Findings from the Sierra Leone Multiple Indicator Cluster Survey 2005: Preliminary Report

Publication date: 2006

Monitoring the Situation of Children and Women Findings from the Sierra Leone Multiple Indicator Cluster Survey 2005 PRELIMINARY REPORT Revised August 2006 Multiple Indicator Cluster Survey – 3 Statistics Sierra Leone United Nations Children’s Fund – Sierra Leone Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page i Table 1: Key MICS3 indicators TOPIC MICS3 INDICATOR NUMBER INDICATOR VALUE Child Mortality 1 Under-five mortality rate 267 deaths per 1,000 live births 6 Underweight prevalence (2 SD ≤; 3 SD ≤) 31; 9 percent 7 Stunting prevalence (2 SD ≤; 3 SD ≤) 40; 20 percent 8 Wasting prevalence (2 SD ≤; 3 SD ≤) 9; 2 percent 15 Exclusive breastfeeding rate (0-5 months) 8 percent 16 Continued breastfeeding rate (12-15 months; 20-23 months) 88; 57 percent Nutrition 17 Timely complementary feeding rate (6-9 months) 52 percent 25 Tuberculosis immunization coverage 84 percent 26 Polio immunization coverage 57 percent 27 DPT immunization coverage 56 percent 28 Measles immunization coverage 62 percent 31 N/A Children fully immunized at their first birthday Children fully immunized at one-year (12-23 months) of age 35 percent 54 percent 22 Antibiotic treatment of suspected pneumonia 21 percent 24 Solid fuels 99 percent 37 Under-fives sleeping under insecticide-treated nets 5 percent 38 Under-fives sleeping under mosquito nets 20 percent Child health 39 Ant-malarial treatment (under-fives) 45 percent 11 Use of improved drinking water sources 47 percent Environment 12 Use of improved sanitation facilities 30 percent 21 Contraceptive prevalence 5 percent 4 Skilled attendant at delivery 43 percent Reproductive health 5 Institutional deliveries 19 percent 55 Net primary school attendance rate 69 percent Education 61 Gender parity index (primary; secondary) 1.01; 0.78 girls per boy 62 Birth registration 48 percent 67 Marriage before age 15, before age 18 27 / 62 percent 68 Young women aged 15-19 currently married/in union 36 percent Child protection 70 Polygyny 43 percent 82 Comprehensive knowledge about HIV prevention among young people 18 percent 83 Condom use with non-regular partners 20 percent 85 Higher risk sex in the last year 43 percent HIV/AIDS, Sexual behaviour, and orphaned and vulnerable children 77 School attendance of orphans versus non-orphans 0.78 orphans per non-orphan Note: Definitions for the indicators listed in the table above can be found in Chapter 4: Table 22. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page ii Contents ACKNOWLEDGEMENTS. iv I. BACKGROUND AND OBJECTIVES . 1 INTRODUCTION. 1 SURVEY OBJECTIVES . 2 II. SAMPLE AND SURVEY METHODOLOGY. 2 SAMPLE DESIGN. 2 QUESTIONNAIRES. 3 FIELDWORK AND PROCESSING. 4 SAMPLE COVERAGE . 4 CHILD MORTALITY . 5 NUTRITIONAL STATUS . 7 BREASTFEEDING. 9 IMMUNIZATION . 10 ANTIBIOTIC TREATMENT OF CHILDREN WITH SUSPECTED PNEUMONIA. 12 SOLID FUEL USE. 13 MALARIA. 14 WATER AND SANITATION . 16 CONTRACEPTION. 18 ASSISTANCE AT DELIVERY . 19 PRIMARY SCHOOL ATTENDANCE. 20 BIRTH REGISTRATION . 21 EARLY MARRIAGE AND POLYGYNY . 22 KNOWLEDGE OF HIV/AIDS TRANSMISSION AND CONDOM USE . 23 ORPHANS AND VULNERABLE CHILDREN SCHOOL ATTENDANCE . 25 IV. TABLES . 26 Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page iii List of Tables Table 1: Key MICS3 indicators . i Table 2: Results of household and individual interviews . 26 Table 3: Child mortality. 27 Table 4: Child malnourishment. 28 Table 5: Breastfeeding . 29 Table 6: Vaccinations in first year of life . 30 Table 7: Antibiotic treatment of pneumonia . 31 Table 8: Solid fuel use . 32 Table 9: Children sleeping under bednets. 33 Table 10: Treatment of children with anti-malarial drugs . 34 Table 11: Use of improved water sources. 36 Table 12: Use of sanitary means of excreta disposal . 38 Table 13: Use of contraception . 40 Table 14: Assistance during delivery. 42 Table 15: Primary school net attendance ratio. 43 Table 16: Education gender parity . 44 Table 17: Birth registration. 45 Table 18: Early marriage and polygyny. 46 Table 19: Comprehensive knowledge of HIV/AIDS transmission. 47 Table 20: Condom use at last high-risk sex . 48 Table 21: School attendance of orphaned and vulnerable children . 49 Table 22: Indicator definitions. 50 Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page iv ACKNOWLEDGEMENTS This work has been successfully completed through the support and commitment of several people and organisations in Sierra Leone. Many thanks go to the respondents who provided valuable pieces of information about their households and about themselves. In addition they were very accommodating and hospitable to the surveyors in the process of collecting information for this survey The technical personnel whose hard work and dedication resulted in a high-quality survey product—including enumerators, supervisors, data entry and processing personnel—deserve great words of commendation. They ably and professionally completed their work even in the face of difficult conditions. Some enumerators had to walk for over 10 miles to conduct an interview in a household that was selected for the survey. The Government of Sierra Leone, including its ministries and departments, is acknowledged for its support and contributions to the development of the survey questionnaire. Special mention should be made of the following: Ministry of Development and Economic Planning Ministry of Health and Sanitation Ministry of Energy and Power Ministry of Education Ministry of Social Welfare Gender and Children’s Affairs Ministry of Youth, Education and Sports Ministry of Local Government and Decentralisation The following international agencies are acknowledged for the technical support they provided to the MICS3 survey: UNICEF Sierra Leone (technical and financial support) UNFPA FAO WHO WFP The contributions of other organizations and individuals whom space does not permit to list here are also acknowledged. Mr. John Pessima Deputy Statistician General Statistics Sierra Leone Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 1 I. BACKGROUND AND OBJECTIVES INTRODUCTION This preliminary report is based on the Sierra Leone Multiple Indicator Cluster Survey, conducted in 2005 by Statistics Sierra Leone with financial and technical support from UNICEF Sierra Leone. The survey was conducted, in large part, in order to monitor progress towards goals and targets emanating from recent international agreements that the Government of Sierra Leone is part of: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see Box 1). Box 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 sub-national levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 2 The Government of Sierra Leone (GoSL), in collaboration with its development partners, is implementing several policies and strategies aimed at accomplishing national and international goals. The GoSL has recently developed its Poverty Reduction Strategy, the main goals of which are in line with the Millennium Development Goals (MDGs). MICS3 has been identified as a major effort to generate valid and reliable data and information that will be used to monitor key indicators that are being tracked by the GoSL to ensure the realization of major international commitments that include World Fit for Children (WFFC) goals, the Millennium Development Goals (MDGs), the UNGASS on HIV/AIDS, and the Abuja targets for malaria. Roughly 20 of the 48 MDG indicators have been estimated in the MICS3, offering the largest single source of data for MDG monitoring. The MICS3 effort will also contribute to the development of a monitoring and evaluation system for Sierra Leone’s National Programme for Food Security, Job Creation, Good Governance and Human Development. This preliminary report presents selected results on some of the principal topics covered in the MICS3 survey and on a subset of indicators. The results in this report are preliminary and are subject to change as further analyses are conducted, although major changes are not expected. A comprehensive final report on the Sierra Leone MICS3 2005 survey is scheduled for publication in the third quarter of 2006. SURVEY OBJECTIVES The 2005 Sierra Leone Multiple Indicator Cluster Survey has as its primary objectives the following: 1. To provide up-to-date information for assessing the situation of children and women in Sierra Leone; 2. 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; 3. To contribute to the improvement of data and monitoring systems in Sierra Leone and to strengthen technical expertise in the design, implementation, and analysis of such systems. II. SAMPLE AND SURVEY METHODOLOGY SAMPLE DESIGN The sample for the 2005 Sierra Leone MICS3 Survey was designed to provide estimates of health indicators at the national level, for urban and rural areas, and for the four regions—North, South, East and West—and the thirteen districts of Sierra Leone. The sample was selected in two stages using a stratified cluster sampling methodology. In the first stage, 320 enumeration areas (EAs) were selected, using probability proportional to size methodology, through systematic sampling from a sample frame of all EAs in Sierra Leone that was ordered by region Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 3 and, within regions, by district. Using the comprehensive EA-level household lists that had been developed in the 2004 Sierra Leone national census, a random sample of 25 households was drawn within each of the 320 selected EAs to yield an overall sample of 8,000 households. A household was defined as “a group of people who all eat from the same pot”. The resulting sample was theoretically self-weighting, although sample weights have been employed to adjust for minor variations among regions and rural/urban EAs with regards to the proportion of households, women, and children for whom the MICS3 interview was completed among sampled households found to be occupied and the eligible women and children who lived in them. QUESTIONNAIRES Three questionnaires were used in the survey: the Household Questionnaire, the Questionnaire for Individual Women, and the Questionnaire for Children Under Five. The questionnaires are based on the MICS3 model questionnaires. Within each interviewed household, information was collected about the household and the dwelling from the head-of-household or from another adult who lived in the household. Information was also collected from every woman of child- bearing age (defined as 15-49 years) and from the primary caretaker of every child aged less than 5 years of age. The questionnaires included the following modules: • Household Questionnaire o Household listing o Education o Water and sanitation o Household characteristics o Insecticide treated bednets o Support to children orphaned and made vulnerable by HIV/AIDS o Child labour o Salt iodization o Child discipline o Child disability o Maternal mortality o Cost and source of supplies • Questionnaire for Individual Women o Child mortality o Tetanus toxoid o Maternal and newborn health o Marriage/Union o Contraception o HIV/AIDS o Female genital cutting o Sexual behaviour Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 4 • Questionnaire for Children Under Five o Birth registration and early learning o Vitamin A o Breastfeeding o Care of illness o Malaria o Immunization o Anthropometry English is the only written language in Sierra Leone; for this reason, questionnaires were written in English and verbally translated by enumerators into the language preferred by the respondent (generally Krio, Timne, Mende or Limba), using standardized, pre-tested key words. The questionnaires were pre-tested in September 2005. Based on the results of the pre-test, modifications were made to the wording of the questions, the response categories, and the key words. FIELDWORK AND PROCESSING Fourteen supervisors and sixty-one enumerators were trained for 10 days in early October 2005. The data were collected by fourteen teams, each composed of one or two female enumerators, two or three male enumerators, one driver and a supervisor. The fieldwork began in October 2005 and concluded in November 2005. Completed questionnaires were checked in the field by supervisors and then transported to Freetown, where data entry personnel checked each questionnaire to make sure that it had been clearly and correctly completed. Data were entered on thirty microcomputers using CSPro software. In order to ensure quality control, all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programs developed using CSPro software under the global MICS3 project and adapted to the Sierra Leone questionnaire were used throughout. Data entry and processing began in November 2005 and were completed in April 2006. Data were analysed using the SPSS software program and the model syntax and tabulation plans developed for this purpose. SAMPLE COVERAGE Of the 8,000 households selected for the sample, only 7,125 were found to be occupied. This surprisingly low rate of occupation is due to the following reasons: 1. The sample frame of households that was used to randomly select 25 households in each selected EA contained many households that consisted of people who had returned to their original homes at the time of the census only for the purpose of being registered there (for political reasons). Once the census was completed, they moved back to their “real homes” elsewhere. Sub-optimal performance of the task of verifying the presence of all households sampled for the MICS3 survey compounded this problem and led to many houses being classified as “not found / destroyed”. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 5 2. Names and/or addresses on the lists of sampled households were not adequately descriptive to permit identification of the households. 3. Some households had, after the census, dissipated following the death of the head of household. 4. The diamond mining clusters in the Eastern province had household heads who were miners and had moved from their places of registration in search of new areas where diamonds could been found. 5. Sample frames in EAs in border villages along the Sierra Leone/Liberia border included households that had returned to Liberia for registration in their national elections. 