Georgia: Monitoring the situation of children and women: Multiple Indicator Cluster Survey 2005

Publication date: 2008

Georgia Multiple Indicator Cluster Survey 2005 Georgia Monitoring the situation of children and women Multiple Indicator Cluster Survey 2005 G eorgia 2005 M ultiple Indicator C luster S urvey State Department of Statistics of Georgia National Centre for Disease Control United Nations Children’s Fund M IC S MICS Georgia Monitoring the situation of children and women Multiple Indicator Cluster Survey 2005 Published in June 2008. Cover photo: Marika Amurvelashvili The Georgia Multiple Indicator Cluster Survey (MICS) was carried by State Department of Statistics of Georgia and National Centre for Disease Control of Georgia. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF). The survey has been conducted as part of the third round of MICS surveys (MICS3) carried out around the world in more than 50 countries, in 2005-2006, following the first two rounds of MICS surveys that were conducted in 1995 and the year 2000. Survey tools are based on the models and standards developed by the global MICS project, designed to collect information on the situation of children and women in countries around the world. Additional information on the global MICS project may be obtained from www.childinfo.org. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 3 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1 13 Under-five mortality rate 35 per thousand 2 14 Infant mortality rate 31 per thousand NUTRITION Nutritional status 6 4 Underweight prevalence 2.1 per cent 7 Stunting prevalence 10.4 per cent 8 Wasting prevalence 2.1 per cent Breastfeeding 45 Timely initiation of breastfeeding 36.6 per cent 15 Exclusive breastfeeding rate 10.9 per cent 16 Continued breastfeeding rate at 12-15 months at 20-23 months 40.5 19.6 per cent per cent 17 Timely complementary feeding rate 34.8 per cent 18 Frequency of complementary feeding 28.1 per cent 19 Adequately fed infants 19.8 per cent Salt iodization 41 Iodized salt consumption 87.2 per cent Vitamin A 43 Vitamin A supplementation (post-partum mothers) 15.8 per cent Low birth weight 9 Low birth weight infants 4.7 per cent 10 Infants weighed at birth 95.7 per cent CHILD HEALTH Care of illness 33 Use of oral rehydration therapy (ORT) 50.1 per cent 34 Home management of diarrhoea 20.6 per cent 35 Received ORT or increased fluids, and continued feeding 36.5 per cent 23 Care seeking for suspected pneumonia 73.6 per cent 22 Antibiotic treatment of suspected pneumonia 55.5 per cent Solid fuel use 24 29 Solid fuels 53.6 per cent ENVIRONMENT Water and Sanitation 11 30 Use of improved drinking water sources 94.2 per cent 13 Water treatment 4.6 per cent 12 31 Use of improved sanitation facilities 96.8 per cent 14 Disposal of child's faeces 56.3 per cent REPRODUCTIVE HEALTH Contraception and unmet need 21 19c Contraceptive prevalence 31.5 per cent Maternal and newborn health 20 Antenatal care 96.3 per cent 44 Content of antenatal care Blood sample taken 95.4 per cent Blood pressure measured 94.7 per cent Urine specimen taken 95.6 per cent Weight measured 94.7 per cent 4 17 Skilled attendant at delivery 98.3 per cent 5 Institutional deliveries 95.5 per cent Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Georgia, 2005 4 MONITORING THE SITUATION OF CHILDREN AND WOMEN Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD DEVELOPMENT Child development 46 Support for learning 84.0 per cent 47 Father's support for learning 56.3 per cent 48 Support for learning: children’s books 72.1 per cent 49 Support for learning: non-children’s books 83.2 per cent 50 Support for learning: materials for play 12.7 per cent 51 Non-adult care 7.9 Per cent EDUCATION Education 52 Pre-school attendance 43.2 per cent 53 School readiness 60.4 per cent 54 Net intake rate in primary education 72.7 per cent 55 6 Net primary school attendance rate 94.6 per cent 56 Net secondary school attendance rate 88.3 per cent 57 7 Children reaching grade five 99.0 per cent 58 Transition rate to secondary school 99.5 per cent 59 7b Primary completion rate 70.2 per cent 61 9 Gender parity index primary school secondary school 1.01 0.98 ratio ratio Literacy 60 8 Adult literacy rate 99.3 per cent CHILD PROTECTION Birth registration 62 Birth registration 91.9 per cent Child labour 71 Child labour 18.4 per cent 72 Labourer students 94.6 per cent 73 Student labourers 18.9 per cent Child discipline 74 Child discipline Any psychological/physical punishment 66.1 per cent Early marriage 67 Marriage before age 15 Marriage before age 18 1.9 17.7 per cent per cent 68 Young women aged 15-19 currently married/in union 10.7 per cent 69 Spousal age difference Women aged 15-19 Women aged 20-24 20.4 11.6 per cent per cent Domestic violence 100 Attitudes towards domestic violence 6.9 per cent Disability 101 Child disability 14.4 per cent Orphaned and vulnerable children 75 Prevalence of orphans 4.9 per cent 78 Children’s living arrangements 2.9 per cent HIV/AIDS KNOWLEDGE AND ATTITUDES HIV/AIDS knowledge and attitudes 82 19b Comprehensive knowledge about HIV prevention among young people 15.0 per cent 89 Knowledge of mother- to-child transmission of HIV 45.6 per cent 86 Attitude towards people with HIV/AIDS 6.4 per cent 87 Women who know where to be tested for HIV 29.3 per cent 88 Women who have been tested for HIV 11.0 per cent 90 Counselling coverage for the prevention of mother-to-child transmission of HIV 41.5 per cent 91 Testing coverage for the prevention of mother-to-child transmission of HIV 40.7 per cent GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 5 Table of Contents List of Tables . 7 List of Figures . 9 List of Abbreviations . 10 Acknowledgements . 11 Executive Summary . 12 I. Introduction . 17 Background. 17 Survey Objectives . 19 II. Sample and Survey Methodology. 20 Sample Design . 20 Questionnaires . 20 Training and Fieldwork . 21 Data Processing . 21 III. Sample Coverage and the Characteristics of Households and Respondents. 23 Sample Coverage . 23 Characteristics of Households . 23 Characteristics of Respondents . 24 IV. Child Mortality . 26 V. Nutrition . 29 Nutritional Status . 29 Breastfeeding . 30 Salt Iodization . 33 Post-partum Mothers’ Vitamin A Supplementation . 34 Low Birth Weight . 34 VI. Child Health . 36 Oral Rehydration Treatment . 36 Care Seeking and Antibiotic Treatment of Pneumonia . 38 Solid Fuel Use . 39 VII. Environment . 40 Water and Sanitation . 40 VIII. Reproductive Health. 43 Contraception . 43 Antenatal Care . 43 Assistance at Delivery . 45 IX. Child Development . 46 6 MONITORING THE SITUATION OF CHILDREN AND WOMEN X. Education . 48 Pre-School Attendance and School Readiness . 48 Primary and Secondary School Participation . 48 Adult Literacy . 50 XI. Child Protection . 51 Birth Registration . 51 Child Labour . 51 Child Discipline . 52 Early Marriage . 52 Domestic Violence . 53 Child Disability . 53 Children’s Living Arrangement and Orphanhood . 54 XII. HIV/AIDS Knowledge and Attitudes . 55 Knowledge of HIV Transmission and Condom Use . 55 List of References . 58 Statistical Tables . 59 Appendix A. Sample Design . 122 Appendix B. List of Personnel Involved in the Survey . 126 Appendix C. Estimates of Sampling Errors . 127 Appendix D. Data Quality Tables . 143 Appendix E. MICS Indicators: Numerators and Denominators . 151 Appendix F. Questionnaires . 155 GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 7 List of Tables Table HH.1: Results of household and individual interviews . 61 Table HH.2: Household age distribution by sex . 62 Table HH.3: Household composition . 63 Table HH.4: Women’s background characteristics. 64 Table HH.5: Children’s background characteristics . 65 Table CM.1: Child mortality . 66 Table CM.2: Children ever born and proportion dead . 66 Table NU.1: Child malnourishment . 67 Table NU.2: Initial breastfeeding . 68 Table NU.3: Breastfeeding . 69 Table NU.4: Adequately fed infants . 70 Table NU.5: Iodized salt consumption . 71 Table NU.6: Post-partum mothers’ vitamin A supplementation . 72 Table NU.7: Low birth weight infants . 73 Table CH.1: Oral rehydration treatment . 74 Table CH.2: Home management of diarrhoea . 75 Table CH.3: Care seeking for suspected pneumonia . 76 Table CH.4: Antibiotic treatment of pneumonia . 77 Table CH.5: Knowledge of the two danger signs of pneumonia . 78 Table CH.6: Solid fuel use . 79 Table CH.7: Solid fuel use by type of stove or fire . 80 Table EN.1: Use of improved water sources . 81 Table EN.2: Household water treatment . 82 Table EN.3: Time to source of water . 83 Table EN.4: Person collecting water . 84 Table EN.5: Use of sanitary means of excreta disposal . 85 Table EN.6: Disposal of child’s faeces. 86 Table EN.7: Use of improved water sources and improved sanitation . 87 Table RH.1: Use of contraception . 88 Table RH.2: Antenatal care provider . 90 Table RH.3: Antenatal care . 91 Table RH.4: Prevalence of anaemia in women . 92 Table RH.5: Assistance during delivery . 93 Table CD.1: Family support for learning . 94 Table CD.2: Learning materials . 95 Table CD.3: Children left alone or with other children . 96 Table ED.1: Early childhood education . 97 Table ED.2: Primary school entry . 98 Table ED.3: Primary school net attendance ratio . 99 Table ED.4: Secondary school net attendance ratio . 100 Table ED.5 Secondary school age children attending primary school . 101 Table ED.6: Children reaching grade 5 . 102 Table ED.7: Primary school completion and transition to secondary education . 103 Table ED.8: Education gender parity . 104 Table ED.9: Adult literacy . 105 8 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CP.1: Birth registration . 106 Table CP.2: Child labour . 107 Table CP.3: Labourer students and student labourers . 108 Table CP.4: Child discipline . 109 Table CP.5: Early marriage . 110 Table CP.6: Spousal age difference . 111 Table CP.7: Attitudes toward domestic violence. 112 Table CP.8: Child disability . 113 Table HA.1: Knowledge of preventing HIV transmission . 114 Table HA.2: Identifying misconceptions about HIV/AIDS . 115 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission . 116 Table HA.4: Knowledge of mother-to-child HIV transmission . 117 Table HA.5: Attitudes toward people living with HIV/AIDS . 118 Table HA.6: Knowledge of a facility for HIV testing . 119 Table HA.7: HIV testing and counselling coverage during antenatal care . 120 Table HA.8: Children’s living arrangements and orphanhood . 121 GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 9 List of Figures Figure HH.1: Age and sex distribution of household population .24 Figure CM.1: Under-5 mortality rates by background characteristics .27 Figure CM.2: Trend in under-5 mortality rates .28 Figure NU.1: Percentage of children under-5 who are undernourished .30 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth .31 Figure NU.3: Infant feeding patterns by age: per cent distribution of children under 3 years by feeding pattern by age group .32 Figure NU.4: Percentage of households consuming adequately iodized salt .33 Figure NU.5: Percentage of infants weighing less than 2500 grams at birth . 35 Figure CH.3: Percentage of children aged 0-59 months with diarrhoea who received oral rehydration treatment .37 Figure CH.4: Percentage of children aged 0-59 months with diarrhoea who received ORT or increased fluids, AND continued feeding .38 Figure EN.1: Percentage distribution of household members by source of drinking water .40 Figure HA.1: Per cent of women who have comprehensive knowledge of HIV/AIDS transmission . 56 10 MONITORING THE SITUATION OF CHILDREN AND WOMEN List of Abbreviations AIDS Acquired Immune Deficiency Syndrome AIHA American International Health Alliance ANC Antenatal care CDC Centers for Disease Control and Prevention CEE Central and Eastern Europe CIS Commonwealth of Independent States CSPro Census and Survey Processing System DHS Demographic and Health Survey DPT Diphtheria Pertussis Tetanus EDPRP Economic Development and Poverty Reduction Programme GERHS-1999 Georgia Women’s Reproductive Health Survey, 1999-2000 GERHS-2005 Georgia Reproductive and Health Survey, 2005 GPI Gender Parity Index HIV Human Immunodeficiency Virus ICT Information and Communications Technology IDD Iodine Deficiency Disorders IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MONEE Monitoring Eastern Europe NAR Net Attendance Rate NGO Non-governmental Organization ORT Oral rehydration treatment ppm Parts Per Million pps Probability Proportional to Size PSU Primary Sampling Unit SDS State Department of Statistics of Georgia SPSS Statistical Package for Social Sciences U5MR Under-5 mortality rate UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children’s Fund USAID United States Agency for International Development WFFC World Fit For Children WHO World Health Organization GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 11 Acknowledgements UNICEF Georgia takes the opportunity to express deep gratitude to its colleagues in HQs and the Regional Office in Geneva for the support and technical assistance received throughout the process. Our deepest appreciation goes to Trevor Croft at Blancroft Research International. His valuable support and technical expertise has been instrumental to the finalization of the survey. Likewise, we would like to thank Turgay Unalan for his timely and professional assistance in pulling together the whole report. Needless to say that our national counterparts, the National Department of Statistics, and the National Centre for Disease Control have had a primary role in the development and implementation of the survey. 12 MONITORING THE SITUATION OF CHILDREN AND WOMEN Executive Summary The Georgia Multiple Indicator Survey is a nationally representative sample survey of households, women and children. During November-December 2005, questionnaires completed with 12,010 households, 9,847 women aged 15-49, and 2,037 children under five years of age. CHILD MORTALITY The infant mortality rate among Georgian children is estimated at 31 per thousand live births, while the probability of dying before age 5 is 35 per thousand live births. NUTRITION Nutritional Status Only 2.1 per cent of children under age five in Georgia are moderately underweight and only 0.3 per cent are classified as severely underweight. Slightly more than 10 per cent of children are moderately stunted or too short for their age and almost 5 per cent are moderately wasted or too thin for their height. The percentage of children who are overweight is 15.2 per cent. Breastfeeding More than one-third of women (36.6 per cent) with a birth in the two years preceding the survey started breastfeeding within one hour of birth. By the end of the first day after birth, nearly two-thirds of women (65.1 per cent) had started breastfeeding their child. Approximately 11 per cent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 34.8 per cent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, 40.5 per cent of children are still being breastfed and by age 20-23 months, 19.6 per cent are still breastfed. Salt Iodization In about 98 per cent of households, salt used for cooking was tested for iodine content and in 87.2 per cent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Post-partum Mothers’ Vitamin A Supplementation Only 15.8 per cent of mothers with a birth in the previous two years before the MICS received a Vitamin A supplement within eight weeks of the birth. Low Birth Weight Overall, 95.7 per cent of newborns were weighed at birth and approximately 5 per cent of infants are estimated to weigh less than 2500 grams at birth. CHILD HEALTH Oral Rehydration Treatment Overall, 10.4 per cent of under-five children had had diarrhoea in the two weeks preceding the survey. About 40 per cent received fluids from ORS packets and 13.6 per cent received recommended homemade GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 13 fluids. Almost half of the children with diarrhoea received no treatment at all. About one-fifth of children with diarrhoea (20.6 per cent) received increased fluids and at the same time continued feeding (home management of diarrhoea). Also, 36.5 per cent of children either received oral rehydration therapy (ORT) or had their fluid intake increased, and at the same time, feeding was continued, as per the recommendation. Care Seeking and Antibiotic Treatment of Pneumonia Only 2.7 per cent of children aged 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 73.6 per cent were taken to an appropriate provider. 55.5 per cent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Overall, 21.1 per cent of women know of the two danger signs of pneumonia – fast and laboured breathing. Solid Fuel Use More than half (53.6 per cent) of all households in Georgia use solid fuels for cooking. Among households using solid fuels for cooking, a great majority of them use closed stove with chimney (92.2 per cent). ENVIRONMENT Water and Sanitation Overall, 94.2 per cent of the population uses an improved source of drinking water. As a result, a great majority of the households (94 per cent) are not using any water treatment method and within the remaining 6 per cent of households, most of them are using an appropriate water treatment method (4.6 per cent). Among those that use unimproved drinking water sources, the use of appropriate water treatment method is lower (2.8 per cent). For 78.9 per cent of households, the drinking water source is on the premises. For 17.3 per cent of all households, it takes less than 30 minutes to get to the water source and bring water. A very high proportion of the population of Georgia lives in households (96.8 per cent) using improved sanitation facilities. Stools are disposed of safely for 56.3 per cent of children age 0-2. REPRODUCTIVE HEALTH Contraception Current use of contraception was reported by 31.5 per cent of women currently married or in union. The most popular method is IUD, which is used by 8.2 per cent of married women. The next most popular method is periodic abstinence, which accounts for 6.7 per cent of married women, followed by condoms (5.9 per cent). Overall, 11.8 per cent of married women use a traditional method while modern method users are almost 20 per cent. Antenatal Care Coverage of antenatal care (by a doctor, nurse, or midwife) is quite high with 96.3 per cent of women receiving antenatal care at least once during the pregnancy. Only 2.3 per cent of women did not receive any antenatal care. Nearly all pregnant women received antenatal care one or more times during their pregnancy (97.4). During these visits, almost all women had their blood test taken (95.4 per cent), blood pressure measured (94.7 per cent), urine specimen taken (95.6 per cent), or weight measured (94.7 per cent). 14 MONITORING THE SITUATION OF CHILDREN AND WOMEN Assistance at Delivery Nearly all births (93.8 per cent) occurring in the year prior to the MICS survey were delivered by skilled personnel. A large majority of these births (93.8 per cent) in the year prior to the MICS survey were delivered with the assistance of a medical doctor. Nurses or midwives assisted with the delivery of only 4.5 per cent of births. Overall, 95.5 per cent of births were delivered in a health facility. CHILD DEVELOPMENT For 84 per cent of under-five children, an adult engaged in more than four activities that promote learning and school readiness during the three days preceding the survey. The average number of activities that adults engaged with children was five. The father was involved with one or more activities for 56.3 per cent of children. More than 83 per cent of children are living in households where at least three non-children’s books are present. On the other hand, 72.1 per cent of children aged 0-59 months have children’s books. The median number of both non-children’s books and children’s books is 10. Nearly 13 per cent of children aged 0-59 months had 3 or more playthings to play with in their homes, while 5.8 per cent had none of the playthings asked mothers/caretakers were asked about specifically. Among children aged 0-59 months 7.7 per cent had been left in the care of other children, while 2.8 per cent had been left alone during the week preceding the interview. Combining the two care indicators, it is calculated that 7.9 per cent of children were left without adequate care during the week preceding the survey. EDUCATION Pre-School Attendance and School Readiness Less than half of children (43.2 per cent) aged 36-59 months are attending pre-school. Overall, 60.4 per cent of children who are currently age 6 or 7 years and attending the first grade of primary school were attending pre-school the previous year. Primary and Secondary School Participation Of children who are of primary school entry age (age 6 and 7), 82.3 per cent are attending the first grade of primary school. The majority of children of primary school age are attending school (94.6 per cent) but there are still some children (5.4 per cent) who are out of school when they are expected to be attending school. The overall secondary school net attendance ratio is 88.3 per cent. Of all children starting grade one, almost all of them (99 per cent) will eventually reach grade five. Gender parity index (GPI) for primary school is 1.01, indicating almost no difference in the attendance of girls and boys to primary school. The GPI declines slightly, to 0.98, for secondary education. Adult Literacy Adult literacy is quite high - 99.3 per cent. CHILD PROTECTION Birth Registration The births of 91.9 per cent of under-five children in Georgia have been registered. