Findings from the Iraq Multiple Indicator Cluster Survey 2006: Monitoring the Situation of Children and Women

Publication date: 2007

1 Monitoring the Situation of Children and Women Findings from the Iraq Multiple Indicator Cluster Survey 2006 PRELIMINARY REPORT March 2007 Implementing agencies: Central Organization for Statistics & Information Technology (COSIT) Kurdistan Regional Statistics Office (KRSO) Suleimaniyah Statistical Directorate (SSD) Partner: Ministry of Health (MOH) UNITED NATIONS CHILDREN’S FUND 2Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Summary Table of Findings MICS and MDG Indicators, Iraq, 2006 INDICATOR NUMBER VALUE TOPIC MICS- 3 MDG INDICATOR NATIONAL KURDISTAN REGION UNIT 1 13 Under-five mortality rate 41 39 Per 1,000 Child Mortality 2 14 Infant mortality rate 34 32 Per 1,000 6 4 Underweight prevalence: (moderate and severe) 7.6 7.9 Percent (severe) 1.4 1.6 Percent 7 Stunting prevalence (moderate and severe) 21.4 13.1 Percent (severe) 7.5 3.9 Percent 8 Wasting prevalence (moderate and severe) 4.8 4.9 Percent (severe) 1.2 1.2 Percent 15 Exclusive breastfeeding rate 25.1 23.5 Percent 16 Continued breastfeeding rate (infants 12-15 months) 67.6 68.3 Percent 16 (infants 20-23 months) 35.7 36.2 Percent Nutrition 17 Timely complementary feeding rate 51.0 49.3 Percent 25 Tuberculosis immunization coverage 90.6 96.3 Percent 26 Polio immunization coverage 58.0 72.2 Percent 27 DPT immunization coverage 54.9 65.7 Percent 28 15 Measles immunization coverage 54.0 65.8 Percent 31 Fully immunized children 35.4 52.6 Percent 33 Use of oral rehydration therapy (ORT) 30.7 30.1 Percent 34 Home management of diarrhoea 15.3 14.8 Percent 35 Received ORT or increased fluids and continued feeding 63.8 66.0 Percent 22 Antibiotic treatment of suspected pneumonia 82.0 73.8 Percent Child health 24 29 Solid fuels 4.6 5.9 Percent 11 30 Use of improved drinking water sources 79.2 96.9 Percent Environment 12 31 Use of improved sanitation facilities 92.3 97.7 Percent 21 19c Contraceptive prevalence 49.8 58.2 Percent 4 17 Skilled attendant at delivery 88.5 88.1 Percent Reproductive health 5 Institutional deliveries 62.6 67.8 Percent 55 6 Net primary school attendance rate 83.1 88.2 Percent 61 9 Gender parity index for primary school 0.91 0.97 None Gender parity index for secondary school 0.79 0.99 None Education 59 2 Primary completion rate 78.9 114.1 Percent 62 Birth registration 95.0 98.5 Percent 67 Marriage (before age 15) 5.4 6.8 Percent (before age 18) 22.6 26.1 Percent 71 Child labour 10.7 6.4 Percent Child protection 68 Young women aged 15-19 currently married 19.0 10.0 Percent 82 19b Comprehensive knowledge about HIV prevention among young women 2.1 0.7 Percent HIV/AIDS, and orphaned children 77 20 School attendance of orphans versus non-orphans 0.84 1.10 None 3Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 CONTENTS CONTENTS . 3 FIGURES .5 ABBREVIATIONS. 6 PREFACE.7 ACKNOWLEDGEMENTS . 8 I. BACKGROUND AND OBJECTIVES.10 INTRODUCTION.10 SURVEY OBJECTIVES .11 II. SAMPLE AND SURVEY METHODOLOGY.12 SAMPLE DESIGN .12 QUESTIONNAIRES .12 FIELDWORK AND PROCESSING.13 SAMPLE COVERAGE .14 III. RESULTS.15 CHILD MORTALITY .15 NUTRITIONAL STATUS .15 BREASTFEEDING .17 IMMUNIZATION .17 ORAL REHYDRATION THERAPY .19 HOME MANAGEMENT OF DIARRHOEA .20 ANTIBIOTIC THERAPY OF CHILDREN WITH SUSPECTED PNEUMONIA.21 SOLID FUEL USE.21 WATER AND SANITATION .21 CONTRACEPTION.23 ASSISTANCE AT DELIVERY .24 DELIVERY IN A HEALTH FACILITY.24 PRIMARY SCHOOL ATTENDANCE.24 PRIMARY SCHOOL COMPLETION AND TRANSITION TO SECONDARY EDUCATION .25 BIRTH REGISTRATION .25 CHILD LABOUR .26 EARLY MARRIAGE .27 KNOWLEDGE OF HIV/AIDS TRANSMISSION .28 ORPHANS SCHOOL ATTENDANCE .29 4Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 TABLES Table 1: Results of household and individual interviews .30 Table 2: Child mortality.31 Table 3: Child malnourishment.32 Table 4: Breastfeeding .33 Table 5: Vaccinations in first year of life .34 Table 6: Vaccinations under Polio national campaign .35 Table 7: Vaccinations under MMR (Measles- Mumps-Rubella) national campaign .36 Table 8: Oral rehydration therapy.37 Table 9: Home management of diarrhoea .38 Table 10: Antibiotic therapy of suspected pneumonia .39 Table 11: Solid fuel use.40 Table 12: Use of improved water sources .41 Table 13: Use of sanitary means of excreta disposal.42 Table 14: Use of contraception .43 Table 15: Assistance during delivery .44 Table 16: Primary school net attendance ratio .45 Table 17: Education gender parity.46 Table 18: Primary school completion and transition to secondary education .47 Table 19: Birth registration .48 Table 20: Child labour.49 Table 21: Early marriage .50 Table 22: Comprehensive knowledge of HIV/AIDS transmission for women aged 15-49 years .51 Table 23: Comprehensive knowledge of HIV/AIDS transmission for women aged 15-24 years .52 Table 24: School attendance of orphaned children.53 5Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 FIGURES Figure 1: Percentage of children aged 0-59 months who are undernourished, Iraq, 2006.16 Figure 2: Percentage of children 12-23 months who received immunizations by age 12 months, Iraq, 2006.18 Figure 3: Percentage of children aged 0-59 months with diarrhoea who received the recommended oral rehydration therapy, Iraq, 2006.20 Figure 4: Percent distribution of the population by source of drinking water, Iraq, 2006.22 Figure 5: Percentage of women aged 15-49 years currently married who are using (or whose husband is using) a contraceptive method by number of living children, Iraq, 2006 .23 Figure 6: Percent distribution of children aged 0-59 months where birth is registered, Iraq, 2006.26 Figure 7: Percentage of children aged 5-14 years who are involved in child labour activities by mother’s education, Iraq, 2006 .27 Figure 8: Percentage of women aged 15-24 years who have comprehensive knowledge of HIV/AIDS transmission, Iraq, 2006.28 6Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CDC Center for Disease Control CEDAW Convention on the Elimination of All Forms of Discrimination against Women COSIT Central Organization for Statistics and Information Technology CRC Convention on the Rights of the Child CSPro Census and Survey Processing System DHS Demographic and Health surveys DPT Diptheria, Pertussis, and Tetanus GPI Gender Parity Index Hep B Hepatitis B HIV Human Immunodeficiency Virus IUD Intrauterine Device KRSO Kurdistan Regional Statistics Office LAM Lactational Amenorrhea Method LAS League of Arab States MDG Millennium Development Goals MENA Middle East and North Africa MICS Multiple Indicator Cluster Survey MICS-2 The second round of the Multiple Indicator Cluster Survey MICS-3 The third round of the Multiple Indicator Cluster Survey MMR Measles, Mumps, and Rubella MOH Ministry of Health NA Not applicable NAR Net Attendance Ratio NCHS National Center for Health Statistics (USA) ORS Oral Rehydration Solution ORT Oral Rehydration Therapy PAPFAM Pan Arab Project for Family Health PPS Probability Proportional to Size PSU Primary Sampling Unit RHF Recommended Home Fluid SD Standard Deviation SPSS Statistical Package for Social Sciences SSD Suleimaniyah Statistical Directorate UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund WFFC World Fit For Children WHO World Health Organization 7Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 PREFACE With due acknowledgement of the huge joint effort rendered by all partners, we are pleased to present the preliminary findings of the Multiple Indicator Cluster Survey (MICS) on key social indicators related to the situation of children and women in Iraq. This survey represents the third round of the Multiple Indicator Cluster Survey (MICS-3) in Iraq. The first MICS was undertaken in 1996, and MICS-2 was completed in 2000. This preliminary report for MICS-3 presents the main findings at the national level for the 18 governorates of Iraq on some of the main topics covered in the overall survey. Further analysis and disaggregated estimates for indicators at the governorate level will be included in the final report. The primary implementers of MICS-3 are Iraq’s Central Organization for Statistics and Information Technology and the statistical offices in Kurdistan Region, in collaboration with the Ministry of Health. The survey was completed with the much appreciated technical and financial support from UNICEF, and complied with the standard methodologies recommended by UNICEF throughout the various stages of preparation, field work and production of results. MICS is a large-scale and truly representative survey, with a sample size of 18,144 households randomly selected from all governorates of Iraq, including the Kurdistan Region. Iraq is one of the first countries in the Middle East and North African region to release its MICS-3 survey findings, despite the huge technical, financial and operational difficulties involved in carrying out such a task during this difficult period of time. That Iraq is able to undertake data collection in this way is indeed an outstanding achievement and testifies to the great spirit of resilience and dedication shared by all partners in the MICS-3 process. It is hoped that the MICS-3 findings will positively contribute to monitoring progress towards implementing major international commitments and goals, including the World Fit for Children (WFFC) goals and the Millennium Development Goals (MDGs). This critical information will enable the Government of Iraq and all its partners to improve policy development for basic services, and prioritize efforts to protect and promote the wellbeing of Iraqi children and women. Ali Ghaleb Baban Minister of Planning and Development Cooperation 8Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 ACKNOWLEDGEMENTS Our children are our flowerbuds of today and our treasure for tomorrow. They are our greatest assets and the Multiple Indicators Cluster Survey (MICS) is an indispensable means of establishing scientific approaches to address the many possible problems facing children and to establish reliable approaches to improve their conditions. We in the Central Organization for Statistics and Information Technology (COSIT) and Kurdistan Regional Statistics Office (KRSO) are both committed to full and active participation in any noble activity on these lines and extend our appreciation to all those who contributed directly or indirectly to the preparation, implementation and the delivery of the findings of the MICS-3. The Iraq Country Office, Headquarters and MENA Regional Office of the United Nations Children's Fund (UNICEF) and their staff should be acknowledged for their efforts in realising this and spending time and energy for advocating, realising and capacity building in this respect. Our sincere thanks and appreciation go to all the employees in the various departments of the COSIT and KRSO who played a major coordinating role throughout the survey. Their contribution has culminated in the successful completion of this important survey and production of reliable results despite the immense difficulties facing our beloved country. We would also like to acknowledge our fruitful partnership with WHO and UNFPA and the valuable technical support of Measure DHS/ ORC Macro and PAPFAM/LAS and their constructive comments and advice provided throughout the various stages of the survey. Dr. Mehdi Alalak and Dr Jamal Ameen Head of COSIT Head of KRSO 9Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Higher