Georgia - Multiple Indicator Cluster Survey - 1999

Publication date: 1999

Republic of Georgia Multiple Indicator Cluster Survey, 1999 State Department of Statistics National Center for Disease Control UNICEF Tbilisi, 2000 2 Abbreviations ARI Acute Respiratory Infection BCG Bacillus of Calmette and Guérin (vaccine to prevent tuberculosis) CMSI Center of Medical Statistics and Information DPT Diphtheria, Pertussis, and Tetanus vaccine HH Household IDD Iodine Deficiency Disorders MICS Multiple Indicator Cluster Survey MoE Ministry of Education NCDC National Center for Disease Control, Georgia PHD Public Health Department PPM Parts Per Million PPS Proportionate to Population Size PSU Primary Sampling Unit SDS State Department of Statistics, Georgia VAD Vitamin A Deficiency WSC World Summit for Children 3 Contents I INTRODUCTION 1.1 Background and Planning of the Survey 1.2 Objectives of the Survey II METHODS 2.1 Survey Design 2.2 Sampling 2.3 Data Collection Instruments 2.4 Training 2.5 Fieldwork 2.6 Data Entry 2.7 Data Analysis III SURVEY FINDINGS 3.1 General Survey Information Response Rates and Frequency of Missing Information General Description of the Population Surveyed 3.2 Water and Sanitation Access to Safe Drinking Water Access to Sanitary Means of Excreta Disposal 3.3 Maternal and Child Health Antenatal Care Childbirth Care Birthweight Breastfeeding 3.4 Nutrition Anthropometry Iodine Deficiency and Iodized Salt Vitamin A Deficiency and Vitamin A Supplementation 3.5 Immunization BCG DTP Polio Measles All Vaccines 3.6 Prevalence and Treatment of Diarrheal and Respiratory llnesses in Children/Care of Illness 4 Respiratory llnesses in Children/Care of Illness Diarrhea in Previous two Weeks Acute Respiratory Illnesses 3.7 Education Early Education Primary School Education Secondary School Education Adult Literacy 3.8 Children’s Rights Registration of Births Children’s Living Arrangements Child Labour 3.9 Miscellaneous Goals, Indicators, and Other Factors Disabilities in Children 24-59.9 Months Heating Food Frequency APPENDIX Appendix A. Indicators for Monitoring Progress at End-Decade Appendix B. Sample Size Calculations Appendix C. Questionnaires Note: The nation-wide data presented in the report excludes Abkhazia and South Osetia as the Government of Georgia does not have control over those territories. 1 I. Introduction 1.1 Background and Planning of the Survey Over the past ten years, a set of goals for children and development in the 1990s have been formulated in several international forums attended by virtually all Governments, relevant United Nations agencies, and major NGOs. In support of these goals the Plan of Action was elaborated calling for concerted national action and international co-operation to strive for the achievement, in all countries, of the following major goals for the survival, protection, and development by the year 2000. · Reduction of 1990 under-5 child mortality rates by one third or to a level of 70 per 1,000 live births, whichever is the greater reduction; · Reduction of maternal mortality rates by half of 1990 levels; · Reduction of severe and moderate malnutrition among under-5 children by one half of 1990 levels; · Universal access to safe drinking water and to sanitary means of excreta disposal; · Universal access to basic education and completion of primary education by at least 80 per cent of primary school age children; · Reduction of the adult illiteracy rate to at least half its 1990 level (the appropriate age group to be determined in each country), with emphasis on female literacy; · Protection of children in especially difficult circumstances The definition of the indicators for global reporting can be found in Appendix A. Responding to the World Declaration on the Survival, Protection, and Development of Children, the Government of Georgia developed a National Plan of Action up to the Year 2000, which formulates the programmes of action for ensuring the implementation of the Declaration of the World Summit for Children. The National Plan of Action identifies the need to establish appropriate mechanisms for the regular and timely collection, analysis, and publication of data related to the welfare of children. At a planning meeting held in February, 1999 with the participation of the representatives from the Ministry of Health, Ministry of Education, and the State Department of Statistics, it was decided to conduct a Multiple Indicator Cluster Survey (MICS) in order to obtain specific end-decade data. At that meeting the following working groups were formed for survey implementation (Table 1). Table 1. Organizations involved in the 1999 Georgian MICS Survey design and sampling SDS, CMSI, NCDC, UNICEF Fieldwork NCDC Data analysis NCDC, UNICEF Report writing NCDC, UNICEF With participation of all the counterparts, the data gaps were identified and decided to collect information on specific indicators. 2 1.2 Objectives of the Survey As stated above the prior objective of the survey was to assess the progress being made towards the achievement of the end-decade goals (international as well as national) set forth at the World for Summit for Children in 1990 (see appendix A). Namely, the purpose was to collect information on the following indicators: · Household general characteristics · Salt iodisation · Water and Sanitation · Child labour · Education · Maternal and newborn health · Birth registration and age · Breastfeeding · Care of illness · Immunisation · Anthropometry Relatively few reproductive health-related and no AIDS-related questions were asked in the 1999 Georgian MICS. The reason for this was because a CDC Reproductive Health Survey was scheduled to be performed in Georgia in 2000 which would obtain detailed information on women reproductive issues and on HIV/AIDS. II. Methods 2.1 Survey Design The survey was designed to collect nationwide data (excluding Abkhazia and South Osetia due to political instability) with subnational estimates. Twelve regions of the country were combined into seven survey regions and separate sampling was performed in each survey region. Grouping of regions was done taking into account the geographic location and similarity of medical characteristics of the population, especially for the immunisation module. The survey regions are as follows (see Figure 1 for a map of Georgia): 1. Tbilisi 2. Kakheti 3. Mtskheta-Tianeti, Shida Kartli 4. Kvemo Kartli, Samtskhe-Javakheti 5. Racha-Lechkhumi, Imereti 6. Guria, Samegrelo 7. Ajara 3 Figure 1. Map of Georgia 2.2 Sampling The survey used multistage sampling method. A sampling frame was provided by the State Department for Statistics listing all regions, districts, strata, census enumeration units and census areas. The size of the smallest unit, census area, is 20-60 households (HHs), the following unit by size is the census enumeration unit incorporating 4-5 census areas with the size from 67 to 900 households; strata is the combination of 3-5 census enumeration areas and so on for the remaining units. At the first stage census enumeration units (which were the primary sampling unit or PSU) were selected from the sampling frame, from each of the survey region using probability proportional to household size (PPS) method. At the second stage 35 housholds (40 in Tbilisi) were selected in each PSU using systematic sampling method, selecting every n-th HH depending on the size of the PSU. The sample size calculations were performed based on immunizations for children 15-26 months as it required the largest sample size. The details of the sample size calculations can be found in Appendix C. The decision was to sample 35 households in each PSU (40 in Tbilisi) and that a total of 474 clusters would be included in the survey. The collection of data at the cluster level was divided into two stages. During the first stage 150 SDS interviewers obtained lists of households residing in 474 PSUs and using systematic sampling method (every n-th HH), selected 35 HHs (40 for Tbilisi) in each. For example, if the PSU size contained 350 HHs, every 10th HH was selected for the mini-interview. At this stage the SDS interviewers collected information only on HH composition for the selected HHs. A copy of the form used can be found in Appendix C. Salt was tested for iodine content using a rapid test kit. At this stage 17,000 households were visited from 15 to 30, April, 1999. 4 Table 2. Demographics of the study regions PSU size (No. of HHs) Regions Estimated Population size Estimated no. of HHs No. of PSUs No. of PSUs selected Avg Min Max Tbilisi 1,327,000 372,753 621 77 553 324 914 Kakheti 449,900 127,813 287 45 416 234 673 Mtskheta-Mtianeti, Shida Kartli 516,100 148,518 339 93 445 67 765 Kvermo Kartli, Samtskhe-Javakheti 853,000 234,986 488 68 415 147 751 Racha-Lechkumi, Imereti 890,900 253,097 504 69 463 147 839 Guria, Samegrelo 712,390 215,549 458 93 460 139 903 Ajara 409,000 92,117 256 29 360 183 619 Total 5,158,290 1,444,832 2,953 474 67 914 Note that Abkhazia and Osetia were not surveyed; they had population sizes of 515,000 and 49,200, respectively. At the second stage, which took place during 7-30 June, 40 interviewers and 40 assistants from the National Center for Disease Control (NCDC) visited all the HHs having underfives using the HH composition information generated during the first stage. Some of the HHs with eligible children for the education/child labour module (5-16 years of age) were sampled. It was assumed that each HH had only one child 5-16 years of age and thus 150 HHs would need to be visited per region, with the exception of Tbilisi where 160 HHs were to be sampled because of a higher non-response rate. For the entire country, this resulted in the target of visiting 150 HH with children 5-16 years of age in six of the regions and 160 HH in Tbilisi, for a total of 1060 HH (150*6 + 160 = 1060). Because there were sometimes more than one child 5-16 years of age in the HH, the final sample size was approximated to 1400 for the education module and 1300 for the child labour module. A sample of HHs with no children was also obtained in each PSU to allow for more valid regional and national estimates for the water- and sanitation-related goals. In each survey region, 125 HHs (135 for Tbilisi) with no children were selected for a total of 885 HHs (125*6 + 135 = 885). These HHs without children were randomly selected from the SDS list. Therefore, prior to initiating the second stage of sampling, the NCDC supervisors, using the SDS generated lists, determined the number of HHs to be selected in each PSU. All HHs with children less than five years of age were selected; HHs with children 5-16 years of age were systematically sampled to assure 150 were selected for each survey region (160 in Tbilisi); and HHs with no children were systematically sampled to assure 125 HH for each survey region (135 in Tbilisi). Thus, the NCDC interviewers had the identification numbers for each HHs they were to visit. Questionnaire modules for the household, underfives, and women's questionnaire were to be completed in all HHs visited. The education/child labour modules were to be completed only for those HHs which were identified for this purpose. The interviewer for his/her cluster had the ID numbers of the HHs with information on which module to be completed in each of them. 5 2.3 Data Collection Instruments The data collection instruments were modeled on early draft versions of the UNICEF End-Decade Multiple Indicator questionnaires with some modifications specific to the Georgian situation. The final version of the End Decade Multiple Indicator Survey Manual was not available until February, 2000 and the Georgian MICS was performed in June, 1999. There were some slight modifications of the UNICEF/MICS forms between May 1999 to February 2000. The final version of the UNICEF/MICS forms can be found at WWWWWW.CCHHIILLDDIINNFFOO .OO RRGG. The questionnaire was translated and adapted to local conditions by NCDC staff and one consultant for education/child labour module. The questionnaire was pilot tested 2 times, after which the translated version, skipping and coding was improved. When the final version was ready the questionnaire was sent to all participation institutions for providing comments. A schematic of the different forms used and the age groups can be found in Figure 2 and the English translation of the forms can be found in Appendix C. 2.4 Training SDS training: supervisors went to the regional centers and conducted one-day training sessions for district interviewers. They also supplied interviewers with the instructions on how to select HHs within each cluster and how to conduct interviews; in which cases they had to replace HHs; and what was regarded as a “non-response.” In almost all cases HHs were selected from the lists of HHs collected from the district or village/town center. During that training the use of the rapid salt testing kit was demonstrated. NCDC interviewers training: 7-day-long on how to complete the various modules of the questionnaire and on anthropometric techniques, plus a 3-day pilot test in Tbilisi. 2.5 Fieldwork Fieldwork took part at two stages. First mini-interviews were conducted where 17,000 households were visited by the SDS interviewers. During this stage data was collected on the composition of the households, namely on age distribution in order to identify target population eligible for interviewing. At this stage the salt was tested for iodisation. The fieldwork took two weeks with the participation of 150 interviewers. At the second stage 40 NCDC interviewers and 40 interviewer assistants, visited already selected households for conducting MICS modules. The second stage lasted four weeks. For testing salt, the MBI Kit part number 05-860-00 was used (MBI, T. Nagar, India). The particular kit used had an expiration date of 4/2000 and the following color codes: 0, 7ppm, 15 ppm, and 30 ppm. For data coding purposes, the following three categories were used: < 15 ppm, 15 ppm, and 30 ppm. This particular kit tests for potassium iodate; no kits were used to test for potassium iodide. 6 For the collection of weights, the UNICEF electronic scale was used (Seca UNICEF Electronic Scale 890). Lengths and standing heights were obtained using a portable length/height board. The weights of children was determined by measuring the mother’s weight first and then the mother and child combined. (Note: the UNICEF scale will automatically subtract the difference between the two weight measurements). Recumbent lengths was obtained in children less than 24 months of age and standing heights on older children. Immunisation information was collected, when available, during the interview with the mother/primary care taker. In addition, immunization information was collected at the child’s immunization clinic (“policlinic”). Therefore, all immunization information is based on both parental and clinic immunization records. If there was a discrepancy between the mother/primary care takers information and the clinic record, the clinic record was used. 2.6 Data Entry Data entry took place in July. The data entry programme was written in Delphi 4, taking into account skipping and checking. 