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 15 Child Labour More than 18 per cent of the children age 5-14 years were involved in child labour, mainly unpaid and working for family businesses. Of the 92.1 per cent of the children 5-14 years of age attending school, 18.9 per cent are also involved in child labour activities. On the other hand, of the 18.4 per cent of the children classified as child labourers, the majority of them are also attending school (94.6 per cent). Child Discipline In Georgia, 66.1 per cent of children aged 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. Early Marriage Only 1.9 per cent of women age 15-49 married before age 15 and 17.7 per cent of women age 20-49 married before age 18. Among women age 15-19, only 10.1 per cent are currently married. While 20.4 per cent of married women age 15-19 are married to a partner 10 or more years older, this percentage is lower among women age 20-24 (11.6 per cent). Domestic Violence Overall, 6.9 per cent of women in Georgia feel that a husband has the right to beat his wife, mostly in cases when they neglect the children (5.9 per cent). Child Disability According to the mothers’ report, 14.4 per cent of children aged 2-9 years display some kind of disability. The most frequently mentioned disability was inability to speak/difficulty speaking (5.8 per cent). Children’s Living Arrangement and Orphanhood Overall, 86.4 per cent of children aged 0–17 are living with both parents, 8.6 per cent are living with the mother only, 1.9 per cent are living with the father and 2.9 per cent are not living with either biological parent. For 4.9 per cent of children aged 0–17, one or both parents are dead. HIV/AIDS AND SEXUAL BEHAVIOUR Knowledge of HIV Transmission and Condom Use In Georgia, 80.2 per cent of the interviewed women have heard of AIDS. However, the percentage of women who know all three main ways of preventing HIV transmission is only 33.2 per cent. More than half of women know of having one faithful uninfected sex partner and know of using a condom every time (58.4 and 55.8 per cent respectively), and 45.1 per cent know of abstaining from sex as main ways of preventing HIV transmission. Of the interviewed women, 26.7 per cent reject the two most common misconceptions concerning HIV and know that a healthy-looking person can be infected. Comprehensive knowledge of HIV prevention methods and transmission is fairly low; 13.3 per cent of women were found to have comprehensive knowledge. Also only 15 per cent of young women (15-24 years) have comprehensive accurate knowledge of HIV. More than two-thirds of women (67.3 per cent) know that HIV can be transmitted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is 45.6 per cent, while 12.9 per cent of women did not know of any specific way. 16 MONITORING THE SITUATION OF CHILDREN AND WOMEN Nearly all women aged 15-49 received antenatal care from a health care professional during their last pregnancy (96.3 per cent) and information about HIV was provided to 41.5 per cent of women; 45.1 per cent of women were tested for HIV during the antenatal care visit, and 40.7 per cent received the results of the HIV test. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 17 A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” I. Introduction Background This report is based on the Georgia Multiple Indicator Cluster Survey, conducted in 2005 by the State Department of Statistics (SDS) of Georgia and the National Centre for Disease Control. The survey provides valuable information on the situation of children and women and was based in large part on the need 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 below). 18 MONITORING THE SITUATION OF CHILDREN AND WOMEN Georgia, as one of the signatories of the Millennium Declaration, made a commitment to integrate the Millennium Development Goals within its national development strategies, and report periodically on the status of their attainment. As a response to its commitments, the Economic Development and Poverty Reduction Programme (EDPRP) was adopted in August, 2003. In June 2004, the country launched its baseline MDG Report that customised the globally set goals and targets to the Georgian context. On 23 February 2005 the government adopted the EDPRP implementation report. Civil society and international organizations contributed to the report by participating in the customized construction of its goals and respective targets (United Nations, 2005). Following the launch of the baseline report, the government of Georgia affirmed the need to assess the progress in the implementation of MDGs for the period of 2004-2005. For that purpose the government reconstituted the Permanent Commission on MDG with its Resolution #119 of 28 July 2005. The resolution furthermore introduced appropriate changes to Government Resolution #7, adopted on 31 March 2004, designating the prime minister as chair of the Permanent Commission and the Ministry of Economic Development as a coordinator of the process (United Nations, 2005). Moreover, Georgia has joined the Global Call to Action against Poverty through the campaign “Future without Poverty”, which was started by eight NGOs and currently unites over 40 organizations and individuals. The coalition has already conducted several forums, generating active participation of public figures, government agencies and international organizations (United Nations, 2005). The government of Georgia started a comprehensive reform programme aimed at improving socio- economic conditions while reducing the current level of extreme poverty (Goal 1) through sustainable economic growth. For the first time in years, the share of population living below the official poverty line has decreased, although there is no change in the extreme poverty level. Overall, rural poverty remains more pronounced than urban poverty. The quality and institutional setup of the educational system have improved (Goal 2). The educational system is undergoing radical reform, orienting itself toward European standards, eliminating corruption and shifting to a new system of financing. Further reforms aim at introducing a comprehensive national curriculum focusing on the development of analytical and other relevant and necessary skills. Gender equality issues were promoted to the state level (Goal 3) resulting in the creation of an Advisory Council on Gender Equality (in the Georgian parliament) and a separate Governmental Commission on Gender Equality Issues. These institutions shall address the prevailing problems of under-representation of women in elective bodies and in executive positions, discrepancies in employment, remuneration opportunities and underdeveloped state response mechanisms to instances of gender discrimination. To reduce the child mortality rate and improve maternal health under Goals 4 and 5, the government is expanding child and reproductive health services, as well as improving access and quality. Special state primary and referral healthcare programmes have contributed to a slight decrease in mortality rates. Additionally, international assistance programs have also put emphasis on child and maternal healthcare. Another contributing factor to the decreasing child mortality rate is the decline in home deliveries. Immunizations remain at a high level. Moreover, the government has put itself in a better position to secure the financial sustainability of programs which address the reduction of the child mortality rate. Despite these positive financial projections and overall improvements, the unreliability of existing statistics makes optimal targeting of programmes difficult. Positive tendencies have developed in combating HIV/AIDS, tuberculosis and malaria (Goal 6). Georgia has a well-established HIV/AIDS control service and a well-developed infrastructure to support the effective reduction of these pandemics. However, some factors contributing to the spread of the pandemics remain, including wide-spread intravenous drug abuse, the alarming situation in neighbouring countries and a low public awareness of appropriate precautions. To address the environmental sustainability requirement of Goal 7, the government has created the Commission on Sustainable Development of Georgia; adopted a strategy and action plan on biodiversity preservation; initiated elaboration of forestry policy and strategy; continued the introduction of the Clean Development Mechanism; and facilitated the phase-out of ozone-depleting substances. However, further efforts are required to improve access to safe water supply and housing. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 19 Georgia remains committed to the global partnership for development (Goal 8) with a liberal trade regime, an improvement of its financial and banking systems and progress in addressing external debt issues within the Paris Club framework. The government has also placed telecommunications among the priorities in its programme for 2004-2009, elaborating the ICT development framework; it will, additionally, develop a National Strategy of ICT Development (United Nations, 2005). In order to establish effective monitoring at national and local levels, the relevant indicators are being incorporated into a uniform system. For this purpose, an integrated national database, GeoInfo, is being set up with UN assistance. The database builds on the DevInfo programme which is being used throughout the world and unites the indicators for MDG, EDPRP and the National Action Plan for Children. In 2006, UNICEF started a new programme of cooperation with the government that aims to make a significant contribution towards achieving the MDGs. During the five years of the country programme, UNICEF will work with central and local governments to address the needs and to protect the rights of the most vulnerable women and children in Georgia. This final report presents the results of the indicators and topics covered in 2005 Georgia Multiple Indicator Cluster Survey. It is expected that the findings will be a large and important source of data for monitoring outcomes towards achievement of the MDGs in Georgia. Survey Objectives The 2005 Georgia Multiple Indicator Cluster Survey has as its primary objectives: To provide up-to-date information for assessing the situation of children and women in Georgia;• 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; To contribute to the improvement of data and monitoring systems in Georgia and to strengthen • technical expertise in the design, implementation, and analysis of such systems. 20 MONITORING THE SITUATION OF CHILDREN AND WOMEN II. Sample and Survey Methodology Sample Design The sample for the Georgia 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 11 regions: Tbilisi, Kakheti, Mtskheta – Mtianeti, Shida Kartli, Kvemo Kartli, Samtskhe–Javakheti, Racha-Lechkhumi -Kvemo, Svaneti, Imereti, Guria, Samegrelo-Zemo Svaneti, Adjara. In order to more closely follow the population distribution of the population, the sample design used a complicated stratification design, with unequal numbers of clusters in each stratum. However, the sample selection had too few households in the smaller regions to provide reliable estimates of certain indicators. The sample was selected in four stages and the sample design was stratified according to 11 regions, 3 settlement types (Large town, Small town, and Village), and 4 geographic strata (Valley, Foothills, Mountain, and High mountain). In total, 49 separate strata were identified and within 475 clusters a total of 14,250 households were selected (30 households in each cluster). There was no updating of household listing prior to the survey. The sample is not self-weighting and for reporting national level results, sample weights that were calculated at stratum level are used. 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 jure household members, the household, and the dwelling; 2) a women’s questionnaire administered in each 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. The questionnaires included the following modules: The Household Questionnaire included the following modules: Household Listing• Education• Water and Sanitation• Household Characteristics• Child Labour• Child Discipline• Disability• Salt Iodization• The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: Child Mortality• Maternal and Newborn Health• Marriage and Union• Contraception• Attitudes Towards Domestic Violence• HIV knowledge• GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 21 Cigarette Smoking• Haemoglobin Test• 16 The Questionnaire for Children under-five was administered to mothers or caretakers of children under 5 years of age17 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: Birth Registration and Early Learning• Child Development• Breastfeeding• Care of Illness• Immunization• 18 Anthropometry• The questionnaires are based on the MICS3 model questionnaire19. From the MICS3 model English and Russian versions, the questionnaires were translated into Georgian and were pre-tested in Tbilisi and in Mtskheta–Mtianeti in September 2005. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Georgia MICS questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, and measured 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 was conducted for one week in September 2005. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent two days in practice interviewing in the pre-test location – Tbilisi and Mtskheta-Mtianeti. The data were collected by 12 teams; each was comprised of five interviewers, two drivers, one editor/ measurer and one supervisor. Because of the difficult terrain and poor roads in some areas, four-wheel drive vehicles were used. Fieldwork began in November 2005 and concluded in December 2005. Data Processing Data were entered using the CSPro software. The data were entered on three microcomputers and carried out by three data entry operators and two data entry supervisors. In order to ensure quality control, 16 Haemoglobin measurements were performed in every third household in all clusters on women 15-49 years of age. 17 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 18 In the 2005 Georgia MICS questionnaire, the respondents were asked to show the interviewers immunization cards for children under the age of 5 and the immunization dates were recorded for each antigen. If the vaccination card was not available, the respondent was asked if the child has received the immunization and for Polio and DPT, how many times they received it. However, it was observed that relatively few women had immunization records at home and most immunization cards are maintained at health clinics. Therefore, the immunization levels were based primarily on recall and it appeared that the respondents’ reporting of the immunizations received and, in particular, the number of doses was under reported. As a result, it was decided that the immunization levels are not reported because of the strong potential for biased estimates. 19 The model MICS3 questionnaire can be found at www.childinfo.org, or in UNICEF, 2006. 22 MONITORING THE SITUATION OF CHILDREN AND WOMEN all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programmes developed under the global MICS3 project and adapted to the Georgia questionnaire were used throughout. Data processing began simultaneously with data collection in November 2005 and was completed in January 2006. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 14, and the model syntax and tabulation plans developed by UNICEF this purpose. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 23 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage Of the 14,250 households selected for the sample, 12,268 were found to be occupied. Of these, 12,010 were successfully interviewed for a household response rate of 97.9 per cent. In the interviewed households, 10,908 women (age 15-49) were identified. Of these, 9,847 were successfully interviewed, yielding a response rate of 90.3 per cent. In addition, 2,196 children under age five were listed in the household questionnaire. Questionnaires were completed for 2,037 of these children, which corresponds to a response rate of 92.8 per cent. Overall response rates of 88.4 and 90.8 are calculated for the women’s and under-5s’ interviews respectively (Table HH.1). Response rates were similar across residence while slight variations in response rates observed by regions. Although the capital city of Tbilisi had the lowest household response rate, the highest response rate for the women questionnaire was found in Tbilisi. The highest response rates for household and children under-5 questionnaires were found in Racha-Lechkhumi-Kvemo Svaneti while Guria region had the lowest response rate for children under-5 questionnaire. Characteristics of Households The 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 12,010 households successfully interviewed in the survey, 43,731 household members were listed. Of these, 20,988 were males, and 22,743 were females. These figures also indicate that the survey estimated the average household size at 3.64. Comparing the age and sex distribution of Georgia from MICS with the official estimates for the year 2005 (Department of Statistics, 2006), it is observed that MICS survey has a slightly lower proportion of women age 15-64 (1.4 percentage points) and men age 15-64 (0.9 percentage points). On the other hand, for age group 65 and higher, MICS has a slightly higher proportion of males (1.3 percentage points) and females (0.9 percentage points). For age group 0-14, the MICS estimates for males and females are very close to the official estimates. Table HH.3 provides basic background information on the households. Within households, the sex of the household head, region, urban/rural status, number of household members, and ethnic20 group of the household head are shown in the table. These background characteristics are also used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. 20 This was determined by asking the question “To what ethnic group does the head of this household belong?” in the household questionnaire. 24 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure HH.1: Age and Sex Distribution of Household Population, Georgia, 2005 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Percent Males Females 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 age 15-49 were found. Looking at the number of households in each region, we can notice significant differences between weighted and unweighted numbers of household. In order to gain qualitative results for some regions it was necessary to do over-sampling while in Tbilisi and Imereti, the regions with the highest proportions of households, it was decided to do under-sampling as it is possible to obtain plausible results with a lower number of households than required by the probability proportional to size of the region. The distribution of households by area of residence showed that exactly half of the households are urban and other half is rural. Most of the households had a male head (70 per cent) and more than one-third of the households had 4-5 members while another third had 2-3 members. For 84.6 per cent of households the ethnic group of the head of the household was Georgian. In 14.9 per cent of the households interviewed there was at least one child under age five while 64.2 per cent of the households had at least one women age 15-49. Characteristics of Respondents 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 areas, age, marital GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 25 status, motherhood status, education21, wealth index quintiles22, and ethnicity. Among all women age 15- 49, 61.7 per cent of them are currently married/in union and 6.7 per cent are formerly married/in union. Distribution by motherhood status is similar; 63.7 per cent of women have given birth. Primary education is almost universal among women in Georgia and as high as 36 per cent of women have received higher education. The distribution of women according to wealth index quintiles implies that as the wealth index quintile increases, the proportions of women living in such households slightly increase. Some background characteristics of children under 5 are presented in Table HH.5. These include distribution of children by several attributes: sex, region and area of residence, age in months, mother’s or caretaker’s education, wealth, and ethnicity. Almost equal proportions of children live in urban and rural areas. For 58 per cent of the children, their mother completed secondary or secondary special/vocational school and a further 41.2 per cent completed higher education. The distribution of children according to wealth index quintiles shows a slightly lower proportion for the poorest category and a slightly higher proportion for the richest category. For 81.2 per cent of children, the ethnic group of household head was Georgian. 