.1 1715 Age < 6 months 8.7 4.6 241 6-11 months 15.8 7.7 221 12-23 months 19.1 6.8 470 24-35 months 10.0 2.4 468 36-47 months 10.4 3.1 617 48-59 months 14.9 6.2 552 Primary/None 11.4 4.2 1053Mother's education level Secondary 14.4 5.3 1516 Total 13.2 4.8 2569 World Summit for Children Goal => Number 3, 9, 26 107 d r a f t Table 7: Percentage of children age 12-23 months immunised against childhood diseases at any time before the survey and before the first birthday, Bosnia and Herzegovina, MICS 2000 BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles (MMR) All None Vaccinated at any time before the survey according to: , Vaccination card 78,3 77,9 77,1 75,2 78,1 77,3 75,6 53,5 52,9 3,8 Mother`s report 16,9 14,6 14,2 12,5 15,6 14,2 9,6 10,8 6,9 96,3 Either 95,2 92,5 91,3 87,7 93,8 91,5 85,2 64,4 59,8 100,0 Vaccinated by 12 months of age among those who have cards 100,0 98,7 97,8 96,6 98,9 98,1 96,4 38,2 30,3 ,0 Total percent vaccinated by 12 months 95,2 91,3 89,3 84,8 92,7 89,7 82,1 24,6 18,1 ,0 The denominator for the vaccination coverage rates includes children age 12-23 months, and for this table is 480 children Table 8: Percentage of children age 18-29 months immunised against childhood diseases at any time before the survey and before 18 months of age, Bosnia and Herzegovina MICS 2000 BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles (MMR) All None Vaccinated at any time before the survey according to: , Vaccination card 78,2 78,6 78,2 76,8 78,4 78,2 77,0 70,2 68,3 4,6 Mother`s report 15,7 14,1 13,9 11,9 15,3 12,7 9,1 11,7 7,5 95,4 Either 94,0 92,7 92,1 88,7 93,8 90,9 86,1 81,9 75,8 100,0 Vaccinated by 18 months of age among those who have cards 100,0 99,5 99,0 98,9 99,7 99,2 98,9 95,8 92,0 ,0 Total percent vaccinated by 18 months 94,0 92,3 91,2 87,8 93,5 90,2 85,2 78,5 69,7 ,0 The denominator for the vaccination coverage rates includes children age 18-29 months, and for this table is 496 children 108 d r a f t Table 9: Percentage of children age 12-23 months currently vaccinated against childhood diseases, Bosnia and Herzegovina MICS 2000 BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles All None % with health card Number of children Sex Male 94.8 93.5 90.9 86.1 93.9 90.9 83.0 63.5 58.3 3.5 79.1 230 Female 95.6 91.6 91.6 89.2 93.6 92.0 87.2 65.2 61.2 4.0 79.2 250 Entity Federation of B&H 95.1 92.7 91.3 88.4 94.5 92.2 86.6 70.1 66.0 3.5 80.2 344 Republika Srpska 95.6 91.9 91.2 86.0 91.9 89.7 81.6 50.0 44.1 4.4 76.5 136 Area Urban 97.5 91.8 91.1 89.2 93.7 92.4 88.6 66.5 63.9 2.5 79.7 158 Rural 94.1 92.9 91.3 87.0 93.8 91.0 83.5 63.4 57.8 4.3 78.9 322 Primary/None 93.8 92.6 90.9 86.9 95.5 92.0 84.1 65.3 60.8 4.0 82.4 176Mother's education level Secondary 96.1 92.4 91.4 88.2 92.8 91.1 85.9 63.8 59.2 3.6 77.3 304 Total 95.2 92.5 91.3 87.7 93.8 91.5 85.2 64.4 59.8 3.8 79.2 480 Table 10: Percentage of children age 18-29 months currently vaccinated against childhood diseases, Bosnia and Herzegovina MICS 2000 BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles All None % with health card Number of children Sex Male 94.9 93.6 92.7 89.3 94.4 91.0 85.5 82.1 75.2 3.4 79.1 234 Female 93.1 92.0 91.6 88.2 93.1 90.8 86.6 81.7 76.3 5.7 79.8 262 Entity Federation of B&H 92.8 91.7 91.4 88.8 93.1 91.1 87.1 86.2 79.6 5.2 80.2 348 Republika Srpska 96.6 95.3 93.9 88.5 95.3 90.5 83.8 71.6 66.9 3.4 77.7 148 Area Urban 95.7 92.0 92.0 88.3 93.2 91.4 87.0 82.7 77.2 3.7 79.0 162 Rural 93.1 93.1 92.2 88.9 94.0 90.7 85.6 81.4 75.1 