2.7 Data Analysis Data analyses were performed using SPSS for Windows and Epi Info (Version 6.04c). For many of the tables, both weighted and unweighted estimates are provided. 7 Figure 2. Schematic of the forms used in the second stage of the survey. A. Household module B. Water & Sanitation Cluster no. HH no. C. Household listing Cluster no. HH no. Line no. D. Disability Module (2-5 years of age) Cluster no., HH no. Line no. E. Demographic info (Women 15-49, married/partner) Cluster no., HH no. Line no. G. Education Module (5-16 years of age) Cluster no. HH no. Line no. (<5 years of age) J. Birth Reg., Early learning K. Breastfeeding L. Care of Illness M. Anthropometry Cluster no., HH no. Line no. I. Immunizations (15-26 months of age) Cluster no. HH no. Line no. H. Child Labor Module (5-14 years of age) Cluster no., HH no. Line no. F. Maternal/Newborn Health (women with birth in previous year) Cluster no., HH no. Line no. 8 IIIIII SSUURRVVEEYY RREESSUULLTTSS Survey results are first presented for response rates and then a general description of the population surveyed. After that, different health, education, and child’s rights variables will be presented with a general format to first present the World Summit for Children goal or indicator(s) for a specific topic area. Next, the results from the MICS in Georgia will be presented. Many of the results are presented with weighted and unweighted estimates. The weighted estimates should always be used because they are more representative of the country. Percentages calculated based on fewer than 50 individuals should be interpreted cautiously. Finally, the Georgian results will be compared to those from the UNICEF region CEE/CIS/Baltic State countries* when such information is available. 3.2 WATER AND SANITATION Access to Safe Drinking Water The World Summit for Children goal 4 is for universal access to safe drinking water. The indicator is the proportion of the population using any of the following types of water supply: piped water, public tap, tubewell or borehole with a pump, a protected well or spring, or rainwater. Table 15 depicts the main sources of drinking water. Overall, 75.6% of the population uses safe drinking water. There was a bit of variability by region, ranging from a low of 40.2% in Guria, and Samegrelo to 99.8% in Tbilisi. Access was higher in the urban areas (89.4%) compared to rural areas (61.2%). Nationally, water piped into the dwelling was the most common source of safe water (43.0%), followed by water piped into the yard (14.0%). Worldwide it is estimated that 72% of the population has access to safe water; 90% of those in urban areas and 62% of those in rural areas. (UNICEF, 2000) In the CEE/CIS/Baltic State countries, seven countries had estimates. The median overall estimate was 74% (range, 49% to 93%), for urban the median was 98% (range, 66% to 99%), and for rural, the median was 53% (range, 18% to 84%). Georgia has overall estimates slightly higher than the worldwide or regional estimate. Access to Sanitary Means of Excreta Disposal The World Summit for Children goal 5 is for “universal access to sanitary means of excreta disposal.” For the survey, a sanitary means of excreta disposal was defined as: flush toilet connected to a sewage system or septic tank; a pour flush latrine; improved pit latrine; or traditional pit latrine. The use of a bucket or other means was considered a nonsanitary means of disposal. Overall, 99.5% of the population had access to sanitary means of excreta disposal. All survey regions had high levels as did both urban (99.9%) and rural areas (99.0%). * The CEE/CIS and Baltic States for the UNICEF Region are comprised of the following 27 countries: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Estonia, Georgia, Hungary, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova (Republic of), Poland, Romania, Russian Federation, Slovakia, Tajikistan, TFYR Macedonia, Turkey, Turkmenistan, Ukraine, Uzbekistan, and Yugoslavia. 9 The worldwide estimates of access to adequate sanitation are 44% overall; 79% of the population in urban areas and 25% of populations in rural areas. Of the seven CIS/CEE/Baltic States with this information, the median overall percentage was 85.5% (Range, 50% to 100%), in urban areas the median was 93.5% (range 46% to 100%), and in rural areas the median was 56% (range 8% to 100%). 3.3 Maternal and Child Health The goals and indicators covered in this section are antenatal care, childbirth care, birthweight, and breastfeeding/complementary food. Antenatal Care Goals relating to antenatal care are in the World Summit for Children goals number 9 and 11. The indicator is the proportion of women 15-49 years of age who received antenatal care at least once during pregnancy by a skilled health professional. For the Georgian MICS, this question was asked of all women, 15-49 years of age, who had a birth within the previous year. A skilled health professional included: doctors, nurses, and midwives. Nonskilled professionals were traditional birth attendants, friends, or “other.” Overall, 96.8% of women had received some form of antenatal care. Among all women giving birth in the previous year, 95.3% received care from a “skilled” person. A doctor was the most frequent professional seen. No worldwide or regional estimates were found. Childbirth Care The World Summit for Children goal 11 lists as one of its indicators the proportion of births attended by skilled health personnel. In the Georgian MICS this question was asked of women 15- 49 years of age who had given birth in the previous year. Skilled health personnel were doctors, nurses, and midwives. Overall, 96.4% of the women had a skilled health person assisting at delivery, primarily doctors. There was little variation by survey region in the presence of a skilled person nor by urban/rural status. Worldwide it is estimated that 58% of births have a skilled health professional assisting in the delivery.(UNICEF, 2000) In the CEE/CIS/Baltic states, this figure is 94%. Birthweight The World Summit for Children goal (WSC goal 12) was to reduce the occurrence of low birthweight (less than 2.5 kg) to less than 10%. The frequency of low birthweight in this survey was found to be 4.2%. Because of the small number of births per study region (ranging from 56 to 149), it is difficult to compare the regions. Rural areas tended to have a slightly lower frequency of low birthweight compared to urban areas (2.9% and 5.3%, respectively). Worldwide it is estimated that 17% of infants are born with low birthweight. (UNICEF, 2000) The average frequency for the 13 CIS/CEE/Baltic State countries with information was 7% (range 4% to 9%). 10 Georgia has successfully met WSC goal 12. The low risk of low birthweight may be partially attributed to the high proportion of women receiving antenatal care and small family size. Breastfeeding in children less than two years of age The World Summit for Children goal 16 lists a number of ways to assess proper breastfeeding and complimentary food use in infants and children up to 24 months of age. While no specific coverage values are listed in WSC goal 16, countries should attempt to assure proper infant and child feeding habits. The goals are divided into four age groups: < 4 months; 6 – 9.9 months, 12-15.9 months, and 20-23.9 months. Each of these age groups is discussed next. <4 month old children: In this age group children the ideal situation is for children to be exclusively breastfed. Approximately 18% of children <4 months of age were exclusively breastfeeding (defined as breastfeeding but allowing for vitamins, mineral supplements, and medicine; see Table 20). The number of children in this age range was small (n=161) so it is difficult to determined subgroups with higher or lower proportions, but it appears that females and those living in urban areas were more likely to be exclusively breastfed. Worldwide it is estimated that 44% of children in this age group are exclusively breastfed, and for countries in the CEE/CIS/Baltic States region, 10 have information with estimates from 4% to 54% with a median of 16.5%.(UNICEF, 2000) 6-9.9 month old children: In this age group the ideal is for infants to be breastfed and also receiving complementary foods. The proportion of children 6-9.9 months of age breastfed and receiving sold or mushy food was 12.2% (Table 20). Males and children from rural areas appeared to be more likely to receive solid or mushy food. Worldwide it is estimated that 47% of children in this age are breastfed and received complementary foods, and for countries in the CEE/CIS/Baltic States region, only three had estimates of 35%, 38%, and 61% (UNICEF, 2000) Children 12-15.9 months: Children in this age group should, ideally, still be breastfeeding in addition to receiving other foods. Thirty percent of children 12-15.9 months of age were still breastfeeding (see Table 20). Males and children living in urban areas were slightly more likely to be still breastfeeding at the time of the survey. No worldwide or regional estimates were found for this indicator. Children 12-23.99 months: Ideally children should receive some breast milk up to 24 months of age. Overall, 12% of children 12-23.9 months of age were still breastfeeding (Table 20). Worldwide it is estimated that 53% of children in this age range are still breastfed, and of the three countries in the CEE/CIS/Baltic States region with information on this indicator, the estimates were 13%, 21%, and 79%.(UNICEF, 2000) It appears that activities directed towards proper breastfeeding and complementary food use in children < 24 months of age would be useful. There would be a number of benefits of proper feeding, including the potential to help lower the prevalence of stunting in Georgia and for mild subclinical vitamin A deficiency if a problem exists in the country. 11 3.4 NUTRITION The nutrition-related indicators covered in this section are anthropometry in children less than five years of age, proportion of households using iodized salt; and vitamin A supplement use in women after birth. Anthropometry The World Summit for Children goals (WSC goal 3) for anthropometry were to reduce the 1990 levels by half in children less than five years of age. No national anthropometry data were available for Georgia for 1990. The overall prevalence of malnutrition as measured by anthropometry was low (Table 21). More detailed results of the anthropometry can be seen in Table 22. The Georgian children had, relative to other countries, low prevalences of low weight -for-age <-2 SD (3.1%), low prevalence of stunting (height-for-age <-2SD, 11.7%), and wasting (weight-for-height < -2SD, 2.3%).(Gorstein et al., 1994) In the reference population it is expected that 2.3% would have a Z score <-2 SD. The low prevalence of low weight-for-height in all areas and age groups would indicate that “wasting” is not a problem in Georgia. The prevalence of low height-for-age indicates that there is no significant problem with stunting in the country, but that a number of efforts might be directed towards lowering this prevalence. Rural areas tended to have higher prevalences of low anthropometry compared to urban areas. Compared to the average prevalence in 10 countries in the UNICEF CEE/CIS/Baltic States region with anthropometry data (UNICEF, 2000), Georgia had slightly lower prevalences. While there is no way to directly measure the World Summit for Children goals on anthropometry, the anthropometry information suggests there is little wasting in the country and that the prevalence of stunting is low. The causes of stunting are complex and are generally related to low socioeconomic status. However, there may be some interventions that might help lower the prevalence of stunting. These would include improvements in proper feeding of infants, iodization of salt, and assuring high immunization levels, especially in younger children. Two other factors that play a role in stunting are diarrheal and respiratory diseases. It appears that in Georgia the prevalence of diarrhea and respiratory diseases are low in this population and that when they occur there is adequate treatment. Iodine Deficiency and Iodized Salt One of the World Summit for Children indicator for iodine deficiency disorders (WSC goal 14) was to assure that 90% of households were consuming iodized salt. Other parts of the goal are to determine the prevalence of iodine deficiency disorders (IDD), which were not assessed in this survey. The proportion of households with salt containing 15 ppm or more potassium iodate was 8.1%. The proportion of households with adequately iodized salt by study region ranged from 1.1% in Kvemo Kartli/Samtshke-Javakheti to 17.5% in Tbilisi. Urban areas had, on average, a higher proportion of households using iodized salt (12.3%) compared to rural areas (2.7%). The proportion of households with iodized salt was not influenced by whether or not there were children in the household. The proportion of households using iodized salt was very low in this survey. However, this proportion is likely to be an underestimate because the rapid salt test kits used in the survey could 12 detect only salt fortified with potassium iodate and some salt in Georgia may have been fortified with potassium iodide. Worldwide it is estimated that 66% of the salt is iodized.(UNICEF, 2000) Of the 11 countries in the UNICEF CEE/CIS/Baltic States region with iodized salt information (UNICEF, 2000), the average proportion of households with iodized salt was 25% (range, 0% to 100%). Achieving 90% coverage of households using iodized salt should be a priority in Georgia. Vitamin A Deficiency and Vitamin A Supplementation Goal 15 of the World Summit for Children relates to the virtual elimination of vitamin A deficiency (VAD) and its consequences. One of the indicators was to determine the proportion of mothers who received a vitamin A supplement before their infant was 8 weeks old. While there is no information suggesting that VAD is a significant health problem in Georgia, vitamin A supplements are provided to some women after birth. Overall, 8.6% of women who had a child in the previous 12 months reported receiving a vitamin A supplement before their infant was two months of age. By survey region, the vitamin A coverage ranged from 2.8% in Kakheti to 16.5% in Tbilisi. Women in urban areas were slightly more likely to receive a vitamin A supplement compared to women in rural areas (10.6% vs. 6.6%). Of the countries in the CEE/CIS/Baltic States, mild subclinical VAD has been identified in certain areas in Romania, Turkey, and Uzbekistan. Most countries in the region have no data available.(WHO, 1996) Only one country in the region, Yugoslavia, has reported coverage information for vitamin A capsules in children 6-59 months of age.