21 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 22 Principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to each household asset, and obtain wealth scores for each household in the sam- ple (The assets used in these calculations were as follows: persons per sleeping room, type of floor, type of roof, type of wall, type of cooking fuel, electricity, radio, TV, mobile and non-mobile phone, refrigerator, watch, bicycle, motor- cycle or scooter, animal-drawn cart, car or truck, boat with a motor, source of drinking water, and type of sanitary fa- cility). Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of the households they were living in. 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, and 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, and Filmer and Pritchett, 2001. 26 MONITORING THE SITUATION OF CHILDREN AND WOMEN IV. Child Mortality One of the overarching aims of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce 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. The technique converts these data into probabilities of dying by taking into account both the mortality risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Georgia, the East model life table was selected as most appropriate. Table CM.1 provides estimates of child mortality by various background characteristics, while Table CM.2 provides the basic data used in the calculation of the mortality rates for the national total. The infant mortality rate is estimated at 31 per thousand, while the probability of dying under-5 mortality rate (U5MR) is 35 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to the end of the first quarter of the year 2000. There is some difference between the probabilities of dying among males and females. Infant and under-5 mortality rates are considerably lower in urban compared to rural areas. There are also significant differences in mortality in terms of mother’s education level. The probabilities of dying among children whose mothers have higher education are considerably lower than those with only secondary education. While the wealth index quintile of the household does not make a considerable difference for infant mortality, the under-five mortality rates are higher among poorer households. Differentials in under-5 mortality rates by background characteristics are also shown in Figure CM.1. 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 15 years. Even though the previous MICS in 1999 did not collect information on child mortality, there are two recent surveys in Georgia that present comparable data on child mortality. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 27 Figure CM.1 Under-5 Mortality Rates by Background Characteristics, Georgia, 2005 39 32 24 45 43 32 23 44 22 35 0 10 20 30 40 50 60 70 80 Sex M ale F emale A rea Urban R ural M o ther’s Educatio n Seco ndary Seco ndary spec ial/vo catio nal H igher Wealth Quintiles P o o rest 60 % R ichest 40 % Geo rgia Per 1000 According to the Women’s Reproductive and Health Survey conducted in 1999-2000 (GERHS-1999) (Serbanescu et. al. 2001), the infant mortality rate is 40.7 (reference date is around the year 1995) and the trend for infant mortality rate is one of decline. The other recent data source, Georgia Reproductive Health Survey 2005 (GERHS-2005) (Serbanescu et. al., 2007) estimates infant mortality as 29 per thousand (reference date is around the year 2000) and the difference between MICS 2005 and GERHS-2005 can be attributable to sampling errors involved in both surveys23 and the method of calculation (GERHS using a direct calculation while MICS approach is indirect calculation). The large confidence intervals associated with the estimated rates are due to the relatively small number of observed births on which the estimates are based. According to GERHS-1999, U5MR is 44.8 per thousand (reference date is around the year 1995) and GERHS-2005 implies a significant decline to 32.7 per thousand (reference date is around the year 2000) just like MICS 2005 finding of 35 per thousand for the year 2000. The differences can also be explained by the sampling errors involved24 and the different methodologies in calculation. As shown in Figure CM.2, the trend for U5MR rate indicated by MICS 2005 results is in agreement with those estimated in the GERHS-1999 GERHS-2005. Further qualification of these apparent declines and differences as well as its determinants should be taken up in a more detailed and separate analysis. 23 Confidence interval calculated for GERHS-2005 puts the infant mortality estimate between 22.9 and 35.1 per thou- sand. Corresponding confidence interval for infant mortality rate from MICS 2005 is not available yet. 24 Confidence interval calculated for GERHS-2005 puts the U5MR estimate between 26.2 and 39.2 per thousand. Cor- responding confidence interval for U5MR from MICS 2005 is not available yet. 28 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure CM.2: Trend in Under-5 Mortality Rates, Georgia, 2005 0 10 20 30 40 50 60 1986 1990 1994 1998 2002 2006 Year Pe r 1 ,0 00 MICS 2005 GERHS 2005 GERHS 1999 Like in many former Soviet countries where the estimates from government sources tend to underestimate the infant and child mortality rates, sometimes by a considerable margin, Georgia MICS 2005 estimates for infant and under-5 mortality are higher compared to official government rates based on death registration (CDC and ORC Macro, 2003; UNICEF, 2003). GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 29 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. More than half of all child deaths worldwide are linked to malnutrition. 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. The World Fit for Children goal is to reduce the prevalence of malnutrition among children under five years of age by at least one-third (between 2000 and 2010), with special attention to children under 2 years of age. A reduction in the prevalence of malnutrition will assist in 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. Undernourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is the WHO/CDC/NCHS reference, which was recommended for use by UNICEF and the World Health Organization at the time the survey was implemented. 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 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 (UNICEF, 2006). 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. 30 MONITORING THE SITUATION OF CHILDREN AND WOMEN In Table NU.1, children who were not weighed and measured (6.4 per cent of children) and those whose measurements are outside a plausible range (4.7 per cent) are excluded. Only 2.1 per cent of children under age five in Georgia are moderately underweight and as low as 0.3 per cent are classified as severely underweight (Table NU.1). Slightly more than 10 per cent of children are moderately stunted or too short for their age and almost 5 per cent are moderately wasted or too thin for their height. Comparable figures from MICS 1999 are 3.1 per cent for underweight, 11.7 per cent for stunted and 2.3 per cent for wasted children. The percentage of children who are overweight is 15.2 per cent in MICS 2005. Figure NU.1: Percentage of children under-5 who are undernourished, Georgia, 2005 0 2 4 6 8 10 12 14 16 0 6 12 18 24 30 36 42 48 54 60 Age (in Months) Pe rc en t Underweight Stunted Wasted As a result of low percentages of underweight and wasted children in Georgia, variations by background characteristics are not striking. Only higher education of mothers has an inverse relationship with all three indices. On the other hand, clear variations are observable for stunting. Children in Kvemo Kartli are more likely to be stunted than other children (18.5 per cent) while the percentage stunted is lowest in Tbilisi. Boys appear to be slightly more likely to be stunted, and wasted than girls. The age pattern shows that a higher percentage of children aged 12-23 months are underweight and stunted 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. The wealth status of the household and the ethnic group of the household head are important determinants of stunting among children. Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continue to be breastfed with safe, appropriate and adequate complementary feeding for up to 2 years of age and beyond. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 31 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 of recommended child feeding practices are as follows: Exclusive breastfeeding rate (< 6 months & < 4 months)• Timely complementary feeding rate (6-9 months) • Continued breastfeeding rate (12-15 & 20-23 months)• Timely initiation of breastfeeding (within 1 hour of birth)• Frequency of complementary feeding (6-11 months)• Adequately fed infants (0-11 months)• Table NU.2 provides the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth (which includes those who started within one hour). More than one-third of women (36.6 per cent) with a birth in the two years preceding the survey started breastfeeding within one hour of birth. By the end of the first day after birth, nearly two-thirds of women (65.1 per cent) start breastfeeding their child. As the education of women increases, the percentage of women who started breastfeeding their children slightly decreases. There are also regional differences ranging from less than 30 per cent in Tbilisi, Adjara, and Kakheti to 48.1 per cent in Samegrelo-Zemo Svaneti. Differentiation by background characteristics for percentage of women who started breastfeeding within one day of birth is less salient, except for regions where the percentage ranges from 56 per cent in Adjara to 73.8 per cent in Shida Kartli and 83.9 per cent in Mtskheta-Mtianeti (Figure NU.2). Figure NU.2 Percentage of mothers who started breastfeeding within one hour and within one day of birth, Georgia, 2005 64 68 84 74 62 60 68 62 66 56 65 65 65 30 30 46 45 42 35 46 27 48 30 35 39 37 Pe rc en t Within one day Within one hour Tb ilis i Ka kh eti Mt skh eta -M tia ne ti Sh ida Ka rtli Kv em o K art li Sa mt skh e-J ava kh eti Ra ch a-L ech kh um i an d K vem o S van eti Im ere ti Gu ria Sa me gre lo an d Z em o S van eti Ad jar a Ur ba n Ru ral Ge org ia 32 MONITORING THE SITUATION OF CHILDREN AND WOMEN In Table NU.3, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. Despite the high prevalence of breastfeeding of newborns, exclusive breastfeeding, which should continue until six months of age, is not very common in Georgia. Approximately 11 per cent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 34.8 per cent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, 40.5 per cent of children are still being breastfed and by age 20-23 months, 19.6 per cent are still breastfed. Girls were more likely to be exclusively breastfed than boys. Women living in rural areas have higher percentages of breastfeeding compared to women in urban areas during the first year of life. Due to low number of observations, it was not possible to look at more differentiations. 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 third month, the percentage of children exclusively breastfed is below 10 per cent. Only about 10 per cent of children are receiving breast milk after 2 years. Figure NU.3 Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group, Georgia, 2005 Age (in Months) Pe rc en t W eaned (no t breast f ed) B reast f ed and comp lement ary foods B reast f ed and o ther milk/ formula B reast f ed and non-milk liquids B reast f ed and p lain wat er only Exclusively breast f ed The adequacy of infant feeding in children under 12 months is provided in Table NU.4. 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. Infants aged 6-8 months are considered to be adequately fed if they are receiving breast milk and complementary food at least twice per day, while infants aged 9-11 months are considered to be adequately fed if they are receiving breast milk and eating complementary food at least three times a day. Exclusive breastfeeding among infants age 0-5 months is 10.9 per cent while the proportion of infants age 6-8 months who are adequately fed is 28 per cent. By age 9-11 months, there is almost no improvement (28.2 per cent). As a result of these feeding patterns, only 28.1 per cent of children aged 6-11 months are being adequately fed. Adequate feeding among all infants (aged 0-11) drops to 19.8 per cent. Although girls are better fed in the first months of their life compared to males, overall proportions are very close for 0-11 months. Infants living in rural areas are GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 33 more adequately fed in all age groups examined and the overall proportion in rural areas is almost twice as high as that in urban areas (26.8 and 14.4 per cent, respectively). Differentiations by other background characteristics are not very clear due to low number of observations. Salt Iodization Iodine Deficiency Disorders (IDD) are 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). In February 2005, as a result of long-standing advocacy and technical support from UNICEF-USAID, the Parliament of Georgia adopted a law “on the Prevention of Iodine and other Microelement and Vitamin Deficiencies”. The law bans the import and sale of non-iodized salt and effectively lays the groundwork for food fortification policy in the country. As Georgia is 100 per cent dependent on imported salt supplies, the implementation of the current law is expected to make it possible to achieve universal salt iodization. The Salt Situation Analysis conducted in 2003 as a collaborative effort of the Georgian government and UNICEF, showed that consumption of adequately iodized salt by households increased from 8.1 per cent in 1999 (MICS 1999) to 67 per cent in 2003 (UNICEF, 2007). In about 98 per cent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodide or potassium iodate. Table NU.5 shows that in a very small proportion of households (0.6 per cent), there was no salt available. In 87.2 per cent of households, salt was found to contain 15 parts per million (ppm) or more of iodine. Use of adequately iodized salt was lowest in Shida Kartli region (74.8 per cent) and highest in Samegrelo-Zemo Svaneti (93.6 per cent) (Figure NU.4). There were small differentiations by urban-rural residence, education of household head and wealth index quintiles. Figure NU.4 Percentage of households consuming adequately iodized salt, Georgia, 2005 87 88 86 75 91 84 84 89 82 94 90 89 85 87 0 20 40 60 80 100 Regions Pe rc en t Tb ilis i Ka kh eti Mt skh eta -M tia ne ti Sh ida Ka rtli Kv em o K art li Sa mt skh e-J ava kh eti Ra ch a-L ech kh um i an d K vem o S van eti Im ere ti Gu ria Sa me gre lo an d Z em o S van eti Ad jar a Ur ba n Ru ral Ge org ia 34 MONITORING THE SITUATION OF CHILDREN AND WOMEN Post-partum Mothers’ Vitamin A Supplementation Vitamin A is essential for eye health and 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. 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. Currently, there is no Vitamin A distribution for children in Georgia. 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. Only 15.8 per cent of mothers with a birth in the previous two years before the MICS received a Vitamin A supplement within eight weeks of the birth (Table NU.6). This percentage is highest in Kakheti (20.5 per cent) and lowest in Shida Kartli (6.9 per cent). Vitamin A coverage among pregnant women increases to 17.7 per cent if the ethnic group of household head is Georgian. When compared with the finding from MICS 1999 (8.6 per cent), there is a slight increase in the percentage of women who received Vitamin A supplementation. 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 GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 35 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 birth25. Overall, 95.7 per cent of births were weighed at birth and approximately 5 per cent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.7). There was no significant variation by region (Figure NU.5). The percentage of low birth weight does not vary based on other background characteristics. The corresponding percentage from MICS 1999 is 4.2 per cent. Figure NU.5 Percentage of Infants Weighing Less Than 2500 Grams at Birth, Georgia, 2005 4.8 4.9 3.7 5.6 4.3 5.6 3.3 3.4 6.1 4.9 4.7 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 Percent Tb ilis i Ka kh eti Mt skh eta -M tia ne ti Sh ida Ka rtli Kv em o K art li Sa mt skh e-J ava kh eti Ra ch a-L ech kh um i an d K vem o S van eti Im ere ti Gu ria Sa me gre lo an d Z em o S van eti Ad jar a Ge org ia 25 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. 36 MONITORING THE SITUATION OF CHILDREN AND WOMEN VI. Child Health 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 deaths 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 per cent. The indicators are: Prevalence of diarrhoea• Oral rehydration therapy (ORT)• Home management of diarrhoea• (ORT or increased fluids) • AND continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the given period and whether this was more or less than the child usually ate and drank. Overall, 10.4 per cent of under-5 children had diarrhoea in the two weeks preceding the survey (Table CH.1). There was a differentiation in diarrhoea prevalence by region (from 5.9 per cent in Kvemo Kartli to 15.8 per cent in Mtskheta-Mtianeti). The peak of diarrhoea prevalence occurs in the weaning period, among children under two years of age. Table CH.1 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add to 100. About 40 per cent received fluids from ORS packets and 13.6 per cent received recommended homemade fluids. Almost half of the children with diarrhoea received no treatment at all. There was less differentiation by sex of child and urban-rural residence (Figure CH.3). For other background characteristics, it is not possible to observe the differentiation clearly because of the low number of cases. Overall, slightly more than half of children with diarrhoea received one or more of the recommended home treatments. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 37 Figure CH.3 Percentage of children aged 0-59 months with diarrhoea who received oral rehydration treatment, Georgia, 2005 52 47 55 43 46 51 49 50 0 20 40 60 80 100 Ma le Fe ma le Se co nd ary Se co nd ary sp ec ial /vo ca tio na l Hi gh er Ur ba n Ru ral Ge or gia P er ce nt More than one-third (36.2 per cent) of under five children with diarrhoea drank more than usual while 52.7 per cent drank the same or less (Table CH.2). About 60 per cent ate somewhat less, same or more (continued feeding), but 37.8 per cent ate much less or ate almost none. Given these figures, about one-fifth of children received increased fluids and at the same time continued feeding. Combining the information in Table CH.2 with those in Table CH.1 on oral rehydration therapy, it is observed that 36.5 per cent of children either received ORT or fluid intake was increased, and at the same time, feeding was continued, as is the recommendation. There was no significant difference in the home management of diarrhoea by sex while in urban areas, more children with diarrhoea (40.6 per cent) received ORT or increased fluids AND continued feeding, while the figure is 32.3 per cent in rural areas (Figure CH.4). Due to the low number of observations it is not possible to comment on the differentiations according to other background characteristics. 