6. During the verification of households, some communities did not provide accurate information on existing households, thinking that the households may benefit from possible humanitarian assistance after the MICS3 exercise. During data collection, such households did not meet the standard definition of households. Of the 7,125 occupied households, 7,078 were successfully interviewed for a household response rate of 99.3 per cent. In the interviewed households, 9,257 eligible women (aged 15-49) were identified. Of these, 7,654 were successfully interviewed, yielding a response rate of 82.1 per cent. The response rate for the Questionnaire for Children Under Five was 88.9 per cent; mothers/caretakers of 5,246 children under five were successfully interviewed, from among 5,904 children under five who were identified in the interviewed households. Overall response rates of 82.1 percent and 88.3 percent are calculated for the women’s and under-5’s interviews respectively (Table 2). III. RESULTS CHILD MORTALITY Key indicators Estimates West-Central Africa1 20052 (MICS3) 2000 (MICS2) 2004 Infant mortality rate 158 170 109 Under-five mortality rate 267 286 191 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. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. On the other hand, using direct measures of child mortality from birth histories is time consuming and complicated. Demographers have therefore had to devise ways to measure childhood mortality indirectly. These “indirect methods” minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. 1 Source: The State of the World’s Children 2006. UNICEF, UNICEF House, 3 UN Plaza, New York, NY 10017, USA. (SOWCR 2006) 2 Note that the method used to produce estimates of UFMR and IMR actually produces a retrospective estimate that pertains to 2002 (for MICS3) and 1997 (for MICS2). Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 6 The infant mortality rate (IMR) is the probability of dying before the first birthday. The under- five mortality rate (UFMR) is the probability of dying before the fifth birthday. In MICS3, the IMR and UFMR are calculated based on an indirect estimation technique; the so-called Brass method. The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five year age groups of women. The technique converts these data into probabilities of dying by taking account of both the mortality risks to which children are exposed and their length of exposure to the risk of dying. Table 3 provides estimates of child mortality by various background characteristics. The IMR in Sierra Leone is estimated at 158 per thousand, while the U5MR is estimated to be 267per thousand. The IMR and U5MR are approximately 20 and 14 percent higher, respectively, for males than females. Infant and under-5 mortality rates are lowest in the West and highest in the East and South. Mortality rates are similar across all wealth quintiles except for the richest quintile, where they are approximately 68 percent of the national average. Mortality rates are similarly low for children whose mothers have achieved a secondary education level. Discussion: Child Mortality Sierra Leone has the ignominious distinction of having an under-five mortality rate (UFMR) that is both the highest in the world and far higher than the regional norm of 191 deaths per 1,000 live births. The comparison of the 2005 and 2000 estimates of the UFMR should be made with care, as the methodology that is used to calculate the UFMR generates retrospective estimates. For example, the UFMR estimate generated during the 2000 MICS2 is actually an estimate of the UFMR in Sierra Leone during 1997. Similarly, the 2005 MICS3 has generated an estimate of the UFMR in 2002—the year when the conflict ended. It can thus be concluded that child mortality in Sierra Leone did not reduce from its astronomically high level between 1997 and 2002 substantially—although it perhaps should not have been expected to, given the conflict that was raging in the country during that time. The MDG for UFMR is to reduce the under-five mortality rate to 100 by 2015. While it is true that various interventions that are designed under the Sierra Leone Poverty Reduction Strategy Paper (PRSP) to support the achievement of this MDG are just now being put into place, this MICS3 result suggests that it will be very difficult for this MDG to be achieved. Efforts must be redoubled to fully and rapidly implement policies that are designed to integrate the country’s strategic approach to improving child survival, including the development and implementation of an integrated child survival strategy and scaling up the Community-Based Integrated Management of Child Illness initiative (CB-IMCI) in all districts of the country. Millennium Development Goal Indicator Under-five mortality rate Goal 100 deaths per 1,000 live births by 2015 Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 7 NUTRITIONAL STATUS Key indicators Estimates (percent) West-Central Africa3 2005 (MICS3) 2000 (MICS2) 1996-2004 Underweight prevalence (2 SD ≤ / 3 SD ≤) 31 / 9 27 / 9 28 / 9 Stunting prevalence (2 SD ≤ / 3 SD ≤) 40 / 20 34 / 16 35 / -- Wasting prevalence (2 SD ≤ / 3 SD ≤) 9 / 2 10 / 2 10 / -- Exclusive breastfeeding rate (0-5 months) 8 2 20 Continued breastfeeding rate (12-15 months / 20-23 months) 88 / 57 85 / 51 -- / 48 Timely complementary feeding rate (6-9 months) 52 52 65 Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well-nourished. In a well-nourished population, there is a standard distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference distribution. The reference population used here is the WHO/CDC/NCHS reference, which is recommended for use by UNICEF and the World Health Organization. Each of the three nutritional status indicators—underweight, stunting, and wasting—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. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. 3 Source: SOWCR 2006. Millennium Development Goal Indicator Proportion of children under five- years that are underweight Goal 12 percent by 2015 Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 8 Table 4 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, which takes into account those children whose weight-for-height is above 2 standard deviations from the median of the reference population. In Table 4, children who were not weighed and measured (approximately 0.9 percent of children interviewed in the MICS3) and those whose measurements are outside a plausible range are excluded. More than three in ten children (31 percent) under five years of age in Sierra Leone are moderately underweight and nine percent are classified as severely underweight (Table 4). Forty percent of children are stunted or too short for their age and nine percent are wasted or too thin for their height. The three indicators of malnutrition are similarly high in the North, East and South regions and are markedly lower in the West. Those children whose mothers have secondary or higher education are less likely to be malnourished than children of mothers with no or primary-only education. Boys appear to be slightly more likely to be underweight, stunted, and wasted than girls. The age pattern shows that a higher percentage of children aged 12-23 months are undernourished according to all three indices in comparison to children who are younger and older, with the exception of a high level of stunting among children aged 36-47 months (Figure 1). This pattern is expected and is related to the age at which many children cease to be breastfed and begin to be more broadly exposed to contamination in water, food, and environment. Figure 1: Percentage of children aged 0-59 months who are undernourished, Sierra Leone, 2005 0 5 10 15 20 25 30 35 40 45 50 55 0 6 12 18 24 30 36 42 48 54 60 Age (months) Pe rc en t Stunted Underweight Wasted Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 9 BREASTFEEDING Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continued breastfeeding with safe, appropriate and adequate complementary feeding up to 2 years of age and beyond. In Table 5, the assessment of breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk and vitamins, mineral supplements, or medicine. The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. Approximately 10 and 8 percent of children aged less than four and six months, respectively, are exclusively breastfed—levels that should be considered unacceptably low. At age 6-9 months, 52 percent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, 88 percent of children are still being breastfed and by age 20-23 months, 57 percent are still breastfed. More females than males are exclusively breastfed before six months of age while more males than females continue breast feeding beyond 20 months of age. Among regions, the North stands out as generally having the highest level of breastfeeding indicators, while the level of complementary feeding of children aged 6-9 months is highest in the South. Discussion: Nutrition and Breastfeeding The prevalence of underweight, stunting and wasting among children under five years of age in Sierra Leone has remained steady or deteriorated slightly since 2000; levels of these indicators are roughly in line with Western and Central African (WCA) norms. This slight decline in nutritional status may be due to the cessation of relief programs that provided food supplementation to vulnerable groups. The practice of exclusive breastfeeding in Sierra Leone has improved from the meagre level of 2 percent in 2000 but remains extremely low at 8 percent, comparing unfavourably with the WCA norm of 20 percent. MICS3 estimates of complementary feeding and continued breastfeeding rates remain virtually unchanged from 2000 and are similar to WCA norms. There remains ample room for improvement of infant and young child feeding practices and promotion of growth monitoring and promotion in line with the life cycle of young children in Sierra Leone. Policy makers should focus on creating a conducive environment for rational food production, income generation, and implementation of the food security component of the PRSP. Programmatic approaches that integrate nutritional interventions into other child survival strategies are called for. The Family Package—which includes interventions such as insecticide treated bednets, exclusive breastfeeding, immunizations, complementary feeding, nutritional Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 10 supplements, etc.—should be promoted and introduced at the household level, especially through outreach services. IMMUNIZATION Estimates (percent) 2005 (MICS3) 2005 (MICS3) 2000 (MICS3) West-Central Africa4 (2004) Numerator Imm. Status at first birthday Imm. Status at time of survey Imm. Status at time of survey Unclear Denominator 12-23 month- olds 12-23 month- olds 12-23 month- olds Unclear Column # 1 2 3 4 Tuberculosis immunization coverage 84 86 73 67 Polio immunization coverage 57 64 61 57 DPT immunization coverage 56 63 46 52 Measles immunization coverage 62 76 62 55 Fully immunized children 35 54 39 -- Yellow fever 60 75 -- -- Note: Only estimates in columns 2 and 3 are directly comparable. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. All of these vaccinations are provided through the Sierra Leone Ministry of Health (MoH) and, together with the yellow fever vaccine, form the basic MoH EPI package in Sierra Leone. Caretakers of children under the age of five who were interviewed as part of the MICS3 were asked to show interviewers their children’s vaccination cards. When these cards were available, interviewers copied vaccination information from the cards onto the MICS3 questionnaire. When cards were not available, vaccination status was assessed through a structured oral history taken from the caretaker. Overall, interviewers were shown health cards for 53 percent of the children included in MICS3. The percentage of children aged 12 to 23 months who received each of the vaccinations is shown in Table 6 and Figure 2. The denominator for the estimates presented in the table and figure is comprised of 1075 children aged 12-23 months so that only children who are old enough to be fully vaccinated are counted. The numerator in this table includes only those children 4 Source: SOWCR 2006. Millennium Development Goal Indicator Percentage of children under one year immunized against measles Goal 100 percent by 2015 Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 11 who were vaccinated before their first birthday; that is, those children who received timely vaccination. In the calculation of “timely vaccination”, the proportion of vaccinations given before the first birthday to children without health cards is assumed to be the same as for children with health cards. Figure 2: Percentage of children 12-23 months who received immunizations by age 12 months, Sierra Leone, 2005 78 8484 73 75 62 35 56 57 0 20 40 60 80 100 BCG DPT Polio Measles All Pe rc en t Dose 1 Dose 2 Dose 3 Approximately 84 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 78 percent. The percentage declines for subsequent doses of DPT to 73 percent for the second dose and 56 percent for the third dose. Similarly, 84 percent of children received Polio 1 by age 12 months and this declines to 57 percent by the third dose. The coverage for measles vaccine by 12 months is, at 62 percent, higher than for OPV3 or DPT3. Coverage for yellow fever vaccine at age 12 months is 50 percent. The percentage of children aged 12-23 months who received all eight recommended vaccinations excluding yellow fever (BCG, DPT x 3, OPV x 3, and measles) by their first birthday is 35 percent. Discussion: Immunization The MICS3 has introduced a new approach to the measurement of immunization rates. Timely immunization—that is, completion of basic immunizations by an infant’s first birthday, as measured among 12-23 month-olds—is the basis of the MICS3 EPI assessment. This contrasts with the approach taken during MICS2, when indicators were defined based on current immunization status among surveyed 12-23 month-olds, thus aggregating the vaccination status of children of different ages in the calculation. Estimates of timely immunization are not available from MICS2; it is therefore necessary to examine current immunization status as measured during MICS3 and MICS2 (columns 2 and 3 in table above) in order to examine trends in vaccination status over time. A comparison of these Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 12 data suggests that clear gains have been made in improving vaccination status of children in Sierra Leone during the past five years. This finding, along with data that show immunization rates in Sierra Leone to be 7-to-19 percent above regional norms, suggests that the EPI program in Sierra Leone is a relatively strong component of the health system. Vaccination rates in Sierra Leone are still far short