(UNICEF, 2000) Data concerning whether or not VAD is a significant health problem are lacking in Georgia (WHO 1996). It is unlikely that VAD is a severe or moderate public health problem in Georgia. VAD tends to occur in areas where there are high prevalences of diarrheal and respiratory diseases in children, outbreaks of vaccine preventable diseases, high prevalences of malnutrition, and high risk of low birthweight, all factors that are relatively infrequent in Georgia. To assess whether or not mild, subclinical VAD exists would require an additional survey. However, for VAD and other reasons, it would be prudent to improve proper breastfeeding in infants. 3.5 IMMUNIZATION The World Summit for Children goal 22 was to have 90% of children immunized by one year of age against diphtheria, pertussis, tetanus, measles, poliomyelitis, and tuberculosis by the year 2000. For the Georgian MICS, the age group studied was children 15-26.9 months of age rather than 12- 23.9 months. The reason for this is measles vaccine is not recommended for children in Georgia until 12 months of age, where many other countries give measles vaccine at 9 months of age. In addition, in the Georgian MICS, immunization information was obtained from the household and also from the local immunization clinic (“polyclinic”). The estimates of coverage by antigen and for all vaccines are shown in Tables 26 and 27. Each antigen will be discussed separately followed by overall immunization levels. Please note that more detailed information on immunizations can be found in the consultant report Immunization Programme Evaluation, Georgia: Survey Data and Results by Alasdair Wylie, UNICEF Consultant, 10 January 2000. 13 BCG As shown in Table 26, the BCG (Bacillus of Calmette and Guérin) coverage from a vaccination card and mother’s report is presented. Overall, it was estimated that 91.4% of the children age 15- 26.9 months of age had been immunized with BCG. Note that this figure does not include information on BCG vaccine scars. While the survey instructed the interviewer to inspect the child’s left shoulder for a BCG vaccine scar, this information is not included in Tables 26 or 27. Adding the BCG scar information would increase the BCG vaccination coverage by around 1%. According to the vaccine information, 79.9% of the study population had received their BCG vaccination by 12 months of age. There was little difference in the coverage of 15-26.9 month olds by sex 90.7% and 92.0%, respectively. Coverage by survey region varied from a low of 81.9% in Kvemo Kartli, Samtshke-Javakheti to a high of 96.2% in Tbilisi. Wordwide it is estimated that 82% of one-year old children have received BCG vaccine and in the CEE/CIS/Baltic the estimate is 91%. DPT The DPT (diphtheria, pertussis, and tetanus vaccine) coverage is the proportion of children receiving at least 1, 2, or 3 doses of DPT vaccine. The WSC goal is for 90% of children to have received 3 DPT doses by 12 months of age. In the Georgian MICS, the proportion of children having 3 DPT doses by 12 months of age was 61.4%. Among children 15-26.9 months, 80.5% had received 3 DPT doses. The percentage of children with 3 DPT was higher in females than males (83.8% and 76.6%, respectively), and by survey region, ranged from a low of 74.2% in Mtshkheta- Mtianeti, Shida Kartli to a high of 88.6% in Tbilisi. Worldwide, it is estimated that 77% of one-year-old children had received 3 doses of DPT, and in the CEE/CIS/Baltic states, the estimate is 93%. (UNICEF, 2000) Polio Polio vaccine coverage is defined as the proportion of children receiving at least 1, 2, or 3 doses of polio vaccine. The WSC goal is for 90% of children to have received 3 polio doses by 12 months of age. In the Georgian MICS, the proportion of children receiving 3 doses of polio by 12 months of age was 61.9% (Table 26). Among children 15-26.9 months of age, 80.9% had received 3 doses of polio vaccine. The percentage of females receiving 3 doses of polio vaccine as higher in females than males (84.0% and 77.2%, respectively), and by survey region varied from a low of 73.2% in Guria, Samegrelo to a high of 90.5% in Kakheti. Worldwide it is estimated that 77% of one-year-old children receive 3 doses of polio vaccine, and in the CEE/CIS/Baltic states, the estimate is 94%.(UNICEF, 2000) Measles The WSC goal is the proportion of children receiving measles vaccine by 12 months of age. While this goal is applicable to countries that recommend measles vaccine to be given to children at 9 months of age, in Georgia the recommended age is 12 months of age. By 15 months of age, 53% of the children had received a measles vaccination. For children 15-26.9 months of age, the measles 14 vaccine coverage was 73.3%. In the 15-26.9 month olds, the measles immunization levels were higher in females than males (79.3% and 66.0%, respectively), and varied from low coverage of 55.9% in Racha-Lechkhumi, Imereti to a high of 84.8% in Tbilisi. Worldwide it is estimated that 74% of one-year-old children are immunized against measles, and in the CEE/CIS/Baltic states, the estimate is 92%.(UNICEF, 2000) All Vaccines “All Vaccines” refers to the percentage of children who have received 3 DPT, 3 polio, and a measles vaccination. The percentage of children who received all of these vaccines by 12 months of age is not provided because measles vaccine was not recommended until 12 months of age. For children 15-26.9 months of age, 67.4% had received all the vaccines. The percentage was higher in females than males (72.0% and 62.0%, respectively), and ranged from a low of 50.7% in Guria, Samegrelo to a high of 81.1% in Tbilisi. No worldwide or regional estimates were found for all vaccines. 3.6 PREVALENCE AND TREATMENT OF DIARRHEAL AND RESPIRATORY ILLNESSES IN CHILDREN/CARE OF ILLNESS The prevalence of diarrheal and respiratory illnesses were assessed in children less than five years of age. In addition, the treatment and health seeking behaviors for these ill children was assessed. Diarrhea in previous two weeks and treatment in children less than five years of age While there were four World Summit for Children indicators for diarrhea (WSC goal 23), the Georgian MICS collected information related to two of the indicators: the proportion of under fives with diarrhea in previous two weeks who received appropriate oral rehydration and the proportion who had increased oral fluids and continued feeding. Note that the other two indicators usually require other data sources for their estimates. No specific target values were provided in the WSC 23 goal. Approximately 6% of the children less than five years of age were reported as having diarrhea within the previous two weeks (Table 27). The period prevalence did not vary substantially by sex but there were apparent differences between the regions with period prevalence estimates ranging from a low of 2.8% in Kakhti and a high of 8.5% in Racha-Lechkhumi, Imereti. All of these prevalences are relatively low. The youngest ages (<24 months) tended to have a higher prevalence (~8.5%) compared to older children (>24 months) who had a prevalence of ~4-5%. One of the World Summit for Children indicators (WSC goal 23) was the proportion of children less than five years of age with diarrhea within the last two weeks who were treated with oral rehydration salts or an appropriate household solution. Appropriate household solutions/fluids were breast milk, milk, infant formula, and water. In addition, in Georgia, tea and yogurt were added as acceptable fluids. There seemed to be some confusion on the “water alone” category on the questionnaire. The intent of the question was to determine if water was the only fluid administered to the child during the diarrheal episode, which would not be considered appropriate. Water given with other fluids was acceptable. In the implementation of the question, it appeared that it was used 15 to ask if at anytime during the diarrheal illness was the child given only water. The various types of treatments children received are shown in Table 28. Overall, 95.7% of the children received recommended fluids. This proportion was similar for males and females, by survey region, urban/rural, and by age group. The worldwide estimate on the proportion of children with diarrhea under five years of age receiving oral rehydration salts and/or recommended home fluids is 69%. Within the CEE/CIS/Baltic States region, eight countries had information on this indicator, with estimates ranging from 5% to 99% and a median of 30.5%. Another WSC indicator for diarrheal diseases is that children with diarrhea should continue to be feed and should have increased fluids. The proportions by the amount they drank and feeding are shown in Table 28. Overall, of the children with diarrhea, 33% had increased fluid intake AND continued to feed. There are no worldwide or regional estimates for this indicator. Acute respiratory infections in children under five years Goal 24 of the World Summit for Children included an indicator on the proportion of children less than five years of age who had an acute respiratory infection (ARI) in the previous two weeks and were taken to an appropriate health provider. The End Decade definition of an ARI is a child with a cough who breathed faster than usual with short, quick breaths or had difficulty breathing and the symptoms were due to one of the following: 1) a problem in the chest; 2) a problem in the chest and blocked nose; or 3) do not know why. For the Georgian MICS appropriate providers were a hospital, health center, dispensary, MCH clinic, emergency room, or a private physician. Inappropriate providers were a pharmacy, a traditional healer, or a relative/friend. The period prevalence of an ARI in the two weeks prior to the survey was low -3.8%. Because of the small numbers of children with an ARI, differences between sex, regions, urban/rural, and age groups should be performed cautiously. The providers seen by the children with ARI is depicted in Table 30 with most children being taken to a health center (41%) and the second most common health provider was a private physician (34%). Overall, 98.5% of the children saw an appropriate provider. No worldwide or regional estimates for this indicator were found. 3.7 EDUCATION In this section several aspects of education are covered. First, preschool/early education, followed by primary school education (in Georgia, children approximately 6-11 years of age), secondary school (lower secondary 12-14 and upper secondary 15-17 years old), and then finally literacy levels of the population 15 years of age and older. Early Education Early education was defined as the proportion of children 36-59.9 months of age attending some form of education program. The World Summit for Children for this indicator was goal number 26. No specific values were provided as a goal for the indicator. 16 Overall, it is estimated that 30.9% of children 36-59.9 months of age attend some form of early education programme. In the Table 31 are weighted and unweighted estimates, and estimates for whether the child attended a state-owned (28.8%) or privately-owned (2.1%) preschool. The proportion is similar in males and females. There were differences by region, ranging from a high attendance in either state- or privatately-owned preschools of 46.5% in Mtskheta-Mtianeti/Chida Kartli to a low of 11.0% in Ajara. Urban children were more likely to attend than rural children (40.1% vs. 21.2%) and the proportion attending school was higher in 4 year olds compared to 3 year olds (34.4% vs. 27.2%, respectively). No worldwide or regional estimates for this indicator were found. Primary School Education The World Summit for Children goal 6 addresses primary education indicators. Based on the MICS questionnaire, the net primary school attendance can be estimated. This estimate can be calculated from household-based surveys and is the proportion of primary school age children attending primary school. For the Georgia MICS, primary school is grades I through VI, approximately children 6 through 11 years of age (during the survey 7 through 12 years of age). No specific attendance values were provided in the goal. 97.5% of primary school age children attend either a state or private primary school. There were small differences in the overall proportion attending school by survey region, sex, or urban/rural status. Worldwide the net primary school attendance is estimated to be 81% for males and 75% for females. For the four CIS/CEE/Baltic States with information, the median for males was 84% (range 74% to 89%) and females was 82% (range 71% to 90%). Another indicator for WSC goal 6 was the proportion of children entering first grade of primary school who eventually reach grade five. The percentages of children who advanced one grade are shown in Table 33. The overall percent reaching grade 5 of those who entered first grade is calculated as the product of the four probabilities, which would be 100% in this table. The data are not presented by sex, region, or urban/rural status because there was only one child who did not advance in the normal sequence. Worldwide it is estimated that 77% of children who start primary school reach grade 5. For the 17 CIS/CEE/Baltic States with this information, the median was 98% (range 82% to 100%).(UNICEF, 2000) Secondary School Education There were no World Summit for Children goals concerning secondary education. Secondary school in Georgia is defined as grade VI through XI, approximately ages 12 through 17 years of age for children at the time of the survey. Overall, 97.6% of the children were attending lower secondary school (ages 12 through 14) and there was little difference between males and females. Adult Literacy The World Summit for Children goal 7 relates to adult literacy with a goal to reduce the illiteracy percent to at least half its 1990 level. For purposes of the Georgian MICS, adult was defined as an individual 15 years of age or older. The question in the survey was whether the adult can read a letter or newspaper with the following responses: easily, with difficulty, not at all, and do not know. An adult was defined as literate if one of the first two responses was selected, illiterate otherwise. 17 Overall, 98.8% of the adults were literate, 99.1% of males and 98.5% of females. The literacy rates were high in all survey regions and in urban/rural areas. There was a slight decline in literacy in the older age groups. Worldwide it is estimated that in 1995 81% of males and 65% of females were literate.(UNICEF, 2000) In the CIS/CEE/Baltic states, 22 countries had estimates. The median was 99% in males (range 92% to 100%) and 99% in females (range 72% to 100%). In Georgia estimates for 1995 adult literacy levels were 100% in males and 99% in females. 