38 MONITORING THE SITUATION OF CHILDREN AND WOMEN Figure CH.4 Percentage of children aged 0-59 with diarrhoea who received ORT or increased fluids, AND continued feeding Georgia, 2005 36 37 41 32 34 48 35 36 0 10 20 30 40 50 60 Sex Male Female Area Urban Rural Mother's Education Secondary Secondary special/vocational Higher Georgia Percent Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one-third deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were NOT due to a problem in the chest and a blocked nose. The indicators are: Prevalence of suspected pneumonia• Care seeking for suspected pneumonia• Antibiotic treatment for suspected pneumonia• Knowledge of the danger signs of pneumonia• Table CH.3 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. Only 2.7 per cent of children aged 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 73.6 per cent were taken to an appropriate provider. In most of these cases, children with suspected pneumonia were taken to a public source for treatment while for only 5.5 per cent of the cases the child was not taken to a health facility or seen by health personnel. The low number of cases of suspected pneumonia prevented the analysis of any differentiation by background characteristics. Table CH.4 presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, residence, and wealth index quintiles merged into two categories. In Georgia, 55.5 per cent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Once again, the low numbers of observations make it impossible to explore the differentiations in the use of antibiotics. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 39 Issues related to knowledge of danger signs of pneumonia are presented in Table CH.5. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, 21.1 per cent of women know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is if the child develops a fever (61.8 per cent). More than one-third of mothers (34.8 per cent) identified fast breathing and 39.7 per cent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. There was important differentiation by region in the proportions of mothers/caretakers who recognize the two danger signs of pneumonia. While the proportion is as low as 7.1 per cent in Racha- Lechkhumi-Kvemo Svaneti, nearly one-third of mothers/caretakers recognized the two dangers of pneumonia in Adjara. Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. The use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Overall, more than half (53.6 per cent) of all households in Georgia are using solid fuels for cooking (Table CH.6). Use of solid fuels is very low in urban areas (17.8 per cent), but very high in rural areas, where almost 90 per cent of the households are using solid fuels. Differentials with respect to household wealth and the educational level of the household head are also significant. The findings show that use of solid fuels is very uncommon among households in Tbilisi and among the richest households. The table also clearly shows that the overall percentage is high due to the widespread use of wood for cooking purposes. Solid fuel use alone is a poor proxy for indoor air pollution, since the concentration of the pollutants is different when the same fuel is burnt in different stoves or fires. Use of closed stoves with chimneys minimizes indoor pollution, while open stove or fire with no chimney or hood means that there is no protection from the harmful effects of solid fuels. The type of stove used with a solid fuel is depicted in Table CH.7. In Georgia, among households using solid fuels for cooking, a great majority of them use a closed stove with a chimney (92.2 per cent). The lowest percentage is in Imereti (85.1 per cent) while the highest is in Adjara. 40 MONITORING THE SITUATION OF CHILDREN AND WOMEN VII. Environment Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half the proportion of people without sustainable access to safe drinking water and basic sanitation between 1990 and 2015. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one third. The list of indicators used in MICS is as follows: Water Use of improved drinking water sources• Use of adequate water treatment method• Time to source of drinking water• Person collecting drinking water• Sanitation Use of improved sanitation facilities• Sanitary disposal of child’s faeces• The distribution of the population by source of drinking water is shown in Table EN.1 and Figure EN.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, yard or plot), public tap/standpipe, tubewell/borehole, protected well, protected spring, rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes, such as hand washing and cooking. Figure EN.1 Percentage distribution of household members by source of drinking water, Georgia, 2005 Unprotected well or spring 5% Other unimproved 1% Protected well or spring 19% Tubewell/borehole 2% Public tap/standpipe 4% Piped into dwelling, yard or plot 69% GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 41 Overall, 94.2 per cent of the population is using an improved source of drinking water – 98.7 per cent in urban areas and 90 per cent in rural areas. Even in the region where the percentage is lowest (Kvemo Kartli) the use of improved drinking water is 88.7 per cent. Also, the proportion is as high as 89.3 per cent even among poor households. In general, the differentials by background characteristics are very small. The source of drinking water for the population varies significantly by region (Table EN.1). In Tbilisi, 96.7 per cent of the population uses drinking water that is piped into their dwelling while in Guria and Kakheti regions, 11.5 and 15.1 per cent, respectively, use piped water. In Racha-Lechkhumi- Kvemo Svaneti and Samtskhe-Javakheti regions, the most widely used source is piped water into yard/land plot (59.1 and 47.9 per cent respectively). On the other hand, in Guria, Samegrelo-Zemo Svaneti, and Shida Kartli regions, the most widely used source is protected well. In urban areas, the main source of drinking water is water piped into dwelling (80 per cent) while it is water piped into yard/land plot in rural areas (35.4 per cent). Use of in-house water treatment is presented in Table EN.2. Households were asked about ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, and using solar disinfection were considered to be proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. As a reflection of the high proportion of households already using improved sources of drinking water, a great majority of the households (94 per cent) are not using any water treatment method and within the remaining 6 per cent of households most of them are using an appropriate water treatment method (4.6 per cent). Among those that use unimproved drinking water sources, the use of appropriate water treatment method is lower (2.8 per cent). The amount of time it takes to obtain water is presented in Table EN.3 and the person who usually collected the water in Table EN.4. Note that these results refer to one roundtrip from home to the drinking water source. Information on the number of trips made in one day was not collected. Table EN.3 shows that for 78.9 per cent of households, the drinking water source is on the premises. For 17.3 per cent of all households, it takes less than 30 minutes to get to the water source and bring water, while only less than 1 per cent of households spend more than 1 hour for this purpose. In Kakheti, Shida Kartli, and Kvemo Kartli regions, for less than 60 per cent of the households the source water is on premises while in Tbilisi nearly all households reach water on their premises. Urban households, households where the education level of household is higher and households with higher socioeconomic status are more likely to have water on premises. Excluding those households with water on the premises, the average time to the source of drinking water is 16.3 minutes. The time spent in Mtskheta- Mtianeti region on collecting water is as high as 39.3 minutes. Table EN.4 shows that, for most of households, either an adult female or adult male is responsible for collecting water if the source of drinking water is not on the premises. An adult female is usually the person collecting the water (61.8 per cent) while adult men collect water in 35.7 per cent of cases. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases, including diarrhoeal diseases and polio. Improved sanitation facilities for excreta disposal include: flush or pour flush to a piped sewer system, septic tank, or latrine; ventilated improved pit latrine, pit latrine with slab, and composting toilet. Similar to the finding in MICS 1999 (99.5 per cent), a very high proportion of the population of Georgia is living in households (96.8 per cent) using improved sanitation facilities (Table EN.5). There are only small differences observed by background characteristics. Residents of Racha-Lechkhumi-Kvemo Svaneti region are slightly less likely than others to use improved facilities (92 per cent). In rural areas, the population is mostly using pit latrines with slabs (81.2 per cent). In contrast, the most common facilities in urban areas are flush toilets with connection to a sewage system (80.4 per cent). The use of toilets with flush to pit latrine is more common in Racha-Lechkhumi-Kvemo Svaneti region (19.2 per cent) while pit latrine with slab use is quite common in Guria, and Kakheti (85 and 80.2 per cent respectively). There is a strong positive correlation between the wealth index quintile of the household and the use of piped sewer system while there is a negative correlation between the wealth index quintile and the use of pit latrine with slab. 42 MONITORING THE SITUATION OF CHILDREN AND WOMEN Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet or by rinsing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table EN.6. Overall, stools are disposed of safely for 56.3 per cent of children age 0-2. For more than half of the children, the child’s last stool was put or rinsed into toilet or latrine (54.6 per cent). The child’s last stool was put/ rinsed into drain or ditch for 10.3 per cent of the cases and thrown into garbage for another 12.3 per cent. Safe disposal of child’s faeces was slightly more common in urban areas (61.7 per cent) compared to rural areas (50.3). Among regions, the lowest proportion of children whose stools are disposed of safely was observed in Samtskhe-Javakheti. An overview of the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.7. Overall, use of improved source of drinking water and at the same time using sanitary means of excreta disposal is very high in Georgia (91.9 per cent). There are some differentiations by background characteristics; rural households, households with lower socioeconomic status and households where the level of education of the household head is lower have slightly lower proportions of the use of improved water sources and improved sanitation. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 43 VIII. Reproductive Health Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. A World Fit for Children goal is access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. Current use of contraception was reported by 31.5 per cent of women currently married or in union (Table RH.1)26. The most popular method is IUD, which is used by 8.2 per cent of married women in Georgia. The next most popular method is periodic abstinence, which accounts for 6.7 per cent of married women, followed by condoms (5.9 per cent). Less than five per cent of women reported use of other contraceptives. Overall, 11.8 per cent of married women use a traditional method while modern method users are almost 20 per cent. Contraceptive prevalence is highest in Tbilisi at 38 per cent and lowest in Kvemo Kartli (21.4 per cent). Thirty five per cent of married women in urban areas use a method of contraception compared to 28 per cent in rural areas. Adolescents are far less likely to use contraception than older women. Only 17.1 per cent of married or in union women aged 15-19 currently use a method of contraception compared to 34.6 per cent of 20-24 year olds and 39.8 per cent of 25-29 year olds. Use of contraception reaches to a peak at ages 30-34 and then drops again. Women’s education level is strongly associated with contraceptive prevalence. The percentage of women using any method of contraception rises from about 15 per cent among those with pre-primary and primary education to 26.4 per cent among women with secondary education, and to 39 per cent among women with higher education. Similarly, the use of contraception increases from 24.3 per cent among women in poorest households to 38.8 per cent in richest households. It is also interesting to note that the rate of contraception use is particularly low for households headed by Azerbaijanis. Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The management of anaemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women’s nutritional status and prevent infections (e.g., malaria and STIs) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and care, in particular 26 This is a significant drop compared to MICS 1999 (40.5) and the corresponding estimate from GERHS 2005 is 47.3 per cent. As presented in Appendix C, confidence limits for this estimate in MICS 2005 are between 29.8 and 33.3 per cent. Further analysis is needed for possible explanations of this finding being inconsistent with previous MICS and outside sources. 44 MONITORING THE SITUATION OF CHILDREN AND WOMEN for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: Blood pressure measurement• Urine testing for bateriuria and proteinuria• Blood testing to detect syphilis and severe anaemia• Weight/height measurement (optional)• Similar to MICS 1999 (95.3 per cent), coverage of antenatal care (by a doctor, nurse, or midwife) is quite high with 96.3 per cent of women receiving antenatal care at least once during the pregnancy. Only 2.6 per cent of women did not receive any antenatal care. The lowest level of antenatal care is found in Samtskhe-Javakheti (88.5 per cent), while there were only small differences by background characteristics. The type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding is presented in Table RH.2. A large majority of women age 15-49 who gave birth in the two years preceding the survey received antenatal care from a medical doctor (94.8 per cent). The lowest level of antenatal care by a doctor was among women living in households where the household head is Azerbaijani (79.1 per cent). There was also a positive correlation between the wealth index quintile and the antenatal care being provided by a medical doctor. The types of services pregnant women received are shown in Table RH.3. Nearly all pregnant women received antenatal care one or more times during their pregnancy (97.4). Although this proportion approaches 100 per cent with increasing education of women and socioeconomic status, no considerable variation is observed by background characteristics. During these visits, almost all women had their blood test taken (95.4 per cent), blood pressure measured (94.7 per cent), urine specimen taken (95.6 per cent), or weight measured (94.7 per cent). Higher education and socioeconomic status and head of household being Georgian further increased the probability of these services being received by women. The Georgia MICS included the measurement of haemoglobin from female respondents to ascertain iron deficiency anaemia in women. Additionally, women measured for anaemia were asked whether they smoked, as this can affect anaemia levels. The haemoglobin measurement was designed to be conducted in one third of cases and all women in every third household in all clusters were selected for haemoglobin test27. Table RH.4 shows the result of the survey on prevalence of anaemia among women. Regardless of its status, more than one-quarter of women were found to have anaemia (27.7 per cent). Most of them classified as mild anaemia (22.7 per cent) and only about 5 per cent of the cases the anaemia status was moderate to severe. The lowest level of anaemia was found in Mtskheta-Mtianeti (13.9 per cent) while the highest was in Racha-Lechkhumi-Kvemo Svaneti (32.6 per cent). Younger women and women with no children had lower percentages of anaemia. In order to see the effect of smoking on the prevalence of anaemia, in Georgia MICS 2005, the interviewers were also instructed to ask the smoking questions to women selected for haemoglobin testing. The results, however, did not reveal any significant variation by smoking status of women. To correctly assess anaemia levels, the haemoglobin levels measured are usually adjusted for altitude, which requires an estimate of altitude for each sample cluster in MICS 2005. However, following the end of the fieldwork, as there was no clear list of the names of the locations of the clusters, it was not possible to correctly identify the clusters and then produce a list of altitudes for each cluster. As a result, the 27 Unfortunately, there was no variable or code in the household questionnaire that gives information on whether a household was selected for haemoglobin testing or not. This made it impossible to properly assess the completeness of reporting for anaemia and adjust the weighting scheme for non-response. However, using an approximate method to assess completeness, and assuming that one out of three households were to be selected the response rate for the anaemia testing appears to be roughly 80 per cent. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 45 figures presented for anaemia are unadjusted for altitude and therefore are likely to be underestimates of correct levels. Assistance at Delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. Nearly all births (98.3 per cent) occurring in the year prior to the MICS survey were delivered by skilled personnel (Table RH.5). The corresponding proportion from MICS 1999 was already at a high level (96.4 per cent). A large majority of these births (93.8 per cent) in the year prior to the MICS survey were delivered with assistance by a medical doctor. Nurses or midwives assisted with the delivery of only 4.5 per cent of births. Overall, 95.5 per cent of births were delivered in a health facility. As a result of high proportions of women giving birth with the help of skilled personnel and delivered in healthcare facilities, the differentiations by background characteristics were almost negligible. 46 MONITORING THE SITUATION OF CHILDREN AND WOMEN IX. Child Development It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, adult activities with children, presence of books in the home, for the child, and the conditions of care are important indicators of quality of home care. A World Fit for Children goal is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. For 84 per cent of under-5 children, an adult engaged in more than four activities that promote learning and school readiness during the three days preceding the survey (Table CD.1). The average number of activities that adults engaged with children was five. The table also indicates the father’s involvement in such activities and father is involved with one or more activities for 56.3 per cent of children. Around 7 per cent of children were living in a household without their fathers. There are no gender differentials in terms of adult activities with children; however, a slightly higher proportion of fathers engaged in activities with male children (58.6 per cent) than with female children (53.5 per cent). Higher proportions of adults engaged in learning and school readiness activities with children in urban areas (86.5 per cent) than in rural areas (81.4 per cent). Adult engagement in activities with children was greatest in Racha-Lechkhumi- Kvemo Svaneti (95.5 per cent) and lowest in Samtskhe- Javakheti (77.1 per cent). Differentials by ethnicity are also observed: while the proportion was 66.7 per cent for children living in households where the ethnic group of the head is Azerbaijani, it is 86.6 per cent for those living in the households where the ethnic group of the head is Georgian. Father’s involvement showed a similar pattern in terms of adults’ engagement in such activities. Exposure to books in early years not only provides the child with a greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. The presence of books is important for later school performance and IQ scores. In Georgia, 83.2 per cent of children are living in households where at least three non-children’s books are present (Table CD.2). On the other hand, 72.1 per cent of children aged 0-59 months have children’s books. Both the median number of non-children’s books and children’s books are 10. While almost no gender differentials are observed, urban children appear to have more access to both types of books than those living in rural households. More than 90 per cent of under-5 children living in urban areas live in households with more than three non-children’s books, while the figure is 75.7 per cent in rural households. The proportion of under-5 children who have three or more children’s books is 84.3 per cent in urban areas, compared to 59.7 per cent in rural areas. The presence of children’s books is positively correlated with the child’s age; in the homes of 67.2 per cent of children aged 0-59 months, there are three or more children’s books, while the figure is 75 per cent for children aged 0-23 months. Table CD.2 also shows that 12.7 per cent of children aged 0-59 months had 3 or more playthings to play with in their homes, while 5.8 per cent had none of the playthings asked about to the mothers/caretakers (Table CD.2). The playthings in MICS included household objects, homemade toys, toys that came from a store, and objects and materials found outside the home. Nearly 86 per cent of children play with toys that come from a store; however, the percentages for other types of toys is below 25 per cent. The proportion of children who have three or more playthings to play with is very close for male and female children. Similarly, almost no urban-rural and education differentials are observed in this respect. There are differentials by region, ethnic group of household head, and as can be expected, the age of the child. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS, two questions were asked to find out whether children aged 0-59 months were GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 47 left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.3 shows that 7.7 per cent of children aged 0-59 months were left in the care of other children, while 2.8 per cent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that 7.9 per cent of children were left with inadequate care during the week preceding the survey. No differences were observed according to the sex of the child. Children aged 24- 59 months were left with inadequate care more (9.5 per cent) than those who were aged 0-23 months (5.3 per cent). Children in urban areas were slightly more likely to be left with inadequate care (9.2 per cent) compared to those in rural areas (6.6 per cent). Inadequate care was more prevalent among children in Shida Kartli (12.1 per cent) while it is less prevalent in Kakheti (2.9 per cent). 48 MONITORING THE SITUATION OF CHILDREN AND WOMEN X. Education Pre-School Attendance and School Readiness Pre-school education in an organized learning or child education programme is important for children’s readiness to attend school. One of the World Fit for Children goals is the promotion of early childhood education. Less than half of children (43.2 per cent) aged 36-59 months are attending pre-school in Georgia (Table ED.1). Urban-rural and regional differentials are significant – the figure is as high as 64 per cent in urban areas, compared to 24.4 per cent in rural areas. Among children aged 36-59 months, preschool attendance is more prevalent in Tbilisi (72.6 per cent). Almost no gender differential exists, but differentials by mother’s education and socioeconomic status are significant. The proportion of children age 36-59 months reaches to 60.6 per cent if the mother has higher education. More than two-thirds of children living in rich households attend preschool, while the figure drops to 17.4 per cent in poor households. The proportions of children attending preschool at ages 48-59 months is higher than those age 48-59 months (47.2 and 39.1 per cent respectively). The table also shows the proportion of children in the first grade of primary school who attended pre- school the previous year (Table ED.1), an important indicator of school readiness. Overall, 60.4 per cent of children who are currently age 6 or 7 and attending the first grade of primary school were attending pre- school the previous year. The proportion is exactly the same for males and females, while nearly three- quarters of children in urban areas (72.3 per cent) had attended pre-school the previous year compared to 49.6 per cent among children living in rural areas. Regional differentials are also very significant and socioeconomic status has a positive correlation with school readiness – while the indicator is 44 per cent among the poorest households, it increases to 82.2 per cent among those children living in the richest households. Primary and Secondary School Participation Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. The indicators for primary and secondary school attendance include: Net intake rate in primary education• Net primary school attendance rate• Net secondary school attendance rate• Net primary school attendance rate of children of secondary school age• Female to male education ratio (or gender parity index - GPI)• The indicators of school progression include: Survival rate to grade five• Transition rate to secondary school• Net primary completion rate• GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 49 Of children who are of primary school entry age (age 6 and 7)28 in Georgia, 82.3 per cent are attending the first (and second) grade29 of primary school (ED.2). The percentage of children at age 7 attending the first grade is quite high (92.6 per cent) compared to children at age 6 (72.7 per cent) implying that there are possibly children failing to start school on time. More female children (85.2 per cent) were attending first grade compared to male children (79.5 per cent). Differentials are also present by region and urban-rural areas. In Imereti, for instance, the value of the indicator declines to 72.1 per cent, while it is around 90 per cent for many other regions. Children’s participation to primary school is timelier in urban areas (86.1 per cent) than in rural areas (78.6 per cent). A positive correlation with mother’s education is observed; for children age 6-7 whose mothers have at least higher education, 90 per cent were attending the first grade. In rich households, the proportion is around 93 per cent, while it is 75 per cent among children living in the poorest households. It is also interesting to note that if the ethnic group of the household head is Azerbaijani the proportion declines to 64.4 per cent. Table ED.3 provides the percentage of children of primary school age attending primary or secondary school. The majority of children of primary school age are attending school (94.6 per cent). However, there are still some children (5.4 per cent) who are out of school when they are expected to be participating in school. On average, there are no significant differences between males and females in regard to primary school attendance. The lowest total net attendance ratios were observed among children in Kakheti (89.9 per cent) and among children living in households where the ethnic group of the household head is Azerbaijani (86.9 per cent). The secondary school net attendance ratio is presented in Table ED.4. The overall secondary school net attendance ratio is 88.3 per cent and compared to the primary school attendance level, where around 5.4 per cent of children are not attending school at all, 11.7 per cent of children of secondary school age are not attending secondary school. It is expected that some of these children are attending primary school (see below). The primary school net attendance ratio of children of secondary school age is presented in Table ED.5. Less than seven per cent of children of secondary school age are attending primary school when they should be attending secondary school. Therefore, the remaining five per cent are not attending school at all. The proportion of children who are secondary school age but attending primary school is higher in Kvemo Kartli (11.6 per cent), in rural areas (8.5 per cent), among children in poorer households (10.9 per cent) and among households where the ethnic group of the household head is Azerbaijani (14.2). As expected, this proportion is highest among children age 12, reflecting the fact that education had previously been started one year later than at present. The percentage of children entering first grade who eventually reach grade 5 is presented in Table ED.6. Of all children starting grade one, almost all of them (99 per cent) will eventually reach grade 5. Notice that this number includes children that repeat grades and that eventually move up to reach grade 5. There are no differentials by background characteristics, which implies that, regardless of their background characteristics, once the children are enrolled in primary school they will definitely reach to grade 5. The net primary school completion rate and transition rate to secondary education are presented in Table ED.7. At the moment of the survey, only 70.2 per cent of the children of primary completion age (11 years) were attending the last grade of primary education30. This value should be distinguished from the gross primary completion ratio, which includes children of any age attending the last grade of primary. 28 Even though the survey was conducted shortly after the start of the school year in Georgia, due to missing in- formation on month of birth for children, it was impossible to identify all the children who are expected to start the school and the tables were slightly adjusted to compensate this. Unfortunately, the MICS3 household questionnaire did not include month of birth information and only recorded completed age in household roster. Therefore, the table includes children age 7 as well as age 6 at the time of the survey. 29 For similar reason mentioned above, this table includes children who are attending grade 2. 30 Due to missing information on month of birth for children in the questionnaire, it was impossible to identify all the children who are expected to attend the last grade of primary school. Therefore, this figure is lower than expected as a result of children who were at age 11 at the time of the survey but recently started secondary school and/or did not reach the last grade at the time of the survey. 50 MONITORING THE SITUATION OF CHILDREN AND WOMEN Almost all of the children (99.5 per cent) who successfully completed the last grade of primary school were found to be attending the first grade of secondary school at the time of the survey. There was no variation by background characteristics. The ratio of girls to boys attending primary and secondary education is provided in Table ED.8. These ratios are better known as the Gender Parity Index (GPI). Notice that the ratios included here are obtained from net attendance ratios rather than gross attendance ratios. The last ratios provide an erroneous description of the GPI mainly because in most cases the majority of over-aged children attending primary education tend to be boys. The table shows that gender parity for primary school is 1.01, indicating almost no difference in the attendance of girls and boys to primary school. Primary school net attendance ratio (NAR) is quite high at 95 per cent for girls and 94.3 per cent for boys. The GPI is slightly down to 0.98 for secondary education implying that the disadvantage of girls is almost negligible. Secondary school NAR drops to less than 90 per cent (87.5 per cent for girls and 88.9 per cent for boys). The low figures for the GPI for secondary school NAR, implying the disadvantage of girls, are more pronounced if the child is living in the Samtskhe-Javakheti and Mtskheta-Mtianeti regions, from the poorest households, mother’s education is lower, and ethnic group of the household head is Azerbaijani. Adult Literacy One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s questionnaire was administered, the results are based only on females age 15-24. Literacy was assessed on the ability of women to read a short simple statement or on school attendance. The per cent literate is presented in Table ED.9. In Georgia, adult literacy is quite high - at 99.3 per cent - and there is no significant variation by background characteristics. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 51 XI. Child Protection Birth Registration The Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The indicator is the percentage of children under 5 years of age whose birth is registered. The births of 91.9 per cent of children under 5 in Georgia have been registered (Table CP.1). There are no significant variations in birth registration across sex and age categories. Children in Kvemo Kartli are somewhat less likely to have their births registered (78.1 per cent) than other children, but this appears to be due primarily to a relatively large proportion of mothers who do not know if their child’s birth was registered. Mother’s education was also found to have a positive correlation with the registration of births. Among those whose births are not registered, cost (23.3 per cent), travel distance (14.8 per cent), and lack of knowledge of the place to register (10.6 per cent) appeared to be the main reasons (Table not shown). Child Labour Article 32 of the Convention on the Rights of the Child states: “States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development.” World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions addressed the issue of child labour, that is, children 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: Ages 5-11: at least one hour of economic work or 28 hours of domestic work per week. • Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. • This definition allows differentiation between child labour and child work to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the prevalence of child labour, since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained above. Table CP.2 presents the results of child labour by the type of work. Percentages do not add up to the total child labour, as children may be involved in more than one type of work. More than 18 per cent of the children age 5-14 years was involved in child labour, mainly unpaid and working for a family business. Male children and children living in rural areas are slightly more involved in child labour compared to females and those living in urban areas. Regional differentiation was observed, ranging from 12.8 per cent in Samegrelo-Zemo Svaneti to 26.1 per cent in Guria. The corresponding estimate from MICS 1999 was 30 per cent implying an important drop in the percentage of children involved in labour. Table CP.3 presents the percentage of children classified as student labourers or as labourer students. Student labourers are children attending school who were involved in child labour activities at the moment of the surveys. More specifically, of the 92.1 per cent of the children 5-14 years of age attending school, 18.9 per cent are also involved in child labour activities. On the other hand, out of the 18.4 per cent of the children classified as child labourers, the majority of them are also attending school (94.6 per cent). 52 MONITORING THE SITUATION OF CHILDREN AND WOMEN Child Discipline A World Fit for Children states: “children must be protected against any acts of violence …” and the Millennium Declaration calls for the protection of children from abuse, exploitation and violence. In the Georgia MICS survey, mothers/caretakers of children age 2-14 years were asked a series of questions on the ways parents tend to use to discipline their children when they misbehave. Note that for the child discipline module, one child aged 2-14 per household was selected randomly during fieldwork. Out of these questions, the two indicators used to describe aspects of child discipline are: 1) the number of children 2-14 years that experience psychological aggression as punishment or minor physical punishment or severe physical punishment; and 2) the number of parents/caretakers of children 2-14 years of age that believe that in order to raise their children properly, they need to physically punish them. In Georgia, 66.1 per cent of children aged 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members (Table CP.4). More importantly, 19 per cent of children were subjected to severe physical punishment. On the other hand, 12.7 per cent of mothers/caretakers who believed that children should be physically punished, which implies an interesting contrast with the actual prevalence of physical discipline. Male children were more likely to be subjected to both minor and severe physical discipline (48.3 and 21.9 per cent) than female children (42.9 and 15.8 per cent). Only 17.5 per cent of children in Georgia have been disciplined through non-violent methods and 15.9 per cent of children have neither been punished and nor disciplined. Early Marriage Marriage before the age of 18 is a reality for many young girls. According to UNICEF’s worldwide estimates, over 60 million women aged 20-24 were married/in union before the age of 18. Factors that influence child marriage rates include: the state of the country’s civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. The right to “free and full” consent to a marriage is recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be “free and full” when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women mentions the right to protection from child marriage in article 16, which states: “The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage.” While marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to other rights - such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices - and is frequently addressed by the Committee on the Rights of the Child. Other international agreements related to child marriage are the Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages and the African Charter on the Rights and Welfare of the Child and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa. Child marriage was also identified by the Pan-African Forum against the Sexual Exploitation of Children as a type of commercial sexual exploitation of children. Young married girls are a unique, though often invisible, group. Required to perform heavy amounts of domestic work, under pressure to demonstrate fertility, and responsible for raising children while still children themselves, married girls and child mothers face constrained decision-making and reduced life choices. Boys are also affected by child marriage but the issue impacts girls in far larger numbers and with more intensity. Cohabitation - when a couple lives together as if married - raises the same human GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 53 rights concerns as marriage. Where a girl lives with a man and takes on the role of caregiver for him, the assumption is often that she has become an adult woman, even if she has not yet reached the age of 18. Additional concerns due to the informality of the relationship - for example, inheritance, citizenship and social recognition - might make girls in informal unions vulnerable in different ways than those who are in formally recognized marriages. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy-related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There is evidence to suggest that girls who marry at young ages are more likely to marry older men, which puts them at increased risk of HIV infection. Two of the indicators are to estimate the percentage of women married before 15 years of age and percentage married before 18 years of age. The percentage of women married at various ages is provided in Table CP.5. In Georgia, only 1.9 per cent of women age 15-49 married before age 15 and 17.7 per cent of women age 20-49 married before age 18. Among women age 15-19, only 10.7 per cent are currently married. Women are more likely to have an early marriage if they are living in Kvemo Kartli (4.5 per cent married before age 15 and 25.3 per cent married before age 18), less educated (4 per cent married before age 15 and 32.5 per cent married before age 18) and if the ethnic group of household head is Azerbaijani (6.1 per cent married before age 15 and 31.3 per cent married before age 18). Another component is the spousal age difference, with an indicator being the percentage of married/ in union women with a difference of 10 or more years younger than their current spouse. Table CP.6 presents the results of the age difference between husbands and wives. While 20.4 per cent of married women age 15-19 are married to a partner 10 or more years older, this percentage is lower among women age 20-24 (11.6 per cent). Due to the small number of cases, it is impossible to comment on differentiation according to background characteristics for spousal difference among women age 15-19. Figures for women age 20-24 indicate that getting married to a partner 10 or more years older is correlated with lower education and socioeconomic status. Domestic Violence A number of questions were asked of women age 15-49 years to assess their attitudes towards whether husbands have the right to hit or beat their wives/partners in a variety of scenarios. These questions were asked in order to obtain an indication of the cultural beliefs that tend to be associated with the prevalence of violence against women by their husbands/partners. The main assumption here is that women that agree with the statements indicating that husbands/partners are justified in beating their wives/ partners under the situations described in reality tend to be abused by their own husbands/partners. The responses to these questions can be found in Table CP.7. Overall, 6.9 per cent of women in Georgia feel that a husband has the right to beat his wife, mostly in cases when they neglect the children (5.9 per cent). Domestic violence is more accepted in Kvemo Kartli (14.7 per cent) and among the less educated (17.1 per cent). On the other hand, it is less common if the ethnic group of household head is Georgian (5.4 per cent). Child Disability One of the World Fit for Children goals is to protect children against abuse, exploitation, and violence, including the elimination of discrimination against children with disabilities. For children age 2 through 9 years, a series of questions were asked to assess a number of disabilities/impairments, such as sight impairment, deafness, and difficulties with speech. This approach rests in the concept of functional disability developed by WHO and aims to identify the implications of any impairment or disability for the development of the child (e.g. health, nutrition, education, etc.). Table CP.8 presents the results of these questions. According to the mother’s report, 14.4 per cent of children aged 2-9 years display some kind of disability. The most frequently mentioned disability was inability to speak/difficulty speaking (5.8 per 54 MONITORING THE SITUATION OF CHILDREN AND WOMEN cent). This proportion is higher in Samtskhe-Javakheti (19.2 per cent) while it is lowest in Imereti (10.5 per cent). Reported disability is more prevalent among children living in the poorest households (16.1 per cent) and if the household head is Armenian (23.9 per cent). Among children aged 3-9 years, the proportion reported by mothers as having abnormal speech was 19.8 per cent. This proportion is associated with the education of mother and socioeconomic status of the household. It was also more frequent among children where the ethnic group of household head is not Georgian. For 7.6 per cent of children aged 2 years, mothers reported that the child cannot name at least one object. Children’s Living Arrangement and Orphanhood Children who are orphaned or in vulnerable households may be at increased risk of neglect or exploitation if the parents are not available to assist them. Monitoring the variations in different outcomes for orphans and vulnerable children and comparing them to their peers gives us a measure of how well communities and governments are responding to their needs. The frequency of children living with neither parent, mother only, and father only is presented in Table HA.8. Overall, 86.4 per cent of children aged 0–17 are living with both parents, 8.6 per cent are living with the mother only, 1.9 per cent are living with the father and 2.9 per cent are not living with either biological parent. For 4.9 per cent of children aged 0–17, one or both parents are dead. The lowest percentage of children living with both parents was found in Tbilisi (82.5 per cent) and in urban areas (83 per cent). The highest proportion of children living with both parents was in Racha-Lechkhumi-Kvemo Svaneti region. As can be expected, there was a declining trend with increasing age as a result of one or both parents being dead. GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 55 XII. HIV/AIDS Knowledge and Attitudes Knowledge of HIV Transmission and Condom Use One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from the infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal (for example, that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent the further spread of the disease. The HIV module was administered to women 15-49 years of age. One indicator which is both an MDG and UNGASS indicator is the per cent of young women who have comprehensive and correct knowledge of HIV prevention and transmission. Women were asked whether they knew of the three main ways of HIV transmission – having only one faithful uninfected partner, using a condom every time, and abstaining from sex. The results are presented in Table HA.1. In Georgia, 80.2 per cent of the interviewed women have heard of AIDS. However, the percentage of women who know of all three main ways of preventing HIV transmission is only 33.2 per cent. More than half of women know of having one faithful uninfected sex partner and know of using a condom every time (58.4 and 55.8 per cent respectively), and 45.1 per cent know of abstaining from sex as main ways of preventing HIV transmission. While 70.6 per cent of women know at least one way, 29.4 per cent do not know any of the three ways. There are important differences by background characteristics. The percentage of women who have heard AIDS is 51.9 per cent in Kvemo Kartli while it is 94.4 per cent in Tbilisi. This percentage is highest among women living in households where head is Georgian (85.9 per cent) and as low as 29.1 per cent among women living in households where the head is Azerbaijani. Lower proportions of women in rural areas (68.3 per cent) and young women age 15-19 (68.9 per cent) have heard of AIDS. Also, there is a strong positive correlation between the AIDS knowledge and the level of education and socioeconomic status of the household. This is also reflected in the proportion of women who know all three ways of preventing HIV transmission. Table HA.2 presents the per cent of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Georgia, that HIV can be transmitted by sharing food and mosquito bites. The table also provides information on whether women know that HIV cannot be transmitted by supernatural means, and that HIV can be transmitted by sharing needles. Of the interviewed women, 26.7 per cent reject the two most common misconceptions and know that a healthy-looking person can be infected. Nearly 53 per cent of women know that HIV cannot be transmitted by sharing food, and 41.3 per cent of women know that HIV cannot be transmitted by mosquito bites, while 58.4 per cent of women know that a healthy-looking person can be infected. In general, misconceptions are more common in rural areas, among poorer and among less educated women. With respect to regional differences, women in Samtskhe-Javakheti and Kvemo Kartli regions had the lowest percentages (14.7 and 15.6 per cent respectively) for rejecting the two most common misconceptions and know a healthy-looking person can be infected while Tbilisi and Guria regions had the highest (33.3 and 32.9 per cent respectively). Table HA.3 summarizes information from Tables HA.1 and HA.2 and presents the percentage of women who know 2 ways of preventing HIV transmission and reject the three most common misconceptions. Comprehensive knowledge of HIV prevention methods and transmission is fairly low overall, though there are differences by area of residence. Overall, 17.4 per cent of women were found to have comprehensive knowledge, which was slightly higher in urban areas (21 per cent) compared to rural areas (13.3 per cent). As expected, the percentage of women with comprehensive knowledge increases with 56 MONITORING THE SITUATION OF CHILDREN AND WOMEN the woman’s education level (Figure HA.1). The regional differences are also considerable (ranging from 6.7 per cent in Samtskhe-Javakheti to 25.7 per cent in Guria). Comprehensive knowledge of HIV/AIDS transmission was as low as 2.8 per cent if the household head is Azerbaijani. Figure HA.1 Percent of women who have comprehensive knowledge of HIV/AIDS transmission, Georgia, 2005 5 33 50 59 46 1 17 26 39 27 1 10 17 27 17 0 10 20 30 40 50 60 70 Pre Primary and Primary Secondary Secondary special/vocational Higher Georgia Pe rc en t Knows 2 ways to prevent HIV Identify 3 misconceptions Comprehensive knowledge A key indicator used to measure countries’ response to HIV epidemics is the proportion of young people 15-24 years who know two methods of preventing HIV, reject two misconceptions and know that a healthy looking person can have HIV. Fifteen per cent of young women (15-24 years) have comprehensive accurate knowledge of HIV. Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeeding. The level of knowledge among women age 15-49 years concerning mother-to-child transmission is presented in Table HA.4. Overall, more than two-thirds of women (67.3 per cent) know that HIV can be transmitted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is 45.6 per cent, while 12.9 per cent of women did not know of any specific way. Knowledge of mother-to-child transmission of HIV transmission and knowledge of three ways that AIDS can be transmitted are higher among women with higher education and have a positive correlation with socioeconomic status of the household. The lowest percentages of knowledge were in Kvemo Kartli region while women in Tbilisi and Guria had the highest percentages. The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) would care for family member sick with AIDS; 2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status of a family member a secret. Table HA.5 presents the attitudes of women towards people living with HIV/AIDS. Nearly one-quarter of women (23.2 per cent) stated that they would not care for a family member who was sick with AIDS while 53.8 per cent stated that they would want to keep it a secret if a family member had HIV. Larger proportions of women stated that they believe a female teacher with HIV should not be allowed to work (64 per cent) and that they would not buy fresh vegetables from a person with HIV/AIDS GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 57 (72.4 per cent). Overall, as high as 93.6 per cent of women agreed with at least one of the discriminatory statements. There was no significant variation by background characteristics. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. Only 29.3 per cent of women know where to be tested (comparable figure from MICS 1999 is 23.5 per cent) and 11 per cent of women aged 15-49 had actually been tested. Of these, a large proportion has been told the result (83.4 per cent). Knowledge of a place to get tested for HIV showed significant variations by region, ranging from 12.6 per cent in Kvemo Kartli to 47.3 per cent in Tbilisi. The proportion of women who know where to be tested in urban areas (38.6 per cent) was more than twice of those in rural areas (18.6 per cent). As with many other indicators, this variable also showed a positive correlation with education and socioeconomic status of the household. Among women who had given birth within the two years preceding the survey, the per cent who received counselling and HIV testing during antenatal care is presented in Table HA.7. Nearly all women aged 15-49 received antenatal care from a health care professional during their last pregnancy (96.3 per cent). Information about HIV was provided to 41.5 per cent of women, 45.1 per cent of women were tested for HIV during the antenatal care visit, and 40.7 per cent received the results of HIV test. More than 50 per cent of women received HIV counselling and 60 per cent or more women were tested during antenatal care visits and received the results in Tbilisi and Adjara while less than 20 per cent of women in Samtskhe-Javakheti were given counselling, tested for HIV and received the results. HIV counselling, testing for HIV and getting the results were positively correlated with education and socioeconomic status of the household. Women from households headed by an ethnic Azerbaijani were less likely to receive counselling or be tested and told the result. 58 MONITORING THE SITUATION OF CHILDREN AND WOMEN List of References Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. CDC and ORC Macro, 2003. Reproductive, Maternal and Child Health in Eastern Europe and Eurasia: A Comparative Report. DHS Other Documentation No. OD28, Calverton, Maryland: ORC Macro. Department of Statistics (2007). Statistical Yearbook of Georgia 2006, Department of Statistics under Ministry of Economic Development of Georgia, Tbilisi. Filmer, D. and Pritchett, L., 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. Serbanescu, F. et. al., 2001. Women’s Reproductive Health Survey Georgia, 1999-2000, Final Report. National Centre for Disease Control, Centre for Medical Statistics and Information, Ministry of Health and Social Affairs, State Department of Statistics, Centers for Disease Control and Prevention, UNFPA, UNICEF, USAID, UNHCR, and AIHA. Tbilisi. Serbanescu, F. et. al., 2007. Reproductive Health Survey Georgia, 2005, Final Report. National Centre for Disease Control and Medical Statistics, Ministry of Labour, Health and Social Affairs, Department of Statistics Ministry of Economic Development, Centers for Disease Control and Prevention, UNFPA, and USAID. Tbilisi. State Department of Statistics, National Centre for Disease Control, and UNICEF, 2000. Multiple Indicator Cluster Survey, 1999. Tbilisi. UNICEF 2003. Social Monitor 2003. The MONEE Project, CEE/CIS/Baltic States, Innocenti Social Monitor. UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. UNICEF, 2007. UNICEF in Georgia. Tbilisi. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations programme for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN United Nations, 2004. Millennium Development Goals in Georgia. Tbilisi. United Nations, 2005. Millennium Development Goals in Georgia: Progress Report for 2004-2005. Tbilisi. www.childinfo.org Statistical Tables GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 61 Ta bl e H H .1 : R es ul ts o f h ou se ho ld a nd in di vi du al in te rv ie w s N um be r o f h ou se ho ld s, w om en , a nd c hi ld re n un de r 5 b y re su lts o f t he h ou se ho ld , w om en 's a nd u nd er -fi ve 's in te rv ie w s, a nd h ou se ho ld , w om en 's a nd u nd er - fiv e' s re sp on se ra te s, G eo rg ia , 2 00 5 R es id en ce R eg io n U rb an R ur al Tb ili si K ak he ti M ts kh et a- M tia ne ti S hi da K ar tli K ve m o K ar tli S am ts kh e- Ja va kh et i R ac ha - Le ch kh um i an d K ve m o S va ne ti Im er et i G ur ia S am eg re lo an d Ze m o S va ne ti A dj ar a To ta l N um be r o f ho us eh ol ds S am pl ed 74 70 67 80 19 50 13 50 93 0 13 20 15 30 11 70 60 0 15 30 99 0 15 00 13 80 14 25 0 O cc up ie d 62 30 60 38 16 79 11 10 78 8 11 61 13 29 10 61 45 4 12 66 88 8 13 16 12 16 12 26 8 In te rv ie w ed 60 37 59 73 15 79 10 93 76 0 11 43 13 16 10 45 45 3 12 54 87 6 13 04 11 87 12 01 0 R es po ns e ra te 96 .9 98 .9 94 .0 98 .5 96 .4 98 .4 99 .0 98 .5 99 .8 99 .1 98 .6 99 .1 97 .6 97 .9 N um be r o f w om en E lig ib le 57 24 51 84 15 60 89 6 67 5 98 7 12 54 99 9 25 1 99 5 69 2 11 57 14 42 10 90 8 In te rv ie w ed 52 64 45 83 14 88 79 6 58 8 88 7 11 52 90 3 20 8 90 4 60 8 99 7 13 16 98 47 R es po ns e ra te 92 .0 88 .4 95 .4 88 .8 87 .1 89 .9 91 .9 90 .4 82 .9 90 .9 87 .9 86 .2 91 .3 90 .3 O ve ra ll re sp on se ra te 89 .1 87 .5 89 .7 87 .5 84 .0 88 .5 91 .0 89 .0 82 .7 90 .0 86 .7 85 .4 89 .1 88 .4 N um be r o f c hi ld re n un de r 5 E lig ib le 10 68 11 28 32 2 18 6 12 5 21 4 29 0 21 6 52 16 7 11 0 21 5 29 9 21 96 M ot he r/C ar et ak er in te rv ie w ed 99 9 10 38 30 9 17 4 11 4 19 0 27 1 19 9 52 16 1 96 19 4 27 7 20 37 R es po ns e ra te 93 .5 92 .0 96 .0 93 .5 91 .2 88 .8 93 .4 92 .1 10 0. 0 96 .4 87 .3 90 .2 92 .6 92 .8 O ve ra ll re sp on se ra te 90 .6 91 .0 90 .2 92 .1 88 .0 87 .4 92 .5 90 .7 99 .8 95 .5 86 .1 89 .4 90 .4 90 .8 62 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HH.2 Household age distribution by sex Per cent distribution of the household population by five-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, Georgia, 2005 Males Females Total Number Per cent Number Per cent Number Per cent Age 0-4 1198 5.7 1024 4.5 2222 5.1 5-9 1355 6.5 1199 5.3 2553 5.8 10-14 1663 7.9 1568 6.9 3230 7.4 15-19 1783 8.5 1770 7.8 3553 8.1 20-24 1673 8.0 1725 7.6 3397 7.8 25-29 1551 7.4 1501 6.6 3052 7.0 30-34 1476 7.0 1479 6.5 2955 6.8 35-39 1341 6.4 1481 6.5 2822 6.5 40-44 1613 7.7 1626 7.1 3239 7.4 45-49 1387 6.6 1383 6.1 2769 6.3 50-54 1325 6.3 1817 8.0 3142 7.2 55-59 1139 5.4 1162 5.1 2302 5.3 60-64 665 3.2 1004 4.4 1669 3.8 65-69 1086 5.2 1360 6.0 2446 5.6 70+ 1734 8.3 2637 11.6 4371 10.0 Missing/DK 1 .0 9 .0 9 .0 Dependency age groups < 15 4215 20.1 3790 16.7 8005 18.3 15-64 13953 66.5 14947 65.7 28900 66.1 65 + 2820 13.4 3997 17.6 6817 15.6 Missing/DK 1 .0 9 .0 9 .0 Children aged 0-17 5271 25.1 4849 21.3 10120 23.1 Adults 18+/Missing/ DK 15718 74.9 17894 78.7 33611 76.9 Total 20988 100.0 22743 100.0 43731 100.0 GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 63 Table HH.3: Household composition Per cent distribution of households by selected characteristics, Georgia, 2005 Weighted per cent Number of households Weighted Unweighted Sex of household head Male 70.0 8411 8521 Female 30.0 3599 3489 Region Tbilisi 25.6 3069 1579 Kakheti 9.0 1081 1093 Mtskheta-Mtianeti 3.0 356 760 Shida Kartli 7.3 875 1143 Kvemo Kartli 10.7 1280 1316 Samtskhe-Javakheti 4.6 551 1045 Racha-Lechkhumi and Kvemo Svaneti 1.5 180 453 Imereti 17.5 2097 1254 Guria 3.5 424 876 Samegrelo and Zemo Svaneti 9.9 1186 1304 Adjara 7.6 910 1187 Residence Urban 50.0 6009 6037 Rural 50.0 6001 5973 Number of household members 1 14.7 1768 1720 2-3 33.0 3968 3913 4-5 35.8 4294 4308 6-7 14.1 1692 1757 8-9 1.9 233 252 10+ .5 55 60 Education of household head* Pre-Primary and Primary 8.1 969 1030 Secondary 45.2 5430 5759 Secondary special/vocational 19.0 2280 2307 Higher 27.7 3330 2913 Ethnic group of household head** Georgian 84.6 10164 10194 Russian 1.3 161 139 Azerbaijani 6.7 810 727 Armenian 4.9 594 670 Other Ethnicity 2.3 272 268 Total 100.0 12010 12010 At least one child aged < 18 years 47.4 12010 12010 At least one child aged < 5 years 14.9 12010 12010 At least one woman aged 15-49 years 64.2 12010 12010 * 1 unweighted case with missing information about education of household head not shown ** 12 unweighted cases with missing information about ethnic group of household head not shown 64 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table HH.4: Women's background characteristics Per cent distribution of women aged 15-49 years by background characteristics, Georgia, 2005 Number of women Weighted per cent Weighted Unweighted Region Tbilisi 27.8 2735 1488 Kakheti 8.1 801 796 Mtskheta-Mtianeti 3.0 293 588 Shida Kartli 6.5 644 887 Kvemo Kartli 11.4 1120 1152 Samtskhe-Javakheti 4.9 480 903 Racha-Lechkhumi and Kvemo Svaneti .9 87 208 Imereti 15.0 1479 904 Guria 3.1 302 608 Samegrelo and Zemo Svaneti 9.5 933 997 Adjara 9.9 972 1316 Residence Urban 53.3 5253 5264 Rural 46.7 4594 4583 Age 15-19 15.4 1514 1472 20-24 14.8 1458 1415 25-29 13.6 1339 1351 30-34 13.6 1339 1337 35-39 13.9 1372 1384 40-44 15.5 1523 1543 45-49 13.2 1302 1345 Marital/Union status Currently married/in union 61.7 6071 6183 Formerly married/in union 6.7 659 671 Never married/in union 31.7 3117 2993 Motherhood status Ever gave birth 63.7 6269 6395 Never gave birth 36.3 3578 3452 Education Pre-Primary and Primary .9 90 83 Secondary 41.5 4085 4367 Secondary special/vocational 21.6 2130 2196 Higher 36.0 3543 3201 Wealth index quintiles Poorest 16.2 1596 1741 Second 18.4 1812 1959 Middle 19.4 1906 2306 Fourth 22.9 2253 2332 Richest 23.2 2280 1509 Ethnic group of household head Georgian 84.8 8350 8344 Russian .5 45 40 Azerbaijani 8.1 793 712 Armenian 4.9 484 573 Other Ethnic 1.7 170 171 Total 100.0 9847 9847 ** 7 unweighted cases with missing information about ethnic group of household head not shown GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 65 Table HH.5: Children's background characteristics Per cent distribution of children under five years of age by background characteristics, Georgia, 2005 Number of under-5 children Weighted per cent Weighted Unweighted Sex Male 54.1 1103 1116 Female 45.9 934 921 Region Tbilisi 28.7 585 309 Kakheti 8.6 175 174 Mtskheta-Mtianeti 3.0 61 114 Shida Kartli 7.4 151 190 Kvemo Kartli 12.8 261 271 Samtskhe-Javakheti 5.5 113 199 Racha-Lechkhumi and Kvemo Svaneti .9 18 52 Imereti 12.3 250 161 Guria 2.5 51 96 Samegrelo and Zemo Svaneti 8.6 174 194 Adjara 9.7 199 277 Residence Urban 50.3 1025 999 Rural 49.7 1012 1038 Age < 6 months 9.1 185 171 6-11 months 9.8 200 213 12-23 months 18.3 373 364 24-35 months 20.1 410 424 36-47 months 20.7 421 422 48-59 months 22.0 448 443 Mother’s education Pre-Primary and Primary .8 16 13 Secondary 41.7 850 921 Secondary special/vocational 16.3 333 360 Higher 41.2 838 743 Wealth index quintiles Poorest 17.0 346 369 Second 18.8 384 421 Middle 20.1 409 520 Fourth 19.7 401 413 Richest 24.4 497 314 Ethnic group of household head* Georgian 81.2 1654 1653 Russian .5 10 11 Azerbaijani 9.6 195 182 Armenian 5.7 116 134 Other Ethnic 3.0 61 56 Total 100.0 2037 2037 * 1 unweighted case with missing information