National Steering Committee supervising the implementation of the Multiple Indicator Cluster Survey (MICS-3): - Dr. Mehdi Al-Alalak – Director of Central Organization for Statistics and Information Technology (COSIT) – Chairperson - Dr. Mohammed Shuaib – Directorate of Public health and primary Health Care-member - Mr. Loay Haqi Rasheed – Director General of Technical Affairs Directorate / COSIT – member - Ms. Siham Mohammad AbdelHamid – Expert and Manager of Social and Educational Statistics / COSIT - member - Ms. Huda Hadawi Mohammed – Director of Environment Statistics/ COSIT – member - Ms. Eman AbdelWahab- Chief of Statisticians / Directorate of Social and Education Statistics / COSIT – member and decision maker. - Dr. Mohamed Jabr – Deputy Director General of Public Health and Primary Health Care Directorate / Ministry of Health (MOH) – member - Dr. Nagham Mohsen Al-Khafagi – Director of Biostatistics Department / MOH - member - Dr. Hanan Hashem Hasan – Director of Maternal & Child Care Unit / MOH - member - Dr. Thaker Wa’dallah – Specialized doctor / Maternal & Child Care Unit / MOH – member - Mr. Hasan Karim Abbas – Chief Engineer / Ministry of Municipalities and Public Works (MMPW) – member - Mr. Anmar Rashed – Research Director of Planning, Studies & Statistics Dept / Ministry of Labour and Social affairs (MOLSA) – member - Mr. Ali Makki – Director of Education Statistics / Ministry of Education (MOE) – member. IT Committee - Ms. Fawziah Ibrahim – Chief of System Analysis / COSIT – member - Ms. Huda Ajaj – Chief Senior Programmer / COSIT – member - Ms. Suhad Hassan – Assistant Chief Programmer / MOH - Ms. Donya Ibrahim – Engineer / MOH Higher Steering Committee / Kurdistan Region: - Dr. Sahib Qaraman, Head of Regional Statistics Office - Mr. Zirar Haji Merkhan, Director General of Regional Statistics Office - Mr. Mahmud Othman Ma’aruf, Director of Suleimanyah Statistics Office - Dr. Najmuddin Hassan, Director General of Health and Environmental Prevention Affairs, Directorate of Health Suleimanyah United Nations Children’s Fund UNICEF - Staff members from UNICEF Headquarters, Regional Office for Middle East and North Africa region, and Country Office for Iraq International MICS-3 Consultant - Dr. Manar El Sheikh Abdel-Rahman 10Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 I. BACKGROUND AND OBJECTIVES INTRODUCTION This preliminary report is based on the Iraq Multiple Indicator Cluster Survey (MICS-3), conducted in 2006 by the Central Organization for Statistics and Information Technology (COSIT), the Kurdistan Regional Statistics Office (KRSO) and Suleimaniyah Statistical Directorate (SSD), in partnership with the Ministry of Health (MOH). The survey was based, in large part, on the need to monitor progress towards attainment of goals and targets emanating from the recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of ‘A World Fit For Children’, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards the same. UNICEF was assigned a supporting role in this task (see Table 1.1). Table 1.1 A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” As a follow up to the second round of the Multiple Indicator Cluster Survey (MICS2) that was conducted in Iraq in year 2000, UNICEF, in close collaboration with its partners, has supported the conduct of the third round of Multiple Indicator Cluster Surveys (MICS-3). 11Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 MICS is one of the key tools that Governments, UNICEF and its development partners use to monitor ongoing progress towards the realization of children and women’s rights as enunciated in the Convention on the Rights of the Child (CRC) and Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). The data on the indicators covered by MICS are used to measure and report on progress - at the national, regional and global levels - towards the achievement of the goals as enunciated in the ‘World Fit for Children Goals’ (WFFC) and, Millennium Development Goals (MDGs) declarations. Results of Iraq’s MICS-3 will also provide the necessary data and information for the report that the Government of Iraq plans to submit to the UN General Assembly’s Commemorative Session, scheduled in 2007. The national report will cover progress made in Iraq with regards to the implementation of the WFFC goals, whose targets are also milestones to achieving the MDGs. The value of this survey goes beyond the mere generation of data and international reporting purposes. While this preliminary report specifically includes estimates at the national level, the final report will provide disaggregated estimates at subnational levels. The 2006 MICS-3 results should eventually gain special prominence in the development and updating of Iraq’s National Development Strategy and will significantly contribute to the ongoing efforts of the Ministry of Planning and Development Cooperation and the Ministry of Planning in Kurdistan Region, as well as other Iraqi ministries, in formulating effective programmes, plans of actions and policies for children and women that are directed towards expanding inclusion and the reduction of inequalities and poverty. Finally, it is hoped that the MICS-3 findings will contribute significantly towards enriching the deliberations of the planned COMPACT, Donor Conferences, and in ultimately influencing the priorities and resource allocations of the Government, UN agencies, donors and other development partners in Iraq. This preliminary report presents selected results on some of the principal topics covered in the survey and on a subset of indicators1. The results in this report are preliminary and are subject to change, although major changes are not expected. A comprehensive full report is scheduled for publication shortly. SURVEY OBJECTIVES The 2006 Iraq Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Iraq; • To furnish data needed for monitoring progress toward goals established by the Millennium Development Goals and the goals of A World Fit For Children (WFFC) as a basis for future action; • To contribute to the improvement of data and monitoring systems in Iraq and to strengthen technical expertise in the design, implementation and analysis of such systems. 1 For more information on the definitions, numerators, denominators and algorithms of Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) indicators covered in the survey: see Chapter 1, Appendix 1 and Appendix 7 of the MICS Manual – Multiple Indicator Cluster Survey Manual 2005: Monitoring the Situation of Children and Women, also available at www.childinfo.org. 12Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 II. SAMPLE AND SURVEY METHODOLOGY SAMPLE DESIGN The sample for the Iraq Multiple Indicator Cluster Survey was designed to provide estimates on a large number of indicators on the situation of children and women at the national level; for areas of residence of Iraq represented by rural and urban (metropolitan and other urban) areas; for the18 governorates of Iraq; and also for metropolitan, other urban, and rural areas for each governorate. Thus, in total, the sample consists of 56 different sampling domains, that includes 3 sampling domains in each of the 17 governorates outside the capital city Baghdad (namely, a “metropolitan area domain” representing the governorate city centre, an “other urban area domain” representing the urban area outside the governorate city centre, and a “rural area domain”) and 5 sampling domains in Baghdad (namely, 3 metropolitan areas representing “Sadir City”, “Resafa side”, and “Kurkh side”, an other urban area sampling domain representing the urban area outside the three Baghdad governorate city centres, and a sampling domain comprising the rural area of Baghdad). The sample frame for the MICS-3 survey is divided into two separate parts. The first is derived from the 1997 census of Iraq, and covers the 15 Southern governorates. The other one is based on information provided by the Statistical Offices in the Kurdistan Region. Primary sampling units (PSUs) were constructed by merging the majalas/ blocks or villages which comprise the lowest area unit in the frames in urban and rural areas respectively. Nomads, who consist of 0.09 of the total population, were omitted in the frames. The sample was selected in two stages. Within each of the 56 sampling domains, 54 PSUs were selected with linear systematic probability proportional to size (PPS). In some cases it was necessary to segment PSUs using a specified splitting rule. In such cases the size of the segments (number of households) was quick-counted and the selection of segments was done using PPS. After mapping and listing of households were carried out within the selected PSU or segment of the PSU, linear systematic samples of six households were drawn. Cluster sizes of 6 households were selected to accommodate the current security conditions in the country to allow the surveys team to complete a full cluster in a minimal time. The total sample size for the survey is 18144 households. The sample is not self-weighting. For reporting national level results, sample weights are used. QUESTIONNAIRES Three questionnaires were used in the survey. In addition to the household questionnaire which was used to collect information on all household members, an individual woman questionnaire was administered in each household to all women aged 15-49. Mothers or caretakers of under 5 children were identified in each household, and these persons were interviewed using the questionnaire for children under 5. The questionnaires included the following modules: • Household Questionnaire o Household Listing o Education o Water and Sanitation o Household Characteristics o Child Labour o Child Discipline o Disability 13Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 o Salt Iodization • Questionnaire for Individual Women o Marriage o Child Mortality o Birth History o Tetanus Toxoid o Maternal and Newborn Health o Contraception and Unmet Need o Attitude Towards Domestic Violence o HIV/AIDS • Questionnaire for Children Under Five o Birth Registration and Early Learning o Vitamin A o Breastfeeding o Care of Illness o Immunization o Anthropometry The questionnaires were based on the third round of the Multiple Indicator Cluster survey model questionnaires. From the MICS-3 model English version, the questionnaires were revised and customized to suit local conditions and translated into Arabic and Kurdish languages. The Arabic language version of the questionnaire was pre-tested during January 2006 while the Kurdish language version was pre-tested during March 2006. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. FIELDWORK AND PROCESSING Fieldwork, training, and data processing were conducted at consecutive dates for the 15 South/Centre governorates of Iraq and for the Kurdistan Region. All supervisors (from COSIT, KRSO, SSD and MOH) were trained for 14 days in a training of trainers’ workshop in December 2005 in Amman by experts from Measures DHS/ ORC Macro and PAPFAM. These supervisors in turn, trained the interviewers for 10 days in January and February 2006 for Iraq South/Centre governorates and Kurdistan Region respectively. Refresher trainings were carried out prior to start of fieldwork in Kurdistan Region. The data were collected by 167 teams; each was comprised of two interviewers (one female from MOH and one male from COSIT, KRSO, or SSD) except for Baghdad and Al- Anbar governorates which had larger teams. In general, in the South/Centre governorates, groups of three teams were supervised by a local supervisor from the statistical office of each governorate. A central supervisor from the steering committee members and MOH was assigned to each governorate. In Kurdistan Region, groups of three teams were supervised by two local supervisors (one from KRSO/SSD and one from MOH). Two central supervisors from KRSO/SSD and MOH were also assigned to each governorate. A high committee, consisting of members from KRSO/SSD and MOH was also assigned for overall supervision of the survey in Kurdistan. Fieldwork began in the South/Centre governorates of Iraq in February 2006 and concluded in March 2006. In the Kurdistan Region, fieldwork began in Suleimaniyah governorate in April 2006 and was completed in April 2006 while fieldwork was initiated in May 2006 in Erbil/Dohuk governorates and concluded in June 2006. 14Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Questionnaires were edited simultaneously with fieldwork and data were entered on 88 microcomputers (70 in South/Centre governorates and 18 in Kurdistan Region) using the Census and Survey Processing System (CSPro) software. In order to ensure quality control, all questionnaires were entered twice and internal consistency checks were performed. Procedures and standard programs developed under the global MICS-3 project and adapted to Iraq questionnaires were used. Data processing in the South/Centre parts of Iraq began simultaneously with data collection in March 2006 and finished in April 2006. Similarly, in Kurdistan Region, data processing began on April 2006 and finished in June 2006. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program customizing the model syntax and tabulation plans developed for this purpose. SAMPLE COVERAGE One cluster of the 3024 clusters selected was not completed. Of the 18144 households selected for the sample, 18123 were found to be occupied. Of these, 17873 were successfully interviewed for a household response rate of 98.6 percent. In the interviewed households, 27564 women (age 15-49) were identified. Of these, 27186 were successfully interviewed, yielding a response rate of 98.6 percent. In addition, 16570 children under age five were listed in the household questionnaire. Of these, questionnaires were completed for 16469 which correspond to a response rate of 99.4 percent. Overall response rates of 97.3 and 98.0 are calculated for the women’s and under-5’s interviews respectively (Table 1). The Iraq MICS-3 sampled all women of reproductive age. Of the 27186 successfully interviewed women, 15875 women (58 percent) were currently married, 958 women (4 percent) were formerly married, and 10353 women (38 percent) were never married. 15Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 III. RESULTS CHILD MORTALITY One of the overarching goals of the MDGs and the World Fit for Children is to reduce infant and under-five mortality. Monitoring progress towards this goal is an important but difficult objective. The infant mortality rate is the probability of dying before the first birthday. The under five mortality rate is the probability of dying before the fifth birthday. These rates are expressed per 1,000 live births. In this report, infant and under five mortality rates are directly calculated by using information collected from the birth history module of the questionnaire administered to individual women. For all births of the respondent the module collect information on sex, month and year of birth, survivorship status and current age, or, if the child had died, age at death. The under-5 mortality rate for the most recent five-year period (which corresponds to the years 2001-2006) is estimated at 41 deaths per 1,000 births (Table 2). This means that around one in twenty-four children born in Iraq die before reaching the fifth birthday. Eighty five percent of deaths under age five occur in the first year of life; the infant mortality rate is 34 deaths per 1,000 births. The results of the survey show that, as expected, male children are more likely to die in infancy than female children. Differences exist in under-5 mortality and infant mortality by education of the mother. Children born to mothers with no education experience a 32 percent increased risk of dying before their fifth birthday than children born to mothers who had secondary or higher education (49 vs. 37 per 1,000 live births, respectively). This educational advantage is also observed for infant mortality rates with 42 deaths per 1,000 live births to women with no education, compared to only 33 deaths per 1,000 to women with secondary or higher education. Work is in progress to finalize analysis on mortality estimates and more detailed results from the survey will be presented in the final report. NUTRITIONAL STATUS Children’s nutritional status is a reflection of their overall health. Children, who have access to adequate food supply and good nutrition, are less prone to develop infections that lead to repeated illness like diarrhoeal diseases and respiratory infections. These children 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 age five. Undernourishment in a population can be gauged by comparing children to this reference distribution. The reference population used here is the World Health Organization / Center for Disease Control / National Center for Health Statistics (WHO/CDC/NCHS) reference, which is recommended for use by UNICEF and the World Health Organization. Each of the three nutritional status indicators can be 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 or severely underweight while those whose weight for age is more than three standard deviations below the median are classified as severely underweight. 16Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Height for age is a measure of linear growth. Children whose height for age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height for age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Children whose weight for height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Finally, children whose weight for height is more than two standard deviations above the median of the reference population are classified as overweight. Overweight or obesity is a chronic condition that increases the risk of many diseases and health conditions. Individual behaviours, environmental factors and genetics all contribute to the complexity of being overweight. Table 3 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. In Table 3, children who were not weighed and measured and those whose measurements are outside a plausible range are excluded (7 percent). Eight percent of children under age five in Iraq are moderately or severely underweight and one percent are classified as severely underweight (Table 3). Over one-fifth (21 percent) of children are severely or moderately stunted (or too short for their age) and eight percent are severely stunted. Five percent of children are severely or moderately wasted (or too thin for their height) and one percent are severely wasted. 0 5 10 15 20 25 30 0 6 12 18 24 30 36 42 48 54 60 Age (months) Pe rc en t Stunted Underweight Wasted Figure 1: Percentage of children aged 0-59 months who are undernourished, Iraq, 2006 17Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Children in rural areas are more likely to be stunted than other children. Children who live in metropolitan areas are better nourished than those who live in other areas. Looking at educational differentials, as expected those children whose mothers have secondary or higher education are the least likely to be underweight and stunted. Gender differentials are very small. The age pattern shows that a higher percentage of children aged 12-23 months are stunted in comparison to children who are younger and older (Figure 1). Overall, about nine percent of children in Iraq are overweight. BREASTFEEDING Breastfeeding for the first three years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continued breastfeeding with safe, appropriate and adequate complementary feeding up to 2 years of age and beyond. In Table 4, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk and vitamins, mineral supplements, or medicine. The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding (receiving breast milk and solid/ mushy food) of children 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. Only one in four children aged less than six months are exclusively breastfed (25 percent), At age 6-9 months, half of the children are breastfed together with receiving solid or semi-solid foods (51 percent). By age 12-15 months, 68 percent of children are still being breastfed and by age 20-23 months, 36 percent continue breastfeeding. Girls are slightly more likely to be exclusively breastfed and have timely complementary feeding than boys, while boys breastfed slightly longer than girls. Slightly more children living in rural areas (27 percent) are exclusively breastfed compared to urban areas (24 percent). IMMUNIZATION According to national immunization schedule by a first birthday each child in Iraq should receive through routine immunization - a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against Diphtheria, Pertussis, and Tetanus, four doses of polio vaccine, three doses of Hepatitis B (Hep B) and a measles vaccination at the age of 9 months. In addition, a Measles, Mumps, and Rubella (MMR) vaccination is given to children at 15 months of age as part of the second opportunity for measles vaccination to protect against measles, as well as against mumps and rubella. Following the World Health Organization (WHO) guidelines (recommendation) children are considered fully immunized if they receive DPT (1-3 doses), polio (1-3 doses), BCG, and measles vaccines by 12 months of age. For the estimation of fully immunized children, children age 12-23 are considered in this report. Full vaccination indicators incorporating the MMR and Hep B will be included in the final report. Mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the MICS-3 questionnaire. If 18Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio, how many times. Overall, 61 percent of children aged 12-23 months had health cards that were seen by interviewers. A further 24 percent indicated that they had health cards, but were not seen at the time of interview. The percentages of children aged 12 to 23 months who received a BCG and each of three DPT and polio vaccinations, measles vaccinations, and were fully immunized are shown in Table 5. The denominator for the percentages in the table consists of children aged 12-23 months so that only children who were old enough to be fully vaccinated were counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panels, only those who were vaccinated before their first birthday were included. For children without vaccination cards, the proportion of vaccinations given before 12 months was assumed to be the same as for children with vaccination cards. Approximately 91 percent of children aged 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 81 percent. The percentage declines for subsequent doses of DPT to 71 percent for the second dose, and 55 percent for the third dose (Figure 2). Similarly, 86 percent of children received Polio 1 by age 12 months and this percentage declines to 58 percent by the third dose. The coverage for measles vaccine by 12 months is at 54 percent. The percentage of children who had all recommended vaccinations (full vaccination) by age 12 months is 35 percent. The Ministry of Health launched two rounds of national polio campaigns in Iraq during June and July of 2005. The campaigns targeted children 0-59 months of age. Therefore, only children in the MICS-3 sample who were 7 months or more in South/Centre Iraq and children 11 months or more in Kurdistan were exposed to this campaign. 