5.1 79.6 334 Primary/None 89.1 89.6 88.6 84.5 90.7 87.6 82.4 79.8 72.5 7.8 80.3 193Mother's education level Secondary 97.0 94.7 94.4 91.4 95.7 93.1 88.4 83.2 77.9 2.6 78.9 303 Total 94.0 92.7 92.1 88.7 93.8 90.9 86.1 81.9 75.8 4.6 79.4 496 d r a f t Table 11: Percentage of children under 5 with diarrhoea in the two weeks before the survey, and treatment with ORS or ORT, Bosnia and Herzegovina MICS 2000 Had diarrhoea in last two weeks Number of children under 5 Breast milk Gruel Local acceptable ORS packet Other milk or infant formula Water with feeding Any recommended treatment No treatment Number of children with diarrhoea Sex Male 9.6 1347 23.3 18.6 20.9 15.5 27.9 33.3 81.4 18.6 129 Female 8.2 1274 19.0 21.0 17.1 10.5 27.6 34.3 81.9 18.1 105 Entity Federation of B&H 8.6 1903 23.8 12.8 11.6 13.4 29.3 31.1 79.3 20.7 164 Republika Srpska 9.7 718 15.7 35.7 37.1 12.9 24.3 40.0 87.1 12.9 70 Area Urban 9.2 868 25.0 21.3 20.0 17.5 27.5 31.3 86.3 13.8 80 Rural 8.8 1753 19.5 18.8 18.8 11.0 27.9 35.1 79.2 20.8 154 Age < 6 months 8.2 244 80.0 10.0 5.0 5.0 15.0 25.0 95.0 5.0 20 6-11 months 12.6 230 51.7 10.3 10.3 17.2 27.6 31.0 82.8 17.2 29 12-23 months 12.3 480 22.0 18.6 18.6 8.5 44.1 33.9 86.4 13.6 59 24-35 months 8.4 478 2.5 35.0 22.5 22.5 27.5 30.0 80.0 20.0 40 36-47 months 7.2 627 6.7 20.0 17.8 11.1 22.2 42.2 82.2 17.8 45 48-59 months 7.3 562 4.9 17.1 31.7 14.6 17.1 34.1 68.3 31.7 41 Primary/None 8.1 1074 20.7 20.7 17.2 9.2 29.9 33.3 81.6 18.4 87Mother's education level Secondary 9.5 1547 21.8 19.0 20.4 15.6 26.5 34.0 81.6 18.4 147 Total 8.9 2621 21.4 19.7 19.2 13.2 27.8 33.8 81.6 18.4 234 World Summit for Children Goal => Number 23 110 d r a f t Table 12: Percentage of children under 5 with diarrhoea in the two weeks before the survey who took increased fluids and continued to feed during the episode, Bosnia and Herzegovina, MICS 2000 Drinking during diarrhoea Eating during diarrhoea Had diarrhoe a in last two weeks Number of children under 5 More Same/ Less Missing/ NK Total somewh at less/ same/ more Much less/ none Missing/ NK Total Received increased fluids and continued eating Number of children with diarrhoea Sex Male 9.6 1347 20.9 56.6 22.5 100.0 62.0 37.2 .8 100.0 12.4 129 Female 8.2 1274 13.3 66.7 20.0 100.0 62.9 36.2 1.0 100.0 9.5 105 Entity Federation of B&H 8.6 1903 15.9 56.7 27.4 100.0 62.2 36.6 1.2 100.0 9.8 164 Republika Srpska 9.7 718 21.4 71.4 7.1 100.0 62.9 37.1 .0 100.0 14.3 70 Area Urban 9.2 868 18.8 60.0 21.3 100.0 58.8 40.0 1.3 100.0 11.3 80 Rural 8.8 1753 16.9 61.7 21.4 100.0 64.3 35.1 .6 100.0 11.0 154 Age < 6 months 8.2 244 10.0 65.0 25.0 100.0 70.0 30.0 .0 100.0 10.0 20 6-11 months 12.6 230 17.2 51.7 31.0 100.0 86.2 13.8 .0 100.0 10.3 29 12-23 months 12.3 480 23.7 59.3 16.9 100.0 54.2 45.8 .0 100.0 15.3 59 24-35 months 8.4 478 22.5 60.0 17.5 100.0 60.0 40.0 .0 100.0 12.5 40 36-47 months 7.2 627 15.6 66.7 17.8 100.0 60.0 40.0 .0 100.0 13.3 45 48-59 months 7.3 562 9.8 63.4 26.8 100.0 58.5 36.6 4.9 100.0 2.4 41 Primary/None 8.1 1074 16.1 62.1 21.8 100.0 64.4 35.6 .0 100.0 12.6 87Mother's education level Secondary 9.5 1547 18.4 60.5 21.1 100.0 61.2 37.4 1.4 100.0 10.2 147 Total 8.9 2621 17.5 61.1 21.4 100.0 62.4 36.8 .9 100.0 11.1 234 World Summit for Children Goal => Number 23 111 d r a f t Table 13: Percentage of children 0-59 months of age reported ill during the two weeks before the survey who received increased fluids and continued feeding, Bosnia and Herzegovina, MICS 2000 Drinking during illness Eating during