Gambia - Multiple Indicator Cluster Survey - 2000

Publication date: 2000

Children of primary school age attending primary school by sex and poverty status, MICS 2000 36% 30% 33% 74% 70% 72% 0% 10% 20% 30% 40% 50% 60% 70% 80% Male Female Total Poorest Richest Under-five children: underweight, stunting or wasting by poverty status, MICS 2000 23% 31% 11% 16% 8% 7% 0% 5% 10% 15% 20% 25% 30% 35% Underweight Stunting Wasting Poorest Richest W o rk in g c h ild re n 5 -1 4 ye a rs b y p o v e r ty s ta tu s , M IC S 2 0 0 0 4 0 % 1 1 % 5 % 3 4 % 0 % 5 % 1 0 % 1 5 % 2 0 % 2 5 % 3 0 % 3 5 % 4 0 % 4 5 % P o o re s t R ic h e s t C u rre n tly W o rk in g F a m ily W o rk (fa rm o r b u s in e s s ) W o rk in g c h ild re n 5 -1 4 ye a rs b y p o v e r ty s ta tu s , M IC S 2 0 0 0 4 0 % 1 1 % 5 % 3 4 % 0 % 5 % 1 0 % 1 5 % 2 0 % 2 5 % 3 0 % 3 5 % 4 0 % 4 5 % P o o re s t R ic h e s t C u rre n tly W o rk in g F a m ily W o rk (fa rm o r b u s in e s s ) 2 Contents List of Figures 3 Foreword and Acknowledgements 4 Executive Summary 5 Summary Indicators 9 I. Introduction 11 Background of the Survey .11 [Country] Background .11 Survey Objectives .18 II. Survey Methodology 19 Sample Design .19 Questionnaires.19 Fieldwork and Processing .19 III. Sample Characteristics and Data Quality 20 Response Rates .20 Age Distribution and Missing Data .20 Characteristics of the Household Population .21 IV. Results 21 A. Infant and Under-Five Mortality.21 B. Education.22 Early childhood education .22 Basic education .22 Literacy .23 C. Water and Sanitation .24 Use of drinking water.24 Use of sanitation .24 D. Child Malnutrition.25 Nutritional status.25 Breastfeeding .26 Salt iodization .27 Vitamin A supplementation .28 Low birth weight.28 E. Child Health.29 Immunization coverage.29 Diarrhea.30 Acute respiratory infection .31 IMCI initiative .31 Malaria .32 F. HIV/AIDS.33 AIDS knowledge.33 AIDS testing.35 G. Reproductive Health .36 Contraception.36 Prenatal care.37 Assistance at delivery .38 H. Child Rights .39 Birth registration .39 Orphanhood and living arrangements of children.39 Child labour .40 3 Appendix A: Sample Design 41 Appendix B: List of Personnel Involved in the [Country] MICS 45 Appendix C: List of Tables 48 Appendix D: Questionnaires 90 List of Figures Figure 1: Single year age distribution of the household population by sex, Country, Year .20 Figure 2: Percentage of children of primary school age attending primary school, Country, Year23 Figure 3: Percentage distribution of living children by breastfeeding status, Country, Year .27 Figure 4: Percentage of children aged 12-23 months who received immunizations by age 12 months, Country Year.30 Figure 5: Percentage of women aged 15-49 who have sufficient knowledge of HIV/AIDS transmission by level of education, Country, Year .35 Figure 6: Percentage distribution of women with a birth in the last year by type of personnel delivering antenatal care, Country, Year .38 4 Foreword and Acknowledgements The Declaration and Plan of Action adopted at the World Summit for Children, held in New York in September 1990, established a set of goals for the decade 1990 to 2000. With regards to this, a study was first conducted in 1996 and a similar or even more comprehensive one conducted in May/June 2000. Both studies were aimed at monitoring progress made by The Gambia towards the attainment of the Mid-decade and End-decade goals set during the above-mentioned Summit. By the ratification of the CRC and CEDAW, The Gambia like many UN member States committed itself to the improvement of the plight of children and women by the year 2000. The two conventions are not only comprehensive and holistic in nature but also have high impact on the plight of children and women when implemented simultaneously. The social and welfare status of both women and children will be markedly improved, thereby enhancing sustainable development in each member state. To evaluate the efforts towards implementation of these conventions, UNICEF in collaboration with other UN agencies such as WHO, UNFPA and the US Public Health Services develop the Multiple Indicate Cluster Survey (MICS). The MICS is a household survey that examines the behaviours of a comprehensive set of indicators related to the welfare of children and women. The modules development for the survey captured data on Household (economy), Education, Child Labour, Maternal Mortality, Water and Sanitation, Salt Iodization and health i.e. Oral Rehydration Solution (ORS), Child Mortality, Tetanus Toxoid, Maternal & Newborn Health, Contraceptive use, HIV/AIDS, Vitamin A supplementation, Breastfeeding care of illness, Malaria, Immunization and Anthropometry. In 2000, The government of The Gambia in collaboration with UNICEF and other partners carried out the second MICS to monitor progress made at End-decade as articulated in the National Plan of Action. The survey was conducted through inter-agency collaboration with the Central Statistics Department acting as the leading/co-ordinating agency. Collaborating agencies included the Department of State for Health (DoSH), Department of State for Education (DoSE), Department of Community Development, Women’s Bureau, Department of Water Resources, Department of Social Welfare and other NGOs such as the Gambia Family Planning Association (GFPA) and the Gambia-German Family Planning Project (GGFPP). The prototype questionnaires developed by UNICEF were used with some modification to suit the local conditions. However, in The Gambia a module on Knowledge on Rehydration solutions was added to determine the rate at which women know how to prepare the salt-sugar solution (SSS) as it is necessary, as ORS packet may not be available at certain times when needed. A word of thanks and gratitude are in order here for all persons and agencies that participated in the different phases of this study especially UNICEF-Banjul Office that funded the survey. Similar sentiments are also extended to the Co-ordinator, Mr. Nyakassi M.B Sangyang and his supporting colleagues, Mr Alieu Saho and Mr Alieu Sarr for their administrative assistance as well as their invaluable contributions in the preparation of the report. I also register my gratitude to Ms Isatou Sissoho, WATSAN Project Officer and Mr Sheriffo Sonko, Project Officer, Monitoring and Evaluation both of UNICEF-Banjul Office for their support in providing logistics needed for the implementation of the study and technical support respectively. Last but not least, I would like to extend our sincere thank and appreciation to Mr. Edrissa Ceesay and Ms Lolly Jallow our programmers both of CSD for their invaluable efforts in providing the required tables. Finally, we hope that all scholars, researchers, planner and decision-makers would find these research results useful. Alieu S.M. Ndow Director of Statistics February 20, 2002 5 Executive Summary The 2000 Gambia Multiple Indicator Cluster Survey (MICS) is a nationally representative survey of households, women, and children. The main objectives of the survey are to provide up-to-date information for assessing the situation of children and women in The Gambia at the end of the decade. Another objective is to furnish data needed for monitoring progress towards the goals established at the World Summit for Children as a basis for future action. Infant and Under Five Mortality • Distortions in the MICS data on deaths among children preclude obtaining estimates of very recent mortality rates. The data from the 1993 Census show that the infant and under-five mortality rate were 84 and 129 per 1, 000 respectively. Estimates from the MICS2 appear to suggest that both infant and under-five mortality have increased to 98 and 141 per 1, 000 respectively. In fact, the IMR and U5MR data from UNICEF (2000) also do suggest that both have increased. Estimates from UNICEF indicate both the IMR and U5MR at 92 and 128 per 1, 000 respectively. Education • Fifty-two per cent of children of primary school age in The Gambia are attending primary school. School attendance in the Basse and Janjanbureh are significantly lower than in the rest of the country at 29 and 30 per cent respectively. At the national level, there is slight difference between male and female primary school attendance at 54 and 49 per cent respectively. • Almost all (97 per cent) the children who enter the first grade of primary school eventually reach grade five. • Less than half (36 per cent) of the population over age 15 years is literate. The percentage literate declines from 52 per cent among those aged 15-24 to 16 per cent among the population aged 65 and older. In a similar trend literacy rates decline from among those who live in Banjul from 64 to 20 per cent from among those who live in Basse. Water and Sanitation • Eighty-four per cent of the population has access to safe drinking water – 95 per cent in urban areas and 77 per cent in rural areas. The situation in the Janjanbureh region is lower than in other regions. About 71 per cent of the population in this region get its drinking water from a safe source. • Eighty-eight per cent of the population of The Gambia is living in households with sanitary means of excreta disposal. The traditional pit latrine is inclusive and this in most places is not regarded as an ideal sanitary means of excreta disposal due to its nature. Child Malnutrition • Seventeen per cent of children under age five in The Gambia are underweight or too thin for their age. Nineteen per cent of children are stunted or too short for their age and eight per cent are wasted or too thin for their height. • Children whose mothers have secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with less education. • Children of women in the richest quintile are least likely to underweight and stunted than those of women in the poorest quintile. Breastfeeding Approximately 36 per cent of children aged less than four months are exclusively breastfed. At age 6-9 months, 36 per cent of children are receiving breast milk and solid or semi-solid 6 foods. By age 20-23 months, about half (54 per cent) of the children are continuing to breastfeed. Salt Iodization • About eight per cent of households in The Gambia have adequately iodised salt a level considerably lower than recommended. The percentage of households with adequately iodised salt ranges from 2 per cent in Kerewan to 33 per cent in the Janjanbureh LGA. Vitamin A Supplementation • Within the six months prior to the MICS, about 4 per cent of children aged 6-59 months received a high dose Vitamin A supplement. Approximately 2 per cent did not receive a supplement in the last 6 months but did receive one prior to that time. • The data suggest that mother’s level of education is not inversely related to the likelihood of Vitamin A supplementation. The percentage receiving a supplement in the last six months decreases from 4 per cent among children whose mothers have no education to less than one per cent among children of mothers with secondary or higher education. • Only about 14 per cent of mothers with a birth in the year before the MICS received a Vitamin A supplement within eight weeks of the birth. • For women in the richest quintile, about 13 per cent of women with a birth in the last 12 months received Vitamin A supplements compared to 17.3 per cent of women in the poorest quintile. Low Birth weight • Approximately 12 per cent of infants are estimated to weigh less than 2,500 grams at birth. This percentage is somewhat higher than the average for the Latin America and Caribbean region at 9 per cent. Immunisation Coverage • Almost all (99 per cent) 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 97 per cent. The percentage declines for subsequent doses of DPT to 95 per cent for the second dose, and 90 per cent for the third dose. • Similarly, 97 per cent of children received Polio 1 by age 12 months and this declines to 88 per cent by the third dose. • The coverage for measles vaccine is almost the same as DPT3 at 88 per cent. • Over half, six in every ten of children had all eight recommended vaccinations in the first 12 months of life. • Vaccination coverage is highest among male than female children at 65 and 58 per cent respectively. • Vaccination coverage is highest among children whose mothers have secondary or higher education. The education differences are not significant across different doses of different vaccines. However, vaccination coverage is lower among children with primary educated mothers, suggesting that drop out rates are higher among children with primary educated mothers. • Across wealth quintiles, vaccination coverage is highest among the fourth richest (66 per cent) and lowest among the poorest (60 per cent). Diarrhoea • Approximately 74 per cent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF). 7 • Only 27 per cent of children with diarrhoea received increased fluids and continued eating as recommended. Acute Respiratory Infection • Eight per cent of under-five children had an acute respiratory infection in the two weeks prior to the survey. More than 70 per cent of these children were taken to an appropriate health provider. IMCI Initiative • Among under-five children, who were reported to have had diarrhoea or some other illness in the two weeks preceding the MICS, 27 per cent received increased fluids and continued eating as recommended under the IMCI programmed. • Among children across poverty quintiles, there is not much difference among children of women in varying poverty levels with 24 per cent of children in poorest quintile and 28 per cent of those in the richest quintile receiving increased fluids and continued eating. • Thirty-nine per cent of mothers know at least two of the signs that a child should be taken immediately to a health facility. • Maternal education positively influences health seeking behaviour of mothers as 46 per cent of mothers with secondary education and above knowing at least two signs for seeking immediate health care compared to 38 per cent of women with no education. • Forty-seven per cent of caretakers in the richest quintile compared to 37 per cent in the poorest have knowledge of at least two sign for seeking immediate health care. Malaria • In The Gambia, 42 per cent of under five children slept under a bed-net the night prior to the survey interview. However, about 35 per cent of the bed-nets used are impregnated with insecticide. • Approximately 62 per cent of children with a fever in the two weeks prior to the MICS interview were given Paracetamol to treat the fever and 55 per cent were given Chloroquine while only 3 per cent were given Fansidar. A relatively considerable percentage of children (12 per cent) were given some other medicine. HIV/AIDS • Thirty-four per cent of women aged 15-49 know all three of the main ways to prevent HIV transmission – having only one uninfected sex partner, using a condom every time, and abstaining from sex. • Twenty per cent of women correctly identified three misconceptions about HIV transmission – that HIV can be transmitted through supernatural means, that it can be transmitted through mosquito bites, and that a healthy looking person cannot be infected. • Twenty-five per cent of women of reproductive age in The Gambia know a place to get tested for AIDS and about 7 per cent have been tested. • The percentage of women who have sufficient knowledge of HIV transmission and the percentage who know where to get tested for HIV increases dramatically with the level of education. Similarly the proportion of women with sufficient knowledge on HIV transmission decrease with an increase in poverty level. Contraception • Current use of contraception was reported by 9 per cent of married or in union women. The most popular methods are the pill and injections, which are used by four per cent of married women followed by IUD, which accounts for 1 per cent of married women. Contraceptive use is highest among the better educated and richest. 8 Prenatal Care • Seven out of ten women with recent births in The Gambia are protected against neonatal tetanus. The vast majority of these women received two or more doses of tetanus toxoid within the last three years. Coverage of vaccination against neonatal tetanus toxoid is not significantly affected either by education or wealth index. • Virtually all women in The Gambia receive some type of prenatal care and 91 per cent receives antenatal care from skilled personnel (doctor, nurse, and midwife). There is no significant difference between women across education and wealth index categories. Assistance at Delivery • A doctor, nurse, or midwife delivered about 55 per cent of births occurring in the year prior to the MICS survey. This percentage is highest in Banjul at 91 per cent and lowest in Kuntaur at 29 per cent. The level of education and wealth index are associated with assistance at delivery by skilled personnel. Birth Registration • The births of 32 per cent of children under five years in The Gambia have been registered. Birth registration coverage is highest for children aged 6-11 months and lowest for those aged 48-59 months. Coverage is influenced by maternal education and wealth index quintile. Orphanhood and Living Arrangements of Children • Overall, 73 per cent of children aged 0-14 are living with both parents. Children who are not living with a biological parent comprise 10 per cent and children who have one or both parents' dead amount to 8 per cent of all children aged 0-14. • The situation of children in Banjul slightly differs from that of other children. In Banjul, the rate at which children live with both parents is lowest, and with mother only when father is alive is higher than in other regions. This can be attributed to the high rate of emigration of both parents and also non-residential polygamy, among others. Child Labour • About two per cent of children aged 5-14 years engage in paid work. About twice as many – 4 per cent – participate in unpaid work for someone other than a household member. • Less than half of children (43 per cent) engage in domestic tasks, such as cooking, fetching water, and caring for other children, for less than four hours a day while 4 per cent spend more than four hours a day on such tasks. 9 Summary Indicators World Summit for Children Indicators Under-five mortality rate Probability of dying before reaching age five To be provided later Infant mortality rate Probability of dying before reaching age one To be provided later Underweight prevalence Proportion of under-fives who are too thin for their age 17.1 percent Stunting prevalence Proportion of under-fives who are too short for their age 19.1 percent Wasting prevalence Proportion of under fives who are too thin for their height 8.2 percent Use of safe drinking water Proportion of population who use a safe drinking water source 84.0 percent Use of sanitary means of excreta disposal Proportion of population who use a sanitary means of excreta disposal 87.9 percent Children reaching grade five Proportion of children entering first grade of primary school who eventually reach grade five 96.6 percent Net primary school attendance rate Proportion of children of primary school age attending primary school 51.6 percent Literacy rate Proportion of population aged 15+ years who are able to read a letter or newspaper 36.4 percent Antenatal care Proportion of women aged 15-49 attended at least once during pregnancy by skilled personnel 90.7 percent Contraceptive prevalence Proportion of married women aged 15-49 who are using a contraceptive method 9.0 percent Childbirth care Proportion of births attended by skilled health personnel 54.6 percent Birth weight below 2.5 kg. Proportion of live births that weigh below 2500 grams 11.8 percent Iodised salt consumption Proportion of households consuming adequately iodised salt 7.5 percent Children receiving Vitamin A supplementation Proportion of children aged 6-59 months who have received a Vitamin A supplement in the last 6 months 3.7 percent Mothers receiving Vitamin A supplementation Proportion of mothers who received a Vitamin A supplement before infant was 8 weeks old 14.0 percent Exclusive breastfeeding rate Proportion of infants aged less than 4 months who are exclusively breastfed 36.1 percent Timely complementary feeding rate Proportion of infants aged 6-9 months who are receiving breast milk and complementary food 35.7 percent Continued breastfeeding rate Proportion of children aged 12-15 months and 20-23 months who are breastfeeding 96.8 percent (12-15) 53.9 percent (20-23) DPT immunisation coverage Proportion of children immunised against diphtheria, pertussis and tetanus by age one 91.7 percent Measles immunisation coverage Proportion of children immunised against measles by age one 88.0 percent Polio immunisation coverage Proportion of children immunised against polio by age one 94.0 percent Tuberculosis immunisation coverage Proportion of children immunised against tuberculosis by age one 92.9 percent Children protected against neonatal tetanus Proportion of one year old children protected against neonatal tetanus through immunisation of their mother 77.1 ORT use Proportion of under-five children who had diarrhoea in the last 2 weeks who were treated with oral rehydration salts or an appropriate household solution 74.2 percent Home management of diarrhoea Proportion of under-five children who had diarrhoea in the last 2 weeks and received increased fluids and continued feeding during the episode 27.1 percent Care seeking for acute respiratory infections Proportion of under-five children who had ARI in the last 2 weeks and were taken to an appropriate health provider 74.9 percent Pre-school development Proportion of children aged 36-59 months who are attending some form of organised early childhood education program 16.3 percent 10 Indicators for Monitoring Children’s Rights Birth registration Proportion of under-five children whose births are reported registered 32.2 