Gambia - Multiple Indicator Cluster Survey - 2010

Publication date: 2010

The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 20 10 Contributors to the Report 1. Alieu S M Ndow – Gambia Bureau of Statistics 2. Edrissa Ceesay – Gambia Bureau of Statistics 3. Lolley Kah Jallow – Gambia Bureau of Statistics 4. Baba Suwareh – Gambia Bureau of Statistics 5. Wally Ndow - Gambia Bureau of Statistics 6. Momodou Lamin Cham – Gambia Bureau of Statistics 7. Alieu Bahoum - Gambia Bureau of Statistics 8. Sainabou Jasseh - Gambia Bureau of Statistics 9. Musu Koma - Gambia Bureau of Statistics 10. Lamin Dibba - Gambia Bureau of Statistics 11. Momodou Fatajo - Gambia Bureau of Statistics 12. Buba Jadama- Gambia Bureau of Statistics 13. Lamin Kanteh - Gambia Bureau of Statistics 14. Mam -Yassin Ceesay- Gambia Bureau of Statistics 15. Mama Jarju- Gambia Bureau of Statistics We acknowledge the substantial comments on the earlier draft as well as support in data processing from the following colleagues from the MICS Global Team and from the regional office. 1. Attila Hancioglu, MICS IV Global Coordinator 2. Ivana Bjelic, MICS Data Processing Expert 3. Michelle Seroussi, MICS IV Regional Coordinator The Gambia Multiple Indicator Cluster Survey (MICS) was carried out in 2010 by The Gambia Bureau of Statistics in collaboration with the Ministry of Basic and Secondary Education, Ministry of Health and Social Welfare (Reproductive and Child Health Unit, Expanded Programme for Immunization Unit, Planning Unit and National Malaria Control Unit), the Women’s Bureau, the National Nutrition Agency, the Department of Community Development, the Department of Water Resources, Department of Social Welfare, The Gambia Family Planning Association, Child Protection Alliance, National Aids Secretariat and the then Ministry of Economic Planning and Industrial Development (MEPID). Financial and technical support was provided by the United Nations Children’s Fund (UNICEF). MICS is an international household survey programme developed by UNICEF. The Gambia’s MICS was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women, and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed commitments. Additional information on the global MICS project may be obtained from www.childinfo.org. The Gambia Bureau of Statistics (GBOS). 2011. The Gambia Multiple Indicator Cluster Survey 2010, Final Report. Banjul, The Gambia: The Gambia Bureau of Statistics (GBOS). The Gambia Bureau of Statistics UNICEF United Nations Children’s Fund Ministry of Basic and Secondary Education, Ministry of Health and Social Welfare (Reproductive and Child Health Unit, Planning Unit, Expanded Programme for Immunization and National Malaria Control Programme), the Women’s Bureau, the National Nutrition Agency, the Department of Community Development, the Department of Water Resources, The Gambia Family Planning Association, Child Protection Alliance, Department of Social Welfare, National Aids Secretariat and the Ministry of Finance and Economic Affairs (MoFEA) The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 FINAL REPORT | JUNE 2012 ivMICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 v MICS Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, The Gambia, 2010 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1.1 4.1 Under-five mortality rate 109 per thousand 1.2 4.2 Infant mortality rate 81 per thousand NUTRITION Nutritional status 2.1a 2.1b 2.2a 2.2b 2.3a 2.3b 1.8 Underweight prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) Stunting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) Wasting prevalence Moderate and Severe (- 2 SD) Severe (- 3 SD) 17.4 percent 4.2 percent 23.4 percent 6.8 percent 9.5 percent 2.1 percent Breastfeeding and infant feeding 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 Children ever breastfed Early initiation of breastfeeding Exclusive breastfeeding under 6 months Continued breastfeeding at 1 year Continued breastfeeding at 2 years Predominant breastfeeding under 6 months Duration of breastfeeding Bottle feeding Introduction of solid, semi-solid or soft foods Minimum meal frequency Age-appropriate breastfeeding Milk feeding frequency for non-breastfed children 97.9 percent 51.6 percent 33.5 percent 92.9 percent 30.6 percent 79.7 percent 19.3 percent 10.4 percent 34.3 percent 28.8 percent 49.6 percent 16.5 percent Salt iodization 2.16 Iodized salt consumption 22.0 percent Vitamin A 2.17 Vitamin A supplementation (children under age 5) 72.8 percent Low birth weight 2.18 2.19 Low-birthweight infants Infants weighed at birth 10.2 percent 50.8 percent CHILD HEALTH Vaccinations 3.1 3.2 3.3 3.4 3.5 3.6 4.3 Tuberculosis immunization coverage Polio immunization coverage Immunization coverage for diphtheria, pertussis and tetanus (DPT) Measles immunization coverage Hepatitis B immunization coverage Yellow fever immunization coverage 98.9 percent 93.4 percent 89.3 percent 87.6 percent 87.2 percent 87.5 percent Tetanus toxoid 3.7 Neonatal tetanus protection 75.5 percent Care of illness 3.8 3.9 3.10 Oral rehydration therapy with continued feeding Care seeking for suspected pneumonia Antibiotic treatment of suspected pneumonia 66.6 percent 68.8 percent 69.8 percent Solid fuel use 3.11 Solid fuels 97.6 percent viMICS Topic MICS4 Indicator Number MDG Indicator Number Indicator Value Malaria 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 6.7 6.8 Household availability of insecticide-treated nets (ITNs) Households protected by a vector control method Children under age 5 sleeping under any mosquito net Children under age 5 sleeping under insecticide-treated nets (ITNs) Malaria diagnostics usage Antimalarial treatment of children under 5 the same or next day Antimalarial treatment of children under age 5 Pregnant women sleeping under insecticide-treated nets (ITNs) Intermittent preventive treatment for malaria Place for handwashing Availability of soap 50.9 percent 70.6 percent 41.1 percent 33.3 percent 18.3 percent 27.7 percent 30.2 percent 26.1 percent 66.2 percent 36.2 percent 55.0 percent WATER AND SANITATION Water and sanitation 4.1 4.2 4.3 4.4 7.8 7.9 Use of improved drinking water sources Water treatment Use of improved sanitation facilities Safe disposal of child's faeces 85.8 percent 3.7 percent 76.3 percent 88.1 percent REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.2 5.3 5.4 5.4 5.3 5.6 Adolescent fertility rate Early childbearing Contraceptive prevalence rate Unmet need 118 per 1,000 19.1 percent 13.3 percent 21.5 percent Maternal and newborn health 5.5a 5.5b 5.6 5.7 5.8 5.9 5.5 5.2 Antenatal care coverage At least once by skilled personnel At least four times by any provider Content of antenatal care Skilled attendant at delivery Institutional deliveries Caesarean section 98.1 percent 72 percent 84.4 percent 56.6 percent 55.7 percent 2.5 percent CHILD DEVELOPMENT Child development 6.1 6.2 6.3 6.4 6.5 6.6 6.7 Support for learning Father's support for learning Learning materials: children’s books Learning materials: playthings Inadequate care Early child development index Attendance to early childhood education 48.3 percent 21.3 percent 1.2 percent 44.1 percent 20.6 percent 68.1 percent 18.1 percent EDUCATION Literacy and education 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 2.3 2.1 2.2 Literacy rate among young women School readiness Net intake rate in primary education Primary school net attendance rate (adjusted) Secondary school net attendance rate (adjusted) Children reaching last grade of primary Primary completion rate Transition rate to secondary school Gender parity index (primary school) Gender parity index (secondary school) 48.2 percent 37.2 percent 35.0 percent 62.6 percent 34.2 percent 95.3 percent 74.5 percent 56.8 percent 1.05 ratio 1.00 ratio Summary Table of Findings (cont.) The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 vii MICS Topic MICS4 Indicator Number MDG Indicator Number Indicator Value CHILD PROTECTION Birth registration 8.1 Birth registration 52.5 percent Child discipline 8.5 Violent discipline 90.3 percent Early marriage and polygyny 8.6 8.7 8.8 8.9 8.10a 8.10b Marriage before age 15 Marriage before age 18 Young women age 15-19 currently married or in union Polygyny Spousal age difference Women age 15-19 Women age 20-24 8.6 percent 46.5 percent 23.5 percent 40.7 percent 45.9 percent 46.3 percent Female genital mutilation/ Cutting 8.11 8.12 8.13 Approval for female genital mutilation/cutting (FGM/C) Prevalence of female genital mutilation/cutting (FGM/C) among women Prevalence of female genital mutilation/cutting (FGM/C) among daughters 64.2 percent 76.3 percent 42.4 percent Domestic violence 8.14 Attitudes towards domestic violence 74.5 percent HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED AND VULNERABLE CHILDREN HIV/AIDS knowledge and attitudes 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 6.3 Comprehensive knowledge about HIV prevention Comprehensive knowledge about HIV prevention among young people Knowledge of mother- to-child transmission of HIV Accepting attitude towards people with HIV Women who know where to be tested for HIV Women who have been tested for HIV and know the results Sexually active young women who have been tested for HIV and know the results HIV counselling during antenatal care HIV testing during antenatal care 31.6 percent 32.8 percent 90.8 percent 8.0 percent 73.2 percent 7.5 percent 8.7 percent 62.8 percent 45.5 percent Sexual behaviour 9.10 9.11 9.12 9.13 9.14 9.15 9.16 6.2 Young women who have never had sex Sex before age 15 among young women Age-mixing among sexual partners Sex with multiple partners Condom use during sex with multiple partners Sex with non-regular partners Condom use with non-regular partners 87.6 percent 5.3 percent 44.3 percent 1.1 percent 37.2 percent 11.8 percent 33.5 percent Orphaned children 9.17 9.18 9.19 9.20 6.4 6.4 Children’s living arrangements (living with both parents) Prevalence of children with at least one parent dead School attendance of orphans School attendance of non-orphans 61.7 percent 8.2 percent 75.5 percent 71.4 percent Summary Table of Findings (cont.) viiiMICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 ix MICS Table of Contents Summary Table of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Table of contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix List of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv List of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix I. Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Survey Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 II. Sample and Survey Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Training and Fieldwork. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Data Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 III. Sample Coverage and the Characteristics of Households and Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Sample Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Characteristics of Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 IV. Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 V. Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Breastfeeding and Infant and Young Child Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Salt Iodization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Children’s Vitamin A Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Low Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 VI. Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Neonatal Tetanus Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Oral Rehydration Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Care Seeking and Antibiotic Treatment of Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Solid Fuel Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71 xMICS VII. Water and Sanitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 Use of Improved Water Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 Use of Improved Sanitation Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Handwashing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 VIII. Reproductive Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Fertility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Unmet Need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 Assistance at Delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Place of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 IX. Child Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Early Childhood Education and Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Early Childhood Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 X. Literacy and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Literacy among Young Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 School Readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Primary and Secondary School Participation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 XI. Child Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151 Birth Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151 Child Discipline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Early Marriage and Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Female Genital Mutilation/Cutting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Domestic Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 XII. HIV/AIDS, Sexual Behaviour, and Orphans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Knowledge about HIV Transmission and Misconceptions about HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Accepting attitudes toward People Living with HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Sexual Behaviour Related to HIV Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190 Appendix A. Sample Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Appendix B. List of Personnel Involved in the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Appendix C. Estimates of Sampling Errors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Appendix D. Data Quality Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Appendix E. MICS4 Indicators: Numerators and Denominators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 Appendix F. Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 Table of contents The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 xi MICS List of Tables Table HH.A: Results of household, women’s and under-5 interviews. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table HH.1: Results of household, women’s and under-5 interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Table HH.2: Household age distribution by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table HH.3: Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table HH.4: Women’s background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table HH.5: Under-5’s background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table CM.2: Child mortality… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table NU.1: Nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table NU.2: Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table NU.3: Breastfeeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table NU.4: Duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table NU.5: Age-appropriate breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Table NU.6: Introduction of solid, semi-solid or soft foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table NU.7: Minimum meal frequency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table NU.8: Bottle feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table NU.9: Iodized salt consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table NU.10: Children’s vitamin A supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table NU.11: Low birth weight infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table CH.1: Vaccinations in first year of life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table CH.2: Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table CH.3: Neonatal tetanus protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table CH.4: Oral rehydration solutions and recommended homemade fluids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table CH.5: Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table CH.6: Oral rehydration therapy with continued feeding and other treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table CH.8: Knowledge of the two danger signs of pneumonia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table CH.9: Solid fuel use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table CH.10: Solid fuel use by place of cooking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table CH.11: Household availability of insecticide treated nets and protection by a vector control method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table CH.12: Children sleeping under mosquito nets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Table CH.13: Pregnant women sleeping under mosquito nets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table CH.14: Anti-malarial treatment of children with anti-malarial drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table CH.15: Malaria diagnostics usage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table CH.16: Intermittent preventive treatment for malaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 xiiMICS Table WS.1: Use of improved water sources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table WS.2: Household water treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table WS.3: Time to source of drinking water. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table WS.4: Person collecting water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Table WS.5: Use of improved Sanitation facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table WS.6: Use and sharing of sanitation facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table WS.7: Disposal of child’s faeces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Table WS.8: Drinking water and sanitation ladders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Table WS.9: Water and soap at place for handwashing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table Ws.10: Availability of soap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table RH.1: Adolescent birth rate and total fertility rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table RH.2: Early childbearing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table RH.3: Trends in early childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Table RH.4: Use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Table RH.5: Unmet need for contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table RH.6: Antenatal care provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table RH.7: Number of antenatal care visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Table RH.8: Content of antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table RH.9: Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Table RH.10: Place of delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Table CD.1: Early childhood education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Table CD.2: Support for learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Table CD.3: Learning material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Table CD.4: Inadequate care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Table CD.5: Early child development index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Table ED.1: Literacy among young women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table ED.2: School readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table ED.3: Primary school entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Table ED.4: Primary school attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Table ED.5: Secondary school attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table ED.6: Children reaching last grade of primary school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Table ED.7: Primary school completion and transition to secondary school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Table ED.8: Education gender parity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Table ED.9: School attendance of orphans and non-orphans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 List of tables The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 xiii MICS Table CP.1: Birth registration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Table CP.4: Child discipline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Table CP.5: Early marriage and polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Table CP.6: Trends in early marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Table CP.7: Spousal age difference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Table CP.8: Female genital mutilation/cutting (FGM/C) among women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Table CP.9: Female genital mutilation/cutting (FGM/C) among daughters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Table CP.10: Approval of female genital mutilation/cutting (FGM/C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Table CP.11: Attitudes toward domestic violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission among young people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Table HA.3: Knowledge of mother-to-child HIV transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Table HA.4: Accepting attitudes toward people living with HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Table HA.5: Knowledge of a place for HIV testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 Table HA.6: Knowledge of a place for HIV testing among sexually active young women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Table HA.7: HIV counselling and testing during antenatal care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188 Table HA.8: Sexual behaviour that increases the risk of HIV infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Table HA.9: Sex with multiple partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Table HA.10: Sex with multiple partners (young women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Table HA.11: Sex with non-regular partners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 xivMICS List of Figures Figure HH.1: Population pyramid, The Gambia, MICS4 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Figure CM1: Differential in Under-5 Mortality Rates and Infant Mortality Rates by background characteristics (refer to mid-2010), The Gambia, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Figure CM2. Under-5 Mortality Rates and Infant Mortality Rates (refer to mid-2004, The Gambia, 2010 . . . . . . . . . . . . . . . . . . . . . . . . 29 Figure NU.1: Percentage of children under 5 who are undernourished, The Gambia 2010…. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and one day of birth, The Gambia 2010. . . . . . 37 Figure NU.3: Percent distribution of children under age 2 by feeding pattern by age group, The Gambia, 2010 . . . . . . . . . . . . . . . 37 Figure NU.4: Percentage of households consuming adequately iodised salt, The Gambia, 2010.…. . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Figure NU.5: Percentage of infants weighing less than 2500 grams at birth, The Gambia 2010.…. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Figure CH.1: Percentage of children age 12-23 months who received the recommended vaccinations by 12 months, The Gambia, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Figure CH.2: Percentage of women protected against neonatal tetanus by major background characteristics, The Gambia, 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Figure 9: Percentage of household members using improved sources of drinking water, The Gambia, 2010…. . . . . . . . . . . . . . . . . 86 Figure 10: Percentage of household members using improved sanitation facilities, The Gambia, 2010…. . . . . . . . . . . . . . . . . . . . . . 86 Figure HA1: Two ways of preventing HIV transmission, Comprehensive knowledge of HIV Prevention and attitudes towards people living with HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 xv MICS Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillus-Calmette-Guérin CEDAW Convention on the Elimination of Discrimination Against Women CRC Convention on the Rights of the Child CSPro Census and Survey Processing System MoBSE Ministry of Basic and Secondary Education MoHSW Ministry of Health and Social Welfare DPT Diphteria, Pertussis and Tetanus EPI Expanded Programme on Immunization FGM/C Female Genital Mutilation/Cutting GBoS Gambia Bureau of Statistics GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders ITN Insecticide Treated Net IUD Intrauterine Device LAM Lactational Amenorrhea Method LGA Local Government Area MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey NAR Net Attendance Rate NaNA National Nutrition Agency ORS Oral Rehydration Solution ORT Oral Rehydration Treatment OVC Orphans and Vulnerable Children PPM Parts Per Million SPSS Statistical Package for Social Sciences STIs Sexually Transmitted Infections TVET Technical, Vocational Education and Training UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit for Children WHO World Health Organization Notations (x) This notation implies that the percentage or proportion, x, in brackets is calculated on a number of cases that fall in the range 25 to 49 unweighted cases. (*) This notation implies that the percentage or proportion, *, in brackets is calculated on a number of cases that fall in the range 1 to 24 unweighted cases and the actual percentage or proportion is not shown but it is represented by an asterisk. xviMICS 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 regard to this, Multiple Indicator Cluster Survey (MICS) was first conducted in 1996, another similar or even more comprehensive one was conducted in May/June 2000 and a third one was conducted in December- January 2005/2006. This is the fourth survey in the series of Multiple Indicator Cluster Surveys (MICS) conducted in The Gambia. The fourth survey was conducted in 2010. These 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. To evaluate the efforts towards implementation of these conventions, UNICEF in collaboration with other UN agencies such as the WHO, UNFPA and the US Public Health Services developed the Multiple Indicate Cluster Survey (MICS). The MICS is a household survey that examines the behaviour of a comprehensive set of indicators related to the welfare of children and women. The module development for the survey captured data on households characteristics, education, water and sanitation, insecticides treated nets, indoor residual spraying, salt iodization, handwashing, birth registration, early childhood development, Breastfeeding, care of illness, malaria, immunization, anthropometry, child mortality, desire for last birth, illness symptoms, maternal and newborn health, rehydration solutions, contraception, unmet need, female genital mutilation, attitudes toward domestic violence, marriage/ union, sexual behavior, and HIV/AIDS. By the ratification of the Convention on the Rights of the Child (CRC) and Convention on the Elimination of all forms of Discrimination against Women (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 a high impact on the plight of children and women when implemented simultaneously. The social and welfare status of both women and children is expected to be markedly improved, thereby enhancing sustainable development in each member state. In 2010, the Government of The Gambia in collaboration with UNICEF conducted the fourth 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 Gambia Bureau of Statistics (GBoS), acting as the lead agency. Collaborating agencies included the: • Ministry of Health and Social Welfare (MoHSW) (Reproductive and Child Health Unit, Planning Unit, Expanded Programme for Immunization and National Malaria Control Programme), • Ministry of Basic and Secondary Education (MoBSE) • Department of Community Development • Women’s Bureau • Department of Water Resources • Department of Social Welfare • Gambia Family Planning Association (GFPA). • Child Protection Alliance • Ministry of Finance and Economic Affairs (MoFEA) • National Nutrition Agency • National Aids Secretariat The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 xvii MICS I wish to express my gratitude to all persons and agencies that participated in the different phases of the survey. Our sincere thanks go to UNICEF, through its Banjul Office for providing the much-needed financial support for the conduct of the MICS4. I also wish to express my heart-felt gratitude to Ms. Mariam Khan Senghore, M & E Officer - UNICEF Banjul, for her support during the implementation of the MICS. I am also indebted to the staff of GBoS, namely: Edrissa Ceesay, Sample survey statistician/Programmer, MICS4; Lolley Jallow–Kah, Programmer, MICS4; and Baba Suwareh, Co-ordinator, MICS4. Similar sentiment is also extended to the following GBoS staff for their contribution to the report: Wally Ndow, Sainanbou Jasseh, Momodou Fatajo, Momodou Lamin Cham, Alieu Bahoum, Mama Jarjue, Mam – Yassin Ceesay, Musu Kuta Komma, Lamin Dibba, Buba Jadama and Lamin Kanteh. Finally, my sincere thanks go to the following consultants hired by UNICEF: Mr. Amidou for his support in data entry, Mr. Ngagne Diakhaté for his support in data analysis and Mr. Amagagin for his support in calculating the sampling weights. I would like to extend my heartfelt gratitude to Mr. Alieu Saho, the local consultant who assisted the Bureau in the implementation of the MICS (from the design to report writing) and for the guidance he provided to the report writers. I hope that scholars, researchers, institutions, planners and decision-makers and individuals will find the MICS4 results useful. Alieu S M Ndow Statistician General June 2012 xviiiMICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 xix MICS Executive Summary The Gambia Multiple Indicator Cluster Survey 2010 is a nationally representative survey of households, children and women. The main objectives of the survey are to provide up-to-date information for assessing the situation of children and women in The Gambia. Another objective is to furnish data needed for monitoring progress towards the goals established at the World Summit for Children and the Millennium Development Goals as a basis for future action. The findings of this survey would also be utilized by government and development partners in planning and monitoring programme implementation. Infant and Under-5 Mortality • The data from the MICS IV 2010 show that the infant and under-5 mortality rates were 81 and 109 per 1,000, respectively. These Figures represent an impressive fall in mortality indicators compared to MICSIII, which showed 98 and 141 per 1,000 respectively for infant and under-5 mortality. Education • 62.6 per cent of children of primary school age in The Gambia are attending primary school. Although over the past five years primary school attendance in the Kuntaur LGA has decreased from 41.2 per cent to 34.7 per cent, it is still among the lowest attendance rates. At the national level, there is a slight difference between male (61.0%) and female (64.1%) primary school attendance rates. • Almost all (95.3%) of the children who enter the first grade of primary school eventually reach Grade 6. • Literacy levels among women aged 15-24 is 48.2 per cent. The highest level is found in Banjul and the lowest in Basse and Kuntaur, each registering less than 30 per cent. Water and Sanitation • 85.8 per cent of the population has access to improved drinking water – 94.8 and 78 per cent in the urban1 and rural, areas, respectively. Apart from Banjul and Kanifing, which have the highest proportions (100% and 99.6%, respectively), the differences among the LGAs are small, with the exception of Janjanbureh. • 76.3 per cent of the population of the country lives in households with sanitary means of excreta disposal. Child Malnutrition • 17.4 per cent of children under-5 in the country are underweight or too thin for their age. 23.4 per cent of children are stunted or too short for their age and 9.5 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. Children of women in the richest quintile are least likely to be underweight and stunted. Breastfeeding • About 34 per cent of children aged less than six months are exclusively breastfed. At age 6-8 months, 19.7 per cent of children currently breastfeeding receive breast milk and solid or semi-solid foods, whilst 43.7 per cent of those currently not breastfeeding receive breast milk and solid or semi-solid foods. By age 18-23 months, a little less than half (42.9%) of the children continue to breastfeed. Salt Iodization • 22 per cent of households in The Gambia have adequately iodized salt at a level considerably lower than the recommended level. The percentage of households with adequately iodized salt ranges from 6.3 per cent in Kerewan to 38.5 per cent in the Janjanbureh LGA. 1 See Appendix 7 for definition and list of urban settlements xxMICS Vitamin A Supplementation • Within the six months prior to the MICS, 72.8 per cent of children aged 6-59 months received a high dose of Vitamin A supplement and a further 82.5 per cent received the Vitamin A supplement six months prior to that. Low Birth Weight • 10.2 per cent of infants were estimated to weigh less than 2,500 grams at birth. Of the total number of births only 50.8 per cent were weighed. Immunization Coverage • About 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 96.5 per cent. The second and third doses of DPT were respectively given to 96.2 and 89.3 per cent of children aged 12-23 months. • Similarly, 97.2 per cent of children received Polio 1 by age 12 months and this declined to 93.4 per cent for the third dose. • The coverage for measles was 87.6 per cent among children vaccinated by 12 months of age. • Over three quarters, 87.4 per cent of the children, had all nine antigens as recommended in the first 12 months of life. • There are small differences in vaccination coverage across sex, education and wealth quintiles (household wealth status). Diarrhoea • About 17 per cent of children aged 0-59 months had diarrhoea in the last two weeks prior to the date of interview of the survey. Of these, 71.2 per cent received one or more of the recommended home treatments (i.e. were treated with ORS or RHF) and continued feeding. Acute Respiratory Infection • About 6 per cent of under-5 children had an acute respiratory infection in the two weeks prior to the survey. About 69 per cent of these children were taken to an appropriate health provider. Malaria • In The Gambia, 41.1 per cent of under-5 children slept under a bednet the night prior to the survey interview. However, about 33.3 per cent of these bednets were impregnated with insecticide. • 59.1 per cent of children with a fever in the two weeks prior to the MICS interview were given Paracetamol/Panadol to treat the fever and 9 per cent were given Chloroquine while 3.8 per cent were given Fansidar. About 30.2 per cent of these children were given any appropriate anti-malarial drug and 27.7 per cent received the drug within 24 hours of the onset of symptoms. HIV/AIDS • About 78 per cent of women aged 15-49 know all two of the main ways to prevent HIV transmission – having only one faithful uninfected sex partner and using a condom every time during sex. • 31 per cent of women aged 15-49 correctly identified three most common misconceptions of 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. • 73.2 per cent of women aged 15-49 know a place to get tested for HIV and about 32 per cent have been tested. • The percentage of women who have sufficient knowledge of preventing HIV transmission tends to increase with the level of education and is lower among the poorest than the richest quintiles. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 xxi MICS Antenatal Care • Almost all pregnant women (98.1 per cent) receive antenatal care (ANC) one or more times during pregnancy. Assistance at Delivery • A doctor, nurse/midwife, or Auxiliary nurse delivered about 57.1 per cent of births occurring in the year preceding the MICS. This percentage is highest in Banjul (96.8 per cent) and lowest in Kuntaur (32.8 per cent). Overall, 56.6 per cent of births occurring in the two years preceding the survey were delivered by skilled personnel and 57.7 per cent of the births were delivered in health facilities. The level of education and wealth quintiles are highly correlated to assistance at delivery by skilled personnel. Birth Registration • Births of about 53 per cent of under-5 children have been registered. Birth registration coverage increases with the age of a child. Coverage is influenced by maternal education and wealth index quintile. xxiiMICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 1 MICS I. Introduction 1.1 Background This report is based on the The Gambia’s Multiple Indicator Cluster Survey, conducted in 2010 by the Gambia Bureau of Statistics (GBoS), in collaboration with the: • Ministry of Health and Social Welfare (MoSHSW) (Reproductive and Child Health Unit, Planning Unit, Expanded Programme for Immunization and National Malaria Control Programme) • Ministry of Basic and Secondary Education (MoSBSE) • Department of Community Development • Women’s Bureau • Department of Water Resources • Department of Social Welfare • Gambia Family Planning Association (GFPA). • Child Protection Alliance • The Ministry of Finance and Economic Affairs (MoFEA) • National Nutrition Agency • National Aids Secretariat Financial and technical support was provided by UNICEF. The survey provides valuable information on the situation of children and women in The Gambia, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table on next page). 