of the UNICEF goal of 90 percent or the MDG for measles vaccination of 100 percent. Policy recommendations to strengthen the EPI program include prioritizing the placement of adequate personnel at the community-level to carry out EPI programs and supporting the integration of EPI activities in the broader Integrated Child Survival Strategies. EPI program managers should continue to focus on strengthening outreach EPI services and establishing appropriate technology for cold chain maintenance. ANTIBIOTIC TREATMENT OF CHILDREN WITH SUSPECTED PNEUMONIA Key indicators Estimates (percent) West-Central Africa5 2005 (MICS3) 2000 (MICS2) 1998-2004 Antibiotic treatment of suspected pneumonia 21 -- -- Care seeking for suspected pneumonia 48 50 35 At the global level, pneumonia is the leading cause of death in children, and the use of antibiotics in under-5s with suspected pneumonia is an important intervention to reduce severe morbidity and mortality in children. In the MICS3 survey, a child with suspected pneumonia is defined as a child whose caretaker reported that s/he had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were due to a problem in the chest and a blocked nose. The analysis below was limited to children who had suspected pneumonia during the two weeks prior to the survey. Table 7 presents data that describe the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, age, region, residence, and socioeconomic factors. In Sierra Leone, 21 percent of under-5 children with suspected pneumonia during the two weeks prior to the survey were treated with an antibiotic. The percentage treated with an antibiotic was highest (47 percent) in the Western Area and varied among the other regions from 27 percent in the East to 13 percent in the North. The table also shows that antibiotic treatment of suspected pneumonia is highest among children from the two highest wealth quintiles and among children whose mothers/caretakers have secondary education or higher. Discussion: Antibiotic Treatment of Children with Suspected Pneumonia As with timely vaccination in the previous section, antibiotic treatment of suspected pneumonia represents an indicator that was not measured in the 2000 MICS2, making it impossible to assess trends in this indicator over time. A related indicator—the percentage of children with ARI taken to an appropriate health provider—was measured in the MICS2, and its value has remained static over the past five years (see table above). The value of this latter indicator remains higher 5 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 13 in Sierra Leone than the WCA norm, suggesting that programs to raise awareness of Sierra Leonean caretakers regarding the need to seek care for severe ARI have achieved some success. Policy makers should seek to increase demand for ARI services while also ensuring that quality ARI services are provided at the nation’s community-level health facilities. The Community- Based Integrated Management of Childhood Illnesses (CB-IMCI) framework, which is currently being implemented in three districts in Sierra Leone, should be supported and scaled up in the remaining districts as quickly as feasible over the next several years in order to act to reduce severe ARI morbidity and mortality in children. SOLID FUEL USE Key indicators Estimates (percent) 2004 Regional Norm: 2005 (MICS3) 2000 (MICS2) West-Central Africa Solid fuels 99 -- -- 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—through its contribution to acute respiratory illness. Households in all areas and among almost all groups in Sierra Leone make nearly universal (99 percent) use of solid fuels for cooking purposes. Some households make use of charcoal—these households are mostly located in the Western Area and represent households that lie in the highest wealth quintile and/or where the household head has achieved secondary or higher education. Residents of the rest of the country cook almost exclusively with wood. Table 8 presents data regarding this indicator. Discussion: Solid Fuel Use The overwhelming reliance on solid fuels for cooking in Sierra Leone is due to the ready availability of inexpensive wood products and the comparatively high price and limited availability of alternative fuels. Given the dire economic conditions in Sierra Leone at this time, it is probably not realistic to expect people to change their fuel source. Efforts to reduce ARI through control of indoor pollution should therefore focus on promoting stoves that limit indoor pollution, such as closed stoves with chimneys (used by less than one percent of households in Sierra Leone) or open stoves with chimneys or hoods (used by nine percent of households). Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 14 MALARIA Key indicators Estimates (percent) West-Central Africa6 2005 (MICS3) 2000 (MICS2) 1999-2004 Under-fives sleeping under insecticide- treated nets 5 2 2 Under-fives sleeping under mosquito nets 20 15 15 Ant-malarial treatment (under-fives) ¾ Within 24 hours of onset of symptoms ¾ Any time 45 52 -- 61 -- 43 Malaria is a leading cause of death of children under age five in Sierra Leone. It also contributes to anaemia in children and is a common cause of school absenteeism. Preventive measures, especially the use of mosquito nets treated with insecticide (ITNs), can dramatically reduce malaria morbidity and mortality rates among children. In areas where malaria is common, international recommendations suggest treating any fever in children as if it were malaria and immediately giving the child a full course of recommended anti-malarial tablets. Children with severe malaria symptoms, such as fever or convulsions, should be taken to a health facility. Also, children recovering from malaria should be given extra liquids and food and should continue breastfeeding. The MICS3 questionnaire incorporates questions on the use of bednets, both at household level and among children under five years of age, as well as anti-malarial treatment, and intermittent preventive therapy for malaria. MICS3 results indicate that ITNs are available in only five percent of households in Sierra Leone. Results indicate that 20 percent of children under the age of five slept under any mosquito net the night prior to the survey and 5 percent slept under an ITN (Table 9). Both ITN use as well as untreated bed net use among children under five declines steadily with increasing age of the child and there were no significant gender disparities in ITN / bed net use among children under five. Questions on the prevalence of fever and its treatment were asked for all children under age five. Slightly more than one in three (35 percent) of children were ill with fever in the two weeks prior to the MICS3 (Table 10). Fever prevalence is highest among children aged 12-23 months (41 percent) and thereafter declines slowly with increasing age. The prevalence of fever is relatively similar across all levels of mother’s education and wealth quintiles. Among regions, fever was least prevalent in the Western Area (26 percent) and most prevalent in the North (39 percent). Among children who experienced fever in the two weeks prior to the survey, caretakers were asked to report all of the medicines that were given to their children to treat the fever, including both medicines given at home and medicines given or prescribed at a health facility. Overall, 52 percent of children with fever in the last two weeks were treated with an “appropriate” anti- malarial drug and 45 percent received anti-malarial drugs within 24 hours of onset of symptoms. 6 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 15 “Appropriate” anti-malarial drugs include Chloroquine, Fansidar, and artimisine combination drugs. In Sierra Leone, 46 percent of children with fever were given Chloroquine and 5 percent were given quinine. Only one percent received artimisine combination therapy. More than two- thirds of children with malaria (68 percent) were given other types of medicines that are not anti- malarials, including anti-pyretics such as paracetamol, aspirin or ibuprofen. Overall, children with fever in the East (54 percent) and South (53 percent) are the most likely to have received an appropriate anti-malarial drug within 24 hours of the onset of symptoms while those in the North, where malaria is most prevalent, are the least likely (35 percent) to receive an appropriate anti-malarial drug in timely fashion. Urban children are slightly more likely than rural children to be treated appropriately as are the children of mothers with secondary or higher education. Little difference was noted between boys and girls receiving appropriate anti-malarial drugs. Discussion: Malaria One in six children in Sierra Leone takes malaria medication every two weeks. The use of mosquito nets—both ITNs as well as normal bednets—has increased slightly from 2000 due to the program that distributes ITNs free of charge to families with pregnant women and children. However, the percentage of households that use bednets is still low. These findings suggest that the people of Sierra Leone continue to emphasize a curative, rather than preventive, approach to malaria control among children. Among the four regions of Sierra Leone, the North has the highest level of malaria morbidity and highest use of bednets but the lowest level of treatment of febrile children with an appropriate anti-malaria drug. These differences between the North and the other regions are less stark than during MICS2—when the North had the highest morbidity but lowest use of antibiotics and bednets—suggesting that the emphasis on targeting the Northern Region with additional resources to control malaria has achieved some success and should be continued. Policy makers and programmers should allocate more resources to interventions that prevent malaria. Roughly equal disease burden and bednet use in the East, South and North suggest that resources be distributed equitably among these three regions. ITNs must be made much more widely available to the public at low cost through a sustainable mechanism. This process could be aided by tax waivers for ITNs and additional funding to support an increase in the coverage of ITN distribution programs and other strategies to prevent malaria. On the curative side, malaria in children should be dealt with through an integrated approach to management of sick children—that is, through CB-IMCI, the roll-out of which should be prioritized. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 16 WATER AND SANITATION Key indicators Estimates for Sierra Leone (percent) West-Central Africa7 2005 (MICS3) 2004 (census) 2002 (SOWC) 2000 (MICS2) 2002 Use of improved drinking water sources 47 53 57 54 58 Use of improved sanitation facilities 30 -- 39 63 35 Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, good access to drinking water can 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 11. 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, 47 percent of the population has access to improved drinking water sources – 84 percent in urban areas and 32 percent in rural areas. Among regions, the situation is best in the largely urban Western Area (87 percent) and worst in the North, where only 30 percent of the population gets its drinking water from an improved source. Figure 3: Percent distribution of the population by source of drinking water, Sierra Leone, 2005 Tubewell 6% Piped into yard 5% Public tap 13% Protected well 20% Other protected source 3% Unprotected well 8% Unprotected spring 7% Surface water 38% Other unprotected source 0% The sources of drinking water for the population of the North, South, and East follow similar patterns (Table 11). Surface water is the primary source of drinking water in all three regions, 7 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 17 especially in the North, where over half of the population gets their water from this unsafe source. Substantial proportions (15-18 percent) of the populations in these three regions get their drinking water from unprotected wells or springs. The primary improved water sources in these regions are public taps, tube wells, and protected wells. In the Western Area, the primary improved water source is piped water, whether it is piped into the dwelling, the yard, or at a public tap. Inadequate disposal of human excreta and poor personal hygiene are associated with a range of diseases including diarrheal diseases and polio. Improved sanitation facilities include: flush toilets connected to sewage systems or septic tanks, other flush toilets, improved pit latrines, and traditional pit latrines with slabs. Thirty percent of the population of Sierra Leone lives in households that use improved sanitation facilities (Table 12). This percentage is 64 in urban areas and 17 percent in rural areas. Residents of the East and North are the least likely to use improved facilities; only 20 and 22 percent of the population there, respectively, use them. In the East and South most of the population uses rivers, bush, fields, or has no facilities. In contrast, in the North the most common facility is a pit latrine without slab or an open pit. 54 percent of the population in the Western Area uses a pit latrine with slab. Discussion: Water and Sanitation The MICS3 estimates of Sierra Leonean population’s access to improved sources of drinking water (47 percent) and sanitation facilities (30 percent) are lower than previous estimates. Enumerators were carefully trained on the different definitions of improved water and sanitation facilities and may have collected more accurate data than has been collected in the past. Other reasons that the MICS3 estimates may be lower than previous estimates include the following: 1. There has been a gradual movement of population from urban (where improved sources are more readily available) to rural locations following the end of the conflict. The MICS2 survey was conducted in 2000 at the height of the war, when many people had moved temporarily to urban locations. There was massive destruction of water and sanitation facilities during the war until it ended in 2002. 