percent Children’s living arrangements Proportion of children aged 0-14 years in households not living with a biological parent 10.2 percent Orphans in household Proportion of children aged 0-14 years who are orphans living in households 0.6 percent (both parents) 7.9 percent (one parent) Child labour Proportion of children aged 5-14 years who are currently working 26.9 percent Indicators for Monitoring IMCI and Malaria Home management of illness Proportion of under-five children reported ill during the last 2 weeks who received increased fluids and continued feeding 23.5 percent Care seeking knowledge Proportion of caretakers of under-five children who know at least 2 signs for seeking care immediately 39.4 percent Bednets Proportion of under-five children who sleep under an insecticide impregnated bednet 35.1 percent Malaria treatment Proportion of under five children who were ill with fever in the last 2 weeks who received anti- malarial drugs 56.0 percent Indicators for Monitoring HIV/AIDS Knowledge of preventing HIV/AIDS Proportion of women who correctly state the 3 main ways of avoiding HIV infection 33.9 percent Knowledge of misconceptions of HIV/AIDS Proportion of women who correctly identify 3 misconceptions about HIV/AIDS 19.6 percent Knowledge of mother to child transmission Proportion of women who correctly identify means of transmission of HIV from mother to child 37.7 percent Attitude to people with HIV//AIDS Proportion of women expressing a discriminatory attitude towards people with HIV/AIDS 24.2 percent Women who know where to be tested for HIV Proportion of women who know where to get a HIV test 25.2 percent Women who have been tested for HIV Proportion of women who have been tested for HIV 7.2 percent 11 I. Introduction Background of the Survey At the World Summit for Children held in New York in 1990, the government of The Gambia pledged itself to a Declaration and Plan of Action for Children. Subsequently, a National Programme of Action (NPA) for Children was developed and implemented. An Inter-ministerial Committee and a multi-sectoral Technical Working Group was established by government with mandate to produce the 1992-2003 National Programme of Action for the Survival, Protection and Development of Gambian Children. The Programme of Action analysed the overall situation of children in The Gambia and identified their existing unmet needs as well as the challenges they present nationally. Due to financial resource constraints, government incorporated the goals and objectives of the NPA into the National Health Policy in order to strengthen and sustain service delivery in the programme areas of Malaria Control, Acute Respiratory Infections, Safe Motherhood, and the Expanded Programme of Immunisation, Diarrhoea Control and Nutrition. The Plan of Action also called for the establishment of mechanisms for monitoring progress toward the goals and objectives set for the year 2000. Toward this end, UNICEF, in co- ordination with other international organisations, has developed a core set of 75 indicators of specific aspects to the situation of children. A MICS survey was conducted in 1996 to measure progress at mid-decade. The 2000 Gambia MICS survey has been implemented to provide end-decade information on many of the indicators. Information on other indicators will be derived from the vital registration system and various diseases monitoring systems. The Gambia's MICS2 was conducted by the Central Statistics Department in collaboration with other government Departments such as the Department of Social Welfare, Department of Community Development, Department of Water Resources, Women’s Bureau, Department of State for Health and Department of State for Education. Other NGOs such as Gambia Family Planning Association (GFPA) and Gambia German Family Planning Programme also participated. Funding was provided by The Gambia UNICEF office. This report presents results on the principal topics covered in the survey and on the World Summit indicators. Background DEMOGRAPHIC SITUATION Population Size and Growth The Gambia’s population estimated at 1,038,145 in 1993 recorded one of the fastest growth rates in the world in the recent past. With an estimated annual growth rate of 4.2 per cent, the population doubling time is estimated at about 17 years. Such a rate of population growth is alarming in view of the accelerated growth experienced since 1983. It is worth noting that over the period 1973-83 the population recorded a growth rate of 3.4 per cent per annum. This rapid increase in the rate of population growth has been partly attributed to high fertility, declining mortality and the effect of migration. Across regions, disparities have been observed in levels of population growth with Kanifing and Brikama Local Government Areas recording the highest growth rates (8.4 and 7.8 per cent respectively, between 1983 and 1993) 12 over the past two decades. Over the period 1983-93, the urban population was estimated to have grown at the rate of 6.2 per cent per annum compared to a rural growth rate of 3.2 per cent per annum. Population Distribution and Urbanisation As is the experience in many developing countries, there is increasing urbanisation in The Gambia with large population movements from rural to urban areas. According to data from the 1993 census, over a quarter of the population (26.1 per cent) of the country live in Banjul and Kanifing Municipal areas and about half (49 per cent) of the population live in Banjul, Kanifing and Brikama Local Government Areas. Rapid population growth and increased population density is becoming a major concern in view of the involvement of a sizeable proportion of the Gambian population in agriculture. Since 1963, population density has increased from 30 persons per square kilometre to 46 person in 1973, 64 persons in 1983 and 97 persons per square kilometre in 1993. With an estimated population of 1.3 million, the density now stands at 121 persons to a square kilometre. The implications of such an increase in population density on available arable land for cultivation and therefore on the welfare of largely agricultural population is indeed worrying to policy makers. Another worrying demographic development is the rapid increase in the urban population. Until the 1970s population movements from rural to urban areas were not of much concern to policy makers. This was because such movements were mainly seasonal with rural migrants moving to urban areas in search of menial jobs during the dry season (stretching from December to May) and returning to rural areas at the beginning of the rains. Since the Sahelian droughts of the mid-1970s, however, the propensity for such migrants to settle in urban areas has increased considerably. This has been because, due to consecutive years of droughts, rural income levels have considerably declined forcing many rural dwellers to seek economic refuge in urban areas. The resultant effect has been the swelling of urban populations in The Gambia. Political instability in the sub-region and the relative political and economic stability in The Gambia also attracted large numbers of migrants from the sub- region, mainly into urban areas. Consequently, the proportion of the population resident in urban areas increased from 22.9 per cent in 1973 to 30.8 per cent in 1983 and 37.1 per cent in 1993. This development in addition to having economic consequences in terms of increased urban unemployment, increase pressure on the limited social amenities in urban areas. The health and education sectors are probably the worse hit as these sectors struggle to keep pace with the increasing demand for these facilities. Age Structure The Gambia, as is characteristic of most high fertility countries, has a largely youthful population. The proportion of the population aged below 15 years increased from 41.3 per cent in 1973 to 43.8 per cent in 1993. This young age structure is depicted in the results of this study with 46.0 per cent of the enumerated population aged less than 15 years. For the population aged 15-64 years, the proportion of the population in that age category declined from 52.5 per cent in 1973 to 51.5 per cent in 1983 and 51.3 per cent in 1993. The comparative proportion of the population in this age category from the results of this study is 51.0 per cent. For the population aged less than 18 years, results of the 1973 census showed that 46.5 per cent of the population fall in that age group compared to 49.5 per cent in 1983, 50.4 per cent in 1993 and 50.9 per cent according to the 2000 MICS results. The population aged 65 years and over which constituted 3.9 per cent of the population in 1973 only 13 constituted 3.7 per cent of the population in 1983 and 3.2 per cent in 1993. For the MICS data 3.0 per cent of the population was aged 65 years and over. This age structure may be mainly attributable to high fertility and mortality levels experienced in The Gambia over the last three decades. The review above indicates similarities in the age structure as observed from three consecutive censuses and from the MICS results. The apparent increase in the youthful population as observed in the MICS may be surprising in view of the fact that over the years there have been declines in fertility and mortality and therefore an increase in longevity. The persistently high levels of migration into the country, particularly from Sierra Leone, Southern Senegal, Liberia, Nigeria and Guinea-Bissau, which has been experienced over the years, may explain this. Observed similarities in age structure between the results of the MICS2 and the previous censuses is an indication of the accuracy of age reporting for the MICS2. Fertility Fertility levels in The Gambia are among the highest in the world. Although a modest decline in levels was recorded over the past two decades, levels remain high. During the period 1973- 83, fertility was estimated at 6.4 declining to 6.0 in 1993. This modest decline in fertility was in part attributed to contraceptive use among the population and changes in marital patterns observed during the period. Disparities have been observed in fertility levels among regions with the levels lowest in Banjul and Kanifing municipal areas and highest in the predominantly rural Local Government Areas. Similar differentials have been observed among ethnic groups. Regional and ethnic differences in fertility may be explained by differences in levels of contraceptive use, attitude to family size and variations in marital patterns, in general. Estimates from the MICS2 indicate that the total fertility rate is 5.4 children per woman. Mortality In spite of considerable achievements in terms of mortality decline during the past three decades, mortality levels in The Gambia remain among the highest in the sub-region. Infant mortality estimated at 84 deaths per 1000 live births in 1993 recorded significant decline from levels estimated at 167 deaths in 1983. Over the same period, under-five mortality was estimated to have declined from 260 deaths per 1000 in 1983 to 129 deaths in 1993. Lower levels of child and under-five mortality have been observed in the Banjul and Kanifing municipal areas when compared to other regions of The Gambia, although, in general, mortality levels have declined significantly across all regions during the past three decades. Similarly mortality levels in urban areas have been found to be higher than in rural areas. Such differences in levels of mortality may be attributed to a host of factors. These range from differential access to health services, differentials in socio-economic status of the population across regions to differences in nutritional status across regions. Variations observed in mortality levels across ethnic groups have also been partly attributed to differences in access to health services across regions. Probably due to the effect of improved access to health services throughout the country over the past two decades, a considerable decline was observed in differentials in mortality levels across regions. Estimates of both under-five and infant mortality from the MICS2 appear to suggest that child mortality has increased in The Gambia. The U5MR and IMR are estimated at 141 and 98 per 1, 000 respectively. The upsurge in child mortality rates, which has been experienced in other sub-Saharan African countries, should be viewed with caution since it is difficult to 14 establish from a single data source. Furthermore, the quality of the MICS data on mortality was not very good. Maternal educational attainment is negatively correlated with child mortality. For example, under-five mortality for children born to mothers with no education in 1993 was estimated at 138 deaths per 1000 live births compared to 120 among children of women with primary level education and 88 deaths per 1000 for children of women with secondary education and above. The decline in mortality levels has translated into improvements in life expectancy with the life expectancy for both sexes increasing from 42.8 years in 1983 to 55 years in 1993. Improvements in mortality observed in The Gambia may not be explained by a single factor but improvements in access to health services have been singled out as a major factor. Achievements of the Primary Health Care Programme in bringing health services close to rural communities, in particular, has been singled out as having greatly influenced levels of mortality. Improvements in access to health services with the establishment of additional health facilities over the past decade and beyond are believed to have accounted for part of the mortality decline. In view of the influence of education on infant and child survival, gains in survival among children has also been partly attributed to improvements in female educational attainment over the period. Population Policy and Programme Faced with largely unfavourable economic conditions, rapid deforestation aggravated by rapid population growth, the Government of the Gambia decided to adopt a National Population Policy in 1992. The policy designed to curb the rapid rate of population growth had the overall goal of improving the quality of life and raising the standard of living of all Gambians. For the attainment of the goals of the policy, strategic components have been identified. These include reproductive/sexual health and family planning, education, family and gender relations, youth, environment, nutrition, population distribution and urbanisation, migration, information education and communication/advocacy, research, capacity building and legislative reform. Activities have been identified as integral parts of the national population programme. In view of the cross cutting nature of some of the activities of the population programme, an attempt has been made to harmonise the National Population Policy and Programme with other government initiated programmes. Key among these programmes are the National Education Policy, The Gambia Environment Action Plan, the Housing, Health and Family Planning Policies. The major targets of the National Population Policy have been identified as: - Reduce the maternal mortality rate from 1050 per 100,000 (1990) to 800 per 1,000 by the year 2000 and to 500 per 100,000 by 2004; - Reduction of the total fertility rate from 6.0 (1993) to 5.5 by 2000 and 5 by 2004. - Extend primary health care services from 60 per cent (1985) to 80 per cent of the rural population by 2000 and to 100 per cent by 2004 - Increase contraceptive prevalence from current estimates of 7 per cent (modern methods) to 15 per cent by 2000 and 22.5 per cent by 2004 15 - Reduce pregnancy among women aged 15-19 years and 35 years and above by 20 per cent by 2000 and by another 50 per cent by 2004 - Increase the coverage of the Expanded Programme for Immunisation of children under age 2 years from 83 per cent (1994) to 90 per cent by 2000 and to 100 per cent by 2004 - Reduce infant mortality rate from 92 per 1000 (1993) to 72 per 1000 by 2000, and to 56 per 1000 by 2004 A key strategy identified by the policy in achieving these goals is improved access to health services throughout the country and the introduction of measures geared towards the improvement of the quality of health services in general. Improvements in the area of maternal and child health services has been particularly singled out for attention. HEALTH SITUATION Human deprivation has for long been measured in terms of material possession. In view of the pivotal importance of health in the general well being of mankind, however, recent development paradigm have adopted indices of human development which consider the state of health of the population as an important input. A considerable number of indices in this report may be affected by the state of health of the population, in general, and the state of health services in the country in particular. It would be useful, therefore, to provide some information on the state of health of The Gambia in this chapter to facilitate a better understanding of some of the findings of this study. Health Care Delivery System Until the adoption of the Primary Health Care (PHC) strategy in 1979, the healthcare delivery system in The Gambia was largely centralised with the only government run referral hospitals in Banjul and Bansang. The PHC strategy was adopted with the main aim of making health care more accessible and affordable to the majority of Gambians. A key target of the PHC was mainly rural settlements with a population of over 400 persons. For each PHC village a Village Health Worker (VHW) and a Traditional Birth Attendant (TBA) was trained to provide primary health care in their communities. The Village Health Workers (VHWs) are assigned the role of maintaining the supply of essential drugs, the provision of outpatient care, making home visits and carrying out health education programmes. The Traditional Birth Attendants (TBAs) assist in deliveries and identify and refer at-risk mothers. Health care delivery at the primary level in The Gambia is provided through the PHC programme. At the secondary level health care is delivered through a number of major and minor health centres. These have been identified as 7 major health centres 12 minor health centres and 19 dispensaries. The Major Health Centres are staffed by resident doctors, registered and enrolled nurses and other auxiliary staff. Minor Health Centres until recently, when doctors were posted to a number of them, only had registered and enrolled nurses and other support staff. Dispensaries, on the other hand, are staffed by enrolled and community health nurses. Health care provision at the secondary level entails our-patient services and in-patient services at a small scale. Although reports indicate that there have not been major changes in the number of secondary services in the past 15 years, there have been major improvements in the quality of services with the upgrading of 7 major health centres. Cases that cannot be handled by this level of health services are referred to the hospitals. 