2MICS A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and sub-national levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” This final report presents the results of the indicators and topics covered in the survey. Health Care Delivery System Until the adaptation of the Primary Health Care (PHC) strategy in 1979, the health care delivery system in The Gambia was largely centralized with the only government referral hospitals in Banjul and Bansang. The PHC strategy was adopted with the main aim of making health care accessible and affordable to the majority of Gambians. A key target of the PHC was mainly rural settlements. For each PHC village, a village health worker (VHW) and a traditional birth attendant (TBA) are 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 assist in delivering, identifying and referring of at-risk mothers to health facilities at the secondary and tertiary levels. Minor and major health centres serve as the unit for delivery of basic health services at the secondary level. The minor health centres provide up to 70 per cent of the basic health care package to the population and they serve a population of 15,000 people whilst the major health centres serve as referral points for minor health centres for such services like: obstetric emergency, essential surgical services and further medical care. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 3 MICS At the tertiary level, health services are currently provided mainly by four government hospitals. These hospitals are located in Banjul, Bwiam, Farafenni and Bansang. The Royal Victoria Teaching Hospital (RVTH), 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 areas. Farafenni Hospital provides referral services to people of the North Bank Region and adjacent rural areas. Although the hospital provides most specialist services, it is yet to be fully operational. Sulayman Junkung hospital at Bwiam also provides referral services to surrounding villages in both the Western Region and some parts of the Lower River Region. Bansang Hospital, the oldest rural hospital, serves the eastern part of the country with the catchment area covering about a third of the country’s population. In addition to operating as a referral hospital, it also has an outpatient department/unit. Health services obtained through government-funded health institutions are complemented by services provided by the private sector and non-governmental organizations (NGOs). Individuals and NGOS have established a number of health facilities, mainly in the urban areas. Probably due to higher costs involved in the provision of health services by these facilities, only a small proportion of the population utilizes such services. There are a number of private clinics and hospitals located in the urban areas. Recognizing the important role Traditional Medicine plays in healthcare delivery, the Ministry of Health established a Traditional Medicine unit to integrate alternative medicine in the national health delivery system. The unit is charged with the responsibility of advocating, coordinating and supporting traditional healers throughout the country. As a result an Association of Traditional Healers was setup in which all healers should register. 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 public health services depend to a large extent on expatriate doctors, the majority of whom are Cubans and Nigerians provided through technical assistance. The increase in the number of doctors serving in the rural areas might have had the most impact particularly with the posting of Cuban doctors to areas that have never been served by a resident doctor. Recently, the University of the Gambia and Leeds Metropolitan University are producing health personnel and hence an increase in the health sector work force. A critical problem the health sector has been facing for many years is the retention of trained nurses in the system. Nurses have been leaving the services in large numbers and MOH&SW has been facing the problem of trying to replenish those leaving through training. A large number of nurses have, over the years, been attracted to the higher income levels for nurses in Europe and the USA, which has in some instances caused a shortage of nurses in the health sector. The introduction of a course in medicine at the University of the Gambia provides a ray of hope in the provision of much needed trained medical personnel. The first batch of 14 medical doctors started in 1999 and graduated from the University in 2006 (11 males and 3 females). There are currently 31 male and 18 female house officers. Notwithstanding the potential of the university to train a sizeable number of doctors and other health personnel, the health sector continues to be faced with the perennial problem of high staff attrition which has aggravated the problem of staff shortages. 4MICS Major Challenges of the Health Care System Notwithstanding the significant gains made in the health sector over the years, the sector continues to be faced with major challenges. With a rapidly growing population and increasing pressure on limited resources for the health sector, the sector has, over the years, struggled to meet the demand for services. Inadequate financial and logistical support, shortage of adequately and appropriately trained health staff, high staff attrition and an inefficient referral system have, over the years, aggravated the problems of the sector. These problems have curtailed the gains made in reducing morbidity and mortality in the country. Specialist services are still in high demand in the Gambia. Since most specialists are non-Gambians and usually on technical assistance, the withdrawal of such assistance could adversely affect the quality of services in the country. 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 specialists, health funding in the country is heavily dependent on donor assistance. This raises issues of sustainability in the light of evidence of donor fatigue in the recent past. Nonetheless, government continues to place high premium on the health sector and spends about 11.08 percent (2011) of total government expenditure on the sector. The emergence and increase in non-communicable disease such as Hypertension and Diabetes has compounded these challenges and has proven to be a severe strain on the health delivery system. The Health Policy The National Health Policy Framework, 2007-2020, “Health is Wealth”, seeks to address the common health desires of the population through a number of initiatives both in the area of preventive and curative health services. With a vision to improve the health of all Gambians with a per capita income of US$ 1,500 by 2020, as stated in the policy has a mission to promote and protect the health of the population. It seeks to promote equity in access and affordability of quality services, maintain ethics and standards, promote health system reforms, and improve staff retention and client satisfaction. Cognizant of the multi-dimensional nature of health and the potential for health status to be influenced by a variety of factors, a number of areas have been identified in the policy that would collectively have the potential to impact on the health status. Under the current policy, areas identified for interventions relate to health care programmes and clinical care delivery, health system strengthening and capacity development, and technical support services. The policy recognizes the need for community participation and the contribution of traditional medicine to the attainment of the national health goals. The major targets of the health policy have been identified as follows: 1. To reduce infant mortality rate from 75 per 1000 to 28 per 1000 by 2015 2. To reduce under-5 mortality rate from 99 per 1000 to 43 per 1000 by 2015 3. To reduce maternal mortality ratio from 730 per 100,000 to 150 per 100,000 by 2015 4. To increase life expectancy at the national level to from 63.4 to 69 years by 2015 5. To increase life expectancy for women from 65 years to 70 years by 2015 6. To increase life expectancy for men from 62.4 years to 68 years by 2015 7. To reduce malaria incidence by 50 per cent by 2015 8. To reduce HIV/AIDS prevalence (HIV 1 from 1.1 per cent to 0.5 per cent and HIV 2 from 0.7 per cent to 0,1 per cent by 2015) 9. To reduce total fertility rate from 5.4 to 4.6 by 2015 10. To reduce tuberculosis incidence rate from 120 per 100,000 to 60 per 100,000 by 2015 11. To reduce morbidity due to non-communicable diseases by 10 per cent by 2015 (2007 base) 12. To reduce morbidity due to other communicable diseases by 50 per cent (2007 base). The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 5 MICS National Nutrition Policy The National Nutrition Agency (NaNA) is responsible for the implementation of the National Nutrition Policy (2010-2020). The goal of this policy is to attain optimal nutritional requirement of the population of the Gambia to assure a healthy and sustainable livelihood. The policy also addresses issues such as reducing malnutrition, morbidity and mortality among the general population, especially the most vulnerable groups: pregnant and lactating women and children under five years of age, thereby contributing to the productivity of the population of the Gambia and the socio-economic development of the country The policy seeks to address the following broad objectives: 1. To reduce the prevalence of malnutrition among women of child bearing age 2. To promote optimal infant and young child feeding practices 3. To create an enabling environment for mothers and care givers to make and implement informed feeding choices 4. To raise public awareness on the main problems affecting infant and young child feeding 5. To promote the utilization of diverse and safe foods of high nutritional value 6. To contribute to the diversification of the food production base 7. To increase awareness on causes consequences and prevention of micronutrient malnutrition in the general population 8. To increase household consumption of iodized salt from 7 per cent in 2005 to 90 per cent by 2015 9. To eliminate vitamin A deficiency and its consequences among the general population 10. To reduce the prevalence of diseases related to micronutrient deficiencies among the general population especially women and children 11. To reduce the morbidity and mortality rates related to iron deficiency anaemia in all age groups 12. To contribute towards ensuring that food production and/or consumed by the Gambian population is of high quality and safe 13. To raise public awareness on the importance of food quality and safety 14. To improve the nutritional status of children under five, pregnant and lactating women and other vulnerable groups 15. To ensure that stakeholders appreciate the importance of a good nutritional status in both the management and prevention of infectious diseases 16. To increase awareness of the risk factors and major determinants of diet-related NCDs 17. To reduce the mortality associated with diet-related NCDs 18. To improve the health and quality of life of individuals with diet-related NCDs 19. To establish an effective nutritional care and support system for the socio - economically deprived and nutritionally vulnerable groups 20. To increase awareness on the relationship between nutrition and HIV/AIDS 6MICS 21. To provide nutritional information, care and support to people infected and affected by HIV/AIDS 22. Improve timely access to adequate food by people in emergency situations 23. To make nutrition information available to all stakeholders for appropriate decision making, planning, policy development and programming 24. Create an enabling environment for human nutrition research 25. To inform and educate the Gambian population on the need for an importance of good nutrition, through effective information and communication mechanisms 26. To improve on the resources base of the Agency for effective functioning and investment in nutrition 27. To create an enabling environment to facilitate resources mobilization for various partners and stakeholders for the provision of adequate resources 28. To coordinate investment in nutrition 29. To ensure that nutrition is mainstreamed in key development policies and programmes The broad policy objectives are to be realized through; 1. Working with all stakeholders including communities and community based organizations involved in nutrition and nutrition related areas. 2. Mainstreaming nutrition into other sector policies programmes and strategies and 3. Better coordination of nutrition interventions in the country Two key factors in the strategies to attain the policy objectives are: a well-coordinated information, education and communication (IEC) programme and a Behaviour Change Communication (BCC) programme. National Population Policy The National Population Policy (2007 – 2020), amongst other developmental problematiques recognizes the high fertility rate as well as the young population age structure of the Gambian population. According to the 2003 Population and Housing Census, 42 per cent of the population is under the age of 15 and 22 percent are between 15 and 24 years. Other characteristics of the Gambia’s population include high maternal, infant and child mortality rates, low literacy rates, a high prevalence of poverty as well as strong traditional and socio cultural believes and practices. To better integrate the Gambia’s population into overall socio-economic development as well as to reduce poverty within the framework of vision 2020, the PRSP II and its successor program the PAGE as well as to realize the MDG goals and targets, the national population policy has the following targets. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 7 MICS 1. To reduce the proportion of girls who marry before the age of 18 years by 30 per cent by the year 2009 and by 80 per cent by the year 2020. 2. To reduce the proportion of girls below 20 years and women below 40 years being pregnant by 50 per cent by the year 2010 and by 80 per cent by the year 2020. 3. To increase the gross enrollment ratio (7 – 15 years) of 91 per cent (2002/203) to 100 per cent by 2015. 4. To improve the completion rate from 80 per cent (2002/2003) to 100 per cent by 2015 5. To achieve full immunization coverage of 100 per cent of infant (0 – 11 months) by 2013. 6. Reduce HIV 1 prevalence rate among 15 to 49 years old pregnant women from 1.1 per cent in 2005 to less than 1 per cent by 2012. 7. Reduce malnutrition rate among children under 5 years from 14 per cent in 2005 to 8 per cent by 2012 8. Increase the rate of exclusive breastfeeding from 45.6 per cent in 2005 to 80 per cent by 2012 9. Reduce under 5 mortality rate from 99 per cent 1000 live births in 2003 to 54 per 1000 live births by 2013 10. Revise/enact and enforce laws affecting the rights of women of The Gambia and children in general by 2008 and those affecting sexual and reproductive health rights by 2010 11. Expand youth friendly centers in all local Government Areas and strengthen them to provide youths with life skills by the year 2010. The policy also has strategies that are aimed at protecting the welfare of children. Below are the strategies. 1. Enforcing all laws and protocols regarding the welfare of children in The Gambia 2. Providing equal opportunities for children regarding education, health, legal and other social services in The Gambia 3. Providing respite, care and other forms of support for children in difficult circumstances 4. Involving children in the design of policies and programmes that concerns them 5. Support the decentralization of the Department of Social Welfare to increase access to child welfare services 6. Protecting children from abuse, exploitation, harmful traditional practices such as early forces marriage and female genital mutilation/cutting (FGM/C) 7. Adopting a rights based approach when implementing progrmmes and activities on child issues 8. Planning and implementing programmes that will help reform youth offenders and protect children against the risk of committing offences 9. Implementing programmes on parenting skills to help families cope with difficult children 10. Sensitizing and educating the public on child rights and the effects of child abuse, and commercial sex exploitation of children (CSEC) 11. Strengthening families through community based programmes to support and care for orphans and other vulnerable children 8MICS As population is a cross cutting issue, the policy has been harmonized with other policies and programmes including the National Health Policies; the Family Planning Policy; the Education Policy; The Gambia Environmental Action Plan (GEAP); the Strategy for Poverty Alleviation; the National Youth Policy; and the National Policy for Advancement of Women and other national and policies. Education Policy 2004 -2015 The development of the Education Policy 2004 – 2015 is premised on The Gambia’s vision 2020 and the governments’ development programme, Poverty Reduction Strategic Paper (PRSP), both of which are the development agendas of government that seek to improve the human capital of the country by reducing the number of people living below the poverty line. The Gambia as a Nation remains highly committed to developing its human resource base with priority given to free basic education for all. It is for this reason that this policy is being used as a means for the attainment of high level of economic growth to alleviate poverty with the emphasis on the critical areas for the realization the MDGs, EFA and NEPAD. Hence the guiding principle for education therefore is premised on non-discriminatory and all inclusive provision of education underlining in particular gender equity and the targeting of poor and disadvantaged groups; respect for the rights of the individual; cultural diversity, indigenous languages and knowledge; promotion of ethical norms and values, and a culture of peace; and development of science and technology competences. These guiding principles are in conformity with the national development agenda of the Gambia as articulated in vision 2020 statement. “to transform The Gambia into a financial centre; a tourist paradise; a trading export-oriented agricultural and manufacturing nation thriving on free market policies and a vibrant private sector, sustained by a well-educated, trained, skilled, healthy, self- reliant and enterprising population, and guaranteeing a well-balanced eco-system and a decent standard of living for one and all, under a system of government based on the consent of the citizenry” In order to translate the vision into reality, the sector is guided by a Mission Statement embodied in the following statement “A Provision of Relevant and Quality Education for All Gambians for Poverty Reduction” Based on these principles and the economic development prospects of the country, the basic aims of the Education Policy are: 1. To promote a broad-based education at the basic level for lifelong learning and training. 