2. Interviewers’ access to remote and rural locations (where improved sources of water and sanitation are less readily available) in MICS2 was limited, which may have led to an overestimation of access to improved sources of water and sanitation in that survey. The results above suggest that policy makers should consider allocating resources to provide potable water to rural communities while emphasizing sustainability through support to community-based water system maintenance structures. Water and sanitation programs in Sierra Leone should emphasize both the development of improved water sources as well as raising the public’s awareness regarding good hygiene practices. Millennium Development Goal Indicator Population with access to safe drinking water Goal 82.5 percent by 2015 Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 18 Policy makers should consider revitalizing and enforcing the GoSL act that stipulates that a house owner must first construct a latrine before building a house. Policies that provide incentives for the private sector to produce materials used to build basic sanitation facilities (e.g., latrine slabs, etc.) may also contribute to the improvement of the public’s access to improved sanitary facilities. Programs that promote and facilitate the construction of low-cost family latrines in rural communities would help to raise the low level of households with access to improved sanitary facilities. CONTRACEPTION Key indicators Estimates (percent) West-Central Africa8 2005 (MICS3) 2000 (MICS2) 1996-2004 Contraceptive prevalence 5 4 17 Current use of contraception was reported by only 5 percent of women currently married or in union (Table 13). The most popular method is the pill which is used by 3 percent of married women in Sierra Leone. The next most popular method are injectable contraceptives which are used by 2 percent of married women. Contraceptive prevalence is highest in the Western Area at 20 percent and ranges from two to four percent in the remaining regions. Adolescents are less likely to use contraception than older women. Only about 2 percent of married or in-union women aged 15-19 currently use a method of contraception compared to 4 percent of 20-24 year olds and a slightly higher percentage of older women. Women’s education level is strongly associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 3 percent among those with no education to 8 percent among women with primary education, and to 20 percent among women with secondary or higher education. The method mix is fairly constant across the different strata of women’s educational status. Discussion: Contraception The astonishingly low contraceptive prevalence in Sierra Leone contributes directly to high birth rates as well as high rates of child and maternal mortality. The contraceptive prevalence in Sierra Leone even lags behind the low norms of the region (17 percent), suggesting that adequate efforts have not been made in Sierra Leone to promote contraception. Barriers to higher use of contraception in Sierra Leone include low awareness of the need for contraception, poor availability of contraceptives, and negative cultural perceptions regarding contraceptives. The promotion and provision of contraceptives must be integrated into all appropriate aspects of the health services, particularly delivery, postnatal and outreach services. Research is needed in order to identify barriers to contraception use, messages that will effectively increase demand for 8 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 19 contraceptives, types of contraceptives that Sierra Leoneans find acceptable, and culturally acceptable mechanisms to supply contraceptives to those who need them. ASSISTANCE AT DELIVERY Key indicators Estimates (percent) West-Central Africa9 2005 (MICS3) 2000 (MICS2) 1996-2004 Skilled attendant at delivery 43 42 45 Institutional deliveries 19 -- -- The provision of delivery assistance by skilled attendants can greatly improve outcomes for mothers and infants through the use of technically appropriate procedures as well as accurate and speedy diagnosis and treatment of complications. Skilled assistance at delivery is defined as assistance provided by a doctor, nurse, midwife or auxiliary midwife. About 43 percent of births in Sierra Leone occurring in the year prior to the MICS survey were attended by skilled personnel (Table 14). This percentage is highest in the Western Area at 83 percent and lowest in the North at 25 percent. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled birth attendant. Increasing wealth is clearly associated with increasing use of skilled birth attendants. Thirty-eight percent of births in Sierra Leone during the year prior to the MICS survey were delivered with assistance of a nurse or midwife. Auxiliary midwifes attended 3 percent of births while doctors assisted with the delivery of 2 percent of births. The relative proportions of different types of skilled birth attendants used were similar across the four regions and varied primarily in magnitude. Among unskilled birth attendants, the most commonly used included traditional birth attendants (37 percent) and relative/friend (14 percent). An estimated eighteen percent of all deliveries in Sierra Leone take place in health institutions, reflecting the low access of the population to health facilities where deliveries can be managed. Discussion: Assistance at Delivery The percentage of births attended by skilled birth attendants (SBAs) in Sierra Leone remains unchanged since last measured in 2000 and is in line with the regional value of 45 percent. Access to SBAs and health delivery services in institutions in Sierra Leone is limited by financial barriers (payments must be made to providers, even though delivery services are theoretically free of charge), difficulties reaching health facilities, perceptions that care is of poor quality, and a cultural preference for home births. Policy makers in Sierra Leone need to finalize and ratify the Safe Motherhood Initiative policy that, among other things, stipulates that mother-friendly facilities should be developed. Health officials and administrators need to ensure that policies providing special facilities to vulnerable groups are achieved in the field. Health workers must receive supportive supervision to 9 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 20 strengthen the quality of the services they provide and adequate remuneration if they are not to seek under-the-table payments for delivery. PRIMARY SCHOOL ATTENDANCE Key indicators Estimates West-Central Africa10 2005 (MICS3) 2000 (MICS2) 1996-2004 Net primary school attendance rate (%) 69 42 55 Gender parity index: ratio of girls : boys (primary; secondary) 1.01; 0.78 -- 0.86; 0.8 Universal access to basic education and the completion 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, 69 percent of children of primary school age in Sierra Leone are attending primary school or secondary school (Table 15). In urban areas, 85 percent of children attend school while in rural areas 63 percent attend. School attendance is highest in the Western Area at 89 percent and elsewhere ranges from 63 percent in the North to 72 percent in the East. There is no meaningful difference between male and female primary school attendance at any level or within any strata. The ratio of girls to boys attending primary and secondary education is provided in Table 16. The table shows that gender parity for primary school is 1.01, indicating virtually no difference in the attendance of girls and boys to primary school. However, the indicator drops to 0.78 at the national level for secondary education. This represents a rural/urban and rest-of-the- country/Freetown divide; the ratio is 0.64 in all three regions other than the Western Area (where it is 0.90) and 0.56 in rural areas as opposed to 0.82 in urban areas. Increasing wealth status of households appears to be strongly associated with increases in gender parity for secondary school attendance. Discussion: Primary School Attendance Primary school attendance in Sierra Leone has increased dramatically over the past five years and has now surged ahead of the regional norm. This is most likely due to improved access to education in areas that were held by the rebels at the time of the MICS2 survey as well as increased support to primary education throughout the country. Educational policy as it pertains to primary education appears to be achieving success and should be continued. Current policy calls for an effective coordination mechanism to be established as responsibility for educational 10 Source: SOWCR 2006. Millennium Development Goal Indicator Net primary school attendance rate Goal 100 percent by 2015 Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 21 programs is devolved from the Ministry of Education (MoE) to district and local councils. Organizations supporting primary education in Sierra Leone will need to work together with the government at all levels to ensure that the coordination mechanism functions effectively and resources are distributed equitably. The gender parity index shows an encouraging situation at the primary level, with equivalent attendance rates for girls and boys. Although past figures are not available in Sierra Leone to assess trends, gender parity for primary education in Sierra Leone appears to be ahead of the rest of the region. Support for girls education has been strongest at the primary level and gender parity at the secondary level may have suffered as a result. The MoE needs to enforce the Girls Education policy—especially at the second and tertiary levels—and otherwise intensify efforts that promote secondary and tertiary-level girls education. BIRTH REGISTRATION Key indicators Estimates (percent) West-Central Africa11 2005 (MICS3) 2000 (MICS2) 1999-2004 Birth registration 48 47 41 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 48 percent of children under-five years in Sierra Leone have been registered (Table 17). There are no significant variations in birth registration across sex or age categories. Increasing mother’s education status is positively associated with birth registration status. Birth registration status varies sharply by region; the highest level of birth registration is found in the South (72 percent), followed by the West (67 percent), the East (45 percent), and the North (29 percent). Caretakers whose children’s births had not been registered were asked why; common responses include “costs too much” (21 percent), “must travel too far” (15 percent), “didn’t know child should be registered” (33 percent), and “doesn’t know where to register” (20 percent). Discussion: Birth Registration Little progress has been made in birth registration in Sierra Leone over the past five years. The government should implement the official policy to integrate birth registration into the BCG vaccination process—84 percent of infants receive the BCG vaccination by their first birthday, and registering the births of most or all of these infants would dramatically boost the percentage of births that are registered and strengthen this important aspect of child’s rights. 11 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 22 EARLY MARRIAGE AND POLYGYNY Key indicators Estimates (percent) West-Central Africa12 2005 (MICS3) 2000 (MICS2) 1986-2004 Marriage before age 15, before age 18 27 / 62 -- -- / 45 Young women aged 15-19 currently married/in union 36 -- -- Polygyny 43 -- -- 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 18. Twenty-seven percent of women interviewed during the MICS3 were married before fifteen years of age. Among different age strata of respondents, this indicator is lowest among women currently aged 15-19 years (15 percent), indicating that the practice of early marriage in Sierra Leone is declining. The percentage of women married before fifteen years of age is highest in rural areas and in households that are poorer and where the mother’s educational status is lower. Sixty-two percent of all women interviewed during the MICS3 were married before eighteen years of age while thirty-six percent of women respondents currently aged 15-19 years reported that they were currently married or in union. The patterns of these two indicators among different sub-populations (e.g., rural/urban, by region, etc.) are similar to those described in the paragraph above for marriage below fifteen years of age. . Polygyny is widely practiced in Sierra Leone. Forty-three percent of the women interviewed during the MICS3 who are currently married or in union reported that their husband/partner has another wife. Among regions, the practice of polygyny is by far the lowest in the Western Area (12 percent)—in the remaining regions, it ranges from 38 percent in the East to 53 percent in the North. The percentage of women whose partners are in polygynous relationships increases with the increasing age category of the women. Increasing women’s educational status is associated with a decreasing percentage of women reporting polygyny. Women in the highest wealth quintile report the lowest prevalence of polygyny (27 percent). The percentage of women reporting polygyny in the remaining four quintiles is similar, ranging from 43 to 46 percent. Discussion: Early Marriage and Polygyny The data presented above paint a disturbing picture of early marriage and widespread polygyny. Local experts concur that cultural norms, early pregnancy and forced marriage are all likely contributing factors to early marriage and polygyny in Sierra Leone. Efforts to estimate the indicators reported above have only recently begun at the global level, and the MICS3 survey has generated the first estimate of many of these indicators in Sierra Leone. 