illness Reported illness in last two weeks Number of children under 5 More Same/Less Missing/NK Total somewhat less/same/ more Much less/none Missing/NK Total Received increased fluids and continued eating Number of sick children Sex Male 19.9 1347 26.1 62.3 11.6 100.0 65.3 34.0 .7 100.0 15.7 268 Female 17.6 1274 26.3 62.5 11.2 100.0 64.3 33.9 1.8 100.0 16.5 224 Entity Federation of B&H 19.0 1903 27.1 58.8 14.1 100.0 63.8 34.5 1.7 100.0 16.6 362 Republika Srpska 18.1 718 23.8 72.3 3.8 100.0 67.7 32.3 .0 100.0 14.6 130 Area Urban 19.1 868 25.3 62.0 12.7 100.0 61.4 36.1 2.4 100.0 15.1 166 Rural 18.6 1753 26.7 62.6 10.7 100.0 66.6 32.8 .6 100.0 16.6 326 Age < 6 months 14.8 244 13.9 69.4 16.7 100.0 69.4 27.8 2.8 100.0 11.1 36 6-11 months 21.7 230 26.0 54.0 20.0 100.0 78.0 20.0 2.0 100.0 14.0 50 12-23 months 24.4 480 29.9 60.7 9.4 100.0 62.4 35.9 1.7 100.0 21.4 117 24-35 months 20.5 478 29.6 62.2 8.2 100.0 62.2 37.8 .0 100.0 13.3 98 36-47 months 16.4 627 24.3 67.0 8.7 100.0 61.2 38.8 .0 100.0 16.5 103 48-59 months 15.7 562 25.0 61.4 13.6 100.0 65.9 31.8 2.3 100.0 14.8 88 Primary/None 18.7 1074 28.9 59.7 11.4 100.0 60.2 38.3 1.5 100.0 16.4 201Mother's education level Secondary 18.8 1547 24.4 64.3 11.3 100.0 68.0 30.9 1.0 100.0 15.8 291 Total 18.8 2621 26.2 62.4 11.4 100.0 64.8 33.9 1.2 100.0 16.1 492 112 d r a f t Table 14: Percentage of carers of children aged 0-59 months who know at least 2 signs for seeking immediate medical assistance, Bosnia and Herzegovina MICS 2000 Not able to drink/ breast-feed Becomes more ill Develops a fever Has fast breathing Has difficult breathing Has blood in stool Is drinking poorly Knows at least two signs Number of carers Entity Federation of B&H 26.3 36.8 95.3 31.6 40.6 34.0 12.9 65.6 1903 Republika Srpska 15.7 34.8 88.6 36.5 40.0 45.0 8.4 74.0 718 Area Urban 22.2 35.1 95.6 31.5 42.4 38.7 13.4 69.8 868 Rural 24.0 36.9 92.4 33.7 39.5 36.2 10.8 66.9 1753 Primary/None 23.5 34.9 93.7 34.7 38.2 34.8 11.9 63.9 1074Mother's education level Secondary 23.3 37.2 93.3 31.7 42.0 38.5 11.5 70.7 1547 Total 23.4 36.3 93.5 33.0 40.4 37.0 11.7 67.9 2621 Table 15: Percentage of children 5-14 years of age who are currently working, Bosnia and Herzegovina MICS 2000 Paid work Unpaid work Domestic work: < 4 hours/day Domestic work: 4 or more hours/day Family work (farm or business) Currently working Number of children Sex Male 1,1 6,0 48,8 ,5 17,09 19,5 2645 Female ,7 5,9 61,9 ,7 13,16 15,9 2598 Entity Federation of BH 1,0 7,0 56,8 ,6 13,21 16,2 3589 Republika Srpska ,6 3,7 52,1 ,5 19,35 20,9 1654 Area Urban ,7 4,0 60,2 ,1 6,73 9,3 1843 Rural 1,0 7,0 52,6 ,8 19,71 22,3 3400 Age 5-9 years ,4 4,0 43,1 ,2 9,08 11,0 2490 10-14 years 1,3 7,7 66,3 ,9 20,63 23,8 2753 Total ,9 5,9 55,3 ,6 15,14 17,7 5243 Monitoring Children's Rights Indicator 113 d r a f t Percentage of children entering first grade of primary school who eventually reach grade 5, Bosnia and Herzegovina, MICS 2000 Percent in grade 1 reaching grade 2 Percent in grade 2 reaching grade 3 Percent in grade 3 reaching grade 4 Percent in grade 4 reaching grade 5 Percent who reach grade 5 of those who enter grade 1 Sex Male 100.0 100.0 99.6 99.6 99.2 Female 99.2 100.0 99.6 100.0 98.8 Entity Federation of B&H 99.5 100.0 99.4 99.7 98.6 Republika Srpska 100.0 100.0 100.0 100.0 100.0 Area Urban 99.5 100.0 99.4 100.0 99.0 Rural 99.7 100.0 99.7 99.7 99.1 Total 99.6 100.0 99.6 99.8 99.0 World Summit for Children Goal => Number 6

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