about ethnic group of household head not shown 66 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CM.1: Child mortality Infant and under-five mortality rates*, Georgia, 2005 Infant mortality rate** Under-five mortality rate*** Sex Male 34 39 Female 28 32 Residence Urban 21 24 Rural 39 45 Mother’s education Pre-Primary and Primary (*) (*) Secondary 37 43 Secondary special/vocational 28 32 Higher 21 23 Wealth index quintiles Poorest 60% 38 44 Richest 40% 20 22 Total 31 35 * East model, reference date is 2000.4 ** MICS indicator 2; MDG indicator 14 *** MICS indicator 1; MDG indicator 13 (*) Rates for women with pre-primary and primary education not shown due to small number of cases (83 unweighted cases) Table CM.2: Children ever born and proportion dead Mean number of children ever born and proportion dead by age of women, Georgia, 2005 Mean number of children ever born Proportion dead Number of women Age 15-19 .024 .000 1514 20-24 .287 .035 1458 25-29 .605 .038 1339 30-34 .906 .038 1339 35-39 .986 .045 1372 40-44 1.093 .053 1523 45-49 1.135 .071 1302 Total .708 .050 9847 GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 67 Table NU.1: Child malnourishment Percentage of children aged 0-59 months who are severely or moderately malnourished, Georgia, 2005 Weight for age Height for age Weight for height Number of children aged 0-59 months % below % below % below % below % below % below % above - 2 SD* - 3 SD* - 2 SD** - 3 SD** - 2 SD*** - 3 SD*** + 2 SD Sex Male 2.1 .5 11.0 5.1 2.6 .7 14.3 982 Female 2.1 .0 9.8 4.6 1.6 .0 16.2 830 Region Tbilisi 1.5 .4 3.6 1.9 1.9 .4 14.0 523 Kakheti 2.3 .0 13.1 3.7 3.6 .0 15.5 157 Mtskheta-Mtianeti .5 .0 10.0 4.5 .3 .0 22.2 55 Shida Kartli 2.1 .0 7.4 2.5 4.6 1.8 15.0 145 Kvemo Kartli 2.5 .8 18.5 10.0 1.0 .0 18.7 217 Samtskhe-Javakheti 3.8 .0 18.0 8.6 .3 .0 13.2 99 Racha-Lechkhumi and Kvemo Svaneti (.0) (.0) (8.7) (4.8) (7.2) (.0) (12.0) 17 Imereti 2.9 .0 15.0 7.7 3.2 .9 16.3 229 Guria .8 .8 4.1 .0 4.9 .0 7.4 46 Samegrelo and Zemo Svaneti 1.9 .0 7.3 3.8 1.6 .2 8.9 151 Adjara 2.1 .6 15.4 7.0 .4 .0 19.7 174 Residence Urban 1.7 .3 7.5 3.0 1.9 .3 15.0 917 Rural 2.5 .3 13.5 6.8 2.3 .5 15.4 895 Age < 6 months 2.1 .0 2.8 1.2 2.0 .0 11.6 171 6-11 months 2.5 1.0 8.4 2.4 1.1 1.1 22.7 182 12-23 months 3.3 .3 13.7 5.1 .7 .0 20.0 337 24-35 months 2.2 .7 12.1 5.6 3.0 .9 12.4 367 36-47 months 1.7 .0 10.5 6.6 1.5 .1 12.4 367 48-59 months 1.1 .0 10.2 5.2 3.7 .3 14.3 387 Mother’s education Pre-primary and Primary (*) (*) (*) (*) (*) (*) (*) 12 Secondary 2.7 .3 15.2 6.7 2.5 .2 14.0 745 Secondary special/ vocational 2.3 .8 11.5 6.4 2.3 .8 16.9 296 Higher 1.4 .1 5.4 2.6 1.8 .4 15.9 758 Wealth index quintiles Poorest 2.5 .2 18.0 8.8 3.2 .7 15.7 308 Second 2.8 .4 11.5 5.4 2.5 .8 13.4 339 Middle 1.3 .3 12.1 5.8 1.4 .1 17.3 361 Fourth 2.1 .7 8.4 3.9 3.1 .6 15.5 364 Richest 1.9 .0 4.7 1.7 .9 .0 14.2 440 Ethnic group of household head**** Georgian 2.0 .2 8.7 3.6 2.0 .5 14.6 1483 Azerbaijani 2.7 1.2 27.2 15.5 1.4 .0 18.7 154 Armenian 2.4 .0 14.5 9.7 4.3 .0 20.1 109 Other Ethnic 1.1 .0 3.2 .0 3.4 .0 11.2 65 Total 2.1 .3 10.4 4.9 2.1 .4 15.2 1812 * MICS indicator 6; MDG indicator 4 ** MICS indicator 7 *** MICS indicator 8 **** 1 unweighted case with missing information about ethnic group of household head not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 68 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.2: Initial breastfeeding Percentage of women aged 15-49 years with a birth in the two years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, Georgia, 2005 Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with a live birth in the two years preceding the survey Region Tbilisi 29.5 64.3 236 Kakheti 29.6 67.7 64 Mtskheta-Mtianeti (46.1) (83.9) 24 Shida Kartli 44.9 73.8 46 Kvemo Kartli 41.7 62.4 91 Samtskhe-Javakheti 35.4 60.2 47 Racha-Lechkhumi and Kvemo Svaneti (*) (*) 6 Imereti 45.6 67.7 113 Guria (27.3) (62.4) 16 Samegrelo and Zemo Svaneti 48.1 65.7 54 Adjara 29.5 56.0 73 Residence Urban 34.7 65.4 399 Rural 38.7 64.8 371 Months since birth < 6 months 39.5 64.5 190 6-11 months 36.5 65.0 199 12-23 months 35.3 65.5 381 Mother’s education Pre-primary and Primary (*) (*) 3 Secondary 38.9 67.5 304 Secondary special/ vocational 36.1 62.7 122 Higher 35.1 63.9 341 Wealth index quintiles Poorest 38.9 66.8 121 Second 45.0 66.6 135 Middle 42.0 65.1 154 Fourth 31.4 61.7 160 Richest 29.6 65.8 200 Ethnic group of household head Georgian 38.1 65.3 643 Azerbaijani 28.1 63.5 60 Armenian 35.4 60.1 43 Other Ethnic (*) (*) 24 Total 36.6 65.1 770 * MICS indicator 45 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 69 Ta bl e N U .3 : B re as tfe ed in g Pe rc en ta ge o f l iv in g ch ild re n ac co rd in g to b re as tfe ed in g st at us a t e ac h ag e gr ou p, G eo rg ia , 2 00 5 C hi ld re n 0- 3 m on th s C hi ld re n 0- 5 m on th s C hi ld re n 6- 9 m on th s C hi ld re n 12 -1 5 m on th s C hi ld re n 20 -2 3 m on th s P er c en t ex cl us iv el y br ea st fe d N um be r o f ch ild re n P er c en t ex cl us iv el y br ea st fe d* N um be r o f ch ild re n % r ec ei vi ng br ea st m ilk & so lid / m us hy fo od ** N um be r of ch ild re n P er c en t br ea st fe d* ** N um be r o f ch ild re n P er c en t br ea st fe d* ** N um be r o f ch ild re n Se x M al e 7. 8 61 7. 8 90 34 .2 70 44 .2 59 23 .3 69 Fe m al e 18 .0 61 13 .7 96 35 .4 64 37 .7 76 (1 4. 1) 47 R es id en ce U rb an 10 .3 75 8. 6 11 7 29 .9 65 41 .1 69 (2 2. 9) 50 R ur al (1 7. 0) 48 14 .8 68 39 .5 69 40 .0 67 17 .1 67 M ot he r’s e du ca tio n P re -p rim ar y an d P rim ar y - - - - - - (* ) 2 - - S ec on da ry (1 0. 5) 41 7. 4 64 31 .0 51 35 .8 58 (1 9. 8) 41 S ec on da ry s pe ci al /v oc at io na l (* ) 19 (4 .6 ) 26 (* ) 14 (4 6. 5) 29 (9 .8 ) 26 H ig he r (1 6. 4) 63 15 .0 95 34 .3 69 (4 4. 6) 47 (2 4. 6) 49 W ea lth in de x qu in til es P oo re st 6 0% 14 .3 57 11 .7 86 42 .7 70 42 .2 77 20 .9 69 R ic he st 4 0% 11 .7 66 10 .1 99 26 .2 65 (3 8. 4) 59 (1 7. 7) 48 To ta l 12 .9 12 3 10 .9 18 5 34 .8 13 4 40 .5 13 6 19 .6 11 7 * M IC S in di ca to r 1 5 ** M IC S in di ca to r 1 7 ** * M IC S in di ca to r 1 6 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s 70 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.4: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times yesterday and percentage of infants adequately fed, Georgia, 2005 Per cent of infants 0-5 months exclusively breastfed 6-8 months who received breastmilk and complementary food at least 2 times in prior 24 hours 9-11 months who received breastmilk and complementary food at least 3 times in prior 24 hours 6-11 months who received breastmilk and complementary food at least the minimum recommended number of times per day* 0-11 months who were appropriately fed** Number of infants aged 0-11 months Sex Male 7.8 25.5 31.4 28.2 18.9 196 Female 13.7 30.9 24.6 28.0 20.8 190 Residence Urban 8.6 23.5 17.9 21.1 14.4 217 Rural 14.8 33.2 36.9 35.1 26.8 168 Mother’s education Secondary 7.4 26.2 37.1 32.0 21.0 143 Secondary special/ vocational 4.6 46.3 8.1 23.9 14.3 53 Higher 15.0 25.7 26.4 26.0 20.5 189 Wealth index quintiles Poorest .0 39.5 48.4 43.0 (24.1) 44 Second 25.4 49.5 35.8 42.7 35.6 69 Middle 7.5 16.3 34.4 26.7 16.9 76 Fourth 8.4 10.1 7.9 9.3 8.8 93 Richest 12.0 30.2 21.5 26.1 19.5 103 Total 10.9 28.0 28.2 28.1 19.8 385 * MICS indicator 18 ** MICS indicator 19 ( ) Figures that are based on 25-49 unweighted cases GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 71 Table NU.5: Iodized salt consumption Percentage of households consuming adequately iodized salt, Georgia, 2005 Per cent of households in which salt was tested Number of households interviewed Per cent of households with Number of households in which salt was tested or with no salt salt test result No salt < 15 PPM 15+ PPM* Total Region Tbilisi 97.1 3069 0.6 12.8 86.6 100.0 2,997 Kakheti 98.5 1081 0.2 12.2 87.6 100.0 1,067 Mtskheta-Mtianeti 98.8 356 0.8 12.8 86.4 100.0 354 Shida Kartli 98.4 875 0.6 24.6 74.8 100.0 866 Kvemo Kartli 96.4 1280 0.2 9.2 90.6 100.0 1,237 Samtskhe-Javakheti 98.2 551 0.8 15.5 83.6 100.0 545 Racha-Lechkhumi and Kvemo Svaneti 94.4 180 3.8 12.6 83.6 100.0 176 Imereti 97.6 2097 0.4 11.0 88.6 100.0 2,056 Guria 98.1 424 0.4 17.3 82.3 100.0 418 Samegrelo and Zemo Svaneti 98.1 1186 1.0 5.4 93.6 100.0 1,175 Adjara 98.7 910 0.6 9.8 89.6 100.0 903 Residence Urban 97.3 6009 0.6 10.5 88.9 100.0 5,885 Rural 97.9 6001 0.5 14.0 85.4 100.0 5,910 Education of household head Pre-primary and Primary 96.4 969 0.7 14.0 85.3 100.0 941 Secondary 97.9 5430 0.6 14.0 85.4 100.0 5,349 Secondary special/ vocational 97.9 2280 0.6 9.3 90.1 100.0 2,245 Higher 97.3 3330 0.5 10.9 88.6 100.0 3,259 Wealth index quintiles Poorest 97.2 2774 0.8 15.2 84.0 100.0 2,719 Second 98.2 2206 0.6 10.4 89.0 100.0 2,178 Middle 98.4 2139 0.5 11.6 88.0 100.0 2,114 Fourth 97.5 2543 0.7 11.8 87.6 100.0 2,496 Richest 97.1 2349 0.4 11.6 88.0 100.0 2,289 Ethnic group of household head Georgian 97.8 10164 0.6 11.8 87.6 100.0 9,997 Russian 96.7 161 2.9 15.8 81.3 100.0 160 Azerbaijani 96.0 810 0.0 10.1 89.9 100.0 777 Armenian 98.8 594 0.4 22.4 77.2 100.0 589 Other Ethnic 96.6 272 0.0 11.5 88.5 100.0 262 Total 97.6 12010 0.6 12.2 87.2 100.0 11,795 * MICS indicator 41 72 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table NU.6: Post-partum mothers' vitamin A supplementation Percentage of women aged 15-49 years with a live birth in the 2 years preceding the survey by whether they received a high dose vitamin A supplement before the infant was 8 weeks old, Georgia, 2005 Received vitamin A supplement* Not sure if received vitamin A Number of women aged 15-49 years Region Tbilisi 10.7 2.0 236 Kakheti 20.5 3.5 64 Mtskheta-Mtianeti (7.1) (3.6) 24 Shida Kartli 6.9 8.2 46 Kvemo Kartli 12.1 4.3 91 Samtskhe-Javakheti 18.8 2.3 47 Racha-Lechkhumi and Kvemo Svaneti (*) (*) 6 Imereti 23.0 1.6 113 Guria (20.0) (4.7) 16 Samegrelo and Zemo Svaneti 26.6 4.4 54 Adjara 16.6 2.9 73 Residence Urban 15.5 3.4 399 Rural 16.2 2.8 371 Education Pre-primary and Primary (*) (*) 3 Secondary 18.2 2.7 304 Secondary special/vocational 14.7 1.7 122 Higher 14.3 3.9 341 Wealth index quintiles Poorest 13.4 1.4 121 Second 20.4 1.1 135 Middle 16.3 3.4 154 Fourth 14.2 4.1 160 Richest 15.2 4.3 200 Ethnic group of household head Georgian 17.1 2.9 643 Azerbaijani 6.0 6.5 60 Armenian 9.5 .8 43 Other Ethnic (*) (*) 24 Total 15.8 3.1 770 *MICS indicator 43 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 73 Table NU.7: Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Georgia, 2005 Per cent of live births: Number of live births Below 2500 grams* Weighed at birth** Region Tbilisi 4.8 96.1 236 Kakheti 4.9 95.4 64 Mtskheta-Mtianeti (3.7) (92.9) 24 Shida Kartli 5.6 100.0 46 Kvemo Kartli 4.3 86.9 91 Samtskhe-Javakheti 5.6 95.8 47 Racha-Lechkhumi and Kvemo Svaneti (*) (*) 6 Imereti 3.3 98.4 113 Guria (3.4) (93.4) 16 Samegrelo and Zemo Svaneti 6.1 98.3 54 Adjara 4.9 97.4 73 Residence Urban 4.5 96.1 399 Rural 4.9 95.2 371 Mother’s education Pre-primary and Primary (*) (*) 3 Secondary 4.4 94.4 304 Secondary special/vocational 6.3 98.7 122 Higher 4.2 95.8 341 Wealth index quintiles Poorest 6.6 94.5 121 Second 3.9 94.5 135 Middle 4.0 96.5 154 Fourth 5.4 95.8 160 Richest 3.9 96.5 200 Ethnic group of household head Georgian 4.9 96.9 643 Azerbaijani 3.8 82.2 60 Armenian 4.6 96.6 43 Other Ethnic (*) (*) 24 Total 4.7 95.7 770 * MICS indicator 9 ** MICS indicator 10 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 74 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.1: Oral rehydration treatment Percentage of children aged 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Georgia, 2005 Had diarrhoea in last two weeks Number of children aged 0-59 months Children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea Fluid from ORS packet Recommended homemade fluid No treatment ORT use rate * Sex Male 10.8 1103 42.1 14.5 47.7 52.3 119 Female 9.9 934 37.0 12.3 52.6 47.4 93 Region Tbilisi 11.8 585 (41.4) (8.7) (52.8) (47.2) 69 Kakheti 15.1 175 (*) (*) (*) (*) 26 Mtskheta-Mtianeti 15.8 61 (*) (*) (*) (*) 10 Shida Kartli 6.8 151 (*) (*) (*) (*) 10 Kvemo Kartli 5.9 261 (*) (*) (*) (*) 15 Samtskhe- Javakheti 13.6 113 (25.6) (18.2) (56.2) (43.8) 15 Racha- Lechkhumi and Kvemo Svaneti 6.7 18 (*) (*) (*) (*) 1 Imereti 7.0 250 (*) (*) (*) (*) 18 Guria 13.2 51 (*) (*) (*) (*) 7 Samegrelo and Zemo Svaneti 14.2 174 (55.7) (24.4) (26.3) (73.7) 25 Adjara 7.9 199 (*) (*) (*) (*) 16 Residence Urban 10.4 1025 43.5 11.7 48.9 51.1 106 Rural 10.4 1012 36.2 15.4 50.8 49.2 105 Age 0-11 months 13.7 385 34.6 14.5 52.6 47.4 53 12-23 months 13.8 373 (48.1) (13.8) (44.3) (55.7) 51 24-35 months 10.9 410 (37.5) (10.8) (52.3) (47.7) 45 36-47 months 8.5 421 (44.6) (8.8) (48.6) (51.4) 36 48-59 months 6.0 448 (32.1) (22.1) (52.6) (47.4) 27 Mother’s education Pre-primary and Primary (*) 16 (*) (*) (*) (*) 2 Secondary 11.3 850 43.3 15.4 45.1 54.9 96 Secondary special/vocational 9.6 333 (30.2) (14.1) (56.9) (43.1) 32 Higher 9.8 838 37.8 11.6 54.2 45.8 82 Wealth index quintiles Poorest 11.2 346 (33.1) (6.6) (60.3) (39.7) 39 Second 9.3 384 (50.0) (15.4) (38.3) (61.7) 36 Middle 10.3 409 34.5 20.9 50.7 49.3 42 Fourth 13.2 401 38.1 14.1 53.6 46.4 53 Richest 8.5 497 (45.1) (10.3) (44.6) (55.4) 42 Ethnic group of household head Georgian 10.3 1654 42.8 11.2 48.9 51.1 170 Azerbaijani 5.4 195 (*) (*) (*) (*) 10 Armenian 15.6 116 (*) (*) (*) (*) 18 Other Ethnic 17.8 71 (*) (*) (*) (*) 13 Total 10.4 2037 39.9 13.6 49.9 50.1 212 * MICS indicator 33 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 75 Table CH.2: Home management of diarrhoea Percentage of children aged 0-59 months with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode, Georgia, 2005 Had diarr- hoea in last two weeks Number of children aged 0-59 months Children with diarrhoea who: Home manage- ment of diarrhoea* Received ORT or increased fluids AND continued feeding** Number of children aged 0-59 months with diarrhoea Drank more Drank the same or less Ate somewhat less, same or more Ate much less or none Sex Male 10.8 1103 34.5 58.6 64.4 35.6 19.9 36.2 119 Female 9.9 934 38.4 45.2 54.8 40.7 21.4 36.8 93 Region Tbilisi 11.8 585 (47.8) (44.0) (59.6) (37.4) (25.8) (36.2) 69 Kakheti 15.1 175 (*) (*) (*) (*) (*) (*) 26 Mtskheta-Mtianeti 15.8 61 (*) (*) (*) (*) (*) (*) 10 Shida Kartli 6.8 151 (*) (*) (*) (*) (*) (*) 10 Kvemo Kartli 5.9 261 (*) (*) (*) (*) (*) (*) 15 Samtskhe-Javakheti 13.6 113 (37.0) (41.1) (63.8) (36.2) (15.1) (31.1) 15 Racha-Lechkhumi and Kvemo Svaneti 6.7 18 (*) (*) (*) (*) (*) (*) 1 Imereti 7.0 250 (*) (*) (*) (*) (*) (*) 18 Guria 13.2 51 (*) (*) (*) (*) (*) (*) 7 Samegrelo and Zemo Svaneti 14.2 174 (23.5) (63.0) (68.1) (31.9) (17.9) (56.3) 25 Adjara 7.9 199 (*) (*) (*) (*) (*) (*) 16 Residence Urban 10.4 1025 40.3 49.7 63.6 34.5 23.5 40.6 106 Rural 10.4 1012 32.1 55.8 56.8 41.3 17.7 32.3 105 Age 0-11 months 13.7 385 32.5 58.2 79.8 20.2 25.6 49.2 53 12-23 months 13.8 373 (36.2) (57.0) (47.3) (48.8) (16.7) (29.1) 51 24-35 months 10.9 410 (45.8) (43.6) (55.9) (41.8) (22.6) (33.6) 45 36-47 months 8.5 421 (41.0) (53.4) (56.8) (40.2) (22.4) (32.2) 36 48-59 months 6.0 448 (21.2) (48.1) (58.4) (41.6) (12.4) (36.1) 27 Mother’s education Pre-primary and Primary (*) 16 (*) (*) (*) (*) (*) (*) 2 Secondary 11.3 850 36.7 58.6 56.0 44.0 19.0 33.7 96 Secondary special/ vocational 9.6 333 (45.1) (31.8) (71.7) (21.9) (35.0) (48.2) 32 Higher 9.8 838 31.5 54.4 61.3 36.2 17.4 35.1 82 Wealth index quintiles Poorest 11.2 346 (26.1) (60.1) (50.9) (49.1) (9.4) (20.7) 39 Second 9.3 384 (38.0) (52.5) (62.0) (32.3) (26.6) (44.9) 36 Middle 10.3 409 28.7 56.6 70.6 29.4 18.8 42.5 42 Fourth 13.2 401 31.9 64.6 56.2 43.8 15.3 26.5 53 Richest 8.5 497 (57.0) (27.5) (61.9) (33.1) (34.1) (50.1) 42 Ethnic group of household head Georgian 10.3 1654 34.1 53.4 62.1 36.7 20.3 37.5 170 Azerbaijani 5.4 195 (*) (*) (*) (*) (*) (*) 10 Armenian 15.6 116 (*) (*) (*) (*) (*) (*) 18 Other Ethnic 17.8 71 (*) (*) (*) (*) (*) (*) 13 Total 10.4 2037 36.2 52.7 60.2 37.8 20.6 36.5 212 * MICS indicator 34 ** MICS indicator 35 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 76 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .3 : C ar e se ek in g fo r s us pe ct ed p ne um on ia Pe rc en ta ge o f c hi ld re n ag ed 0 -5 9 m on th s w ith s us pe ct ed p ne um on ia in th e la st tw o w ee ks ta ke n to a h ea lth p ro vi de r, G eo rg ia , 2 00 5 H ad a cu te re sp ira to ry in fe ct io n N o. o f ch ild re n ag ed 0 -5 9 m on th s C hi ld re n w ith s us pe ct ed p ne um on ia w ho w er e ta ke n to : A ny ap pr op ria te pr ov id er * N o. c hi ld re n 0- 59 m on th s w ith s us pe ct ed pn eu m on ia Pu bl ic s ou rc es Pr iv at e so ur ce s O th er s ou rc e G ov t. H os pi ta l G ov t. he al th ce nt re G ov t. he al th p os t P riv at e ho sp ita l/ cl in ic P riv at e ph ys ic ia n O th er pr iv at e m ed ic al R el at iv e/ fri en d O th er Se x M al e 2. 4 11 03 (3 3. 6) (1 7. 9) (9 .1 ) (4 .5 ) (1 1. 3) (.0 ) (4 .4 ) (6 .6 ) (7 6. 4) 27 Fe m al e 3. 0 93 4 (4 1. 9) (1 6. 2) (.0 ) (.0 ) (1 0. 0) (2 .6 ) (.0 ) (.0 ) (7 0. 8) 28 R es id en ce U rb an 2. 5 10 25 (4 3. 1) (2 3. 0) (.0 ) (.0 ) (1 6. 7) (.0 ) (1 .2 ) (6 .9 ) (8 2. 7) 26 R ur al 2. 8 10 12 (3 3. 1) (1 1. 7) (8 .5 ) (4 .2 ) (5 .3 ) (2 .5 ) (3 .0 ) (.0 ) (6 5. 3) 29 W ea lth in de x qu in til es P oo re st 6 0% 3. 0 11 39 (3 2. 1) (1 4. 1) (7 .1 ) (3 .5 ) (5 .4 ) (2 .1 ) (.0 ) (.0 ) (6 4. 3) 34 R ic he st 4 0% 2. 2 89 8 (4 7. 7) (2 2. 1) (.0 ) (.0 ) (1 9. 7) (.0 ) (5 .9 ) (8 .8 ) (8 9. 5) 20 To ta l 2. 7 20 37 37 .8 17 .1 4. 5 2. 2 10 .7 1. 3 2. 2 3. 3 73 .6 54 * M IC S in di ca to r 2 3 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 77 Table CH.4: Antibiotic treatment of pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, Georgia, 2005 Percentage of under fives with suspected pneumonia who received antibiotics in the last two weeks* Number of children with suspected pneumonia in the two weeks prior to the survey Sex Male (63.0) 27 Female (48.3) 28 Residence Urban (52.5) 26 Rural (58.1) 29 Wealth index quintiles Poorest 60% (56.9) 34 Richest 40% (*) 20 Total 55.5 54 * MICS indicator 22 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 78 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e C H .5 : K no w le dg e of th e tw o da ng er s ig ns o f p ne um on ia Pe rc en ta ge o f m ot he rs /c ar et ak er s of c hi ld re n ag ed 0 -5 9 m on th s by k no w le dg e of ty pe s of s ym pt om s fo r t ak in g a ch ild im m ed ia te ly to a h ea lth fa ci lit y, a nd pe rc en ta ge o f m ot he rs /c ar et ak er s w ho re co gn iz e fa st a nd d iffi cu lt br ea th in g as s ig ns fo r s ee ki ng c ar e im m ed ia te ly , G eo rg ia , 2 00 5 Pe rc en ta ge o f m ot he rs /c ar et ak er s of c hi ld re n ag ed 0 -5 9 m on th s w ho th in k th at a c hi ld s ho ul d be ta ke n im m ed ia te ly to a h ea lth fa ci lit y if th e ch ild : M ot he rs / ca re ta ke rs w ho re co gn iz e th e tw o da ng er si gn s of pn eu m on ia N um be r o f m ot he rs / ca re ta ke rs o f ch ild re n ag ed 0- 59 m on th s Is n ot a bl e to d rin k or br ea st fe ed B ec om es si ck er D ev el op s a fe ve r H as fa st br ea th in g H as d iffi cu lt br ea th in g H as bl oo d in st oo l Is dr in ki ng po or ly H as o th er sy m pt om s R eg io n Tb ili si 17 .1 52 .6 63 .0 34 .8 44 .0 44 .9 20 .5 10 .1 21 .9 58 5 K ak he ti 13 .1 44 .2 63 .1 35 .3 41 .8 39 .8 25 .7 5. 5 19 .1 17 5 M ts kh et a- M tia ne ti 12 .3 51 .2 47 .4 24 .6 38 .5 34 .6 23 .5 16 .8 16 .8 61 S hi da K ar tli 9. 8 46 .5 59 .6 24 .7 28 .5 24 .4 20 .2 10 .2 13 .2 15 1 K ve m o K ar tli 14 .6 60 .5 61 .6 36 .1 35 .4 35 .5 19 .1 6. 0 20 .2 26 1 S am ts kh e- Ja va kh et i 13 .6 43 .5 56 .5 27 .8 40 .0 24 .1 21 .9 5. 1 17 .4 11 3 R ac ha -L ec hk hu m i a nd K ve m o S va ne ti 7. 1 50 .9 53 .1 22 .8 28 .1 36 .2 9. 4 .0 7. 1 18 Im er et i 15 .8 62 .7 54 .4 40 .7 34 .9 34 .8 13 .1 8. 0 20 .9 25 0 G ur ia 8. 5 37 .8 54 .9 35 .6 37 .9 18 .1 9. 5 7. 8 16 .0 51 S am eg re lo a nd Z em o S va ne ti 16 .7 44 .8 74 .7 28 .8 39 .6 33 .5 24 .0 11 .7 22 .1 17 4 A dj ar a 34 .1 67 .3 66 .6 46 .0 47 .5 54 .4 27 .7 14 .8 32 .9 19 9 R es id en ce U rb an 15 .4 52 .5 63 .9 34 .3 41 .2 38 .8 18 .7 9. 6 21 .0 10 25 R ur al 18 .1 54 .5 59 .6 35 .3 38 .2 37 .7 22 .6 8. 9 21 .2 10 12 M ot he r's e du ca tio n P re -p rim ar y an d P rim ar y (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 16 S ec on da ry 18 .1 52 .0 59 .8 33 .3 38 .5 35 .6 21 .5 9. 0 20 .3 85 0 S ec on da ry s pe ci al /v oc at io na l 13 .5 53 .3 60 .5 39 .4 41 .2 43 .5 18 .4 7. 6 22 .8 33 3 H ig he r 16 .3 54 .8 64 .3 33 .9 40 .1 38 .6 20 .7 10 .3 20 .9 83 8 W ea lth in de x qu in til es P oo re st 15 .6 46 .3 61 .4 33 .6 34 .7 32 .9 24 .3 10 .7 17 .5 34 6 S ec on d 17 .5 56 .3 56 .3 35 .4 35 .7 36 .8 19 .9 7. 6 20 .8 38 4 M id dl e 17 .1 51 .9 62 .7 33 .1 40 .8 36 .1 20 .1 10 .7 22 .5 40 9 Fo ur th 16 .3 56 .2 65 .1 37 .3 39 .6 41 .5 19 .8 7. 