3.8 CHILDREN’S RIGHTS Registration of births in children under five years Birth registration is considered one of the additional indicators for “monitoring children’s rights.” No target values were provided. In Georgia, almost 95% of the children under five had a registered birth, and this percentage did not vary much by sex, region, urban/rural, or age (Table 35). The most common reason for not registering the birth was because it cost too much. No worldwide or regional estimates were found. Children’s living arrangements This is also one of the additional indicators for monitoring children’s rights with no target values provided concerning whether or not children were living with a biologic parent. In Georgia, overall 95.3% of children 0-14 years of age lived with both parents; there was little variability by sex, survey region, urban/rural status, or age groups. No worldwide or regional estimates were found. Child labour One of the additional indicators for monitoring children’s rights was concerning child labor in those 5-14 years of age. A child is considered to be working if they work 4 or more hours per day. This work could be paid, unpaid, or domestic work. Overall, 30.0% of the children were working. There was little difference by sex, but there was a difference by age; older children (10-14 years of age) were more likely to work (39.3%) than younger children (5 –9 years, 19.1%). There was also variability by survey region, ranging from a low of 18.1% in Tbilisi to a high of 39.2% in Racha- Lechkhumi, Imereti. In addition, the proportion was higher in rural vs. urban areas (39.6% a dn 21.4%, respectively). 18 3.9 MISCELLANEOUS GOALS, INDICATORS, AND OTHER FACTORS Disabilities in children 24-59.9 months The World Summit for Children goal 8 has an indicator the child disability rate. No specific goal values were provided. The prevalence of disabilities, such as blindness, hearing loss, and a number of other factors were rare. Because they occurred so infrequently, there was no attempt to present these disabilities by sex, region, urban/rural, or age group. The number of disabilities in each child is shown in Table 39. No worldwide or regional estimates were found. Main source of heating in dwelling There are no WSC goals related to heating. This question was added to the Georgian MICS. Overall, in Georgia, burning wood is the primary way households are heated (72.9%) followed by use of oil (15.6%). There were differences between survey regions. Food Frequency The frequency of consumption of certain foods was obtained. This was a question added to the Georgian MICS. The frequency of the consumption of meat, cheese, butter, other mild products, fruits, and vegetables can be seen in Table 41. 19 Table 3. The non-response percentage during the first stage of the survey by State Department of Statistics Region Eligible Interviewed Non-response (%)* Tbilisi 3084 2986 3.2 Kakheti 1570 1570 0.0 Mtskheta-Mtianeti, Shida Kartli 3259 3117 4.4 Kvemo Kartli, Samtskhe-Javakheti 2388 2360 1.2 Racha-Lechkhumi, Imereti 2421 2375 1.9 Guria, Samegrelo 3252 3239 0.4 Ajara 1025 1025 0.0 Total 16999 16672 1.9 *Non-response defined as after two visits HH members were either not at home or they refused to participate in the survey. Table 4. The non-response percentage for the household module during the second stage of the survey by National Center for Disease Control Region Eligible Interviewed Non-response (%) Tbilisi 135 134 0.7 Kakheti 125 124 0.8 Mtskheta-Mtianeti, Shida Kartli 125 124 0.8 Kvemo Kartli, Samtskhe-Javakheti 125 125 0.0 Racha-Lechkhumi, Imereti 125 119 4.8 Guria, Samegrelo 125 123 1.6 Ajara 125 109 12.8 Total 885 858 3.1 20 Table 5. The non-response percentage for children less than 5 years of age during the second stage of the survey by National Center for Disease Control Region Eligible Interviewed Non-response (%) Tbilisi 720 656 8.9 Kakheti 450 433 3.8 Mtskheta-Mtianeti, Shida Kartli 705 652 7.5 Kvemo Kartli, Samtskhe-Javakheti 650 627 3.5 Racha-Lechkhumi, Imereti 542 496 8.5 Guria, Samegrelo 863 818 5.2 Ajara 354 313 11.6 Total 4284 3995 6.7 Table 6: Percentage of cases missing information for selected questions Question Reference population Percent missing Number Complete birth date Women 15-49 0 0 Complete birth date Children under 5 <1 1 Diarrhoea in last 2 weeks Children under 5 <1 1 Weight Children under 5 14.5 561 Height Children under 5 15.6 604 21 Table 7: Age distribution of household population by sex (second stage of the survey) Males Females Age Number Percent Number Percent <5 1,851 16.2 1,767 13.8 5-9 1,257 11.0 1,375 10.8 10-14 743 6.5 858 6.7 15-19 526 4.6 702 5.5 20-24 656 5.7 1,118 8.7 25-29 1,050 9.2 1,269 9.9 30-34 1,045 9.2 1,065 8.3 35-39 1,025 9.0 800 6.3 40-44 653 5.7 555 4.3 45-49 480 4.2 576 4.5 50-54 404 3.5 495 3.9 55-59 392 3.4 510 4.0 60-64 509 4.5 606 4.7 65-69 394 3.5 408 3.2 70+ 435 3.8 676 5.3 Missing/DK 0 0.0 1 0.0 Total 11,420 100.0 12,781 100.0 Table 8: Percent distribution of households by background characteristics (second stage of the survey) Percent Number Tbilisi 17.1 792 Kakheti 12.0 558 Mtskheta-Mtianeti, Shida Kartli 16.4 762 Kvemo Kartli, Samtskhe-Javakheti 14.4 668 Racha-Lechkhumi, Imereti 13.0 604 Guria, Samegrelo 18.1 839 Ajara 8.9 412 Urban 46.0 2,133 Rural 54.0 2,501 22 Table 9: Percent distribution of households by the number of rooms in the dwelling, by survey region (second stage of the survey) No. of rooms in dwelling Tbilisi Kakheti Mtskheta-Tianeti, Shida Kartli Kvemo Kartli, Samtskhe- Javakheti Racha- Lechkhumi, Imereti Guria, Samegrelo Ajara Georgia 1 18.7 3.2 11.3 2.4 5.9 1.6 10.2 8.1 2 28.4 14.5 21.8 21.6 13.6 9.8 20.4 19.5 3 35.1 12.9 21.0 21.6 22.9 12.3 16.7 22.8 4 11.2 30.6 20.2 27.2 18.6 25.4 21.3 20.5 5 4.5 12.9 6.5 10.4 11.0 20.5 13.9 10.5 6 2.2 12.9 3.2 10.4 17.8 7.4 10.2 8.6 7 6.5 2.4 2.5 9.8 4.6 3.0 8 4.8 8.1 4.0 5.1 5.7 0.9 3.7 9 0.8 1.6 1.6 4.1 1.1 10 0.8 1.6 1.7 2.5 0.9 1.0 >10 0.0 0.0 2.4 0.8 0.8 0.8 0.9 0.7 Note that the columns sum up to 100% Table 10: Percent distribution of households by the number of rooms in the dwelling and number of household members (second stage of the survey) Number of rooms No of HH members 1 2 3 4 5-10 >10 1 25 28 13 18 16 2 14 24 26 18 19 3 10 25 24 18 22 4 8 18 23 23 25 1 5-10 5 16 23 22 33 1 >10 20 10 70 Total 8 20 23 21 28 1 Note that the rows sum up to 100%. 23 Table 11: Percent distribution of number of household members by survey region (second stage of the survey) Number of members in household Tbilisi Kakheti Mtskheta- Tianeti, Shida Kartli Kvemo Kartli, Samtskhe- Javakheti Racha- Lechkhumi, Imereti Guria, Samegrelo Ajara Georgia 1 6.7 8.1 8.1 4.8 8.4 8.9 2.8 7.0 2 12.7 16.1 14.5 7.2 10.1 10.6 11.0 11.4 3 23.9 12.1 12.1 7.2 10.9 16.3 10.1 14.6 4 14.2 21.8 15.3 16.8 15.1 20.3 27.5 17.3 5 16.4 21.0 17.7 20.0 22.7 18.7 18.3 19.1 6 11.2 14.5 12.1 24.8 21.0 14.6 15.6 16.3 7 10.4 3.2 8.1 9.6 5.0 6.5 5.5 7.6 8 .7 1.6 5.6 5.6 1.7 .8 5.5 2.6 9 2.2 3.2 1.6 1.6 1.8 1.5 10 1.6 3.2 1.6 2.5 .8 .9 1.4 >10 1.4 0.8 2.5 0.8 0.9 1.1 Note that the columns sum up to 100% 24 Table 12: Percent distribution of women 15-49 by background characteristics (second stage of the survey) Characteristic Wtd (%) Unwtd (%) Number Characteristic Wtd (%) Unwtd (%) Number Tbilisi 25.5 17.9 867 Marital status Kakheti 8.7 11.1 539 Currently married 92.7 93.0 4502 Mtskheta-Mtianeti, Shida Kartli 10.0 16.1 778 Formerly married 5.3 5.0 244 Kvemo Kartli, Samtskhe- Javakheti 16.7 15.4 744 Never married 2.0 2.0 96 Racha-Lechkhumi, Imereti 17.3 12.6 609 Guria, Samegrelo 13.8 18.1 877 Ever gave birth 96.9 96.9 4691 Ajara 8.1 8.8 428 Never gave birth 3.1 3.1 151 Urban 53.0 47.3 2290 Rural 47.0 52.7 2552 Age 15-19 4.5 4.6 224 20-24 19.0 19.2 932 25-29 22.9 23.1 1120 30-34 20.0 19.5 942 35-39 14.2 14.1 684 40-44 10.2 10.3 498 45-49 9.1 9.1 442 Total 100.0 100.0 4842 25 Table 13: Percent distribution of women 15-49 with a live birth in the year preceding the interview by background characteristics (second stage of the survey) Characteristic Percent Number Characteristic Percent Number Wt Unwt Wt unwt Tbilisi 23.2 15.7 110 Marital status Kakheti 7.0 10.1 71 Currently married 99.1 99.1 696 Mtskheta-Mtianeti, Shida Kartli 9.4 16.0 112 Not currently married 0.9 0.9 6 Kvemo Kartli, Samtskhe-Javakheti 15.9 16.3 114 Racha-Lechkhumi, Imereti 24.4 13.1 92 Literacy Guria, Samegrelo 12.3 20.8 146 Can read newspaper 98.1 97.9 686 Ajara 7.9 8.0 56 Difficulty/cannot/dk 1.9 2.1 15 Urban 50.2 42.2 296 Rural 49.8 57.8 405 Age 15-19 15.1 15.3 107 20-24 34.3 34.5 242 25-29 25.0 25.5 179 30-34 17.2 16.8 118 35-39 6.2 5.4 38 40-44 2.2 2.4 17 Total 100.0 100.0 701 wt=weighted estimates, unwt=unweighted estimates 26 Table 14: Percent distribution of children under five by background characteristics (second stage of the survey) Weighted Percent Unweighted Percent Number Male 51.1 51.3 2019 Female 48.9 48.7 1919 Tbilisi 27.6 16.3 641 Kakheti 7.0 10.8 425 Mtskheta-Mtianeti, Shida Kartli 10.2 16.2 638 Kvemo Kartli, Samtskhe-Javakheti 16.6 15.8 623 Racha-Lechkhumi, Imereti 18.3 12.4 487 Guria, Samegrelo 12.0 20.7 814 Ajara 8.2 7.9 310 Urban 51.9 43.3 1705 Rural 48.1 56.7 2233 Age < 6 months 7.0 7.1 279 6-11.9 months 10.3 9.8 386 12-23.9 months 19.0 18.8 742 24-35.9 months 22.2 22.0 868 36-47.9 months 20.5 21.1 832 48-59.9 months 21.0 21.1 831 Total 100.0 100.0 3938 27 Table 15: Percentage of the population with access to safe drinking water Main source of drinking water Piped into dwelling Piped into yard Public tap Tubewell/ Bore-hole Protected well/spring Rain-water Total with safe drinking water No. Persons Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Tbilisi 95.0 95.0 4.7 4.7 0.2 0.2 0.0 0.0 0.0 0.0 0.0 0.0 99.8 99.8 576 Kakheti 8.7 8.7 24.4 24.4 14.7 14.7 1.6 1.6 17.4 17.4 6.9 6.9 73.7 73.7 505 Mtskheta-Mtianeti, Shida Kartli 32.0 32.0 16.5 16.5 6.3 6.3 1.1 1.1 4.0 4.0 11.1 11.1 71.0 71.0 569 Kvemo Kartli, Samtskhe-Javakheti 24.6 24.6 30.7 30.7 22.6 22.6 0.8 0.8 0.0 0.0 9.4 9.4 88.1 88.1 641 Racha-Lechkhumi, Imereti 29.7 29.7 14.6 14.6 4.5 4.5 1.1 1.1 2.0 2.0 8.6 8.6 60.5 60.5 555 Guria, Samegrelo 6.9 6.9 2.1 2.1 9.6 9.6 2.5 2.5 4.0 4.0 15.1 15.1 40.2 40.2 523 Ajara 56.6 56.6 13.5 13.5 2.0 2.0 0.0 0.0 0.0 0.0 1.2 1.2 73.2 73.2 512 Urban 74.8 69.8 8.2 8.9 3.2 4.4 0.6 0.7 1.4 1.9 1.3 1.4 89.4 87.1 1667 Rural 9.9 11.7 20.0 20.5 12.9 12.1 1.3 1.2 4.3 5.1 12.8 12.1 61.2 62.6 2214 Total 43.0 36.6 14.0 15.5 8.0 8.8 0.9 1.0 2.8 3.7 6.9 7.5 75.6 73.1 3881 Table continued on next page 28 (continued) Table 15: Percentage of the population with access to safe drinking water Main source of drinking water Unpro-tected well/spring Pond, river, stream Tanker truck/vendors Other DK Total Total with safe drinking water No. Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Tbilisi 0.2 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 99.8 99.8 576 Kakheti 24.0 24.0 0.0 0.0 0.0 0.0 0.4 0.4 2.0 2.0 100.0 73.7 73.7 505 Mtskheta-Mtianeti, Shida Kartli 27.1 27.1 0.0 0.0 0.0 0.0 0.0 0.0 1.9 1.9 100.0 71.0 71.0 569 Kvemo Kartli, Samtskhe-Javakheti 8.3 8.3 1.1 1.1 0.0 0.0 2.5 2.5 0.0 0.0 100.0 88.1 88.1 641 Racha-Lechkhumi, Imereti 26.8 26.8 0.0 0.0 0.2 0.2 0.0 0.0 0.0 0.0 100.0 60.5 60.5 555 Guria, Samegrelo 57.4 57.4 0.8 0.8 0.0 0.0 0.0 0.0 0.8 0.8 100.0 40.2 40.2 523 Ajara 25.2 25.2 0.0 0.0 0.0 0.0 1.6 1.6 0.0 0.0 100.0 73.2 73.2 512 Urban 9.7 11.6 0.0 0.0 0.1 0.1 0.5 0.6 0.4 0.7 100.0 89.4 87.1 1667 Rural 35.8 34.7 0.6 0.5 0.0 0.0 0.6 0.7 1.7 1.5 100.0 61.2 62.6 2214 Total 22.5 24.8 0.3 0.3 0.0 0.0 0.6 0.7 1.0 1.1 100.0 75.6 73.1 3881 29 Table 16: Percentage of the population with access to sanitary means of excreta disposal Type of toilet facility used by household Flush to sewage system or septic tank Pour flush toilet Improved pit latrine Traditional pit latrine Bucket/ other Total Total with sanitary means of excreta disposal Number of persons Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt 100.0 Wt Unwt Tbilisi 96.4 96.4 0.0 0.0 1.4 1.4 2.1 2.1 0.2 0.2 100.0 99.8 99.8 576 Kakheti 6.1 6.1 2.6 2.6 4.8 4.8 86.5 86.5 0.0 0.0 100.0 100.0 100.0 505 Mtskheta-Mtianeti, Shida Kartli 26.5 26.5 2.5 2.5 36.6 36.6 32.0 32.0 2.5 2.5 100.0 97.5 97.5 569 Kvemo Kartli, Samtskhe-Javakheti 17.0 17.0 0.0 0.0 38.4 38.4 44.6 44.6 0.0 0.0 100.0 100.0 100.0 641 Racha-Lechkhumi, Imereti 28.1 28.1 0.0 0.0 43.1 43.1 20.9 20.9 1.3 1.3 100.0 98.7 98.7 555 Guria, Samegrelo 18.5 18.5 1.3 1.3 31.5 31.5 48.6 48.6 0.0 0.0 100.0 100.0 100.0 523 Ajara 39.1 39.1 2.1 2.1 39.0 39.0 51.2 51.2 0.0 0.0 100.0 100.0 100.0 512 Urban 76.9 72.1 2.9 3.5 12.6 14.6 7.5 9.7 0.1 0.1 100.0 99.9 99.9 1667 Rural 4.1 4.4 1.0 1.0 34.3 30.9 59.7 62.7 1.0 0.9 100.0 99.0 99.1 2214 Total 41.2 33.5 2.0 2.1 23.2 23.9 33.1 39.9 0.5 0.6 100.0 99.5 99.4 3881 There was only one household reporting use of a bucket, none with an overhang latrine, and none reporting no facilities/bush/field; 21 households reporting “other” facilities. 30 Table 17: Percent distribution of women age 15-49 with a birth in the last year by type of personnel delivering antenatal care Person delivering antenatal care Doctor Nurse, midwife** TBA, relative, friend, other Any skilled personnel* No antenatal care received Total Number of women Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Tbilisi 96.4 96.4 0.0 0.0 0.9 0.9 96.4 96.4 2.7 2.7 100.0 110 Kakheti 90.1 90.1 5.6 5.6 0.0 0.0 95.7 95.7 4.2 4.2 100.0 71 Mtskheta-Mtianeti, Shida Kartli 95.5 95.5 0.0 0.0 0.9 0.9 95.5 95.5 3.6 3.6 100.0 112 Kvemo Kartli, Samtskhe-Javakheti 85.9 85.9 3.5 3.5 6.1 6.1 89.4 89.4 4.4 4.4 100.0 114 Racha-Lechkhumi, Imereti 97.8 97.8 1.1 1.1 0.0 0.0 98.9 98.9 1.1 1.1 100.0 92 Guria, Samegrelo 96.6 96.6 0.7 0.7 0.7 0.7 97.3 97.3 2.1 2.1 100.0 146 Ajara 82.1 82.1 7.1 7.1 1.8 1.8 89.2 89.2 8.9 8.9 100.0 56 Urban 96.5 96.3 0.7 1.0 0.7 0.7 97.2 97.3 2.1 2.0 100.0 296 Rural 90.4 90.6 3.0 2.7 2.3 2.2 93.4 93.3 4.3 4.4 100.0 405 Total 93.4 93.0 1.9 2.0 1.5 1.6 95.3 95.0 3.2 3.4 100.0 701 * Skilled personnel include doctors, nurses, and midwives.** TBA=Traditional birth attendant; table categorized as the most skilled person seen. 31 Table 18: Percent distribution of women aged 15-49 with a birth in the last year by type of personnel assisting at delivery Person assisting at delivery Doctor Nurse, midwife** TBA, Relative, friend, other Any skilled personnel* No assistance received Total Number of women Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Tbilisi 97.3 97.3 1.8 1.8 0.0 0.0 99.1 99.1 0.9 0.9 100.0 110 Kakheti 84.5 84.5 7.0 7.0 7.0 7.0 91.5 91.5 1.4 1.4 100.0 71 Mtskheta-Mtianeti, Shida Kartli 90.2 90.2 6.3 6.3 0.9 0.9 96.5 96.5 2.7 2.7 100.0 112 Kvemo Kartli, Samtskhe-Javakheti 89.5 89.5 3.5 3.5 5.3 5.3 93.0 93.0 1.8 1.8 100.0 114 Racha-Lechkhumi, Imereti 97.8 97.8 1.1 1.1 1.1 1.1 98.9 98.9 0.0 0.0 100.0 92 Guria, Samegrelo 94.5 94.5 2.7 2.7 2.1 2.1 97.2 97.2 0.7 0.7 100.0 146 Ajara 83.9 83.9 7.1 7.1 1.8 1.8 91.0 91.0 7.1 7.1 100.0 56 Urban 97.0 97.0 1.5 1.4 0.0 0.0 98.5 98.4 1.4 1.7 100.0 296 Rural 89.3 88.4 4.9 5.7 4.2 4.2 94.2 94.1 1.6 1.7 100.0 405 Total 93.2 92.0 3.2 3.9 2.1 2.1 96.4 95.6 1.5 1.7 100.0 701 * Skilled personnel include doctors, nurses, and midwives.