2. To mainstream gender in the creation of opportunities for all to acquire literacy and livelihood skills, and the utilization of these skills in order to earn a living and become economically self-reliant members of the community 3. To develop the physical and mental skills which will contribute to nation building economically, socially and culturally in a sustainable environment 4. To encourage creativity and the development of a critical and analytical mind 5. To further an understanding and appreciation of the contribution of science and technology to Development 6. To cultivate sound moral and ethical values in the development of life skills 7. To develop a healthy body and an appreciation of the value of a healthy mind in response to the life threatening diseases like HIV/AIDS malaria and tuberculosis 8. To create an awareness of the importance of peace, democracy and human rights, duties and responsibilities of the individual in fostering these qualities. 9. To foster an appreciation of and respect for the cultural heritage of The Gambia. 10. To promote a sense of patriotism service, loyalty, integrity and dedication to the nation and humanity. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 9 MICS Policy Objectives The 2004 – 2015 policy focuses on ensuring that the right to quality education for all is upheld and that Education for All, with its ramifications, and the Millennium Development Goals are achieved. The ultimate object of eliminating poverty, enhancing quality living and nurturing a learning society forms the cornerstone of the policy. With the priority areas and key strategies in mind, the policy seeks to attain the following objectives: 1. To increase the basic education GER to 100 per cent by 2015, taking into account enrolment in the Madrassas. 2. To increase the completion rates in basic education to 100 percent by 2015 3. To increase the supply of trained teachers and make more efficient use of the teaching force by maintaining the pupil/teacher ratio at 45.1 at the basic level 4. To increase double shift classes from 25 percent to 32 per cent by 2015 across all levels 5. To phase out double shift teachers by 2015 6. To maintain multi-grade teaching in a combined class size not exceeding 40 7. To increase the share of enrolment of girls to 50 per cent of total enrolment at the levels of basic and secondary education by 2015 8. To improve the quality of teaching and learning at all levels 9. To improve learning outcomes at all levels – at least 80 per cent of students will attain minimum grade competencies/ mastery levels by 2015 10. To increase the enrolment ratio of early childhood by 50 per cent especially in the rural areas by 2015 11. To increase access, for adults and out of school youths to functional literacy and numeracy programmes in order to halve the illiterate population by 2015 12. To provide marketable and social skills to enable individuals to deal effectively with the demands and challenges of everyday life 13. To introduce the teaching of the five most commonly used languages - Mandinka, Wollof, Fula, Jola and Sarahuleh at the basic, senior secondary and higher education levels as subjects 14. To increase the transition rate from Grade 9 to 10 to a minimum of 50 per cent 15. To increase the quota of graduate teachers of Gambian nationality at the level of senior secondary from 26 per cent to 100 per cent by 2015 16. To strengthen the institutional and management capacity of the Technical, Vocational Education and Training (TVET) system 17. To establish a sound financial basis for the long-term development and sustainability of TVET 18. To increase cost sharing and cost recovery at post-secondary training institutions 19. To develop and strengthen public – private partnerships in the financing of higher education 20. To institutionalize access programmes for higher education, especially for girls, particularly in science, mathematics and technology 21. To improve the organizational structure of the sector for efficient and effective service delivery 10MICS Women’s Act The Women’s Act, 2010 was enacted by the National Assembly on Tuesday the 12th day of April 2010. The Act domesticates all provisions of the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) and the protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (The Protocol). The Act has the following sections and subsections: 1. Preliminary 2. Women’s Human Rights Protection 3. Governments obligation to eliminate all forms of discrimination 4. Temporary Special measures in favour of women 5. Prohibition of discrimination against women in employment 6. Elimination of discrimination in the field of education 7. Right to Health 8. Rural Women 9. Marriage and the family 10. Additional Rights under the protocol 11. National women’s Council 12. Establishments and Composition 13. Functions 14. Financial Provisions 15. Administration 16. Miscellaneous It is evident from the above sections and subsection of the act that this legal instrument does not just address women’s’ rights issues but also addresses institutional issues of structures/agencies that will deal with the rights issues as well as strategies that will facilitate addressing gender inequities. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 11 MICS The Children’s Act The Gambia enacted the children’s act in 2005; which is a clear manifestation of the Gambia government’s commitment to improve the lives and welfare of its children and the creation of a Gambia fit for children where the children’s right to survival, development, protection and participation are actively promoted and protected, through appropriate legislative, administrative and other measures in fulfillment of national and international obligations. In the Gambia, a child is defined as anybody below the age of 18 years. The act captures fundamental development problems as they pertain to children ranging from education, health, human rights etc. For education, part II section 18.1 of the act states ‘every child has a right to free and compulsory basic education and it shall be the duty of the Government to provide the education’. The Act states in section 18.2 that ‘every parent or guardian shall ensure that his or her child or ward attend and complete basic education’. The act also addresses issues of disability and vulnerability of children. It states in section 12.2 that ‘every child who is in need of special protection measures (includes children with disabilities, and street children), has the right to any such measure that is appropriate to his or her physical, social, economic, emotional, and material needs and under conditions which ensure his or her dignity, promote his or her self-reliance and active participation in the affairs of the community. Furthermore, the act also states in section 12.2 that every person, authority, body or institution having the care or responsibility for ensuring the care of a child in need of special protection measures shall endeavor, within the available resources, to provide the child with such assistance and facilities which are necessary for his or her education, training, preparation for employment, rehabilitation and recreational opportunities in a manner conducive to his or her archiving the fullest possible social integration, individual development and his or her cultural and moral development . The Act also paves the way for the introduction of more effective measures to protect children from abuse and exploitation. It provides for a register of child abusers and tightens laws on trafficking 1.2 Survey Objectives The Gambia’s Multiple Indicator Cluster Survey 2010 has the following primary objectives: 1. To provide up-to-date information for assessing the situation of children and women in The Gambia; 2. To furnish data needed for monitoring progress towards the goals established in the Millennium Declaration, the goals of A World Fit for Children (WFFC) and other internationally agreed upon goals as a basis for future action; 3. 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. 4. To generate data on the situation of children and women, including the identification of vulnerable groups and of disparities, to inform policies and interventions. 12MICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 13 MICS II. Sample and Survey Methodology Sample Design The sample for The Gambia Multiple Indicator Cluster Survey (MICS) was designed to provide estimates on a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for the eight Local Government Areas (LGAs): Banjul, Kanifing, Brikama, Mansakonko, Kerewan, Kuntaur, Janjanbureh and Basse. Other than Banjul and Kanifing which are entirely urban settlements, urban and rural areas within each LGA were identified as the main sampling domains and the sample was selected in two stages. Within each LGA, at least 44 and at most 60 census enumeration areas, (EA’s) or clusters were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a sample of 20 households was drawn through circular systematic sampling; the sample of households is not self-weighting. For reporting national level results, sample weights are used. See table HH.A for the distribution of sample households. A more detailed description of the sample design can be found in Appendix A. Questionnaires Three sets of questionnaires were used in the survey: 1. a household questionnaire which was used to collect information on all de facto households members (usual residents), the household, and the dwelling; 2. a women’s questionnaire administered in each selected household to all women aged 15-49 years; and 3. an under-5 questionnaire, administered to mothers or caretakers of all children under 5 living in the household. Table HH.A: Allocation of MICS 4 Sample households and EAs by LGA and residence Local government area (LGA) Residence Stratum no Census number of households 2003 Census population, 2003 Census EAs, 2003 Sampled EAs 2010 Households in EAs selected 2003 Households selected for interviews 2010 Banjul Urban 1 6853 35061 92 44 3616 880 Kanifing Urban 2 49016 322735 634 60 4737 1200 Brikama Urban Rural 3 4 28289 16850 235273 154321 426 298 36 23 2398 1566 720 460 Mansakonko Urban Rural 5 6 2026 6406 13302 58865 33 122 9 35 622 1927 180 700 Kerewan Urban Rural 7 8 4527 13715 34720 138115 66 256 9 39 633 2157 180 780 Kuntaur Urban Rural 9 10 611 6493 5040 73451 11 113 3 41 191 2574 60 820 Janjabureh Urban Rural 11 12 2126 7989 16836 90376 40 139 8 37 438 2248 160 740 Basse Urban Rural 13 14 3149 9444 23729 158857 57 190 4 42 181 2267 80 840 Total 157494 1360681 2477 390 25555 7800 14MICS The questionnaires included the following modules: 1. The Household Questionnaire included the following modules: • Household Listing Form • Education • Water and Sanitation • Household Characteristics • Insecticide Treated Nets • Indoor Residual Spraying • Child Discipline • Handwashing • Salt Iodization 2 The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: • Women’s Background • Child Mortality • Desire for Last Birth • Maternal and Newborn Health • Illness Symptoms • Rehydration Solution • Contraception • Unmet Need • Female Genital Mutilation/Cutting • Attitudes Towards Domestic Violence • Marriage/Union • Sexual Behaviour • HIV/AIDS 3 The Questionnaire for Children under Five was administered to mothers or caretakers of children under 5 years of age2 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Age • Birth Registration • Early Childhood Development • Breastfeeding • Care of Illness • Malaria • Immunization • Anthropometry 2 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 15 MICS The questionnaires are based on the MICS4 model questionnaire3. Given that the MICS4 model questionnaires were in an English version, the questionnaires were not translated into the local languages for the training part. The training programme for staff conducting or supervising the interviews included detailed discussions of the contents of the questionnaires, how to complete the questionnaires, and interviewing techniques. In addition to taking the trainees through the questionnaires in English, the questions were also verbally translated into the three main local languages of The Gambia (Wollof, Mandinka and Fula). A participatory approach was adopted during these translation sessions to ensure that all participants had common understanding of the translation of all the questions. The questionnaires were pre-tested in few selected EAS in the Greater Banjul in April, 2010. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of The Gambia MICS4 questionnaires is provided in Appendix F. In addition to administering the questionnaires, the field staff tested the salt used for cooking in the households for iodine content, observed the place for hand washing and assisted the measurer to measure the weights and heights of children age under 5 years. Details and findings of these measurements are provided in the respective sections of the report. Training and Fieldwork Training for the fieldwork lasted for 18 days and was conducted in March 2010. The training consisted of classroom lectures, mock interviews in the training hall and practice interviews in the field. The mock interviews were also conducted in local languages during the training and all trainees were given the chance to conduct an interview or serve as a respondent. The field practice interviews were observed by the trainers to ensure that interviewers understood what they are instructed to do during the data collection Seven days was allocated for the pre–testing of the questionnaires and the last day of the training was used to review the questionnaires completed during the pre–test. Individual problems in completing the questionnaires were identified and remedies found. The data were collected by seven teams; each team was comprised of five interviewers, one editor, one measurer, a supervisor and a driver. Fieldwork began in April 2010 and was completed in August 2010. Data Processing Data were entered using the Census and Survey Processing System (CSPro) software. The data was entered to 20 microcomputers and carried out by 40 data entry operators. The data entry was supervised by four supervisors. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS4 programme and adapted to The Gambia questionnaire were used throughout. Data processing began simultaneously with data collection in April 2010 and was completed in August 2010. The data was analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF for this purpose. 3 The model MICS4 questionnaires can be found at www.childinfo.org 16MICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 17 MICS III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 7,800 households selected for the sample, 7,799 households were found to be occupied. Of these, 7,791 were successfully interviewed for a household response rate of 99.9 per cent. In the interviewed households, the survey identified 15,138 women (age 15-49 years). Of these, 14,685 were successfully interviewed, resulting to a response rate of 97.0 per cent within interviewed households. In addition, 11,807 children under age five were listed. Questionnaires were completed for 11,637 of these children, which corresponds to a response rate of 98.6 per cent within interviewed households. Overall response rates of 96.9 and 98.5 per cent are calculated for the women’s and under-5’s interviews respectively (Table HH.1). The difference in response rates across LGAs is not significant for the three different questionnaires. For the household questionnaire, all the LGAs have a response rate of more than 99 per cent. Mansankonko, Kerewan, Kuntaur and Janjanbureh have a response rate of 100 per cent. For the women’s questionnaire, the response rate ranges from 96.6 per cent in Janjanbureh and Basse to 99.3 per cent Kerewan. For the under-5 questionnaire, the response rate was highest in Kuntaur with 99.6 per cent and lowest in Janjanbureh with 97.3 per cent. Table HH.1: Results of household, women’s and under-5 interviews Number of households, women, and children under 5 by results of the household, women’s and under-5’s interviews, and Household, women’s and under-5’s response rates, The Gambia, 2010 Area LGA Kuntaur Janjan- bureh Basse Total Urban Rural Banjul Kanifing Brikama Mansa- konko Kerewan Households Sampled 3460 4340 880 1200 1180 880 960 880 900 920 7800 Occupied 3459 4340 880 1200 1179 880 960 880 900 920 7799 Interviewed 3456 4335 878 1199 1177 880 960 880 900 917 7791 Household response rate 99.9 99.9 99.8 99.9 99.8 100.0 100.0 100.0 100.0 99.7 99.9 Women Eligible 5323 9815 1148 2019 1956 1551 1718 1977 1904 2865 15138 Interviewed 5175 9510 1113 1962 1889 1491 1706 1955 1820 2749 14685 Women’s response rate 97.2 96.9 97.0 97.2 96.6 96.1 99.3 98.9 95.6 96.0 97.0 Women’s overall response rate 97.1 96.8 96.7 97.1 96.4 96.1 99.3 98.9 95.6 95.6 96.9 Children under 5 Eligible 3074 8733 555 1052 1445 1316 1580 1856 1515 2488 11807 Mothers/caretakers interviewed 3028 8609 548 1038 1419 1293 1573 1848 1474 2444 11637 Under-5’s response rate 98.5 98.6 98.7 98.7 98.2 98.3 99.6 99.6 97.3 98.2 98.6 Under-5’s overall response rate 98.4 98.5 98.5 98.6 98.0 98.3 99.6 99.6 97.3 97.9 98.5 18MICS Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 7,791 households successfully interviewed in the survey, 63,150 household members were listed. Of these, 30,943 were males, and 32,203 were females. Information