8 21 .3 40 1 R ic he st 16 .9 55 .5 62 .8 34 .4 45 .4 42 .2 19 .7 9. 6 22 .6 49 7 Et hn ic g ro up o f h ou se ho ld h ea d* G eo rg ia n 16 .3 53 .7 62 .1 34 .8 39 .7 38 .8 20 .2 9. 9 21 .5 16 54 A ze rb ai ja ni 22 .8 57 .5 59 .4 33 .7 36 .9 34 .5 22 .3 6. 7 19 .2 19 5 A rm en ia n 16 .3 49 .5 58 .3 36 .9 41 .2 39 .4 22 .9 5. 4 19 .7 11 6 O th er E th ni c 11 .2 43 .9 67 .0 33 .0 45 .8 33 .1 22 .9 7. 5 19 .0 71 To ta l 16 .7 53 .5 61 .8 34 .8 39 .7 38 .2 20 .6 9. 3 21 .1 20 37 * 1 u nw ei gh te d ca se w ith m is si ng in fo rm at io n ab ou t e th ni c gr ou p of h ou se ho ld h ea d no t s ho w n (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 79 Ta bl e C H .6 : S ol id fu el u se Pe r c en t d is tr ib ut io n of h ou se ho ld s ac co rd in g to ty pe o f c oo ki ng fu el , a nd p er ce nt ag e of h ou se ho ld s us in g so lid fu el s fo r c oo ki ng , G eo rg ia , 2 00 5 Pe rc en ta ge o f h ou se ho ld s us in g: E le ct ric ity Li qu ifi ed P et ro le um G as (L P G ) N at ur al G as K er os en e C ha rc oa l W oo d A ni m al du ng O th er M is si ng To ta l S ol id fu el s fo r c oo ki ng * N um be r o f ho us eh ol ds R eg io n Tb ili si 10 .5 10 .0 77 .9 .3 .0 1. 2 .0 .0 .0 10 0. 0 1. 2 30 69 K ak he ti .6 3. 9 11 .7 .3 .9 82 .3 .0 .0 .2 10 0. 0 83 .3 10 81 M ts kh et a- M tia ne ti 7. 2 20 .6 10 .3 .0 .2 61 .6 .0 .0 .0 10 0. 0 61 .8 35 6 S hi da K ar tli 2. 1 6. 4 15 .6 .0 .9 74 .9 .0 .1 .0 10 0. 0 75 .9 87 5 K ve m o K ar tli 5. 5 8. 9 28 .2 .1 .3 55 .8 1. 0 .1 .1 10 0. 0 57 .2 12 80 S am ts kh e- Ja va kh et i 3. 1 10 .6 6. 6 .0 .8 66 .0 12 .6 .0 .3 10 0. 0 79 .4 55 1 R ac ha -L ec hk hu m i a nd K ve m o S va ne ti 10 .5 4. 3 .0 .2 1. 6 83 .1 .0 .2 .0 10 0. 0 85 .0 18 0 Im er et i 4. 8 10 .4 17 .9 .2 1. 3 65 .2 .1 .1 .1 10 0. 0 66 .7 20 97 G ur ia 1. 6 5. 6 1. 1 .2 .6 90 .6 .0 .4 .0 10 0. 0 91 .5 42 4 S am eg re lo a nd Z em o S va ne ti 2. 4 11 .4 .1 .2 .5 84 .6 .2 .6 .0 10 0. 0 85 .9 11 86 A dj ar a 3. 7 39 .4 2. 6 .1 .3 53 .6 .0 .0 .1 10 0. 0 54 .0 91 0 R es id en ce U rb an 9. 4 17 .9 54 .7 .2 .1 17 .4 .2 .1 .0 10 0. 0 17 .8 60 09 R ur al 1. 4 5. 4 3. 4 .2 1. 0 87 .1 1. 3 .1 .1 10 0. 0 89 .5 60 01 Ed uc at io n of h ou se ho ld h ea d* * P re -p rim ar y an d P rim ar y 3. 1 6. 7 10 .5 .3 .7 77 .3 1. 3 .1 .0 10 0. 0 79 .4 96 9 S ec on da ry 4. 6 9. 3 19 .0 .1 .6 64 .9 1. 1 .2 .1 10 0. 0 66 .8 54 30 S ec on da ry s pe ci al /v oc at io na l 5. 0 14 .2 26 .0 .2 .5 53 .5 .4 .1 .0 10 0. 0 54 .6 22 80 H ig he r 7. 7 15 .1 53 .0 .2 .5 23 .3 .2 .0 .0 10 0. 0 24 .1 33 30 W ea lth in de x qu in til es P oo re st .2 .4 .0 .1 .4 97 .4 1. 3 .2 .1 10 0. 0 99 .3 27 74 S ec on d 1. 4 2. 5 .9 .3 1. 0 92 .2 1. 5 .1 .2 10 0. 0 94 .8 22 06 M id dl e 5. 6 16 .6 12 .7 .2 1. 5 62 .3 .8 .3 .1 10 0. 0 64 .9 21 39 Fo ur th 14 .5 29 .4 47 .6 .3 .1 8. 1 .1 .0 .0 10 0. 0 8. 2 25 43 R ic he st 5. 3 9. 8 84 .8 .1 .0 .0 .0 .0 .0 10 0. 0 .0 23 49 Et hn ic g ro up o f h ou se ho ld h ea d* ** G eo rg ia n 5. 7 11 .7 29 .1 .2 .6 52 .5 .1 .1 .0 10 0. 0 53 .2 10 16 4 R us si an 10 .0 17 .7 59 .3 1. 6 .0 10 .5 .0 .9 .0 10 0. 0 11 .3 16 1 A ze rb ai ja ni 1. 1 5. 8 16 .0 .0 1. 2 74 .0 1. 6 .1 .2 10 0. 0 76 .8 81 0 A rm en ia n 5. 5 16 .5 37 .6 .0 .0 28 .9 11 .3 .1 .1 10 0. 0 40 .3 59 4 O th er E th ni ci ty 4. 3 10 .5 30 .5 .5 .0 53 .9 .0 .0 .3 10 0. 0 53 .9 27 2 To ta l 5. 4 11 .6 29 .1 .2 .6 52 .2 .7 .1 .1 10 0. 0 53 .6 12 01 0 * M IC S in di ca to r 2 4; M D G In di ca to r 2 9 ** 1 u nw ei gh te d ca se w ith m is si ng in fo rm at io n ab ou t e du ca tio n of h ou se ho ld h ea d no t s ho w n ** * 1 2 un w ei gh te d ca se s w ith m is si ng in fo rm at io n ab ou t E th ni c gr ou p of h ou se ho ld h ea d no t s ho w n 80 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table CH.7: Solid fuel use by type of stove or fire Percentage of households using solid fuels for cooking by type of stove or fire, Georgia, 2005 Percentage of households using solid fuels for cooking: Number of households using solid fuels for cooking Closed stove with chimney Open stove or fire with chimney or hood Open stove or fire with no chimney or hood DK stove type/missing Total Region Tbilisi (*) (*) (*) (*) 100.0 38 Kakheti 91.9 3.7 3.4 .9 100.0 900 Mtskheta-Mtianeti 97.1 2.1 .6 .2 100.0 220 Shida Kartli 94.6 4.4 .1 .9 100.0 664 Kvemo Kartli 92.9 6.2 .3 .5 100.0 731 Samtskhe-Javakheti 94.4 3.9 1.1 .6 100.0 437 Racha-Lechkhumi and Kvemo Svaneti 89.7 1.3 8.6 .3 100.0 152 Imereti 85.1 10.5 4.2 .1 100.0 1397 Guria 98.2 .9 .7 .2 100.0 388 Samegrelo and Zemo Svaneti 93.2 5.1 1.0 .8 100.0 1014 Adjara 98.4 1.3 .3 .0 100.0 491 Residence Urban 92.7 5.4 1.3 .6 100.0 1062 Rural 92.1 5.3 2.1 .5 100.0 5371 Education of household head* Pre-primary and Primary 93.1 5.3 1.4 .3 100.0 769 Secondary 91.7 5.7 2.1 .5 100.0 3620 Secondary special/ vocational 93.9 3.8 1.8 .5 100.0 1244 Higher 91.1 5.9 2.4 .7 100.0 801 Wealth index quintiles Poorest 93.9 4.3 1.3 .5 100.0 2750 Second 93.4 4.8 1.3 .6 100.0 2089 Middle 87.1 7.8 4.4 .6 100.0 1385 Fourth 91.2 6.4 2.4 .0 100.0 209 Richest - - - - - - Ethnic group of household head** Georgian 92.2 5.2 2.0 .5 100.0 5404 Russian (96.8) (3.2) (.0) (.0) 100.0 17 Azerbaijani 91.2 7.1 1.3 .4 100.0 621 Armenian 93.3 4.5 2.3 .0 100.0 239 Other Ethnicity 94.3 3.4 2.0 .3 100.0 146 Total 92.2 5.3 2.0 .5 100.0 6434 * 1 unweighted case with missing information about education of household head not shown ** 8 unweighted cases with missing information about Ethnic group of household head not shown ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 81 Ta bl e EN .1 : U se o f i m pr ov ed w at er s ou rc es Pe r c en t d is tr ib ut io n of h ou se ho ld m em be rs a cc or di ng to m ai n so ur ce o f d rin ki ng w at er a nd p er ce nt ag e of h ou se ho ld m em be rs u si ng im pr ov ed d rin ki ng w at er s ou rc es , G eo rg ia , 2 00 5 M ai n so ur ce o f d rin ki ng w at er To ta l Im pr ov ed so ur ce o f dr in ki ng w at er * N um be r o f ho us eh ol d m em be rs Im pr ov ed s ou rc es U ni m pr ov ed s ou rc es P ip ed in to dw el lin g P ip ed in to ya rd / pl ot P ub lic ta p/ st an d- pi pe Tu be - w el l/ bo re - ho le P ro - te ct ed w el l P ro - te ct ed sp rin g R ai n- w at er B ot tle d w at er U np ro - te ct ed w el l U np ro - te ct ed sp rin g Ta nk er tru ck C ar t w ith ta nk / dr um S ur fa ce w at er O th er R eg io n Tb ili si 96 .7 2. 8 .5 .0 .0 .0 .0 .1 .0 .0 .0 .0 .0 .0 10 0. 0 10 0. 0 10 68 2 K ak he ti 15 .1 35 .8 19 .2 6. 0 8. 5 8. 8 .0 .0 3. 0 1. 6 1. 2 .3 .5 .1 10 0. 0 93 .4 39 08 M ts kh et a- M tia ne ti 31 .2 36 .0 3. 9 2. 4 5. 2 14 .6 .0 .0 .3 2. 8 .0 2. 9 .3 .3 10 0. 0 93 .4 13 43 S hi da K ar tli 24 .0 15 .3 12 .0 2. 1 27 .9 10 .5 .0 .0 4. 1 2. 5 .6 .8 .0 .2 10 0. 0 91 .7 30 68 K ve m o K ar tli 30 .3 23 .4 7. 3 1. 0 14 .5 12 .2 .0 .0 1. 5 3. 6 4. 8 .3 .5 .5 10 0. 0 88 .7 49 75 S am ts kh e- Ja va kh et i 21 .9 47 .9 9. 7 .0 1. 2 9. 8 .1 .3 .2 8. 5 .2 .2 .0 .1 10 0. 0 90 .9 22 19 R ac ha -L ec hk hu m i an d K ve m o S va ne ti 24 .8 59 .1 .2 .5 .7 9. 8 .0 .0 .4 3. 0 .0 1. 3 .0 .2 10 0. 0 95 .1 54 7 Im er et i 37 .8 32 .3 .9 5. 3 11 .4 6. 7 .0 .0 4. 1 1. 4 .0 .0 .0 .1 10 0. 0 94 .4 70 40 G ur ia 11 .5 30 .1 .4 4. 8 43 .4 4. 1 .0 .0 4. 4 .7 .0 .1 .2 .2 10 0. 0 94 .4 15 11 S am eg re lo a nd Z em o S va ne ti 15 .4 18 .3 .7 1. 6 50 .1 3. 0 .0 .0 9. 4 1. 2 .0 .0 .0 .2 10 0. 0 89 .2 43 82 A dj ar a 53 .6 32 .7 .7 .9 2. 4 4. 9 .0 .0 .4 3. 7 .0 .1 .0 .7 10 0. 0 95 .1 40 56 R es id en ce U rb an 80 .0 9. 7 1. 4 .7 6. 0 .9 .0 .1 .9 .0 .2 .1 .0 .1 10 0. 0 98 .7 21 12 7 R ur al 13 .2 35 .4 7. 2 3. 5 19 .9 10 .7 .0 .0 4. 1 3. 8 1. 2 .4 .2 .3 10 0. 0 90 .0 22 60 4 Ed uc at io n of h ou se ho ld h ea d P re -p rim ar y an d P rim ar y 21 .0 33 .3 7. 1 3. 6 11 .9 13 .0 .1 .0 3. 3 3. 5 1. 7 .4 .7 .5 10 0. 0 89 .9 32 97 S ec on da ry 33 .3 28 .8 5. 5 2. 1 16 .0 7. 1 .0 .0 3. 1 2. 5 .9 .3 .1 .3 10 0. 0 92 .8 20 12 9 S ec on da ry s pe ci al / vo ca tio na l 44 .6 22 .4 5. 0 2. 7 14 .8 5. 3 .0 .0 2. 6 2. 0 .4 .2 .1 .1 10 0. 0 94 .7 85 88 H ig he r 73 .9 10 .6 1. 4 1. 4 7. 5 2. 4 .0 .1 1. 3 .7 .3 .1 .1 .1 10 0. 0 97 .4 11 71 4 W ea lth in de x qu in til es P oo re st .8 41 .9 8. 0 2. 2 22 .7 13 .7 .0 .0 4. 6 4. 2 1. 0 .6 .2 .3 10 0. 0 89 .3 87 46 S ec on d 7. 7 37 .6 8. 2 4. 2 22 .3 10 .1 .0 .0 4. 5 3. 1 1. 4 .5 .2 .3 10 0. 0 90 .0 87 48 M id dl e 28 .7 30 .7 4. 8 3. 9 18 .9 5. 3 .0 .0 3. 3 2. 5 1. 1 .2 .2 .4 10 0. 0 92 .3 87 44 Fo ur th 90 .3 4. 7 1. 2 .4 2. 0 .7 .0 .1 .4 .0 .1 .0 .0 .1 10 0. 0 99 .4 87 50 R ic he st 10 0. 0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 10 0. 0 87 42 Et hn ic g ro up o f h ou se ho ld h ea d* * G eo rg ia n 47 .6 22 .7 3. 9 2. 2 13 .9 5. 0 .0 .0 2. 6 1. 3 .2 .2 .1 .2 10 0. 0 95 .4 36 72 4 R us si an 86 .4 5. 8 1. 1 .7 2. 6 2. 1 .0 .0 1. 3 .0 .0 .0 .0 .0 10 0. 0 98 .7 35 7 A ze rb ai ja ni 14 .5 24 .8 9. 4 2. 3 16 .0 15 .3 .0 .0 4. 3 5. 1 6. 8 .4 .7 .4 10 0. 0 82 .3 35 06 A rm en ia n 54 .7 28 .0 3. 3 .1 2. 0 3. 5 .0 .0 .1 8. 1 .0 .1 .0 .0 10 0. 0 91 .6 21 95 O th er E th ni ci ty 41 .2 20 .8 9. 7 4. 5 3. 7 17 .0 .0 .0 .6 2. 5 .0 .0 .0 .0 10 0. 0 96 .9 92 2 To ta l 45 .5 23 .0 4. 4 2. 1 13 .2 5. 9 .0 .0 2. 5 2. 0 .7 .2 .1 .2 10 0. 0 94 .2 43 73 1 * M IC S in di ca to r 1 1; M D G in di ca to r 3 0 ** 4 4 un w ei gh te d ca se s w ith m is si ng in fo rm at io n ab ou t e th ni c gr ou p of h ou se ho ld h ea d no t s ho w n 82 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e EN .2 : H ou se ho ld w at er tr ea tm en t Pe r c en t d is tr ib ut io n of h ou se ho ld p op ul at io n ac co rd in g to d rin ki ng w at er tr ea tm en t m et ho d us ed in th e ho us eh ol d, a nd p er ce nt ag e of h ou se ho ld p op ul at io n th at a pp lie d an a pp ro pr ia te w at er tr ea tm en t m et ho d, G eo rg ia , 2 00 5 W at er tr ea tm en t m et ho d us ed in th e ho us eh ol d A ll dr in ki ng w at er so ur ce s Im pr ov ed d rin ki ng w at er s ou rc es U ni m pr ov ed d rin ki ng w at er s ou rc es N on e B oi l A dd bl ea ch / ch lo rin e S tra in th ro ug h a cl ot h U se w at er fil te r Le t i t st an d an d se ttl e O th er D on 't kn ow A pp ro pr ia te w at er tre at m en t m et ho d* N um be r o f ho us eh ol d m em be rs A pp ro pr ia te w at er tre at m en t m et ho d N um be r o f ho us eh ol d m em be rs A pp ro pr ia te w at er tre at m en t m et ho d N um be r o f ho us eh ol d m em be rs R eg io n Tb ili si 87 .5 9. 1 .0 .2 .5 1. 3 1. 7 .2 9. 5 10 68 2 9. 5 10 68 2 - - K ak he ti 96 .0 1. 8 .0 .6 .0 1. 8 .0 .0 1. 8 39 08 1. 7 36 49 2. 7 25 9 M ts kh et a- M tia ne ti 94 .3 4. 3 .0 .0 .6 .6 .5 .0 4. 8 13 43 4. 7 12 54 5. 9 89 S hi da K ar tli 98 .0 .9 .2 .1 .0 .7 .0 .1 1. 1 30 68 1. 1 28 15 .7 25 4 K ve m o K ar tli 96 .3 2. 9 .0 .0 .0 .6 .1 .1 2. 9 49 75 2. 8 44 14 3. 6 56 0 S am ts kh e- Ja va kh et i 95 .8 3. 3 .1 .0 .4 .1 .3 .1 3. 7 22 19 3. 7 20 17 3. 6 20 2 R ac ha -L ec hk hu m i a nd K ve m o S va ne ti 97 .2 1. 8 .4 .0 .0 .5 .0 .2 2. 2 54 7 2. 3 52 0 .0 27 Im er et i 97 .1 2. 6 .1 .1 .0 .2 .0 .1 2. 6 70 40 2. 5 66 46 3. 2 39 4 G ur ia 98 .6 .7 .0 .0 .0 .4 .1 .2 .7 15 11 .4 14 27 6. 1 85 S am eg re lo a nd Z em o S va ne ti 98 .3 1. 4 .0 .0 .0 .1 .0 .2 1. 4 43 82 1. 2 39 09 2. 6 47 3 A dj ar a 89 .5 7. 9 .7 .4 .1 .6 .7 .2 8. 6 40 56 9. 1 38 59 .0 19 8 R es id en ce U rb an 90 .2 7. 4 .1 .2 .3 .9 1. 1 .2 7. 7 21 12 7 7. 7 20 85 8 4. 2 26 9 R ur al 97 .5 1. 6 .1 .2 .1 .5 .0 .1 1. 8 22 60 4 1. 7 20 33 2 2. 7 22 71 Ed uc at io n of h ou se ho ld h ea d P re -p rim ar y an d P rim ar y 96 .1 2. 5 .1 .0 .0 1. 1 .0 .1 2. 6 32 97 1. 8 29 65 9. 4 33 2 S ec on da ry 96 .4 2. 6 .1 .1 .0 .4 .2 .1 2. 7 20 12 9 2. 8 18 67 6 2. 0 14 53 S ec on da ry s pe ci al /v oc at io na l 94 .2 4. 1 .1 .3 .2 .9 .4 .0 4. 3 85 88 4. 6 81 35 .5 45 2 H ig he r 88 .9 8. 2 .1 .2 .4 1. 0 1. 4 .3 8. 6 11 71 4 8. 8 11 41 1 2. 9 30 3 W ea lth in de x qu in til es P oo re st 98 .4 1. 0 .1 .1 .1 .3 .0 .0 1. 2 87 46 1. 1 78 06 2. 0 94 0 S ec on d 97 .4 1. 4 .2 .1 .0 .9 .0 .1 1. 6 87 48 1. 6 78 77 1. 6 87 1 M id dl e 96 .6 2. 4 .1 .2 .0 .4 .1 .2 2. 5 87 44 2. 2 80 68 5. 7 67 6 Fo ur th 91 .0 7. 4 .0 .2 .2 .6 .6 .3 7. 6 87 50 7. 7 86 97 1. 7 53 R ic he st 86 .5 9. 9 .0 .3 .5 1. 4 1. 9 .0 10 .2 87 42 10 .2 87 42 - - Et hn ic g ro up o f h ou se ho ld h ea d G eo rg ia n 93 .7 4. 6 .1 .2 .2 .8 .5 .2 4. 8 36 72 4 4. 9 35 02 3 2. 3 17 01 R us si an 89 .7 8. 1 .0 .0 .0 1. 3 .0 .9 8. 1 35 7 8. 2 35 2 (* ) 5 A ze rb ai ja ni 97 .6 1. 9 .0 .0 .0 .5 .0 .0 1. 9 35 06 1. 6 28 84 3. 3 62 2 A rm en ia n 93 .5 5. 4 .0 .1 .1 .6 .7 .0 5. 4 21 95 5. 6 20 10 4. 0 18 4 O th er E th ni ci ty 94 .1 4. 5 .0 .0 .0 .0 2. 5 .0 4. 5 92 2 4. 1 89 4 (1 8. 3) 29 To ta l 94 .0 4. 4 .1 .2 .2 .7 .5 .1 4. 6 43 73 1 4. 7 41 19 1 2. 8 25 40 * M IC S in di ca to r 1 3 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 83 Table EN.3: Time to source of water Per cent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, Georgia, 2005 Time to source of drinking water Water on premises Less than 15 minutes 15 minutes to less than 30 minutes 30 minutes to less than 1 hour 1 hour or more Don't know/ Missing Total Mean time to source of drinking water* Number of households Region Tbilisi 99.3 .6 .0 .1 .0 .0 100.0 7.0 3069 Kakheti 56.0 17.3 16.7 7.5 2.4 .1 100.0 19.0 1081 Mtskheta-Mtianeti 70.3 9.8 5.9 5.1 8.7 .3 100.0 39.3 356 Shida Kartli 58.1 26.9 11.5 2.3 1.1 .0 100.0 12.8 875 Kvemo Kartli 59.6 17.8 13.7 8.5 .5 .0 100.0 17.4 1280 Samtskhe-Javakheti 70.0 10.1 10.6 6.8 2.3 .2 100.0 22.9 551 Racha-Lechkhumi and Kvemo Svaneti 87.1 7.0 3.2 2.0 .7 .0 100.0 18.5 180 Imereti 82.4 11.5 3.2 2.2 .5 .1 100.0 14.4 2097 Guria 76.6 19.0 3.6 .3 .0 .4 100.0 8.7 424 Samegrelo and Zemo Svaneti 75.2 21.0 2.6 .5 .2 .4 100.0 8.4 1186 Adjara 88.7 7.1 2.2 1.4 .4 .3 100.0 14.2 910 Residence Urban 95.3 3.0 1.0 .5 .1 .1 100.0 12.8 6009 Rural 62.4 20.5 10.2 5.2 1.6 .2 100.0 16.7 6001 Education of household head Pre-primary and Primary 63.1 17.6 10.3 7.1 1.7 .3 100.0 18.2 969 Secondary 74.0 14.4 7.1 3.4 1.0 .1 100.0 16.1 5430 Secondary special/ vocational 78.7 12.6 5.3 2.3 1.0 .2 100.0 16.3 2280 Higher 91.5 5.0 2.1 .9 .4 .1 100.0 14.7 3330 Wealth index quintiles Poorest 58.6 21.5 12.1 5.8 1.8 .2 100.0 17.0 2774 Second 62.6 21.0 9.6 5.1 1.6 .1 100.0 16.4 2206 Middle 76.7 14.3 5.3 2.6 .8 .3 100.0 14.8 2139 Fourth 97.4 1.6 .5 .3 .1 .1 100.0 13.2 2543 Richest 100.0 .0 .0 .0 .0 .0 100.0 . 2349 Ethnic group of household head** Georgian 81.2 11.5 4.4 1.9 .9 .1 100.0 15.5 10164 Russian 94.6 2.4 3.0 .0 .0 .0 100.0 12.2 161 Azerbaijani 45.8 22.5 17.5 13.5 .6 .0 100.0 18.2 810 Armenian 85.5 3.8 7.1 2.9 .5 .2 100.0 21.6 594 Other Ethnicity 67.2 10.7 15.8 5.1 .6 .6 100.0 18.8 272 Total 78.9 11.7 5.6 2.8 .9 .1 100.0 16.3 12010 * The mean time to source of drinking water is calculated based on those households that do not have water on the premises. ** 12 unweighted cases with missing information about ethnic group of household head not shown 84 MONITORING THE SITUATION OF CHILDREN AND WOMEN Table EN.4: Person collecting water Per cent distribution of households according to the person collecting drinking water used in the household, Georgia, 2005 Person collecting drinking water Adult woman Adult man Female child under age 15 Male child under age 15 Don't know/ Missing Total Number of households Region Tbilisi (*) (*) (*) (*) (*) 100.0 20 Kakheti 57.5 41.4 .6 .3 .2 100.0 476 Mtskheta-Mtianeti 54.8 41.9 .0 2.5 .8 100.0 106 Shida Kartli 67.3 32.3 .0 .3 .1 100.0 367 Kvemo Kartli 62.4 36.5 .2 .5 .5 100.0 517 Samtskhe-Javakheti 55.2 38.4 1.5 3.6 1.3 100.0 164 Racha-Lechkhumi and Kvemo Svaneti 52.3 47.7 .0 .0 .0 100.0 23 Imereti 64.2 31.9 1.1 1.1 1.6 100.0 369 Guria 51.9 41.6 2.6 1.6 2.2 100.0 99 Samegrelo and Zemo Svaneti 70.0 26.8 .5 1.1 1.6 100.0 294 Adjara 56.6 41.2 .8 .0 1.3 100.0 103 Residence Urban 61.6 34.0 .9 2.2 1.3 100.0 281 Rural 61.9 36.0 .7 .7 .8 100.0 2258 Education of household head Pre-primary and Primary 67.2 30.6 .1 .8 1.2 100.0 358 Secondary 59.7 37.9 .7 1.0 .7 100.0 1413 Secondary special/ vocational 66.9 30.7 .8 .6 1.0 100.0 486 Higher 57.0 40.0 1.0 1.1 .9 100.0 281 Wealth index quintiles Poorest 62.4 35.3 .8 .6 1.0 100.0 1149 Second 62.9 35.1 .0 1.2 .7 100.0 825 Middle 59.9 37.6 1.1 .8 .5 100.0 498 Fourth 53.6 36.5 3.6 3.1 3.2 100.0 67 Ethnic group of household head* Georgian 60.4 37.2 .7 .8 1.0 100.0 1914 Azerbaijani 66.6 32.4 .3 .5 .3 100.0 439 Armenian 59.4 31.5 2.0 5.4 1.7 100.0 86 Other Ethnicity 70.4 26.6 1.5 .8 .8 100.0 98 Total 61.8 35.7 .7 .9 .9 100.0 2539 * 4 unweighted cases with missing information about ethnic group of household head not shown (*) Figures that are based on less than 25 unweighted cases GEORGIA MULTIPLE INDICATOR CLUSTER SURVEY 2005 85 Ta bl e EN .5 : U se o f s an ita ry m ea ns o f e xc re ta d is po sa l Pe r c en t d is tr ib ut io n of h ou se ho ld m em be rs a cc or di ng to ty pe o f t oi le t f ac ili ty u se d by th e ho us eh ol d, a nd th e pe rc en ta ge o f h ou se ho ld m em be rs us in g sa ni ta ry m ea ns o f e xc re ta d is po sa l, G eo rg ia , 2 00 5 Ty pe o f t oi le t f ac ili ty u se d by h ou se ho ld To ta l P er ce nt ag e of p op ul at io n us in g sa ni ta ry m ea ns o f ex cr et a di sp os al * N um be r o f ho us eh ol d m em be rs Im pr ov ed s an ita tio n fa ci lit y Fl us h/ po ur fl us h to : Ve nt ila te d im pr ov ed pi t l at rin e P it la tri ne w ith sl ab C om po s- tin g to ile t Fl us h/ po ur fl us h to s om e- w he re e ls e Fl us h/ po ur flu sh to un kn ow n pl ac e/ no t su re /d on 't kn ow P it la tri ne w ith ou t sl ab / op en p it B uc ke t O th er M is si ng P ip ed se w er sy st em S ep tic ta nk P it la tri ne R eg io n Tb ili si 98 .0 .2 1. 0 .0 .7 .0 .0 .0 .0 .0 .0 .1 10 0. 0 99 .9 10 68 2 K ak he ti 5. 8 .1 8. 6 3. 0 80 .2 .0 .0 1. 1 1. 1 .0 .0 .0 10 0. 0 97 .8 39 08 M ts kh et a- M tia ne ti 18 .5 .8 7. 0 .4 71 .9 .0 .1 .0 1. 4 .0 .0 .0 10 0. 0 98 .5 13 43 S hi da K ar tli 20 .3 .1 .1 .2 73 .3 .0 .0 .0 5. 8 .0 .0 .2 10 0. 0 94 .0 30 68 K ve m o K ar tli 24 .7 .3 3. 1 .2 64 .7 .6 .0 .0 6. 4 .0 .0 .0 10 0. 0 93 .6 49 75 S am ts kh e- Ja va kh et i 16 .0 .5 6. 0 .2 67 .4 3. 5 .1 .0 6. 4 .1 .0 .0 10 0. 0 93 .4 22 19 R ac ha -L ec hk hu m i a nd K ve m o S va ne ti 11 .3 .1 19 .2 .2 61 .2 .0 .0 .0 7. 8 .2 .0 .0 10 0. 0 92 .0 54 7 Im er et i 35 .0 .3 7. 6 .4 54 .1 .0 .0 .0 2. 6 .1 .0 .0 10 0. 0 97 .3 70 40 G ur ia 7. 7 1. 9 2. 8 1. 2 85 .0 .0 .0 .0 1. 2 .0 .0 .2 10 0. 0 98 .6 15 11 S am eg re lo a nd Z em o S va ne ti 11 .4 .6 4. 5 .3 75 .8 .3 .1 .0 6. 7 .1 .0 .1 10 0. 0 93 .0 43 82 A dj ar a 37 .7 1. 6 9. 1 .7 45 .9 3. 4 .7 .1 .6 .0 .0 .1 10 0. 0 98 .4 40 56 R es id en ce U rb an 80 .4 .4 1. 7 .2 16 .1 .0 .0 .0 1. 1 .0 .0 .1 10 0. 0 98 .7 21 12 7 R ur al 3. 7 .6 7. 6 .8 81 .2 1. 1 .1 .2 4. 5 .1 .0 .0 10 0. 0 95 .1 22 60 4 Ed uc at io n of h ou se ho ld h ea d* * P re -p rim ar y an d P rim ar y 15 .7 .5 4. 1 .8 72 .3 2. 0 .0 .0 4. 5 .0 .0 .0 10 0. 0 95 .5 32 97 S ec on da ry 26 .5 .4 6. 2 .6 61 .8 .7 .1 .1 3. 6 .1 .0 .1 10 0. 0 96 .1 20 12 9 S ec on da ry s pe ci al / vo ca tio na l 41 .4 .6 4. 5 .4 48 .7 .3 .3 .3 3. 6 .0 .0 .0 10 0. 0 95 .9 85 88 H ig he r 71 .8 .5 2. 7 .4 23 .4 .2 .0 .1 .7 .0 .0 .1 10 0. 0 99 .1 11 71 4 W ea lth in de x qu in til es P oo re st .0 .1 3. 4 .0 90 .6 1. 5 .0 .0 4. 3 .1 .0 .0 10 0. 0 95 .6 87 46 S ec on d .6 .4 6. 9 .2 84 .7 .9 .1 .0 6. 1 .1 .0 .0 10 0. 0 93 .7 87 48 M id dl e 14 .1 1. 3 10 .0 1. 4 67 .6 .5 .3 .5 4. 0 .0 .0 .2 10 0. 0 95 .0 87 44 Fo ur th 89 .2 .6 3. 3 .9 5. 7 .0 .0 .0 .1 .0 .0 .1 10 0. 0 99 .7 87 50 R ic he st 99 .9 .0 .1 .0 .0 .0 .0 .0 .0 .0 .0 .0 10 0. 0 10 0. 0 87 42 Et hn ic g ro up o f h ou se ho ld h ea d* * G eo rg ia n 43 .1 .5 4. 7 .5 47 .9 .6 .1 .1 2. 3 .0 .0 .1 10 0. 0 97 .3 36 72 4 R us si an 85 .7 .8 .6 .0 10 .5 .0 .0 .0 1. 3 .0 .0 1. 0 10 0. 0 97 .6 35 7 A ze rb ai ja ni 6. 9 .0 6. 3 1. 1 76 .7 .8 .0 .0 8. 2 .0 .0 .0 10 0. 0 91 .8 35 06 A rm en ia n 51 .4 .2 3. 1 .1 40 .6 .4 .1 .0 4. 0 .0 .0 .0 10 0. 0 95 .9 21 95 O th er E th ni ci ty 34 .6 .3 4. 2 .0 58 .6 .0 .0 .0 2. 3 .0 .0 .0 10 0. 0 97 .7 92 2 To ta l 40 .8 .5 4. 7 .5 49 .7 .6 .1 .1 2. 9 .0 .0 .1 10 0. 0 96 .8 43 73 1 * M IC S in di ca to r 1 2; M D G in di ca to r 3 1 ** 6 u nw ei gh te d ca se s w ith m is si ng in fo rm at io n ab ou t e du ca tio n of h ou se ho ld h ea d no t s ho w n ** 4 1 un w ei gh te d ca se s w ith m is si ng in fo rm at io n ab ou t e th ni c gr ou p of h ou se ho ld h ea d no t s ho w n 86 MONITORING THE SITUATION OF CHILDREN AND WOMEN Ta bl e EN .6 : D is po sa l o f c hi ld 's fa ec es Pe r c en t d is tr ib ut io n of c hi ld re n ag ed 0 -2 y ea rs a cc or di ng to p la ce o f d is po sa l o f c hi ld 's fa ec es , a nd th e pe rc en ta ge o f c hi ld re n ag ed 0 -2 y ea rs w ho se s to ol s ar e di sp os ed o f s af el y, G eo rg ia , 2 00 5 Pl ac e of d is po sa l o f c hi ld 's fa ec es P ro po rti on o f ch ild re n w ho se st oo ls a re di sp os ed o f sa fe ly * N um be r o f

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