** TBA=Traditional birth attendant; table categorized as the most skilled person seen. 32 Table 19: Percentage of live births in the last 12 months that weighed below 2500 grams at birth Percent of live births: Below 2500 grams Weighed at birth Number of live births Wt Unwt Wt Unwt Male Female Tbilisi 4.5 4.5 100.0 100.0 112 Kakheti 6.1 6.1 91.7 91.7 72 Mtskheta-Mtianeti, Shida Kartli 0.0 0.0 96.4 96.4 112 Kvemo Kartli, Samtskhe- Javakheti 5.1 5.1 83.6 83.6 116 Racha-Lechkhumi, Imereti 5.6 5.6 96.8 96.8 93 Guria, Samegrelo 4.2 4.2 96.0 96.0 149 Ajara 0.0 0.0 82.1 82.1 56 Urban 5.3 4.8 98.1 98.0 299 Rural 2.9 3.0 89.5 89.8 411 Total 4.2 3.8 93.8 93.2 710 33 Table 20: Percent of living children by breastfeeding status Percent of children 0- 3.99 months exclusively breastfed Percent of children 6- 9.99 months receiving solid/mushy food Percent of children 12-15.99 months still breastfed Percent of children 20-23.99 months still breastfed wt unwt n wt unwt n wt unwt n wt unwt n Male 15.2 17.4 86 15.8 16.2 142 32.5 35.3 102 9.9 10.2 137 Female 20.8 18.7 75 7.7 9.0 111 27.7 28.6 105 14.1 13.5 141 Tbilisi 23.1 23.1 25 5.0 5.0 40 26.9 26.9 26 14.1 14.1 64 Kakheti 14.3 14.3 14 17.9 17.9 28 47.1 47.1 17 14.8 14.8 27 Mtskheta-Mtianeti, Shida Kartli 15.6 15.6 32 9.1 9.1 33 44.8 44.8 29 10.0 10.0 40 Kvemo Kartli, Samtskhe- Javakheti 16.0 16.0 22 18.0 18.0 61 21.2 21.2 33 6.5 6.5 46 Racha-Lechkhumi, Imereti 15.8 15.8 17 13.9 13.9 36 30.6 30.6 36 10.3 10.3 29 Guria, Samegrelo 26.5 26.5 34 14.7 14.7 34 32.7 32.7 49 13.5 13.5 52 Ajara 0.0 0.0 11 6.1 6.1 21 23.5 23.5 17 15.0 15.0 20 Urban 19.7 20.0 70 8.2 7.9 101 33.6 32.9 85 12.1 11.2 143 Rural 15.9 16.5 91 16.0 16.4 152 26.7 31.1 122 11.7 12.6 135 Total 17.9 18.0 161 12.2 13.0 253 30.0 31.9 207 12.0 11.9 278 wt=weighted estimates; unwt=unweighted estimates; n=sample size 34 Table 21: Percentage of under-five children who are severely or moderately undernourished Weight for age Height for age Weight for height Percent below - 2 SD Percent below - 3 SD Percent below - 2 SD Percent below - 3 SD Percent below - 2 SD Percent below - 3 SD Number of children wt unwt wt unwt wt unwt wt unwt wt unwt wt unwt waz haz whz Male 3.8 4.4 0.4 0.3 12.5 13.0 4.0 4.1 2.8 2.7 0.4 0.4 1753 1704 1697 Female 2.3 2.8 0.0 0.0 10.9 11.8 3.3 3.7 1.8 1.8 0.5 0.4 1681 1635 1633 Tbilisi 0.8 0.8 0.2 0.2 10.9 10.9 3.2 3.2 2.1 2.1 0.6 0.6 496 476 476 Kakheti 5.9 5.9 0.5 0.5 15.9 15.9 5.1 5.1 2.5 2.5 0.0 0.0 409 395 394 Mtskheta-Mtianeti, Shida Kartli 3.8 3.8 0.0 0.0 11.4 11.4 4.4 4.4 1.3 1.3 0.2 0.2 554 544 541 Kvemo Kartli, Samtskhe- Javakheti 4.2 4.2 0.0 0.0 15.4 15.4 5.4 5.4 4.4 4.4 0.8 0.8 529 501 503 Racha-Lechkhumi, Imereti 3.2 3.2 0.5 0.5 6.2 6.2 1.8 1.8 1.6 1.6 0.2 0.2 438 434 432 Guria, Samegrelo 4.1 4.1 0.1 0.1 13.8 13.8 4.0 4.0 1.9 1.9 0.4 0.4 736 723 719 Ajara 3.3 3.3 0.4 0.4 12.4 12.4 3.0 3.0 1.9 1.9 0.4 0.4 272 266 265 Urban 1.7 2.2 0.2 0.1 9.6 10.1 2.8 2.9 2.1 2.0 0.7 0.6 1428 1381 1380 Rural 4.5 4.6 0.3 0.2 13.9 14.0 4.5 4.6 2.5 2.5 0.2 0.3 2006 1958 1950 < 6 months 3.6 3.7 1.0 0.8 8.5 9.0 2.6 2.1 3.1 3.0 1.1 1.3 245 233 232 6-11 months 2.3 3.1 0.4 0.3 9.2 8.8 2.6 2.4 2.7 3.0 0.3 0.3 353 339 337 12-23 months 4.0 4.2 0.0 0.0 15.7 15.0 4.4 5.0 2.2 2.1 0.0 0.0 636 605 605 24-35 months 3.1 4.1 0.1 0.1 10.2 11.8 3.6 3.9 1.9 2.3 0.5 0.5 760 740 741 36-47 months 2.8 3.0 0.2 0.1 11.0 11.9 3.8 4.0 2.1 1.7 0.7 0.4 727 717 716 48-59 months 2.7 3.4 0.2 0.3 12.9 14.2 3.8 4.3 2.6 2.3 0.4 0.3 713 705 699 Total 3.1 3.6 0.2 0.2 11.7 12.4 3.7 3.9 2.3 2.3 0.5 0.4 3434 3339 3330 wt=weighted estimates; unwt=unweighted estimates; 35 Table 22: Percentage of under-five children who are severely or mode rately undernourished, Global Database on Child Growth and Malnutrition Age Grp, Mos N WEIGHT/HEIGHT (%) HEIGHT/AGE (%) WEIGHT/AGE (%) Males and females <-3SD <-2SD 1 >+2SD Mean Z-Score SD Z-score <-3SD <-2SD 1 Mean Z-Score SD Z-score <-3SD <-2SD 1 Mean Z-Score SD Z-score TOTAL (0-59) 3434 0.5 2.3 12.7 0.58 1.32 3.7 11.7 -0.33 1.47 0.2 3.1 0.20 1.22 0-5 245 1.1 3.1 13.7 0.52 1.37 2.6 8.5 -0.22 1.44 1.0 3.6 0.26 1.21 6-11 353 0.3 2.7 19.6 0.63 1.57 2.6 9.2 -0.11 1.49 0.4 2.3 0.31 1.31 12-23 636 0.0 2.2 17.7 0.82 1.48 4.4 15.7 -0.50 1.51 0.0 4.0 0.30 1.34 24-35 760 0.5 1.9 8.7 0.49 1.15 3.6 10.2 -0.10 1.56 0.1 3.1 0.27 1.19 36-47 727 0.7 2.1 11.1 0.50 1.24 3.8 11.0 -0.31 1.43 0.2 2.8 0.10 1.15 48-59 713 0.4 2.6 10.4 0.56 1.25 3.8 12.9 -0.58 1.33 0.2 2.7 0.05 1.15 Male 1753 0.4 2.8 13.0 0.61 1.35 4.0 12.5 -0.37 1.48 0.4 3.8 0.20 1.26 0-5 133 0.0 3.2 14.7 0.61 1.38 4.0 9.9 -0.38 1.49 1.9 3.0 0.20 1.23 6-11 191 0.5 3.2 19.0 0.53 1.50 4.0 12.5 -0.25 1.53 0.7 3.8 0.16 1.30 12-23 316 0.0 3.8 17.2 0.87 1.55 4.9 16.5 -0.51 1.50 0.0 5.8 0.33 1.42 24-35 377 0.3 2.1 10.2 0.56 1.20 4.6 11.5 -0.09 1.61 0.2 3.8 0.34 1.23 36-47 366 1.4 3.0 12.0 0.54 1.33 2.5 10.4 -0.32 1.41 0.4 2.8 0.15 1.17 48-59 370 0.4 2.0 9.5 0.54 1.23 3.9 13.2 -0.65 1.32 0.3 3.3 0.02 1.17 Female 1681 0.5 1.8 12.4 0.55 1.29 3.3 10.9 -0.28 1.46 0.0 2.3 0.19 1.19 0-5 112 2.3 2.9 12.6 0.41 1.35 1.0 6.9 -0.03 1.37 0.0 4.3 0.32 1.19 6-11 162 0.0 2.1 20.3 0.73 1.63 1.0 5.7 -0.04 1.43 0.0 0.6 0.46 1.31 12-23 320 0.0 0.6 18.3 0.77 1.40 3.8 15.0 -0.49 1.52 0.0 2.1 0.27 1.26 24-35 383 0.6 1.7 7.1 0.41 1.09 2.6 8.9 -0.11 1.52 0.0 2.4 0.20 1.16 36-47 361 0.0 1.2 10.1 0.46 1.15 5.2 11.6 -0.30 1.45 0.0 2.7 0.05 1.12 48-59 343 0.9 3.3 11.3 0.57 1.59 3.7 12.5 -0.50 1.33 0.2 2.1 0.08 1.12 36 (continued) Table 22: Percentage of under-five children who are severely or moderately undernourished, Global Database on Child Growth and Malnutrition N WEIGHT/HEIGHT (%) HEIGHT/AGE (%) WEIGHT/AGE (%) <-3SD <-2SD 1 >+2SD Mean Z-Score SD Z-score <-3SD <-2SD 1 Mean Z-Score SD Z-score <-3SD <-2SD 1 Mean Z-Score SD Z-score RESIDENCE Urban 1428 0.7 2.1 13.7 0.64 1.82 2.8 9.6 -0.13 1.43 0.2 1.7 0.36 1.42 Rural 2006 0.2 2.5 11.7 0.52 1.65 4.5 13.9 -0.53 1.49 0.3 4.5 0.03 1.52 REGIONS Tbilisi (capital) 496 0.6 2.1 15.8 0.68 1.41 3.2 10.9 -0.04 1.50 0.2 0.8 0.43 1.19 Kakheti 409 0.0 2.5 9.9 0.42 1.26 5.1 15.9 -0.66 1.36 0.5 5.9 -0.11 1.25 Mtsketa- Mtianeti, Shida Kartli 554 0.2 1.3 11.5 0.60 1.26 4.4 11.4 -0.46 1.41 0.0 3.8 0.14 1.22 Kv. Kartli, Samtskhe- Javakheti 529 0.8 4.4 11.9 0.52 1.37 5.4 15.4 -0.48 1.67 0.0 4.2 0.08 1.25 Racha- Lechkhumi, Imereti 438 0.2 1.6 11.3 0.56 1.19 1.8 6.2 -0.17 1.29 0.5 3.2 0.24 1.18 Guria, Samegrelo 736 0.4 1.9 13.8 0.65 1.29 4.0 13.8 -0.56 1.41 0.1 4.1 0.14 1.25 Ajara 272 0.4 1.9 9.4 0.43 1.30 3.0 12.4 -0.50 1.39 0.4 3.3 -0.01 1.17 NOTES All anthropometry values do not include the areas of Abkahzia or South Ossetia due to political instability; these areas account for approximately 10% of the population in Georgia. Sample sizes are based on the number of children with weight-for-age; sample sizes for weight-for-height and height-for-age were slightly smaller 1 % <-2SD includes %<-3SD 37 Table 23: Percentage of households consuming adequately iodized salt Percent of households with salt testing Percent of households with no salt Percent of households in which salt was tested < 15 PPM 15+ PPM Number of households interviewed Wt Unwt Wt Unwt Wt Unwt Wt Unwt Tbilisi 10.0 10.0 85.7 85.7 8.3 8.3 17.5 17.5 140 Kakheti 0.0 0.0 98.9 98.9 16.3 16.3 12.8 12.8 87 Mtskheta-Mtianeti, Shida Kartli 0.0 0.0 00.3 00.3 12.4 12.4 12.4 12.4 138 Kvemo Kartli, Samtskhe-Javakheti 0.0 0.0 98.3 98.3 6.2 6.2 1.1 1.1 180 Racha-Lechkhumi, Imereti 0.7 0.7 97.1 97.1 15.2 15.2 3.8 3.8 136 Guria, Samegrelo 0.5 0.5 99.5 99.5 8.7 8.7 2.7 2.7 184 Ajara 0.0 0.0 100.0 100.0 10.3 10.3 4.1 4.1 97 Urban 4.6 2.9 92.2 94.5 9.4 9.3 12.3 10.8 511 Rural 0.2 0.2 99.6 99.6 12.1 11.8 2.7 2.9 451 Total 1.5 1.9 95.3 96.9 10.6 10.5 8.1 7.0 962 Note: Adequately iodized salt is salt testing 15 PPM (parts per million) or more. 38 Table 24: Percentage of women with a birth in the last 12 months by whether they received a high dose Vitamin A supplement before the infant was 2 months old Received Vitamin A supplement No. of women Wt Unwt Tbilisi 16.5 16.5 109 Kakheti 2.8 2.8 71 Mtskheta-Mtianeti, Shida Kartli 5.4 5.4 112 Kvemo Kartli, Samtskhe- Javakheti 12.4 12.4 113 Racha-Lechkhumi, Imereti 2.2 2.2 91 Guria, Samegrelo 9.0 9.0 145 Ajara 5.6 5.6 54 Urban 10.6 10.3 292 Rural 6.6 6.9 403 Total 8.6 8.3 695 6 women (<1%) did not know if they received vitamin A capsules and are excluded from this table. 39 Table 25: Percentage of children age 15-26.9 months immunized against childhood diseases at any time before the survey and before the first birthday* Percentage of children who received: BCG DPT1 DPT2 DPT3 Polio 1 Polio2 Polio3 Measles All None n Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Vaccinated at any time before the survey According to: Vaccination card 81.6 81.8 82.3 81.6 80.9 79.5 77.5 76.3 81.0 80.1 80.2 78.6 76.8 75.3 65.4 64.3 61.4 60.3 13.7 13.4 718 Mother’s report 85.1 84.4 76.8 75.9 71.4 70.3 66.0 65.2 78.3 76.7 73.0 71.3 68.0 66.7 67.2 67.1 50.3 49.9 8.2 8.2 718 Either 91.4 91.1 86.8 86.1 84.0 82.7 80.5 79.5 86.5 85.8 83.7 82.5 80.9 79.9 73.3 72.7 67.4 66.0 5.7 5.6 718 Vaccinated by 12 months of age* 79.9 79.7 75.1 75.5 71.1 71.2 61.4 62.1 73.9 74.2 71.0 70.8 61.9 62.4 47.6 47.8 - - - 718 *For measles, the information is vaccinated by 15 months of age; those without vaccine dates and an unknown history of vaccinations are considered as not vaccinated. 40 Table 26: Percentage of children age 15-26.9 months currently vaccinated against childhood diseases Percentage of children who received: BCG DPT1 DPT2 DPT3 Polio 1 Polio2 Polio3 Measles All None n Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Male 90.7 90.5 84.5 83.5 81.2 79.4 76.6 74.9 84.0 83.2 80.9 79.0 77.2 75.6 66.0 65.1 62.0 60.3 5.1 5.4 315 Female 92.0 91.6 88.7 88.1 86.2 85.4 83.8 83.1 88.5 87.8 86.1 85.1 84.0 83.4 79.3 78.7 72.0 70.5 5.9 5.7 403 Tbilisi 96.2 96.2 91.7 91.7 90.2 90.2 88.6 88.6 92.4 92.4 90.9 90.9 89.4 89.4 84.8 84.8 81.1 81.1 2.3 2.3 132 Kakheti 93.2 93.2 93.2 93.2 91.9 91.9 85.1 85.1 94.6 94.6 91.9 91.9 90.5 90.5 78.4 78.4 77.0 77.0 2.7 2.7 74 Mtskheta-Mtianeti, Shida Kartli 92.7 92.7 84.7 84.7 77.4 77.4 74.2 74.2 86.3 86.3 77.4 77.4 75.0 75.0 70.2 70.2 62.1 62.1 4.0 4.0 124 Kvemo Kartli, Samtskhe-Javakheti 81.9 81.9 81.9 81.9 81.9 81.9 78.4 78.4 81.9 81.9 82.8 82.8 79.3 79.3 79.3 79.3 74.1 74.1 14.7 14.7 116 Racha-Lechkhumi, Imereti 92.6 92.6 86.8 86.8 82.4 82.4 75.0 75.0 85.3 85.3 80.9 80.9 75.0 75.0 55.9 55.9 52.9 52.9 5.9 5.9 68 Guria, Samegrelo 91.5 91.5 82.4 82.4 76.1 76.1 74.6 74.6 80.3 80.3 75.4 75.4 73.2 73.2 60.6 60.6 50.7 50.7 4.2 4.2 142 Ajara 88.7 88.7 83.9 83.9 83.9 83.9 82.3 82.3 80.6 80.6 80.6 80.6 79.0 79.0 79.0 79.0 62.9 62.9 4.8 4.8 62 Total 91.8 91.1 86.8 86.1 84.0 82.7 80.5 79.5 86.5 85.8 83.7 82.5 80.9 79.9 73.3 72.7 67.4 66.0 5.7 5.6 718 Vaccination coverage based on vaccination card and mothers report. 41 Table 27: Percentage of under-five children with diarrhoea in the last two weeks and treatment with ORS or ORT Children with diarrhoea who received: Had diarrhoea in last two weeks Breast milk Gruel or soup Other home fluids ORS packet Milk or infant formula Water with feeding Water alone Other liquids wt unwt n wt unwt wt unwt wt unwt wt unwt wt unwt wt unwt wt unwt wt unwt Male 6.3 6.4 2006 15.2 15.5 63.5 63.0 86.4 86.0 24.7 29.0 30.0 30.2 76.7 72.9 66.4 69.0 20.9 19.8 Female 5.6 6.0 1906 14.8 17.4 63.7 64.0 79.7 78.6 26.1 26.1 30.7 31.5 75.6 73.7 59.1 62.8 26.4 21.6 Tbilisi 3.6 3.6 636 17.4 17.4 60.9 60.9 91.3 91.3 13.6 13.6 26.1 26.1 91.3 91.3 - 60.9 60.9 26.1 26.1 Kakheti 2.8 2.8 425 25.0 25.0 50.0 50.0 58.3 58.3 25.0 25.0 8.3 8.3 75.0 75.0 83.3 83.3 16.7 16.7 Mtskheta-Mtianeti, Shida Kartli 8.1 8.1 629 27.5 27.5 81.6 81.6 83.7 83.7 15.6 15.6 26.1 26.1 92.2 92.2 51.1 51.1 20.0 20.0 Kvemo Kartli, Samtskhe-Javakheti 7.0 7.0 618 9.3 9.3 65.1 65.1 74.4 74.4 18.6 18.6 41.9 41.9 46.5 46.5 72.1 72.1 14.0 14.0 Racha-Lechkhumi, Imereti 8.5 8.5 485 12.2 12.2 61.0 61.0 85.4 85.4 29.3 29.3 24.4 24.4 90.2 90.2 51.2 51.2 36.6 36.6 Guria, Samegrelo 7.8 7.8 810 15.9 15.9 49.2 49.2 85.7 85.7 47.6 47.6 34.9 34.9 55.6 55.6 85.7 85.7 12.7 12.7 Ajara 3.6 3.6 309 0.0 0.0 90.0 90.0 90.0 90.0 22.2 22.2 44.4 44.4 50.0 50.0 40.1 40.1 30.0 30.0 Urban 5.7 6.1 1694 14.6 15.4 64.1 63.5 82.1 81.7 27.7 30.7 24.9 25.2 83.2 80.8 59.2 64.1 24.9 22.3 Rural 6.2 6.3 2218 15.4 17.1 63.2 63.5 84.6 83.2 23.0 25.4 36.0 35.1 69.1 67.6 67.0 67.6 21.9 19.4 0-5.99 months 9.4 10.1 276 52.9 57.1 16.6 18.5 56.6 57.1 9.8 14.8 28.0 33.3 56.5 53.6 42.9 48.1 7.0 3.8 6-11.99 months 7.5 8.3 385 13.5 18.8 75.2 75.0 89.0 87.5 28.3 28.1 44.2 37.5 77.9 75.0 56.1 62.5 16.6 18.8 12-23.99 months 9.2 9.1 735 22.3 23.9 76.2 74.6 84.0 84.8 30.1 30.8 33.6 32.3 80.2 77.6 67.7 70.8 24.2 20.0 24-35.99 months 4.5 5.0 863 4.3 2.3 63.7 59.5 91.1 88.4 20.8 27.5 29.0 29.3 76.6 74.4 60.3 61.9 18.5 19.0 36-47.99 months 4.0 4.2 827 0.0 0.0 58.9 60.0 90.7 88.2 37.4 38.2 18.2 23.5 73.8 71.4 76.3 80.0 30.8 23.5 48-59.99 months 4.6 4.7 826 1.7 2.6 66.5 73.7 81.4 81.6 19.1 21.6 26.1 28.9 82.4 78.9 65.3 65.8 37.4 34.2 Total 6.0 6.2 3912 15.0 16.4 63.6 63.5 83.3 82.6 25.4 27.7 30.3 30.8 76.2 73.3 63.0 66.1 23.4 20.7 Of 3938 children under five, diarrhea in the last two weeks was unknown for 26 (0.7%); 42 Table 28: Percentage of under-five children with diarrhoea in the last two weeks who received recommended fluids or treatment Had diarrhoea in last two weeks (%, n) Received recommended fluids No. of children with diarrhoea wt unwt n wt unwt Male 6.3 6.4 2006 94.9 94.5 129 Female 5.6 6.0 1906 96.6 94.7 115 Tbilisi 3.6 3.6 636 100.0 100.0 23 Kakheti 2.8 2.8 425 90.9 90.9 12 Mtskheta-Mtianeti, Shida Kartli 8.1 8.1 629 98.0 98.0 51 Kvemo Kartli, Samtskhe-Javakheti 7.0 7.0 618 95.3 95.3 43 Racha-Lechkhumi, Imereti 8.5 8.5 485 97.6 97.6 41 Guria, Samegrelo 7.8 7.8 810 88.9 88.9 63 Ajara 3.6 3.6 309 88.9 88.9 11 Urban 5.7 6.1 1694 96.3 95.1 104 Rural 6.2 6.3 2218 95.0 94.2 140 0-5.99 months 9.4 10.1 276 93.0 89.3 28 6-11.99 months 7.5 8.3 385 94.5 93.5 32 12-23.99 months 9.2 9.1 735 96.6 95.5 67 24-35.99 months 4.5 5.0 863 97.1 95.3 43 36-47.99 months 4.0 4.2 827 98.2 97.1 35 48-59.99 months 4.6 4.7 826 93.0 94.6 39 Total 6.0 6.2 3912 95.7 94.6 244 Of 3938 children under five, diarrhea in the last two weeks was unknown for 26 (0.7%); 43 Table 29: Percentage of under-five children with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode Children with diarrhoea who: Had diarrhoea in last two weeks (%, n) Drank more Drank the same or less Ate somewhat less, same or more Ate much less or none Received increased fluids and continued eating* Number of children with diarrhoea wt unwt n wt unwt wt unw t wt Unwt wt unwt Wt unwt Male 6.3 6.4 2006 50.7 51.2 41.4 40.3 66.7 66.9 33.3 33.1 33.5 34.7 129 Female 5.6 6.0 1906 47.8 45.2 45.6 45.2 75.0 75.9 25.0 24.1 33.2 31.8 115 Tbilisi 3.6 3.6 636 47.8 47.8 47.8 47.8 73.9 73.9 26.1 26.1 31.8 31.8 23 Kakheti 2.8 2.8 425 41.7 41.7 41.7 41.7 83.3 83.3 - - 36.4 36.4 12 Mtskheta-Mtianeti, Shida Kartli 8.1 8.1 629 56.9 56.9 33.3 33.3 79.2 79.2 20.8 20.8 44.7 44.7 51 Kvemo Kartli, Samtskhe-Javakheti 7.0 7.0 618 51.2 51.2 44.2 44.2 64.3 64.3 35.7 35.7 35.7 35.7 43 Racha-Lechkhumi, Imereti 8.5 8.5 485 58.5 58.5 39.0 39.0 70.7 70.7 29.3 29.3 36.6 36.6 41 Guria, Samegrelo 7.8 7.8 810 41.3 41.3 44.4 44.4 69.8 69.8 30.2 30.2 26.2 26.2 63 Ajara 3.6 3.6 309 9.1 9.1 72.7 72.7 50.0 50.0 50.0 50.0 0.0 0.0 11 Urban 5.7 6.1 1694 50.4 49.0 42.4 41.3 72.7 72.5 27.3 27.5 34.9 34.7 104 Rural 6.2 6.3 2218 48.2 47.9 44.2 43.6 68.2 70.1 31.8 29.9 31.9 32.4 140 0-5.99 months 9.4 10.1 276 48.7 39.3 44.3 50.0 89.2 92.9 10.8 7.1 37.9 32.1 28 6-11.99 months 7.5 8.3 385 50.5 50.0 44.1 43.8 82.7 78.1 17.3 21.9 46.3 43.8 32 12-23.99 months 9.2 9.1 735 45.7 44.8 49.1 47.8 72.6 74.6 