12 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 23 Levels of marriage before age 18 are higher in Sierra Leone than the regional average, suggesting that this aspect of child protection has been inadequately addressed by policy makers and program managers. The Government of Sierra Leone’s Child Rights Bill makes marriage below the age of 18 illegal. Concerned organizations need to advocate for the passage of this act. Although legislation alone will not eliminate early marriage, the Child Rights Bill is an important first step that establishes an age for informed consent and responsibility. Policies are also required to prevent or discourage children and young women from entering into polygynous unions. A woman’s educational status is positively correlated with a reduced probability that she will marry early or be in a polygynous union, suggesting that efforts to promote education of girls and young women may contribute to reducing these practices. KNOWLEDGE OF HIV/AIDS TRANSMISSION AND CONDOM USE Key indicators Estimates (percent) West-Central Africa13 2005 (MICS3) 2000 (MICS2) 1998-2004 Comprehensive knowledge about HIV prevention among young people ¾ Knowledge of 3 ways of prevention ¾ Rejection of 3 misconceptions 18 35 24 -- 21 19 18 -- -- Condom use with non-regular partners 20 -- -- Higher risk sex in the last year 43 -- -- One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Populations in different countries are likely to have variations in misconceptions although some appear to be universal (for example, that sharing food can transmit HIV or that mosquito bites can transmit HIV). Table 19 presents the percentage of women aged 15-49 years who know 2 ways of preventing HIV transmission. The level of this indicator is fairly low at 44 percent. Eighty-one per cent of women living in the Western Area know 2 prevention methods; among women in the other three regions, the percentage of women who know two prevention methods ranges from 34 percent in the North to 42 percent in the South. As expected, the percentage of women who know two prevention methods increases with the woman’s education level and wealth status. A key indicator used to measure countries’ responses to the HIV epidemic is the proportion of young people 15-24 years who have comprehensive correct knowledge of HIV: that is, who 1) know two methods of preventing HIV, 2) reject two misconceptions regarding HIV, and 3) know that a healthy looking person can have HIV. Only 18 percent of young women in this age category in Sierra Leone have comprehensive correct knowledge of HIV. Among all women 13 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 24 aged 15-49 years, level of education, residence, and wealth levels are all highly associated with the level of comprehensive correct knowledge of HIV. Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms during sex, especially with non-regular partners, is especially important for reducing the spread of HIV. Globally, over half of new HIV infections are among young people 15-24 years; a change in behavior among this age group will thus be especially important to reduce new infections. Condom use during sex with men other than husbands or live-in partners (non-marital, non- cohabiting men) was assessed in women 15-24 years of age who had sex with such a partner in the previous year (Table 20). Forty-three percent of women 15-24 years report having sex with a non-regular partner in the 12 months prior to the MICS. Among those women, only one in five report having used a condom when they had sex with the high-risk partner. The use of a condom during high-risk sex in was highest among women aged 15-24 years in the Western Area (31 percent) and the North (21 percent) and lowest in the East (11 percent). Women with secondary or higher education, woman living in urban areas, and women in the highest wealth quintile were more likely to use a condom with such a partner. Discussion: Knowledge of HIV/AIDS Transmission and Condom Use None of the MICS3 indicators presented in this section have been measured previously in Sierra Leone. Two components of comprehensive knowledge about HIV/AIDS—knowledge of 3 ways of prevention and rejection of 3 misconceptions—were measured in both MICS2 and MICS3 and are presented in the table above. The resulting comparison shows that there is an observed improvement in each component, although the overall percentage of women with comprehensive knowledge remains disturbingly low. HIV/AIDS prevention can be most effectively addressed at the policy level through the establishment of policies that empower women, such as girls education, income generation, etc. IEC programs that seek to educate the public about HIV/AIDS should attempt to improve knowledge about both prevention as well as misconceptions and should be gender-sensitive with a specific focus on women. Two indicators presented in the table above highlight the finding that young women aged 15-24 in Sierra Leone are at substantial risk of contracting HIV. High percentages of women in this age group engage in high-risk sex without the protection of a condom. Experts in Sierra Leone note that a lack of information on HIV/AIDS, poverty, lack of life skills, peer pressure, and lack of access to condoms all contribute to this dismal finding. High-risk sexual activity among this important target group increases the spread of HIV and must be combated directly. Enhanced enforcement of the National Youth Policy and Child Rights Bill should contribute to addressing this problem. Information regarding HIV/AIDS should be integrated into educational curricula at all appropriate levels and IEC programs that promote delayed sex and use of condoms should be intensified. In summary, the data presented above suggest that HIV/AIDS interventions in Sierra Leone should be more vigorously implemented with a specific focus on women. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 25 ORPHANS AND VULNERABLE CHILDREN SCHOOL ATTENDANCE Key indicators Estimates (percent) Sub-Saharan Africa14 2005 (MICS3) 2000 (MICS2) 1998-2004 School attendance of orphans versus non- orphans ( double orphans per non-orphan) 0.82 .71 0.83 As the HIV epidemic progresses, more and more children are becoming orphaned and vulnerable due to HIV and AIDS. Children who are orphaned or living away from their parents may be at increased risk of neglect or exploitation if the parents are not available to assist them. Monitoring the variations in educational outcomes for children who have lost both parents (i.e., 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 Sierra Leone, 1.4 percent of children aged 10-14 years have lost both parents (Table 21). Among those children, only 63 per cent are currently attending school. Among children ages 10- 14 who have not lost a parent and who live with at least one parent, 81 percent are attending school. These two figures can be used to form a ratio—double orphans to non-orphans school attendance ratio—that has a value of 0.82. This would suggest that double orphans are disadvantaged compared to children who are not orphans with respect to their access to educational opportunities. Discussion: Orphans and Vulnerable Children School Attendance The school attendance rate of orphans in Sierra Leone is in line with norms for the continent and illustrates the disadvantages faced by orphans in accessing opportunities available to other, less vulnerable children. The GoSL and its partners should ensure that policy on Orphans and Vulnerable Children is being followed and that communities are actively involved in programs to support orphans and other disadvantaged children. 14 Source: SOWCR 2006. Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 26 IV. TABLES Table 2: Results of household and individual interviews Numbers of households, women and children under 5 by results of the household, women's and under-five's interviews, and household, women's and under-five's response rates, Sierra Leone, 2005 Area Region Rural Urban East North South West Total Sampled households 5625 2375 1850 2850 2000 1300 8000 Occupied households 5086 2039 1604 2602 1761 1158 7125 Interviewed households 5053 2025 1600 2564 1758 1156 7078 Household response rate 99.4 99.3 99.8 98.5 99.8 99.8 99.3 Eligible women 6624 2633 2281 3548 2202 1226 9257 Interviewed women 5334 2320 1586 2971 1907 1190 7654 Women response rate 80.5 88.1 69.5 83.7 86.6 97.1 82.7 Women's overall response rate 80.0 87.5 69.4 82.5 86.5 96.9 82.1 Eligible children under 5 4670 1234 1478 2273 1638 515 5904 Mother/Caretaker Interviewed 4076 1170 1149 2099 1485 513 5246 Child response rate 87.3 94.8 77.7 92.3 90.7 99.6 88.9 Children's overall response rate 86.7 94.2 77.5 91.0 90.5 99.4 88.3 Preliminary Report on Sierra Leone Multiple Indicator Cluster Survey 2005 Page 27 Table 3: Child mortality Infant and under-five mortality rates [based on North method], Sierra Leone, 2005 Infant Mortality Rate* Under-five Mortality Rate** Male 172 283 Sex Female 143 249 East 166 280 North 149 252 South 189 317 Region West 79 126 Rural 165 279 Area Urban 123 207 None 165 279 Primary 146 247 Mother's education Secondary+ 100 164 Poorest 159 268 Second 172 290 Middle 161 272 Fourth 168 283 Wealth index quintiles Richest 108 179 Christian 158 267 Religion Muslim 158 267 Total 158 267 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 28 Ta bl e 4: C hi ld m al no ur is hm en t Pe rc en ta ge o f u nd er -fi ve c hi ld re n w ho a re s ev er el y or m od er at el y un de rn ou ris he d, S ie rr a Le on e, 2 00 5 W ei gh t f or ag e: % b el ow -2 S D W ei gh t f or ag e: % b el ow - 3 SD * H ei gh t f or ag e: % b el ow -2 S D H ei gh t f or a ge : % b el ow -3 S D ** W ei gh t f or he ig ht : % be lo w -2 S D W ei gh t f or he ig ht : % be lo w -3 S D ** * W ei gh t f or he ig ht : % ab ov e +2 S D N um be r o f ch ild re n M al e 31 .6 8. 5 41 .0 20 .7 10 .1 2. 2 2. 8 18 52 Se x Fe m al e 29 .5 8. 5 38 .1 19 .2 7. 7 1. 8 2. 9 18 99 E as t 34 .4 7. 8 38 .9 21 .9 11 .5 1. 8 2. 2 97 1 N or th 33 .9 11 .1 44 .4 22 .8 8. 1 2. 2 2. 6 12 27 So ut h 27 .4 7. 2 39 .2 17 .1 8. 6 2. 0 2. 6 11 32 R eg io n W es t 20 .5 5. 8 28 .1 14 .7 6. 0 1. 5 5. 5 42 1 R ur al 33 .0 9. 1 42 .1 22 .0 9. 4 2. 0 2. 5 28 13 Ar ea U rb an 23 .1 6. 6 31 .9 13 .8 7. 3 1. 7 3. 7 93 8 < 6 m on th s 4. 0 .5 10 .4 2. 7 3. 5 .8 10 .6 37 6 6- 11 m on th s 31 .9 11 .3 22 .5 8. 1 14 .5 2. 8 2. 6 41 2 12 -2 3 m on th s 45 .7 14 .1 46 .7 21 .8 16 .2 3. 4 2. 4 82 2 24 -3 5 m on th s 34 .4 9. 9 45 .2 23 .7 7. 7 1. 3 1. 7 77 8 36 -4 7 m on th s 29 .3 7. 2 50 .4 28 .6 5. 3 1. 9 1. 1 80 2 Ag e 48 -5 9 m on th s 21 .5 3. 4 37 .7 19 .7 4. 6 1. 1 2. 4 55 3 N on e 32 .0 8. 8 41 .9 21 .9 8. 8 1. 7 2. 5 29 01 P rim ar y 27 .5 8. 1 32 .6 13 .5 10 .8 3. 0 3. 3 43 3 M ot he r's ed uc at io n Se co nd ar y 23 .6 7. 0 30 .0 12 .5 7. 6 2. 6 4. 7 41 3 P oo re st 37 .0 9. 5 43 .8 24 .1 8. 9 2. 7 3. 0 73 2 S ec on d 32 .1 8. 2 43 .6 23 .1 8. 5 1. 5 2. 6 81 1 M id dl e 31 .2 9. 4 41 .0 21 .2 10 .7 2. 3 2. 7 79 6 Fo ur th 29 .6 8. 5 41 .1 17 .7 7. 5 1. 6 1. 9 76 8 w ea lth in de x qu in til es R ic he st 21 .6 6. 5 26 .1 12 .5 8. 8 1. 7 4. 3 64 4 C hr is tia n 26 .7 8. 7 35 .0 19 .2 8. 9 2. 1 3. 9 76 0 M us lim 31 .5 8. 4 40 .7 20 .1 8. 9 1. 9 2. 6 29 84 R el ig io n of H ou se ho ld H ea d O th er /M is si ng 45 .8 .0 45 .8 45 .8 .0 .0 .0 7 To ta l 30 .6 8. 5 39 .6 19 .9 8. 9 2. 0 2. 8 37 51 * M IC S in di ca to r 6 ; M D G in di ca to r 4 ** M IC S in di ca to r 7 ** * M IC S in di ca to r 8 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 29 Ta bl e 5: B re as tfe ed in g Pe rc en t o f l iv in g ch ild re n ac co rd in g to b re as tfe ed in g st at us a t e ac h ag e gr ou p, S ie rr a Le on e, 2 00 5 C hi ld re n 0- 3 m on th s C hi ld re n 0- 5 m on th s C hi ld re n 6- 9 m on th s C hi ld re n 1 2- 15 m on th s C hi ld re n 20 -2 3 m on th s P er ce nt ex cl us iv el y br ea st fe d N um be r of ch ild re n P er ce nt ex cl us iv el y br ea st fe d * N um be r of ch ild re n P er ce nt re ce iv in g br ea st m ilk a nd so lid /m us hy fo od * * N um be r of ch ild re n P er ce nt br ea st fe d* ** N um be r of ch ild re n P er ce nt br ea st fe d ** * N um be r of ch ild re n M al e 8. 8 14 8 6. 6 24 3 54 .8 20 3 89 .8 18 1 62 .7 13 8 Se x Fe m al e 11 .1 14 5 8. 5 25 9 49 .4 17 0 85 .5 19 4 51 .1 13 0 E as t 10 .2 77 7. 1 12 6 51 .3 77 91 .8 11 3 55 .5 53 N or th 14 .4 11 5 12 .4 19 7 49 .1 15 3 91 .4 13 4 69 .7 11 9 So ut h 4. 6 85 2. 6 14 7 61 .0 11 5 82 .7 10 7 46 .7 73 R eg io n W es t 5. 3 17 2. 7 33 37 .5 29 65 .2 21 29 .6 24 R ur al 9. 5 25 6 7. 6 42 7 54 .7 29 7 88 .7 30 5 61 .4 20 6 Ar ea U rb an 12 .9 37 7. 6 76 42 .9 75 82 .7 70 42 .7 62 N on e 10 .9 24 0 8. 5 41 4 53 .7 30 0 88 .6 30 5 61 .9 21 0 P rim ar y 6. 9 32 4. 4 49 47 .3 39 82 .1 41 43 .2 27 Se co nd ar y 4. 1 22 2. 3 39 46 .3 33 84 .7 29 34 .4 30 M ot he r's ed uc at io n N on -s ta nd ar d cu rr ic ul um . 0 . 0 . 0 . 0 10 0. 0 1 Po or es t 14 .5 75 11 .0 11 7 63 .2 69 90 .2 79 58 .7 45 S ec on d 7. 6 77 9. 0 12 1 43 .2 84 85 .4 93 66 .7 59 M id dl e 5. 2 60 3. 5 11 5 58 .9 92 92 .8 82 65 .9 61 Fo ur th 13 .0 50 8. 0 92 51 .1 85 84 .3 69 48 .2 65 w ea lth in de x qu in til es R ic he st 9. 1 31 5. 0 57 41 .3 43 83 .7 52 41 .2 39 C hr is tia n 17 .1 53 12 .9 85 45 .5 70 89 .7 67 44 .5 50 M us lim 8. 0 24 0 6. 3 41 6 53 .8 30 2 87 .1 30 7 59 .9 21 8 R el ig io n of H ou se ho ld H ea d O th er /M is si ng 10 0. 0 1 50 .0 2 10 0. 0 1 10 0. 0 1 . 0 To ta l 9. 9 29 4 7. 6 50 3 52 .3 37 3 87 .6 37 5 57 .0 26 8 * M IC S in di ca to r 1 5 ** M IC S in di ca to r 1 7 ** * M IC S in di ca to r 1 6 Sierra Leone Multiple Indicator Cluster Survey 2005 Page 30 Table 6: 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, Sierra Leone, 2005 BCG * DPT 1 DPT 2 DPT 3 ** Polio 0 Polio 1 Polio 2 Polio 3 **** Measles **** Yellow Fever** All ***** None Number of children aged 12-23 months Vaccination card 49.6 47.1 42.7 37.2 43.2 48.5 44.0 38.3 33.2 30.7 28.0 .1 1074 Mother's report 36.3 34.9 33.9 25.4 23.2 38.5 35.8 25.8 42.7 43.9 25.6 10.8 1074 Either 85.9 82.0 76.5 62.6 66.4 87.0 79.9 64.0 75.9 74.5 53.6 10.9 1074 Vaccinated by 12 months of age 84.0 78.3 72.8 55.5 65.2 84.1 75.1 57.0 62.4 59.9 35.0 10.9 1074 * MICS Indicator 25 ** MICS Indicator 26 *** MICS Indicator 27 **** MICS Indicator 28 ; MDG Indicator 15 ***** MICS Indicator 31 Sierra Leone Multiple Indicator Cluster Survey 2005 Page 31 Table 7: Antibiotic treatment of pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, Sierra Leone, 2005 * MICS indicator 22 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 Male 21.2 294Sex Female 20.7 276 East 27.3 147 North 13.3 212 South 19.8 177 Region West 47.4 34 Rural 18.4 476Area Urban 33.9 94 0-11 months 15.0 162 12-23 months 28.4 136 24-35 months 19.7 100 36-47 months 20.4 105 Age 48-59 months 21.7 65 None 19.2 466 Primary 26.0 64 Mother's education Secondary 33.0 41 Poorest 19.8 128 Second 17.5 140 Middle 13.0 119 Fourth 26.8 131 wealth index quintiles Richest 36.1 53 Christian 30.3 92Religion of Household Head Muslim 19.1 478 Total 20.9 570 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 32 Ta bl e 8: S ol id fu el u se Pe rc en t d is tr ib ut io n of h ou se ho ld s ac co rd in g to ty pe o f c oo ki ng fu el , a nd p er ce nt ag e of h ou se ho ld s us ed s ol id fu el s fo r c oo ki ng , S ie rr a Le on e, 2 00 5 Ty pe o f f ue l u si ng fo r c oo ki ng El ec tri ci ty N at ur al ga s B io ga s Ke ro -s in e C oa l/ lig ni te C ha rc oa l W oo d S tra w / sh ru bs / gr as s A gr ic ul tu ra l cr op re si du e O th er To ta l So lid fu el s fo r co ok in g * N um be r o f ho us eh ol ds Ea st .0 .0 .0 .0 .0 4. 4 95 .3 .2 .0 .2 10 0. 0 99 .8 15 93 N or th .0 .0 .0 .0 .0 .7 98 .9 .1 .1 .3 10 0. 0 99 .7 25 85 S ou th .1 .0 .0 .1 .0 1. 4 98 .3 .0 .0 .2 10 0. 0 99 .7 17 49 R eg io n W es t .2 .1 .3 2. 5 .2 40 .6 55 .6 .0 .0 .6 10 0. 