on the gender of 4 household members could not be found during secondary editing. These figures also indicate that the survey estimated the average household size at 8.1 persons. Table HH.2: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, The Gambia, 2010 Males Females Missing Total Number Percent Number Percent Number Percent Number Percent Age 0-4 5410 17.5 5178 16.1 0 8.3 10588 16.8 5-9 4859 15.7 4749 14.7 0 .0 9608 15.2 10-14 3868 12.5 4056 12.6 0 8.3 7925 12.5 15-19 3445 11.1 3385 10.5 0 .0 6830 10.8 20-24 2497 8.1 2949 9.2 0 .0 5446 8.6 25-29 2005 6.5 2654 8.2 2 56.1 4661 7.4 30-34 1790 5.8 1970 6.1 0 .0 3760 6.0 35-39 1528 4.9 1555 4.8 0 .0 3083 4.9 40-44 1254 4.1 1063 3.3 0 .0 2317 3.7 45-49 1037 3.4 806 2.5 0 .0 1843 2.9 50-54 853 2.8 1385 4.3 0 12.3 2238 3.5 55-59 578 1.9 702 2.2 0 .0 1280 2.0 60-64 624 2.0 622 1.9 0 .0 1245 2.0 65-69 430 1.4 336 1.0 0 .0 767 1.2 70-74 348 1.1 331 1.0 0 .0 679 1.1 75-79 191 .6 172 .5 0 .0 362 .6 80-84 139 .4 161 .5 0 .0 300 .5 85+ 79 .3 122 .4 1 15.0 202 .3 Missing/DK 9 .0 9 .0 0 .0 18 .0 Dependency age groups 0-14 14138 45.7 13983 43.4 1 16.6 28121 44.5 15-64 15610 50.4 17090 53.1 2 68.4 32702 51.8 65+ 1187 3.8 1122 3.5 1 15.0 2310 3.7 Missing/DK 9 .0 9 .0 0 .0 18 .0 Child and adult populations Children age 0-17 years 16344 52.8 16017 49.7 1 16.6 32362 51.2 Adults age 18+ years 14590 47.2 16177 50.2 3 83.4 30770 48.7 Missing/DK 9 .0 9 .0 0 .0 18 .0 Total 30943 100.0 32203 100.0 4 100.0 63150 100.0 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 19 MICS The percentage distribution of the MICS4 survey population by 5-year age group is very similar to the distribution of the 2003 population of The Gambia for almost all age groups. However, a marked percentage difference has been noticed between the two distributions for the age group 50-54 for females. This particular age group in the survey showed 4.3 per cent of the female population listed in the survey. This is almost double the percentage of male population in this age group (2.8 per cent) for the census. The 2003 census results show that about 2.4 females were in this age group and this could be attributed to age heaping. For both distributions (survey and census) the age group 0-14 accounted for 43.4 per cent of the population. The age group 15-64 accounted for 53.1 per cent of the population. A similar trend has been observed for the other age cohorts for both the survey and census age distributions except for the female population aged 50 - 54. Note that the figure below, Figure HH.1 is the distribution by 5-year age group of the MICS4 sample population. Figure HH.1: Population pyramid, The Gambia, MICS4 2010 Table HH.3 - HH.5 provide basic information on the households’, female respondents age 15-49, and children under-5 by presenting the unweighted, as well as the weighted cases. Information on the basic characteristics of households, women and children under-5 interviewed in the survey is essential for the interpretation of findings presented later in the report and also can provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about the weighting. Table HH.3 provides basic background information on the households. Within households, the sex of the household head, LGA, urban/rural status, number of household members, education of household head, and ethnicity4 of the household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the number of observations by major categories of analysis in the report. The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households where at least one child under 18, at least one child under 5, and at least one eligible woman aged 15-49 were found. The table also shows the weighted average household size estimated by the survey. About 84 per cent of household heads are males and above two-thirds of household heads (68.4%) have no education. More than half of the households live in urban areas (58.5 per cent). Table HH.3 also shows that 28.8 per cent of households consist of 10 or more persons. 4 This was determined by asking to what ethnic group does the head of this household belongs. See household questionnaire for other questions on background information. 20MICS Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, The Gambia, 2010 Weighted percent Number of households Weighted Unweighted Sex of household head Male 83.5 6508 6619 Female 16.5 1283 1172 LGA Banjul 3.7 291 878 Kanifing 27.4 2138 1199 Brikama 30.6 2385 1177 Mansakonko 6.1 473 880 Kerewan 13.0 1016 960 Kuntaur 4.1 320 880 Janjanbureh 6.7 519 900 Basse 8.3 650 917 Area of Residence Urban 58.5 4557 3456 Rural 41.5 3234 4335 Number of household members 1 9.3 721 694 2 5.6 436 400 3 7.0 546 496 4 8.4 658 598 5 9.3 726 676 6 9.7 758 728 7 9.1 710 654 8 6.7 524 546 9 6.0 469 451 10+ 28.8 2243 2548 Education of household head None 68.4 5332 5778 Primary 6.5 508 443 Secondary + 24.8 1929 1552 Missing/DK .3 21 18 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 21 MICS Table HH.3: Household composition (cont.) Percent and frequency distribution of households by selected characteristics, The Gambia, 2010 Weighted percent Number of households Weighted Unweighted Ethnicity of household head Mandinka/Jahanka 29.3 2283 2345 Wollof 13.9 1084 1225 Jola/Karoninka 13.8 1076 589 Fula/Tukulor/Lorodo 23.1 1802 2094 Serere 4.1 323 328 Sarahuleh 5.4 418 471 Creole /Aku Marabou .8 61 75 Manjago 1.8 138 89 Bambara 1.8 136 139 Non Gambian 3.8 300 236 Other ethnic group 1.1 83 67 Missing/DK 1.1 87 133 Total 100.0 7791 7791 Households with at least One child age 0-4 years 63.9 7791 7791 One child age 0-17 years 84.0 7791 7791 One woman age 15-49 years 84.4 7791 7791 Mean household size 8.1 7791 7791 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In both tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to region, urban-rural residence, age, marital status, motherhood status, births in the last two years, education5 , wealth index quintiles6, and ethnicity. 5 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 6 Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calculations were as follows: Number of rooms, main material of dwelling floor, main material of the roof, main material of the exterior walls, fuel mainly used for cooking, and other assets owned, such as electricity, radio, television, bicycle, car, cattle, chicken, etc. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, Filmer and Pritchett, 2001, and Gwatkinet. Al., 2000. 22MICS Table HH.4: Women’s background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, The Gambia, 2010 Weighted percent Number of women Weighted Unweighted LGA Banjul 2.7 394 1113 Kanifing 24.8 3645 1962 Brikama 27.5 4041 1889 Mansakonko 5.8 853 1491 Kerewan 12.5 1832 1706 Kuntaur 4.9 726 1955 Janjanbureh 7.7 1134 1820 Basse 14.0 2060 2749 Area of Residence Urban 51.5 7565 5175 Rural 48.5 7120 9510 Age 15-19 23.7 3481 3410 20-24 20.7 3034 2936 25-29 18.3 2690 2668 30-34 13.7 2008 2025 35-39 10.8 1592 1586 40-44 7.4 1081 1173 45-49 5.4 798 887 Marital/Union status Currently married/in union 67.8 9960 10624 Widowed 1.3 194 190 Divorced 2.7 396 326 Separated .4 55 44 Never married/in union 27.8 4081 3501 Births in last two years Had a birth in last two years 33.8 4963 5222 Had no birth in last two years 66.2 9719 9459 Missing .0 3 4 Education None 54.3 7973 9166 Primary 14.0 2055 1880 Secondary + 31.7 4656 3639 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 23 MICS The table shows that 67.8 per cent of the women interviewed were married at the time of the survey and 48.5 per cent of them live in the rural areas. More than half (54.3 per cent) of the women did not receive any form of formal education. The table also shows that 24.8 per cent of these live in the richest households and 16.4 per cent live in the poorest households. Some background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, region and area of residence, age in months, mother’s or caretaker’s education, wealth, and ethnicity of the household head. Of the under-5 children whose mothers/caretakers were interviewed, 51.0 per cent are males and 57.4 per cent live in the rural areas. The majority of under-5 children who were interviewed are in the age group of 12-23 and 24 - 35 months. They account for 20.7 and 20.4 per cent of the under-5s. About Twenty-one per cent of the under-fives were found in the poorest households and 17.6 per cent in the richest households. Table HH.4: Women’s background characteristics (cont.) Percent and frequency distribution of women age 15-49 years by selected background characteristics, The Gambia, 2010 Weighted percent Number of women Weighted Unweighted Wealth index quintile Poorest 16.4 2402 3549 Second 17.7 2606 2732 Middle 19.2 2821 2676 Fourth 21.9 3219 2829 Richest 24.8 3638 2899 Ethnicity of household head Mandinka/Jahanka 31.0 4546 4603 Wollof 14.7 2153 2442 Jola/Karoninka 12.7 1859 941 Fula/Tukulor/Lorobo 19.6 2885 3503 Serere 3.9 578 496 Sarahuleh 10.2 1503 1676 Creole/ & Aku Marabou .6 89 96 Manjago 1.6 230 134 Bambara 1.5 219 244 Non Other-non Gambian 1.7 249 184 Other ethnic group 1.4 206 124 Missing/DK 1.1 167 242 Total 100.0 14685 14685 24MICS Table HH.5: Under-5’s background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, The Gambia, 2010 Weighted percent Number of under-5 children Weighted Unweighted Sex Male 51.0 5931 5925 Female 49.0 5706 5711 Missing .0 0 1 LGA Banjul 1.8 214 548 Kanifing 18.2 2123 1038 Brikama 27.5 3201 1419 Mansakonko 6.5 754 1293 Kerewan 15.0 1750 1573 Kuntaur 6.3 737 1848 Janjanbureh 8.1 944 1474 Basse 16.4 1914 2444 Area of Residence Urban 42.6 4952 3028 Rural 57.4 6685 8609 Age 0-5 months 12.6 1472 1412 6-11 months 11.5 1342 1352 12-23 months 20.7 2415 2438 24-35 months 20.4 2376 2408 36-47 months 19.7 2292 2282 48-59 months 15.0 1740 1745 Mother’s education* None 68.9 8021 8902 Primary 13.1 1521 1248 Secondary + 18.0 2095 1487 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 25 MICS Table HH.5: Under-5’s background characteristics (cont.) Percent and frequency distribution of children under five years of age by selected characteristics, The Gambia, 2010 Weighted percent Number of under-5 children Weighted Unweighted Wealth index quintile Poorest 20.8 2424 3433 Second 20.3 2358 2355 Middle 20.8 2416 2264 Fourth 20.6 2394 2078 Richest 17.6 2046 1507 Ethnicity of household head Mandinka/Jahanka 29.4 3426 3460 Wollof 15.3 1775 2002 Jola/Karoninka 11.2 1303 625 Fula/Tukulor/Lorobo 21.8 2541 3079 Serere 3.6 417 318 Sarahuleh 11.3 1320 1420 Creole/ Aku Marabou .3 33 37 Manjago 1.2 134 77 Bambara 1.9 216 214 Non Gambian 1.5 177 117 Other ethnic group 1.4 158 95 Missing/DK 1.2 137 193 Total 100.0 11637 11637 * Mother’s education refers to educational attainment of mothers and caretakers of children under 5. 26MICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 27 MICS IV. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) is the reduction of infant and under-five mortality. Specifically, the MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. 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 MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). 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 (Table CM.1). The technique converts the proportions dead among children of women in each age group into probabilities of dying by taking into account the approximate length of exposure of children to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in The Gambia, the South model life table was selected as most appropriate. Table CM.2 provides estimates of child mortality. The infant mortality rate is estimated at 81 per thousand, while the probability of dying under age 5 (U5MR) is around 109 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to mid-2004. Analysing the data by place of residence shows that both infant and under-5 mortality are highest in the rural areas, with both proportions also higher than the national averages. There is some difference between the probabilities of dying among males and females. Infant and under-5 mortality rates are lowest in Banjul, while the figures for Basse are 47 and 80 per cent higher respectively than that of Banjul. There are also significant differences in mortality in terms of educational levels, wealth, and ethnicity. It is observed that for both mortalities the higher the educational attainment of the mother the lower the mortality rates. Women in the poorest households tend to have higher probability of their children dying before their first or fifth birthday compared to their counterparts in the richer households. Differentials in under-5 mortality rates by selected background characteristics are shown in Figure CM.1. Figure CM1. Differential in Under-5 Mortality Rates and Infant Mortality Rates by background characteristics (refer to mid-2010), The Gambia, 2010 28MICS Table CM.2: Child mortality Infant and under-five mortality rates, South Model, The Gambia, 2010 Infant mortality rate1 Under-five mortality rate2 Sex Male 85 114 Female 76 104 LGA Banjul 51 62 Kanifing 76 102 Brikama 74 99 Mansakonko 74 98 Kerewan 77 101 Kuntaur 86 119 Janjanbureh 85 115 Basse 98 142 Area of Residence Urban 75 99 Rural 85 117 Mother’s education None 84 116 Primary 77 102 Secondary+ 60 75 Wealth index quintile Poorest 88 122 Second 83 112 Middle 83 113 Fourth 82 111 Richest 64 81 Ethnicity of household head Mandinka/Jahanka 87 120 Wollof 66 84 Jola/Karoninka 83 120 Fula/Tukulor/Lorobo 80 107 Serere 58 73 Sarahuleh 91 127 Creole/Aku Marabou 50 61 Manjago 29 36 Bambara 83 113 Other ethnic group 66 86 Non-Gambian 91 137 Total 81 109 1 MICS indicator 1.2; MDG indicator 4.2; 2 MICS indicator 1.1; MDG indicator 4.1 Rates refer to 2005.3, South Model was assumed to approximate the age pattern of mortality in The Gambia. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 29 MICS Figure CM.2 shows the series of U5MR estimates of the survey, based on responses of women in different age groups, and referring to various points in time, thus showing the estimated trend in U5MR based on the survey. The MICS estimates indicate a decline in mortality during the last 5 years. The most recent U5MR estimate (109 per thousand live births) from MICS is about 22 per cent lower than the estimate from MICS III (2005/06) for the past 5 years, while the trend indicated by the survey results are in broad agreement with those estimated in 2005/06, in the previous MICS survey. The mortality trend depicted by the 2003 Population and Housing Census is also a declining one; however, MICS results are considerably higher than those indicated by 2003 Population and Housing Census (The U-5 mortality from the 2003 census estimates is 99 per thousand live births and infant mortality is 75 per thousand live births). Further qualification of these apparent declines and differences as well as there determinants should be taken up in a more detailed and separate analysis. The figures below show child mortality estimates for MICS 2010, MICS 2005/06 and the 2003 Population and Housing Census. Figure CM2a. Under-5 Mortality Rates and Infant Mortality Rates (refer to mid-2004), The Gambia, 2010 Figure CM2b. Under-5 Mortality Rates and Infant Mortality Rates (refer to mid-2000), The Gambia, 2006 Figure CM2c. Under-5 Mortality Rates and Infant Mortality Rates , The Gambia, 2003 30MICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 31 MICS V. Nutrition Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in achieving the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on new WHO growth standards . Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as 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 MICS, weights and heights of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF (www.childinfo.org). Findings in this section are based on the results of these measurements. Table NU.1 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population, and mean z-scores for all three anthropometric indicators. Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a plausible range are excluded from Table NU.1. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example if a child has been weighed but his/her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality tables DQ.6 and DQ.7. Overall 99 per cent of children had both their weights and heights measured (Table DQ.6). Table DQ.7 shows that due to incomplete dates of birth, implausible measurements, and missing weight and/or height, 1.6 per cent of children have been excluded from calculations of the weight-for-age indicator, while the figures are 1.6 per cent for the height-for-age indicator, and 1.7 per cent for the weight- for-height indicator. Table NU.1 shows that almost one in five children under age five (17.4 per cent) in The Gambia are moderately underweight and 4.2 per cent are classified as severely underweight. Less than a quarter of children (23.4%) are moderately stunted or too short for their age and 9.5 per cent are moderately wasted or too thin for their height. 32MICS Table NU.1: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, The Gambia, 2010 Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z-Score (SD) Stunted Mean Z-Score (SD) Wasted Overweight Mean Z-Score (SD) percent below percent below percent below percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD Sex Male 17.8 4.6 -1.0 5849 25.4 7.5 -1.2 5806 10.0 2.3 2.4 -.5 5822 Female 16.9 3.7 -1.0 5635 21.3 6.1 -1.1 5618 8.9 1.9 1.5 -.5 5603 LGA Banjul 10.3 2.0 -.7 209 13.0 3.6 -.7 206 6.6 1.4 1.9 -.4 206 Kanifing 8.3 2.2 -.7 2099 14.0 3.5 -.7 2094 7.8 1.6 1.6 -.4 2091 Brikama 12.8 2.6 -.8 3143 19.3 3.9 -1.0 3129 6.2 1.1 2.2 -.4 3132 Mansakonko 19.8 3.2 -1.1 750 25.3 7.2 -1.3 749 7.5 .9 1.5 -.5 752 Kerewan 17.8 4.3 -1.1 1719 31.7 12.7 -1.4 1690 9.0 2.4 4.2 -.4 1687 Kuntaur 27.8 8.0 -1.4 729 25.5 8.3 -1.3 731 17.6 4.1 .6 -1.0 725 Janjanbureh 28.7 7.8 -1.4 939 33.3 10.5 -1.5 936 12.7 3.0 .9 -.8 941 Basse 24.7 6.2 -1.3 1896 27.7 7.9 -1.3 1890 13.7 3.2 .9 -.8 1892 Area of Residence Urban 11.9 2.7 -.8 4885 17.3 4.0 -.9 4863 7.6 1.5 1.8 -.4 4866 Rural 21.4 5.3 -1.2 6599 27.8 9.0 -1.3 6562 10.9 2.5 2.0 -.6 6559 Age 0-5 months 10.6 4.1 -.4 1461 12.0 4.8 -.3 1446 10.5 4.0 6.7 -.2 1424 6-11 months 18.7 5.1 -1.0 1335 15.5 4.8 -.7 1324 12.8 3.2 2.3 -.7 1325 12-23 months 20.9 6.0 -1.1 2369 28.8 9.8 -1.4 2349 12.1 3.0 1.9 -.6 2360 24-35 months 18.4 3.7 -1.1 2342 33.1 8.6 -1.5 2338 7.1 1.4 1.0 -.5 2341 36-47 months 16.3 3.4 -1.1 2269 23.7 5.9 -1.3 2260 7.5 .9 .8 -.5 2265 48-59 months 17.2 2.6 -1.1 1708 17.9 4.8 -1.1 1707 8.2 .7 .5 -.7 1710 Mother’s education None 19.0 4.6 -1.1 7896 25.6 7.8 -1.2 7850 10.1 2.2 1.8 -.6 7852 Primary 15.8 3.4 -.9 1505 20.3 6.1 -1.0 1502 8.7 1.6 2.3 -.5 1503 Secondary+ 12.4 3.1 -.8 2083 17.0 3.7 -.9 2073 7.9 1.9 2.1 -.5 2070 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 33 MICS Table NU.1: Nutritional status of children (cont.) Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, The Gambia, 2010 Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z-Score (SD) Stunted Mean Z-Score (SD) Wasted Overweight Mean Z-Score (SD) percent below percent below percent below percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD Wealth index quintile Poorest 23.5 6.2 -1.3 2390 31.2 11.1 -1.4 2376 11.3 2.8 2.1 -.6 2379 Second 18.7 4.4 -1.1 2320 26.3 7.7 -1.2 2313 9.5 2.2 2.4 -.5 2309 Middle 18.0 3.7 -1.0 2375 24.2 6.8 -1.2 2363 9.1 1.6 1.7 -.5 2367 Fourth 16.0 4.0 -1.0 2378 21.7 5.2 -1.1 2363 9.8 2.3 1.8 -.6 2360 Richest 9.5 2.1 -.7 2021 11.8 2.8 -.7 2010 7.4 1.3 1.7 -.5 2010 Ethnicity of household head Mandinka/Jahanka 16.5 4.2 -1.0 3395 22.8 7.1 -1.1 3371 8.8 1.9 1.4 -.5 3374 Wollof 18.7 4.1 -1.0 1748 23.5 8.0 -1.1 1740 11.0 2.5 2.2 -.6 1738 Jola/Karoninka 12.9 2.7 -.9 1281 19.9 5.2 -1.1 1274 6.3 1.1 2.1 -.3 1274 Fula/Tukulor/Lorobo 20.0 5.1 -1.1 2503 27.0 7.8 -1.3 2493 10.3 2.3 2.0 -.6 2494 Serere 13.7 2.4 -.9 410 18.8 5.0 -1.0 408 6.6 1.7 2.1 -.5 406 Sarahuleh 20.6 5.4 -1.1 1308 23.4 6.4 -1.1 1300 12.5 2.9 1.5 -.7 1301 Creole / Aku Marabou (16.9) (6.4) (-1.0) 32 (19.0) (2.6) (-.6) 32 14.3 6.4 (.0) (-1.0) 32 Manjago 8.3 .0 -.5 128 10.7 1.3 -.5 129 5.2 1.3 3.2 -.3 129 Bambara 14.4 1.4 -.9 208 22.9 6.6 -1.1 207 6.4 .9 4.5 -.3 207 Other ethnic group 12.4 3.2 -.8 158 28.7 5.1 -1.3 158 4.8 2.6 5.3 -.1 158 Non Gambian 14.8 3.5 -.8 177 23.2 5.0 -.9 177 10.7 .4 2.8 -.5 177 Missing/DK 19.4 4.0 -1.1 137 21.7 4.9 -1.0 135 14.6 3.4 1.2 -.8 136 Total 17.4 4.2 -1.0 11484 23.4 6.8 -1.1 11425 9.5 2.1 1.9 -.5 11425 1 MICS indicator 2.1a and MDG indicator 1.8; 2 MICS indicator 2.1b; 3 MICS indicator 2.2a; 4 MICS indicator 2.2b; 5 MICS indicator 2.3a; 6 MICS indicator 2.3b ( ) Figures that are based on 25-49 unweighted case Children in Janjanbureh are more likely to be underweight and stunted than other children. In contrast, the percentage of those wasted is highest in Kuntaur. Those children whose mothers have had secondary and above education are the least likely to be underweight and stunted compared to children of mothers with no education. Boys appear to be slightly more likely to be underweight, stunted, and wasted than girls. The age pattern shows that a higher percentage of children aged 12-23 months are undernourished according to all three indices in comparison to children who are younger and older (Figure NU.1). This pattern is expected and is related to the age at which many children cease to be breastfed and are exposed to contamination in water, food, and environment. 34MICS Figure NU.1: Percentage of children under 5 who are undernourished, The Gambia 2010 Breastfeeding and Infant and Young Child Feeding 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. WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators related to recommended child feeding practices are as follows: • Early initiation of breastfeeding (within 1 hour of birth) • Exclusive breastfeeding rate (< 6 months) • Predominant breastfeeding (< 6 months) • Continued breastfeeding rate (at 1 year and at 2 years) • Duration of breastfeeding • Age-appropriate breastfeeding (0-23 months) • Introduction of solid, semi-solid and soft foods (6-8 months) • Minimum meal frequency (6-23 months) • Milk feeding frequency for non-breastfeeding children (6-23 months) • Bottle feeding (0-23 months) The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 35 MICS Table NU.2: Initial breastfeeding Percentage of last-born children in the 2 years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a pre-lacteal feed, The Gambia, 2010 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a pre-lacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth2 Within one day of birth LGA Banjul 97.9 65.4 90.2 30.5 89 Kanifing 97.1 56.9 83.3 47.5 908 Brikama 98.3 47.3 89.0 33.1 1379 Mansakonko 97.1 35.7 91.2 20.8 311 Kerewan 98.2 57.7 93.5 40.1 723 Kuntaur 97.4 30.3 91.9 47.8 310 Janjanbureh 98.5 58.6 92.9 32.4 412 Basse 98.1 56.3 94.8 28.4 832 Area of residence Urban 97.6 53.3 87.4 42.3 2135 Rural 98.2 50.3 92.4 31.3 2828 Months since birth 0-11 months 98.0 51.3 89.8 35.2 2654 12-23 months 99.5 52.6 92.4 37.5 2213 Assistance at delivery Skilled attendant 98.6 57.4 90.9 35.6 2810 Traditional birth attendant 99.1 44.7 91.6 36.6 1975 Other/Missing 73.5 34.8 66.5 36.4 177 Place of delivery Public sector health facility 98.5 56.6 91.3 35.0 2470 Private sector health facility 99.5 61.1 86.0 40.3 294 Home 99.0 45.4 91.5 37.4 2145 Other/Missing 20.2 12.8 20.2 3.2 55 Mother’s education None 98.0 51.8 91.4 36.0 3236 Primary 97.5 48.8 89.7 35.8 713 Secondary+ 97.8 52.9 87.0 36.1 1014 Wealth index quintile Poorest 97.9 45.2 91.2 34.9 1033 Second 98.3 49.0 91.3 31.2 968 Middle 97.6 51.9 91.8 33.6 1000 Fourth 97.9 54.7 90.6 39.4 1100 Richest 97.8 57.5 85.9 41.1 862 36MICS Table NU.2 provides the proportion of children born in the last two years who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a pre-lacteal feed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 51.6 per cent of babies are breastfed for the first time within one hour of birth, while 90.3 per cent of newborns in The Gambia start breastfeeding within one day of birth. Women in Banjul are more likely to breastfeed their children within one hour after birth (65.4%) than women in other LGAs. However, rural women are more likely to breast feed their children within one day of birth (92.4%) than urban women (87.4%). Women who breastfed their children within one hour of birth is highest for women with secondary education and above. Similarly, women from the richest households were more likely to breastfeed their children within one hour of birth than women from the other wealth quintiles. But the proportion of women who breastfed their children within one day of birth is highest for women with no formal education and women from the poorest to the fourth quintile. In Table NU.3, breastfeeding status is based on the reports of mothers/caregivers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. Table NU.2: Initial breastfeeding (cont.) Percentage of last-born children in the 2 years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a pre-lacteal feed, The Gambia, 2010 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a pre-lacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth2 Within one day of birth Ethnicity of household head Mandinka/Jahanka 97.5 54.2 90.8 28.8 1426 Wollof 97.9 52.5 90.3 50.8 778 Jola/Karoninka 99.2 50.0 89.8 30.6 573 Fula/Tukulor/Lorobo 98.0 49.8 89.6 38.6 1055 Serere 97.6 48.2 94.1 38.0 163 Sarahuleh 98.3 55.3 93.6 36.1 607 Creole / Aku Marabou (*) (*) (*) (*) 14 Manjago 100.0 37.9 89.1 32.7 65 Bambara 93.5 41.9 81.9 43.0 92 Other ethnic group 100.0 29.5 82.2 12.9 62 Non Gambian 94.8 47.3 69.8 40.7 69 Missing/DK 97.3 47.6 95.2 21.8 59 Total 97.9 51.6 90.3 36.0 4963 1 MICS indicator 2.4; 2 MICS indicator 2.5 (*)Figures that are based on less than 25 unweighted cases The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 37 MICS Figure NU.2 Percentage of mothers who started breastfeeding within one hour and one day of birth, The Gambia 2010 Figure 3. Percent distribution of children under age 2 by feeding pattern by age group, Gambia, 2010 In Table NU.3, approximately 34 per cent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. By age 12-15 months, 92.9 per cent of children are still being breastfed and by age 20-23 months, 30.6 per cent are still breastfed. Girls were more likely to be exclusively breastfed than boys. Children between 0-5 months in rural areas were more likely to be exclusively breastfed than those in the urban areas (37.0% compared to 29.4%). It is observed that children of parents with no education and secondary education and above were more likely to be exclusively breastfed than children of mothers with primary education. Similarly, children from households in the second quintile were more likely to be exclusively breastfed than children form the other quintiles. Figure NU.3 shows the detailed pattern of breastfeeding 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. By the end of the sixth month, the percentage of children exclusively breastfed is below 3 per cent. Only about 1 per cent of children are receiving breast milk after 2 years. 38MICS Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, The Gambia, 2010 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Sex Male 32.3 79.2 739 95.0 394 33.3 374 Female 34.8 80.3 733 90.6 371 27.7 345 LGA Banjul (37.1) (76.5) 28 (*) 17 (*) 17 Kanifing 26.9 73.6 277 91.3 120 28.6 114 Brikama 40.0 76.4 470 89.4 217 26.2 186 Mansakonko 43.2 86.7 88 100.0 51 19.8 48 Kerewan 32.5 83.2 195 93.8 132 27.8 111 Kuntaur 16.4 76.0 88 (96.1) 42 38.0 57 Janjanbureh 28.9 85.1 117 91.5 61 52.1 60 Basse 34.1 88.1 209 95.1 125 33.1 124 Area of residence Urban 29.4 73.8 673 91.9 304 27.4 270 Rural 37.0 84.7 799 93.5 461 32.5 449 Mother’s education None 34.9 83.2 932 92.8 524 33.9 479 Primary 25.8 73.9 218 99.4 110 35.2 80 Secondary+ 34.9 73.5 321 87.6 132 18.3 159 Wealth index quintile Poorest 30.7 86.9 274 96.0 166 36.4 188 Second 38.4 80.8 317 92.0 184 28.4 113 Middle 35.6 78.8 302 91.7 130 40.3 141 Fourth 30.5 81.4 325 91.7 162 22.4 154 Richest 31.9 69.4 254 92.7 123 22.9 123 Ethnicity of household head Mandinka/Jahanka 38.9 80.3 455 94.8 204 32.9 207 Wollof 20.9 77.7 221 90.7 138 26.9 108 Jola/Karoninka 50.5 84.1 183 83.7 85 30.9 82 Fula/Tukulor/Lorobo 31.3 79.2 315 96.5 159 35.7 170 Serere 24.1 74.1 53 96.3 34 9.8 15 Sarahuleh 21.5 82.2 132 92.6 93 27.5 88 Creole / Aku Marabou (*) (*) 5 (*) 4 (*) 1 Manjago (*) (*) 20 (*) 16 (*) 3 Bambara 38.2 91.7 28 (*) 14 (*) 16 Other ethnic group 24.5 61.7 24 (*) 9 (*) 11 Non Gambians (*) (*) 21 (*) 4 (*) 11 Missing/DK (*) (*) 12 (*) 5 (*) 6 Total 33.5 79.7 1472 92.9 765 30.6 718 1 MICS indicator 2.6; 2 MICS indicator 2.9; 3 MICS indicator 2.7; 4 MICS indicator 2.8; ( ) Figures that are based on 25-49 unweighted cases; (*) Figures that are based on less that 25 unweighted cases The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 39 MICS Table NU.4: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, The Gambia, 2010 Median duration (in months) of Number of children age 0-35 monthsAny breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Sex Male 20.1 1.1 5.9 3888 Female 19.5 1.2 5.9 3717 LGA Banjul 18.9 .7 4.9 139 Kanifing 18.8 .6 5.6 1368 Brikama 19.7 1.9 5.5 2103 Mansakonko 19.0 2.2 6.8 480 Kerewan 19.8 1.0 5.7 1164 Kuntaur 20.6 .5 5.5 483 Janjanbureh 21.6 .7 6.8 614 Basse 19.7 1.2 6.7 1254 Area of Residence Urban 19.5 .8 5.6 3250 Rural 20.0 1.4 6.1 4355 Mother’s education None 20.3 1.3 6.1 5113 Primary 20.4 .7 5.6 1016 Secondary+ 18.0 .9 5.2 1475 Wealth index quintile Poorest 20.4 .7 6.7 1594 Second 20.4 1.7 5.7 1541 Middle 20.6 1.7 5.9 1554 Fourth 18.9 .7 5.8 1589 Richest 18.6 .8 5.2 1326 Ethnicity of household head Mandinka/Jahanka 19.5 1.9 6.2 2250 Wollof 20.1 .6 5.5 1167 Jola/Karoninka 20.2 2.6 5.9 831 Fula/Tukulor/Lorobo 20.6 .9 6.3 1638 Serere 20.2 .9 5.3 273 Sarahuleh 18.9 .6 5.7 881 Creole /& Aku Marabou (*) (*) (*) 20 Manjago 15.9 2.3 5.9 97 Bambara 18.0 .7 7.3 146 Other ethnic group 19.9 . 3.9 107 Median 19.8 1.2 5.9 7605 Mean for all children (0-35 months) 19.3 2.0 6.5 7605 1 MICS indicator 2.10 (*) Figures that are based on less that 25 unweighted cases 40MICS Table NU.4 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 19 months for any breastfeeding, 2 months for exclusive breastfeeding, and about 7 months for predominant breastfeeding. For any breastfeeding, the median duration is 20 months among children whose mothers have primary or no education and 18 months among those whose mothers have secondary and above education. There is not much difference between urban and rural in terms of mean duration of any breastfeeding. In Table NU.5, the adequacy of infant feeding in children under 24 months is provided. Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding, while infants aged 6-23 months are considered to be adequately fed if they are receiving breast milk and solid, semi-solid or soft food. Only 33.5 per cent of children less than six months are exclusively breastfed and this percentage drops to 16 per cent in Kuntaur and under 30 per cent in Kanifing and Janjanbureh. More girls 0-5 months (34.8%) than boys (32.3%) were exclusively breastfed. And more rural children 0-5 months (37.0 %) than urban children of the same age (29.4 %). About fifty six percent of 6-23 old infants were currently breastfed and receiving solid, semi-solid or soft foods with slightly more male children (57.0%) compared to females (54.6 %). As a result of these feeding patterns, only 55.9 per cent of children aged 6-23 months are being adequately fed. Analysing the data by LGA shows that the proportion of children 0 – 23 months who are appropriately breastfed is highest in Kerewan with 58.9 per cent and lowest in Kanifing with 40 per cent. Adequate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the prevention of under nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. Overall, 34.3 per cent of infants age 6-8 received solid, semi-solid, or soft foods (Table NU.6). Among currently breastfeeding infants this percentage is 34.3 while it is 54.9 among infants currently not breastfeeding. In general, male infants 6-8 months are more likely to receive solid, semi-solid or soft foods (36.5 %) than their female counterparts (32.2%). Similarly, children living in rural areas (38.0%) were more likely to receive solid, semi-solid or soft foods than children living in urban areas (29.6%). Table NU.7 presents the proportion of children age 6-23 months who received semi-solid or soft foods the minimum number of times or more during the previous day according to breastfeeding status (see the note in Table NU.7 for a definition of minimum number of times for different age groups). Overall, less than one-third of children age 6-23 months (28.8 %) were receiving solid, semi-solid and soft foods the minimum number of times. A slightly higher proportion of males (29.4%) were enjoying the minimum meal frequency compared to females (28.1%). Among currently breastfeeding children age 6-23 months, less than one-third of them (27.5%) were receiving solid, semi-solid and soft foods the minimum number of times and this proportion was higher among males (28.5 %) compared to females (26.4 %). Among non-breastfeeding children, nearly one-third of the children were receiving solid, semi-solid and soft foods or milk feeds 4 times or more. The continued practice of bottle-feeding is a concern because of possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.8 shows that ten per cent of children under 2 years are fed using a bottle with a nipple. Percentage of children age 0-23 months fed with a bottle with a nipple is predominant in Banjul and Kanifing with 23.9 and 22.5 per cent respectively. This explains the huge disparity between 0-23 months fed with a bottle with a nipple in urban areas (17.1 %) and rural areas (5.5 %). The use of feeding children with a bottle with a nipple is linked to the wealth index of the household. Children 0-23 months from the richest households (25.2%) are more likely to be fed with a bottle with a nipple than children from poorer households. It is also linked to the mother’s level of education as children whose mothers have no education are the least likely to be fed with a bottle with a nipple. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 41 MICS Table NU.5: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, The Gambia, 2010 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Percent appropriately breastfed2 Number of children Sex Male 32.3 739 57.0 1951 50.3 2690 Female 34.8 733 54.6 1806 48.9 2538 LGA Banjul (37.1) 28 48.4 65 45.0 93 Kanifing 26.9 277 45.5 657 40.0 934 Brikama 40.0 470 55.0 975 50.1 1444 Mansakonko 43.2 88 48.1 238 46.8 326 Kerewan 32.5 195 67.4 605 58.9 800 Kuntaur 16.4 88 62.7 245 50.5 334 Janjanbureh 28.9 117 64.2 311 54.5 429 Basse 34.1 209 53.9 661 49.1 869 Area of Residence Urban 29.4 673 52.3 1536 45.3 2209 Rural 37.0 799 58.3 2221 52.7 3020 Mother’s education None 34.9 932 58.0 2508 51.8 3440 Primary 25.8 218 56.4 522 47.4 741 Secondary+ 34.9 321 48.0 727 44.0 1048 Wealth index quintile Poorest 30.7 274 58.9 835 52.0 1109 Second 38.4 317 63.6 713 55.9 1030 Middle 35.6 302 58.1 743 51.6 1045 Fourth 30.5 325 52.5 832 46.4 1158 Richest 31.9 254 44.9 633 41.2 887 Ethnicity of household head Mandinka/Jahanka 38.9 455 51.9 1033 47.9 1489 Wollof 20.9 221 64.4 605 52.8 827 Jola/Karoninka 50.5 183 59.0 411 56.4 594 Fula/Tukulor/Lorobo 31.3 315 55.2 812 48.5 1128 Serere 24.1 53 58.1 119 47.6 172 Sarahuleh 21.5 132 52.7 504 46.2 637 Creole / Aku Marabou (*) 5 (*) 11 (*) 17 Manjago (*) 20 (44.3) 48 44.1 68 Bambara 38.2 28 62.6 73 55.8 101 Other ethnic group (*) 24 (74.3) 44 56.6 68 Non Gambians (*) 21 (44.1) 49 34.7 70 Total 33.5 1472 55.9 3757 49.6 5229 1 MICS indicator 2.6; 2 MICS indicator 2.14 ( ) Figures that are based on 25-49 unweighted cases; (*) Figures that are based on less that 25 unweighted cases 42MICS Table NU.6: Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day, The Gambia, 2010 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods1 Number of children age 6-8 months Sex Male 36.6 378 (*) 1 36.5 379 Female 32.1 380 (*) 3 32.2 385 Area of Residence Urban 29.8 333 (*) 0 29.6 335 Rural 37.9 425 (*) 4 38.0 429 Total 34.3 758 (*) 4 34.3 764 1 MICS indicator 2.12 (*) Figures that are based on less that 25 unweighted cases Table NU.7: Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breastfeeding status, The Gambia, 2010 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid and soft foods the minimum number of times Number of children age 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Percent with minimum meal frequency2 Number of children age 6-23 months Sex Male 28.5 1520 19.0 32.9 431 29.4 1951 Female 26.4 1402 13.8 33.7 404 28.1 1806 Age 6-8 months 19.7 758 (*) (*) 6 19.9 764 9-11 months 13.7 560 (*) (*) 18 15.2 578 12-17 months 32.5 1064 23.4 35.7 134 32.9 1199 18-23 months 42.9 539 14.0 31.8 677 36.8 1216 LGA Banjul (20.9) 47 (*) (*) 18 23.8 65 Kanifing 17.2 496 33.9 43.5 161 23.6 657 Brikama 24.7 739 11.0 29.4 235 25.8 975 Mansakonko 29.6 181 9.6 31.4 57 30.1 238 Kerewan 52.9 470 19.9 44.6 135 51.1 605 Kuntaur 31.4 202 (12.1) (41.3) 44 33.2 245 Janjanbureh 32.8 265 (9.3) (48.3) 46 35.1 311 Basse 14.0 522 