16 At the tertiary level, health services are provided by three hospitals. These hospitals are located in Banjul, Farafenni and Bansang. Farafenni Hospital, opened not long ago, will go a long way in providing much needed referral services in the rural areas. The Royal Victoria Hospital (RVH), located in Banjul, is the main referral hospital offering specialist consultant services. The hospital operates a pharmacy, laboratory services and a polyclinic, which provides secondary level health services to Banjul and the surrounding urban area. Farafenni hospital provides referral services to people of the North Bank Division and adjacent areas. Although the hospital provides most specialist services, the hospital is yet to be fully operational. Bansang Hospital, the oldest rural hospital, serves the eastern part of the country with a catchment area covering about a third of the country’s population. In addition to operating as a referral hospital, the hospital also operates a very busy outpatient department. The health services that are provided by government-funded health institutions are supplemented by services provided by the private sector and non-governmental organisations (NGOs). Individuals and NGOs have established a number of health facilities, mainly in urban areas. Probably due to the higher costs involved in the provision of health services by the private sector, only a small proportion of the population is able to afford services provided by such facilities, hence the increasing demand on public-funded health services. Human Resources In the light of marked improvements both in terms of number of service delivery points and the quality of services, there has been a corresponding increase in the number of technical and professional health personnel. The number of doctors/dentists working in government run health services increased from 48 in 1987 to 128 in 1997, an increase of 166 per cent. Although more recent figures are not available, this number might have doubled by now in view of the dramatic increase in the number of Cuban doctors serving in the health sector now. The public health services depend to a large extent on expatriate doctors. A number of problems have been identified with services provided by these doctors. Language difficulties, different medical regimens and shortages between postings have been identified as problems faced with foreign expatriate doctors. Records show that over the past decade or beyond, the number of nurses increased by 11 per cent. This might have led to improvements in quality of care in hospitals and health centres. Except for public health officers who recorded a decline in numbers over the period 1987-97, all other cadre of health personnel registered significant increases. Although the geographic distribution of health personnel is uneven, recent efforts at decentralising health services might have drastically reduced disparities in the ratio of population per health personnel across regions. The increase in the number of doctors serving in rural areas might have had the most impact, particularly with the posting of Cuban doctors in areas that have never been served by a resident doctor. Achievements of the Health Care System With the main objective of improved access to health services, between 1992 and 1994, government embarked on measures to decentralise primary and secondary services. Six divisional teams were created to manage and supervise service delivery at secondary and primary level health facilities. These measures together with improvements, in general, in health infrastructure, led to marked improvements in health in The Gambia. In addition to gains in the curative health sector, marked improvements were recorded in preventive health 17 services. Improvements in infant and child survival, as reviewed earlier, in this chapter have been largely attributed to improvements in both access and quality of health services. The Expanded Programme for Immunisation (EPI) which was launched in 1979 is probably one of the most successful health initiatives in The Gambia. The programme, initially aimed at vaccinating children against measles, polio, pertusis, diphtheria and tetanus, has added yellow fever, Hepatitis B and Haemophillus Influenza Type B on to the list of target immunisable diseases. Immunisation coverage improved considerable over the past decade. For children aged less than one year, the proportion of fully immunised children increased from 65.5 per cent in 1990 to 87 per cent in 1995. Similarly, for children aged less than two years immunisation coverage improved from 80.9 per cent in 1990 to 87 per cent in 1995. Immunisation coverage among diseases differs, with immunisation for some diseases closed to complete coverage. Regional disparities have also been observed in coverage levels. The improvements in levels of immunisation coverage, particularly in the mid-1990s have accounted for the dramatic reduction in the incidence of immunisable diseases. However, between MICS 1 (1995) and MICS 2 (2000), overall immunisation coverage declined from 87 per cent to 62 per cent. This significant decline in coverage can be attributed to the ageing cold chain and the issue of sustainability of the EPI as less and less donor funding is forthcoming. Constraints of the Health Care Delivery System Notwithstanding the apparent gains of the health services of the Gambia over the past decade and beyond, the system is still faced with numerous constraints, which impede progress in the sector. Although infant and child survival has improved remarkably in the recent past, levels remain among the highest in the sub-region, a clear indication of a lot of room for improvement. Similarly, maternal mortality estimated at 1050 per 100,000 live births in 1990 is among the highest in the sub-region. These high levels of mortality are influenced by a host of factors with inadequacy of the health services as a key factor. Over the years it has been observed that resource allocation to the health sector has not been able to match the increasing demand for services. Although there has been an increase in Government recurrent expenditure in the Health Sector over the period 1990/91 to 1996/97, Government per capita expenditure on health in 1996/97 almost remained at the levels of 1990/91 (Public Expenditure Review, 1998). Considering a population growth rate of 4.2 per cent per annum and increased cost of health services over the period under review, the marginal increase in health expenditure is not likely to have much impact on the quality of health services. The introduction of a cost recovery component in the health services is yet another problem faced by the health delivery system. Both the Drug Revolving Fund (DRF) and the Bamako Initiative have put in place mechanisms for cost recovery to facilitate the procurement of drugs. There are growing fears that user charges introduced in 1988 may already be posing a problem of affordability among rural communities and could serve as a disincentive. Another important problem faced by the health sector is the shortage of ambulances. In remote areas of the country, the use of donkey or horse carts for the evacuation of patients is common. This probably prompted Government to initiate a programme of horse cart ambulances in the past. Although this initiative took off, it has largely been unsuccessful. The traditional carts, however, remain the main mode of transportation of the sick in many rural communities. In view of the poor state of roads in these areas, this mode of transport often poses a threat to the lives of patients. 18 Specialist services are still in high demand in The Gambia. Since most specialists are non- Gambians and usually on technical assistance, withdrawal of such assistance could adversely affect the quality of services in The Gambia. This state of affairs renders the health service delivery system of the country quite vulnerable. In addition to vulnerability due to reliance on non-Gambian health specialist, health funding in The Gambia is heavily dependent on donor assistance. This raises issues of sustainability in light of evidence of donor fatigue in the recent past. Health Policy and Other Health Initiatives The National Health Policy 1994-2000, the basis of health initiatives and programmes in The Gambia over the past 5 years, is currently under review. The main aim of this policy is to improve the health status of the Gambian people through the reduction of the high infant and maternal mortality rates currently being experienced in the country. To achieve this aim, disease prevention and health protection programmes have been prioritised. In view of the success of the PHC programme, it was decided that essential elements of the programme formed the basis of the policy. The thrust of the policy during the 1990s was to concentrate on: ¾ Family health, embracing maternal and child health, including family planning, adolescent health, nutrition and immunisation; ¾ Control of endemic diseases, principally malaria, acute respiratory infections (ARI) diarrhoeal diseases, leprosy and tuberculosis, sexually transmitted diseases (STD) and AIDS ¾ Health promotion using Information, Education and Communication (IEC) protocols and preventive health interventions to address non-communicable diseases ¾ Broad-spectrum training for different cadres of health personnel, at the village, secondary, tertiary and central levels of health care delivery. The policy aims to consolidate gains made in the health sector and expand existing health services. In recognition of the influence of other factors on the health status of a population, which may be unrelated to advances in medical technology, the policy promotes inter- sectoral collaboration. Survey Objectives The 2000 Gambia Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in The Gambia at the end of the decade and for looking forward to the next decade; • To furnish data needed for monitoring progress toward goals established at the World Summit for Children and a basis for future action; • To contribute to the improvement of data and monitoring systems in The Gambia and to strengthen technical expertise in the design, implementation, and analysis of such systems. 19 II. Survey Methodology Sample Design The sample for The Gambia Multiple Indicator Cluster Survey (MICS) was designed to provide estimates of health indicators at the national level, for urban and rural areas, and for eight Local government Areas (LGA): Banjul, Kanifing, Brikama, Mansakonko, Kerewan, Kuntaur, Janjanbureh and Basse. The sample was selected in two stages. At the first stage, 128 census enumeration areas were selected with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 4,528 households was drawn. Because the sample was stratified by LGA, it is not self- weighting. For reporting national level results, sample weights are used. Full technical details of the sample are included in Appendix A. Questionnaires The questionnaires for The Gambia MICS were based on the MICS Model Questionnaire with some modifications and additions. A household questionnaire was administered in each household, which collected various informations on household members including sex, age, literacy, marital status, and orphanhood status. The household questionnaire also includes education, child labour, maternal mortality, water and sanitation, and salt iodisation modules. In addition to a household questionnaire, questionnaires were administered in each household for women age 15-49 and children under age five. For children, the questionnaire was administered to the mother or caretaker of the child. The questionnaire for women contains the following modules: 9 Oral Rehydration Solution 9 Child mortality 9 Tetanus Toxoid 9 Maternal and new-born health 9 Contraceptive use 9 HIV/AIDS. The questionnaire for children under age five includes modules on: 9 Birth registration and early learning 9 Vitamin A 9 Breastfeeding 9 Care of Illness 9 Malaria 9 Immunisation 9 Anthropometry From the MICS model English version, key terms in the questionnaires were translated into four languages: Mandinka, Wollof, Fulla and Jola. The questionnaires were pre-tested during March 2000. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. For the full questionnaires, see Appendix B. Fieldwork and Data Processing The field staffs were trained in two groups, the first training was conducted for field supervisors and technicians and the second was conducted for interviewers and data entry operators. The first training was done for five days in late April 2000 and the second training in early May 2000. Seven teams collected the data; each was comprised of five interviewers, one driver, and a supervisor. The MICS Co-ordinator provided overall supervision with the 20 assistant of two other field co-ordinators. The fieldwork began in May 2000 and concluded in June 2000. The data were entered on twelve microcomputers using the Integrated Microcomputer Processing System (IMPS) software and the analysis were done using the SPSS. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under MICS and adapted to The Gambia questionnaire were used throughout. Data processing began in September 2000 and finished in January 2001. III. Sample Characteristics and Data Quality Response Rates Of the 4, 536 households selected for The Gambia MICS sample, 4, 492 were found to be occupied (Table 1). Of these, 4, 478 were successfully interviewed for a household response rate of 99.7 per cent. The response rate was slightly higher in urban areas (99.9 per cent) than in rural areas (99.5 per cent). In the interviewed households, 6, 469 eligible women aged 15-49 were identified. Of these, 5,976 were successfully interviewed, yielding a response rate of 92 per cent. In addition, 3, 849 children under age five were listed in the household questionnaire. Of these, questionnaires were completed for 3, 632 children giving a response rate of 94 per cent. Age Distribution and Missing Data As shown in Table 2 and Figure 1, the single year age distribution of household members by sex exhibits some distortions centred around age 7 for females and on ages 7, 5, and 8 for males. There appears to be significant heaping of female children on ages 6-8 and perhaps a slight dearth of women ages 15-17. For both sexes, some digit preference is evident for ages ending in 0 and 5, a pattern typical of populations in which ages are not always known. Figure 1: Single year age distribution of the household population by sex, The Gambia, 2000 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Age P er ce n t Male Female As a basic check on the quality of the survey data, the percentage of cases missing information on selected questions is shown in Table 3. Less than one per cent of household members have missing information on their level of education and zero per cent is missing data on the year of education. Among female respondents, 0.5 per cent did not report a 21 complete birth date (i.e., month and year). Two per cent of women who had a birth in the 12 months prior to the survey did not report the date of their last tetanus toxoid injection. These low levels of missing data suggest that there were not significant problems with the questions or the fieldwork. The data on number of hours for working children age 5-14 and complete birth date for children less than 5 years are the most likely among the selected information to be missing. Approximately three per cent of children are missing this information, which may be the result of women having difficulties in estimating the number of hours work, poor handling of infant welfare cards and absence of mother’s of children during the time of the interview. Characteristics of the Household Population Information on the characteristics of the household population and the survey respondents is provided to assist in the interpretation of the survey findings and to serve as a basic check on the sample implementation. Table 4 presents the per cent distribution of households in the sample by background characteristics. About 49 per cent of the households (2,219 households) are urban and 51 per cent (2,313 households) are rural. The Kanifing LGA comprises the largest of the five regions with 31 per cent of households while Brikama is next largest with 29 per cent. The remaining regions each contain between 3 and 16 per cent of households. Most of the households have between four and seven members. Fifty six per cent of the households contain at least one child under age five and 78 per cent contain at least one woman aged 15-49 years. Table 5 shows the characteristics of female respondents aged 15-49. Women aged, 15-19 and 20-24 years comprise the highest percentage of the sample at 20 per cent each. This percentage declines steadily across age groups until age 45-49 where it is four per cent. This pattern is typical of countries in the region. Approximately, 73 per cent of women in the sample are currently married and 73 per cent have ever had a birth. The majority of women, about 71 per cent, have had no education while about 20 per cent have had at least some secondary education. Table 6 shows the characteristics of children under age five. About half of the children are male and half are female. Approximately 81 per cent of mothers of children under age five have no education, about 10 percentage points significantly greater than the overall percentage of women with no education in the sample. Note that, for children whose mothers did not live in the household, the education of the child’s caretaker is used. There are slightly less children aged less than six months than aged 6-11 months, a pattern, which is expected. IV. Results A. Infant and Under-Five Mortality The infant mortality rate is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. In the MICS, infant and under five mortality rates are calculated based on an indirect estimation technique (the 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 22 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. The data used for mortality estimation are shown in Table 7. The mean number of children ever born rises from 0.32 among 15-19 year olds to 5.91 among 40-44 year olds and continues to increase to 6.69 among 45-49 year olds as expected since the number of children ever born should continue to rise with age. However, the proportion of children dead has an irregular pattern. In particular, the proportion of children dead among women aged 20-24 is low and the proportions among younger women appear to be high. This pattern may be affected by the age heaping noted in Figure 1 above. If some women in their twenties underreported their ages but reported the births and deaths of their children correctly then the deaths would effectively be moved downward toward age 15. B. Education Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the World Summit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. Early Childhood Education Overall, about 16 per cent of children aged 36-59 months are attending an organised early childhood education programme, such as kindergarten or community childcare with organised learning activities (Table 9). According to the EFA 2000, the GER for early childhood education is 17.7 per cent in 1998. This shows a slightly higher percentage although it was conducted two years prior to the MICS2. However, the difference in attendance rate can be attributed to the fact that EFA 2000 was a school-based survey whilst MICS2 was a household survey; hence the denominators for calculating the rates would be different. Approximately equal percentages of girls and boys are attending these programmes. There are large variations according to region ranging from three per cent of children in Janjanbureh to about 29 per cent in Banjul. In addition, 20 per cent of children in urban the areas attend early learning activities compared to about 14 per cent of children in rural areas. Relatively few children attend at age three (36-47 months) while the majority of children attend at age four (48-59 months). Finally, the education of the mother is strongly related to the likelihood that a child will attend an early childhood education programme. The percentage of children attending increases from 13 per cent to 42 per cent as the mother’s education increases from none to secondary or higher education. Similarly, a larger proportion of children, (29 per cent), in the richest wealth index category attend some form of early childhood education compared with 11 per cent of children in the poorest category. Basic Education Nationally, about 52 per cent of children of primary school age in The Gambia are attending primary school (Table 10 and Figure 2). In urban areas, 64 per cent of children attend primary school while in rural areas 45 per cent attend. School attendance in Basse is significantly lower than in the rest of the country at 29 per cent. At the national level, the attendance rate is higher for males than females with primary school attendance rates of 54 and 49 per cent for males and females respectively. Differentials exist in the proportion of children attending primary school across wealth index categories with more than twice the proportion of children from the richest category, 72 per cent, compared to 33 per cent of children from the poorest quintiles. Almost all (97 per cent) of the children who enter the first grade of primary 23 school eventually reach grade five (Table 11). Virtually, there is no difference across rural- urban, gender and LGA. Figure 2: Percentage of children of primary school age attending primary school, The Gambia, 2000 ������������������������������������������������������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������������������������������������������������������ ��������������������������������������������������������������������������������������������������������������������������������� ��������������������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������� ���������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������� ����������������������������������������������������������������������� ������������������������������������������������������������������ ������������������������������������������������������������������ �������������������������������������������������������� ������������������������������������������������������� ������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������������� ����������������������������������������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������� ������������������������������������������������������������������������������������������������ ������������������������������������������������������������������������������������������������ Kanifing Mansakonko Kuntaur Basse The Gambia Rural 0 10 20 30 40 50 60 70 80 Banjul Brikama Kerewan Janjanbureh Urban Percent However, Basse and Kuntaur compared to other regions have lower percentages of children entering first grade of primary school who eventually reach grade five. Only slight differences have been observed across wealth index categories with the richest having slightly higher proportion, about 99 per cent, of children who entered grade one and eventually reaching grade five compared to about 95 per cent for children from the poorest quintiles. Literacy Less than half (36 per cent) of the population over age 15 years in The Gambia is literate (Table 12). The literate population includes those who are reported to read ‘easily or with difficulty’. Overall, male literacy rates have been found to be almost double the female literacy rates (48 vs. 25 per cent). The percentage literate is lower in the Mansakonko, Kerewan, Kuntaur, Janjanbureh and Basse regions than in the Banjul, Kanifing and Brikama regions. However, the percentage literate among females is lowest in the Basse LGA compared to any other region. Literacy declines with increasing age. The percentage literate declines from 52 per cent among those aged 15-24 to 16 per cent among the population aged 65 and older. Across wealth index categories, the proportion of the population aged 15 years and older who are literate is highest for the richest category (63.2 per cent) and lowest for the poorest (16.7 per cent). According to the EFA 2000, literacy rates remained constant at 37.2 per cent from 1991 to 1994 and then dropped slightly and remained constant at 37.1 per cent from 1995 to 1998. By comparison, this survey result shows a slight further decline since 1998 instead of a rise. 24 C. Water and Sanitation Use of drinking water Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, particularly in rural areas, who bear the primary responsibility for carrying water, often for long distances. About 40 per cent of the population use drinking water from public