81 91 86 71 76 58 55 35 54 0 20 40 60 80 100 BCG DPT Polio Measles All Pe rc e n t Figure 2: Percentage of children 12-23 months who received immunizations by age 12 months, Iraq, 2006 19Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 6 presents results for children vaccinated in each round and in both rounds of the campaign in South/Centre Iraq and in Kurdistan Region. Overall, 84 percent of children in South/Centre Iraq exposed to the campaign received polio vaccinations at both rounds of campaigns. This percentage is the same for Kurdistan Region. The coverage was more or less similar in urban and rural areas and increased by mother’s educational level. An MMR campaign was also launched in April/May 2005 in Iraq South/Centre governorates and in May of the same year in Kurdistan Region. The MMR campaign targeted children aged 12-60 months born from May 2000 to May 2004 for South/Centre of Iraq and children born from June 2000 to June 2004 for Kurdistan. Thus, only children in the MICS-3 sample currently 20 months or more for South/Centre governorates of Iraq and 23 months or more for Kurdistan were exposed to this MMR campaign. Results of the MMR campaign are presented separately for these two groups of children in Table 7. In South/Centre governorates of Iraq, 68 percent of the children exposed to MMR campaign received an MMR vaccination. The MMR campaign mostly covered children born between 2001 and 2003. Similar to the polio campaigns above, the coverage did not vary by urban and rural areas and increased by mother’s education. A generally similar picture is seen for Kurdistan Region with an overall coverage percentage of 67, although the coverage varied by area of residence with a higher percentage in urban areas (70 percent) compared to rural areas (59 percent). The large proportions of immunized children at these campaigns clearly contribute to the overall protection of these children against these diseases. ORAL REHYDRATION THERAPY Dehydration caused by diarrhoea is a major cause of mortality and morbidity among Iraqi children. Dehydration is caused by loss of large quantities of water and electrolytes from the body in liquid stools. Oral rehydration therapy (ORT) – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. RHF are fluids which have electrolytes usually made from sugar, salt and water. Mothers or caretakers were asked to report whether their child had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child drank and ate during the episode. In this survey questions were asked about the following oral homemade treatments: drinking water, rice water, vegetable soup, yogurt drink and fruit juice. None of these homemade treatments is considered as RHF and thus the ORT indicator is based on use of ORS only. Overall, 13 percent of children under-five years of age had diarrhoea in the two weeks preceding the survey (Table 8). The peak diarrhoea prevalence occurred among children aged 6-11 months. Table 8 also shows the percentage of children receiving various types of 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. Drinking water (84 percent) was the most commonly cited fluid, followed by yoghurt drinks (46 percent) and fruit juice (42 percent). Almost one third of the children (31 percent) received ORS (i.e. ORT) while they had diarrhoea. This percentage did not vary much by sex or area of residence. Use of ORS did not vary steadily with age of child (Figure 3). The age group 6-11 months had the highest percentage of ORS use. 20Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 25.5 37.4 32.4 32.1 25.3 26.1 0 5 10 15 20 25 30 35 40 <6 6-11 12-23 24-35 36-47 48-59 Pe rc e n t HOME MANAGEMENT OF DIARRHOEA Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are important strategies for managing diarrhoea. About one quarter (23 percent) of under-five children with diarrhoea drank more than usual while 76 percent drank the same or less (Table 9). Sixty seven percent ate somewhat less, same or more (continued feeding), but 32 percent ate much less or ate almost none. Given these figures, only 15 percent children received increased fluids and at the same time continued feeding. Combining the information in Table 9 with those in Table 8 on oral rehydration therapy, it is observed that 64 percent of children either received ORT or fluid intake was increased, and at the same time, feeding was continued, as is the recommendation. The home management of diarrhoea varies by sex, where males were more likely to receive or increased fluids and continued feeding (66 percent) than females (61 percent). In rural areas 67 percent of children received ORT or increased fluids and continued feeding compared to 62 percent in urban areas. Within urban areas, the percentage of children in metropolitan areas who received ORT or increased fluids and continued feeding (57 percent) is less than children in other urban areas (69 percent). The home management of diarrhoea varied by age of the child, with the highest percentage observed for the 24-35 months age group (75 percent) and the lowest percentage observed for the 0-11 months age group (54 percent). Differentials by mother’s educational level varied, with children of mothers with secondary or higher education receiving the least percentage of receiving ORT or increased fluids and continued feeding. Figure 3: Percentage of children aged 0-59 months with diarrhoea who received the recommended oral rehydration therapy, Iraq, 2006 21Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 ANTIBIOTIC THERAPY OF CHILDREN WITH SUSPECTED PNEUMONIA Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were due to a problem in the chest and not solely a blocked nose. Information was collected for children who had suspected pneumonia as to whether or not they had received an antibiotic within the previous two weeks. Table 10 presents the percentage of children aged 0-59 months with suspected pneumonia in the last two weeks before the survey and the use of antibiotics for the therapy of this pneumonia by sex, age, residence, age, mother’s education. In Iraq, 13 percent of the children surveyed had suspected pneumonia. Although this percentage did not vary in urban and rural areas, Metropolitan areas had a higher percentage of suspected pneumonia (15 percent) compared to other urban areas (12 percent). The prevalence of suspected pneumonia varied by age of the child, with the highest percentage observed for the 12-23 months age group (16 percent). Overall, 82 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. The table also shows that antibiotic therapy of suspected pneumonia is lower among children from rural households and children whose mothers/caretakers have no education than among other children. The use of antibiotics is more or less similar for different age groups of the child, with the least use of antibiotics observed for older children aged 48-59 months (79 percent). SOLID FUEL USE Cooking with solid fuels (biomass and coal) leads to high levels of indoor pollution and is a major cause of ill-health in the world, particularly among under-5 children, in the form of acute respiratory illness. Table 11 shows that overall, only about five percent of all households in Iraq are using solid fuels for cooking. Use of solid fuels is negligible in urban areas (0.6 percent), but increases in rural areas, with 13 percent of the households using solid fuels. Differentials with respect to educational level of the household head are significant – nine percent for no education, five percent for primary education, and two percent for secondary education or higher. The table also shows that about half households use of solid fuel comes from the use of wood for cooking purposes. WATER AND SANITATION Safe drinking water is a basic necessity for good health and also a human right. Unsafe drinking water can be a significant carrier of diseases such as cholera, typhoid, and diarrhoeal diseases such as amoebic and bacillary dysentery. Drinking water can also be contaminated with chemical, physical and radiological contaminants with potentially harmful effects on 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, who bear the primary responsibility for carrying water, often for long distances. The distribution of the population by source of drinking water is shown in Table 12 and Figure 4. The population using improved drinking water sources are those who use any of the following types of supply: piped water, public tap, borehole/ tube well, protected well, protected spring or rainwater. Overall, 79 percent of the population has access to improved drinking water sources – 92 percent in urban areas and only 57 percent in rural areas. The 22Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 above figures do not reflect the condition and reliability of the main drinking water sources. Based on a question in the survey about the reliability of the drinking water source, results show that nearly half (48%) of those who have access to improved drinking water sources indicated problems with the condition of services. Twenty one percent of the respondents reported problems on a daily basis, while 19 percent, and nine percent indicated less than weekly and weekly problems respectively (Table not shown). Two-thirds of the households have water piped into their dwellings (65 percent). Water supply sources from surface water and tanker truck are the main unimproved sources of drinking water, mostly occurring in rural areas. The source of drinking water for the population varies strongly by area of residence (Table 12). In the rural areas, only 47 percent of the population uses drinking water that is piped into their dwelling or into their yard or plot. In the metropolitan areas and other urban areas, 90 and 89 percent, respectively, use piped water. Piped into dwelling 65% Piped into yard 9% Public tap 1% Protected well 2% Tanker-truck 5% Surface water 7% Other 11% Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities include: flush toilets connected to sewerage systems or septic tanks or pit latrines, ventilated improved pit latrines and pit latrines with slabs, and composting toilets. Respondents in Iraq MICS-3 using flush toilets connected to sewerage systems or septic tanks or pit latrines were asked about the functionality of the sewerage systems around their house by indicating whether they have no problems, occasional, weekly, or daily problems. Overall, 92 percent of the population of Iraq is living in households using improved sanitation facilities (Table 13) with 87 percent of the population using flush toilets connected to sewerage systems or septic tanks or pit latrines. The percentage of households using improved sanitation facilities is 98 percent in urban areas and 82 percent in rural areas. The above figures do not reveal the situation on the ground, as 40 percent of the respondents indicated problems with the functionality of the sewage system around their house (Table