27.4 25.4 29.7 30.8 67 24-35.99 months 4.5 5.0 863 51.9 55.8 37.7 32.6 70.3 69.8 29.7 30.2 40.8 45.0 43 36-47.99 months 4.0 4.2 827 66.8 60.0 27.4 31.4 51.2 51.5 48.8 48.5 26.1 21.2 35 48-59.99 months 4.6 4.7 826 38.2 41.0 50.8 48.7 59.4 61.1 40.6 38.9 24.6 27.8 39 Total 6.0 6.2 3912 49.4 48.4 43.3 42.6 70.5 71.1 29.5 28.9 33.4 33.3 244 44 Table 30: Percentage of under-five children with acute respiratory infection in the last two weeks and treatment by health providers Percent of Children with ARI who were taken to: Had acute respiratory infection (%, n) Hospital Health centre Dispens- ary/ER MCH clinic Private physician Any appro- priate provider Inappro- priate provider No. with ARI wt unwt n wt unwt wt unwt wt unwt wt unwt wt unwt wt unwt wt unwt n Male 4.4 4.6 2004 24.7 23.5 44.5 42.4 5.0 4.7 14.6 18.8 32.4 36.5 100.0 100.0 7.6 5.9 85 Female 3.1 3.6 1907 11.8 12.8 42.3 39.1 3.0 3.1 19.6 25.0 35.8 37.5 96.3 96.9 5.9 6.3 64 Tbilisi 3.3 3.3 638 0.0 0.0 60.0 60.0 5.0 5.0 0.0 0.0 35.0 35.0 100.0 100.0 0.0 0.0 20 Kakheti 1.9 1.9 416 25.0 25.0 12.5 12.5 12.5 12.5 50.0 50.0 25.0 25.0 100.0 100.0 12.5 12.5 8 Mtskheta-Mtianeti, Shida Kartli 4.0 4.0 628 18.2 18.2 50.0 50.0 9.1 9.1 18.2 18.2 22.7 22.7 100.0 100.0 4.5 4.5 22 Kvemo Kartli, Samtskhe- Javakheti 1.1 1.1 621 0.0 0.0 60.0 60.0 20.0 20.0 20.0 20.0 20.0 20.0 100.0 100.0 0.0 0.0 5 Racha-Lechkhumi, Imereti 5.3 5.3 487 41.7 41.7 33.3 33.3 0.0 0.0 8.3 8.3 20.8 20.8 95.8 95.8 16.7 16.7 24 Guria, Samegrelo 8.4 8.4 812 15.2 15.2 34.8 34.8 0.0 0.0 27.3 27.3 50.0 50.0 98.5 98.5 3.0 3.0 66 Ajara 1.6 1.6 309 50.0 50.0 75.0 75.0 25.0 25.0 75.0 75.0 50.0 50.0 100.0 100.0 25.0 25.0 4 Urban 4.0 4.4 1694 15.1 17.9 54.4 55.2 4.5 4.5 2.2 3.0 34.0 35.8 98.0 98.5 4.3 4.5 67 Rural 3.5 3.9 2217 24.7 19.5 30.7 29.3 3.8 3.7 33.9 36.6 33.5 37.8 99.1 98.8 10.1 7.3 82 0-5.99 months 3.1 3.6 278 43.9 44.4 55.2 55.6 8.5 11.1 0.0 0.0 16.5 22.2 100.0 100.0 0.0 0.0 9 6-11.99 months 3.4 4.4 384 32.3 25.0 27.3 37.5 0.0 0.0 26.9 31.3 35.0 31.3 100.0 100.0 11.5 6.3 16 12-23.99 months 6.1 6.3 730 25.8 23.3 48.1 48.8 5.5 4.7 12.0 16.3 29.4 32.6 100.0 100.0 3.5 2.3 43 24-35.99 months 3.5 3.4 863 15.6 17.2 36.7 31.0 3.4 3.4 16.4 24.1 39.4 44.8 100.0 100.0 4.8 3.4 29 36-47.99 months 3.1 3.7 828 13.1 14.8 55.9 40.7 7.8 7.4 22.0 25.9 29.0 37.0 100.0 100.0 7.8 7.4 27 48-59.99 months 2.9 3.3 828 2.7 4.0 37.8 36.0 0.0 0.0 20.5 24.0 44.4 44.0 90.3 92.0 15.3 16.0 25 Total 3.8 4.1 3911 19.5 18.8 43.6 40.9 4.2 4.0 16.7 21.5 33.8 36.9 98.5 98.7 9.4 6.0 149 Note: the End Decade indicator definition for ARI is a child with cough who breathed faster than usual with short, quick breaths or had difficulty breathing AND the symptoms were due to: 1) a problem in the chest; 2) a problem in the chest and blocked nose; or 3) do not know why. In the Georgian MICS ARI is defined as a cough and faster breathing. Appropriate providers were a hospital, health center, dispensary, MCH clinic, emergency room, or a private physician. Due to the small number reporting a dispensary (n=4) or emergency room (n=3), these two were combined in the table. Inappropriate providers are a pharmacy (n=1), a traditional healer (n=2), or a relative/friend (n=7). 45 Table 31: Percentage of children aged 36-59.99 months who are attending some form of organized early childhood education programme Weighted Estimated (%) Unweighed Estimates (%) Number of children State Private None State Private None Male 29.5 2.0 68.5 29.5 2.4 68.1 825 Female 28.0 2.2 69.8 28.7 2.1 69.3 771 Tbilisi 34.8 2.6 62.7 34.8 2.6 62.7 233 Kakheti 43.2 - 55.2 43.2 - 55.2 183 Mtskheta-Mtianeti, Shida Kartli 45.2 - 53.5 45.2 - 53.5 230 Kvemo Kartli, Samtskhe- Javakheti 14.3 - 85.7 14.3 - 85.7 252 Racha-Lechkhumi, Imereti 32.1 2.4 65.6 32.1 2.4 65.6 209 Guria, Samegrelo 23.5 4.7 71.8 23.5 4.7 71.8 362 Ajara 9.4 - 89.0 9.4 - 89.0 127 Urban 36.9 3.2 59.8 38.9 4.0 57.1 692 Rural 20.2 1.0 78.8 21.6 0.9 77.5 904 36-47.99 months 25.8 1.4 72.8 26.9 1.8 71.3 792 48-59.99 months 31.6 2.8 65.5 31.2 2.7 66.0 804 Total 28.8 2.1 69.1 29.1 2.3 68.7 1596 There were 12 children who were 3 or 4 years of age for whom information was not collected on this question and 55 children for whom the recorded response was “Don’t know.” 46 Table 32: Percentage of children of primary school age (6-11 years) attending school Male Female Total State Private State Private State Private Wt Unwt Wt Unwt N Wt Unwt Wt Unwt N Wt Unwt Wt Unwt N Tbilisi 94.4 94.4 5.6 5.6 89 96.3 96.3 3.7 3.7 81 95.3 95.3 4.7 4.7 170 Kakheti 94.3 94.3 1.1 1.1 88 94.5 94.5 1.1 1.1 91 94.4 94.4 1.1 1.1 179 Mtskheta-Mtianeti, Shida Kartli 94.2 94.2 4.7 4.7 86 95.9 95.9 1.4 1.4 73 95.0 95.0 3.1 3.1 159 Kvemo Kartli, Samtskhe- Javakheti 96.6 96.6 0.0 0.0 89 92.2 92.2 0.0 0.0 103 94.3 94.3 0.0 0.0 192 Racha-Lechkhumi, Imereti 98.9 98.9 1.1 1.1 92 98.9 98.9 1.1 1.1 95 98.9 98.9 1.1 1.1 187 Guria, Samegrelo 93.9 93.9 3.0 3.0 99 96.8 96.8 2.1 2.1 95 95.4 95.4 2.6 2.6 194 Ajara 98.3 98.3 1.7 1.7 60 98.9 98.9 1.1 1.1 95 98.7 98.7 1.3 1.3 155 Urban 94.7 94.4 4.4 4.0 251 97.2 97.4 2.4 1.8 274 96.0 96.0 3.4 2.9 525 Rural 97.0 96.6 1.3 1.4 352 95.2 95.3 0.9 1.1 359 96.1 95.9 1.1 1.3 711 Age 6 94.1 95.1 4.3 3.3 64 97.7 97.4 0.0 0.0 43 95.9 96.0 2.7 2.0 107 7 98.7 98.5 1.3 1.5 68 97.3 98.7 2.7 1.3 76 97.9 98.6 2.1 1.4 144 8 95.7 94.3 3.3 4.3 70 96.4 97.5 3.6 2.5 79 96.0 96.0 3.4 3.4 149 9 93.7 94.6 5.0 3.6 56 100.0 100.0 0.0 0.0 67 97.2 97.6 2.2 1.6 123 10 94.5 97.2 5.5 2.8 71 98.1 98.3 0.0 0.0 58 96.0 97.7 3.1 1.6 129 Pr im ar y sc ho ol in g 11 99.0 100.0 1.0 0.0 65 96.1 97.0 3.9 3.0 67 98.0 98.5 2.0 1.5 132 12 95.9 97.0 2.7 1.5 67 100.0 100.0 0.0 0.0 66 97.9 98.5 1.4 0.8 133 13 97.8 96.5 2.2 3.5 57 92.9 91.8 0.0 0.0 73 95.0 93.8 1.0 1.5 130 14 94.0 91.1 0.0 0.0 45 96.2 95.2 0.0 0.0 63 95.2 93.5 0.0 0.0 108 15 89.4 87.5 5.5 5.0 40 82.6 80.5 8.8 9.8 41 85.9 84.0 7.2 7.4 81 Total 95.8 95.7 2.9 2.6 603 96.3 96.2 1.7 1.4 633 96.0 96.0 2.3 1.9 1236 47 Table 33: Percentage of children entering first grade of primary school who eventually reach grade 5 Percent attending 2nd grade who were in 1st grade last year Percent attending 3rd grade who were in 2nd grade last year Percent attending 4th grade who were in 3rd grade last year Percent attending 5th grade who were in 4th grade last year Total 100.0% 100.0% 99.2% 100.0% N 151 151 125 128 48 Table 34: Percentage of the population aged 15 years and older that is literate Male Female Total Literate Unknown No.r Literate Unknown No. Literate Unknown No. Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Tbilisi 99.4 99.4 0.0 0.0 1236 99.5 99.5 0.0 0.0 1523 99.4 99.4 0.0 0.0 2759 Kakheti 99.0 99.0 0.0 0.0 859 97.7 97.7 0.1 0.1 952 98.3 98.3 0.1 0.1 1811 Mtskheta-Mtianeti, Shida Kartli 98.3 98.3 0.6 0.6 1318 97.6 97.6 0.9 0.9 1483 97.9 97.9 0.8 0.8 2801 Kvemo Kartli, Samtskhe-Javakheti 98.7 98.7 0.7 0.7 1114 96.4 96.4 1.0 1.0 1262 97.4 97.4 0.9 0.9 2376 Racha-Lechkhumi, Imereti 99.6 99.6 0.2 0.2 999 99.3 99.3 0.4 0.4 1168 99.4 99.4 0.3 0.3 2167 Guria, Samegrelo 99.0 99.0 0.0 0.0 1376 98.4 98.4 0.0 0.0 1603 98.7 98.7 0.0 0.0 2979 Ajara 99.9 99.9 0.0 0.0 667 99.5 99.5 0.0 0.0 789 99.7 99.7 0.0 0.0 1456 Urban 99.4 99.5 0.1 0.1 3305 99.5 99.5 0.1 0.1 4002 99.5 99.5 0.1 0.1 7307 Rural 98.7 98.7 0.3 0.4 4264 97.3 97.3 0.6 0.6 4778 98.0 98.0 0.5 0.5 9042 Age 15-24 99.2 99.1 0.3 0.4 1182 99.4 99.2 0.4 0.4 1820 99.3 99.2 0.4 0.4 3002 25-34 99.7 99.7 0.1 0.1 2095 99.6 99.5 0.1 0.1 2334 99.7 99.6 0.1 0.1 4429 35-44 99.5 99.3 0.1 0.2 1678 99.3 99.2 0.1 0.1 1356 99.4 99.3 0.1 0.2 3034 45-54 99.2 99.2 0.3 0.3 884 99.2 99.0 0.4 0.5 1071 99.2 99.1 0.3 0.4 1955 55-64 98.8 99.0 0.0 0.0 901 97.8 97.7 0.4 0.4 1116 98.2 98.3 0.2 0.2 2011 65+ 96.6 96.6 0.5 0.5 829 93.4 92.9 0.9 1.0 1084 94.8 94.5 0.7 0.8 1913 Total 99.1 99.0 0.2 0.2 7569 98.5 98.3 0.3 0.4 8780 98.8 98.6 0.3 0.3 16,349 49 Table 35: Percent distribution of children aged 0-59 months by whether birth is registered and reasons for non-registration Birth is not registered because: Total Birth is registered Unknown if Birth is registered Costs too much Must travel too far Other Don’t know No. Of children wt unwt wt unwt wt unwt wt unwt wt unwt wt unwt Male 94.9 94.3 2.4 2.8 1.1 1.3 0.3 0.3 0.8 0.8 0.5 0.5 100.0 2019 Female 94.4 93.4 2.3 2.6 1.5 1.9 0.2 0.4 0.8 0.8 0.9 0.9 100.0 1919 Tbilisi 99.1 99.1 0.2 0.2 0.2 0.2 0.0 0.0 0.3 0.3 0.3 0.3 100.0 641 Kakheti 90.6 90.6 2.1 2.1 5.2 5.2 0.7 0.7 1.4 1.4 0.0 0.0 100.0 425 Mtskheta-Mtianeti, Shida Kartli 93.6 93.6 4.2 4.2 1.3 1.3 0.2 0.2 0.2 0.2 0.6 0.6 100.0 638 Kvemo Kartli, Samtskhe-Javakheti 83.9 83.9 8.8 8.8 2.6 2.6 0.8 0.8 1.8 1.8 2.1 2.1 100.0 632 Racha-Lechkhumi, Imereti 98.4 98.4 0.0 0.0 0.6 0.6 0.0 0.0 0.0 0.0 0.2 0.2 100.0 487 Guria, Samegrelo 95.7 95.7 1.0 1.0 1.2 1.2 0.5 0.5 0.9 0.9 0.7 0.7 100.0 814 Ajara 96.1 96.1 1.6 1.6 0.6 0.6 0.3 0.3 0.3 0.3 1.0 1.0 100.0 310 Urban 97.4 96.8 0.9 1.2 0.5 0.6 0.0 0.1 0.8 1.0 0.3 0.3 100.0 1705 Rural 91.6 91.6 3.9 3.8 2.1 2.3 0.6 0.6 0.7 0.7 1.2 1.1 100.0 2233 < 6 months 88.0 86.4 1.8 2.2 4.0 5.4 1.2 1.4 3.0 2.9 2.0 1.8 100.0 279 6-11.99 months 94.7 93.5 1.0 1.3 2.0 2.3 0.3 0.3 0.4 0.5 1.6 2.1 100.0 386 12-23.99 months 94.3 93.4 1.9 2.3 1.5 2.0 0.0 0.0 1.3 1.3 0.9 0.9 100.0 742 24-35.99 months 95.1 94.6 2.2 2.3 1.4 1.8 0.2 0.3 0.6 0.6 0.4 0.3 100.0 868 36-47.99 months 96.0 95.4 2.6 2.8 0.7 0.7 0.1 0.2 0.4 0.6 0.1 0.2 100.0 832 48-59.99 months 95.2 94.6 3.5 4.1 0.1 0.1 0.5 0.5 0.2 0.2 0.5 0.5 100.0 831 Total 94.6 93.9 2.3 2.7 1.3 1.6 0.3 0.4 0.8 0.8 0.7 0.7 100.0 3938 The “Birth is not registered because” don’t know category includes: Didn’t know it should be registered (n=7); does’nt know where to register (n=8); and don’t know (n=14). 50 Table 36: Percentage of children 0-14 years of age in households not living with a biological parent Living with both parents One or both parents dead* No. of children Wt Unwt Wt Unwt Male 95.3 95.9 0.2 0.2 3827 Female 95.4 96.1 0.1 0.1 3979 Tbilisi 91.8 91.8 0.2 0.2 1218 Kakheti 97.6 97.6 0.0 0.0 904 Mtskheta-Mtianeti, Shida Kartli 97.1 97.1 0.2 0.2 1274 Kvemo Kartli, Samtskhe-Javakheti 96.7 96.7 0.4 0.4 1245 Racha-Lechkhumi, Imereti 95.1 95.1 0.0 0.0 945 Guria, Samegrelo 96.8 96.8 0.1 0.1 1507 Ajara 97.7 97.7 0.0 0.0 717 Urban 93.0 93.5 0.1 0.1 3247 Rural 97.6 97.8 0.1 0.1 4559 0-4 years 95.9 96.4 0.0 0.0 3610 5-9 years 95.4 96.2 0.1 0.1 2618 10-14 years 94.0 94.8 0.5 0.4 1577 Total 95.3 96.0 0.1 0.1 7806 51 Table 37: Percentage of children 5-14 years of age who are currently working Domestic work Paid work Unpaid work < 4 hours/ day 4 or more hours/day Currently working* No. of children Wt Unwt Wt Unwt Wt Unwt Wt Unwt Wt Unwt Male 4.8 5.1 24.9 28.8 87.4 86.5 12.6 13.2 31.2 34.6 631 Female 2.2 1.6 21.3 22.9 87.5 88.3 12.5 11.7 28.7 29.2 678 5-9 years 4.0 4.0 14.7 15.6 93.4 94.1 6.6 5.9 19.1 19.2 577 10-14 years 3.0 2.7 30.2 35.0 82.3 81.7 17.7 18.3 39.3 43.1 640 Tbilisi 5.8 5.8 7.6 7.6 87.7 87.7 12.3 12.3 18.1 18.1 171 Kakheti 4.2 4.2 32.7 32.7 88.7 88.7 11.3 11.3 37.5 37.5 168 Mtskheta-Mtianeti, Shida Kartli 2.0 2.0 29.5 29.5 71.1 71.1 28.9 28.9 34.9 34.9 149 Kvemo Kartli, Samtskhe-Javakheti 2.5 2.5 25.7 25.7 88.6 88.6 11.4 11.4 32.2 32.2 202 Racha-Lechkhumi, Imereti 0.6 0.6 33.5 33.5 89.2 89.2 11.3 11.3 39.2 39.2 158 Guria, Samegrelo 5.0 5.0 29.5 29.5 87.5 87.5 16.6 16.6 37.5 37.5 200 Ajara 2.4 2.4 22.5 22.5 98.2 98.2 1.8 1.8 21.1 21.1 169 Urban 3.9 3.3 13.1 14.6 88.4 88.5 11.6 11.5 21.4 22.1 512 Rural 3.1 3.3 34.3 33.9 86.3 87.0 13.7 13.0 39.6 38.9 705 Total 3.5 3.3 23.1 25.8 87.4 87.6 12.6 12.4 30.0 31.8 1217 Paid work can be in cash or in-kind; unpaid work is working for family business or farm; domestic work is household chores (unknown for 37 children and for <4 hours/day includes those who did not perform chores). 52 Table 38: Percentage of children 24-59.99 months of age with a disability D3. Compared with other children, does or did [name] have any serious delay in sitting, standing, or walking? Yes 47/2531 = 1.9% D4. Compared with other children, does [name] have difficulty seeing, either in the daytime or at night? D4a) Squint D4b) Hardly sees No sight in one eye Blind Yes 25/2531 = 1.0% Squints 15/2531 = 0.6% Hardly sees 6/2531 = 0.2% No sight in one eye 3/2531 = 0.1% Blind 1/2531 = 0.0% D5. Does [name] have difficulty hearing? D5a) uses hearing aid D5b) hears with difficulty completely deaf Yes 10/2531 = 0.4% Uses hearing aid 0/2531 = 0.0% Hears with difficulty 8/2531 = 0.3% Completely deaf 2/2531 = 0.1% D6. When you tell the child to do something, does he/she seem to understand what you are saying? No 13/2531 = 0.5% D7. Do the child have difficulty in walking or moving his /her arms or weakness and/or stiffness in the arms or legs? Yes 41/2531 = 1.6% D8. Does the child sometimes have fits, become rigid, or lose consciousness? Yes 78/2531 = 3.1% D9. Does the child learn to do things like other children his/her age? No 15/2531 = 0.6% D10. Does the child speak at all (can he/she make him or herself understood in words; can say recognizable words? No 32/2531 = 1.3% D11. a) (For 3-5 year olds): Does the child have speech that is in any way different from normal (not clear enough to be understood by people other that the immediate family)? b) (For 2-year-olds): Can child name at least one object? Yes 21/2531 = 0.8% No 5/2531 = 0.2% D12. Compared with other child of the same age, does the child appear in any way mentally backward, dull or slow? Yes 17/2531 = 0.7% 53 Table 39: Percentage of children 24-59.99 months of age with a disability, by sex and the number of disabilities Overall Boys Girls Any disabilities 3.9% 4.3% 3.1% One disability 2.1 2.0 2.1 Two disabilities 1.0 1.3 0.7 3-10 disabilities 0.8 1.0 0.3 Table 40: Percentage of households by the source of heating Heating Tbilisi Kakheti Mtskheta- Tianeti, Shida Kartli Kvemo Kartli, Samtskhe- Javakheti Racha- Lechkhumi, Imereti Guria, Samegrelo Ajara Georgia Electric 9.7 0.8 2.4 1.6 4.2 0.8 3.7 4.2 Gas 6.7 1.6 - 3.2 1.7 0.8 1.8 2.9 Oil 48.5 - 2.4 3.2 8.4 1.6 10.1 15.6 Wood 29.1 97.6 93.5 78.4 84.0 96.7 81.7 72.9 None 4.5 - - 3.2 - - 2.8 1.9 Other 1.5 - 1.6 10.4 1.7 - - 2.5 Cells are percentages and the columns add up to 100% Table 41: Frequency of consumption of certain foods within the household Everyday Frequently Rarely Never Meat 1.5 21.5 62.8 14.2 Cheese 27.2 31.5 34.4 6.9 Butter 22.6 27.3 36.8 13.3 Other milk products 30.1 30.7 31.4 7.8 Fruit 25.9 44 27.2 2.8 Vegetable 58.2 33.4 7.8 0.5 Cells are percentages 54 References Gorstein J, Sullivan K, Yip R, de Onis M, Trowbridge F, Fajans P, Clugston G. Issues in the assessment of nutrition status using anthropometry. Bulletin of the World Health Organization 72(2):273-283, 1994. UNICEF. State of the World’s Children 2000. New York, 2000. WHO. Indicators for assessing Vitamin A Deficiency and their application in monitoring and evaluating intervention programmes. WHO/NUT/96.10, Geneva, 1996. 