tap and 19 per cent use tubewell/borehole with pump. The percentage of the population using water from unprotected dug well, piped into yard, protected dug well and piped into dwelling are 15, 10, 9 and 7 per cent respectively. The source of drinking water for the population varies strongly by region (Table 13). In Banjul and Kanifing, 45 and 54 per cent of the population respectively get their water either from piped water in their dwellings or their yard or plot, whereas in other LGAs even lower than 7 per cent of the population use these sources for their drinking water. With regards to the public taps, which is the most important source of supply of drinking water, it is substantially lower in Kuntaur and Janjanbureh LGAs than in other regions. The use of tubewell/borehole as source of drinking water is more in regions that are predominantly rural than those entirely urban. The use of protected dug well is also significantly higher in Janjanbureh than other LGAs. Unprotected dug well, which is an important source (an unsafe source), is commonly used in Brikama, Janjanbureh and Basse LGAs. For the population across wealth index categories, access to safe drinking water sources is highest among the richer population than poor. The population using safe drinking water sources is those who use any of the following sources for their drinking water supply: piped water, public tap, borehole/tubewell, protected well, protected spring or rainwater. Overall, 84 per cent of the population has access to safe drinking water – 95 per cent in urban areas and 77 per cent in rural areas. Access to safe drinking water is high in The Gambia although improvement is needed in other LGAs such as Kuntaur, Janjanbureh and Basse. In contrast to MICS 1996, there is a mark improvement in access to safe drinking water as it has increased from 69 to 84 per cent nationally. Similarly, access to safe drinking water has risen from 80 to 95 per cent in the urban areas and from 65 to 75 per cent in the rural areas. Also, according to MICS 1996, access to safe and convenient source of drinking water was lowest in Brikama with an accessibility rate of 49 per cent. Due to the intervention of the Brikama Area Council, European Development Fund (EDF) and other donors, there has been tremendous achievement in providing better access to safe drinking water and hence raising the accessibility rate to 77 per cent. Use of sanitation Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Sanitary means of excreta disposal include: flush toilets connected to sewage systems or septic tanks, other flush toilets, improved pit latrines, and traditional pit latrines. About eighty-eight per cent of the population of The Gambia is living in households with sanitary means of excreta disposal (Table 14). This percentage is 96 in urban areas and 83 per cent in rural areas. Residents of Kuntaur LGA are much less likely than others to use sanitary means of excreta disposal. For the population 25 across wealth index categories a larger proportion of the richest category (98.5 per cent) have sanitary means of excreta disposal compared to the poorest category (71.5 per cent). About 12 per cent of the population use either open pits, bush/field or has no facilities. According to the MICS 2000 definition, proper sanitary facility includes pit latrine, which in The Gambian context is not regarded as an ideal sanitary means of excreta disposal due to the unsafe and unclean nature of this facility. There were few reported instances when women and/or children fell in pit latrines. Hence, with the exclusion of pit latrines as a sanitary means of excreta disposal, the total population with sanitary means of excreta disposal declines to about 23 per cent. In most regions this is even less than 10 per cent of the population with total sanitary means of excreta disposal. Also, without pit latrines, sanitary means of excreta disposal is available to 48 per cent of the population in the urban areas and to only 9 per cent in the rural areas. D. Child Malnutrition Nutritional status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply and are not exposed to repeated illness, they reach their growth potential and are considered well nourished. In a well-nourished population, there is a standard distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to this standard distribution. The standard or reference population used here is the NCHS standard, which is recommended for use by UNICEF and the World Health Organisation. Each of the three nutritional status indicators is 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. The children whose height for age of more than three standard deviations is 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 above three standard deviations, that is, 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. In Table 15, children who were not weighed and measured (approximately 1 per cent of children) and those measurements that are outside a plausible range are excluded. In addition, unknown birth dates for a small number of children known have been excluded. 26 Almost two in ten children under age five in The Gambia are underweight and four per cent are classified as severely underweight (Table 15). Nineteen per cent of children are stunted or too short for their age and eight per cent are wasted or too thin for their height. With reference to MICS 1996, the proportion of children malnourished has decreased from 21 to 17 per cent (weight for age) and 23 to 19 per cent (height for age) over a period of four years. According to Table 15, children in Janjanbureh are more likely to be underweight, stunted and wasted than other children. Children whose mothers have secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with less education. Boys appear to be slightly more likely to be underweight, stunted, and wasted than girls. The age pattern shows that a higher percentage of children aged 12-23 months are undernourished according to weight for age index, those age 36-47 months according to height for age index and those age 6-11 months according to weight for height index. This pattern differs from the international pattern which in relation to age and in respect of all the three indices, those aged 12-23 months are usually more undernourished, because at these ages many children cease to be breastfed and are exposed to contamination in water, food and environment. In The Gambia, most children continued to be breastfed even beyond the age of 23 months and as a result are not at the ages 12-23 months exposed to contamination. Children of mothers with no education are likely to be underweight, stunted and wasted than of children of women with higher educational attainment. Similarly children of women in the richest wealth index category are better nourished compared to those in poorest categories. 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 Summit for Children goal states that children should be exclusively breastfed for four to six months, that breastfeeding should be complemented with appropriate foods from the age of around six months, and that children continue to be breastfed for two or more years. In Table 16, breastfeeding status is based on women’s reports of children’s consumption in the 24 hours prior to the interview. Exclusive breastfeeding refers to children who receive only breast milk and vitamins, mineral supplements, or medicine. Complementary feeding refers to children who receive breast milk and solid or semi-solid food. The last two columns of the table include children who are continuing to be breastfed at one and at two years of age. Exclusive breastfeeding and continued to be breastfed to 20-23 is higher among female children than male children. Complementary breastfeeding is higher among male children than female children. Also, exclusive breastfeeding is higher among children of mothers of secondary or more education than others and it rises with education and likewise for the urban than rural and to some extent wealth index categories. Complementary breastfeeding is also higher among urban children than those in the rural areas. However, this is due to the differences in the employment rates. As expected, children from the rural areas are breastfed longer compared to those in the urban areas for the same reason above. Similarly, children of mothers in poorest wealth categories are breastfed longer duration compared to those in the richest categories. Approximately 36 per cent of children aged less than four months are exclusively breastfed. This has shown a rise by 8 per cent according to the Anthropometry Baseline Survey, 1998. At age 6-9 months, 36 per cent of children are receiving breast milk and solid or semi-solid 27 foods. By age 12-15 months, about 97 per cent of children are still being breastfed and by age 20-23 months, 54 per cent are still breastfed. Figure 3 shows the detailed pattern of breastfeeding status by the child’s age in months. Even at the earliest ages, the majority of children are receiving liquids or foods other than breast milk. The percentage of children exclusively breastfed diminishes rapidly to close to zero after three months. By the end of one year, almost all of the children are still breastfed. Figure 3: Percentage distribution of living children by breastfeeding status, The Gambia, 2000 0% 20% 40% 60% 80% 100% 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 Age in months Exclusively breastfed Breast milk and water only Breast milk and supplements Not breastfed Salt Iodisation A deficiency of iodine in the diet causes goitre, an enlargement of the thyroid gland, and can cause brain damage due to such a deficiency before birth or during infancy or childhood. The iodisation of salt is a low-cost way of preventing iodine deficiency disorders (IDD). In MICS, interviewers tested household salt for iodine levels by means of a testing kit. Adequately iodised salt contains 15 PPM (parts per million) of iodine or more. Approximately 84 per cent of households had salt that was tested during the MICS (Table 17). It could be observed that 16, 23 and 15 per cent of the households in Banjul, Kanifing and Brikama LGAs respectively had no salt. This is because of the high concentration of single person households in these areas. As most of these households do not cook at home, they do not keep salt in their homes. Among households in which salt was tested, about 8 per cent had adequately iodised salt. This is very close to the results of the Iodine Deficiency Disorders survey conducted by the Nutrition Unit of the Department of State for Health in 1999, which, nationally, found 9 per cent of the households using iodised salt. Regional differences follow the same pattern with Central River Division with the highest percentage of iodised salt (23 per cent, IDD Survey, 1999) compared to an average of 24.5 per cent for Central River Division (North and South) according to MICS2. The Upper River Division (Basse) also has a high proportion, 21 per cent, of households using iodised salt. It is important to note that the regions with the highest consumption of iodised salt get their supplies from Senegal. The percentage of households with adequately iodised salt ranges from 2 per cent in the Kerewan to 33 per cent in the Janjanbureh region. Five per cent of urban households had adequately iodised salt compared to 10 per cent of rural households. Among households across wealth index quintiles, a larger proportion of the poorest households have adequately iodised salt compared to the richest households (Table 17). 28 Vitamin A supplementation Vitamin A deficiency (VAD) can cause eye damage and blindness in children. It also impairs children's immune systems, increasing their chances of dying of common childhood diseases and undermines the health of pregnant and lactating women. Yet, vitamin A supplementation, food fortification or dietary change can easily prevent it. Based on UNICEF/WHO guidelines, in The Gambia, the Department of State for Health recommends that children aged 6-11 months be given one high dose of Vitamin A capsules a year and children aged older than one year be given two capsules. In this country, supplies of Vitamin A capsules is linked to immunisation services and are given when the child has contact with these services after six months of age. Vitamin A supplementation is also given annually both during the Nutrition Surveillance and National Immunisation Days. As a result of increased Vitamin A requirements during pregnancy and lactation, it is recommended that mothers take Vitamin A supplement within eight weeks of giving birth. Within the six months prior to the MICS, about 4 per cent of children aged 6-59 months received the high dose Vitamin A supplement (Table 18). Approximately 2 per cent did not receive the supplement in the last 6 months but did receive one prior to that time. Also about two per cent of children received a Vitamin A supplement at some time in the past but their mother/caretaker was unable to specify when. Vitamin A supplementation coverage is lower in the Brikama Local Government Area (LGA) compared to the other regions. The age pattern of Vitamin A supplementation shows that supplementation in the last six months declines from about 5 per cent among children aged 6-11 months to about 2 per cent among children aged 48-59 months. This is because the national Vitamin A supplementation started just a few days before the MICS2 fieldwork and as usual the younger children are more frequently visiting the Health Centres, where the supplementation is given, than the older children. There are no significant gender differentials in the per4centage of children who received Vitamin A supplementation (Table 18). However, the mother’s level of education is inversely related to the likelihood of receiving Vitamin A supplementation. The percentage receiving a supplement in the last six months decreases from four per cent among children whose mothers have no education to 3 per cent of those whose mothers have primary education and less than one per cent among children of mothers with secondary or higher education. Similarly, of the children of women in the poorest wealth index category 7 per cent received vitamin A supplementation compared to 3, 5 and 2 per cent among the second poorest, middle and richest categories respectively (Table 18). Only about 14 per cent of mothers with a birth in the year before the MICS received a high dose of Vitamin A supplement within eight weeks of the birth (Table 19). This percentage is highest in the Kerewan LGA, about 41 per cent and lowest in the Basse LGA at 3 per cent. Vitamin A supplementation coverage is lowest amongst mothers of children with primary education; this may be because the coverage is higher in Kerewan where literacy rate is very low. However, there is no significant difference between mothers of children with primary education and those with secondary education and above (Table 19). Low Birth Weight Infants who weigh less than 2, 500 grams (2.5 kg.) at birth are categorised as low birth weight babies. Since many infants are not weighed at birth and those who are weighed may be a biased sample of all births, reported birth weight cannot be used to estimate the prevalence of 29 low birth-weight among all children. Normally, the percentage of births weighing below 2,500 grams is estimated from two items in the prototype questionnaire: i) The mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large); and, ii) The mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth. About 42 per cent of births in The Gambia were weighed at birth (Table 20). As the size of the baby is considered unreliable, in the MICS 2 only the latter (weight recorded on health card) is taken into account. This proportion is then multiplied by the total number of children falling in the size category to obtain the estimated number of children in each size category who were of low birth weight. The numbers for each size category are summed to obtain the total number of low birth weight children. This number is then divided by the total number of live births to obtain the percentage of children whose birth weight are low. Approximately 12 per cent of infants are estimated to weigh less than 2,500 grams at birth (Table 20). This percentage is somewhat higher than the average for the Latin America and Caribbean region at 9 per cent (UNICEF, 2000). The prevalence of low birth weight births varies slightly across regions but does not vary much between urban and rural areas or by mother’s education (for mothers with primary and secondary and above). As expected the proportion of under-weight babies is lowest in Banjul and highest in Kuntaur and highest among children of mothers with no education than those with some education. A similar pattern has been observed across wealth index categories (Table 20). E. Child Health Immunisation Coverage According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to be protected against tuberculosis, three doses of DPT to be protected against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. In the MICS 2, mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Mothers were also probed to report any vaccinations the child received that did not appear on the card. Overall, 91 per cent of children had health cards. This has shown an increase of card retention from 78 per cent (MICS 1996) to 91 per cent. If the child did not have a card, a short description of each vaccine was read to the mother and asked to recall whether or not the child had received it and, for DPT and Polio, how many times. Table 21 shows the percentage of children aged 12 to 23 months who received each of the vaccinations. The denominator for the table includes children aged 12-23 months and only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday are included. For children without vaccination cards, the proportion of vaccines given before the first birthday is assumed to be the same as for children with vaccination cards. Almost all (99 per cent) 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 97 per cent of the children. The 30 percentage declines for subsequent doses of DPT to about 96 per cent for the second dose, and 90 per cent for the third dose (Figure 4 and Table 21). Similarly, 97 per cent of children received Polio 1 by age 12 months and this declines to 94 and 88 per cent respectively by the second and third doses. The coverage for measles vaccine by 12 months is almost the same as the coverage for third dose of Polio 3 at 88 per cent. As a result, the percentage of children who had all eight recommended vaccinations by their first birthday is 62 per cent. Overall, the immunisation coverage has dropped significantly from 87 to 62 per cent between MICS 1996 and 2000 respectively. This could be attributed to periodic shortages of some of these antigens in the health centres, the ageing cold chain and problems of sustainability in general. Figure 4: Percentage of children aged 12-23 months who received immunisations by age 12 months, The Gambia 2000 ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ���������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ��������� ���������0 20 40 60 80 100 120 BCG DPT Polio Measles Overall P er ce n t ����� ����� Dose 1 ����� ����� Dose 2 ����� �����Dose 3 In Table 22, the percentage of children aged 12-23 months currently vaccinated against childhood diseases is shown according to background characteristics. Unlike Table 21, the estimates in this Table refer to children who received the vaccinations by the time of the survey, even if they did not occur prior to the age of 12 months. Overall vaccination coverage for male children, 65 per cent, is slightly higher than that of female children at 58 per cent. Urban children, on average, are less likely, 57 per cent, to be vaccinated compared to rural children at 65 per cent. Regional breakdowns are based on small numbers of cases and should be viewed with caution, but it appears that the Basse region has the highest coverage rates for most vaccinations and Janjanbureh LGA has the highest percentage of children who have received all of the recommended vaccinations. Basse LGA also has the highest percentage of children with health cards at 99 per cent. Vaccination coverage is highest among children whose mothers have secondary or higher education. However, educational differences are not significant across doses. On the other hand immunization coverage is lower among children of mothers in the richest wealth index category than those of children of mothers in the poorest category (Table 22). Diarrhoea Dehydration caused by diarrhoea is a major cause of mortality among children in The Gambia. Home management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing 31 dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 22 per cent of under-five children had diarrhoea in the two weeks preceding the survey (Table 23). Diarrhoea prevalence was significantly higher in the Kuntaur LGA at 32 per cent than in other regions. The peak of diarrhoea prevalence occurs in the weaning period, among children age 6-23 months. As expected, the prevalence rate is lowest in Banjul and Kanifing and also among children of mothers with secondary or more education. The prevalence also is lowest among children of women in the richest wealth index category compared to those in the poorest categories (Table 23). Table 23 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add to 100. Slightly more than one in three children received breast milk while they had diarrhoea. Children under age 12 months are especially likely to have received breast milk. About 27 per cent of children received gruel and 33 per cent received ORS. Children of mothers with no education appear to be less likely than other children to receive ORS while children of mothers with secondary or more education appear to be less likely to