not shown). The use of improved sanitation is similar at metropolitan areas and other urban areas. The most common improved sanitation facility in urban areas is flush toilet connected to septic tank (43 percent), while toilets flushed to pit (latrine) are most common in rural areas (36 percent). Figure 4: Percent distribution of the population by source of drinking water, Iraq, 2006 23Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 CONTRACEPTION Current use of contraception of currently married women or husbands of these women was reported by half the women (50 percent) (Table 14). Of these, 33 percent are using modern methods and 17 percent are using traditional methods. The most popular method is the pill which is used by 15 percent of married women in Iraq. The next most popular method is Intrauterine Device (IUD), which accounts for 12 percent of married women. Eight and seven percent of women reported use of the withdrawal method and the lactational amenorrhea method (LAM) respectively. Between two and three percent of women reported use of female sterilization, periodic abstinence and injectables. Condom use is very rare; only one percent of married women reported using it as a method of contraception. Younger women are less likely to use contraception than older women. Only about 21 percent of married women aged 15-19 currently use a method of contraception compared to 36 percent of 20-24 years old and 64 percent of 40-44 years old women. The use of any contraceptive method is negligible when the woman has no living children (one percent). The greater the number of living children a woman has the more likely she is to use contraceptives - the contraceptive use rate rises from 34 percent for women with one living child to 65 percent for women with four or more living children (Figure 5). 0 1 2 3 4+ 1.1 34 53.6 60.8 65 0 20 40 60 Pe r c e n t Women’s education level is associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 45 percent among those with no education to 48 percent among women with primary education, and to 55 percent among women with secondary or higher education. A small number of women had a non-standard curriculum educational level (i.e. went to schools that did not teach a full standard school curriculum) with a 47 percent of them using any method of contraception. The method mix varies by education. Contraceptive users with secondary or higher education are more likely Figure 5: Percentage of women aged 15-49 years currently married who are using (or whose husband is using) a contraceptive method by number of living children, Iraq, 2006 24Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 to use the pill and IUD (32 percent) compared with those with no or primary education users (23 and 25 percent, respectively). ASSISTANCE AT DELIVERY The provision of delivery assistance by skilled attendants can greatly improve outcomes for mothers and infants by the use of technically appropriate procedures and accurate and speedy diagnosis and therapy of complications. Skilled assistance at delivery is defined as assistance provided by a doctor, nurse, or certified midwife. Eighty-nine percent of births occurring in the two years prior to the Iraq MICS-3 survey were delivered by skilled personnel (Table 15). This percentage is more in urban areas (95 percent) than rural areas (78 percent). The more educated a woman is the more likely she is to have delivered with the assistance of a skilled person. More than half of births (55 percent) in the two years prior to the Iraq MICS-3 survey were delivered with assistance of a doctor. Certified midwifes assisted with the delivery of a quarter of births (25 percent), uncertified midwifes assisted with five percent of the births, nurses assisted with nine percent of the births, and traditional birth attendants referred to as “gida” in Iraq assisted with six percent of births. Younger women were more assisted by doctors than older women. In contrast, older women were more assisted by midwifes than younger women. DELIVERY IN A HEALTH FACILITY Overall, approximately 2 out of 3 births occurring in the two years prior to the Iraq MICS-3 survey were delivered in a health facility (63 percent) (Table 15). More births are delivered in health facilities in urban areas (68 percent) than in rural areas (54 percent). Very young and older women were more to deliver their births in a health facility compared to women in the middle age group 30-39. Delivery in a health facility increases with a woman’s educational level – only about half of the uneducated women delivered in a health facility (52 percent), compared with 61 percent for women with primary education and 72 percent for women with secondary or higher education. PRIMARY SCHOOL ATTENDANCE Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. Overall, 5 in 6 children of primary school age in Iraq are attending primary school or secondary school (83 percent) (Table 16). In urban areas, 89 percent of children attend school while in rural areas 75 percent attend. The school attendance increases with mother’s education – 92 percent for mothers with secondary or higher education, 84 percent for mothers with primary education, and 72 percent for mothers with no education. Males have a higher school attendance (87 percent) when compared to females (79 percent). The ratio of girls to boys attending primary and secondary education is provided in Table 17. The table shows that gender parity for primary school is 0.91, indicating that more boys attend primary school compared to girls. The indicator drops to 0.79 for secondary education indicating that for every 100 boys attending secondary school 79 girls attend. The 25Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 disadvantage of girls is particularly pronounced in the rural areas where the gender parity for primary school is 0.83 and gender parity for secondary school is 0.44. Gender parity in metropolitan areas was slightly higher than that of other urban areas. Also gender parity increased with mother’s education. PRIMARY SCHOOL COMPLETION AND TRANSITION TO SECONDARY EDUCATION Improvements of the education system coverage and students educational attainment are regarded as important aspects of the national progress towards the Millennium Development Goal of universal primary completion. Table 18 presents the primary completion rate and the net primary completion rate. The primary completion rate considers the number of children of all ages who are completing the final year of primary education, as a percentage of the population of the official primary school graduation age. The net rate is calculated as the number of children of primary school completion age who are completing the final year of primary education as a percentage of the population of the official primary school graduation age. In Iraq the primary school cycle spans 6 years with children officially entering primary school at 6 years and officially graduating at 11 years. Results show that the primary completion rate is 79 percent. The primary completion rate varies within sex and area of residence. Boys have a higher rate (90 percent) than girls (68 percent) and urban areas have a higher rate (88 percent) than rural areas (65 percent). This indicates attendants of more boys of all ages than girls and more children of all ages in urban areas than in rural areas at the 6th grade. The primary completion rate also increases with mothers’ education. About 30 percent of Iraqi children of primary graduation age (11 years) are attending the 6th grade at age 11 years. There is no difference in the rate between boys (30 percent) and girls (30 percent) and the difference observed in the primary completion rate is due to the fact that the majority of children over age 11 years at the time of the survey attending the 6th grade of primary school are boys. The net completion rate is greater in urban areas (36 percent) compared to rural areas (21 percent) and the rate increases markedly with mothers’ education. Comparing the primary completion rate (79 percent) with the net completion rate (30 percent) indicates the presence of children who are over age 11 years at the time of the survey at the 6th grade. The transition rate to secondary education is also shown in Table 18. In Iraq, 78 percent of children who were in the 6th grade of primary school last year attended the first grade of secondary school this year. The percentage is higher for girls (82 percent) than boys (76 percent) and for urban areas (82 percent) than rural areas (70 percent). The rate is associated positively with mothers’ education. 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 95 percent of children under-five years in Iraq have been registered (Table 19). There are no significant variations in birth registration across sex or mother’s education categories. Older children are more likely to have been registered than younger children. 26Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 88.5 95.2 95.7 97.9 98.9 80 85 90 95 100 0-11 12-23 24.35 36-47 48-59 Pe r c e n t CHILD LABOUR The Convention on the Rights of the Child calls for protections of children against abuse, exploitation and violence. 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. In addition, work can expose them to health, mental, or social development problems. In addition to exploiting children and contributing to long term poverty and further disadvantage, child labour increases the risk of exposure to sexual abuse, physical violence and abuse accidents which lead to permanent disabilities. The child labour module asks a series of questions to the mother/caretaker of each child in the household 5-14 years of age about the kind of work a child does and for how many hours. Data is also collected on economic activities and domestic work. Economic activities include paid or unpaid work for someone who is not a member of the household and work for a family farm or business. Domestic work includes household chores like collecting firewood, fetching water, cooking, cleaning, looking after animals/livestock, or caring for children. Child labour is defined as work that exceeds a minimum number of hours, depending on the age of a child and on the type of work. For ages 5-11, children are considered to be involved in child labour if during the week preceding the survey did at least one hour of economic activity or at least 28 hours of domestic chores. For ages 12-14, this involves at least 14 hours of economic activity or at least 28 hours of domestic chores. In Iraq, the MICS-3 survey estimates that about 1 in 9 children aged 5-14 years work (11 percent) (Table 20). A higher percentage of children work in the rural areas (18 percent) compared to the urban areas (6 percent). Boys (12 percent) work more than girls (9 percent). Child labour rates are slightly higher among the age group 12-14 (12 percent) when compared to the younger age group 5-11 years (10 percent). The results also show that Figure 6: Percent distribution of children aged 0-59 months where birth is registered, Iraq, 2006 27Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 children who work are less likely to participate in schools – 10 percent participate in school and 14 percent do not. Table 20 also shows that only one percent of children 5-14 years engage in paid work. Two percent of these children participate in unpaid work for someone other than a household member, an equal