0 96 .4 11 50 A re a R ur al .0 .0 .0 .0 .0 .6 99 .1 .1 .0 .2 10 0. 0 99 .8 50 52 U rb an .1 .0 .1 1. 4 .1 27 .0 70 .5 .1 .0 .5 10 0. 0 97 .7 20 26 N on e .0 .0 .0 .2 .0 3. 6 95 .8 .1 .0 .3 10 0. 0 99 .6 49 59 Pr im ar y .0 .0 .0 .2 .0 5. 9 93 .7 .0 .0 .2 10 0. 0 99 .7 62 1 S ec on da ry + .3 .0 .2 1. 4 .1 24 .6 72 .8 .1 .0 .4 10 0. 0 97 .7 14 54 N on -s ta nd ar d cu rri cu lu m .0 .0 .0 .0 .0 2. 4 97 .6 .0 .0 .0 10 0. 0 10 0. 0 41 E du ca tio n of ho us eh ol d he ad M is si ng /D K .0 .0 .0 33 .0 .0 33 .0 34 .1 .0 .0 .0 10 0. 0 67 .0 3 Po or es t .0 .0 .0 .0 .0 .0 10 0. 0 .0 .0 .0 10 0. 0 10 0. 0 15 19 S ec on d .0 .0 .0 .0 .0 .0 99 .8 .1 .0 .1 10 0. 0 99 .9 14 93 M id dl e .0 .0 .0 .0 .0 .0 99 .7 .0 .0 .3 10 0. 0 99 .7 13 41 Fo ur th .0 .0 .0 .1 .0 1. 6 97 .7 .1 .2 .5 10 0. 0 99 .5 13 19 w ea lth in de x qu in til es R ic he st .3 .1 .2 2. 1 .1 39 .6 56 .9 .1 .0 .6 10 0. 0 96 .7 14 07 C hr is tia n .0 .0 .1 .7 .1 13 .6 85 .0 .1 .1 .4 10 0. 0 98 .9 16 01 M us lim .1 .0 .0 .3 .0 6. 6 92 .6 .1 .0 .2 10 0. 0 99 .3 54 58 R el ig io n of H ou se ho ld H ea d O th er /M is si ng .0 .0 .0 .0 .0 .0 89 .5 .0 .0 10 .5 10 0. 0 89 .5 19 To ta l .1 .0 .0 .4 .0 8. 2 90 .9 .1 .0 .3 10 0. 0 99 .2 70 78 * M IC S in di ca to r 2 4; M D G in di ca to r 2 9 Sierra Leone Multiple Indicator Cluster Survey 2005 Page 33 Table 9: Children sleeping under bednets Percentage of children aged 0-59 months that slept under an insecticide treated net during the previous night, Sierra Leone, 2005 Slept under a bednet * Sleep under an insecticide treated net ** Slept under an untreated net Slept under a net but don't know if treated Don't know if slept under a net Did not sleep under a bednet Number of children aged 0-59 months Male 20.6 5.4 14.5 .8 .5 78.8 2605Sex Female 19.8 5.2 13.6 1.0 .4 79.8 2639 East 13.2 6.7 6.5 .1 .4 86.4 1300 North 27.2 6.0 19.6 1.6 .7 72.1 2040 South 21.3 4.2 16.5 .7 .3 78.3 1444 Region West 5.5 1.8 3.5 .2 .2 94.3 460 Rural 21.7 5.3 15.5 .9 .5 77.8 4144Area Urban 14.5 5.3 8.6 .6 .5 85.0 1101 0-11 months 24.8 7.4 16.5 .9 .4 74.9 1016 12-23 months 21.2 6.3 13.8 1.2 .5 78.3 1074 24-35 months 20.0 5.1 14.1 .8 .6 79.4 1069 36-47 months 18.0 4.6 12.7 .7 .6 81.4 1181 Age 48-59 months 17.0 2.9 13.4 .7 .3 82.7 884 Poorest 14.1 3.7 9.4 1.1 .4 85.5 1109 Second 19.2 4.2 13.9 1.0 .6 80.2 1231 Middle 26.6 5.7 20.0 .9 .5 72.9 1156 Fourth 22.1 6.4 15.1 .6 .6 77.4 1020 wealth index quintiles Richest 18.5 7.5 10.5 .5 .3 81.2 729 Christian 14.7 5.6 8.4 .8 .4 84.9 995 Muslim 21.5 5.2 15.4 .9 .5 78.0 4240 Religion of Household Head Other/Missing 32.0 21.3 .0 10.7 .0 68.0 9 Total 20.2 5.3 14.1 .9 .5 79.3 5245 * MICS indicator 38 ** MICS indicator 37; MDG indicator 22 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 34 Ta bl e 10 : T re at m en t o f c hi ld re n w ith a nt i-m al ar ia l d ru gs Pe rc en ta ge o f c hi ld re n 0- 59 m on th s of a ge w ho w er e ill w ith fe ve r i n th e la st tw o w ee ks w ho re ce iv ed a nt i-m al ar ia l d ru gs , S ie rr a Le on e, 2 00 5 N ot e: th is ta bl e is pr es en te d ov er tw o pa ge s d ue to it s l ar ge si ze C hi ld re n w ith a fe ve r i n th e la st tw o w ee ks w ho w er e tre at ed w ith : H ad a fe ve r i n la st tw o w ee ks N um be r o f ch ild re n ag ed 0 -5 9 m on th s A nt i-m al ar ia ls : S P /F an si da r An ti- m al ar ia ls : C hl or oq ui ne A nt i-m al ar ia ls : A rm od ia qu in e An ti- m al ar ia ls : Q ui ni ne An ti- m al ar ia ls : A rte m is ni n ba se d co m bi na tio ns A ny ap pr op ria te an ti- m al ar ia l dr ug w ith in 2 4 ho ur s of o ns et of s ym pt om s * N um be r o f ch ild re n w ith fe ve r in la st tw o w ee ks M al e 35 .5 26 05 .2 1. 1 46 .5 1. 6 4. 4 0. 9 45 .7 92 4 Se x Fe m al e 34 .3 26 39 .5 1. 3 45 .8 2. 2 6. 1 1. 4 44 .3 90 6 E as t 35 .0 13 00 .0 1. 0 54 .3 4. 4 11 .9 2. 6 53 .9 45 5 N or th 38 .7 20 40 .0 1. 1 40 .3 1. 0 1. 6 0. 6 35 .3 78 9 So ut h 32 .5 14 44 .4 1. 2 50 .6 1. 2 6. 0 0. 6 52 .9 46 9 R eg io n W es t 25 .5 46 0. 3 2. 3 35 .9 0. 8 0. 8 1. 5 44 .3 11 8 R ur al 35 .0 41 43 .9 0. 7 45 .7 1. 8 5. 1 0. 7 44 .0 14 51 A re a U rb an 34 .4 11 00 .7 3. 0 47 .7 2. 1 6. 0 3. 1 49 .1 37 9 0- 11 35 .5 10 15 .9 0. 0 43 .6 2. 3 5. 9 1. 7 44 .0 36 1 12 -2 3 40 .7 10 74 .4 1. 5 50 .6 2. 9 5. 8 1. 6 49 .9 43 7 24 -3 5 34 .7 10 69 .4 1. 6 44 .9 1. 2 4. 3 0. 3 42 .9 37 1 36 -4 7 32 .2 11 81 .1 1. 5 46 .5 1. 4 4. 8 1. 5 45 .5 38 0 Ag e 48 -5 9 31 .1 88 4. 4 1. 1 44 .4 1. 5 5. 0 0. 7 41 .4 27 5 N on e 34 .6 42 26 .4 0. 8 43 .8 1. 8 5. 0 0. 8 42 .2 14 64 Pr im ar y 38 .1 54 1. 4 2. 8 57 .5 1. 6 7. 6 2. 0 53 .7 20 6 M ot he r's ed uc at io n Se co nd ar y 33 .5 47 2. 8 2. 4 53 .1 3. 2 4. 3 3. 0 59 .7 15 8 Po or es t 33 .4 11 08 .7 0. 6 45 .3 3. 3 6. 4 0. 6 44 .7 37 0 S ec on d 31 .9 12 31 .2 0. 5 40 .4 1. 4 3. 4 0. 5 35 .1 39 3 M id dl e 37 .5 11 55 .8 0. 7 43 .6 1. 0 3. 9 1. 2 42 .2 43 4 Fo ur th 37 .9 10 19 .6 1. 8 52 .3 1. 5 4. 7 0. 7 52 .2 38 7 w ea lth in de x qu in til es R ic he st 33 .8 72 9. 3 3. 2 51 .2 2. 8 9. 7 3. 6 54 .9 24 6 C hr is tia n 34 .2 99 5. 4 1. 4 55 .5 4. 0 7. 4 0. 8 55 .5 34 0 R el ig io n of H ou se ho ld H ea d M us lim 35 .1 42 40 .1 1. 1 44 .0 1. 4 4. 8 1. 2 42 .6 14 87 To ta l 34 .9 52 44 .7 1. 2 46 .1 1. 9 5. 2 1. 2 45 .0 18 30 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 35 Ta bl e 10 : Tr ea tm en t o f c hi ld re n w ith a nt i-m al ar ia l d ru gs (c on tin ue d fr om p re vi ou s pa ge ) Pe rc en ta ge o f c hi ld re n 0- 59 m on th s of a ge w ho w er e ill w ith fe ve r i n th e la st tw o w ee ks w ho re ce iv ed a nt i-m al ar ia l d ru gs , S ie rr a Le on e, 2 00 5 C hi ld re n w ith a fe ve r i n th e la st tw o w ee ks w ho w er e tre at ed w ith : A nt i- m al ar ia ls : O th er A nt i- m al ar ia l A ny ap pr op ria te an ti- m al ar ia l dr ug O th er m ed ic at io ns : P ar ac et am ol / Pa na do l/ Ac et am in op ha n O th er m ed ic at io ns : As pi rin O th er m ed ic at io ns : Ib up ro fe n O th er m ed ic at io ns : O th er D on 't kn ow A ny ap pr op ria te an ti- m al ar ia l dr ug w ith in 24 h ou rs o f on se t o f sy m pt om s * N um be r o f ch ild re n w ith fe ve r i n la st tw o w ee ks M al e 3. 9 51 .9 69 .5 23 .9 1. 3 25 .0 6. 6 45 .7 92 4 Se x Fe m al e 3. 9 51 .8 66 .6 18 .2 2. 4 25 .1 7. 4 44 .3 90 6 E as t 3. 1 61 .0 73 .6 23 .8 0. 8 25 .3 3. 5 53 .9 45 5 N or th 3. 2 44 .8 59 .4 19 .8 1. 0 19 .2 12 .0 35 .3 78 9 So ut h 4. 4 56 .6 76 .6 23 .6 4. 8 30 .3 3. 1 52 .9 46 9 R eg io n W es t 9. 9 45 .0 71 .0 8. 4 0. 0 42 .0 2. 3 44 .3 11 8 R ur al 2. 7 50 .4 65 .6 20 .3 1. 8 22 .7 8. 2 44 .0 14 51 A re a U rb an 8. 5 57 .6 77 .4 23 .9 2. 0 33 .7 2. 5 49 .1 37 9 0- 11 5. 8 50 .9 63 .8 20 .3 1. 1 26 .6 10 .4 44 .0 36 1 12 -2 3 2. 7 56 .8 69 .1 21 .7 1. 4 23 .8 6. 9 49 .9 43 7 24 -3 5 3. 6 49 .0 67 .9 21 .5 1. 8 26 .0 5. 6 42 .9 37 1 36 -4 7 4. 1 52 .1 70 .5 19 .8 2. 9 28 .0 5. 8 45 .5 38 0 A ge in M on th s 48 -5 9 3. 5 49 .7 69 .5 22 .1 2. 2 20 .1 6. 0 41 .4 27 5 N on e 3. 4 48 .7 66 .6 19 .5 1. 8 23 .0 8. 0 42 .2 14 64 Pr im ar y 2. 4 63 .3 73 .2 27 .7 3. 3 32 .5 4. 9 53 .7 20 6 M ot he r's ed uc at io n Se co nd ar y 10 .7 66 .5 74 .5 26 .1 0. 0 33 .5 0. 6 59 .7 15 8 Po or es t 2. 7 49 .1 61 .8 20 .0 1. 6 23 .6 8. 6 44 .7 37 0 S ec on d 1. 8 43 .8 59 .8 17 .1 0. 7 21 .4 8. 9 35 .1 39 3 M id dl e 2. 8 48 .8 69 .4 23 .3 2. 4 22 .4 8. 2 42 .2 43 4 Fo ur th 4. 5 58 .6 73 .8 20 .8 2. 3 25 .1 5. 6 52 .2 38 7 w ea lth in de x qu in til es R ic he st 10 .0 63 .5 79 .5 25 .1 2. 4 37 .6 1. 5 54 .9 24 6 C hr is tia n 5. 8 62 .0 73 .6 25 .6 2. 0 23 .5 3. 4 55 .5 34 0 R el ig io n of H H H ea d M us lim 3. 5 49 .6 66 .8 20 .0 1. 8 25 .4 7. 8 42 .6 14 87 To ta l 3. 9 51 .9 68 .1 21 .0 1. 8 25 .0 7. 0 45 .0 18 30 M IC S in di ca to r 3 9; M D G in di ca to r 2 2 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 3 6 Ta bl e 11 : U se o f i m pr ov ed w at er s ou rc es Pe rc en t d is tr ib ut io n of h ou se ho ld p op ul at io n ac co rd in g to m ai n so ur ce o f d rin ki ng w at er a nd p er ce nt ag e of h ou se ho ld m em be rs u si ng im pr ov ed d rin ki ng w at er s ou rc es , Si er ra L eo ne , 2 00 5 ( N ot e: th is ta bl e is p re se nt ed o ve r t wo p ag es d ue to it s l ar ge si ze ) Im pr ov ed s ou rc es P ip ed in to dw el lin g P ip ed in to y ar d or p lo t P ub lic ta p/ st an dp ip e Tu be w el l/b or eh ol e P ro te ct ed w el l R ai nw at er co lle ct io n P ro te ct ed sp rin g Im pr ov ed so ur ce o f dr in ki ng w at er N um be r o f ho us eh ol d m em be rs E as t 0. 5 3. 7 14 .9 5. 4 26 .8 0. 0 0. 4 51 .8 97 93 N or th 0. 3 0. 6 4. 7 2. 5 20 .9 0. 2 0. 9 30 .2 17 28 2 S ou th 0. 0 0. 0 9. 0 16 .8 19 .3 0. 0 0. 9 46 .0 97 98 R eg io n W es t 9. 5 28 .1 39 .6 0. 0 7. 9 0. 0 1. 5 86 .6 58 46 R ur al 0. 1 0. 9 6. 7 7. 5 15 .9 0. 1 0. 6 31 .8 30 62 6 A re a U rb an 5. 2 15 .1 28 .3 2. 6 30 .8 0. 0 1. 5 83 .6 12 09 2 N on e 0. 6 2. 8 9. 7 5. 7 18 .6 0. 1 0. 8 38 .3 30 56 3 P rim ar y 0. 9 3. 9 13 .0 9. 4 23 .7 0. 1 0. 8 51 .9 36 69 S ec on da ry + 5. 6 13 .7 24 .4 5. 8 24 .0 0. 0 1. 3 74 .8 81 96 N on -s ta nd ar d cu rri cu lu m 0. 0 0. 0 8. 4 12 .8 22 .3 0. 0 0. 0 43 .6 27 2 E du ca tio n of ho us eh ol d he ad M is si ng /D K 25 .8 15 .5 0. 0 0. 0 58 .7 0. 0 0. 0 10 0. 0 19 P oo re st 0. 0 0. 0 0. 9 2. 6 7. 0 0. 0 0. 2 10 .8 85 42 S ec on d 0. 0 0. 1 4. 2 5. 1 13 .4 0. 0 0. 5 23 .3 85 44 M id dl e 0. 1 0. 8 7. 4 11 .0 23 .4 0. 2 0. 6 43 .5 85 42 Fo ur th 0. 1 2. 9 20 .1 9. 1 30 .0 0. 1 1. 3 63 .7 85 46 w ea lth in de x qu in til es R ic he st 7. 6 20 .9 31 .4 2. 7 26 .8 0. 1 1. 7 91 .2 85 45 C hr is tia n 2. 8 7. 0 15 .0 5. 1 16 .1 0. 2 1. 3 47 .5 91 43 M us lim 1. 2 4. 4 12 .2 6. 4 21 .2 0. 0 0. 8 46 .2 33 48 2 R el ig io n of H ou se ho ld H ea d O th er /M is si ng 0. 0 0. 0 10 .8 0. 0 29 .0 0. 0 0. 0 39 .8 93 To ta l 1. 6 4. 9 12 .8 6. 1 20 .1 0. 1 0. 9 46 .5 42 71 9 M IC S in di ca to r 1 1; M D G in di ca to r 3 0 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 37 Ta bl e 11 : U se o f i m pr ov ed w at er s ou rc es (c on tin ue d fr om p re vi ou s pa ge ) Pe rc en t d is tr ib ut io n of h ou se ho ld p op ul at io n ac co rd in g to m ai n so ur ce o f d rin ki ng w at er a nd p er ce nt ag e of h ou se ho ld m em be rs u si ng im pr ov ed d rin ki ng w at er s ou rc es , Si er ra L eo ne , 2 00 5 M IC S in di ca to r 1 1; M D G in di ca to r 3 0 U ni m pr ov ed s ou rc es U np ro te ct e d w el l U np ro te ct e d sp rin g Ta nk er - tru ck C ar t w ith sm al l ta nk /d ru m S ur fa ce w at er B ot tle d w at er O th er U ni m pr ov e d so ur ce o f dr in ki ng w at er N um be r o f ho us eh ol d m em be rs Ea st 7. 8 8. 8 0. 0 0. 0 31 .3 0. 3 0. 0 48 .2 97 93 N or th 10 .7 4. 6 0. 0 0. 1 54 .1 0. 1 0. 1 69 .8 17 28 2 So ut h 7. 7 9. 9 0. 0 0. 1 36 .3 0. 0 0. 0 54 .0 97 98 R eg io n W es t 3. 6 2. 4 0. 0 0. 0 5. 9 0. 0 1. 5 13 .4 58 46 R ur al 8. 8 8. 5 0. 0 0. 1 50 .7 0. 1 0. 1 68 .2 30 62 6 Ar ea U rb an 7. 3 1. 4 0. 0 0. 1 6. 5 0. 3 0. 7 16 .4 12 09 2 N on e 9. 3 7. 0 0. 0 0. 1 45 .1 0. 2 0. 2 61 .7 30 56 3 Pr im ar y 6. 4 7. 4 0. 0 0. 2 34 .1 0. 0 0. 1 48 .1 36 69 Se co nd ar y + 6. 1 4. 5 0. 0 0. 1 13 .7 0. 1 0. 7 25 .2 81 96 N on -s ta nd ar d cu rr ic ul um 4. 4 0. 0 0. 0 0. 0 52 .0 0. 0 0. 0 56 .4 27 2 E du ca tio n of h ou se ho ld he ad M is si ng /D K 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 19 Po or es t 7. 8 11 .8 0. 0 0. 1 69 .4 0. 1 0. 0 89 .2 85 42 S ec on d 7. 9 8. 0 0. 0 0. 0 60 .7 0. 1 0. 0 76 .7 85 44 M id dl e 12 .0 6. 7 0. 0 0. 1 37 .4 0. 1 0. 2 56 .5 85 42 Fo ur th 10 .3 4. 8 0. 0 0. 2 20 .5 0. 4 0. 2 36 .3 85 46 w ea lth in de x qu in til es R ic he st 3. 9 1. 0 0. 0 0. 1 2. 9 0. 0 0. 9 8. 8 85 45 C hr is tia n 5. 6 7. 5 0. 0 0. 1 39 .0 0. 1 0. 2 52 .5 91 43 M us lim 9. 2 6. 2 0. 0 0. 1 37 .9 0. 1 0. 3 53 .8 33 48 2 R el ig io n of H ou se ho ld H ea d O th er /M is si ng 0. 0 10 .7 0. 0 0. 0 49 .5 0. 0 0. 0 60 .2 93 To ta l 8. 4 6. 5 0. 0 0. 1 38 .2 0. 1 0. 3 53 .5 42 71 9 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 38 Ta bl e 12 : U se o f s an ita ry m ea ns o f e xc re ta d is po sa l Pe rc en t d is tr ib ut io n of h ou se ho ld p op ul at io n ac co rd in g to ty pe o f t oi le t u se d by th e ho us eh ol d an d th e pe rc en ta ge o f h ou se ho ld m em be rs u si ng s an ita ry m ea ns o f ex cr et a di sp os al , S ie rr a Le on e, 2 00 5 Im pr ov ed s an ita tio n fa ci lit y Fl us h to pi pe d se w er sy st em Fl us h to se pt ic ta nk Fl us h to pi t (la tri ne ) V en til at ed Im pr ov ed P it la tri ne (V IP ) Pi t la tri ne w ith sl ab C om po st in g to ile t P er ce nt ag e of po pu la tio n us in g sa ni ta ry m ea ns o f ex cr et a di sp os al * N um be r o f ho us eh ol ds m em be rs Ea st 0. 00 0. 85 1. 44 0. 85 16 .3 8 0. 00 19 .5 2 97 92 .6 N or th 0. 14 0. 12 0. 25 0. 95 20 .5 9 0. 30 22 .3 6 17 28 2 So ut h 0. 00 0. 77 0. 26 0. 40 30 .4 3 0. 00 31 .8 6 97 97 .7 R eg io n W es t 3. 69 10 .6 5 2. 02 0. 41 53 .8 1 0. 00 70 .5 9 58 46 .3 R ur al 0. 10 0. 14 0. 20 0. 89 15 .6 3 0. 17 17 .1 2 30 62 6 Ar ea U rb an 1. 74 6. 29 2. 21 0. 33 53 .7 8 0. 00 64 .3 5 12 09 2 N on e 0. 08 0. 56 0. 27 0. 62 21 .0 3 0. 17 22 .7 3 30 56 3 Pr im ar y 0. 00 1. 25 0. 65 1. 53 29 .1 5 0. 00 32 .5 8 36 68 .7 Se co nd ar y + 2. 48 7. 13 2. 72 0. 80 45 .0 6 0. 00 58 .2 0 81 95 .9 N on -s ta nd ar d cu rr ic ul um 2. 20 0. 00 0. 00 0. 00 31 .4 9 0. 00 33 .6 9 27 1. 75 E du ca tio n of ho us eh ol d he ad M is si ng /D K 25 .8 1 0. 00 0. 00 0. 00 74 .1 9 0. 00 10 0. 00 19 .2 79 P oo re st 0. 00 0. 00 0. 00 0. 48 0. 46 0. 14 1. 08 85 42 .2 S ec on d 0. 01 0. 00 0. 00 0. 84 5. 64 0. 21 6. 70 85 44 .5 M id dl e 0. 00 0. 00 0. 00 0. 95 20 .5 8 0. 11 21 .6 4 85 41 .8 Fo ur th 0. 05 0. 11 0. 40 1. 09 41 .8 7 0. 15 43 .6 6 85 45 .6 w ea lth in de x qu in til es R ic he st 2. 75 9. 29 3. 45 0. 28 63 .5 8 0. 00 79 .3 5 85 44 .8 C hr is tia n 1. 45 3. 80 1. 10 1. 50 26 .7 1 0. 00 34 .5 7 91 43 .2 R el ig io n of H ou se ho ld H ea d M us lim 0. 32 1. 36 0. 68 0. 52 26 .3 5 0. 16 29 .3 8 33 48 2 To ta l 0. 56 1. 88 0. 77 0. 73 26 .4 3 0. 12 30 .4 9 42 71 9 * M IC S In di ca to r 1 2; M D G In di ca to r 3 1 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 39 Ta bl e 13 : U se o f s an ita ry m ea ns o f e xc re ta d is po sa l Pe rc en t d is tr ib ut io n of h ou se ho ld p op ul at io n ac co rd in g to ty pe o f t oi le t u se d by th e ho us eh ol d an d th e pe rc en ta ge o f h ou se ho ld m em be rs u si ng s an ita ry m ea ns o f ex cr et a di sp os al , S ie rr a Le on e, 2 00 5 U ni m pr ov ed s an ita tio n fa ci lit y Fl us h to so m ew he re el se P it la tri ne w ith ou t sl ab /o pe n pi t B uc ke t H an gi ng to ile t/h an gi ng la tri ne N o fa ci lit ie s or b us h or fie ld O th er M is si ng P er ce nt ag e of po pu la tio n us in g sa ni ta ry m ea ns o f ex cr et a di sp os al * N um be r o f ho us eh ol ds m em be rs E as t 0. 