receive breast milk and gruel. Approximately seven in ten children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or recommended home fluid (RHF). About half of the under-five children with diarrhoea drank more than usual while 36 per cent drank the same or less (Tables 24). About 54 per cent at somewhat less, the same, or more than usual while 36 per cent ate much less than usual or none. Overall, only 27 per cent of children with diarrhoea received increased fluids and continued eating as recommended. Overall, there are no significant gender differences in the prevalence of diarrhoea (Tables 23 and 24). Acute respiratory infection Acute lower respiratory infections, particularly pneumonia, are one of the leading causes of child deaths in The Gambia. Children with acute respiratory infection are defined as those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were due to a problem in the chest, or both a problem in the chest and a blocked nose, or whose mothers did not know the source of the problem. Only 8 per cent of under- five children had an acute respiratory infection in the two weeks prior to the survey according to the above criteria (Table 25). Of these, 52 per cent were taken to Health Centre for treatment, and only 8 per cent each were taken to either a Hospital, Dispensary or to a MCH Clinic. Three per cent were taken to a VHW and 2 per cent to traditional healers. Overall, almost 75 per cent of children with ARI were taken to an appropriate health provider (i.e., Hospital, Health Centre, MCH Clinic and Dispensary). Interestingly, slightly more female children, 8 per cent, compared to male, 7 per cent, had acute respiratory infection in the two weeks before the survey (Table 25). IMCI initiative The Integrated Management of Childhood Illnesses (IMCI) is a programme developed by UNICEF and WHO that combines strategies for control and treatment of five major killers of 32 children – acute lower respiratory tract infections, diarrhoea dehydration, measles, malaria, and malnutrition. The programme focuses on the improvement of case management skills by health workers, improvement of the health system, and improvement of family and community practices in the prevention and early management of childhood illnesses. Appropriate home management of illness is one component of IMCI. The approach teaches mothers that appropriate home management of diarrhoea or any other illness requires giving more fluids and continuing to feed sick children in a normal manner. Table 26 presents information on the drinking and eating behaviour of sick children. Less than half (47 per cent) of children were reported to have had diarrhoea or some other illness in the two weeks preceding the survey. Of these, 42 per cent drank more liquids during the illness and 59 per cent continued eating (i.e., ate somewhat less, the same, or more). Overall, only 24 per cent of ill children received increased fluids and continued eating as recommended under the IMCI programme. There are no gender differences in the proportion of children who reported illness in the last two weeks prior to the survey (Table 26). Promoting knowledge among caretakers about when it is appropriate to seek care for ill children is another important component of the IMCI programme. In the MICS2, mothers or caretakers of children were asked to name all of the symptoms that would cause them to take a child to a health facility right away. The most common response, given by 74 per cent of mothers, was that they would take their child to a health facility right away if he/she developed a fever (Table 27). Twenty four per cent said that the child becoming sicker would cause them to take the child to a health facility and 16 per cent mentioned difficulty in breathing. Between 11 and 21 per cent of mothers cited an inability to breastfeed, fast breathing, blood in stools, and drinking poorly as reasons for taking a child to a health facility right away. Similarly, mothers or caregivers from the richest quintiles, 47 per cent, are more likely to know at least two signs compared to mothers or caregivers from the poorest quintiles, 37 per cent (Table 27). Interestingly, mothers in Janjanbureh, 80 per cent, and to a lesser extent, in Mansakonko, 56 per cent, are more likely to know at least two signs for seeking care immediately than mothers in other regions. Overall, 50 per cent in the Kanifing, 38 per cent in Brikama, about 25 per cent in Kuntaur and 14 per cent in Basse. These regional differences are also reflected in the urban-rural and educational differentials. Urban mothers and those with education were more likely to mention at least two signs for seeking care than other mothers (Table 27). Malaria Malaria is a leading cause of death of children under-five in The Gambia. 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, can dramatically reduce malaria 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 MICS2 questionnaire incorporates questions on the use of bed-nets among children. In The Gambia, these questions were asked in all the regions since the regions are considered high-risk areas of malaria. Nationally, about 42 per cent of under-five children slept under a bed-net the night prior to the survey (Table 28). This percentage declines steadily with age. 33 Less than half of the infants under 6 months of age (44 per cent), a similar proportion of children aged 12-23 months and 38 per cent of children aged 48-59 months. Most of the bed nets are not treated with insecticide, however. In general the use of bed nets is more common in rural areas, and among the poor than the rich according to the MICS2 findings. Overall, only 35 per cent of the bed-nets are impregnated with insecticide. This has shown a slight improvement over four years in the use of impregnated bed-nets according to the MICS 1996 which shows a result of 28 per cent of children slept under dipped bed-nets. There is therefore a great need for more IEC programmes for the usage of permethrine as malaria is the highest killer disease among under-five children. There are no significant gender differences in the use of treated bed-nets among under-five children (Table 28). Questions on the prevalence and treatment of fever were asked for all children under-five. Slightly more than one in ten under-five children were ill with fever in the two weeks prior to the MICS (Table 29). The prevalence of fever reaches 16 per cent of all children aged 6-11 months then declines to around 15 per cent for children aged 12-35 months and 15 per cent among children aged 48-59 months. Fever is less common among children whose mothers have secondary or higher education than among children of less educated mothers. Similarly, fever is more common among the children from the poorest quintiles than those from the richest quintiles. Regional differences in fever prevalence are not large, ranging from 7 in Banjul and Basse to 21 per cent in the Brikama LGA (Table 29). Mothers were asked to report all of the medicines given to a child during their illness, that is, any medicine given at home and medicines given or prescribed at a health facility. Approximately 62 per cent of children were given Paracetamol and 55 per cent were given Chloroquine while 3 per cent were given Fansidar. A relatively considerable percentage of children (12 per cent) were given some other medicine. Overall, children with fever in Brikama, where malaria is probably most prevalent, are most likely to have received an appropriate anti-malarial drug. However, the results show a different pattern while those in Banjul, the least likely to be affected with malaria, receive an appropriate anti-malaria drug. Although the differentials are not wide, urban children are more likely than rural children to be treated appropriately with any anti-malarial drug. This may be explained by the relatively higher socio-economic status enjoyed by the urban population (Table 29). F. HIV/AIDS AIDS Knowledge One of the most important strategies for reducing the rate of HIV/AIDS infection is the promotion of accurate knowledge of how AIDS is transmitted and how to prevent transmission. Among women aged 15-49, about 83 per cent have ever heard of AIDS (Table 30). This percentage is very high in urban areas (87 per cent) and somewhat lower in rural areas (79 per cent). For women with secondary level education and above 89 per cent reported to have heard of AIDS compared to 82 per cent of those with primary level education and 79 per cent of those with no education. In the MICS, several statements about means of HIV/AIDS transmission were read to women and asked to state whether they believed the statements were true. Fifty-one per cent believe that having only one uninfected sex partner can prevent HIV transmission. About 50 per cent believe that using a condom every time one has sex can prevent HIV transmission. Overall, 32 per cent know all three ways and about 59 per cent were knows at least one of the means of preventing transmission (Table 30). 34 Accurate knowledge of the means of HIV/AIDS transmission is substantially lower among women in Basse than among women in other regions. Education is a very important factor in AIDS knowledge. The percentage who know all three ways of preventing transmission is nearly two times greater among women with secondary or more education compared to women with no education. Differences across age groups are not particularly large. The percentage of women who know all three ways ranges from about 24 per cent among 45-49 year olds to 38 per cent among 25-29 year olds and 37 per cent for those aged 30-34 years (Table 30). Overall, 48 per cent of women correctly stated that AIDS couldn't be transmitted by supernatural means whereas about 31 per cent stated that AIDS couldn't be transmitted by mosquito bites (Table 31). Slightly more than five in ten women correctly believe that a healthy looking person can be infected. Women in the Kuntaur, Janjanbureh and Basse LGAs are less likely to know all three misconceptions about AIDS transmission compared to women elsewhere in the country. Women in Banjul are more likely to recognise all three misconceptions. Still, only about 39 per cent of women in Banjul correctly identified all three misconceptions. As expected, the level of educational attainment is positively related to knowledge on HIV/AIDS transmission. Regarding wealth index categories, no marked differentials have been observed on knowledge of HIV/AIDS transmission (Table 31). Nationally, 56 per cent of women know that AIDS can be transmitted from mother to child (Table 32). When asked specifically about the mechanisms through which mother to child transmission can occur, 54 per cent said that transmission during pregnancy was possible, about 48 per cent said that transmission at delivery was possible, and about 43 per cent agreed that AIDS can be transmitted through breast milk. Slightly less than four in ten women know all three modes of transmission. This percentage does not vary much across background categories such as age, LGA and residence. Across levels of education, knowledge on HIV/AIDS transmission increases with an increase in educational attainment. However, there are no marked differentials between women with primary and secondary education and above. Women in the poorest wealth index categories tend to be least informed on the mode of HIV/AIDS transmission than women in the richest categories (Table 32). The MICS survey also attempted to measure discriminatory attitudes towards people living with HIV/AIDS. Respondents were asked whether they agreed with two questions. The first asked whether a teacher who has the AIDS virus should be allowed to continue teaching in school. The second question asked whether the respondent would buy food from a shopkeeper or food seller who the respondent knew to be infected with AIDS. Slightly more than one in five respondents believe that the teacher should not be allowed to work. Thirteen per cent would not buy food from a person with HIV/AIDS. However, about 76 per cent agree with neither discriminatory statement whilst 24 per cent agree with at least one discriminatory statement. Interestingly, the data suggest that urban women and those with secondary or higher education are more likely to express discriminatory attitude than rural women and those with no or primary education. Similar results can be observed among regions and across wealth index categories, for example, persons from the richest categories are more likely to express discriminatory attitude towards people with HIV/AIDS (Table 33). Table 34 summarises information from two previous tables on AIDS knowledge (Tables 30 and 31). The second column shows the percentage of women who know all three ways of preventing HIV transmission – having one faithful uninfected partner, using a condom every time, and abstaining from sex. About 34 per cent of women know all three ways. The third 35 column of the table shows the percentage of women who correctly identified all three misconceptions about HIV transmission – that HIV can be transmitted through supernatural means, that it can be transmitted through mosquito bites, and that a healthy looking person cannot be infected. Nationally, about one in five women correctly identified these misconceptions. Finally, the fourth column of the table shows the percentage of women who have ‘sufficient knowledge’ of HIV/AIDS transmission. These are women who know all three ways of preventing HIV transmission and correctly identified all three misconceptions. In The Gambia, only 12 per cent of women aged 15-49 have sufficient knowledge of HIV/AIDS transmission. Knowledge of HIV/AIDS transmission varies dramatically by level of education (Figure 5). Women with secondary or higher education are almost two times more likely to know all three ways to prevent transmission compared to women with no education. They are also three times more likely to correctly identify all three misconceptions about AIDS and four times more likely to have sufficient knowledge of HIV/AIDS transmission than women with no education. Women in the richest categories of wealth index also have more sufficient knowledge of HIV/AIDS transmission compared to those in the poorest category (Table 34). Figure 5: Percentage of women aged 15-49 who have sufficient knowledge of HIV/AIDS transmission by level of education, The Gambia, 2000 ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ���������������� ����������������0 10 20 30 40 50 60 Knows 3 ways to prevent transmission Correctly identified 3 misconceptions Has sufficient knowledge ����� None ���� Primary ���� Secondary + AIDS Testing Voluntary testing for AIDS, accompanied by counselling, allows those infected to seek health care and to prevent the infection of others. Testing is particularly important for pregnant women who can then take steps to prevent infecting their babies. In some places, a relatively large proportion of people who are tested do not return to get their results due to fear of having the disease, fear that their privacy will be violated, or other reasons. The indicators shown in Table 35 are designed to monitor whether women know a place to get tested for HIV/AIDS, and whether they have been tested and told the result of the test. Nationally, one in four women aged 15-49 years know a place to get tested for AIDS. Women living in Banjul are more likely to know a place, followed by those in Kerewan, Kanifing, Brikama, Kuntaur, Janjanbureh and Basse, respectively. Only 20 per cent of women with no education know a place to get tested compared to 28 per cent of women with primary school education and 44 per cent of women with secondary or higher education. 36 Overall about 7 per cent of women have been tested for AIDS. This percentage is highest in Kerewan at 15 per cent, lowest in Basse at 2 per cent and between 4-10 per cent in the other regions. Generally, the vast majority of women who have been tested were told the result; however, there is some variation across regions, age groups, and education levels. Among the regions, women in Basse are least likely to have been told their result. Adolescent women (15-19) are the least likely of any age group to have been tested and least likely to know the result. Finally, women with no education and with primary education are less likely to be tested than women with secondary or higher education. However, women with primary education are more likely to have been told the result of the test compared to women with secondary education and above. Women aged 15-49 years old who know where to get an AIDS test and who have been tested are higher among the richest wealth index categories and less among the poorest categories. The same pattern holds for women that have been tested and told their result (Table 35). G. Reproductive Health Contraception Current use of contraception was reported by 9 per cent of married or in union women (Table 36). The most popular methods are the pill and injections, which are used by about 4 per cent of women respectively. The next most popular method is the IUD, the usage of which accounts for 0.8 per cent of married or women in union. Other methods such as female sterilisation, condoms, periodic abstinence, diaphram/foam/jelly and withdrawal are less used. Interestingly, the use of lactational amenorrhea method (LAM) is very insignificant at zero per cent. Compared with the 1990 Gambia Contraceptive Prevalence and Fertility Determinants Survey (GCPFDS, 1990), there has been a slight decline in the use of any method of contraception from 12 to 9 per cent. Correspondingly, there has been a slight increase in the use of any modern method from 7 to approximately 9 per cent. Similarly, there have been slight increases in the use of pills and injections from 3 to 4 and 2 to 4 per cent respectively. Contraceptive prevalence is highest in Banjul at 24 per cent, followed by Kuntaur LGA and Kanifing at 10 per cent each. Nine per cent of married or women in union in Brikama and Kerewan use a method of contraception. About 8 and 7 per cent use contraception in Basse and Mansakonko LGAs respectively. In Janjanbureh area, contraceptive use is rare, only 6 per cent of married women reported using any method. Adolescents are far less likely to use contraception than older women. Only about 2 per cent of married or women in union aged 15-19 currently use a method of contraception compared to 6 per cent of 20-24 year olds and about 11 per cent of 25-49 year old women. Comparatively, the use of traditional methods is generally very low, which suggests that more and more women now use modern methods of contraception. It is believed that the information on contraceptive use may be under-reported due to the following reasons: ♦ The questionnaire was mostly administered in the presence of men (mostly household heads) and/or other male family members who may not approve of the use of contraception. Thus, most women are reluctant to say that they use contraceptives, least they would be accused of promiscuity, prostitution, and/or infidelity to their husbands; ♦ Both the Islamic scholars and the Catholic Church do not approve of the use of contraceptives. For instance, over the past several years and to date, virulent campaigns were made against the use of contraceptives on both the radio and television by venerable Islamic scholars during the weekly Friday prayer sermons; 37 ♦ The lack of political commitment and leadership from the highest level; and ♦ The scaling down of the activities of the Gambia Family Planning Association due to administrative and management problems coupled with the lack of resource flow from donors. Women’s education level is associated with higher contraceptive prevalence. The percentage of women using any method of contraception rises from 8 per cent among those with no education to about 13 per cent among women with primary education, and to 18 per cent among women with secondary or higher education. In addition to differences in prevalence rate, the method mix also varies by education. Regarding wealth index categories, the use of contraception is less among the poorest and highest among the richest at about 6 and 13 per cent respectively (Table 36). Prenatal care The quality of prenatal care can contribute to the prevention of maternal mortality by detecting and managing potential complications and risk factors, including pre-eclampsia, anaemia, and sexually transmitted diseases. Prenatal care also provides opportunities for women to learn the danger signs of pregnancy and delivery, to be immunised against tetanus, to learn about infant care, and be treated for existing conditions, such as malaria and anaemia. Tetanus toxoid injections are given to women during pregnancy to protect infants from neonatal tetanus, a major cause of infant death that is due primarily to unhygienic conditions during childbirth. Two doses of tetanus toxoid during pregnancy offer full protection. However, if a woman was vaccinated during a previous pregnancy, she may only need a booster to give full protection. Five doses are thought to provide lifetime protection. About three out of four women with recent births are protected against neonatal tetanus (Table 37). The vast majority of these women received two or more doses of tetanus toxoid within the last three years. Among the regions, women living in Kerewan are more likely to be protected (84 per cent) while those living in Janjanbureh are the least likely to be protected (63 per cent). Note, however, that the regional estimates are based on small numbers of cases and should be interpreted with caution. Women with no education are more likely to be protected against tetanus compared to those with either primary education or secondary or higher education. The respondents who had had a birth in the year prior to MICS2 were asked whether they had received antenatal care and if so, what type of person provided the care. If the woman saw more than one type of provider, all were recorded in the questionnaire. Table 38 presents the percentage distribution of women with a birth in the year prior to the MICS by the type of personnel who delivered antenatal care. If the respondent mentioned more than one provider, she is categorised as having seen the most skilled person she mentioned. Women from among the poorest wealth index category are least likely to be protected against tetanus than those from among the richest category. Virtually all women in The Gambia receive some type of antenatal care. Overall, about 91 per cent receive antenatal care from skilled personnel (doctor, nurse/midwife, and auxiliary midwife). About 3 per cent of women with a birth in the year prior to the survey received antenatal care from a doctor, 82 per cent from a nurse/midwife, and 6 per cent from an auxiliary midwife (Figure 6). Five per cent of women receive some type of care from traditional birth attendants. Note that auxiliary mid wives are more used for antenatal care in Basse, whilst in the other regions, excluding Kuntaur and Janjanbureh, under 5 per cent of 38 women received care from auxiliary mid wives. Generally, in all regions, nurse or mid wife are most likely to provide prenatal care. However, the use of traditional birth attendants for antenatal care is significant in Kerewan and Janjanbureh regions. Also delivery of antenatal care by doctors reduced from 15 per cent in 1990 to 3 per cent. This declined can be attributed to major increases and use of trained nurses/midwives over the years. Figure 6: Percentage distribution of women with a birth in the last year by type of personnel delivering antenatal care, The Gambia, 2000 Assistance at Delivery The provision of delivery assistance by trained attendants can greatly improve outcomes for mothers and children by the use of technically appropriate procedures, and accurate and speedy diagnosis and treatment of complications. Skilled assistance at delivery is defined as assistance provided by a doctor, nurse, or midwife. Skilled personnel (Table 39) delivered about 55 per cent of births occurring in the year prior to the MICS survey. This has shown an upward movement compared to the result (44 per cent) on assistance at delivery provided by any skilled personnel from the 1990 Gambia Contraceptive Prevalence and Fertility Determinant Survey (GCPFDS). However, assistance at delivery by a doctor has reduced from 8 per cent in 1990 to 4 per cent according to the MICS 2000. Assistance at delivery by any skilled personnel is highest in Banjul at 91 per cent and lowest in Kuntaur at 29 per cent. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled person. Almost one in two, (47 per cent), of the births in the year prior to the MICS were delivered with the assistance of nurse/midwife. Doctors assisted with the delivery of 4 per cent of births and auxiliary midwife delivered about 3 per cent of births. Births delivered by auxiliary midwife were more in Banjul compared to any other region of the country. Delivery assistance by a doctor is also highest in Banjul compared to any other part of the country. In Kanifing, about 78 per cent of births are delivered by nurse or mid wife. In the other regions, ����������� ����������� ����������� ����������� ����������� ����������� ����������� ����������� ����������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� �������������������������������������������������������������������������������������������������������� ������������������������������������������� ������������������������������������������� ������������������������������������������� ������������������������������������������� ������������������������������������������� ������������������������������������������� ������������������������������������������� ������������������������������������������� ����������������������������� ����������������������������� ����������������������������� ����������������������������� ����������������������������� ����������������������������� ����������������������������� ����������������������������� ����������������������������� ��������������� ��������������� ��������������� ��������������� ��������������� ��������������� ��������������� ��������������� ��������������� ������������� ������������� ������������� ������������� ������������� ������������� ������������� ������������� ������������� Doctor 3% Nurse/midwife 81% Auxiliary/midwife 6% TBA 5% Other 1% None 4% 39 between 29 and 59 per cent of births are delivered with the assistance of any skilled personnel. As expected, delivery assistance by a doctor as well as delivery by any other skilled personnel is highest from among women in the richest category of the wealth index compared to the poorest category. Overall, traditional birth attendants assist in delivering a quarter of the births in the country (Table 39). H. Child Rights Birth Registration The International Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The births of 32 per cent of children under-five years in The Gambia have been registered (Table 40). There are no significant variations in birth registration by gender. Registration is highest in children aged 6-11 months. Children in Basse and Kuntaur LGAs are more unlikely to have their births registered compared to children from other LGAs. However, this appears to be due primarily to a relatively large proportion of mothers in Basse and Kuntaur who do not know if their child’s birth should be registered. Among those whose births are not registered, cost, travel distance, and lack of knowledge do not appear to be the main reasons. The main reason for not registering is the `Others’ category, about 24 per cent, in which the majority of the respondents said it is the fathers' responsibility to register their children. With regards to education, birth registration increases the higher the mother’s level of education. Birth registration is also highest with children from the richest wealth index category and lowest from children in the poorest wealth index category at 40 and 25 per cent respectively (Table 40). Orphanhood and living arrangements of children Children who are orphaned or living away from their parents may be at increased risk of impoverishment, discrimination, denial of property rights and rights to inheritance, various forms of abuse, neglect, and exploitation of their labour or sexuality. Monitoring the level of orphanhood and the living arrangements of children assists in identifying those who may be at risk and in tracking changes over time. In The Gambia, about 73 per cent of children aged 0-14 are living with both parents (Table 41). A small percentage - 9 per cent – is living with their mother only although their father is alive. About 6 per cent are living with neither parent although both parents are alive. Nationally, children who are not living with a biological parent comprise 10 per cent and children who have one or both parents' dead constitute about 8 per cent of all children aged 0- 14. Older children are more likely to live away from their biological parents than younger children. While about 4 per cent of children under-five are not living with a biological parent, 16 per cent of children aged 10-14 do so. The situation of children in Banjul differs from that of other children in The Gambia. In the Banjul LGA, 63 per cent of children live with both parents. About 16 per cent live with their mothers only but their fathers are also alive and a relatively large proportion, 10 per cent, are living with neither parents even though both parents are alive. A similar situation also obtains in the Janjanbureh LGA. This pattern is most likely due to labour migration of men and, to some extent women migrating to Europe and America, single parenthood, non- residential polygamy and higher rates of divorce. The wealth index categories show that the proportion of children living with both biological parents is highest among those in the 40 poorest category, 80 per cent, than among the richest category, 64 per cent. This may be explained by the fact that most of the parents of children from the richest category are educated and were out of the country, at the time of the survey, either pursuing higher education or looking for greener pastures. Child Labour It is important to monitor the extent to which children work and the type of work in which they participate for several reasons. Children who are working are less likely to attend school and more likely to drop out. This pattern can trap children in a cycle of poverty and disadvantage. Working conditions for children are often unregulated with few safeguards against potential abuse. In addition, many types of work are intrinsically hazardous and others present less obvious hazards to children, such as exposure to pesticides in agricultural work, carrying heavy weights and scavenging in garbage dumps. In The Gambia, the MICS survey estimates that only 2 per cent of children aged 5-14 years engage in paid work (Table 42). Twice as many – 4 per cent – participate in unpaid work for someone other than a household member. ‘Domestic work’ is defined as cooking, shopping, cleaning, washing clothes, fetching water, and caring for children. A significant percentage of children (43 per cent) do these tasks for less than four hours a day, while about 4 per cent spends four or more hours a day on such tasks. Overall, boys and girls do the same amount of domestic work as well as older children (aged 10-14) and (aged 5-9 years). Variations across regions are highest in the percentage of children who engage in more than four hours of domestic work a day. This ranges from under one per cent in Banjul and Mansakonko regions to 9 per cent in Basse (Table 42). Children who have done any paid or unpaid work for someone who is not a member of the household or who did more than four hours of housekeeping chores in the household or who did other family work are considered to be ‘currently working’. Overall, about 27 per cent of children are classified as currently working. There is no difference, among children currently working, between boys and girls. Regionally, the percentage of children currently working is lowest in Kanifing at 8 per cent and highest in Janjanbureh at 47 per cent. Rural children are more than twice likely to work than urban children. The wealth index shows that a staggering 40 per cent of working children are from the poorest households compared to only 11 per cent from the richest households. Similarly, 34 per cent of children from the poorest households work on family farm or business compared to only 5 per cent of children from the richest households (Table 42). 41 Appendix A: Sampling Error Indicator Description of indicator Proportion Standard error Weighted cases Relative error -2SD (Lower Limit) +2SD (Upper Limit) Design effect Under-five mortality rate Probability of dying before reaching age five Infant mortality rate Probability of dying before reaching age one Underweight prevalence Proportion of under-fives who are too thin for their age .035 .005 2554 .148 .025 .046 4.818 Stunting prevalence Proportion of under-fives who are too short for their age .063 .007 2554 .116 .048 .077 5.598 Wasting prevalence Proportion of under fives who are too thin for their height .011 .003 2554 .235 .006 .016 45.988 Use of safe drinking water Proportion of population who use a safe drinking water source .840 .023 30258 .028 .793 .887 .057 Use of sanitary means of excreta disposal Proportion of population who use a sanitary means of excreta disposal .879 .016 30258 .019 .846 .912 .037 Children reaching grade five Proportion of children entering first grade of primary school who eventually reach grade five Net primary school attendance rate Proportion of children of primary school age attending primary school .516 .016 5695 .030 .484 .547 .050 Literacy rate Proportion of population aged 15+ years who are able to read a letter or newspaper .364 .016 16135 .045 .331 .397 .106 Antenatal care Proportion of women aged 15-49 attended at least once during .866 .033 1140 .038 .801 .931 .169 42 pregnancy by skilled personnel Contraceptive prevalence Proportion of married women aged 15-49 who are using a contraceptive method .090 .006 4353 .068 .078 .103 1.408 Childbirth care Proportion of births attended by skilled health personnel .546 .017 1115 .031 .512 .580 .188 Birth weight below 2.5 kg. Proportion of live births that weigh below 2500 grams .141 .022 480 .153 .098 .184 1.647 Iodised salt consumption Proportion of households consuming adequately iodised salt .836 .005 4532 .006 .826 .846 .011 Children receiving Vitamin A supplementation Proportion of children aged 6-59 months who have received a Vitamin A supplement in the last 6 months .037 .005 3235 .148 .026 .047 16.048 Mothers receiving Vitamin A supplementation Proportion of mothers who received a Vitamin A supplement before infant was 8 weeks old .140 .015 1115 .105 .111 .169 3.514 Exclusive breastfeeding rate Proportion of infants aged less than 4 months who are exclusively breastfed .361 .050 235 .140 .260 .462 1.260 Timely complementary feeding rate Proportion of infants aged 6- 9 months who are receiving breast milk and complementary food .357 .040 355 .113 .277 .438 .753 Continued breastfeeding rate Proportion of children aged 12-15 months and 20-23 months who are breastfeeding .435 .050 264 .114 .336 .535 .828 DPT immunisation coverage Proportion of children immunised against diphtheria, pertussis and 43 tetanus by age one Measles immunisation coverage Proportion of children immunised against measles by age one .792 .127 42 .160 .538 1.046 .711 Polio immunisation coverage Proportion of children immunised against polio by age one .980 .051 42 .052 .878 1.081 .121 Tuberculosis immunisation coverage Proportion of children immunised against tuberculosis by age one Children protected against neonatal tetanus Proportion of one year old children protected against neonatal tetanus through immunisation of their mother .771 .021 1115 .027 .729 .813 .143 ORT use Proportion of under-five children who had diarrhoea in the last 2 weeks who were treated with oral rehydration salts or an appropriate household solution .330 .019 785 .058 .292 .368 .623 Home management of diarrhoea Proportion of under-five children who had diarrhoea in the last 2 weeks and received increased fluids and continued feeding during the episode .271 .029 785 .106 .213 .328 1.042 44 Indicator Description of indicator Proportion Standard error Weighted cases Relative error -2SD Lower Limit +2SD Upper Limit Design effect Care seeking for acute respiratory infections Proportion of under- five children who had ARI in the last 2 weeks and were taken to an appropriate health provider .077 .007 3632 .089 .064 .091 6.477 Pre-school development Proportion of children aged 36-59 months who are attending some form of organised early childhood education program .322 .018 3632 .056 .285 .358 .396 Indicators for Monitoring Children’s Rights Birth registration Proportion of under- five children whose births are reported registered .462 .014 3632 .030 .433 .491 .128 Children’s living arrangements Proportion of children aged 0-14 years in households not living with a biological parent .102 .003 13749 .028 .096 .108 .378 Orphans in household Proportion of children aged 0-14 years who are orphans living in households .079 .005 13749 .061 .069 .088 1.952 Child labour Proportion of children aged 5-14 years who are currently working .269 .026 9406 .097 .216 .321 .970 Indicators for Monitoring IMCI and Malaria Home management of illness Proportion of under- five children reported ill during the last 2 weeks who received increased fluids and continued feeding .271 .029 785 .106 .213 .328 1.042 Care seeking knowledge Proportion of caretakers of under- five children who know at least 2 signs for seeking care immediately .394 .011 3632 .028 .372 .416 .148 Bednets Proportion of under- five children who sleep under an insecticide impregnated bednet .416 .014 3632 .034 .388 .445 .246 Malaria treatment Proportion of under five children who were ill with fever in the last 2 weeks who received anti- malarial drugs .560 .033 538 .059 .493 .636 .445 45 Indicators for Monitoring HIV/AIDS Knowledge of preventing HIV/AIDS Proportion of women who correctly state the 3 main ways of avoiding HIV infection .331 .023 1214 .071 .276 .367 .519 Knowledge of misconceptions of HIV/AIDS Proportion of women who correctly identify 3 misconceptions about HIV/AIDS .196 .010 5976 .049 .177 .215 .243 Knowledge of mother to child transmission Proportion of women who correctly identify means of transmission of HIV from mother to child .561 .008 5976 .015 .545 .578 .033 Attitude to people with HIV/AIDS Proportion of women expressing a discriminatory attitude towards people with HIV/AIDS .242 .007 5976 .031 .227 .257 .175 Women who know where to be tested for HIV Proportion of women who know where to get a HIV test .252 .013 5976 .052 .226 .278 .296 Women who have been tested for HIV Proportion of women who have been tested for HIV .072 .005 5976 .063 .063 .081 4.596 Appendix B: List of Personnel Involved in The Gambia MICS 2000 Taskforce Alieu S.M. N’Dow Director, CSD Nyakassi M.B. Sanyang Statistician, CSD Alieu Bahoum Cadet Statistician, CSD Amie Gaye Senior Statistician, CSD Mahen Sumner Principal Statistician, CSD Alieu Saho Statistician, CSD Lamin Fatty Statistician, CSD Lolley Jallow Senior Programmer, CSD Karamo Keita Head, National Rehabilitation Centre, DSW Modou Phall Head, Nutrition Unit, DoSH Amadou Wurrie Jallow Health Officer, Malaria Control Unit, DoSH Rohey Wadda Programme Officer, SPACO Mutarr Jammeh Research Officer, GFPA Nyakassi Jarju Principal Planner, DoSE Alhagie Nyangado Planner, DoSE Dr. Manfred Zahorta Head, Gambia-German Family Planning Project MomodouLamin Cham Health Officer, ESU, DoSE Faal Sanneh Development officer, DCD Sanjally Trawalley Health officer, DoSH Ernest Mendy Health officer, DoSH Isatou Sissoho WATSAN Project Officer, UNICEF Banjul Sheriffo Sonko Monitoring & Evaluation Officer, UNICEF Banjul Baba Danbappa Health Project Officer, UNICEF Banjul Jeneiri Sagnia Education Project Officer, UNICEF Banjul 46 Interviewers Data Entry Clerks Mustapha Daffeh Aminata Deen Mustapha Fofana Yata Sey Chorr Ousman Cham Sainabou Jobe Salimata Janneh Kumba Bah Alhagie Conteh Fatou Fatty Bittaye Bukary Gaye Haddijatou Manjang Fatou Jamba Fatmata Deen Abdoulie Jarra Ndey Rohey Khan Alieu Kujabi Haddy Ceesay Lamin Gibba Samba Njie Bai Cham Haddy Conteh Omar Touray Sarjo I.B. Gibba Muhammed A. Kah Kaddy Kujabi Bakary Sanneh Isatou Ann Famara Nyabally Abie Faye Pa Fofana Sainabou Mbenga Kumba Badgie Nyara Jammeh N’Dow Cherno Bahoum Ramatoulaye Bojang Alhagie Ebou Ceesay Nenneh Cole Lamin Samateh Alhagie Nasiru Deen Saiga Joof Ebou Jawo Jainaba Konteh Baboucarr Jallow Saihou S. Sanyang Fatou Secka Ndey Binta Bojang Kabba N’Dow Lamin Camara Amadou Chorr Coders Karamo Nyabally Abu Camara Alhagie Choi Isatou Sarr Aminata Deen Musa Jammeh Ida Lowe Njie Lamin Jallow Haddy Secka Fabakary Jawneh Madi Gibba Fatou Darboe Modou Njie Mamadou Krubally Field Supervisors Data Entry Supervisors Coding Supervisors Alieu Saho Lolley Jallow Nyakassi M.B. Sanyang Lamin Fatty Edrisa Ceesay Alieu Saho Faal Sanneh Sainabou Jasseh Lamin Fatty Amie Jarra Ali D. Ceesay Ernest Mendy Momodou Lamin Cham Field Co-ordinators Nyakassi M.B. Sanyang Alieu Bahoum Alieu Sarr Project Co-ordinator Adviser Nyakassi M.B. Sanyang Alieu S.M. N’Dow, Director, CSD 47 APPENDIX C: TABLES Table 1: Number of households and women, and response rates, The Gambia, 2000 Urban Rural Total Sampled households 2339 2197 4536 Occupied households 2316 2176 4492 Interviewed households 2313 2165 4478 Household response rate 99.9 99.5 99.7 Eligible women 3017 3452 6469 Interviewed women 2801 3175 5976 Women response rate 92.8 92.0 92.4 Children under 5 1419 2430 3849 Interviewed children under 5 1332 2300 3632 Child response rate 93.9 94.7 94.4 48 Table 2: Single year age distribution of household population by sex, The Gambia, 2000 Male Female Male Female Age Number Percent Number Percent Age Number Percent Number Percent 0 482 3.2 489 3.2 37 115 .8 97 .6 1 496 3.3 441 2.9 38 129 .9 154 1.0 2 436 2.9 453 3.0 39 90 .6 82 .5 3 400 2.7 428 2.8 40 272 1.8 319 2.1 4 334 2.2 383 2.5 41 54 .4 31 .2 5 570 3.8 505 3.3 42 113 .8 73 .5 6 486 3.3 539 3.5 43 89 .6 48 .3 7 579 3.9 545 3.6 44 37 .2 36 .2 8 534 3.6 550 3.6 45 212 1.4 144 .9 9 458 3.1 434 2.8 46 79 .5 53 .3 10 536 3.6 549 3.6 47 52 .3 29 .2 11 312 2.1 301 2.0 48 82 .5 39 .3 12 417 2.8 482 3.1 49 69 .5 20 .1 13 382 2.6 438 2.9 50 197 1.3 374 2.4 14 321 2.2 470 3.1 51 23 .2 96 .6 15 417 2.8 293 1.9 52 63 .4 101 .7 16 235 1.6 245 1.6 53 34 .2 80 .5 17 229 1.5 233 1.5 54 53 .4 54 .4 18 363 2.4 379 2.5 55 104 .7 107 .7 19 256 1.7 258 1.7 56 69 .5 65 .4 20 409 2.7 460 3.0 57 44 .3 31 .2 21 177 1.2 198 1.3 58 45 .3 22 .1 22 216 1.4 278 1.8 59 27 .2 20 .1 23 190 1.3 242 1.6 60 197 1.3 170 1.1 24 174 1.2 195 1.3 61 23 .2 14 .1 25 313 2.1 429 2.8 62 27 .2 24 .2 26 165 1.1 238 1.6 63 40 .3 21 .1 27 234 1.6 227 1.5 64 32 .2 13 .1 28 187 1.3 273 1.8 65 100 .7 42 .3 29 140 .9 158 1.0 66 21 .1 8 .1 30 387 2.6 465 3.0 67 26 .2 9 .1 31 75 .5 110 .7 68 32 .2 12 .1 32 158 1.1 180 1.2 69 28 .2 8 .1 33 119 .8 120 .8 70+ 386 2.6 227 1.5 34 80 .5 107 .7 Missing/DK 225 1.5 139 .9 35 324 2.2 299 2.9 36 136 .9 177 1.2 Total 14914 100.0 15333 100.0 49 Table 3: Percentage of cases with missing information, The Gambia, 2000 Reference population Percent missing Number Level of education Household members .9 14874 Year of education Household members .0 14837 Number of hours worked Working children age 5-14 .9 1736 Complete birth date Women 15-49 .3 5976 Date of last tetanus toxoid injection Women with a live birth in the last year .4 1113 Ever been tested for HIV Women 15-49 .1 5966 Complete birth date Children under 5 3.3 3632 