percentage of children do household chores for 28 hours or more per week, while a higher percentage of children work for family business (7 percent). Involvement of Iraqi children decreases as mother’s education increases (Figure 7). None Prim ary Secondary+ 14.4 10.9 6.6 0 5 10 15 Pe rc en t EARLY MARRIAGE Child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. Women married at younger ages are more likely to dropout of school, experience higher levels of fertility, domestic violence and maternal mortality. The percentage of women married at various ages is provided in Table 21. About one in five young women aged 15-19 years is currently married (19 percent). This proportion does not vary much between urban (19 percent) and rural areas (20 percent), but is strongly related to the mother’s education. Five percent of women aged 15-49 years were married before age 15 while 23 percent of women aged 20-49 years were married before age 18. Examining the age pattern for women aged 20-49 years, it is clear that the prevalence of early marriage age has declined over time; for example, 34 percent of women age 45-49 were married before their 18th birthday compared to 17 percent of women age 20-24. Figure 7: Percentage of children aged 5-14 years who are involved in child labour activities by mother’s education, Iraq, 2006 28Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 KNOWLEDGE OF HIV/AIDS TRANSMISSION One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect them from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal. The survey results showed that the most common misconceptions in the country are (1) sharing food can transmit HIV and (2) people can get the aids virus from mosquito bites. Table 22 presents the percentage of women 15-49 years who know 2 ways of preventing HIV transmission. Knowledge of HIV prevention methods is very low although there are large differences by area of residence. Overall, only 1 in 8 women report knowing two prevention methods (13 percent). In urban areas 17 percent of women identified two methods compared to only six percent in rural areas. Knowledge of HIV prevention methods is more in metropolitan areas (18 percent) than other urban areas (14 percent). As expected, the percentage of women who know two prevention methods significantly increases with women’s education level. 0.2 None 4.0 Urban 0.7 Primary 0.9 Rural 6.3 Secondary+ 0 2 4 6 Area Education Pe rc e n t A key indicator used to measure countries’ responses to the HIV epidemic is the proportion of young women 15-24 years who have comprehensive knowledge of HIV i.e. know two methods of preventing HIV, reject two common misconceptions and know that a healthy looking person can have HIV. Table 23 presents the percentage of women who have comprehensive knowledge of HIV for the age group 15-24 years. Only two percent of young women have comprehensive correct knowledge of HIV. Area of residence is highly associated with comprehensive knowledge of HIV among women of this age group, with greater knowledge for urban women (3 percent) compared to rural women (less than one percent) (Figure 8). Level of education is also positively associated with comprehensive Figure 8: Percentage of women aged 15-24 years who have comprehensive knowledge of HIV/AIDS transmission, Iraq, 2006 29Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 knowledge with a four percent comprehensive knowledge of HIV for women with secondary or higher education compared to less than one percent for women with primary or no education. ORPHANS SCHOOL ATTENDANCE Due to the increase of violence and displacement in Iraq, more and more children are becoming orphaned. Children who are orphaned or living away from their parents may be at increased risk of neglect or exploitation if their parents are not available to assist and protect them. Monitoring the variations in educational outcomes for children who have lost both parents (double orphans) versus children whose parents are alive (and who live with at least one of these parents) is one way to ensure that children’s rights are being met even after their parents have died or are no longer able to care for them. In Iraq, about eight percent of children aged 10-14 are orphans who have lost one parent (Table 24). The percentage of orphans is greater in urban areas (8 percent) than in rural areas (7 percent). One percent of children aged 10-14 have lost both parents. Among those only 64 percent are currently attending school. Among the children aged 10-14 who have not lost a parent and who live with at least one parent, 76 percent are attending school. This would suggest that the double orphans have a disadvantage to the non-orphaned children with a ratio of orphans to non-orphans school attendance ratio of 0.84. 30Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 1: Results of household and individual interviews Number of households, women, and children under 5 by results of the household, women's and under-five's interviews, and household, women's and under-five's response rates, Iraq, 2006 Residence Urban Urban Metropolitan Other Urban Rural Total Number of households Sampled 12312 6480 5832 5832 18144 Occupied 12300 6472 5828 5823 18123 Interviewed 12113 6356 5757 5760 17873 Response rate 98.5 98.2 98.8 98.9 98.6 Number of women Eligible 18626 9840 8786 8938 27564 Interviewed 18381 9709 8672 8805 27186 Response rate 98.7 98.7 98.7 98.5 98.6 Overall response rate 97.2 96.9 97.5 97.4 97.3 Number of children under 5 Eligible 10203 5132 5071 6367 16570 Mother/Caretaker interviewed 10131 5097 5034 6338 16469 Response rate 99.3 99.3 99.3 99.5 99.4 Overall response rate 97.8 97.5 98.1 98.5 98.0 31Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 2: Child mortality Infant and under-five mortality rates for the 5 year period preceding the survey, Iraq, 2006 Under-five mortality rate (per thousand)* Infant mortality rate (per thousand)** Sex Male 44 37 Female 37 32 Residence Urban 41 34 Metropolitan 37 31 Other urban 46 38 Rural 41 34 Mother’s education None 49 42 Primary 40 32 Secondary + 37 33 Total 41 34 * MICS indicator 1; MDG indicator 13 ** MICS indicator 2; MDG indicator 14 32Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Percentage of children aged 0-59 months who are severely or moderately malnourished, Iraq 2006 Weight for age Height for age Weight for height % below % below % below % below % below % below % above - 2 SD* - 3 SD* - 2 SD** - 3 SD** - 2 SD*** - 3 SD*** + 2 SD Number of children aged 0-59 months Sex Male 7.9 1.4 22.1 8.0 5.4 1.2 8.5 7782 Female 7.3 1.4 20.6 7.0 4.1 1.2 10.3 7533 Residence Urban 7.1 1.2 19.4 6.4 4.8 1.1 8.5 9216 Metropolitan 6.0 .9 17.3 5.4 4.1 1.0 7.6 5306 Other urban 8.6 1.5 22.3 7.8 5.7 1.3 9.7 3911 Rural 8.4 1.8 24.4 9.2 4.8 1.3 10.7 6100 Age < 6 months 4.1 .5 13.6 3.6 6.3 1.6 17.1 1330 6-11 months 8.4 2.1 15.3 5.2 6.2 1.6 11.6 1633 12-23 months 9.1 2.0 26.0 10.1 5.3 1.7 10.3 3255 24-35 months 7.7 1.6 22.1 8.1 4.7 1.0 7.4 3090 36-47 months 7.7 1.2 22.4 7.7 3.9 .7 8.2 3056 48-59 months 6.8 .8 21.4 6.8 3.8 1.0 7.0 2952 Mother’s education § None 9.4 1.8 24.0 8.9 5.3 1.3 8.6 2975 Primary 7.7 1.4 22.3 7.4 4.7 1.3 9.7 7446 Secondary + 6.2 1.2 18.0 6.8 4.6 1.0 9.5 4776 Non-standard curriculum 15.0 2.7 28.9 6.4 6.6 2.0 7.1 117 Total 7.6 1.4 21.4 7.5 4.8 1.2 9.4 15316 * MICS indicator 6; MDG indicator 4 ** MICS indicator 7 *** MICS indicator 8 § 2 un-weighted cases with “missing/ don’t know mother’s education” not shown Table 3: Child malnourishment 33Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 4: Breastfeeding Percentage of living children according to breastfeeding status at each age group, Iraq, 2006 Children 0-3 months Children 0-5 months Children 6-9 months Children 12-15 months Children 20-23 months Percent exclusively breastfed Number of children Percent exclusively breastfed* Number of children Percent receiving breast milk and solid/ mushy food** Number of children Percent breastfed*** Number of children Percent breastfed*** Number of children Sex Male 30.8 556 23.5 808 49.3 557 68.3 682 36.2 586 Female 37.3 523 26.7 820 52.6 614 66.8 597 35.2 536 Residence Urban 32.5 664 23.7 1028 51.1 723 63.7 733 36.0 669 Metropolitan 33.8 407 25.5 608 49.4 427 59.4 393 34.7 399 Other urban 30.3 257 21.2 420 53.5 296 68.6 340 38.0 270 Rural 36.3 415 27.4 600 50.9 448 72.9 545 35.2 453 Mother’s education § None 36.1 183 25.4 289 47.0 190 65.1 259 43.6 208 Primary 34.2 563 25.2 853 53.3 582 69.1 625 32.8 549 Secondary + 32.1 329 24.3 481 49.4 394 66.5 389 35.7 361 Total 33.9 1080 25.1 1628 51.0 1171 67.6 1278 35.7 1122 * MICS indicator 15 ** MICS indicator 17 *** MICS indicator 16 § 5-8 un-weighted cases with “non-standard curriculum” not shown 34Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 5: Vaccinations in first year of life Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Iraq, 2006 Percentage of children who received: DPT Polio BCG * 1 2 3 ** 0 1 2 3 *** Measles **** All None ***** Number of children aged 12-23 months Vaccinated at any time before the survey According to: Vaccination card 60.0 54.6 47.4 40.9 60.0 54.9 47.2 40.6 38.2 36.6 0.2 3560 Mother’s report 31.1 27.9 25.8 18.8 23.8 33.2 30.9 22.3 21.8 9.3 5.4 3560 Either 91.1 82.6 73.2 59.7 83.7 88.1 78.1 62.9 60.0 45.8 5.7 3560 Vaccinated by 12 months of age 90.6 81.0 70.9 54.9 83.3 86.4 75.7 58.0 54.0 35.4 5.7 3560 * MICS indicator 25 ** MICS indicator 27 *** MICS indicator 26 **** MICS indicator 28; MDG indicator 15 ***** MICS indicator 31 35Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 6: Vaccinations under Polio national campaign Percentage of children who were exposed to Polio campaign rounds and were vaccinated against Polio during vaccination campaign, South/Centre Iraq and Kurdistan Region, 2006 Polio campaign round in June Polio campaign round in July Both polio campaign rounds Number of children Polio campaign round in June Polio campaign round in July Both polio campaign rounds Number of children children age 7-59 months, South/Centre Iraq children age 11-59 months, Kurdistan Region Residence Urban 86.1 86.8 84.7 7427 87.1 85.3 84.1 1135 Metropolitan 87.5 88.1 86.0 4418 86.6 83.1 82.7 485 Urban-other 84.1 84.8 82.7 3010 87.4 87.0 85.2 650 Rural 85.1 85.0 83.4 5444 85.8 86.5 84.7 424 Mother’s education §§ None 83.7 83.1 81.2 2215 83.7 83.9 83.1 665 Primary 85.9 86.6 84.6 6366 87.4 84.7 82.9 629 Secondary + 86.2 86.4 84.8 4189 92.8 91.9 90.3 252 Non-standard curriculum 97.8 97.8 97.8 99 § § § 14 Age 7-11 months 47.3 58.5 45.6 1336 NA NA NA NA 12-23 months 83.9 82.7 81.3 3146 76.2* 75.6* 72.2* 462* 24-35 months 91.2 90.4 90.0 2841 90.6 89.9 88.9 373 36-47 months 92.5 91.7 91.4 2808 91.8 89.8 89.7 374 48-59 months 93.9 92.9 92.8 2740 91.0 89.9 89.5 351 Total 85.7 86.0 84.1 12872 86.7 85.6 84.3 1560 * Age group 11-23 months § Figure is based on fewer than 25 un-weighted cases and has been suppressed §§ 2 un-weighted cases of children in South/Centre Iraq with “missing/ don’t know mother’s education” not shown 36Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 7: Vaccinations under MMR (Measles- Mumps-Rubella) national campaign Percentage of children who were exposed to MMR campaign and were vaccinated against MMR during vaccination campaign, South/Centre Iraq and Kurdistan Region, 2006 MMR Number of children exposed to MMR campaign MMR Number of children exposed to MMR campaign South/Centre Iraq Kurdistan Region Residence Residence Urban 67.8 5222 Urban 