55 Appendices Appendix A Indicators for Monitoring Progress at End-Decade The following list includes the indicators for monitoring the WSC goals as well as additional indicators to monitor children’s rights, HIV/AIDS, the Integrated Management of Childhood Illness (IMCI) initiative, and malaria. All the indicators on this list are covered in the current MICS except the ones marked with an ‘X’. Age ranges indicated with a hyphen include the month or year given as the outer boundary of the range: for example, ‘6-9 months’ includes 6-month-olds and 9-month-olds. The information in this appendix is from the End-Decade Multiple Indicator Survey Manual: Monitoring Progress Toward the Goals of the 1990 World Summit for Children. Division of Evaluation, Policy, and Planning, United Nations Children’s Fund, New York, 2000. Note that WSC stands for World Summit for Children. Not all for the WSC goals were measured by the MICS in Georgia. Indicator Description Comments Indicators reflecting World Summit for Children goals WSC goal 1. Between 1990 and the year 2000, reduction of infant and under-five child mortality rate by one third or to 50 and 70 per 1,000 live births respectively, whichever is less Under-five mortality rate Probability of dying between birth and exactly five years of age, per 1,000 live births Infant mortality rate Probability of dying between birth and exactly one year of age, per 1,000 live births WSC goal 2. Between 1990 and the year 2000, reduction of maternal mortality rate by half Maternal mortality ratio (MMR) Annual number of deaths of women from pregnancy- related causes, when pregnant or within 42 days of termination of pregnancy, per 100,000 live births For countries without complete vital registration systems, MMR should be measured only once every 7-10 years: process indicators should be used to measure progress in the short term WSC goal 3. Between 1990 and the year 2000, reduction of severe and moderate malnutrition among under-five children by half Underweight prevalence Proportion of under-fives who fall below minus 2 and below minus 3 standard deviations from median weight- for-age of NCHS/WHO reference population To be measured not more than once every three years Stunting prevalence Proportion of under-fives who fall below minus 2 and below minus 3 standard deviations from median height- for-age of NCHS/WHO reference population Moderate and severe levels, and severe levels, should be reported separately Wasting prevalence Proportion of under-fives who fall below minus 2 and below minus 3 standard deviations from median weight-for-height of NCHS/WHO reference population 56 Indicator Description Comments WSC goal 4. Universal access to safe drinking water Use of safe drinking water Proportion of population who use any of the following types of water supply for drinking: piped water; public tap; borehole/pump; protected well; protected spring; rainwater WSC goal 5. Universal access to sanitary means of excreta disposal Use of sanitary means of excreta disposal Proportion of population who have, within their dwelling or compound: toilet connected to sewage system; any other flush toilet (private or public); improved pit latrine; traditional pit latrine WSC goal 6. Universal access to basic education, and achievement of primary education by at least 80 per cent of primary school-age children, through formal schooling or non-formal education of comparable learning standard, with emphasis on reducing the current disparities between boys and girls Children reaching grade 5 Proportion of children entering first grade of primary school who eventually reach grade 5 X Net primary school enrolment ratio Proportion of children of primary -school age enrolled in primary school Not covered in MICS Net primary school attendance rate Proportion of children of primary -school age attending primary school Optional Proportion entering school Proportion of children of primary -school entry age who enter school at that age X Learning achievement Proportion of children aged 10-12 years reaching a specific level of learning achievement in literacy, numeracy and life skills WSC goal 7. Reduction of the adult illiteracy rate (the appropriate age group to be determined in each country) to at least half its 1990 level, with emphasis on female literacy Literacy rate Proportion of population aged 15 years and older who are able, with understanding, to both read and write a short simple statement on their everyday life To be measured at most once every five years WSC goal 8. Provide improved protection of children in especially difficult circumstances and tackle the root causes leading to such situations Total child disability rate Proportion of children aged less than 15 years with some reported physical or mental disability 57 Indicator Description Comments WSC goal 9. Special attention to the health and nutrition of the female child and to pregnant and lactating women Under-five mortality rate: female/male Probability of dying between birth and exactly five years of age, per 1,000 live births: disaggregated by gender Underweight prevalence: female/male Proportion of under-fives who fall below minus 2 standard deviations from median weight-for-age of NCHS/WHO reference population: disaggregated by gender Antenatal care Proportion of women aged 15-49 attended at least once during pregnancy by skilled health personnel ‘Skilled health personnel’ includes only doctors, nurses and midwives; does NOT include traditional birth attendants (trained or untrained) X HIV prevalence: female/male Proportion of population aged 15-49 who are HIV- positive: disaggregated by gender and age Not covered in MICS X Iron-deficiency anaemia Proportion of women aged 15-49 with haemoglobin levels below 12g/100ml for non-pregnant women, and below 11g/100ml for pregnant women Not covered in MICS WSC goal 10. Access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many Contraceptive prevalence Proportion of women aged 15-49 who are using (or whose partner is using) a contraceptive method (either modern or traditional) This indicator should be reported separately for women who are married or in union, and for all women X Fertility rate for women 15 to 19 Number of live births to women aged 15-19 per 1,000 women aged 15-19 Only for estimation at global and regional level: not for measurement at national level X Total fertility rate Average number of live births per woman who has reached the end of her childbearing period Only for estimation at global and regional level: not for measurement at national level 58 Indicator Description Comments WSC goal 11. Access by all pregnant women to prenatal care, trained attendants during childbirth and referral facilities for high-risk pregnancies and obstetric emergencies Antenatal care Proportion of women aged 15-49 attended at least once during pregnancy by skilled health personnel ‘Skilled health personnel’ includes only doctors, nurses and midwives; does NOT include traditional birth attendants (trained or untrained) Childbirth care Proportion of births attended by skilled health personnel See definition of ‘skilled health personnel’ above X Obstetric care Number of facilities providing comprehensive essential obstetric care per 500,000 population Number of facilities providing basic essential obstetric care per 500,000 population Essential obstetric care is defined in UNICEF/WHO/UNFPA, Guidelines for Monitoring the Availability and Use of Obstetric Services WSC goal 12. Reduction of the low birthweight rate (less than 2.5 kg) to less than 10 per cent Birthweight below 2.5 kg Proportion of live births that weigh below 2,500 grams WSC goal 13. Reduction of iron-deficiency anemia in women by one third of the 1990 levels X Iron-deficiency anaemia Proportion of women aged 15-49 with haemoglobin levels below 12g/100ml for non-pregnant women, and below 11g/100ml for pregnant women Not covered in MICS WSC goal 14. Virtual elimination of iodine deficiency disorders Iodized salt consumption Proportion of households consuming adequately iodized salt X Low urinary iodine Proportion of population (school-age children or general population) with urinary iodine levels below 10mcg/100ml To be measured at national level only when 90% or more of households are consuming adequately iodized salt Optional X Goitre in schoolchildren Proportion of children aged 6-11 years with any size of goitre (palpable and visible combined) To be measured only when salt iodization or urinary iodine levels are not measured 59 Indicator Description Comments WSC goal 15. Virtual elimination of vitamin A deficiency (VAD) and its consequences, including blindness Children receiving vitamin A supplements Mothers receiving vitamin A supplements Proportion of children aged 6-59 months who received a high- dose vitamin A supplement in the last 6 months Proportion of mo thers who received a high-dose vitamin A supplement before infant was 8 weeks old X Low vitamin A Proportion of children aged 6-59 months with serum retinol below 20mcg/100ml To be measured at national level only when VAD is close to being eliminated Optional Children with night blindness Proportion of children aged 24-59 months with night blindness To be measured only if a local term for night blindness exists Night blindness in pregnant women Proportion of women who had night blindness during the last pregnancy To be measured only if a local term for night blindness exists WSC goal 16. Empowerment of all women to breastfeed their children exclusively for four to six months and to continue breastfeeding, with complementary food, well into the second year Exclusive breastfeeding rate Proportion of infants under 4 months (120 days) who are exclusively breastfed Timely complementary feeding rate Proportion of infants aged 6-9 months (180-299 days) who are receiving breastmilk and complementary food Continued breastfeeding rate Proportion of children aged 12-15 months and 20-23 months who are breastfeeding Reported separately for the two age groups X Number of baby-friendly facilities Number of hospitals and maternity facilities designated as baby-friendly according to global BFHI crit eria Not covered in MICS WSC goal 17. Growth promotion and its regular monitoring to be institutionalized in all countries by the end of the 1990s No indicators WSC goal 18. Dissemination of knowledge and supporting services to increase food production to ensure household food security No indicators WSC goal 19. Global eradication of poliomyelitis by the year 2000 X Polio cases Annual number of cases of polio Not covered in MICS 60 Indicator Description Comments WSC goal 20. Elimination of neonatal tetanus by 1995 X Neonatal tetanus cases Annual number of cases of neonatal tetanus Only for estimation at global and regional level: not for measurement at national level WSC goal 21. Reduction by 95 per cent in measles deaths and reduction by 90 per cent of measles cases compared to pre-immunization levels by 1995, as a major step to the global eradication of measles in the longer run X Under-five deaths from measles Annual number of under-five deaths due to measles Only for estimation at global and regional level: not for measurement at national level X Under-five measles cases Annual number of cases of measles in children under five years of age Only for estimation at global and regional level: not for measurement at national level WSC goal 22. Maintenance of a high level of immunization coverage (at least 90 per cent of children under one year of age by the year 2000) against diphtheria, pertussis, tetanus, measles, poliomyelitis, tuberculosis and against tetanus for women of childbearing age DPT immunization coverage Proportion of one-year-old children immunized against diphtheria, pertussis and tetanus (DPT) Measles immunization coverage Proportion of one-year-old children immunized against measles Polio immunization coverage Proportion of one-year-old children immunized against poliomyelitis TB immunization coverage Proportion of one-year-old children immunized against tuberculosis Neonatal tetanus protection Proportion of one-year-old children protected against neonatal tetanus through immunization of their mother 61 Indicator Description Comments WSC goal 23. Reduction by 50 per cent in the deaths due to diarrhoea in children under the age of five years and 25 per cent reduction in the diarrhoea incidence rate X Under-five deaths from diarrhoea Annual number of under-five deaths due to diarrhoea Only for estimation at global and regional level: not for measurement at national level Diarrhoea cases Average annual number of episodes of diarrhoea per child under five years of age ORT use Proportion of children aged 0-59 months who had diarrhoea in the last two weeks and were treated with oral rehydration salts or an appropriate household solution (ORT) Home management of diarrhoea Proportion of children aged 0-59 months who had diarrhoea in the last two weeks and received increased fluids and continued feeding during the episode WSC goal 24. Reduction by one third in the deaths due to acute respiratory infections in children under five years X Under-five deaths from acute respiratory infections (ARI) Annual number of under-five deaths due to acute respiratory infections Only for estimation at global and regional level: not for measurement at national level Care seeking for acute respiratory infections Proportion of children aged 0-59 months who had ARI in the last two weeks and were taken to an appropriate health provider WSC goal 25. Elimination of guinea worm disease (dracunculiasis) by the year 2000 X Dracunculiasis cases Annual number of cases of dracunculiasis (guinea worm) in the total population Not covered in MICS WSC goal 26. Expansion of early childhood development activities, including appropriate low-cost family- and community-based interventions Preschool development Proportion of children aged 36-59 months who are attending some form of organized early childhood education programme WSC goal 27. Increased acquisition by individuals and families of the knowledge, skills and values required for better living, made available through all educational channels, including the mass media, other forms of modern and traditional communication and social action, with effectiveness measured in terms of behavioural change No indicators 62 Indicator Description Comments Additional indicators for monitoring children’s rights Birth registration Proportion of children aged 0-59 months whose births are reported registered Children’s living arrangements Proportion of children in households aged 0-14 years not living with a biological parent Calculated separately for children whose biological mother, father, or both parents are dead Orphans in households Proportion of children in households aged 0-14 years who are orphans Calculated separately for children whose biological mother, father, or both parents are dead Child labour Proportion of children in households aged 5-14 years who are currently working (paid or unpaid; inside or outside home) Calculated separately for paid, unpaid, and domestic work for more than 4 hours per day Additional indicators for monitoring IMCI initiative and malaria Home management of illness Proportion of children aged 0-59 months who were ill during the last two weeks and received increased fluids and continued feeding Care-seeking knowledge Proportion of caretakers of children aged 0-59 months who know at least