00 30 .0 3 0. 00 9. 35 40 .4 9 0. 60 0. 00 19 .5 2 97 93 N or th 0. 06 45 .5 7 0. 04 2. 62 25 .7 4 3. 56 0. 05 22 .3 6 17 28 2 S ou th 0. 08 12 .2 8 0. 00 0. 91 51 .6 4 3. 22 0. 00 31 .8 6 97 98 R eg io n W es t 0. 99 24 .2 4 0. 00 0. 31 2. 88 1. 00 0. 00 70 .5 9 58 46 R ur al 0. 11 33 .6 9 0. 02 3. 88 42 .1 9 2. 97 0. 03 17 .1 2 30 62 6 A re a U rb an 0. 35 25 .7 9 0. 00 2. 38 5. 96 1. 16 0. 00 64 .3 5 12 09 2 N on e 0. 09 34 .0 8 0. 02 3. 68 36 .4 2 2. 94 0. 03 22 .7 3 30 56 3 P rim ar y 0. 27 26 .7 4 0. 00 3. 20 35 .3 3 1. 88 0. 00 32 .5 8 36 69 S ec on da ry + 0. 49 23 .9 9 0. 00 2. 86 13 .6 1 0. 86 0. 00 58 .2 0 81 96 E du ca tio n of ho us eh ol d he ad N on -s ta nd ar d cu rri cu lu m 0. 00 26 .7 4 0. 00 0. 00 35 .9 0 3. 66 0. 00 33 .6 9 27 2 P oo re st 0. 00 29 .0 3 0. 00 3. 21 64 .3 1 2. 38 0. 00 1. 08 85 42 S ec on d 0. 00 34 .6 9 0. 00 3. 39 51 .9 0 3. 31 0. 00 6. 70 85 44 M id dl e 0. 05 41 .6 0 0. 08 6. 61 25 .9 7 3. 94 0. 11 21 .6 4 85 42 Fo ur th 0. 12 33 .9 3 0. 00 3. 84 16 .3 4 2. 10 0. 00 43 .6 6 85 46 w ea lth in de x qu in til es R ic he st 0. 72 18 .0 1 0. 00 0. 23 1. 15 0. 54 0. 00 79 .3 5 85 45 C hr is tia n 0. 24 26 .2 8 0. 08 2. 16 35 .0 3 1. 64 0. 00 34 .5 7 91 43 R el ig io n of H ou se ho ld H ea d M us lim 0. 16 32 .8 7 0. 00 3. 82 31 .0 8 2. 67 0. 03 29 .3 8 33 48 2 To ta l 0. 18 31 .4 5 0. 02 3. 46 31 .9 3 2. 45 0. 02 30 .4 9 42 71 9 * M IC S In di ca to r 1 2; M D G In di ca to r 3 1 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 40 Ta bl e 14 : U se o f c on tr ac ep tio n Pe rc en ta ge o f w om en a ge d 15 -4 9 ye ar s m ar rie d or in u ni on w ho a re u si ng (o r w ho se p ar tn er is u si ng ) a c on tr ac ep tiv e m et ho d, S ie rr a Le on e, 2 00 5 N ot us in g an y m et ho d Fe m al e st er il M al e st er il P ill IU D In je ct Im pl C on d D ia p/ fo am / je lly LA M # of w om en 15 -4 9 E as t 96 .2 0. 1 0. 0 2. 6 0. 0 0. 7 0. 0 0. 0 0. 1 0. 0 14 76 N or th 95 .6 0. 0 0. 0 1. 4 0. 0 0. 8 0. 0 0. 0 0. 0 1. 4 25 09 S ou th 98 .0 0. 1 0. 0 1. 2 0. 0 0. 8 0. 0 0. 0 0. 0 0. 0 14 83 R eg io n W es t 79 .7 0. 1 0. 0 9. 6 0. 4 7. 5 0. 8 1. 3 0. 0 0. 0 60 9 R ur al 97 .7 0. 0 0. 0 0. 8 0. 0 0. 4 0. 0 0. 0 0. 0 0. 7 47 07 A re a U rb an 84 .4 0. 1 0. 0 8. 1 0. 3 5. 0 0. 4 0. 6 0. 2 0. 2 13 69 15 -1 9 98 .0 0. 0 0. 0 0. 5 0. 0 0. 0 0. 0 0. 3 0. 0 0. 8 39 6 20 -2 4 96 .3 0. 0 0. 0 2. 0 0. 0 0. 5 0. 0 0. 0 0. 0 0. 8 87 1 25 -2 9 95 .8 0. 1 0. 0 1. 8 0. 1 1. 0 0. 1 0. 2 0. 1 0. 4 15 87 30 -3 4 91 .1 0. 0 0. 0 4. 2 0. 0 3. 3 0. 2 0. 3 0. 1 0. 7 10 53 35 -3 9 94 .1 0. 1 0. 1 3. 5 0. 0 1. 2 0. 1 0. 1 0. 0 0. 5 11 45 40 -4 4 94 .1 0. 2 0. 0 1. 8 0. 3 1. 9 0. 1 0. 0 0. 0 0. 8 64 2 A ge 45 -4 9 96 .3 0. 2 0. 0 1. 3 0. 0 2. 0 0. 2 0. 0 0. 0 0. 0 38 4 0 98 .5 0. 0 0. 0 0. 7 0. 0 0. 3 0. 0 0. 0 0. 0 0. 3 58 6 1 96 .5 0. 0 0. 0 1. 8 0. 1 0. 5 0. 1 0. 2 0. 0 0. 4 93 1 2 93 .6 0. 0 0. 0 3. 2 0. 1 1. 8 0. 2 0. 1 0. 0 0. 8 11 50 3 93 .2 0. 1 0. 0 3. 1 0. 0 1. 8 0. 2 0. 4 0. 2 0. 7 10 49 N um be r o f l iv in g ch ild re n 4+ 94 .3 0. 1 0. 0 2. 5 0. 0 1. 8 0. 0 0. 0 0. 0 0. 6 23 61 N on e 96 .6 0. 0 0. 0 1. 4 0. 0 0. 8 0. 1 0. 1 0. 0 0. 6 49 73 P rim ar y 92 .2 0. 0 0. 0 3. 3 0. 0 3. 0 0. 3 0. 3 0. 0 0. 5 55 7 E du ca tio n S ec on da ry + 79 .7 0. 4 0. 0 11 .7 0. 7 5. 7 0. 2 0. 6 0. 4 0. 0 53 6 P oo re st 98 .0 0. 1 0. 0 0. 3 0. 0 0. 6 0. 0 0. 0 0. 0 0. 7 12 48 Se co nd 99 .0 0. 1 0. 0 0. 3 0. 0 0. 2 0. 0 0. 0 0. 0 0. 2 13 65 M id dl e 97 .5 0. 0 0. 0 1. 2 0. 0 0. 5 0. 0 0. 1 0. 0 0. 5 13 11 Fo ur th 93 .1 0. 0 0. 1 2. 9 0. 0 1. 8 0. 1 0. 3 0. 0 1. 3 11 76 w ea lth in de x qu in til es R ic he st 82 .9 0. 2 0. 0 9. 3 0. 4 5. 2 0. 5 0. 4 0. 2 0. 2 97 6 C hr is tia n 91 .7 0. 3 0. 0 4. 4 0. 3 2. 2 0. 2 0. 1 0. 0 0. 2 11 86 R el ig io n of H ou se ho ld H ea d M us lim 95 .5 0. 0 0. 0 2. 0 0. 0 1. 3 0. 1 0. 2 0. 0 0. 7 48 75 To ta l 94 .7 0. 1 0. 0 2. 5 0. 1 1. 4 0. 1 0. 1 0. 0 0. 6 60 77 * M IC S in di ca to r 2 1; M D G in di ca to r 1 9C Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 41 Ta bl e 15 : U se o f c on tr ac ep tio n Pe rc en ta ge o f w om en a ge d 15 -4 9 ye ar s m ar rie d or in u ni on w ho a re u si ng (o r w ho se p ar tn er is u si ng ) a c on tr ac ep tiv e m et ho d, S ie rr a Le on e, 2 00 5 M IC S in di ca to r 2 1; M D G in di ca to r 1 9C P er io d ab st ai n W ith - dr aw O th er A ny m od er n An y tra d An y m et ho d N um be r o f w om en c ur re nt ly m ar rie d or in un io n E as t 0. 1 0. 1 0. 2 3. 5 0. 3 3. 8 14 76 N or th 0. 0 0. 0 0. 5 2. 4 2. 0 4. 4 25 09 S ou th 0. 0 0. 0 0. 0 2. 0 0. 0 2. 0 14 83 R eg io n W es t 0. 1 0. 0 0. 4 19 .8 0. 6 20 .3 60 9 R ur al 0. 0 0. 0 0. 2 1. 3 1. 0 2. 3 47 07 A re a U rb an 0. 1 0. 0 0. 6 14 .7 0. 9 15 .6 13 69 15 -1 9 0. 0 0. 0 0. 5 0. 7 1. 2 2. 0 39 6 20 -2 4 0. 0 0. 1 0. 2 2. 5 1. 2 3. 7 87 1 25 -2 9 0. 1 0. 0 0. 3 3. 3 0. 9 4. 2 15 87 30 -3 4 0. 0 0. 0 0. 2 8. 1 0. 8 8. 9 10 53 35 -3 9 0. 1 0. 0 0. 2 5. 1 0. 8 5. 9 11 45 40 -4 4 0. 0 0. 0 0. 9 4. 2 1. 7 5. 9 64 2 A ge 45 -4 9 0. 0 0. 0 0. 0 3. 7 0. 0 3. 7 38 4 0 0. 0 0. 0 0. 2 1. 0 0. 5 1. 5 58 6 1 0. 1 0. 1 0. 1 2. 7 0. 8 3. 5 93 1 2 0. 0 0. 0 0. 2 5. 4 0. 9 6. 4 11 50 3 0. 1 0. 0 0. 3 5. 8 1. 0 6. 8 10 49 N um be r o f liv in g ch ild re n 4+ 0. 0 0. 0 0. 5 4. 6 1. 1 5. 7 23 61 N on e 0. 0 0. 0 0. 3 2. 4 1. 0 3. 4 49 73 P rim ar y 0. 0 0. 0 0. 3 6. 9 0. 9 7. 8 55 7 E du ca tio n S ec on da ry + 0. 4 0. 0 0. 4 19 .6 0. 7 20 .3 53 6 P oo re st 0. 1 0. 1 0. 1 1. 0 1. 0 2. 0 12 48 S ec on d 0. 0 0. 0 0. 2 0. 6 0. 4 1. 0 13 65 M id dl e 0. 0 0. 0 0. 3 1. 7 0. 8 2. 5 13 11 Fo ur th 0. 0 0. 0 0. 5 5. 2 1. 8 6. 9 11 76 w ea lth in de x qu in til es R ic he st 0. 2 0. 0 0. 5 16 .2 0. 9 17 .1 97 6 C hr is tia n 0. 2 0. 1 0. 3 7. 5 0. 8 8. 3 11 86 R el ig io n of H ou se ho ld H ea d M us lim 0. 0 0. 0 0. 3 3. 6 1. 0 4. 5 48 75 To ta l 0. 0 0. 0 0. 3 4. 3 1. 0 5. 3 60 77 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 42 Ta bl e 16 : A ss is ta nc e du rin g de liv er y Pe rc en t d is tr ib ut io n of w om en a ge d 15 -4 9 w ith a b irt h in tw o ye ar s pr ec ed in g th e su rv ey b y ty pe o f p er so nn el a ss is tin g at d el iv er y, S ie rr a Le on e, 2 00 5 P er so n as si st in g at d el iv er y M ed ic al do ct or N ur se / m id w ife Au xi lia ry m id w ife Tr ad iti on al bi rth at te nd an t C om m un ity he al th w or ke r R el at iv e/ fri en d O th er / m is si ng N o at te nd an t A ny s ki lle d pe rs on ne l * D el iv er ed in h ea lth fa ci lit y ** N um be r o f w om en w ho ga ve b irt h in pr ec ed in g tw o ye ar s E as t 1. 8 61 .6 3. 2 25 .5 1. 4 3. 7 0. 8 1. 9 66 .6 26 .4 56 1 N or th 2. 4 20 .4 2. 2 43 .3 1. 9 25 .1 1. 5 3. 3 25 13 .7 97 6 So ut h 1. 6 34 .4 4. 3 45 .7 1. 7 8. 1 2. 4 1. 9 40 .2 15 .3 67 2 R eg io n W es t 6. 2 71 .5 5. 2 9. 3 0. 5 5. 2 0 2. 1 82 .9 34 .2 16 6 R ur al 1. 6 30 .4 2. 8 44 .3 1. 7 15 .2 1. 5 2. 5 34 .8 15 .5 18 94 Ar ea U rb an 5 66 .4 4. 9 9. 9 1. 5 8. 5 1. 5 2. 2 76 .4 30 .9 48 0 15 -1 9 2. 8 43 .5 2. 8 33 .7 1. 4 10 .7 3. 1 2. 1 49 19 .2 22 8 20 -2 4 1. 7 39 .8 3. 1 38 .1 1. 9 12 .1 1. 2 2. 1 44 .6 20 .4 49 6 25 -2 9 2. 5 36 .1 3. 4 38 .4 1. 5 14 .3 1. 2 2. 6 42 19 .3 75 5 30 -3 4 2. 4 37 .3 2. 5 35 .7 3. 1 14 3 1. 9 42 .2 18 .6 36 2 35 -3 9 2. 2 35 4. 5 38 .6 0. 8 15 0 3. 7 41 .8 16 .3 36 0 40 -4 4 3. 1 37 .7 2. 4 37 0 16 0. 7 3. 1 43 .2 14 .3 12 9 A ge 45 -4 9 0 35 .5 0 34 .7 2. 3 22 .6 5 0 35 .5 14 .2 44 N on e 1. 4 33 .4 3. 2 40 .7 1. 7 15 .2 1. 6 2. 8 38 16 .1 19 19 P rim ar y 3. 9 49 .1 2. 6 30 .3 0. 4 10 .3 1. 8 1. 6 55 .5 25 .8 23 1 Ed uc at io n Se co nd ar y + 8. 4 63 .2 4. 1 16 .2 2 4. 3 1 0. 9 75 .7 33 .6 21 8 Po or es t 1. 4 24 1. 8 46 .5 1. 7 19 .6 2. 4 2. 7 27 .2 10 .3 48 1 S ec on d 1. 3 30 .7 2 45 2 15 .7 1. 4 1. 9 34 12 .6 54 6 M id dl e 1. 5 33 .3 2. 7 41 .8 1. 5 14 .3 1. 3 3. 5 37 .5 20 .3 52 9 Fo ur th 2. 1 43 .6 4. 2 33 .4 1. 8 11 .1 1. 4 2. 5 49 .9 22 .6 50 5 w ea lth in de x qu in til es R ic he st 7. 1 68 .8 6. 7 8. 9 0. 7 5. 5 1 1. 4 82 .6 32 .4 31 3 C hr is tia n 3. 6 43 .5 3. 5 34 .4 2. 4 8. 7 0. 7 3. 3 50 .5 23 .9 42 8 R el ig io n of H ou se ho ld H ea d M us lim 2 36 .5 3. 1 37 .9 1. 5 14 .9 1. 7 2. 3 41 .7 17 .5 19 43 To ta l 2. 3 37 .7 3. 2 37 .4 1. 6 13 .8 1. 5 2. 5 43 .2 18 .6 23 75 * M IC S in di ca to r 4 ; M D G in di ca to r 1 7 ** M IC S in di ca to r 5 Sierra Leone Multiple Indicator Cluster Survey 2005 Page 43 Table 17: Primary school net attendance ratio Percentage of children of primary school age attending primary school or secondary school (NAR), Sierra Leone, 2005 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio Number of children East 71.6 804 72.3 831 72.0 1635 North 63.0 1837 62.6 1653 62.8 3490 South 67.1 853 68.3 799 67.7 1652 Region West 89.3 510 88.6 508 89.0 1018 Rural 62.7 2948 63.5 2712 63.1 5660 Area Urban 86.4 1055 84.3 1080 85.3 2135 6 53.1 792 54.8 774 53.9 1566 7 62.7 771 69.6 706 66.0 1476 8 72.0 697 71.6 702 71.8 1399 9 79.6 522 75.9 541 77.7 1062 10 74.7 824 73.7 744 74.3 1568 Age 11 81.1 398 78.8 325 80.1 723 None 65.0 3224 65.6 3061 65.3 6285 Primary 81.6 352 84.1 321 82.8 673 Secondary + 89.5 420 87.0 409 88.3 828 Non-standard curriculum 20.0 5 . 0 20.0 5 Mother's education Missing/DK .0 2 50.0 2 25.0 4 Poorest 53.8 842 55.0 754 54.4 1596 Second 62.1 790 62.4 737 62.2 1527 Middle 65.2 829 67.3 796 66.2 1625 Fourth 78.3 815 74.8 730 76.7 1545 wealth index quintiles Richest 87.5 728 87.3 774 87.4 1502 Christian 70.3 834 74.3 849 72.3 1683 Muslim 68.5 3162 68.1 2937 68.3 6099 Religion of Household Head Other/Missing 71.6 7 33.4 6 54.0 13 Total 68.9 4003 69.4 3792 69.2 7795 * MICS indicator 55; MDG indicator 6 Sierra Leone Multiple Indicator Cluster Survey 2005 Page 44 Table 18: Education gender parity Ratio of girls to boys attending primary education and ratio of girls to boys attending secondary education, Sierra Leone, 2005 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* East 72.3 71.6 1.01 11.0 17.2 .64 North 62.6 63.0 1.00 8.2 12.8 .64 South 68.3 67.1 1.02 9.2 14.6 .64 Region West 88.6 89.3 .99 51.2 56.9 .90 Rural 63.5 62.7 1.01 5.1 9.0 .56 Area Urban 84.3 86.4 .98 36.3 44.4 .82 None 65.6 65.0 1.01 11.9 14.9 .80 Primary 84.1 81.6 1.03 17.2 19.8 .87Mother's education Secondary + 87.0 89.5 .97 42.4 50.4 .84 Poorest 55.0 53.8 1.02 2.4 6.3 .38 Second 62.4 62.1 1.01 3.5 7.5 .47 Middle 67.3 65.2 1.03 5.1 9.9 .52 Fourth 74.8 78.3 .96 16.7 23.8 .70 wealth index quintiles Richest 87.3 87.5 1.00 41.2 47.4 .87 Christian 74.3 70.3 1.06 19.2 29.0 .66Religion of Household Head Muslim 68.1 68.5 .99 16.1 19.3 .83 Total 69.4 68.9 1.01 16.8 21.4 .78 * MICS Indicator 61; MDG Indicator 9 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 45 Ta bl e 19 : B irt h re gi st ra tio n Pe rc en t d is tr ib ut io n of c hi ld re n ag ed 0 -5 9 m on th s by w he th er b irt h is re gi st er ed a nd re as on s fo r n on -r eg is tr at io n, S ie rr a Le on e, 2 00 5 B irt h is n ot re gi st er ed b ec au se : B irt h is re gi st er ed * D on 't kn ow if bi rth is re gi st er ed N um be r of c hi ld re n ag ed 0 -5 9 m on th s C os ts to o m uc h M us t tra ve l to o fa r D id n' t k no w ch ild s ho ul d be re gi st er ed La te , di dn 't w an t to p ay fin e D oe sn 't kn ow w he re to re gi st er O th er D on 't kn ow M is si ng N um be r o f ch ild re n ag ed 0- 59 m on th s w ith ou t b irt h re gi st ra tio n M al e 47 .6 1. 3 26 05 21 .4 13 .5 32 .6 3. 1 20 .1 7. 8 1. 6 .1 13 31 Se x Fe m al e 48 .0 1. 6 26 39 20 .0 16 .0 32 .8 3. 3 19 .7 6. 6 1. 5 .0 13 29 E as t 44 .6 1. 3 13 00 28 .6 15 .2 20 .2 4. 4 17 .7 11 .9 1. 9 .0 70 4 N or th 28 .6 1. 6 20 40 15 .1 14 .9 40 .7 1. 1 23 .2 3. 3 1. 6 .0 14 24 S ou th 71 .8 1. 4 14 44 23 .1 16 .1 34 .9 7. 0 13 .1 5. 3 .3 .3 38 7 R eg io n W es t 67 .3 1. 4 46 0 30 .4 6. 8 8. 7 8. 1 16 .2 26 .7 3. 1 .0 14 4 R ur al 44 .2 1. 4 41 44 19 .4 15 .5 34 .2 3. 0 20 .5 6. 0 1. 4 .0 22 53 A re a U rb an 61 .5 1. 5 11 01 27 .7 10 .3 24 .8 4. 3 16 .7 13 .9 2. 3 .0 40 7 0- 11 m on th s 44 .4 1. 0 10 16 19 .0 14 .4 32 .0 3. 1 18 .6 10 .4 2. 5 .0 55 5 12 -2 3 m on th s 49 .8 .5 10 74 20 .9 13 .7 35 .6 3. 1 19 .1 5. 8 1. 8 .0 53 4 24 -3 5 m on th s 49 .9 1. 7 10 69 20 .0 14 .3 33 .7 2. 6 21 .2 7. 1 1. 2 .0 51 8 36 -4 7 m on th s 48 .4 2. 2 11 81 24 .9 13 .4 31 .3 3. 8 19 .5 6. 2 .7 .2 58 3 Ag e 48 -5 9 m on th s 46 .3 1. 8 88 4 18 .2 18 .8 30 .1 3. 4 21 .6 6. 4 1. 5 .0 45 9 N on e 44 .9 1. 5 42 26 20 .0 15 .0 33 .6 3. 1 20 .7 6. 0 1. 5 .0 22 66 P rim ar y 53 .0 1. 5 54 1 27 .7 12 .4 33 .0 2. 4 15 .1 9. 0 .4 .0 24 6 M ot he r's ed uc at io n S ec on da ry 68 .4 .6 47 3 19 .6 14 .0 17 .7 5. 8 15 .8 22 .7 4. 4 .0 14 7 P oo re st 45 .6 1. 3 11 09 18 .9 16 .0 35 .1 3. 3 18 .4 6. 7 1. 7 .0 58 8 S ec on d 45 .3 1. 9 12 31 23 .1 16 .8 31 .3 2. 2 19 .3 5. 9 1. 4 .0 65 0 M id dl e 44 .3 1. 3 11 56 16 .5 13 .6 38 .2 3. 1 22 .6 5. 7 .3 .2 62 9 Fo ur th 46 .4 1. 5 10 20 21 .4 15 .5 32 .3 3. 5 20 .6 4. 8 1. 9 .0 53 1 w ea lth in de x qu in til es R ic he st 63 .1 1. 0 72 9 27 .4 8. 0 18 .5 5. 3 17 .1 20 .0 3. 7 .0 26 2 C hr is tia n 59 .6 .8 99 5 30 .0 22 .8 13 .8 5. 3 16 .2 10 .8 1. 0 .0 39 4 R el ig io n of H ou se ho ld H ea d M us lim 45 .1 1. 6 42 40 19 .1 13 .3 35 .9 2. 9 20 .5 6. 6 1. 6 .0 22 66 To ta l 47 .8 1. 4 52 45 20 .7 14 .7 32 .7 3. 2 19 .9 7. 2 1. 5 .0 26 60 * M IC S In di ca to r 6 2 Sierra Leone Multiple Indicator Cluster Survey 2005 Page 46 Table 20: Early marriage and polygyny Percentage of women aged 15-49 in marriage or union before their 15th birthday, percentage of women aged 20- 49 in marriage or union before their 18th birthday, percentage of women aged 15-19 currently married or in union, and the percentage of married or in union women in a polygynous marriage or union, Sierra Leone, 2005 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 years married/in union ** Number of women aged 15-19 years Percentage of women aged 15-49 years in polygynous marriage/union *** Number of women aged 15- 49 currently married/in union East 27.3 1839 62.5 1581 33.5 258 38.2 1476 North 34.1 2965 69.4 2543 42.2 422 53.1 2509 South 22.2 1820 63.3 1545 41.1 275 41.7 1483 Region West 15.7 1023 37.4 875 12.2 148 11.9 609 Rural 30.5 5475 67.6 4766 46.7 709 47.1 4707Area Urban 18.6 2171 47.0 1777 16.3 394 26.9 1369 15-19 15.4 1103 . 0 35.9 1103 35.9 396 20-24 27.7 1168 55.6 1168 . 0 34.6 871 25-29 32.3 1785 64.2 1785 . 0 42.1 1587 30-34 31.7 1177 65.2 1177 . 0 43.4 1053 35-39 27.4 1253 64.4 1253 . 0 43.6 1145 40-44 26.9 711 62.7 711 . 0 50.5 642 Age 45-49 22.1 450 53.9 450 . 