69.8 824 Metropolitan 67.0 3111 Metropolitan 67.3 351 Other urban 69.1 2110 Urban-other 71.7 473 Rural 67.2 3862 Rural 58.5 306 Mother's education §§ Mother's education None 64.3 1591 None 65.2 483 Primary 66.9 4472 Primary 67.7 447 Secondary + 69.9 2937 Secondary + 68.2 188 Non-standard curriculum 81.8 82 Non-standard curriculum § 12 Age cohorts Age cohorts 2/2001 - 1/2002 74.3 2416 6/2001 - 5/2002 73.5 345 2/2002 - 1/2003 71.1 2790 6/2002 - 5/2003 66.9 379 2/2003 - 1/2004 65.3 2841 6/2003 - 6/2004 60.9 407 2/2004 - 5/2004 48.6 1037 Total 67.6 9084 Total 66.7 1131 § Figure is based on fewer than 25 un-weighted cases and has been suppressed §§ 2 un-weighted cases of children in South/Centre Iraq with “missing/ don’t know mother’s education” not shown 37Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 8: Oral rehydration therapy Percentage of children aged 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral treatments, Iraq, 2006 Children with diarrhoea who received: Had diarrhoea in last two weeks Number of children aged 0- 59 months Fluid from ORS packet Drinking water Rice water Vegetable soup Yogurt drink Fruit juice No treatment ORT Use Rate * Number of children aged 0- 59 months with diarrhoea Sex Male 13.7 8359 30.1 84.7 35.4 29.5 45.8 43.0 6.3 30.1 1146 Female 12.3 8110 31.4 83.4 34.4 29.0 47.4 40.8 7.1 31.4 996 Residence Urban 13.3 9865 29.8 86.1 33.6 28.2 42.3 45.5 7.7 29.8 1315 Metropolitan 13.2 5661 25.5 86.8 28.9 28.8 42.9 48.6 7.2 25.5 748 Other urban 13.5 4204 35.6 85.0 39.9 27.5 41.5 41.4 8.5 35.6 567 Rural 12.5 6604 32.0 80.9 37.0 30.8 53.4 36.3 5.0 32.0 827 Age < 6 months 14.8 1628 25.5 67.9 17.0 5.3 8.8 17.9 20.3 25.5 241 6-11 months 20.2 1794 37.4 85.0 42.0 31.4 40.1 34.8 6.1 37.4 363 12-23 months 16.9 3560 32.4 87.1 37.3 35.7 52.0 47.2 4.5 32.4 601 24-35 months 12.4 3214 32.1 86.0 33.9 29.9 61.1 44.4 3.9 32.1 398 36-47 months 10.0 3182 25.3 82.1 35.6 28.6 48.7 47.6 7.5 25.3 317 48-59 months 7.2 3092 26.1 91.6 37.5 34.2 54.2 53.3 2.4 26.1 223 Mother’s education §§ None 15.2 3245 28.9 78.7 35.5 26.6 50.9 31.3 9.8 28.9 492 Primary 13.6 8051 33.0 83.9 32.3 27.6 46.1 41.3 5.8 33.0 1091 Secondary + 10.9 5051 27.5 89.2 39.7 34.9 43.9 52.8 5.5 27.5 550 Non-standard curriculum 7.5 120 § § § § § § § § 9 Total 13.0 16469 30.7 84.1 34.9 29.3 46.6 42.0 6.7 30.7 2142 * MICS indicator 33 § Figure is based on fewer than 25 un-weighted cases and has been suppressed §§ 2 un-weighted cases of children 0-59 months with “missing/ don’t know mother’s education” not shown 38Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 9: Home management of diarrhoea Percentage of children aged 0-59 months with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode, Iraq, 2006 Children with diarrhoea who: Had diarrhoea in last two weeks Number of children aged 0-59 months Drank more Drank the same or less Ate somewhat less, same or more Ate much less or none Home manage- ment of diarrhoea* Received ORT or increased fluids AND continued feeding** Number of children aged 0-59 months with diarrhoea Sex Male 13.7 8359 21.4 77.6 68.8 30.1 14.8 66.0 1146 Female 12.3 8110 23.8 74.8 64.6 34.3 15.8 61.4 996 Residence Urban 13.3 9865 22.2 76.4 65.7 33.0 15.1 62.0 1315 Metropolitan 13.2 5661 24.3 74.9 61.0 38.0 15.6 56.8 748 Other urban 13.5 4204 19.5 78.4 72.0 26.5 14.5 68.9 567 Rural 12.5 6604 23.0 76.0 68.6 30.5 15.6 66.8 827 Age 0-11 months 17.6 3422 17.9 81.0 59.6 38.6 11.3 53.5 603 12-23 months 16.9 3560 28.2 71.0 62.9 36.7 17.0 61.8 601 24-35 months 12.4 3214 20.5 78.7 76.4 23.2 17.1 74.7 398 36-47 months 10.0 3182 24.3 73.7 72.8 25.6 18.4 68.5 317 48-59 months 7.2 3092 20.5 77.1 71.4 26.7 13.9 71.1 223 Mother’s education §§ None 15.2 3245 28.7 69.8 71.2 26.9 19.0 66.4 492 Primary 13.6 8051 21.0 77.8 68.5 30.4 15.4 66.1 1091 Secondary + 10.9 5051 20.0 79.2 59.6 39.9 11.8 56.9 550 Non-standard curriculum 7.5 120 § § § § § § 9 Total 13.0 16469 22.5 76.3 66.8 32.0 15.3 63.8 2142 * MICS indicator 34 ** MICS indicator 35 § Figure is based on fewer than 25 un-weighted cases and has been suppressed §§ 2 un-weighted cases of children 0-59 months with “missing/ don’t know mother’s education” not shown 39Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 10: Antibiotic therapy of suspected pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, Iraq, 2006 Had suspected pneumonia in the last two weeks Number of children aged 0-59 months Percentage of children aged 0-59 months with suspected pneumonia who received antibiotics in the last two weeks* Number of children aged 0-59 months with suspected pneumonia in the two weeks prior to the survey Sex Male 14.4 8359 80.9 1206 Female 12.4 8110 83.2 1006 Residence Urban 13.5 6604 84.5 1323 Metropolitan 14.5 5661 83.3 822 Other urban 11.9 4204 86.6 501 Rural 13.5 6604 78.2 890 Age 0-11 months 15.5 3422 83.0 530 12-23 months 16.0 3560 81.1 570 24-35 months 13.2 3214 84.2 423 36-47 months 12.5 3182 81.8 399 48-59 months 9.4 3092 78.9 291 Mother’s education §§ None 12.0 3245 75.9 389 Primary 13.8 8051 83.2 1114 Secondary + 13.7 5051 83.7 694 Non-standard curriculum 12.6 120 § 15 Total 13.4 16469 82.0 2213 * MICS indicator 22 § Figure is based on fewer than 25 un-weighted cases and has been suppressed §§ 2 un-weighted cases of children 0-59 months with “missing/ don’t know mother’s education” not shown 40Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 11: Solid fuel use Percent distribution of households according to type of cooking fuel, and percentage of households using solid fuels for cooking, Iraq, 2006 Percentage of households using: Electricity Liquefied Petroleum Gas (LPG) Kerosene Coal, lignite Wood Straw, shrubs, grass Animal dung /Agricultural crop residue Other source Total Solid fuels for cooking* Number of households Residence Urban 0.2 92.2 7.0 0.0 0.3 0.2 0.0 0.0 100.0 0.6 12048 Metropolitan 0.3 93.0 6.6 0.0 0.1 0.1 0.0 0.0 100.0 0.2 7284 Other urban 0.2 90.9 7.7 0.0 0.7 0.5 0.0 0.0 100.0 1.2 4764 Rural 0.2 74.1 12.8 0.3 5.9 4.6 2.1 0.1 100.0 12.9 5825 Education of household head § None 0.2 79.0 11.5 0.2 4.6 3.0 1.4 0.0 100.0 9.3 4161 Primary 0.1 83.7 10.9 0.1 2.3 2.0 0.8 0.0 100.0 5.2 5503 Secondary + 0.3 91.7 6.2 0.0 0.8 0.8 0.3 0.0 100.0 1.8 8205 Total 0.2 86.3 8.9 0.1 2.1 1.7 0.7 0.0 100.0 4.6 17873 * MICS indicator 24; MDG Indicator 29 § 5 un-weighted cases with “missing/ don’t know household head education” not shown 41Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 12: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Iraq, 2006 Main source of drinking water Improved sources Unimproved sources Piped into dwelling Piped into yard/ plot Public tap/ stand- pipe Tube- well/ bore- hole Pro- tected well Pro- tected spring Rain- water Bottled water1 Unpro- tected well Unpro- tected spring Tanker truck Cart with tank/ drum Surface water Bottled water1 Other Total Improved source of drinking water* Number of household members Residence Urban 83.2 6.6 0.2 0.3 0.5 0.0 0.0 1.1 0.0 0.0 0.4 0.1 0.1 0.1 7.4 100 91.9 71765 Metropolitan 86.7 3.6 0.1 0.1 0.1 0.0 0.0 1.6 0.0 0.0 0.1 0.1 0.1 0.1 7.5 100 92.2 41881 Other urban 78.3 10.9 0.3 0.5 0.9 0.0 0.1 0.4 0.1 0.1 0.9 0.1 0.2 0.1 7.2 100 91.5 29884 Rural 33.8 13.1 3.1 1.0 4.1 0.4 1.4 0.2 1.2 1.0 11.7 2.6 19.9 0.1 6.3 100 57.0 41091 Education of household head None 55.4 12.7 1.8 0.9 2.1 0.3 0.8 0.1 1.0 1.0 6.9 1.6 11.0 0.0 4.4 100 74.0 27404 Primary 62.9 10.1 1.4 0.6 2.4 0.1 0.6 0.5 0.5 0.3 4.9 1.2 7.6 0.0 6.8 100 78.5 35262 Secondary + 72.3 6.2 0.9 0.3 1.1 0.1 0.4 1.3 0.2 0.1 2.9 0.5 5.1 0.1 8.5 100 82.5 50166 Missing/Don’t know (44.3) (13.9) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (10.5) (0.0) (0.0) (31.2) (0.0) (0.0) (0.0) (100.0) (58.3) 24 Total 65.2 9.0 1.2 0.5 1.8 0.2 0.5 0.8 0.5 0.4 4.5 1.0 7.3 0.1 7.02 100 79.23 112856 * MICS indicator 11; MDG indicator 30 1 For households using bottled water as the main source of drinking water, the source used for other purposes such as cooking and hand washing is used to determine whether to classify the source as improved. 2 More than 90% of the cases in the category “other” corresponds to “Reverse osmosis” category in Basra governorate Figures in parentheses are based on 25-49 un-weighted cases 3 All figures do not reflect the condition and reliability of the sources. Nearly half (48%) of the survey respondents with access to improved sources of drinking water reported problems with services at least once a week . 42Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 13: Use of sanitary means of excreta disposal Percent distribution of household population according to type of toilet facility used by the household, and the percentage of household population using sanitary means of excreta disposal, Iraq, 2006 Type of toilet facility used by household Improved sanitation facility Unimproved sanitation facility Flush/pour flush to: Piped sewer system Septic tank Pit latrine Ventilated improved pit latrine Pit latrine with slab Compos- ting toilet Flush/ pour flush to some- where else Pit latrine without slab/ open pit No facilities / bush / field Other Total Percentage of population using sanitary means of excreta disposal* Number of household members Residence Urban 34.6 47.1 13.8 1.3 1.4 0.1 1.3 0.2 0.0 0.2 100.0 98.2 71765 Metropolitan 47.5 39.9 10.9 0.2 0.3 0.0 1.0 0.1 0.0 0.1 100.0 98.7 41881 Other urban 16.5 57.3 17.9 2.8 2.9 0.1 1.8 0.3 0.0 0.4 100.0 97.5 29884 Rural 1.9 35.1 36.1 2.8 5.7 0.2 5.1 6.0 6.9 0.2 100.0 81.9 41091 Education of household head None 16.2 35.4 28.9 2.2 4.0 0.1 4.0 3.2 5.7 0.4 100.0 86.7 27404 Primary 21.5 41.7 24.2 1.2 2.7 0.2 2.8 2.8 2.5 0.2 100.0 91.7 35262 Secondary + 27.1 47.5 16.5 2.1 2.5 0.1 1.9 1.4 0.8 0.2 100.0 95.7 50166 Missing/Don’t know (0.0) (0.0) (67.8) (0.0) (21.6) (0.0) (0.0) (0.0) (0.0) (10.5) (100.0) 89.5 24 Total 22.7 42.8 21.9 1.8 2.9 0.1 2.7 2.3 2.5 0.2 100.0 92.3 112856 * MICS indicator 12; MDG indicator 31 Figures in parentheses are based on 25-49 un-weighted cases 43Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 14: Use of contraception Percentage of women aged 15-49 years currently married who are using (or whose husband is using) a contraceptive method, Iraq, 2006 Percent of currently married women who are using: Not using any method Female sterili- zation Male sterili- zation Pill IUD Injections Condom Diaph- ragm/ foam/ jelly LAM Periodic abstin- ence With- drawal Other Any modern method Any tradi- tional method Any method* Number of women currently married Residence Urban 46.8 2.9 0.0 15.7 13.3 2.2 1.5 0.3 5.6 2.3 9.0 0.5 35.9 17.4 53.2 10369 Metropolitan 45.2 2.7 0.0 15.5 14.2 2.6 2.0 0.3 4.9 2.1 10.0 0.4 37.3 17.4 54.8 6121 Other urban 49.0 3.1 0.0 16.0 12.0 1.5 0.8 0.3 6.7 2.5 7.6 0.5 33.7 17.3 51.0 4248 Rural 56.5 2.1 0.0 12.4 10.3 1.8 0.4 0.1 9.6 1.7 4.6 0.4 27.2 16.3 43.5 5506 Age 15-19 79.5 0.1 0.1 6.2 2.3 0.7 0.7 0.0 8.3 0.4 1.8 0.1 10.0 10.6 20.5 1214 20-24 64.5 0.1 0.0 11.5 6.4 1.3 1.0 0.1 9.0 0.9 5.1 0.0 20.5 15.0 35.5 2620 25-29 51.4 0.3 0.0 16.1 11.0 2.1 1.0 0.3 9.2 1.9 6.8 0.0 30.8 17.9 48.6 3092 30-34 43.4 1.1 0.0 16.9 15.4 2.7 1.5 0.3 8.1 1.6 8.5 0.4 38.0 18.6 56.6 3032 35-39 39.1 3.6 0.0 17.9 16.8 3.2 1.0 0.3 6.1 2.8 8.7 0.6 42.8 18.1 60.9 2584 40-44 35.6 8.7 0.1 15.6 17.6 2.3 1.1 0.5 3.7 3.8 9.5 1.5 45.9 18.5 64.4 2053 45-49 51.6 7.5 0.1 11.0 11.6 0.5 1.0 0.2 0.6 3.9 11.3 0.8 31.8 16.5 48.4 1280 Number of living children 0 98.9 0.1 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.4 0.0 0.6 0.5 1.1 2081 1 66.0 0.2 0.1 9.8 2.8 1.2 1.7 0.3 10.6 1.1 6.1 0.1 