Diarrhoea in last 2 weeks Children under 5 .0 3632 Weight Children under 5 .7 3632 Height Children under 5 .1 3632 50 Table 4: Percent distribution of households by background characteristics, The Gambia, 2000 Area Urban Rural Total Banjul 5.2 .0 2.6 Kanifing 62.9 .0 30.8 Brikama 11.7 44.9 28.7 Mansakonko 1.5 6.4 4.0 Kerewan 10.5 20.3 15.5 Kuntaur .7 4.7 2.8 Janjanbureh 1.1 7.0 4.1 Basse 6.3 16.7 11.7 Number of HH members 1 11.1 7.3 11.1 2-3 16.5 11.4 16.5 4-5 21.1 17.6 21.1 6-7 19.2 22.0 19.2 8-9 12.1 14.6 12.1 10+ 20.1 27.1 20.1 Total 100.0 100.0 100.0 At least one child age < 15 70.6 85.2 78.0 At least one child age < 5 48.2 63.1 55.8 At least one woman age 15-49 74.0 82.3 78.2 Number 2219 2313 4532 Unweighted 2339 2197 4536 51 Table 5: Percent distribution of women 15-49 by background characteristics, The Gambia, 2000 Percent Number Unweighted Banjul 2.2 132 1271 Kanifing 27.4 1637 846 Brikama 27.2 1627 635 Mansakonko 3.6 213 634 Kerewan 15.2 908 657 Kuntaur 3.1 187 673 Janjanbureh 3.8 230 635 Basse 17.5 1043 625 Urban 44.3 2648 2801 Rural 55.7 3328 3175 Age 15-19 20.3 1214 1175 20-24 20.3 1210 1180 25-29 19.3 1153 1141 30-34 14.9 890 867 35-39 11.9 713 705 40-44 7.3 439 489 45-49 4.2 250 282 Not stated 1.8 107 137 Currently married 72.8 4353 4256 Formerly married 6.3 379 432 Never married 20.6 1232 1282 Not stated .2 12 6 Ever given birth Yes 72.5 4330 4263 No 27.5 1646 1713 Education level None 70.7 4223 4177 Primary 9.4 564 540 Secondary + 19.9 1189 1259 Total 100.0 5976 5976 52 Table 6: Percent distribution of children under 5 by background characteristics, The Gambia, 2000 Percent Number Unweighted Male 49.9 1811 1859 Female 50.1 1821 1773 Banjul 1.3 47 479 Kanifing 23.7 862 484 Brikama 28.5 1032 451 Mansa Konko 3.0 108 362 Kerewan 16.2 590 455 Kuntaur 3.7 135 574 Janjabureh 3.4 123 365 Basse 20.1 731 462 Urban 37.6 1365 1322 Rural 62.4 2267 2300 Age < 6 months 10.6 386 407 6-11 months 12.0 437 429 12-23 months 23.0 835 827 24-35 months 20.1 731 767 36-47 months 18.4 667 651 48-59 months 15.3 556 525 Not stated .6 21 26 Mother’s education None 80.8 2936 2956 Primary 7.9 286 254 Secondary + 11.3 410 422 Total 100.0 3632 100.0 53 Table 7: Mean number of children ever born (CEB) and proportion dead by mother's age, The Gambia, 2000 Mean number of CEB Proportion dead Number of women Age 15-19 .323 .136 1214 20-24 1.427 .121 1210 25-29 3.007 .154 1153 30-34 4.393 .155 890 35-39 5.232 .170 713 40-44 5.911 .198 439 45-49 6.692 .243 250 Not stated 3.436 .183 107 Total 2.989 .169 5976 54 Table 8b: Mean number of children ever born (CEB) and proportion dead by mother's age and poverty ndex, The Gambia, 2000 Mean number of CEB Proportion dead Number of women Wealth Index Quintile Poorest 15-19 .637 .110 196 Age 20-24 1.930 .128 167 25-29 3.703 .167 184 30-34 4.992 .221 171 35-39 5.737 .216 131 40-44 5.893 .242 95 45-49 7.404 .318 48 Not stated 3.854 .376 16 Second 15-19 .403 .072 216 Age 20-24 1.669 .142 183 25-29 3.220 .155 213 30-34 4.851 .170 176 35-39 5.784 .184 144 40-44 6.672 .169 95 45-49 6.854 .222 59 Not stated 3.669 .226 21 Middle 15-19 .415 .264 232 Age 20-24 1.607 .104 244 25-29 3.164 .146 217 30-34 4.434 .166 164 35-39 5.463 .179 142 40-44 5.733 .213 117 45-49 7.092 .291 42 Not stated 3.931 .134 35 Fourth 15-19 .120 .103 276 Age 20-24 1.293 .130 273 25-29 3.052 .163 247 30-34 4.799 .134 174 35-39 5.215 .131 145 40-44 5.775 .227 75 45-49 6.297 .182 54 Not stated 2.995 .133 18 Richest 15-19 .145 .096 285 Age 20-24 .983 .107 328 25-29 2.218 .129 284 30-34 3.064 .064 202 35-39 4.026 .129 145 40-44 5.083 .097 54 45-49 5.422 .161 44 Not stated 2.069 .031 16 Wealth 15-19 1.063 .037 9 Index 20-24 2.099 .076 15 Quintile 25-29 3.641 .247 9 Not 30-34 7.588 .000 3 stated 35-39 5.080 .158 7 40-44 7.287 .170 4 45-49 9.848 .386 5 Not stated 5.348 .000 0 Total 2.989 .169 5976 55 Table 9: Percentage of children aged 36-59 months who are attending some form of organized early childhood education programme, The Gambia, 2000 Attending programme Number of children Male 16.1 583 Female 16.5 640 Banjul 28.6 14 Kanifing 25.7 297 Brikama 18.6 358 Mansakonko 17.6 36 Kerewan 7.7 185 Kuntaur 5.0 42 Janjabureh 2.9 35 Basse 11.2 255 Urban 20.3 460 Rural 13.9 763 36-47 months 11.1 667 48-59 months 22.5 556 Mother’s education None 12.7 1004 Primary 19.4 88 Secondary + 42.1 131 Wealth Index Quintiles Poorest Second Middle Fourth Richest Not Stated 11.2 11.5 9.4 19.0 29.2 42.3 240 208 247 297 220 11 Total 16.3 1223 56 Table 10: Percentage of children of primary school age attending primary school, The Gambia, 2000 Male Female Total Attending Number Attending Number Attending Number Banjul 73.0 37 67.5 37 70.3 74 Kanifing 70.3 544 67.8 636 69.0 1180 Brikama 69.2 878 64.0 779 66.8 1657 Mansakonko 59.9 103 53.0 113 56.3 216 Kerewan 39.0 500 36.4 459 37.8 959 Kuntaur 36.3 97 33.2 107 34.7 204 Janjabureh 29.6 123 29.8 142 29.7 264 Basse 32.2 553 26.0 588 29.0 1141 Urban 65.4 918 62.4 1037 63.8 1955 Rural 48.1 1916 42.0 1824 45.1 3740 Age 7 33.1 579 28.9 545 31.0 1124 8 55.7 534 46.3 550 50.9 1083 9 58.2 458 49.7 434 54.1 892 10 60.2 536 56.3 549 58.2 1085 11 66.7 312 60.4 301 63.6 612 12 57.0 417 61.2 482 59.3 899 Wealth Index Quintiles Poorest Second Middle Fourth Richest Not stated 36.4 55.6 52.2 56.9 74.4 60.0 628 690 555 502 414 45 30.2 51.2 42.1 58.6 70.3 47.0 624 558 594 541 499 45 33.3 53.6 47.0 57.8 72.2 53.5 1253 1248 1149 1043 913 90 Total 53.7 2834 49.4 2861 51.6 5695 57 Table 11: Percentage of children entering first grade of primary school who eventually reach grade 5, The Gambia, 2000 Percent in grade 1 eventually reaching grade 2 Percent in grade 2 eventually reaching grade 3 Percent in grade 3 eventually reaching grade 4 Percent in grade 4 eventually reaching grade 5 Percent who reach grade 5 of those who enter grade 1 Male 98.9 99.9 98.1 99.5 96.4 Female 99.1 98.1 99.9 99.9 97.0 Banjul 99.2 99.0 100.0 100.0 98.2 Kanifing 100.0 98.5 98.0 100.0 96.5 Brikama 99.3 98.8 100.0 100.0 98.1 MansaKonko 99.2 98.5 100.0 98.6 96.3 Kerewan 100.0 100.0 100.0 100.0 100.0 Kuntaur 97.0 98.5 98.5 100.0 94.0 Janjanbureh 100.0 98.0 100.0 100.0 98.0 Basse 94.7 100.0 97.0 95.8 88.0 Urban 99.4 99.0 98.5 100.0 96.9 Rural 98.7 99.0 99.3 99.4 96.5 Wealth index Quintiles Poorest 98.4 99.3 96.7 100.0 94.5 Second 99.8 98.5 100.0 98.6 96.9 Middle 97.9 97.2 99.7 99.7 94.6 Fourth 98.4 99.9 98.5 100.0 96.8 Richest 99.9 100.0 98.7 100.0 98.6 Not stated 100.0 100.0 100.0 100.0 100.0 Total 99.0 99.0 98.9 99.7 96.6 58 Table 12: Percentage of the population aged 15 years and older that is literate, The Gambia, 2000 Male Female Total Literate Not known Number Literate Not known Number Literate Not known Number Banjul 72.4 .1 177 55.7 .1 188 63.8 .1 365 Kanifing 67.3 .4 2198 45.7 .3 2097 56.7 .3 4295 Brikama 47.3 .3 2327 24.4 .1 2184 36.2 .2 4511 Mansakonko 31.9 .0 279 12.2 .2 324 21.3 .1 602 Kerewan 34.6 .5 1152 16.8 .2 1304 25.1 .4 2456 Kuntaur 43.6 .7 240 12.1 1.1 266 27.0 .9 505 Janjabureh 29.1 .3 375 12.0 .4 346 20.9 .3 720 Basse 36.2 .7 1201 7.4 .2 1479 20.3 .5 2680 Urban 64.1 .3 3410 40.4 .2 3449 52.2 .3 6859 Rural 36.5 .5 4538 13.5 .3 4738 24.8 .4 9276 Age 15-24 63.0 .7 2664 41.0 .1 2781 51.8 .4 5445 25-34 54.8 .3 1859 24.9 .2 2308 38.2 .3 4167 35-44 43.6 .1 1360 14.1 .1 1314 29.1 .1 2674 45-54 30.5 .5 863 8.4 .5 990 18.7 .5 1853 55-64 28.1 .2 609 6.6 1.3 487 18.5 .7 1096 65+ 20.5 .3 593 5.9 .0 307 15.5 .2 900 Wealth Index Quintiles Poorest Second Middle Fourth Richest Not stated 24.7 39.5 44.4 56.6 73.1 34.0 .3 .7 .3 .5 .4 .0 1541 1428 1523 1567 1780 110 8.5 13.1 16.7 29.0 53.2 26.8 .6 .2 .0 .2 .2 .0 1514 1607 1580 1629 1749 108 16.7 25.5 30.3 42.5 63.2 30.4 .4 .4 .1 .4 .3 .0 3055 3035 3103 3196 3529 218 Total 48.4 .4 7948 24.9 .2 8187 36.4 .3 16135 59 Table 13: Percentage of the population using improved drinking water sources, The Gambia, 2000 Main source of water Piped into dwelling Piped into yard or plot Public tap Tube- well/ Bore- hole with pump Pro- tected dug well Bottle water Unpro- tected dug well Pond River or stream Tanker truck vendor Other Don't know Total Total with safe drinking water No. of per- sons Banjul 31.6 13.8 54.6 .0 .0 .0 .0 .0 .0 .0 .0 100.0 100.0 559 Kanifing 25.0 28.6 40.0 .5 1.2 .0 2.8 .0 .0 1.7 .0 100.0 95.5 7452 Brikama .9 5.3 37.2 25.4 8.3 .0 22.6 .0 .0 .4 .0 100.0 77.0 8624 MansaKonko .9 3.5 47.6 23.0 17.0 .0 8.0 .0 .0 .0 .0 100.0 92.4 1100 Kerewan .2 4.4 41.2 32.4 12.0 .2 9.3 .0 .0 .3 .0 100.0 90.4 4742 Kuntaur .3 .3 12.9 55.5 16.7 .0 14.0 .0 .0 .0 .3 100.0 86.1 1003 Janjabureh 2.2 .7 12.6 23.7 31.4 .4 29.1 .0 .0 .0 .0 100.0 70.9 1329 Basse .4 .4 50.3 14.3 8.0 .0 25.4 .0 .0 .6 .0 100.0 73.3 5448 Urban 17.8 21.5 51.3 .6 3.3 .0 4.0 .0 .0 1.5 .0 100.0 94.6 11904 Rural .4 2.1 32.2 30.5 11.9 .0 22.5 .0 .0 .2 .0 100.0 77.1 18354 Wealth Index Quintiles Poorest .0 .0 22.3 34.9 14.9 .2 27.6 .0 .0 .0 100.0 72.3 5948 Second .0 .0 37.0 30.1 9.5 .0 22.2 .0 .5 .0 100.0 76.8 5971 Middle .0 1.2 51.2 20.9 9.7 .0 16.0 .0 1.1 .0 100.0 82.9 5951 Fourth 3.0 9.9 65.5 5.1 6.0 .0 9.4 .0 1.0 .0 100.0 89.6 5977 Richest 33.7 37.8 24.2 .2 1.8 .0 1.6 .0 .8 .0 100.0 97.6 5974 Not stated 1.0 4.7 16.2 53.1 19.1 .0 5.8 .0 .0 .0 100.0 94.2 439 Total 7.3 9.7 39.7 18.7 8.5 .0 15.2 .0 .0 .7 .0 100.0 84.0 30258 60 Table 14: Percentage of the population using sanitary means of excreta disposal, The Gambia, 2000 Type of toilet facility Flush to sewage system/ septic tank Pour flush latrine Improved pit latrine Traditional pit latrine River Open pit Other No facilities/ bush/field Missing Total Total with sanitary means of excreta disposal No. of persons Banjul 61.1 28.7 4.9 2.5 .0 .0 1.5 1.4 .0 100.0 97.2 559 Kanifing 24.6 13.4 23.6 35.8 .0 1.3 .9 .5 .0 100.0 97.3 7452 Brikama 1.1 2.2 4.5 83.9 .0 1.1 1.0 6.2 .0 100.0 91.7 8624 MansaKonko 1.0 .5 4.2 85.7 .0 .3 .2 8.1 .0 100.0 91.1 1100 Kerewan .6 1.1 14.5 65.9 .0 .9 .0 16.8 .0 100.0 82.3 4742 Kuntaur .2 3.3 .9 47.3 .0 4.7 .1 43.5 .0 100.0 51.8 1003 Janjanbureh 2.0 1.3 8.5 72.1 .0 1.5 .0 14.6 .0 100.0 83.9 1329 Basse .7 3.0 4.0 72.2 .0 14.7 .0 5.3 .0 100.0 79.9 5448 Urban 19.1 10.6 17.9 47.9 .0 1.9 .9 1.7 .0 100.0 95.5 11904 Rural .6 2.0 6.1 74.3 .0 4.8 .3 11.9 .0 100.0 83.0 18354 Wealth Index Quintiles Poorest .0 .3 .6 70.5 .0 5.3 .1 23.1 .0 100.0 71.5 5948 Second .1 .1 .5 86.2 .0 3.3 1.8 8.0 .0 100.0 86.9 5971 Middle .0 2.2 9.0 75.4 .0 7.5 .4 5.4 .0 100.0 86.6 5951 Fourth 2.3 6.8 21.2 65.7 .0 1.9 .3 1.7 .0 100.0 96.1 5977 Richest 37.4 17.7 22.1 21.4 .0 .6 .0 .8 .0 100.0 98.5 5974 Not stated 2.3 .7 13.4 70.1 .0 .0 .0 13.4 .0 100.0 86.6 439 Total 7.9 5.4 10.7 63.9 .0 3.7 .5 7.9 .0 100.0 87.9 30258 61 Table 15: Percentage of under-five children who are severely or moderately undernourished, The Gambia, 2000 Weight for age Height for age Weight for height Percent below – 2 SD Percent below –3 SD Percent below – 2 SD Percent below –3 SD Percent below –2 SD Percent below –3 SD Number of children Male 16.6 4.2 20.6 7.1 9.5 1.4 1300 Female 17.6 2.8 17.6 5.3 6.8 .8 1254 Banjul 6.2 1.0 13.7 3.3 3.3 .0 30 Kanifing 9.0 1.7 13.0 4.7 6.0 1.7 534 Brikama 11.3 1.9 14.9 3.9 5.2 .3 717 Mansa Konko 19.1 3.2 20.9 7.9 6.9 .4 83 Kerewan 21.0 5.4 25.6 8.7 9.0 2.5 482 Kuntaur 26.8 6.3 23.3 7.8 12.7 1.7 83 Janjanbureh 29.2 9.1 29.9 14.8 16.3 3.8 90 Basse 26.4 4.5 22.7 6.7 12.1 .0 535 Urban 9.4 1.7 13.2 4.1 5.9 1.4 880 Rural 21.2 4.5 22.3 7.3 9.4 1.0 1674 < 6 months 2.5 .7 4.0 1.5 5.5 1.1 231 6-11 months 15.4 3.6 8.1 1.5 13.2 2.4 321 12-23 months 23.2 3.6 23.5 6.8 11.7 1.6 659 24-35 months 18.6 5.3 21.8 7.4 6.7 .9 506 36-47 months 18.7 4.5 24.8 10.7 6.4 .6 461 48-59 months 13.0 1.4 19.9 4.9 3.6 .0 370 Not stated 4.4 .0 4.4 .0 .0 .0 5 Mother’s education None 18.4 3.6 20.1 6.5 8.7 1.3 2071 Primary 15.2 3.6 18.6 7.1 3.1 .0 203 Secondary + 9.0 2.8 12.5 3.0 7.9 .8 280 Wealth Index Quintiles Poorest Second Middle Fourth Richest Not stated 19.7 22.0 19.6 14.1 9.1 2.6 3.7 5.1 4.5 2.1 2.2 .0 23.8 20.4 23.5 14.7 12.6 4.5 7.6 7.5 8.0 3.7 3.8 .9 7.0 11.3 9.0 7.4 6.2 .8 1.1 2.1 .6 .5 1.5 .8 523 507 557 546 384 36 Total 17.1 3.5 19.1 6.2 8.2 1.1 2554 62 Table 16: Percent of living children by breastfeeding status, The Gambia, 2000 Percent of children 0-3 months exclusively breastfed Number of children Percent of children 6-9 months receiving breastmilk and solid/semi- solid food Number of children Percent of children 12 –15 months breastfed Number of children Percent of children 20-23 months breastfed Number of children Male 34.7 111 39.4 182 97.1 140 49.8 135 Female 35.9 127 33.4 174 96.7 124 57.7 123 Banjul Kanifing Brikama Mansakonko 32.4 42.5 31.8 24.2 3 71 51 10 63.6 67.5 19.6 37.0 4 71 106 8 90.9 97.2 100.0 100.0 3 64 76 9 37.8 32.0 52.2 60.0 4 45 53 4 Kerewan Kuntaur Janjanbureh Basse 25.0 37.5 52.2 43.5 47 9 8 36 23.8 32.6 36.1 35.7 54 10 12 89 95.0 100.0 79.3 95.8 52 8 10 38 56.8 67.3 57.1 65.1 57 12 7 68 Urban 36.8 109 50.7 119 96.2 97 45.0 89 Rural 35.5 126 28.2 236 97.2 163 58.9 160 None Primary Secondary + Wealth Index Quintiles Poorest Second Middle Fourth Richest Not stated 31.3 33.3 59.1 28.8 26.6 35.2 37.0 45.1 86.9 190 5 40 34 46 48 52 50 5 32.9 45.9 48.2 17.3 23.0 34.3 54.4 53.2 24.9 285 30 40 70 73 78 76 55 3 97.3 97.3 93.6 95.2 94.7 96.6 100.0 98.3 100.0 211 16 33 53 70 38 59 38 2 58.3 21.9 41.3 65.1 49.6 60.5 41.3 45.3 92.5 206 18 26 53 55 59 39 40 3 Total 36.1 235 35.7 355 96.8 260 53.9 249 63 Table 17: Percentage of households consuming adequately iodized salt, The Gambia, 2000 Percent of households with salt testing Percent of households with no salt Percent of households in which salt was tested < 15 PPM 15+ PPM Number of households interviewed Banjul 16.3 82.8 96.7 3.3 116 Kanifing 22.6 75.4 95.4 4.6 1397 Brikama 14.8 84.6 96.2 3.8 1298 Mansakonko 7.0 92.5 95.6 4.4 180 Kerewan 6.1 91.9 97.7 2.3 702 Kuntaur 6.8 90.0 83.8 16.2 125 Janjanbureh 6.1 93.2 67.3 32.7 185 Basse 11.3 84.3 78.7 21.3 528 Urban 20.3 78.0 95.3 4.7 2219 Rural 9.2 89.0 90.1 9.9 2313 Wealth Index Quintiles Poorest 5.9 89.0 86.3 13.7 754 Second 5.9 92.6 93.1 6.9 748 Middle 15.8 92.7 94.3 5.7 823 Fourth 17.8 82.3 93.4 6.6 973 Richest 22.5 80.1 94.6 5.4 1180 Not stated 7.5 75.6 93.4 6.6 54 Total 14.6 83.6 92.5 7.5 4532 Note: Adequately iodized salt is salt testing 15 PPM (parts per million) or more. 64 Table 18: Percent distribution of children aged 6-59 months by whether they have received a high dose Vitamin A supplement in the last 6 months, The Gambia, 2000 Percent of children who received Vitamin A: Within last 6 months Prior to last 6 months Not sure when Not sure if received Never received Total Number of children Male 3.9 2.1 1.6 3.1 89.4 100.0 1622 Female 3.5 2.0 2.7 3.3 88.5 100.0 1613 Banjul 4.0 1.2 1.2 4.0 89.5 100.0 41 Kanifing 1.4 1.2 .2 4.8 92.4 100.0 746 Brikama 1.2 .7 .5 2.5 95.1 100.0 935 Mansa konko 3.9 2.0 2.0 3.6 88.5 100.0 91 Kerewan 11.1 5.9 8.4 4.2 70.4 100.0 525 Kuntaur 2.6 .6 4.7 2.8 89.4 100.0 120 Janjanbureh 14.6 5.9 5.6 1.2 72.8 100.0 109 Basse 2.4 1.4 .7 1.9 93.6 100.0 667 Urban 2.2 1.1 1.2 4.1 91.5 100.0 1196 Rural 4.6 2.6 2.7 2.6 87.4 100.0 2039 6-11 months 4.8 1.4 1.1 1.1 91.6 100.0 437 12-23 months 4.6 1.3 2.4 2.7 89.1 100.0 835 24-35 months 3.9 3.0 1.4 3.3 88.5 100.0 731 36-47 months 3.7 2.5 2.9 4.4 86.5 100.0 667 48-59 months 1.6 1.9 2.7 3.7 90.2 100.0 556 Not stated 1.1 .0 .0 17.2 81.7 100.0 9 Mother’s education None 4.2 1.8 2.2 3.5 88.3 100.0 2623 Primary 3.3 3.7 2.7 1.6 88.6 100.0 259 Secondary + .4 2.7 1.1 1.9 93.9 100.0 353 Wealth Index Quintiles Poorest 6.8 4.1 3.8 3.8 81.5 100.0 623 Second 3.4 1.3 1.4 3.3 90.6 100.0 645 Middle 4.5 1.6 3.3 2.8 87.8 100.0 664 Fourth 2.1 2.1 1.4 2.7 91.6 100.0 682 Richest 1.7 1.2 .6 3.6 92.9 100.0 585 Not stated 3.6 .0 3.6 .0 92.7 100.0 36 Total 3.7 2.0 2.1 3.2 88.9 100.0 3235 65 Table 19: Percentage of women with a birth in the last 12 months by whether they received a high dose Vitamin A supplement before the infant was 8 weeks old, The Gambia, 2000 Received Vitamin A suppleme nt Not sure if received Number of women Banjul 18.3 .8 13 Kanifing 12.7 .0 244 Brikama 10.0 .8 333 Mansakonko 15.0 1.9 36 Kerewan 40.5 .9 160 Kuntaur 11.2 1.2 44 Janjanbureh 16.2 2.0 36 Basse 3.4 1.3 249 Urban 13.4 .0 390 Rural 14.3 1.3 725 Mother’s education None 14.6 1.0 892 Primary 11.4 .0 96 Secondary + 11.8 .5 127 Wealth Index Quintiles Poorest 17.3 .8 213 Second 14.2 1.4 224 Middle 14.7 1.9 236 Fourth 10.9 .0 234 Richest 12.6 .1 190 Not stated 17.5 .0 18 Total 14.0 .8 1115 66 Table 20: Percentage of live births in the last 12 months that weighed below 2500 grams at birth, The Gambia, 2000 Percent of live births Below 2500 grams Weighed at birth Number of live births Banjul 5.0 63.5 13 Kanifing 8.3 66.7 244 Brikama 14.5 42.3 333 Mansakonko 7.5 37.4 36 Kerewan 8.9 48.3 160 Kuntaur 23.1 24.4 44 Janjanbureh 15.2 33.3 36 Basse 20.0 16.8 249 Urban 11.5 60.3 390 Rural 12.0 32.0 725 Mother’s education None 12.6 39.0 892 Primary 8.0 37.9 96 Secondary + 10.2 65.4 127 Wealth Index Quintiles Poorest 15.7 21.1 213 Second 10.4 41.7 224 Middle 11.2 35.5 236 Fourth 11.0 47.9 234 Richest 11.3 65.3 190 Not stated 28.3 49.4 18 Total 7.8 43.0 1115 67 Table 21: Percentage of children age 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, The Gambia, 2000 Percentage of children who received: BCG DPT1 DPT2 DPT3 Polio 1 Polio2 Polio3 Measles All None No. of children Vaccinated at any time before the survey According to: Vaccination card 87.4 87.4 81.8 70.8 88.5 86.9 77.9 83.0 60.8 .4 804 Mother’s report 5.5 4.4 3.6 1.4 5.5 4.3 2.8 5.0 1.1 3.3 31 Either 92.9 91.8 85.4 72.2 94.0 91.2 80.7 88.0 61.9 3.7 835 Vaccinated by 12 months of age 98.8 97.2 95.5 90.3 97.2 94.0 88.3 87.9 61.6 0 835 68 Table 22: Percentage of children age 12-23 months currently vaccinated against childhood diseases, The Gambia, 2000 BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles All None % with health card Number of children Male 94.7 92.1 85.7 73.7 93.2 91.4 81.2 88.6 65.1 2.8 92.6 439 Female 90.9 91.3 85.0 70.4 94.8 90.9 80.2 87.4 58.4 4.8 88.8 396 Banjul 90.5 89.5 85.7 77.1 92.4 88.6 75.2 82.9 65.7 5.7 76.2 10 Kanifing 93.3 94.3 78.1 63.8 94.3 92.4 80.0 88.6 57.1 2.9 93.3 187 Brikama 91.1 88.1 83.2 63.4 92.1 87.1 77.2 89.1 52.5 5.9 86.1 232 Mansakonko 83.8 83.8 83.8 76.5 85.3 82.4 76.5 80.9 64.7 10.3 89.7 20 Kerewan 92.5 90.3 88.8 76.1 94.0 89.6 82.8 87.3 64.9 3.0 88.8 174 Kuntaur 86.6 91.0 84.3 72.4 91.0 87.3 79.1 89.6 66.4 8.2 88.1 32 Janjanbureh 94.0 92.9 86.9 82.1 90.5 90.5 88.1 92.9 79.8 6.0 89.3 28 Basse 97.9 96.9 93.8 88.5 99.0 100.0 84.4 86.5 74.0 .0 99.0 152 Urban 91.7 93.1 82.5 70.0 93.8 91.1 78.1 86.0 57.4 3.7 90.6 314 Rural 93.6 90.9 87.1 73.4 94.1 91.2 82.3 89.2 64.7 3.8 90.9 521 Mother’s education None 92.4 92.1 86.5 73.0 94.3 90.8 80.8 87.9 61.7 3.5 91.6 665 Primary 92.8 89.4 78.8 66.6 93.2 93.1 76.3 90.0 59.8 6.6 86.2 68 Secondary + 96.3 90.1 82.0 70.4 92.6 92.5 83.1 87.3 65.0 3.7 88.6 102 Wealth Index Quintiles Poorest 94.1 90.1 82.2 71.0 94.5 89.2 74.9 89.9 60.2 2.5 91.3 157 Second 91.8 91.2 88.1 72.4 89.8 87.3 83.1 86.1 64.1 5.9 90.4 191 Middle 90.4 90.0 88.6 75.9 96.2 92.6 79.2 87.2 60.4 3.6 88.2 163 Fourth 96.8 94.1 85.1 74.9 96.6 94.2 80.6 89.2 65.7 2.1 94.5 161 Richest 91.1 92.8 81.2 64.7 93.0 92.8 84.3 87.2 56.2 4.5 89.0 154 Not Stated 99.0 100.0 99.0 99.0 100.0 100.0 99.0 100.0 99.0 .0 100.0 10 Total 92.9 91.7 85.3 72.2 94.0 91.2 80.7 88.0 61.9 3.7 90.8 835 69 Table 23: Percentage of under-five children with diarrhea in the last two weeks and treatment with ORS or ORT, The Gambia, 2000 Children with diarrhea who received: Had diarrhe a in last two weeks Number of children under 5 Breast milk Gruel Local acceptable ORS packet Other milk or infant formula Water with feeding Any recom- mended treatment No treatment Number of children with diarrhea Male 21.8 1811 38.2 27.2 17.0 35.5 13.9 33.4 77.2 22.8 395 Female 21.4 1821 34.2 26.1 19.2 30.5 12.5 28.9 71.1 28.9 389 Banjul 13.6 47 36.9 26.2 9.2 33.8 4.6 30.8 69.2 30.8 6 Kanifing 16.5 862 35.0 25.0 18.8 37.5 13.8 42.5 75.0 25.0 142 Brikama 21.1 1036 31.6 25.3 18.9 30.5 12.6 20.0 71.6 28.4 218 Mansakonko 24.0 108 37.9 21.8 13.8 35.6 11.5 16.1 70.1 29.9 26 Kerewan 24.0 590 40.4 22.0 20.2 41.3 10.1 21.1 69.7 30.3 141 Kuntaur 31.5 135 35.4 17.1 14.9 21.0 13.8 31.5 68.5 31.5 43 Janjanbureh 18.4 123 43.3 13.4 7.5 43.3 13.4 10.4 74.6 25.4 23 Basse 25.3 731 38.5 37.6 17.9 27.4 16.2 47.9 82.1 17.9 185 Urban 18.8 1365 33.7 23.5 16.1 36.3 13.3 32.0 72.6 27.4 256 Rural 23.3 2267 37.4 28.2 19.1 31.4 13.2 30.8 75.0 25.0 528 < 6 months 12.3 386 79.1 27.5 7.2 15.4 11.0 21.9 86.7 13.3 47 6-11 months 29.2 437 66.7 23.6 7.2 35.7 5.1 15.2 77.2 22.8 128 12-23 months 31.6 835 56.3 29.9 20.6 36.9 13.5 30.8 77.6 22.4 264 24-35 months 22.8 731 5.7 22.7 20.5 35.4 19.2 42.3 75.8 24.2 166 36-47 months 18.3 667 2.7 29.8 26.9 34.3 14.8 39.6 66.7 33.3 122 48-59 months 10.3 556 .0 22.8 14.5 13.8 11.0 25.9 52.6 47.4 57 Not stated 2.7 21 .0 .0 .0 58.6 .0 41.4 58.6 41.4 1 Mother’s education None 22.7 2936 36.0 26.3 16.8 31.3 12.1 31.5 74.0 26.0 666 Primary 16.3 286 41.6 33.4 22.5 47.1 14.3 22.5 77.9 22.1 47 Secondary + 17.5 410 34.5 25.1 27.0 39.9 23.3 33.9 73.6 26.4 72 Wealth Index Quintiles Poorest 23.4 687 35.0 29.3 17.4 29.6 14.2 33.3 74.9 25.1 161 Second 22.2 724 36.1 23.2 20.6 37.2 11.8 24.9 74.8 25.2 161 Middle 25.0 740 38.6 26.8 14.4 32.3 15.0 24.6 70.3 29.7 185 Fourth 20.9 769 36.8 27.6 22.5 33.7 16.5 33.4 80.8 19.2 161 Richest 15.9 669 33.4 26.4 16.7 34.2 6.7 45.6 72.1 27.9 107 Not stated 24.0 43 32.2 25.3 2.3 10.4 4.6 30.9 43.6 56.4 10 Total 21.6 3632 36.2 26.7 18.1 33.0 13.2 31.2 74.2 25.8 785 70 Table 24: Percentage of under-five children with diarrhea in the last two weeks who took increased fluids and continued to feed during the episode, The Gambia, 2000 Children with diarrhea who drank: Children with diarrhea who ate:Had diarrhea in last two weeks Number of children under 5 More Same/Le ss Missing/DK Total Somewhat less/same/ more Much less/none Missing/DK Total Received increased fluids and continued eating Number of children with diarrhea Male 21.8 1811 43.8 37.9 18.3 100.0 57.3 32.7 10.0 100.0 27.8 395 Female 21.4 1821 45.9 34.0 20.0 100.0 50.2 