6.6 10.3 139 13.2 661 Area of Residence Urban 23.9 1180 26.0 38.2 356 27.2 1536 Rural 29.9 1741 9.4 29.6 480 29.8 2221 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 43 MICS Table NU.7: Minimum meal frequency (cont.) Percentage of children age 6-23 months who received solid, semi-solid, or soft foods (and milk feeds for non-breastfeeding children) the minimum number of times or more during the previous day, according to breastfeeding status, The Gambia, 2010 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid and soft foods the minimum number of times Number of children age 6-23 months Percent receiving at least 2 milk feeds1 Percent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Percent with minimum meal frequency2 Number of children age 6-23 months Mother’s education None 28.1 1986 12.7 29.7 522 28.5 2508 Primary 24.3 440 14.4 29.6 82 25.1 522 Secondary+ 27.7 495 25.7 42.5 232 32.4 727 Wealth index quintile Poorest 33.0 663 7.5 28.9 173 32.2 835 Second 35.3 585 11.0 30.3 129 34.4 713 Middle 23.6 584 15.0 36.3 158 26.3 743 Fourth 26.1 622 11.1 27.3 210 26.4 832 Richest 16.7 468 38.3 44.8 165 24.0 633 Ethnicity of household head Mandinka/Jahanka 28.9 790 15.3 30.9 244 29.3 1033 Wollof 31.9 484 21.0 44.0 121 34.3 605 Jola/Karoninka 30.0 309 1.8 17.9 102 27.0 411 Fula/Tukulor/Lorobo 27.7 654 12.9 35.0 159 29.1 812 Serere 32.8 97 42.8 (*) 22 39.1 119 Sarahuleh 17.6 385 13.7 21.2 120 18.5 504 Creole/ Aku Marabou (*) 7 (*) (*) 4 (*) 11 Manjago (6.8) 37 (*) (*) 11 (21.1) 48 Bambara 28.0 56 (*) (*) 17 33.2 73 Other ethnic group (33.8) 36 (*) (*) 8 (35.9) 44 Non Gambian (30.7) 28 (*) (*) 21 (43.8) 49 Missing/DK (21.1) 40 (*) (*) 7 (23.2) 47 Total 27.5 2922 16.5 33.3 835 28.8 3757 1 MICS indicator 2.15; 2 MICS indicator 2.13 ( ) Figures that are based on 25-29 unweighted cases; (*) Figures that are based on less that 25 unweighted cases 44MICS Table NU.8: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, The Gambia, 2010 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Sex Male 10.7 2690 Female 10.1 2538 Age 0-5 months 15.5 1472 6-11 months 11.0 1342 12-23 months 7.0 2415 LGA Banjul 23.9 93 Kanifing 22.5 934 Brikama 9.1 1444 Mansakonko 6.8 326 Kerewan 9.5 800 Kuntaur 4.4 334 Janjanbureh 5.8 429 Basse 4.8 869 Area of Residence Urban 17.1 2209 Rural 5.5 3020 Mother’s education None 6.7 3440 Primary 13.6 741 Secondary+ 20.1 1048 Wealth index quintile Poorest 3.5 1109 Second 7.0 1030 Middle 7.8 1045 Fourth 11.0 1158 Richest 25.2 887 Ethnicity of household head Mandinka/Jahanka 13.1 1489 Wollof 11.2 827 Jola/Karoninka 8.6 594 Fula/Tukulor/Lorobo 5.8 1128 Serere 15.4 172 Sarahuleh 8.4 637 Creole / Aku Marabou (*) 17 Manjago 21.1 68 Bambara 7.7 101 Other ethnic group 14.5 68 Non Gambians 34.0 70 Missing/DK 1.7 59 Total 10.4 5229 1 MICS indicator 2.11 (*) Figures that are based on less that 25 unweighted cases The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 45 MICS Table NU.9: Iodized salt consumption Percent distribution of households by consumption of iodized salt, The Gambia, 2010 Percentage of households in which salt was tested Number of households Percent of households with salt test result Total Number of households in which salt was tested or with no salt Percent of household with no salt Not iodized 0 PPM >0 and <15 PPM 15+ PPM1 LGA Banjul 77 291 22.6 19.5 28.6 29.3 100 289 Kanifing 82.1 2138 17.8 24.4 33.5 24.4 100 2134 Brikama 91.4 2385 8.5 37.5 35.3 18.7 100 2381 Mansakonko 89.9 473 9.2 56.3 16 18.5 100 468 Kerewan 92.4 1016 7.4 68.9 17.4 6.3 100 1014 Kuntaur 94.1 320 5.7 34 33.8 26.4 100 319 Janjanbureh 90.4 519 9 20.3 32.3 38.5 100 516 Basse 93.6 650 6.3 28.8 29.9 35.1 100 649 Area of Residence Urban 83.8 4557 15.9 27.6 33.3 23.1 100 4544 Rural 95.2 3234 4.6 48.8 26.2 20.4 100 3226 Wealth index quintile Poorest 96.7 1301 3 47.5 26.2 23.3 100 1297 Second 93.5 1408 6.3 46.6 29.1 17.9 100 1406 Middle 90.8 1428 9.1 39.6 32.3 19 100 1426 Fourth 81.3 1697 18.5 29 30.1 22.4 100 1692 Richest 84.3 1957 15.4 25.9 32.9 25.9 100 1949 Total 88.6 7791 11.2 36.4 30.4 22 100 7770 1 MICS indicator 2.16 Salt Iodization Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The international goal is to achieve sustainable elimination of iodine deficiency by 2005. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million -PPM). In The Gambia, the National Nutrition Agency (NaNA) in 2003 started working with some of the local salt producers to increase the amount of salt produced and iodized. In 2006, the Food Fortification and Salt Iodization Regulation was enacted to ensure that all salt imported and produced locally for human and animal consumption is iodized (Food Fortification and Salt Iodization Regulation, 2006). Information and Education Communication on the consumption of iodized salt has also been intensified. In Table NU.9, about 89 per cent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of both potassium iodide and potassium iodate. The table shows that in a very small proportion of households (11.2 %), there was no salt available. These were mainly single person households who reported that they don’t cook. In only 22 per cent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Use of iodized salt was lowest in Kerewan (6.3 %) and highest in Janjanbureh (38.5%). The urban and rural difference is small as only 23 per cent of urban households were found to be using adequately iodized salt compared to 20.4 per cent in rural areas. Interestingly, the difference between the richest and poorest households in terms of iodized salt consumption is also small. 46MICS Figure NU.4 Percentage of households consuming adequately iodized salt, The Gambia 2010 Children’s Vitamin A Supplementation Vitamin A is essential for eye health and the proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of under-five deaths. The 1990 World Summit for Children set the goal of virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly’s Special Session on Children in 2002. The critical role of vitamin A for child health and immune function also makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under-five mortality by the year 2015. For countries with vitamin A deficiency problems, current international recommendations call for high-dose vitamin A supplementation every four to six months, targeted to all children between the ages of six to 59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months of life and helps to replenish the mother’s stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A supplementation programs, the definition of the indicator is the percent of children 6-59 months of age receiving at least one high dose vitamin A supplement in the last six months. Based on UNICEF/WHO guidelines, the Gambia Ministry of Health recommends that children aged 6-11 months be given one high dose Vitamin A capsules and children aged 12-59 months given a vitamin A capsule every 6 months. In all parts of the country, Vitamin A capsules are linked to immunization services and are given when the child has contact with these services after six months of age. It is also recommended that mothers take a Vitamin A supplement within eight weeks of giving birth due to increased Vitamin A requirements during pregnancy and lactation. Table NU.10 presents that within the six months prior to the MICS, 72.8 per cent of children aged 6-59 months received a high dose Vitamin A supplement. Approximately 83 per cent did not receive the supplement in the last 6 months but did receive one prior to that time. Vitamin A supplementation coverage is lower in Janjanbureh and Brikama than in other LGAs. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 47 MICS Table NU.10: Children’s vitamin A supplementation Percent distribution of children age 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, The Gambia, 2010 Percentage who received Vitamin A according to: Percentage of children who received Vitamin A during the last 6 months1 Percentage of children who received Vitamin A more than last 6 months Number of children age 6-59 months Child health book/ card/vaccination card Mother’s report Sex Male 59.1 23.6 72.1 82.6 5192 Female 60.8 26.0 73.4 82.4 4974 LGA Banjul 40.8 13.0 70.6 82.9 187 Kanifing 44.1 14.5 74.6 73.5 1846 Brikama 47.2 18.1 54.9 81.7 2731 Mansakonko 53.9 17.8 67 86.6 666 Kerewan 75.4 24.8 80.6 73.9 1556 Kuntaur 68.4 27.3 97.7 92.3 649 Janjanbureh 47.5 18.7 52.7 89.0 827 Basse 90.7 52.4 95.0 92.8 1705 Area of Residence Urban 49.3 20.3 67.6 77.9 4279 Rural 67.6 28.0 76.6 85.9 5886 Age 6-11 months 74.7 12.4 78.3 43.8 1342 12-23 months 72.6 14.3 84.0 83.5 2415 24-35 months 58.4 26.6 72.2 87.5 2376 36-47 months 49.1 31.8 66.6 91.1 2292 48-59 months 47.4 36.9 61.9 92.7 1740 Mother’s education None 61.7 26.3 74.2 83.7 7089 Primary 59.7 24.0 70.1 74.9 1303 Secondary+ 53.2 19.2 69.1 79.8 1774 48MICS Table NU.10: Children’s vitamin A supplementation (cont.) Percent distribution of children age 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, The Gambia, 2010 Percentage who received Vitamin A according to: Percentage of children who received Vitamin A during the last 6 months1 Percentage of children who received Vitamin A more than last 6 months Number of children age 6-59 months Child health book/ card/vaccination card Mother’s report Wealth index quintile Poorest 64.2 25.9 73.4 85.8 2150 Second 59.6 23.5 69.5 83.3 2041 Middle 63.2 27.7 73.1 83.5 2113 Fourth 60.4 26.1 74.6 81.6 2069 Richest 50.8 19.7 73.2 77.5 1793 Ethnicity of household head Mandinka/Jahanka 58.8 21.2 71.3 83.4 2970 Wollof 61.7 22.5 77.0 78.4 1554 Jola/Karoninka 46.4 15.8 60.5 80.2 1120 Fula/Tukulor/Lorobo 57.8 26.9 71.8 82.9 2226 Serere 54.8 20.3 70.4 85.8 364 Sarahuleh 80.2 42.8 87.3 89.5 1188 Creole / Aku Marabou (48.8) (33.4) (74.8) (74.4) 27 Manjago 55.1 13.8 74.7 82.9 114 Bambara 68.9 29.5 76.0 70.6 187 Other ethnic group 43.1 12.6 47.1 81.4 134 Non Gambian 51.4 22.9 65.9 72.9 156 Missing/DK 70.6 36.3 78.6 82.8 125 Total 59.9 24.8 72.8 82.5 10165 1 MICS indicator 2.174 ( ) Figures that are based on 25-49 unweighted cases The age pattern of Vitamin A supplementation shows that supplementation in the last six months increases from 78.3 per cent among children aged 6-11 months to 84.0 per cent among children aged 12-23 months and then declines steadily with age to 61.9 percent among the oldest children. The mother’s level of education is not related to the likelihood of Vitamin A supplementation. The percentage receiving a supplement in the last six months decreases from 74.2 per cent among children whose mothers have no education to 70.1 per cent of those whose mothers have primary education and further decreases to 69.1 per cent among children of mothers with secondary and above. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 49 MICS Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: 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 the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth8. 8 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. 50MICS Table NU.11: Low birth weight infants Percentage of last-born children in the 2 years preceding the survey that are estimated to have weighed below 2500 grams at birth and percentage of live births weighed at birth, The Gambia, 2010 Percent of live births: Number of live births in the last 2 yearsBelow 2500 grams1 Weighed at birth2 LGA Banjul 9.1 90.5 89 Kanifing 9.1 83.5 908 Brikama 8.3 59.2 1379 Mansakonko 7.8 42.0 311 Kerewan 13.8 39.8 723 Kuntaur 15.9 27.8 310 Janjanbureh 10.7 25.4 412 Basse 10.0 31.0 832 Area of Residence Urban 9.1 71.6 2135 Rural 11.1 35.1 2828 Mother’s education None 10.8 42.4 3236 Primary 9.6 55.8 713 Secondary+ 8.7 74.2 1014 Wealth index quintile Poorest 12.2 26.3 1033 Second 11.0 43.4 968 Middle 9.7 47.9 1000 Fourth 9.0 59.0 1100 Richest 9.0 81.4 862 Ethnicity of household head Mandinka/Jahanka 8.7 54.9 1426 Wollof 13.1 50.1 778 Jola/Karoninka 8.8 61.8 573 Fula/Tukulor/Lorobo 10.7 41.8 1055 Serere 13.4 64.9 163 Sarahuleh 9.5 42.4 607 Creole/ Aku Marabou (*) (*) 14 Manjago 7.1 69.8 65 Bambara 13.8 44.2 92 Other ethnic group 6.0 47.2 62 Non Gambians 14.0 66.2 69 Missing/DK 9.3 37.0 59 Total 10.2 50.8 4963 1 MICS indicator 2.18; 2 MICS indicator 2.19 (*) Figures that are based on less that 25 unweighted cases The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 51 MICS Figure NU.5 Percentage of Infants weighing less than 2500 grams at birth, The Gambia 2010 Overall, 50.8 per cent of births were weighed at birth and 10.2 per cent of infants are estimated to weigh less than 2500 grams at birth (Table NU.11). There is notable variation by LGA (Figure NU.5). The percentage of low birth weight does not vary much by urban and rural areas or by mother’s level of education. 52MICS The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 53 MICS VI. Child Health Vaccinations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. 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. Table CH.1: Vaccinations in first year of life Percentage of children age 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, The Gambia, 2010 Vaccinated at any time before the survey according to Vaccinated by 12 months of ageVaccination card Mother’s report Either BCG1 93.6 5.5 99.2 98.9 Polio At birth 92.9 3.9 96.9 96.5 1 92.1 5.8 97.9 97.2 2 92.2 5.4 97.5 96.7 32 90.8 4.3 95.2 93.4 DPT 1 92.7 5.2 97.9 96.5 2 92.6 4.9 97.6 96.2 33 89.5 3.7 93.2 89.3 Measles4 90.0 4.9 94.9 87.6 Hep B At birth 85.1 2.1 87.2 86.2 PNE 1 50.4 3.4 53.8 49.1 PNE 2 41.8 2.9 44.8 38.9 PNE 3 31.0 1.0 32.0 25.0 Yellow fever6 89.6 4.9 94.5 87.5 All vaccinations 84.8 2.5 87.4 38.6 No vaccinations .2 .5 .6 .6 Number of children age 12-23 months 2415 2415 2415 2415 1 MICS indicator 3.1; 2 MICS indicator 3.2; 3 MICS indicator 3.3; 4 MICS indicator 3.4; MDG indicator 4.3; 5 MICS indicator 3.5; 6 MICS indicator 3.6 54MICS Overall, 94.1 per cent of children had health cards (Table CH.2). If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio, how many times. The percentage of children age 12 to 23 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children age 12-23 months so that 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, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. According to the cards and the mother’s recollection, the majority of children under 5 have been fully immunized against the main childhood diseases (87%) but only 38 per cent have received them before they reached their first birthday. Less than 1 per cent of children under 5 have never received any vaccines. Approximately 99 per cent of children age 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 96.5 per cent of them. The percentage declines for subsequent doses of DPT to 96.2 per cent for the second dose, and to 89.3 per cent for the third dose (Figure CH.1). Similarly, 97.2 per cent of children received Polio 1 by age 12 months and this declines to 93.4 per cent by the third dose. The coverage for measles vaccine by 12 months is lower than the other vaccines at 87.6 per cent. This is primarily because, although 94.9 per cent of children (according to the vaccination card and mothers report combined) received the vaccine, only 87.6 per cent received it by their first birthday. As a result, the percentage of children who had all the recommended vaccinations by their first birthday is low at only 38.6 per cent. Figure CH 1. Percentage of children age 12-23 months who received the recommended vaccinations by 12 months, The Gambia, 2010 In The Gambia, PENTA vaccines are also recommended as part of the immunization schedule. The Gambia Expanded Programme on Immunization has switched from Tetra Valent to PENTA Valent on 1st April 2009. PENTA 1 is given at the age of two months, PENTA 2 at three months and PENTA 3 at the age of four months. Table CH.2 shows vaccination coverage rates among children 12-23 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caregivers’ reports. The proportion of children aged 12 -23 months that had all the vaccines are 87.4 per cent. The coverage is higher among children in rural (89.2%) than in urban areas (84.7%). Coverage is also highest among children of mothers/ caregivers with primary education (92.9%) than children of mothers /caregivers with no or secondary education and above (86.0 and 88.7% respectively). Janjanbureh has the highest proportion of children who had all the vaccines (91.1%) and Banjul had the lowest proportion (80.1%). The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 55 MICS Ta bl e CH .2 : V ac ci na ti on s by b ac kg ro un d ch ar ac te ri st ic s Pe rc en ta ge o f c hi ld re n ag e 12 -2 3 m on th s c ur re nt ly v ac ci na te d ag ai ns t c hi ld ho od d is ea se s, Th e G am bi a, 2 01 0 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge w ith v ac ci na tio n c a rd se en N um be r o f ch ild re n ag e 12 -2 3 m on th s Po lio D PT M ea sl es H ep B Ye llo w fe ve r N on e Al l BC G At b irt h 1 2 3 1 2 3 At b irt h 1 2 3 Se x M al e 98 .7 96 .5 98 .3 97 .5 95 .7 97 .7 97 .6 93 .7 94 .5 87 .2 53 .1 44 .7 31 .7 94 .2 .8 87 .5 94 .0 12 92 Fe m al e 99 .7 97 .3 97 .5 97 .7 94 .6 98 .1 97 .5 92 .7 95 .3 87 .2 54 .6 44 .9 32 .3 95 .0 .3 87 .2 94 .2 11 23 LG A Ba nj ul 98 .4 95 .3 97 .2 96 .9 91 .2 95 .9 95 .2 90 .0 93 .9 80 .4 55 .0 49 .2 36 .4 93 .9 1. 6 80 .1 91 .5 49 Ka ni fin g 98 .2 97 .5 96 .8 96 .6 92 .8 96 .3 95 .9 92 .6 92 .5 81 .8 56 .2 42 .9 33 .1 92 .1 1. 8 85 .3 93 .1 39 5 Br ik am a 99 .2 94 .7 98 .3 97 .5 95 .0 98 .4 97 .5 92 .7 95 .7 87 .6 60 .4 51 .1 34 .8 94 .9 .0 86 .4 93 .1 65 3 M an sa ko nk o 98 .6 96 .8 97 .2 97 .5 96 .5 96 .0 97 .7 95 .0 94 .8 91 .4 44 .0 38 .2 29 .0 94 .2 1. 4 87 .0 93 .8 15 4 Ke re w an 99 .9 99 .4 97 .8 97 .5 95 .0 98 .3 98 .2 91 .9 95 .7 94 .4 38 .7 35 .0 24 .9 95 .7 .1 86 .8 94 .1 40 6 Ku nt au r 98 .9 96 .1 97 .6 97 .9 94 .8 98 .3 98 .1 95 .3 94 .2 78 .5 53 .5 43 .5 33 .7 94 .2 1. 1 89 .8 92 .2 14 7 Ja nj an bu re h 98 .7 97 .4 98 .3 97 .7 95 .8 96 .9 96 .5 95 .1 95 .4 82 .1 52 .5 43 .0 32 .2 95 .4 1. 3 91 .1 97 .0 20 3 Ba ss e 10 0. 0 97 .4 99 .0 98 .4 97 .7 99 .3 99 .1 94 .2 95 .1 89 .4 60 .2 49 .6 33 .2 95 .1 .0 89 .7 96 .3 40 7 Ar ea o f R es id en ce Ur ba n 98 .9 97 .0 97 .2 96 .4 93 .1 96 .8 96 .7 91 .9 93 .7 85 .1 56 .5 45 .5 32 .2 93 .3 .9 84 .7 93 .3 97 9 Ru ra l 99 .3 96 .8 98 .5 98 .3 96 .6 98 .6 98 .1 94 .1 95 .6 88 .7 52 .0 44 .3 31 .8 95 .4 .4 89 .2 94 .7 14 36 M ot he r’s e du ca tio n N on e 98 .8 96 .1 97 .4 96 .8 94 .7 97 .2 97 .1 92 .2 93 .9 86 .8 53 .6 44 .2 31 .6 93 .5 .8 86 .0 94 .5 16 36 Pr im ar y 10 0. 