16.1 17.9 34.0 2366 2 46.4 0.1 0.0 16.1 13.9 2.0 1.6 0.2 9.0 1.6 8.8 0.3 33.9 19.7 53.6 2212 3 39.2 1.0 0.0 19.1 15.3 2.3 1.1 0.2 8.4 2.8 10.3 0.2 39.0 21.8 60.8 2047 4+ 35.0 5.3 0.1 18.4 17.5 2.9 1.1 0.3 6.8 3.0 8.8 0.8 45.7 19.3 65.0 7170 Education § None 55.2 3.8 0.1 11.9 10.9 1.8 0.4 0.2 7.1 2.2 5.8 0.6 29.1 15.7 44.8 3199 Primary 51.9 2.4 0.0 13.5 11.1 2.4 0.8 0.2 8.5 1.9 7.0 0.4 30.3 17.8 48.1 7168 Secondary + 44.7 2.1 0.0 17.6 14.7 1.8 2.0 0.4 4.9 2.3 9.2 0.3 38.6 16.7 55.3 5354 Non-standard curriculum 53.6 4.5 0.0 13.1 7.8 2.0 0.0 0.0 8.3 2.6 6.1 2.0 27.4 19.0 46.4 153 Total 50.2 2.6 0.0 14.6 12.2 2.0 1.1 0.2 7.0 2.1 7.5 0.5 32.9 17.0 49.8 15875 * MICS indicator 21; MDG indicator 19C § 1 un-weighted case with “missing/ don’t know education” not shown 44Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 15: Assistance during delivery Percent distribution of women aged 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery, Iraq, 2006 Person assisting at delivery Doctor: gover. or private Nurse Midwife: certified Midwife: not certified Traditional birth attendant: Gida Relative/Friend Other/missing No attendant Total Any skilled personnel* Delivered in health facility** Number of women who gave birth in preceding two years Region Urban 59.8 8.9 26.4 2.2 2.3 0.4 0.1 0.0 100.0 95.0 67.9 4042 Metropolitan 63.7 7.6 25.1 1.3 2.0 0.3 0.1 0.0 100.0 96.4 70.9 2335 Other urban 54.4 10.7 28.1 3.4 2.8 0.5 0.0 0.1 100.0 93.2 63.8 1707 Rural 46.0 9.1 23.0 8.7 10.6 2.0 0.4 0.2 100.0 78.1 54.1 2510 Age 15-19 60.8 9.8 20.5 2.6 6.0 0.1 0.1 0.0 100.0 91.1 70.3 578 20-24 54.8 10.4 24.1 4.0 5.9 0.7 0.2 0.0 100.0 89.3 64.1 1623 25-29 54.0 9.7 25.1 4.9 5.0 1.2 0.2 0.0 100.0 88.8 63.0 1745 30-34 52.4 8.2 26.8 5.1 5.8 1.5 0.1 0.1 100.0 87.4 59.7 1376 35-39 54.0 6.0 28.0 5.6 5.5 0.4 0.3 0.2 100.0 88.0 58.9 848 40-44 55.7 6.7 23.1 6.2 4.5 2.6 0.5 0.6 100.0 85.5 61.5 344 45-49 49.2 15.1 24.8 3.8 7.1 0.0 0.0 0.0 100.0 89.1 63.4 37 Education None 45.2 8.5 25.3 7.7 11.0 2.0 0.2 0.2 100.0 78.9 52.0 1194 Primary 53.0 8.6 25.6 5.5 6.1 0.9 0.2 0.1 100.0 87.1 60.8 3229 Secondary + 62.2 9.9 24.2 1.6 1.5 0.5 0.1 0.0 100.0 96.3 71.5 2103 Non-standard curriculum (49.1) (3.8) (27.8) (10.3) (9.0) (0.0) (0.0) (0.0) (100.0) (80.7) (52.8) 25 Total 54.5 9.0 25.1 4.7 5.5 1.0 0.2 0.1 100.0 88.5 62.6 6551 * MICS indicator 4; MDG indicator 17 ** MICS indicator 5 * Skilled health personnel includes doctors, nurses, and certified midwives Figures in parentheses are based on 25-49 un-weighted cases 45Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 16: Primary school net attendance ratio Percentage of children of primary school age 6-11 years attending primary or secondary school (NAR), Iraq, 2006 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio* Number of children Residence Urban 90.3 5382 86.9 5052 88.6 10433 Metropolitan 90.5 3033 87.7 2782 89.2 5816 Other Urban 89.9 2348 85.8 2270 87.9 4618 Rural 82.5 3816 68.2 3688 75.5 7505 Age 6 64.5 1625 62.6 1549 63.6 3174 7 89.2 1569 83.4 1462 86.4 3031 8 92.8 1504 86.0 1447 89.5 2951 9 93.7 1538 85.2 1402 89.7 2940 10 92.8 1462 82.2 1442 87.6 2904 11 90.8 1501 75.8 1439 83.4 2940 Mother’s education § None 79.4 2473 65.0 2487 72.2 4960 Primary 87.4 3949 80.4 3702 84.0 7651 Secondary + 93.3 2775 90.5 2550 92.0 5325 Total 87.0 9198 79.0 8740 83.1 17938 * MICS indicator 55; MDG indicator 6 § 4 un-weighted cases with “missing/ don’t know mother’s education” not shown 46Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 17: Education gender parity Ratio of girls to boys attending primary education and ratio of girls to boys attending secondary education, Iraq, 2006 Primary school net attendance ratio (NAR), girls Primary school net attendance ratio (NAR), boys Gender parity index (GPI) for primary school NAR* Secondary school net attendance ratio (NAR), girls Secondary school net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school NAR* Residence Urban 86.9 90.3 0.96 44.8 49.6 0.90 Metropolitan 87.7 90.5 0.97 45.8 51.0 0.90 Other Urban 85.8 89.9 0.95 43.3 47.6 0.91 Rural 68.2 82.5 0.83 13.6 30.7 0.44 Mother's education None 65.0 79.4 0.82 21.6 30.1 0.72 Primary 80.4 87.4 0.92 31.9 38.9 0.82 Secondary + 90.5 93.3 0.97 62.6 65.7 0.95 Total 79.0 87.0 0.91 33.5 42.5 0.79 * MICS indicator 61; MDG indicator 9 47Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 18: Primary school completion and transition to secondary education Primary school completion rate and transition rate to secondary education, Iraq, 2006 Net primary school completion rate* Gross primary school completion rate Number of children of primary school completion age Transition rate to secondary education** Number of children who were in the last grade of primary school the previous year Sex Male 29.6 89.5 1501 75.7 957 Female 30.3 68.0 1439 81.9 694 Residence Urban 36.0 88.2 1750 81.5 1191 Metropolitan 36.6 89.6 962 84.5 667 Other Urban 35.3 86.5 788 77.8 524 Rural 21.0 65.3 1190 70.0 459 Mother's education None 15.8 68.1 907 74.7 470 Primary 25.2 73.9 1204 76.2 553 Secondary + 52.1 94.0 829 84.5 588 Mother not in household - - - § 9 Missing/DK § § 1 - - Total 29.9 78.9 2940 78.3 1651 * MICS indicator 59; MDG indicator 7b ** MICS indicator 58 § Figure is based on fewer than 25 un-weighted cases and has been suppressed 48Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 19: Birth registration Percent distribution of children aged 0-59 months by whether birth is registered , Iraq, 2006 Birth is registered* Number of children aged 0-59 months Sex Male 95.2 8359 Female 94.9 8110 Residence Urban 94.7 9865 Metropolitan 93.2 5661 Other urban 96.6 4204 Rural 95.6 6604 Age 0-11 months 88.5 3422 12-23 months 95.2 3560 24-35 months 95.7 3214 36-47 months 97.3 3182 48-59 months 98.9 3092 Mother’s education § None 94.8 3245 Primary 94.7 8051 Secondary + 95.6 5051 Non-standard curriculum 95.8 120 Total 95.0 16469 * MICS indicator 62 § 2 un-weighted cases with “missing/ don’t know mother’s education” not shown 49Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 20: Child labour Percentage of children aged 5-14 years who are involved in child labour activities by type of work, Iraq, 2006 Working outside household Paid work Unpaid work Household chores for 28+ hours/ week Working for family business Total child labour* Number of children aged 5-14 years Sex Male 1.6 2.1 1.0 8.4 12.1 15180 Female 0.1 1.4 2.7 5.9 9.2 14629 Residence Urban 0.9 1.6 0.8 2.5 5.5 17594 Metropolitan 1.1 1.8 0.8 2.2 5.7 9881 Other urban 0.7 1.3 0.7 2.8 5.3 7713 Rural 0.8 2.0 3.4 13.9 18.1 12214 Age 5-11 years 0.5 2.2 0.9 7.6 10.3 21458 12-14 years 1.8 0.6 4.2 5.9 11.7 8350 School participation Yes 0.5 1.9 1.0 6.8 9.5 20739 No 1.8 1.5 3.7 8.1 13.5 9069 Mother’s education § None 1.1 1.4 3.0 10.5 14.4 8750 Primary 1.0 1.9 1.8 7.1 10.9 12398 Secondary + 0.5 1.9 0.7 3.9 6.6 8658 Total 0.9 1.8 1.8 7.2 10.7 29808 * MICS indicator 71 § 4 un-weighted cases with “missing/ don’t know mother’s education” not shown 50Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 21: Early marriage Percentage of women aged 15-49 years in marriage before their 15th birthday, percentage of women aged 20-49 years in marriage before their 18th birthday, percentage of women aged 15-19 years currently married, Iraq, 2006 Percentage married before age 15* Number of women aged 15-49 years Percentage married before age 18* Number of women aged 20-49 years Percentage of women 15-19 married** Number of women aged 15-19 years Residence Urban 5.1 18028 21.5 13790 18.7 4239 Metropolitan 4.9 10677 20.5 8232 19.3 2445 Other urban 5.4 7351 22.9 5558 17.8 1793 Rural 6.0 9158 24.8 7011 19.7 2147 Age 15-19 3.8 6386 na na 19.0 6386 20-24 3.4 5277 17.0 5277 na na 25-29 4.8 4390 19.1 4390 na na 30-34 5.8 3918 23.4 3918 na na 35-39 6.6 3176 24.7 3176 na na 40-44 9.3 2478 29.8 2478 na na 45-49 11.0 1561 33.7 1561 na na Education None 10.3 4971 33.4 4046 26.3 926 Primary 6.4 11390 26.8 8689 25.9 2701 Secondary + 1.9 10632 12.0 7875 9.8 2757 Non-standard curriculum 14.5 192 41.3 190 § 2 Missing/Don’t know § 1 § 1 - - Total 5.4 27186 22.6 20800 19.0 6386 * MICS indicator 67 ** MICS indicator 68 § Figure is based on fewer than 25 un-weighted cases and has been suppressed 51Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 22: Comprehensive knowledge of HIV/AIDS transmission for women aged 15-49 years Percentage of women aged 15-49 years who have comprehensive knowledge of HIV/AIDS transmission, Iraq, 2006 Know 2 ways to prevent HIV transmission Correctly identify 3 misconceptions about HIV transmission Have comprehensive knowledge (identify 2 prevention methods and 3 misconceptions) Number of women Residence Urban 16.5 12.4 5.1 18028 Metropolitan 18.3 14.3 5.8 10677 Other urban 13.9 9.6 4.1 7351 Rural 5.7 4.1 1.5 9158 Age 15-19 8.0 6.0 1.6 6386 20-24 12.3 6.6 2.6 5277 15-24 9.9 6.3 2.1 11662 25-29 15.0 6.3 2.7 4390 30-34 16.0 7.2 3.6 3918 35-39 15.9 6.5 3.1 3176 40-44 13.5 6.6 3.2 2478 45-49 14.0 6.5 2.7 1561 Education § None 2.3 0.6 0.1 4971 Primary 6.8 2.6 0.7 11390 Secondary + 24.4 13.5 5.9 10632 Non-standard curriculum 7.5 1.3 0.3 192 Total 12.9 6.5 2.7 27186 * MICS indicator 82; MDG indicator 19b § 1 un-weighted cases with “missing/ don’t know education” not shown 52Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 23: Comprehensive knowledge of HIV/AIDS transmission for women aged 15-24 years Percentage of women aged 15-24 years who have comprehensive knowledge of HIV/AIDS transmission, Iraq, 2006 Know 2 ways to prevent HIV transmission Correctly identify 3 misconceptions about HIV transmission Have comprehensive knowledge (identify 2 prevention methods and 3 misconceptions)* Number of women Region Urban 13.0 8.4 2.8 7690 Metropolitan 14.9 9.3 2.7 4472 Other urban 10.3 7.2 3.0 3218 Rural 4.1 2.1 0.6 3972 Age 15-19 8.0 6.0 1.6 6386 20-24 12.3 6.6 2.6 5277 15-24 9.9 6.3 2.1 11662 Education § None 1.5 0.5 0.2 1724 Primary 4.6 2.5 0.5 5127 Secondary + 18.6 12.3 4.4 4810 Total 9.9 6.3 2.1 11662 * MICS indicator 82; MDG indicator 19b § 4 un-weighted cases with “non-standard curriculum” not shown 53Iraq Multiple Indicator Cluster Survey Preliminary Report, 2006 Table 24: School attendance of orphaned children School attendance of children aged 10-14 years by orphanhood, Iraq, 2006 Percent of children whose mother and father have died School attendance rate of children whose mother and father have died Percent of children of whom both parents are alive and child is living with at least one parent School attendance rate of children of whom both parents are alive and child is living with at least one parent Double orphans to non-orphans school attendance ratio* Percent of children who are orphaned School attendance of children who are orphaned Percent of children who are not orphaned School attendance of children who are not orphaned OC vs non- OC school attendance ratio Total number of children aged 10-14 years Sex Male 0.9 78.6 92.3 84.9 0.93 7.3 77.6 92.7 85.0 0.91 7151 Female 1.1 52.4 91.4 66.7 0.79 7.8 57.0 92.2 66.5 0.86 7042 Residence Urban 0.9 70.2 91.3 83.7 0.84 8.1 74.1 91.9 83.5 0.89 8570 Metropolitan 1.0 (67.5) 90.6 83.7 0.81 8.6 72.7 91.4 83.5 0.87 4797 Urban-other 0.8 74.6 92.2 83.6 0.89 7.5 76.0 92.5 83.6 0.91 3773 Rural 1.1 56.4 92.7 64.3 0.88 6.8 54.3 93.2 64.2 0.85 5623 Total 1.0 64.1 91.9 75.9 0.84 7.6 67.1 92.4 75.8 0.88 14194 * MICS indicator 77; MDG indicator 20 Figure in parentheses is based on 25-49 un-weighted cases

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