39.2 10.6 100.0 26.4 389 Banjul 13.6 47 20.0 58.5 21.5 100.0 58.5 29.2 12.3 100.0 12.3 6 Kanifing 16.5 862 35.0 46.3 18.8 100.0 56.3 32.5 11.3 100.0 20.0 142 Brikama 21.1 1036 44.2 33.7 22.1 100.0 65.3 20.0 14.7 100.0 34.7 218 Mansakonko 24.0 108 32.2 35.6 32.2 100.0 42.5 42.5 14.9 100.0 17.2 26 Kerewan 24.0 590 33.0 42.2 24.8 100.0 47.7 44.0 8.3 100.0 15.6 141 Kuntaur 31.5 135 38.7 44.2 17.1 100.0 37.0 53.6 9.4 100.0 13.3 43 Janjanbureh 18.4 123 35.8 38.8 25.4 100.0 35.8 52.2 11.9 100.0 17.9 23 Basse 25.3 731 67.5 23.1 9.4 100.0 50.4 44.4 5.1 100.0 38.5 185 Urban 18.8 1365 38.6 39.4 22.0 100.0 54.3 32.9 12.8 100.0 22.6 256 Rural 23.3 2267 47.9 34.3 17.8 100.0 53.5 37.4 9.1 100.0 29.2 528 < 6 months 12.3 386 10.9 73.3 15.8 100.0 64.7 26.1 9.2 100.0 5.3 47 6-11 months 29.2 437 38.9 42.5 18.5 100.0 45.7 38.2 16.1 100.0 19.2 128 12-23 months 31.6 835 44.7 32.9 22.4 100.0 52.2 37.0 10.8 100.0 27.9 264 24-35 months 22.8 731 48.8 35.7 15.5 100.0 56.4 37.8 5.8 100.0 29.6 166 36-47 months 18.3 667 57.1 22.5 20.4 100.0 55.5 35.5 9.0 100.0 36.2 122 48-59 months 10.3 556 49.9 34.1 16.0 100.0 59.0 29.5 11.6 100.0 31.8 57 Not stated 2.7 21 41.4 58.6 .0 100.0 58.6 41.4 .0 100.0 41.4 1 Mother’s education None 22.7 2936 45.3 35.8 18.8 100.0 53.4 36.8 9.8 100.0 27.9 666 Primary 16.3 286 50.0 34.1 15.9 100.0 56.7 31.8 11.5 100.0 24.7 47 Secondary + 17.5 410 37.3 38.6 24.1 100.0 55.1 30.9 14.0 100.0 20.8 72 Wealth Index Quintiles Poorest 23.4 687 42.7 40.2 17.1 100.0 52.0 40.2 7.7 100.0 24.4 161 Second 22.2 724 43.8 33.2 23.0 100.0 54.8 31.2 14.0 100.0 30.7 161 Middle 25.0 740 48.3 29.6 22.1 100.0 45.7 42.7 11.6 100.0 26.0 185 Fourth 20.9 769 47.8 39.9 12.4 100.0 57.9 34.9 7.2 100.0 26.6 161 Richest 15.9 669 40.4 39.6 20.0 100.0 64.3 26.1 9.3 100.0 27.6 107 Not stated 24.0 43 34.7 30.8 34.5 100.0 35.7 36.1 28.2 100.0 32.4 10 Total 21.6 3632 44.9 36.0 19.1 100.0 53.8 35.9 10.3 100.0 27.1 785 * Fewer than 25 cases 71 Table 25: Percentage of under-five children with acute respiratory infection in the last two weeks and treatment by health providers, The Gambia, 2000 Children with ARI who were taken to H a d a c u t e r e s p i r a t o r y i n f e c t i o n N u m b e r o f c h i l d r e n u n d e r 5 H o s p i t a l H e a l t h C e n t r e D i s p e n s a r y V i l l a g e h e a l t h w o r k e r M C H c l i n i c M o b i l e / o u t r e a c h c l i n i c P r i v a t e p h y s i c i a n T r a d i t i o n - a l h e a l e r O t h e r A n y a p p r o p r i a t e p r o v i d e r Number of children with ARI Male 7.3 1811 10.9 43.3 7.8 2.7 9.6 2.2 .1 2.4 7.1 70.6 132 Female 8.2 1821 6.3 60.1 8.7 3.4 6.8 .4 .4 2.1 7.1 78.7 149 Banjul 4.0 47 68.4 10.5 .0 .0 21.1 .0 5.3 5.3 .0 100.0 2 Kanifing 4.1 826 30.0 75.0 5.0 .0 .0 .0 .0 5.0 10.0 90.0 36 Brikama 9.3 1036 4.8 47.6 16.7 2.4 7.1 2.4 .0 .0 4.8 76.2 97 Mansakonko 5.5 108 5.0 45.0 5.0 .0 .0 10.0 .0 .0 5.0 65.0 6 Kerewan 11.4 590 5.8 63.5 .0 1.9 1.9 .0 .0 5.8 1.9 73.1 67 Kuntaur 8.4 135 .0 29.2 8.3 .0 25.0 .0 2.1 4.2 4.2 60.4 11 Janjanbureh 4.4 123 25.0 56.2 18.7 6.2 6.2 12.5 6.2 .0 6.2 93.4 5 Basse 7.8 731 2.8 38.9 5.6 8.3 19.4 .0 .0 .0 16.7 66.7 57 Urban 4.5 1365 24.1 74.70 5.4 .0 .6 .0 .2 5.1 5.8 93.4 62 Rural 9.7 2267 4.0 45.9 9.1 4.0 10.2 1.6 .3 1.4 7.5 69.7 219 < 6 months 6.7 386 16.5 40.5 8.9 .0 1.3 1.2 .0 .0 8.9 68.4 26 6-11 months 7.8 437 5.5 45.9 27.7 1.0 12.7 1.9 .3 9.7 1.7 80.9 34 12-23 months 9.2 835 9.0 64.3 3.6 .0 13.4 .0 .0 3.7 3.4 82.5 76 24-35 months 8.2 731 5.4 36.3 8.8 13.9 3.3 3.8 1.0 .2 7.8 67.4 60 36-47 months 7.2 667 11.6 61.5 3.3 .0 9.0 .7 .0 .0 16.9 75.5 48 48-59 months 6.2 556 5.5 58.1 5.5 .0 3.8 .0 .0 .0 5.2 72.8 34 Not stated 9.9 21 .0 11.5 .0 .0 11.5 .0 .0 .0 .0 11.5 2 None 8.0 2936 8.0 48.1 7.5 3.7 9.4 1.5 .3 1.2 5.9 71.9 235 Primary 8.3 286 10.1 61.8 6.7 .0 2.0 .0 .0 1.0 16.4 80.6 24 Secondary + 5.6 410 11.0 85.4 17.9 .0 1.3 .0 .0 14.0 10.1 100.0 23 Wealth Index Quintiles Poorest 8.8 687 1.1 45.5 5.4 2.6 14.2 .6 .9 .4 7.3 63.1 61 Second 8.4 724 13.1 45.7 15.6 .0 6.8 1.1 .0 2.1 .5 82.2 61 Middle 10.7 740 .0 54.4 6.2 6.9 6.6 2.9 .0 3.3 11.1 72.0 79 Fourth 6.4 769 8.7 53.9 7.8 .7 8.9 .6 .0 .0 9.0 73.4 50 Richest 4.2 669 36.9 74.7 6.3 .0 .7 .0 .3 6.7 6.3 93.7 28 Not stated 6.2 43 11.2 22.5 .0 48.6 8.8 .0 .0 8.8 8.8 91.2 3 Total 7.7 3632 8.4 52.2 8.3 3.1 8.1 1.3 .2 2.2 7.1 74.9 281 72 Table 26: Percentage of children 0-59 months of age reported ill during the last two weeks who received increased fluids and continued feeding, The Gambia, 2000 Children with illness who drank: Children with illness who ate: Reported illness in last two weeks Number of children under 5 More Same/Less Missing/ DK Total Somewhat less/same/ more Much less/none Missing/ DK Total Received increased fluids and continued eating Number of sick children Male 46.7 1811 41.2 50.0 8.8 100.0 60.9 34.3 4.9 100.0 24.1 845 Female 46.9 1821 42.4 47.7 9.9 100.0 56.2 38.4 5.4 100.0 23.0 854 Banjul 37.4 47 24.0 68.2 7.8 100.0 69.8 25.7 4.5 100.0 17.3 17 Kanifing 40.9 862 28.8 63.6 7.6 100.0 70.2 25.3 4.5 100.0 17.2 353 Brikama 48.1 1036 41.9 47.9 10.1 100.0 66.8 26.3 6.9 100.0 28.1 499 Mansakonko 45.6 108 40.6 41.2 18.2 100.0 47.9 43.0 9.1 100.0 27.3 49 Kerewan 49.0 590 29.1 58.7 12.1 100.0 48.9 47.1 4.0 100.0 12.1 289 Kuntaur 57.3 135 35.6 53.5 10.9 100.0 44.1 50.2 5.8 100.0 15.2 77 Janjanbureh 29.9 123 37.6 46.8 15.6 100.0 33.9 58.7 7.3 100.0 17.4 37 Basse 51.7 731 66.1 28.0 5.9 100.0 50.2 46.4 3.3 100.0 34.3 378 Urban 42.1 1365 35.3 54.9 9.8 100.0 63.3 30.6 6.1 100.0 19.5 575 Rural 49.6 2267 45.1 45.7 9.1 100.0 56.1 39.3 4.6 100.0 25.6 1124 < 6 months 38.0 386 14.6 77.1 8.3 100.0 73.1 22.0 4.9 100.0 8.4 147 6-11 months 54.9 437 38.4 51.7 9.9 100.0 46.2 45.0 8.8 100.0 15.6 240 12-23 months 55.4 835 40.7 46.1 13.2 100.0 55.1 38.4 6.5 100.0 23.4 463 24-35 months 46.8 731 46.1 46.2 7.7 100.0 63.8 33.3 2.8 100.0 28.6 342 36-47 months 42.4 667 52.2 39.0 8.8 100.0 62.0 34.1 3.9 100.0 31.3 283 48-59 months 40.0 556 46.1 48.9 4.9 100.0 56.9 39.4 3.7 100.0 24.7 222 Not stated 14.6 21 17.6 82.4 .0 100.0 40.3 59.7 .0 100.0 17.6 3 Mother’s education None 47.1 2936 42.6 47.7 9.7 100.0 56.2 38.8 5.0 100.0 24.0 1383 Primary 47.8 286 44.3 50.3 5.4 100.0 70.9 25.1 4.1 100.0 26.5 137 Secondary + 43.9 410 33.7 56.7 9.6 100.0 67.1 26.1 6.9 100.0 17.6 180 Wealth Index Quintiles Poorest 50.2 687 44.6 47.1 8.3 100.0 49.1 47.3 3.6 100.0 21.7 345 Second 45.1 724 43.2 44.6 12.1 100.0 55.9 36.9 7.1 100.0 27.0 326 Middle 52.6 740 46.7 42.3 11.0 100.0 53.0 41.5 5.5 100.0 25.1 389 Fourth 44.2 769 40.3 53.0 6.8 100.0 63.5 32.0 4.4 100.0 21.0 340 Richest 41.2 669 31.5 60.8 7.7 100.0 74.1 21.5 4.4 100.0 21.4 276 Not stated 53.7 43 42.1 42.5 15.4 100.0 67.3 20.2 12.6 100.0 38.3 23 Total 46.8 3632 41.8 48.8 9.4 100.0 58.5 36.4 5.1 100.0 23.5 1699 73 Table 27: Percentage of caretakers of children 0-59 months who know at least 2 signs for seeking care immediately, The Gambia, 2000 Knows child should be taken to health facility if child: Not able to drink /breastfeed Becomes sicker Develops a fever Has fast breathing Has difficult breathing Has blood in stool Is drinking poorly Knows at least two signs Number of caretakers Banjul 9.2 31.9 86.4 23.8 25.7 21.7 8.6 45.9 47 Kanifing 23.3 40.1 77.5 33.3 30.8 30.6 22.9 50.2 862 Brikama 11.5 24.8 71.6 12.9 12.6 22.0 10.9 38.1 1036 Mansakonko 17.7 31.8 75.4 8.0 15.5 19.9 6.9 56.1 108 Kerewan 18.5 19.3 78.7 15.6 10.5 19.3 3.7 48.6 590 Kuntaur 8.2 9.4 75.4 7.7 5.4 3.5 .3 24.9 135 Janjanbureh 36.2 36.7 58.4 19.5 34.8 62.2 22.7 80.3 123 Basse 6.9 5.2 69.0 4.5 3.5 6.1 2.6 13.9 731 Urban 19.4 31.4 77.6 24.0 21.9 25.5 16.3 46.7 1365 Rural 13.0 19.1 71.2 12.0 11.6 18.3 7.4 35.0 2267 Mother’s education None 14.8 22.8 73.1 15.9 14.1 19.4 9.3 37.9 2936 Primary 15.3 28.2 75.3 18.5 23.0 32.8 18.2 46.1 286 Secondary + 19.9 27.1 76.1 19.6 20.3 23.9 16.4 45.5 410 Wealth Index Quintiles Poorest 15.8 20.1 69.7 9.5 12.3 19.7 7.8 37.2 687 Second 12.0 18.1 75.1 11.6 9.2 20.8 6.1 36.5 724 Middle 15.3 20.0 73.0 13.5 12.0 17.6 9.6 38.3 740 Fourth 13.6 26.3 73.3 22.5 18.7 20.9 12.0 38.7 769 Richest 20.9 35.1 76.4 26.3 26.2 26.4 19.3 46.5 669 Not stated 14.3 16.4 85.5 4.9 8.7 19.9 3.8 44.4 43 Total 15.4 23.7 73.6 16.5 15.5 21.0 10.8 39.4 3632 74 Table 28: Percentage of children 0-59 months of age who slept under an insecticide-impregnated bednet during the previous night, The Gambia, 2000 Slept under a bednet Number of children Bednet treated Yes No DK/ missing Yes No DK/ missing Children who slept under a bednet Male 42.5 57.1 .4 1804 33.8 65.2 1.0 755 Female 41.0 58.8 .2 1816 36.4 62.2 1.4 742 Banjul 37.4 62.4 .2 46 14.9 84.0 1.1 17 Kanifing 37.7 61.9 .4 860 17.1 81.7 1.1 312 Brikama 43.3 56.4 .2 1034 30.8 67.7 1.5 448 Mansakonko 73.2 26.8 .0 108 49.1 50.6 .4 79 Kerewan 45.6 54.2 .2 589 49.0 50.5 .5 267 Kuntaur 57.6 41.5 .9 134 40.1 59.3 .6 77 Janjanbureh 56.3 43.4 .3 123 36.1 63.4 .5 69 Basse 31.6 63.8 .2 726 46.5 51.4 2.1 228 Urban 35.8 63.8 .4 1361 20.9 78.3 .9 473 Rural 45.4 54.4 .2 2259 41.7 57.0 1.3 1024 < 6 months 44.4 54.7 .9 384 33.4 64.2 2.4 168 6-11 months 41.3 58.7 .0 437 32.1 67.0 .9 180 12-23 months 43.8 56.1 .1 833 37.7 60.7 1.7 360 24-35 months 43.0 56.7 .3 725 36.4 62.5 1.2 310 36-47 months 40.2 59.7 .0 664 31.9 68.1 .0 262 48-59 months 37.6 61.7 .7 556 35.9 63.0 1.2 208 Not stated 43.6 56.4 .0 21 57.3 42.7 .0 9 Wealth Index Quintiles Poorest 41.1 58.4 .5 684 41.2 55.6 3.2 283 Second 54.8 44.9 .3 722 36.4 63.6 .0 394 Middle 41.6 58.4 .0 740 42.5 55.9 1.6 299 Fourth 36.5 62.9 .6 765 29.1 70.8 .0 281 Richest 33.0 67.0 .0 665 20.6 77.6 1.7 210 Not stated 68.0 32.0 .0 43 44.4 55.6 .0 29 Total 41.8 57.9 .3 3620 35.1 63.7 1.2 1497 75 Table 29: Percentage of children 0-59 months of age who were ill with fever in the last two weeks who received anti-malarial drugs, The Gambia, 2000 Children with a fever who were treated with: Had a fever in last two weeks Number of children under 5 Para- etamol Chloro- quine Fansidar Other Don’t know Any appropriate anti- malarial drug* Number of children Male 14.4 1826 62.5 58.9 4.0 15.3 2.9 59.6 262 Female 15.3 1832 59.7 50.4 2.4 9.8 4.9 52.5 277 Banjul 7.3 47 65.7 68.6 14.3 11.4 .0 68.6 3 Kanifing 15.1 862 68.5 67.1 2.7 9.6 .0 68.5 130 Brikama 21.1 1036 65.3 57.9 1.1 13.7 3.2 57.9 218 Mansakonko 19.1 108 50.7 40.6 5.8 8.7 14.5 40.6 21 Kerewan 14.1 590 45.3 40.6 3.1 3.1 6.3 40.6 83 Kuntaur 12.5 135 50.0 45.8 .0 13.9 5.6 45.8 17 Janjanbureh 13.7 123 64.0 56.0 14.0 12.0 2.0 58.0 17 Basse 6.7 731 61.3 45.2 6.5 25.8 9.7 48.4 49 Urban 14.2 1365 63.5 57.7 4.1 11.0 2.7 58.8 194 Rural 15.2 2267 60.4 53.9 2.3 12.4 4.6 54.4 344 <6 months 10.7 386 34.2 46.0 1.1 15.3 .0 46.0 41 6-11 months 16.2 437 52.1 66.5 .0 15.0 6.7 66.5 71 12-23 months 15.0 835 59.6 46.6 1.9 14.1 5.3 46.8 125 24-35 months 15.2 731 60.0 58.0 5.3 12.0 2.2 59.6 111 36-47 months 15.9 667 74.3 58.2 5.6 12.2 2.7 59.7 106 48-59 months 14.7 556 70.9 56.9 .9 4.0 5.4 56.9 82 Not stated 9.5 21 100.0 20.1 15.1 .0 .0 20.1 2 Mother’s education None 14.4 2936 58.7 54.8 3.1 10.6 4.6 55.6 423 Primary 19.9 286 73.0 66.1 2.8 22.3 .5 66.1 57 Secondary + 14.2 410 70.6 47.8 1.7 11.3 2.2 48.4 58 Wealth Index Poorest 16.4 687 54.2 49.8 2.6 9.2 4.4 49.8 112 Second 15.5 724 52.2 54.8 5.6 12.2 7.2 56.4 112 Middle 13.2 740 63.3 55.1 2.0 14.2 4.4 56.7 98 Fourth 15.7 769 65.4 56.6 1.7 11.9 1.5 56.9 121 Richest 13.4 669 76.5 62.4 2.3 13.2 1.8 62.4 90 Not stated 10.9 43 40.1 28.6 6.4 .0 6.4 28.6 5 Total 14.8 3632 61.5 55.3 2.9 11.9 3.9 56.0 538 76 Table 30: Percentage of women aged 15-49 who know the main ways of preventing HIV transmission, The Gambia, 2000 Percent who know transmission can be prevented by: Heard of AIDS Have only one faithful uninfected sex partner Using a condom every time Abstaining from sex Knows all three ways Knows at least one way Doesn't know any way Number of women Banjul 88.7 64.8 59.6 53.9 36.9 73.5 26.5 24 Kanifing 84.5 61.0 58.8 57.8 47.6 67.9 32.1 362 Brikama 82.1 51.5 52.2 36.6 31.3 58.2 41.8 343 Mansakonko 82.1 50.0 42.3 29.5 25.0 54.5 45.5 52 Kerewan 90.9 58.3 51.5 30.3 24.2 62.1 37.9 182 Kuntaur 79.5 39.3 36.9 33.6 23.0 47.5 52.5 34 Janjanbureh 80.6 38.0 42.6 22.2 18.5 48.1 51.9 39 Basse 73.6 27.4 28.3 26.4 16.0 39.6 60.4 177 Urban 86.9 57.4 56.9 48.3 38.8 66.2 33.8 604 Rural 79.0 45.1 42.3 31.7 25.5 50.9 49.1 610 15-19 82.2 53.4 51.2 41.3 33.4 60.1 39.9 1184 20-24 86.4 59.4 52.3 47.1 35.5 67.4 32.6 1161 25-29 87.1 62.6 56.4 48.3 38.4 68.6 31.4 1110 30-34 88.1 65.0 56.9 46.5 36.8 70.5 29.5 839 35-39 82.7 55.6 44.0 40.3 29.7 58.7 41.3 692 40-44 80.3 52.3 43.2 38.3 27.6 57.7 42.3 432 45-49 81.5 50.8 35.0 39.1 23.7 56.8 43.2 239 Education None 79.3 42.7 39.3 30.8 22.9 49.3 50.7 635 Primary 82.2 56.3 52.2 46.0 40.4 58.7 41.3 191 Secondary + 89.0 62.7 65.0 52.0 43.1 73.5 26.5 388 Wealth Index Quintiles Poorest 77.9 36.0 32.1 22.8 18.9 42.6 57.4 196 Second 88.9 59.1 59.5 43.3 35.2 66.0 34.0 216 Middle 80.9 49.3 44.3 34.6 28.0 54.6 45.4 232 Fourth 78.6 48.2 48.5 38.4 31.3 55.7 44.3 276 Richest 87.2 59.6 59.5 55.4 44.0 69.1 30.9 285 Not stated 95.9 73.0 49.4 32.2 4.7 76.9 23.1 9 Total 82.9 51.2 49.6 40.0 32.1 58.5 41.5 1214 77 Table 31: Percentage of women aged 15-49 who correctly identify misconceptions about HIV/AIDS, The Gambia, 2000 Percent who know that: AIDS cannot be transmitted by: Heard of AIDS Supernatural means Mosquito bites A healthy looking person can be infected Knows all three miscon- ceptions Knows at least one miscon- ception Doesn't correctly identify any miscon- ception Number of women Banjul 93.2 65.8 48.3 75.2 38.9 84.1 15.9 132 Kanifing 83.2 54.7 36.4 60.9 25.4 72.1 27.9 1637 Brikama 85.0 52.3 32.1 52.8 20.9 67.2 32.8 1627 Mansakonko 85.3 39.9 23.2 40.4 11.2 56.9 43.1 213 Kerewan 93.6 53.1 36.2 72.9 25.1 80.5 19.5 908 Kuntaur 82.5 32.4 18.0 44.0 8.3 58.1 41.9 187 Janjanbureh 84.4 31.2 21.3 41.3 10.6 53.1 46.9 230 Basse 79.0 34.2 17.1 29.6 6.7 50.2 49.8 1043 Urban 87.5 55.4 36.3 61.2 25.0 73.5 26.5 2648 Rural 82.8 42.7 25.8 47.1 15.2 61.5 38.5 3328 15-19 82.9 42.5 28.2 51.1 18.6 62.5 37.5 1214 20-24 85.9 52.3 34.8 54.0 23.0 68.6 31.4 1210 25-29 87.4 52.4 31.4 59.1 20.8 72.8 27.2 1153 30-34 87.0 51.8 34.1 56.5 21.6 70.1 29.9 890 35-39 82.9 47.1 28.7 50.6 17.0 64.0 36.0 713 40-44 80.3 43.1 22.4 46.4 14.7 58.6 41.4 439 45-49 81.6 40.3 24.2 45.3 14.0 60.8 39.2 250 Not stated 89.5 48.3 26.7 48.0 12.8 70.7 29.3 107 Education None 82.0 41.7 23.6 46.1 13.5 59.9 40.1 4223 Primary 88.5 52.7 34.0 60.3 21.9 75.1 24.9 564 Secondary + 93.5 70.0 53.1 75.9 40.0 87.5 12.5 1189 Wealth Index Poorest 81.7 31.4 19.5 38.5 8.6 52.5 47.5 1006 Second 87.4 50.1 29.6 55.1 18.8 69.7 30.3 1105 Middle 85.3 47.1 27.9 48.1 17.2 63.4 36.6 1193 Fourth 81.4 50.1 31.4 55.8 22.4 67.6 32.4 1261 Richest 87.6 59.2 41.1 65.7 28.3 77.3 22.7 1358 Not stated 95.2 42.7 21.0 39.1 6.7 66.5 33.5 53 Total 84.9 48.4 30.5 53.3 19.6 66.8 33.2 5976 78 Table 32: Percentage of women aged 15-49 who correctly identify means of HIV transmission from mother to child, The Gambia, 2000 Percent who know AIDS can be transmitted: Know AIDS can be transmitted from mother to child During pregnancy At delivery Through breastmilk Knows all three Did not know any specific way Number of women Banjul 74.3 71.5 58.3 43.0 38.0 26.7 132 Kanifing 64.7 62.2 55.6 44.7 39.6 35.7 1637 Brikama 51.8 50.6 46.0 43.3 38.4 48.3 1627 Mansakonko 48.4 46.8 45.7 45.7 43.4 51.9 213 Kerewan 63.0 62.1 50.2 43.4 39.3 37.1 908 Kuntaur 48.6 44.4 37.9 41.2 31.6 51.6 187 Janjanbureh 51.5 48.8 44.7 36.7 35.3 50.2 230 Basse 45.1 42.7 36.6 38.9 32.8 56.2 1043 Urban 63.6 61.1 53.9 45.8 40.6 36.8 2648 Rural 50.2 48.7 42.5 40.2 35.4 50.3 3328 15-19 52.0 49.4 43.2 40.2 35.4 48.9 1214 20-24 59.0 56.4 49.2 45.1 38.6 41.1 1210 25-29 61.7 60.5 53.8 46.6 42.4 38.5 1153 30-34 57.1 56.0 49.7 43.5 39.9 43.4 890 35-39 56.6 54.8 49.7 42.9 38.0 44.4 713 40-44 50.1 48.3 40.1 33.2 28.9 50.7 439 45-49 46.2 45.4 38.1 39.1 33.0 53.8 250 Not stated 47.4 40.3 32.8 40.0 30.2 54.2 107 Education None 49.3 47.5 41.5 39.5 34.9 51.2 4223 Primary 60.7 58.8 54.3 49.9 44.2 39.3 564 Secondary + 78.1 75.8 65.9 50.5 44.8 22.4 1189 Wealth Index Quintiles Poorest 44.2 43.0 39.3 35.8 32.6 56.3 1006 Second 53.7 52.3 46.4 43.5 38.0 46.9 1105 Middle 51.6 49.7 43.0 42.3 37.2 49.0 1193 Fourth 56.5 53.8 46.5 41.5 35.8 43.9 1261 Richest 70.4 68.2 59.4 48.0 42.9 30.1 1358 Not stated 60.7 60.1 54.5 56.3 53.7 39.9 53 Total 56.1 54.2 47.6 42.7 37.7 44.4 5976 79 Table 33: Percentage of women aged 15-49 who express a discriminatory attitude towards people with HIV/AIDS, The Gambia, 2000 Percent of women who: Believe that a teacher with HIV should not be allowed to work Would not buy food from a person with HIV/AIDS Agree with at least one discriminatory statement Agree with neither discriminatory statement Number of women Banjul 36.2 20.5 40.1 59.9 132 Kanifing 30.4 17.3 33.8 66.2 1637 Brikama 18.7 10.4 21.7 78.3 1627 Mansakonko 15.3 6.3 16.9 83.1 213 Kerewan 31.2 24.0 34.1 65.9 908 Kuntaur 16.3 9.4 19.3 80.7 187 Janjanbureh 12.1 6.6 14.3 85.7 230 Basse 5.6 3.0 7.0 93.0 1043 Urban 28.6 16.5 31.8 68.2 2648 Rural 15.8 10.2 18.2 81.8 3328 15-19 18.6 9.7 20.3 79.7 1214 20-24 21.1 13.6 25.2 74.8 1210 25-29 24.4 15.3 27.7 72.3 1153 30-34 24.9 16.4 27.6 72.4 890 35-39 22.9 11.7 24.2 75.8 713 40-44 16.6 11.0 19.1 80.9 439 45-49 15.0 10.0 19.1 80.9 250 Not stated 22.6 12.9 24.8 75.2 107 Education None 16.2 9.8 18.3 81.7 4223 Primary 19.5 11.0 23.5 76.5 564 Secondary + 41.2 25.1 45.7 54.3 1189 Wealth Index Quintiles . Poorest 14.0 8.8 16.0 84.0 1006 Second 17.1 10.6 20.0 80.0 1105 Middle 17.8 9.9 20.1 79.9 1193 Fourth 21.2 13.4 24.5 75.5 1261 Richest 34.6 20.7 37.8 62.2 1358 Not stated 7.1 1.8 7.5 92.5 53 Total 21.5 13.0 24.2 75.8 5976 80 Table 34: Percentage of women aged 15-49 who have sufficient knowledge of HIV/AIDS transmission, The Gambia, 2000 Heard of AIDS Know 3 ways to prevent HIV transmission Correctly identify 3 misconceptions about HIV transmission Have sufficient knowledge Number of women Banjul 93.2 49.1 38.9 24.1 132 Kanifing 83.2 46.8 25.4 18.9 1637 Brikama 85.0 31.5 20.9 12.3 1627 Mansakonko 85.3 26.3 11.2 5.4 213 Kerewan 93.6 33.5 25.1 9.4 908 Kuntaur 82.5 25.0 8.3 3.7 187 Janjanbureh 84.4 24.1 10.6 4.6 230 Basse 79.0 21.1 6.7 3.4 1043 Urban 87.5 41.4 25.0 16.0 2648 Rural 82.8 28.0 15.2 8.0 3328 15-19 82.9 32.1 18.6 10.9 1214 20-24 85.9 35.8 23.0 12.9 1210 25-29 87.4 38.4 20.8 12.6 1153 30-34 87.0 36.0 21.6 12.9 890 35-39 82.9 29.0 17.0 10.5 713 40-44 80.3 30.4 14.7 9.5 439 45-49 81.6 25.2 14.0 7.5 250 Not stated 89.5 34.3 12.8 6.3 107 Education None 82.0 27.2 13.5 6.7 4223 Primary 88.5 44.1 21.9 17.0 564 Secondary + 93.5 52.9 40.0 26.2 1189 Wealth Index Quintiles Poorest 81.7 20.6 8.6 3.4 1006 Second 87.4 35.8 18.8 12.2 1105 Middle 85.3 29.7 17.2 8.1 1193 Fourth 81.4 33.5 22.4 13.2 1261 Richest 87.6 47.0 28.3 19.0 1358 Not stated 95.2 14.6 6.7 1.4 53 Total 84.9 33.9 19.6 11.6 5976 81 Table 35: Percentage of women aged 15-49 who know where to get an AIDS test and who have been tested, The Gambia, 2000 Know a place to get tested Have been tested If tested, have been told result Number of women Banjul 41.5 9.9 79.4 132 Kanifing 30.4 8.4 83.1 1637 Brikama 27.6 5.7 75.0 1627 Mansakonko 12.5 3.9 76.0 213 Kerewan 36.4 15.1 92.9 908 Kuntaur 18.1 6.5 88.6 187 Janjanbureh 15.0 6.5 70.7 230 Basse 7.8 1.6 70.0 1043 Urban 30.5 8.6 81.0 2648 Rural 21.0 6.1 86.3 3328 15-19 20.3 3.1 70.8 1214 20-24 28.6 6.7 84.3 1210 25-29 29.0 9.7 78.2 1153 30-34 27.7 9.7 84.3 890 35-39 24.6 9.7 96.1 713 40-44 19.1 5.5 96.9 439 45-49 22.0 7.2 75.8 250 Not stated 18.4 3.5 48.2 107 Education None 19.7 6.1 83.0 4223 Primary 27.7 6.8 91.2 564 Secondary + 43.8 11.4 82.2 1189 Wealth Index Quintiles Poorest 13.0 5.4 92.0 1006 Second 25.6 8.0 85.6 1105 Middle 20.9 5.7 71.0 1193 Fourth 28.2 6.3 83.0 1261 Richest 34.7 10.1 86.7 1358 Not stated 32.1 5.3 7.5 53 Total 25.2 7.2 83.5 5976 82 Table 36: Percentage of married or in union women aged 15-49 who are using (or whose partner is using) a contraceptive method, The Gambia, 2000 Percent of married or in–union women who are using: No method Female steril- ization Pill IUD In- jections Implants Con- dom Dia- phragm/ foam/ jelly LAM Peri- odic absti- nence With- drawal Total Any modern method Any tra- ditional method Any method Number of currently married women Banjul 76.5 .8 11.4 6.5 3.5 .0 .5 .0 .3 .3 .3 100.0 22.5 .9 23.5 67 Kanifing 89.9 .0 5.0 1.4 3.4 .0 .4 .0 .0 .0 .0 100.0 10.1 .0 10.1 1014 Brikama 91.0 .2 4.0 .5 3.9 .0 .0 .0 .0 .0 .7 100.0 8.4 .7 9.0 1166 Mansakonko 93.1 .0 3.1 .9 2.6 .0 .0 .0 .0 .4 .2 100.0 6.2 .6 6.9 161 Kerewan 90.9 .2 3.1 .2 4.6 .0 .0 .0 .0 .0 .0 100.0 9.1 .0 9.1 672 Kuntaur 89.7 .2 3.8 .9 5.4 .2 .0 .0 .0 .0 .0 100.0 10.3 .0 10.3 160 Janjanbureh 94.0 .0 2.1 .0 2.8 .0 .2 .9 .0 .0 .0 100.0 6.0 .0 6.0 194 Basse 92.4 .2 2.9 .9 4.0 .0 .0 .2 .2 .2 .2 100.0 7.1 .5 7.6 920 Urban 87.8 .0 6.7 1.5 3.3 .0 .3 .0 .1 .0 .0 100.0 12.1 .1 12.2 1687 Rural 93.0 .2 2.0 .5 4.2 .0 .0 .1 .0 .1 .4 100.0 6.6 .5 7.0 2666 < 20 years 98.4 .0 .8 .0 .8 .0 .0 .0 .0 .0 .0 100.0 1.6 .0 1.6 382 20-24years 93.6 .0 4.2 .0 1.8 .0 .0 .0 .0 .2 .3 100.0 5.9 .5 6.4 823 25-49 years 89.4 .2 4.1 1.1 4.7 .0 .1 .1 .1 .0 .2 100.0 10.3 .3 10.6 3148 Education None 92.4 .2 2.8 .4 3.8 .0 .1 .1 .0 .1 .2 100.0 7.3 .3 7.6 3548 Primary 87.4 .0 7.5 1.5 2.7 .0 .0 .0 .0 .0 .8 100.0 11.8 .8 12.6 331 Secondary + 82.4 .0 8.8 3.4 4.3 .0 1.0 .0 .0 .0 .1 100.0 17.4 .1 17.6 474 Wealth Index Quintiles Poorest 94.1 .0 1.7 .5 3.0 .0 .0 .4 .0 .0 .3 100.0 5.6 .3 5.9 839 Second 91.5 .5 3.3 .2 4.1 .0 .0 .0 .0 .0 .3 100.0 8.2 .3 8.5 847 Middle 93.5 .1 2.1 .3 3.6 .0 .0 .0 .0 .2 .2 100.0 6.1 .4 6.5 942 Fourth 87.6 .0 6.3 1.0 5.1 .0 .0 .0 .0 .0 .0 100.0 12.4 .0 12.4 838 Richest 87.4 .0 6.2 2.0 3.2 .0 .5 .0 .2 .0 .3 100.0 12.0 .6 12.6 842 Not stated 99.8 .0 .2 .0 .0 .0 .0 .0 .0 .0 .0 100.0 .2 .0 12.6 46 Total 91.0 .1 3.8 .8 3.8 .0 .1 .1 .0 .1 .2 100.0 8.7 .3 9.0 4353 83 Table 37: Percentage of mothers with a birth in the last 12 months protected against neonatal tetanus, The Gambia, 2000 Percent of mothers with a birth in the last 12 months who: Received at least 2 doses, last wi

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