0 97 .8 99 .1 99 .6 97 .2 99 .6 99 .0 97 .3 97 .3 88 .7 59 .1 49 .4 36 .8 97 .3 .0 92 .9 95 .6 30 2 Se co nd ar y+ 99 .7 98 .8 98 .9 98 .6 95 .5 99 .0 98 .2 94 .2 96 .5 87 .8 51 .1 44 .0 30 .3 96 .3 .3 88 .7 91 .9 47 7 W ea lth in de x qu in til e Po or es t 99 .4 95 .9 98 .7 98 .5 96 .9 98 .3 98 .0 94 .0 96 .2 87 .0 50 .2 42 .1 29 .1 96 .0 .6 89 .5 92 .8 54 9 Se co nd 99 .4 97 .3 97 .5 96 .8 94 .0 98 .3 97 .2 92 .5 92 .4 86 .8 53 .5 46 .1 34 .9 92 .4 .2 83 .9 93 .7 45 4 M id dl e 99 .1 96 .2 97 .5 97 .1 93 .5 97 .5 97 .2 91 .3 94 .8 87 .3 55 .5 43 .6 29 .0 93 .5 .9 85 .2 94 .3 48 9 Fo ur th 99 .1 97 .7 98 .4 97 .4 95 .3 98 .1 97 .5 93 .7 94 .8 88 .1 57 .4 49 .2 33 .7 94 .3 .2 88 .3 95 .4 52 0 R i ch es t 98 .6 97 .4 97 .4 97 .8 96 .0 96 .8 97 .8 94 .8 96 .1 86 .6 52 .3 42 .8 34 .0 96 .6 1. 4 89 .8 94 .4 40 3 Et hn ic ity o f h ou se ho ld h ea d M an di nk a 99 .3 97 .1 97 .8 97 .7 96 .1 97 .0 97 .5 93 .7 95 .5 88 .7 55 .1 46 .8 32 .7 95 .1 .4 88 .8 93 .9 67 7 W ol lo f 98 .8 97 .5 97 .2 97 .2 95 .9 97 .5 97 .5 93 .9 97 .3 89 .6 48 .7 43 .5 35 .6 97 .3 1. 2 90 .4 95 .4 38 0 Jo la 99 .9 95 .0 99 .0 99 .0 96 .1 99 .0 99 .0 91 .1 96 .2 85 .3 59 .2 47 .7 30 .6 96 .2 .1 86 .1 92 .5 27 5 Fu la 99 .1 96 .9 97 .5 96 .3 94 .0 97 .7 96 .3 93 .9 93 .1 84 .8 50 .4 40 .3 27 .2 92 .8 .9 86 .6 93 .7 53 5 Se re re 99 .4 97 .5 97 .0 98 .4 97 .8 98 .9 98 .9 97 .6 98 .5 82 .9 55 .3 46 .6 36 .6 98 .5 .6 93 .8 96 .4 82 Sa ra hu le h 99 .6 98 .3 98 .9 97 .5 94 .1 98 .7 97 .7 90 .6 92 .3 88 .9 54 .4 42 .7 32 .3 93 .0 .4 85 .5 96 .2 30 4 Cr eo le / A ku M ar ab ou (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 7 M an ja go 97 .7 92 .3 97 .7 97 .7 97 .7 97 .7 97 .7 92 .6 92 .3 84 .7 89 .0 89 .0 62 .5 74 .5 2. 3 69 .4 (9 2. 3) 30 Ba m ba ra 10 0. 0 10 0. 0 10 0. 0 10 0. 0 86 .6 10 0. 0 99 .2 87 .2 98 .0 92 .2 53 .8 43 .8 24 .8 98 .0 .0 77 .1 (8 9. 9) 43 O th er e th ni c gr ou p 87 .1 87 .1 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 85 .7 77 .5 68 .3 60 .1 51 .9 85 .7 .0 85 .7 (1 00 .0 ) 27 N on G am bi an 10 0. 0 91 .3 94 .4 10 0. 0 87 .4 97 .6 97 .6 96 .5 92 .9 89 .0 43 .7 29 .7 17 .9 92 .9 .0 77 .1 (8 4. 3) 32 M iss in g/ D K (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 23 To ta l 99 .2 96 .9 97 .9 97 .5 95 .2 97 .9 97 .6 93 .2 94 .9 87 .2 53 .8 44 .8 32 .0 94 .5 .6 87 .4 94 .1 24 15 (* ) fi gu re s t ha t a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s; ( ) fig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 56MICS Neonatal Tetanus Protection One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. Prevention of maternal and neonatal tetanus is to assure all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during the pregnancy, they (and their newborn) are also considered to be protected if the following conditions are met: • Received at least two doses of tetanus toxoid vaccine, the last within the prior 3 years; • Received at least 3 doses, the last within the prior 5 years; • Received at least 4 doses, the last within 10 years; • Received at least 5 doses during lifetime. Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 2 years. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. Approximately, 76 per cent of the women with a birth in the last 2 years preceding the survey are protected against neonatal tetanus. The proportion was highest in the rural (76.9%) than in the urban areas (73.6%). Brikama LGA has the lowest proportion of women protected against neonatal tetanus (67.1%) whilst the Basse has the highest proportion with 84.8 per cent. It is also observed that women with secondary education and above and the richer the household, the more likely the woman to be protected against tetanus. About 37 per cent of women have received at least 2 doses of protection against tetanus during their last pregnancy. Figure CH2. Percentage of women protected against neonatal tetanus by major background characteristics, The Gambia, 2010 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 57 MICS Table CH.3: Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years protected against neonatal tetanus, The Gambia, 2010 Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus1 Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime LGA Banjul 47.3 29.4 1.4 .0 .0 78.0 89 Kanifing 37.2 38.1 .9 .0 .0 76.3 908 Brikama 34.8 31.4 1.0 .0 .0 67.1 1379 Mansakonko 45.4 27.0 .8 .0 .1 73.4 311 Kerewan 51.2 23.9 .2 .0 .1 75.4 723 Kuntaur 33.9 40.3 1.0 .0 1.1 76.3 310 Janjanbureh 41.4 40.4 1.7 .0 .1 83.5 412 Basse 23.1 56.1 3.8 .0 1.8 84.8 832 Area of Residence Urban 37.1 35.5 1.0 .0 .0 73.6 2135 Rural 37.0 37.5 1.7 .0 .7 76.9 2828 Education None 34.2 39.1 1.9 .0 .6 75.7 3236 Primary 34.6 38.3 .8 .0 .1 73.9 713 Secondary+ 47.9 27.7 .3 .0 .0 75.9 1014 Wealth index quintile Poorest 36.6 36.7 1.1 .0 .7 75.1 1033 Second 41.1 32.2 1.7 .0 .0 75.0 968 Middle 36.1 38.2 1.3 .0 .4 76.0 1000 Fourth 35.0 36.8 1.6 .0 .6 74.0 1100 Richest 36.8 39.6 1.3 .0 .2 77.9 862 Ethnicity of household head Mandinka 34.7 36.2 1.6 .0 .2 72.7 1426 Wollof 43.3 37.6 .7 .0 .1 81.8 778 Jola 34.6 29.8 1.6 .0 .0 65.9 573 Fula 36.3 38.2 1.3 .0 .7 76.5 1055 Serere 43.1 28.9 .3 .0 .0 72.3 163 Sarahuleh 31.3 47.1 2.3 .0 .7 81.4 607 Creole/ Aku Marabou (*) (*) (*) (*) (*) (*) 14 Manjago 55.1 25.4 .0 .0 .0 80.5 65 Bambara 45.7 19.7 .0 .0 .0 65.4 92 Other ethnic group 61.9 11.4 .0 .0 .0 73.3 62 Non Gambian 38.0 43.9 .0 .0 1.1 83.1 69 Missing/DK 35.0 39.4 6.1 .0 6.1 86.6 59 Total 37.0 36.7 1.4 .0 .4 75.5 4963 1 MICS indicator 3.7 (*) figures that are based on less than 25 unweighted cases 58MICS Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • ORT with continued feeding In the MICS questionnaire, mothers (or caregivers) 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, 17 per cent of children under five had diarrhoea in the two weeks preceding the survey (Table CH.4). The prevalence of diarrhoea was highest in Kuntaur (26.5%) followed Basse (23.4%) and lowest in Banjul (12.9%). The peak of diarrhoea prevalence occurs during the weaning period, among children age 12-23 months. Table CH.4 also shows the percentage of children receiving various types of recommended liquids during an episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily amount to 100. About 39 per cent received fluids from ORS packets or pre-packaged ORS fluids. Children of mothers with primary education are less likely to receive fluids from ORS packets or pre-packaged ORS fluids. Analysing the data by Local Government Area shows that Mansakonko has the highest proportion of children who received fluids from ORS packets or pre-packaged ORS fluids with 48.1 per cent whilst Banjul and Basse has the lowest proportions with 34.5 and 34.6 per cent respectively. A little over half (55.4%) of under five children with diarrhoea drank more than usual while 20.9 percent drank the same and 12.9 per cent drank less (Table CH.5). Twenty-nine per cent ate somewhat less, same or more (continued feeding), but 27.3 per cent ate much less and 3.5 per cent ate almost nothing. Children with diarrhoea from rural areas (61.6%) are more likely to drink more than usual compared to those from the urban areas (46.5%). There exist significant differences by LGA in all forms of drinking and eating practices of children who had diarrhoea in the two weeks preceding the survey. Table CH.6 provides the proportion of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and the percentage of children with diarrhoea who received other treatments. Overall, 71.1 per cent of children with diarrhoea received ORS or increased fluids. Combining the data in Table CH.5 with those in Table CH.4 on oral rehydration therapy, it is observed that 66.6 per cent of children either received ORT and, at the same time feeding was continued, as is the recommendation. In Kuntaur, only one- third of children (33.3 %) received ORT and continued feeding, while the figure is 84.6 per cent in Mansakonko. The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 59 MICS Table CH.4: Oral rehydration solutions and recommended homemade fluids Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, The Gambia, 2010 Had diarrhoea in last two weeks Number of children age 0-59 months Received ORS (Fluid from ORS packet or pre-package ORS fluid) Number of children age 0-59 months with diarrhoea in last two weeks Sex Male 17.6 5931 40.5 1044 Female 16.4 5706 37.1 934 LGA Banjul 12.9 214 34.5 28 Kanifing 16.5 2123 40.1 350 Brikama 13.8 3201 35.8 441 Mansakonko 15.1 754 48.1 114 Kerewan 14.2 1750 43.7 249 Kuntaur 26.5 737 42.8 195 Janjanbureh 16.1 944 38.6 152 Basse 23.4 1914 34.6 449 Area of Residence Urban 16.4 4952 39.3 811 Rural 17.5 6685 38.5 1167 Age 0-11 months 18.4 2814 31.7 517 12-23 months 26.9 2415 47.2 650 24-35 months 18.3 2376 35.1 436 36-47 months 11.0 2292 39.0 251 48-59 months 7.2 1740 37.4 125 Mother’s education None 17.3 8021 40.6 1389 Primary 17.9 1521 32.9 272 Secondary+ 15.2 2095 36.3 318 Wealth index quintile Poorest 17.9 2424 42.7 434 Second 15.6 2358 38.6 368 Middle 16.7 2416 42.4 403 Fourth 18.0 2394 37.7 432 Richest 16.7 2046 31.5 342 Ethnicity of household head Mandinka 15.6 3426 40.8 533 Wollof 17.3 1775 48.1 307 Jola 11.5 1303 39.2 150 Fula 18.9 2541 35.4 481 Serere 14.3 417 32.5 59 Sarahuleh 21.9 1320 34.8 289 Creole/ Aku Marabou (4.5) 33 (*) 1 Manjago 19.5 134 (43.9) 26 Bambara 13.6 216 (50.5) 29 Other ethnic group 21.4 158 (30.2) 34 Non Gambian 16.7 177 (5.8) 30 Missing/DK 29.0 137 (40.7) 40 Total 17.0 11637 38.9 1978 (*) figures that are based on less than 25 unweighted cases ( ) figures that are based on 25-49 unweight cases 60MICS Ta bl e CH .5 : F ee di ng p ra ct ic es d ur in g di ar rh ea Pe rc en t d is tr ib ut io n of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks b y am ou nt o f l iq ui ds a nd fo od g iv en d ur in g ep is od e of d ia rr ho ea , T he G am bi a, 2 01 0 H ad di ar rh oe a in la st tw o w ee ks N um be r of ch ild re n ag e 0- 59 m on th s D rin ki ng p ra ct ic es d ur in g di ar rh oe a: To ta l Ea tin g pr ac tic es d ur in g di ar rh oe a: To ta l N um be r o f ch ild re n ag e 0- 59 m on th s w ith d ia rr ho ea in la st tw o w ee ks Gi ve n m uc h le ss to dr in k Gi ve n so m ew ha t le ss to dr in k Gi ve n ab ou t th e sa m e to dr in k Gi ve n m or e to dr in k Gi ve n no th in g to d rin k M iss in g/ D K Gi ve n m uc h le ss to ea t Gi ve n so m ew ha t le ss to e at Gi ve n ab ou t th e sa m e to e at Gi ve n m or e to e at St op pe d fo od H ad ne ve r be en gi ve n fo od M iss in g/ D K Se x M al e 17 .6 59 31 13 .3 7. 8 20 .7 56 .7 .7 .9 10 0. 0 10 0. 0 28 .9 30 .0 26 .2 9. 1 3. 0 2. 9 .0 10 44 Fe m al e 16 .4 57 06 12 .4 11 .0 21 .1 54 .0 .8 .6 10 0. 0 10 0. 0 25 .5 28 .7 29 .6 9. 7 4. 1 2. 3 .1 93 4 LG A Ba nj ul 12 .9 21 4 11 .5 9. 6 34 .9 39 .8 3. 2 .9 10 0. 0 28 .7 23 .2 33 .7 9. 9 .0 4. 6 .0 10 0. 0 28 Ka ni fin g 16 .5 21 23 10 .3 16 .9 33 .9 35 .5 .7 2. 6 10 0. 0 19 .0 30 .3 36 .7 9. 1 2. 2 2. 7 .0 10 0. 0 35 0 Br ik am a 13 .8 32 01 4. 9 8. 2 18 .3 66 .5 1. 4 .7 10 0. 0 21 .7 36 .1 20 .0 14 .8 1. 8 5. 5 .0 10 0. 0 44 1 M an sa ko nk o 15 .1 75 4 3. 6 8. 3 21 .6 64 .1 1. 5 .9 10 0. 0 10 .5 24 .2 44 .5 15 .9 1. 0 2. 8 1. 1 10 0. 0 11 4 Ke re w an 14 .2 17 50 36 .8 14 .4 31 .7 17 .1 .0 .0 10 0. 0 41 .0 17 .4 33 .0 5. 6 2. 8 .2 .0 10 0. 0 24 9 Ku nt au r 26 .5 73 7 30 .5 1. 7 6. 3 61 .3 .2 .0 10 0. 0 53 .2 16 .8 13 .0 3. 4 11 .1 2. 4 .0 10 0. 0 19 5 Ja nj an bu re h 16 .1 94 4 16 .1 3. 6 13 .9 64 .7 .8 .9 10 0. 0 39 .5 10 .2 27 .1 8. 0 11 .4 3. 7 .0 10 0. 0 15 2 Ba ss e 23 .4 19 14 3. 1 7. 1 14 .9 74 .5 .4 .0 10 0. 0 20 .3 42 .5 27 .6 7. 7 1. 5 .5 .0 10 0. 0 44 9 Ar ea o f R es id en ce Ur ba n 16 .4 49 52 8. 9 14 .8 27 .5 46 .5 .7 1. 6 10 0. 0 20 .6 33 .5 31 .0 10 .3 2. 1 2. 4 .1 10 0. 0 81 1 Ru ra l 17 .5 66 85 15 .7 5. 5 16 .3 61 .6 .8 .2 10 0. 0 31 .9 26 .6 25 .5 8. 7 4. 5 2. 7 .1 10 0. 0 11 67 Ag e 0- 11 m on th s 18 .4 28 14 12 .6 11 .6 26 .3 46 .1 2. 7 .7 10 0. 0 24 .3 27 .1 27 .7 7. 0 3. 8 9. 9 .1 10 0. 0 51 7 12 -2 3 m on th s 26 .9 24 15 15 .3 6. 3 18 .1 59 .7 .1 .5 10 0. 0 31 .1 26 .3 27 .9 9. 7 4. 8 .0 .1 10 0. 0 65 0 24 -3 5 m on th s 18 .3 23 76 8. 8 10 .2 18 .4 61 .9 .0 .6 10 0. 0 26 .6 29 .6 26 .8 14 .4 2. 6 .0 .0 10 0. 0 43 6 36 -4 7 m on th s 11 .0 22 92 14 .7 12 .2 21 .2 51 .1 .0 .8 10 0. 0 26 .8 34 .8 30 .6 6. 2 1. 7 .0 .0 10 0. 0 25 1 48 -5 9 m on th s 7. 2 17 40 12 .3 6. 4 20 .6 57 .8 .0 2. 9 10 0. 0 23 .0 43 .5 24 .9 6. 0 2. 6 .0 .0 10 0. 0 12 5 M ot he r’s e du ca tio n N on e 17 .3 80 21 14 .5 8. 5 20 .2 55 .7 .7 .3 10 0. 0 29 .5 28 .9 26 .8 8. 8 4. 0 1. 9 .1 10 0. 0 13 89 P r im ar y 17 .9 15 21 10 .8 9. 4 27 .5 50 .3 .0 2. 0 10 0. 0 20 .5 32 .9 31 .0 8. 8 3. 3 3. 6 .0 10 0. 0 27 2 Se co nd ar y+ 15 .2 20 95 7. 6 12 .5 18 .1 58 .7 1. 4 1. 6 10 0. 0 23 .4 28 .5 29 .5 12 .3 1. 4 5. 0 .0 10 0. 0 31 8 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 61 MICS Ta bl e CH .5 : F ee di ng p ra ct ic es d ur in g di ar rh ea (c on t. ) Pe rc en t d is tr ib ut io n of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks b y am ou nt o f l iq ui ds a nd fo od g iv en d ur in g ep is od e of d ia rr ho ea , T he G am bi a, 2 01 0 H ad di ar rh oe a in la st tw o w ee ks N um be r of ch ild re n ag e 0- 59 m on th s D rin ki ng p ra ct ic es d ur in g di ar rh oe a: To ta l Ea tin g pr ac tic es d ur in g di ar rh oe a: To ta l N um be r o f ch ild re n ag e 0- 59 m on th s w ith d ia rr ho ea in la st tw o w ee ks Gi ve n m uc h le ss to dr in k Gi ve n so m ew ha t le ss to dr in k Gi ve n ab ou t th e sa m e to dr in k Gi ve n m or e to dr in k Gi ve n no th in g to d rin k M iss in g/ D K Gi ve n m uc h le ss to ea t Gi ve n so m ew ha t le ss to e at Gi ve n ab ou t th e sa m e to e at Gi ve n m or e to e at St op pe d fo od H ad ne ve r be en gi ve n fo od M iss in g/ D K W ea lth in de x qu in til e Po or es t 17 .9 24 24 20 .5 6. 2 17 .0 55 .9 .2 .2 10 0. 0 35 .4 26 .5 21 .2 7. 4 6. 6 2. 9 .0 10 0. 0 43 4 Se co nd 15 .6 23 58 15 .6 8. 4 15 .8 58 .0 1. 6 .5 10 0. 0 31 .3 23 .1 28 .5 10 .8 3. 7 2. 4 .2 10 0. 0 36 8 M id dl e 16 .7 24 16 12 .4 6. 9 19 .4 60 .8 .4 .0 10 0. 0 26 .4 31 .6 28 .0 8. 8 3. 3 1. 8 .1 10 0. 0 40 3 Fo ur th 18 .0 23 94 8. 9 8. 9 21 .4 58 .3 1. 2 1. 3 10 0. 0 24 .7 33 .5 26 .9 9. 5 2. 4 2. 9 .0 10 0. 0 43 2 Ri ch es t 16 .7 20 46 5. 8 17 .5 32 .4 42 .1 .2 1. 9 10 0. 0 16 .9 32 .1 36 .2 10 .9 1. 0 3. 0 .0 10 0. 0 34 2 Et hn ic ity o f h ou se ho ld h ea d M an di nk a 15 .6 34 26 10 .1 7. 4 21 .9 58 .3 1. 1 1. 3 10 0. 0 23 .7 26 .6 33 .8 9. 7 2. 5 3. 6 .0 10 0. 0 53 3 W ol lo f 17 .3 17 75 22 .2 11 .4 22 .4 42 .8 .1 1. 1 10 0. 0 37 .3 24 .6 25 .0 5. 6 5. 8 1. 7 .0 10 0. 0 30 7 Jo la 11 .5 13 03 11 .9 6. 3 21 .6 56 .4 3. 4 .3 10 0. 0 20 .4 36 .2 21 .1 13 .5 3. 1 5. 7 .0 10 0. 0 15 0 Fu la 18 .9 25 41 13 .6 11 .7 20 .2 54 .0 .4 .2 10 0. 0 26 .4 32 .4 24 .4 10 .3 5. 4 1. 1 .0 10 0. 0 48 1 Se re re 14 .3 41 7 17 .8 4. 6 35 .0 38 .1 .0 4. 4 10 0. 0 28 .4 21 .0 38 .6 5. 6 2. 3 4. 1 .0 10 0. 0 59 Sa ra hu le h 21 .9 13 20 5. 9 8. 3 14 .1 71 .0 .4 .3 10 0. 0 22 .1 38 .1 29 .3 8. 6 .8 .9 .3 10 0. 0 28 9 Cr eo le / A ku M ar ab ou (4 .5 ) 33 24 .2 .0 .0 57 .7 18 .1 .0 10 0. 0 81 .9 .0 .0 .0 .0 18 .1 .0 (* ) 1 M an ja go 19 .5 13 4 .0 25 .6 10 .9 63 .6 .0 .0 10 0. 0 30 .5 13 .7 27 .9 27 .9 .0 .0 .0 10 0. 0 26 Ba m ba ra 13 .6 21 6 22 .9 17 .9 32 .5 26 .7 .0 .0 10 0. 0 38 .9 30 .7 18 .9 .0 1. 9 9. 6 .0 10 0. 0 29 O th er e th ni c gr ou p 21 .4 15 8 7. 7 .0 24 .6 67 .7 .0 .0 10 0. 0 42 .3 7. 0 12 .8 18 .8 5. 9 11 .7 1. 6 10 0. 0 34 N on G am bi an 16 .7 17 7 20 .7 2. 0 29 .5 47 .8 .0 .0 10 0. 0 25 .8 24 .3 33 .4 13 .7 2. 8 .0 .0 10 0. 0 30 M iss in g/ D K 29 .0 13 7 15 .7 12 .7 18 .7 52 .9 .0 .0 10 0. 0 45 .2 25 .5 23 .0 .9 2. 8 2. 5 .0 10 0. 0 40 To ta l 17 .0 11 63 7 12 .9 9. 3 20 .9 55 .4 .7 .8 10 0. 0 27 .3 29 .4 27 .8 9. 4 3. 5 2. 6 .1 10 0. 0 19 78 62MICS Ta bl e CH .6 : O ra l r eh yd ra ti on th er ap y w it h co nt in ue d fe ed in g an d ot he r t re at m en ts Pe rc en ta ge o f c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks w ho re ce iv ed o ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g, a nd p er ce nt ag e of c hi ld re n w ith d ia rr ho ea w ho re ce iv ed o th er tr ea tm en ts , T he G am bi a, 2 01 0 Ch ild re n w ith d ia rr ho ea w ho re ce iv ed : O th er tr ea tm en ts : N ot gi ve n an y tr ea tm en t or d ru g N um be r o f ch ild re n ag e 0- 59 m on th s w ith di ar rh oe a in la st tw o w ee ks O RS o r in cr ea se d flu id s O RT w ith co nt in ue d fe ed in g1 Pi ll or sy ru p In je ct io n In tr av en ou s H om e re m ed y, he rb al m ed ic in e O th er An ti- bi ot ic An ti- m ot ili ty Zi nc O th er Un kn ow n An ti- bi ot ic N on - an tib io tic Un kn ow n Se x M al e 72 .6 27 .2 27 .2 4. 2 .2 1. 6 10 .5 .8 .1 1. 2 .2 7.1 8. 7 14 .2 10 44 Fe m al e 69 .5 27 .9 27 .9 3. 5 .3 .5 13 .6 1. 3 .2 1.1 .0 5. 7 10 .3 13 .8 93 4 LG A Ba nj ul 59 .3 66 .7 27 .6 .9 .0 5. 3 8. 7 .0 .0 .0 .0 2. 7 15 .7 17 .1 28 Ka ni fin g 60 .3 76 .0 30 .5 2. 5 .5 2. 4 20 .7 .8 .0 .0 .0 2. 5 13 .6 6. 7 35 0 Br ik am a 75 .1 70 .9 26 .6 2. 8 .3 1. 2 4. 4 .6 .3 1. 2 .4 5. 7 5. 0 16 .4 44 1 M an sa ko nk o 76 .5 84 .6 15 .2 1. 0 .0 .0 6. 1 2. 1 .0 .0 .0 10 .4 13 .8 10 .6 11 4 Ke re w an 51 .9 56 .0 28 .5 9.1 .0 .5 17 .3 1. 6 .0 3. 6 .0 3. 5 7.9 17 .4 24 9 Ku nt au r 76 .8 33 .3 24 .9 15 .8 .2 2. 2 10 .7 1. 0 .2 .2 .0 15 .4 .7 27 .2 19 5 Ja nj an bu re h 77 .3 45 .3 28 .9 .5 1. 3 .0 10 .4 1. 2 .2 .6 .0 6. 8 4. 4 25 .1 15 2 Ba ss e 81 .2 77 .7 29 .4 .0 .0 .2 12 .3 1. 0 .2 1. 6 .0 7.0 15 .4 6. 5 44 9 Ar ea o f R es id en ce Ur ba n 65 .4 74 .9 29 .9 4. 0 .4 1. 9 12 .8 1. 5 .2 1. 0 .2 3. 7 10 .2 10 .1 81 1 Ru ra l 75 .2 60 .8 25 .9 3. 8 .2 .5 11 .3 .7 .1 1. 2 .0 8. 3 8. 9 16 .7 11 67 Ag e 0- 11 m on th s 60 .6 61 .9 28 .8 5. 0 .2 1. 8 14 .9 1. 3 .0 1.1 .4 5. 3 8. 7 14 .8 51 7 12 -2 3 m on th s 77 .7 64 .0 28 .8 3. 9 .2 .8 11 .3 1. 6 .1 1. 5 .0 7. 2 10 .3 14 .8 65 0 24 -3 5 m on th s 75 .6 70 .8 25 .7 3. 5 .3 .6 10 .1 .2 .3 1. 5 .0 7.9 9. 2 12 .8 43 6 36 -4 7 m on th s 66 .6 71 .5 25 .2 2. 6 .6 1. 4 8. 9 .0 .3 .2 .0 6. 0 10 .9 13 .5 25 1 48 -5 9 m on th s 74 .7 74 .4 26 .8 2. 6 .3 .9 15 .4 2. 1 .0 .0 .0 2. 8 5. 4 11 .4 12 5 M ot he r’s e du ca tio n N on e 72 .1 64 .5 26 .6 3. 7 .2 .9 12 .6 1. 0 .2 1. 4 .1 7.4 7.7 15 .1 13 89 Pr im ar y 65 .3 72 .7 23 .9 6. 2 .9 1. 3 13 .8 2. 3 .0 .9 .0 4. 7 13 .0 12 .0 27 2 Se co nd ar y+ 72 .0 70 .3 34 .7 2. 7 .0 1. 7 7.6 .0 .0 .4 .0 3. 9 13 .7 10 .6 31 8 The Gambia MULTIPLE INDICATOR CLUSTER SURVEY 2010 63 MICS Ta bl e CH .6 : O ra l r eh yd ra ti on th er ap y w it h co nt in ue d fe ed in g an d ot he r t re at m en ts (c on t. ) Pe rc en ta ge o f c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks w ho re ce iv ed o ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g, a nd p er ce nt ag e of c hi ld re n w ith d ia rr ho ea

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