0 50.8 384 None 31.0 5632 67.0 5077 60.1 554 45.8 4973 Primary 22.0 841 57.8 596 20.9 244 34.5 557 Education Secondary + 12.4 1152 35.6 856 3.4 297 20.8 536 Poorest 31.0 1482 65.9 1306 44.1 176 42.9 1248 Second 31.8 1556 70.5 1376 50.7 180 45.9 1365 Middle 31.6 1517 67.9 1326 45.8 190 47.8 1311 Fourth 25.6 1510 61.7 1262 39.2 248 45.7 1176 wealth index quintiles Richest 16.3 1582 43.1 1273 13.8 309 26.6 976 Christian 27.2 1678 56.3 1440 20.0 238 29.5 1186 Muslim 27.2 5950 63.7 5087 40.1 863 45.7 4875 Religion of Household Head Other/Missing 23.3 18 54.8 16 100.0 2 44.8 16 Total 27.2 7647 62.0 6543 35.9 1103 42.6 6077 * MICS Indicator 67 ** MICS Indicator 68, *** MICS Indicator 70 Sierra Leone Multiple Indicator Cluster Survey 2005 Page 47 Table 21: Comprehensive knowledge of HIV/AIDS transmission Percentage of women aged 15-49 years who have comprehensive knowledge of HIV/AIDS transmission, Sierra Leone, 2005 Knows 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 East 41.4 23.1 17.4 1839 North 33.8 15.1 7.6 2965 South 41.6 20.1 13.8 1820 Region West 80.8 61.7 54.5 1023 Rural 35.5 15.3 9.9 5475 Area Urban 64.6 47.5 37.6 2171 15-19 46.4 27.2 20.1 1103Age 15-24 20-24 46.5 28.6 20.2 1168 15-24 46.5 27.9 20.1 2271 25-29 42.6 23.0 16.5 1785 30-34 47.2 27.6 21.0 1177 35-39 42.2 23.5 16.3 1253 40-44 39.6 16.9 12.3 711 Age 15-49 45-49 36.8 18.7 14.6 450 None 36.7 17.1 11.2 5632 Primary 51.9 26.3 19.5 841 Secondary + 72.3 58.6 48.1 1152 Education Non-standard curriculum 47.7 52.8 29.1 22 Poorest 27.0 14.3 9.6 1482 Second 31.7 14.7 9.1 1556 Middle 38.9 17.0 10.7 1517 Fourth 51.8 24.3 17.5 1510 wealth index quintiles Richest 68.3 50.9 40.8 1582 Christian 47.0 31.5 25.2 1678 Muslim 42.9 22.5 15.7 5950 Religion of Household Head Other/Missing 40.6 .0 .0 18 Total 43.8 24.4 17.7 7647 * MICS Indicator 82; MDG Indicator 19b Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 48 Ta bl e 22 : C on do m u se a t l as t h ig h- ris k se x Pe rc en ta ge o f y ou ng w om en a ge d 15 -2 4 w ho h ad h ig h ris k se x in th e pr ev io us y ea r a nd w ho u se d a co nd om a t l as t h ig h ris k se x, S ie rr a Le on e, 2 00 5 Ev er h ad s ex H ad s ex in th e la st 1 2 m on th s H ad s ex w ith m or e th an o ne pa rtn er in th e la st 1 2 m on th s N um be r o f w om en a ge d 15 -2 4 Pe rc en t w ho ha d se x w ith no n- m ar ita l, no n- co ha bi tin g pa rtn er * N um be r o f w om en a ge d 15 -2 4 ye ar s w ho h ad s ex in la st 1 2 m on th s Pe rc en t w ho us ed a c on do m at la st s ex w ith a no n- m ar ita l, no n- co ha bi tin g pa rtn er * * N um be r o f w om en a ge d 15 -2 4 ye ar s w ho h ad s ex in la st 1 2 m on th s w ith a n on - m ar ita l, no n- co ha bi tin g pa rtn er E as t 76 .9 72 .5 3. 9 54 5 38 .3 39 5 11 .2 15 1 N or th 77 .1 66 .8 3. 0 85 6 35 .5 57 2 20 .8 20 3 S ou th 82 .5 71 .3 3. 2 54 7 41 .0 39 0 18 .1 16 0 R eg io n W es t 78 .1 72 .5 4. 8 32 2 72 .0 23 4 30 .6 16 8 R ur al 79 .5 69 .8 2. 7 15 06 31 .2 10 51 16 .4 32 8 Ar ea U rb an 76 .7 70 .6 5. 1 76 5 65 .7 54 0 24 .2 35 5 15 -1 9 63 .2 57 .2 3. 4 11 03 55 .2 63 2 20 .4 34 8 A ge 20 -2 4 93 .0 82 .2 3. 6 11 68 34 .9 96 0 20 .5 33 5 N on e 84 .4 74 .3 3. 1 13 57 27 .2 10 09 16 .3 27 5 Pr im ar y 67 .4 59 .5 3. 5 39 7 49 .4 23 6 13 .7 11 7 S ec on da ry + 72 .1 67 .9 4. 8 50 3 84 .6 34 2 27 .2 28 9 Ed uc at io n N on -s ta nd ar d cu rr ic ul um 54 .8 32 .4 .0 13 48 .2 4 .0 2 P oo re st 77 .6 66 .8 1. 9 38 9 31 .8 26 0 13 .5 83 S ec on d 81 .2 70 .8 2. 3 40 5 27 .5 28 6 17 .7 79 M id dl e 80 .3 70 .3 3. 7 42 4 33 .4 29 8 16 .2 99 Fo ur th 80 .1 72 .4 4. 2 48 2 42 .4 34 9 15 .3 14 8 w ea lth in de x qu in til es R ic he st 74 .6 69 .6 4. 7 57 1 69 .0 39 7 27 .7 27 4 C hr is tia n 75 .0 67 .7 4. 0 50 3 55 .5 34 1 27 .1 18 9 M us lim 79 .5 70 .7 3. 4 17 64 39 .6 12 46 18 .0 49 3 R el ig io n of H ou se ho ld H ea d O th er /M is si ng 10 0. 0 10 0. 0 .0 4 23 .9 4 .0 1 To ta l 78 .5 70 .1 3. 5 22 71 42 .9 15 91 20 .4 68 3 * M IC S In di ca to r 8 5 ** M IC S In di ca to r 8 3; M D G In di ca to r 1 9a Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 49 Ta bl e 23 : S ch oo l a tte nd an ce o f o rp ha ne d an d vu ln er ab le c hi ld re n Sc ho ol a tte nd an ce o f c hi ld re n ag ed 1 0- 14 y ea rs b y or ph an s ta tu s an d vu ln er ab ili ty d ue to A ID S, S ie rr a Le on e, 2 00 5 P er ce nt of ch ild re n w ho se m ot he r an d fa th er ha ve di ed Sc ho ol at te nd an ce ra te o f ch ild re n w ho se m ot he r a nd fa th er h av e di ed % ch ild re n of w ho m bo th pa re nt s ar e al iv e an d ch ild is liv in g w ith a t le as t on e pa re nt Sc ho ol at te nd an ce ra te o f ch ild re n of w ho m b ot h pa re nt s ar e al iv e an d ch ild is liv in g w ith at le as t o ne pa re nt D ou bl e or ph an s to no n or ph an s sc ho ol at te nd an ce ra tio * P er ce nt o f ch ild re n w ho a re or ph an ed or vu ln er ab le du e to A ID S Sc ho ol at te nd an ce of c hi ld re n w ho a re or ph an ed or vu ln er ab le du e to A ID S P er ce nt o f ch ild re n w ho a re no t or ph an s or vu ln er ab le du e to A ID S S ch oo l at te nd an ce of c hi ld re n w ho a re n ot or ph an s or vu ln er ab le du e to A ID S O V C v s no n- O V C sc ho ol at te nd an ce ra tio To ta l nu m be r of ch ild re n ag ed 10 -1 4 ye ar s M al e 1. 9 66 .1 67 .2 80 .6 .8 2 30 .5 73 .5 69 .5 80 .7 .9 1 27 42 Se x Fe m al e 2. 2 61 .3 64 .2 72 .4 .8 5 28 .5 68 .3 71 .5 72 .5 .9 4 28 00 E as t 2. 4 76 .0 66 .7 78 .8 .9 6 39 .5 71 .3 60 .5 77 .1 .9 3 10 21 N or th 2. 0 60 .1 69 .9 70 .1 .8 6 29 .1 65 .9 70 .9 69 .7 .9 5 25 12 So ut h 2. 5 53 .9 60 .5 74 .9 .7 2 29 .2 70 .8 70 .8 75 .1 .9 4 10 16 R eg io n W es t 1. 4 71 .4 59 .1 94 .9 .7 5 20 .3 89 .1 79 .7 92 .6 .9 6 99 2 R ur al 2. 3 58 .3 69 .8 69 .7 .8 4 30 .9 62 .7 69 .1 68 .6 .9 1 36 01 Ar ea U rb an 1. 6 77 .5 57 .9 91 .9 .8 4 26 .7 88 .8 73 .3 90 .4 .9 8 19 40 Po or es t 1. 8 38 .9 72 .1 58 .5 .6 6 28 .5 49 .8 71 .5 56 .8 .8 8 98 6 S ec on d 2. 5 56 .5 70 .8 66 .4 .8 5 31 .3 60 .0 68 .7 65 .0 .9 2 92 6 M id dl e 2. 2 68 .0 69 .3 76 .1 .8 9 28 .1 69 .3 71 .9 75 .3 .9 2 10 00 Fo ur th 2. 5 70 .2 63 .5 83 .2 .8 4 32 .4 78 .2 67 .6 83 .7 .9 3 12 22 w ea lth in de x qu in til es R ic he st 1. 6 77 .4 57 .0 94 .6 .8 2 27 .3 88 .6 72 .7 92 .2 .9 6 14 08 C hr is tia n 2. 3 62 .1 65 .1 77 .2 .8 0 28 .6 75 .5 71 .4 78 .5 .9 6 12 53 M us lim 2. 0 64 .0 65 .8 76 .3 .8 4 29 .7 69 .9 70 .3 75 .9 .9 2 42 74 R el ig io n of H ou se ho ld H ea d O th er /M is si ng .0 . 64 .2 88 .9 . 28 .6 25 .1 71 .4 90 .1 .2 8 14 To ta l 1. 4 63 .0 65 .0 80 .8 .8 2 29 .0 56 .8 71 .0 81 .5 .7 2 55 42 * M IC S In di ca to r 7 7; M D G In di ca to r 2 0 Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 50 Ta bl e 24 : I nd ic at or d ef in iti on s # IN D IC A TO R N U M ER A TO R D EN O M IN A TO R 1 U nd er -fi ve m or ta lit y R at e1 5 P ro ba bi lit y of d yi ng b y ex ac t a ge 5 y ea rs 4 S ki lle d at te nd an t a t d el iv er y N um be r o f w om en 1 5- 49 w ith a b irt h in th e 2 ye ar s pr ec ed in g th e su rv ey w ho w er e at te nd ed d ur in g ch ild bi rth b y sk ille d he al th pe rs on ne l To ta l n um be r o f w om en s ur ve ye d ag ed 1 5- 49 ye ar s w ith a b irt h in 2 y ea rs p re ce di ng th e su rv ey 5 In st itu tio na l d el iv er ie s N um be r o f w om en 1 5- 49 w ith a b irt h in th e 2 ye ar s pr ec ed in g th e su rv ey w ho w er e de liv er ed in h ea lth fa ci lit y To ta l n um be r o f w om en s ur ve ye d ag ed 1 5- 49 ye ar s w ith a b irt h in 2 y ea rs p re ce di ng th e su rv ey 6 U nd er w ei gh t p re va le nc e N um be r o f c hi ld re n un de r 5 y ea rs o f a ge w ho fa ll be lo w -2 st an da rd d ev ia tio ns (S D s) fr om th e m ed ia n w ei gh t-f or -a ge o f th e N C H S /W H O s ta nd ar d (m od er at e an d se ve re ); nu m be r w ho fa ll be lo w -3 S D s (s ev er e) To ta l n um be r o f c hi ld re n un de r f iv e ye ar s of ag e w ei gh ed 7 S tu nt in g pr ev al en ce N um be r o f c hi ld re n un de r 5 y ea rs o f a ge w ho fa ll be lo w -2 st an da rd d ev ia tio ns (S D s) fr om th e m ed ia n he ig ht -fo r-a ge o f th e N C H S /W H O s ta nd ar d (m od er at e an d se ve re ); nu m be r w ho fa ll be lo w -3 S D s (s ev er e) To ta l n um be r o f c hi ld re n un de r f iv e ye ar s of ag e m ea su re d 8 W as tin g pr ev al en ce N um be r o f c hi ld re n un de r 5 y ea rs o f a ge w ho fa ll be lo w -2 st an da rd d ev ia tio ns (S D s) fr om th e m ed ia n w ei gh t-f or -h ei gh t o f th e N C H S /W H O s ta nd ar d (m od er at e an d se ve re ); nu m be r w ho fa ll be lo w -3 S D s (s ev er e) To ta l n um be r o f c hi ld re n un de r f iv e ye ar s of ag e w ei gh ed a nd m ea su re d 11 U se o f i m pr ov ed d rin ki ng w at er so ur ce s N um be r o f h ou se ho ld m em be rs li vi ng in h ou se ho ld s us in g im pr ov ed s ou rc es o f d rin ki ng w at er To ta l n um be r o f h ou se ho ld m em be rs in ho us eh ol ds s ur ve ye d 12 U se o f i m pr ov ed s an ita tio n fa ci lit ie s N um be r o f h ou se ho ld m em be rs u si ng im pr ov ed s an ita tio n fa ci lit ie s To ta l n um be r o f h ou se ho ld m em be rs in ho us eh ol ds s ur ve ye d 15 E xc lu si ve b re as tfe ed in g ra te N um be r o f i nf an ts le ss th an 6 m on th s (a nd le ss th an 4 m on th s) of a ge w ho a re e xc lu si ve ly b re as tfe d To ta l n um be r o f i nf an ts 0 -5 (a nd 0 -3 ) m on th s ol d su rv ey ed 15 T he u nd er -f iv e an d in fa nt m or ta lit y ra te s a re o bt ai ne d vi a a ca lc ul at io n (f or w hi ch a so ftw ar e pr og ra m is a va ila bl e) w hi ch u se s a s i np ut a ta bl e on n um be rs o f w om en , c hi ld re n ev er b or n, a nd ch ild re n su rv iv in g, b y ag e of m ot he r. N um be rs fo r t hi s t ab le a re o bt ai ne d fr om th e C hi ld M or ta lit y M od ul e. Si er ra L eo ne M ul tip le In di ca to r C lu st er S ur ve y 20 05 Pa ge 51 # IN D IC A TO R N U M ER A TO R D EN O M IN A TO R 16 C on tin ue d br ea st fe ed in g ra te N um be r o f i nf an ts 1 2- 15 m on th s, a nd 2 0- 23 m on th s of a ge w ho ar e cu rr en tly b re as tfe ed in g To ta l n um be r o f c hi ld re n ag ed 1 2- 15 m on th s; ch ild re n ag ed 2 0- 23 m on th s su rv ey ed 17 Ti m el y co m pl em en ta ry fe ed in g ra te N um be r o f i nf an ts 6 -9 m on th s ol d w ho a re re ce iv in g br ea st m ilk an d co m pl em en ta ry fo od s To ta l n um be r o f i nf an ts 6 -9 m on th s ol d su rv ey ed 21 C on tra ce pt iv e pr ev al en ce N um be r o f w om en c ur re nt ly m ar rie d or in u ni on a ge d 15 -4 9 ye ar s w ho a re u si ng (o r w ho se p ar tn er is u si ng ) a c on tra ce pt iv e m et ho d (e ith er m od er n or tr ad iti on al ) To ta l n um be r o f w om en a ge d 15 -4 9 ye ar s w ho ar e cu rre nt ly m ar rie d or in u ni on 22 A nt ib io tic tr ea tm en t o f su sp ec te d pn eu m on ia N um be r o f c hi ld re n 0- 59 m on th s ol d w ith s us pe ct ed p ne um on ia in th e pr ev io us 2 w ee ks re ce iv in g an tib io tic s To ta l n um be r o f c hi ld re n ag ed 0 -5 9 m on th s ol d w ith s us pe ct ed p ne um on ia in th e pr ev io us 2 w ee ks 24 S ol id fu el s N um be r o f r es id en ts in h ou se ho ld s th at u se s ol id fu el s (w oo d, ch ar co al , c ro p re si du es a nd d un g) a s th e pr im ar y so ur ce o f do m es tic e ne rg y to c oo k To ta l n um be r o f r es id en ts in h ou se ho ld s su rv ey ed 25 Tu be rc ul os is im m un iz at io n co ve ra ge N um be r o f 1 2- 23 m on th -o ld s re ce iv in g B C G v ac ci ne b ef or e fir st bi rth da y1 6 To ta l n um be r o f c hi ld re n ag ed 1 2- 23 m on th s su rv ey ed 26 P ol io im m un iz at io n co ve ra ge N um be r o f 1 2- 23 -m on th -o ld s re ce iv in g O PV 3 va cc in e be fo re fir st b irt hd ay To ta l n um be r o f c hi ld re n ag ed 1 2- 23 m on th s su rv ey ed 27 D P T im m un iz at io n co ve ra ge N um be r o f 1 2- 23 m on th -o ld s re ce iv in g D P T3 v ac ci ne b ef or e fir st b irt hd ay To ta l n um be r o f c hi ld re n ag ed 1 2- 23 m on th s su rv ey ed 28 M ea sl es im m un iz at io n co ve ra ge N um be r o f 1 2- 23 m on th -o ld s re ce iv in g m ea sl es v ac ci ne b ef or e fir st b irt hd ay To ta l n um be r o f c hi ld re n ag ed 1 2- 23 m on th s su rv ey ed 31 Fu lly im m un iz ed c hi ld re n N um be r o f 1 2- 23 m on th -o ld s re ce iv in g D P T1 -3 , O PV -1 -3 , B C G an d m ea sl es b ef or e fir st b irt hd ay To ta l n um be r o f c hi ld re n ag ed 1 2- 23 m on th s su rv ey ed 37 U nd er fi ve s sl ee pi ng u nd er in se ct ic id e tre at ed n et s N um be r o f c hi ld re n ag ed 0 -5 9 m on th s w ho s le pt u nd er a n in se ct ic id e tre at ed m os qu ito n et th e pr ev io us n ig ht 17 To ta l n um be r o f c hi ld re n ag ed 0 -5 9 m on th s su rv ey ed 16 T ot al n um be r o f 1 2- 23 m on th o ld s v ac ci na te d w ith B C G , ( O PV 3, D PT 3, M ea sl es , H ep B , o r H iB ) b ef or e 12 m on th s, as v al id at ed b y ca rd o r m ot he r’s re ca ll. T o es tim at e th e nu m be r o f c hi ld re n w ith ou t a c ar d to h av e re ce iv ed v ac ci ne b ef or e 1s t b irt hd ay th e pr op or tio n of v ac ci na tio ns g iv en d ur in g th e fir st y ea r o f l ife is a ss um ed to b e th e sa m e as fo r t he p ro po rti on o f c hi ld re n w ith a c ar d th at re ce iv ed th e va cc in e be fo re 1 st b irt hd ay . 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Created PDF documents can be opened with Acrobat and Adobe Reader 5.0 and later.) >> /Namespace [ (Adobe) (Common) (1.0) ] /OtherNamespaces [ << /AsReaderSpreads false /CropImagesToFrames true /ErrorControl /WarnAndContinue /FlattenerIgnoreSpreadOverrides false /IncludeGuidesGrids false /IncludeNonPrinting false /IncludeSlug false /Namespace [ (Adobe) (InDesign) (4.0) ] /OmitPlacedBitmaps false /OmitPlacedEPS false /OmitPlacedPDF false /SimulateOverprint /Legacy >> << /AddBleedMarks false /AddColorBars false /AddCropMarks false /AddPageInfo false /AddRegMarks false /ConvertColors /ConvertToCMYK /DestinationProfileName () /DestinationProfileSelector /DocumentCMYK /Downsample16BitImages true /FlattenerPreset << /PresetSelector /MediumResolution >> /FormElements false /GenerateStructure false /IncludeBookmarks false /IncludeHyperlinks false /IncludeInteractive false /IncludeLayers false /IncludeProfiles false /MultimediaHandling /UseObjectSettings /Namespace [ (Adobe) (CreativeSuite) (2.0) ] /PDFXOutputIntentProfileSelector /DocumentCMYK /PreserveEditing true /UntaggedCMYKHandling /LeaveUntagged /UntaggedRGBHandling /UseDocumentProfile /UseDocumentBleed false >> ] >> setdistillerparams << /HWResolution [2400 2400] /PageSize [612.000 792.000] >> setpagedevice

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