two of the following signs for seeking care immediately: child not able to drink or breastfeed, child becomes sicker, child develops a fever, child has fast breathing, child has difficult breathing, child has blood in the stools, child is drinking poorly Bednets Proportion of children aged 0-59 months who slept under an insecticide-impregnated bednet during the previous night Only in malaria risk areas Malaria treatment Proportion of children aged 0-59 months who were ill with fever in the last two weeks and received antimalarial drugs Only in malaria risk areas Indicator Description Comments Additional indicators for monitoring HIV/AIDS Knowledge of preventing HIV/AIDS Proportion o f women who correctly state the three main ways of avoiding HIV infection Knowledge of misconceptions of HIV/AIDS Proportion of women who correctly identify three misconceptions about HIV/AIDS Number reduced in MICS from three to two Knowledge of mother- to- child transmission of HIV Proportion of women who correctly identify means of transmission of HIV from mother to child Attitude to people with HIV/AIDS Proportion of women expressing a discriminatory attitude towards people with HIV/AIDS Women who know where to be tested for HIV Proportion of women who know where to get a HIV test Women who have been tested for HIV Proportion of women who have been tested for HIV 63 Indicator Description Comments X Attitude toward condom use Proportion of women who state that it is acceptable for women in their area to ask a man to use a condom Indicator deleted from MICS Adolescent sexual behaviour Median age of girls/women at first pregnancy 64 Appendix B Sample Size Calculations For immunizations, the sample size calculations are presented in Table C1. In this table the estimated proportion of children immunized was from. Sample sizes were calculated based on the prevalence/coverage estimate + and absolute value of 0.10 and an alpha of 0.05. The sample size assuming simple random sampling is provided and a sample size taking into account the estimated design effect (des eff) of 1.25 is also presented. Based on this information, the number of households necessary to visit to identify the number of children is estimated. One additional estimate is the nonresponse. For example, in Tbilisi, the sample size, taking into account the estimated design effect, was 101 children. Given an estimate of 0.0102 of the population 12-23.9 months of age , and an average number of individual per household of 3.56, the number of households to visit was calculated as 101 / (3.56 * 0.0102) which is approximately 2,788 households (see Monitoring progress toward the goals of the World Summit for Children, A practical handbook for multiple indicator surveys, UNICEF, 1995, page 4.12). The number of households needed to visit was increased to take into account nonresponse (for Tbilisi, estimated at 11%; 2788 * 1.11 = 3095). Given an average of 40 households per PSU, it was estimated that 77 clusters would need to be selected in order to visit 3,095 households (3095 / 40 » 77). Table C2 presents the samples sizes needed for indicators in children less than 5 years of age. 65 Table B1. Sample size calculations based on immunizations Region HH size % of 1-2 cluster size # of clusters 1 Tbilisi Estimated Prevalence 0.7 3.56 0.0102 40 77 simple random 81 des.eff-1.25 101 sample size1 2788 11% non-response 3095 2 Kakheti Estimated Prevalence 0.9 3.52 0.008 35 45 simple random 34 des.eff-1.25 43 sample size1 1509 4% non-response 1570 3 Mtskheta-Mtianeti, Shida Kartli Estimated Prevalence 0.65 3.46 0.0098 35 93 simple random 85 des .eff-1.25 106 sample size1 3133 4% non-response 3259 4 Kvemo Kartli, Samtskhe-Javakheti Estimated Prevalence 0.765 3.63 0.0102 35 68 simple random 68 des.eff-1.25 85 sample size1 2296 4% non-response 2388 5 Racha-Lechkhumi, Imereti Estimated Prevalence 0.77 3.52 0.009 35 69 simple random 59 des.eff-1.25 74 sample size1 2328 4% non-response 2421 6 Guria, Samegrelo Estimated Prevalence 0.75 3.3 0.0086 35 93 simple random 71 des.eff-1.25 89 sample size1 3127 4% non-response 3252 7 Ajara Estimated Prevalence 0.9 4.4 0.0098 35 29 simple random 34 des.eff-1.25 43 sample size1 986 4% non-response 1025 Total: 17009 474 66 Appendix C Questionnaires 68 Cluster No ____ Region ____ District ____ Sector ____ Census Area ____ Interviewer _______________________ Name of the city/village ______________________ Supervisor _______________________ Number of household members of the following age group Interview outcome N Address (indicating the location in the village) Name of the household head <1 y ea rs 1 ye ar o ld 2 ye ar ol ds 3- 4 ye ar ol ds 5 ye ar ol ds 6- 11 y ea r ol ds 12 -1 4 ye ar o ld s 15 -1 6 ye ar o ld s 15 -4 9 ol d w om en T es t o n sa lt io di sa ti on * Fi rs t vi si t S ec on d vi si t R em ar k 1 2 3 4 5 6 7 8 9 10 11* 12 13 16 17 18 19 20 21 22 23 24 25* *Interviewer: in the households number 11 and 25 ask the household that you would like to check whether the salt used in the household is iodised and would like to see a sample of the salt used to cook the main meal eaten my members of the household last night. Once you have examined the salt enter the code for the test outcome in the appropriate cell. Codes: 1=not iodised (no colour) 2=less than 15 PPM (week colour) 3=15 PPM or more (strong colour) 4=No salt at home 5=Salt not tested N Address (indicating the location in the village) Name of the household head Number of household members of the following age group T e st on Interview outcome R e m 69 <1 y ea rs 1 ye ar o ld 2 ye ar ol ds 3- 4 ye ar ol ds 5 ye ar ol ds 6- 11 y ea r ol ds 12 -1 4 ye ar o ld s 15 -1 6 ye ar o ld s 15 -4 9 ol d w om en Fi rs t vi si t S ec on d vi si t 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 Interviewer: After the completion of the interview under the column ‘interview outcome‘ enter the following codes: 1=interview completed 2=not at home Under the column ‘remark’ enter the following codes: 1=house is not inhibited in the last 12 months 2=not at home 70 HHOOUUSSEEHHOOLLDD MMOODDUULLEE We are representatives of the Ministry of Health and work on child and mother well-being issues. We would like to get certain information from mother or caretaker of children in this household on health and education related issues. Received information will remain strictly confidential. All numeric data, e.g. day, month, number of rooms, should be written in Arabic numbers. HOUSEHOLD INFORMATION PANEL A A1. Cluster number: A2. Household number: A3. Interviewer number: A4. Name of the head of household: __________________________________________ A5. Date of interview: ____ ____ ____ Day Month Year A7. Area: Urban 1 Rural 2 A6. Region: Tbilisi 1 Kakheti 2 Mtskheta-Mtianeti, Shida Kartli 3 Kvemo Kartli, Samtskhe-Javakheti 4 Racha-Lechkhumi, Imereti 5 Guria, Samegrelo 6 Ajara 7 A8: Number of rooms in dwelling: ____ A9. Main source of heating in the dwelling: (circle only one response) Electric heater 1 Gas heater 2 Oil heater 3 Wood heater 4 Do not have any 5 Other 6 A10. Average weekly menu of the household 10a Meat 10b Cheese 10c Butter 10d Other dairy product 10e Fruit 10f Vegetable Everyday Often Seldom Never 10a 1 2 3 4 10b 1 2 3 4 10c 1 2 3 4 10d 1 2 3 4 10e 1 2 3 4 10f 1 2 3 4 A11. Is the Interview complete? Yes 1 No 2 A12. If interview not completed, why not? Refusal 1 Not at home 2 HH not found 3 Other 4 Interviewer/Supervisor notes: (Use this space to record any notes about the survey of this household, such as information on call-back times, etc.) 71 WATER AND SANITATION MODULE B Circle the number for only one answer in the space at the right, If a respondent gives more than one answer, circle the most usual source/facility. B1. What is the main source of drinking water for members of your household? Piped -in dwelling 1 -into yard/plot 2 Public tap 3 Piped well water 4 Tubewell/borehole with pump 5 Protected dug well or protected spring 6 Unprotected dug well or spring 7 River or stream 8 Rainwater collection 9 Tanker-truck, vendor 10 Pond 11 Other (specify) 88 No answer/don’t know 99 B2. How long does it take to get there, get water, and come back? ____________ (number of minutes) Water on promises 888 Don’t know 999 B3. What kind of toilet facility does your household use? Flush to sewage system or septic tank 1 Pour flush latrine (water seal type) 2 Improved pit latrine 3 Traditional pit latrine 4 No facilities 5Þnext module Other (please specify) _________ 8 B4. Is this facility located in your dwelling, yard or compound? In dwelling/yard 1 Outside the dwelling/yard 2 Don’t know 9 72 HOUSEHOLD LISTING FORM C Cluster no. ____ Household no. ____ First, please tell me the name of each person who usually lives here (use country’s definition of household members first, then list children. Add a continutation sheet if there is not enough room on this page. Then ask: are there any others who live here, even if they are not at home now? (these may include children in school or at work). If yes, complete listing. Tehn, ask and record answers to questions as described in the Instructions to Interviewers. Tick here if you use a continuation sheet. C 3. L in e N o C4. Name C5. Gender 1-male 2-female C6. Year of birth (999-don’t know)) C7. Can he/she read a letter or newspaper 1-easily 2-with difficulty 3-not at all 9-do not know C8. Circle line number if women is age 15-49 C9. Marital status 1-married/in union 2-widowed 3-divorced 4-separated 5-never married C10. Circle line number of each child under 5 years of age and insert line no. of mother/ caretaker C11. Circle line number of each child of 5-14 years age and insert line no. of mother/ caretaker C12. Is this child’s natural mother alive? 1 Yes 2 No 3 DK C13. (if alive) Does natural mother live in this household 1 Yes 2 No C14. Is the child’s natural father alive? 1 Yes 2 No 3 DK C15. (if alive) Does natural father live in this household 1 Yes 2 No 01 1 2 1 2 3 9 01 1 2 3 4 5 01 01 1 2 9 1 2 1 2 9 1 2 02 1 2 1 2 3 9 02 1 2 3 4 5 02 02 1 2 9 1 2 1 2 9 1 2 03 1 2 1 2 3 9 03 1 2 3 4 5 03 03 1 2 9 1 2 1 2 9 1 2 04 1 2 1 2 3 9 04 1 2 3 4 5 04 04 1 2 9 1 2 1 2 9 1 2 05 1 2 1 2 3 9 05 1 2 3 4 5 05 05 1 2 9 1 2 1 2 9 1 2 06 1 2 1 2 3 9 06 1 2 3 4 5 06 06 1 2 9 1 2 1 2 9 1 2 07 1 2 1 2 3 9 07 1 2 3 4 5 07 07 1 2 9 1 2 1 2 9 1 2 08 1 2 1 2 3 9 08 1 2 3 4 5 08 08 1 2 9 1 2 1 2 9 1 2 09 1 2 1 2 3 9 09 1 2 3 4 5 09 09 1 2 9 1 2 1 2 9 1 2 10 1 2 1 2 3 9 10 1 2 3 4 5 10 10 1 2 9 1 2 1 2 9 1 2 73 DISABILITY MODULE D D1. Cluster no. ____ D2. Household no. ____ To be administered to caretakers of all children 2 through 5 years old, living in the household. Circle response in corresponding box. If the child has any symptoms, that is any response is circled, then insert the line number and name of a child . Child’s name Child’s name Child’s name Line no. Line no. Line no. D3. Compared with other children, do or did [name] have any serious delay in sitting, standing, or walking? Yes Yes Yes D4. Compared with other children, do [name] have difficulty seeing, either in the daytime or at night? D4a) Squint D4b) Hardly sees No sight in one eye Blind Yes 0 1 2 3 Yes 0 1 2 3 Yes 0 1 2 3 D5. Do [name] have difficulty hearing? D5a) uses hearing aid D5b) hears with difficulty completely deaf Yes 0 1 2 Yes 0 1 2 Yes 0 1 2 D6. When you tell the child to do something, does he/she seem to understand what you are saying? No No No D7. Do the child have difficulty in walking or moving his /her arms or weakness and/or stiffness in the arms or legs? Yes Yes Yes D8. Does the child sometimes have fits, become rigid, or lose consciousness? Yes Yes Yes D9. Does the child learn to do things like other children his/her age? No No No D10. Does the child speak at all (can he/she make him or herself understood in words; can say recognizable words? No No No D11. a) (For 3-5 year olds): Does the child have speech that is in any way different from normal (not clear enough to be understood by people other that the immediate family)? b) (For 2-year-olds): Can child name at least one object? Yes No Yes No Yes No D12. Compared with other child of the same age, does the child appear in any way mentally backward, dull or slow? Yes Yes Yes 74 DEMOGRAPHIC INFORMATION E Cluster no. _____ Household no. ____ To be administered to each woman from 15 through 49 who has ever been married or had a partner. The dates should be written in Arabic. E3. Line no. (from household list) E4. Name E5. Date of birth ____ ____ Month Year E6. What was the date of your first marriage ____ ____ Month Year E7. Are you pregnant now? Yes 1 No 2 Don’t know 3 E8. Have you ever given birth? Yes 1 No 2 E9. What was the date of your first delivery ____ ____ Month Year E10. What was the date of you last delivery ____ ____ ____ Day Month Year If the respondent had last delivery within the last year go on to Maternal and Newborn Health module 75 MATERNAL AND NEWBORN HEALTH Cluster no. _____ Household no. ____ Women line no. ____ This module is to be administered to all women with a live birth in the year preceding interview date. F4. When you were pregnant with your last child, did you have difficulty with your vision during the daylight? Yes 1 No 2 Don’t know 9 F5. During the pregnancy, do you suffer from night blindness? Yes 1 No 2 Don’t know 9 F6. In the first two month after your last birth, did you receive a Vitamin A dose? Yes 1 No 2 Don’t know 9 F7. Did you see anyone for antenatal care for his pregnancy? If yes, whom did you see? (circle all answers given) Health professional: Yes No Doctor 1 2 Nurse/midwife 1 2 Auxiliary midwife 1 2 Other person: Traditional birth attendant 1 2 Relative/friend 1 2 Other 1 2 No one 1 2 F8. Who assisted with the delivery of your last child? (circle all answers given) Health professional: Yes No Doctor 1 2 Nurse/midwife 1 2 Auxiliary midwife 1 2 Other person: Traditional birth attendant 1 2 Relative/friend 1 2 Other 1 2 No one 1 2 I II F9. When your last child was born was he/she very large, larger than average, average, smaller than average, or very small? Very large 1 Larger than average2 Average 3 Smaller than average 4 Very small 5 Don’t know 6 Very large 1 Larger than average2 Average 3 Smaller than average 4 Very small 5 Don’t know 6 F10. Was the child measured at birth? Yes 1 No 2 Þ Q.12 Don’t know 3 Þ Q.12 Yes 1 No 2 Þ Q.12 Don’t know 3 Þ Q.12 F11. How long was the child? According to card_____(cm) Based on answer_____ (cm) Don’t know 9999 According to card_____(cm) Based on answer_____ (cm) Don’t know 9999 F12. Was the child weighed at birth? Yes 1 No 2 Þ Q.12 Don’t know 3 Þ Q.12 Yes 1 No 2 Þ Q.12 Don’t know 3 Þ Q.12 F13. How much did the child weigh? Based on card_____(grams) Based on answer______ (gr) Don’t know 9999 Based on card_____(grams) Based on answer______ (gr) Don’t know 9999 76 EDUCATION MODULE G G1 Cluster No _____ G2 Household No _____ To be administered to the caretakers of all 5-16 year-old children. See HHlist form and copu the line No to G3 and the name of a child to G4. G 3. L in e N o G4. Name of the child G5. Has the child ever attended pre - school institution? 1 Yes 2 No G6. (for 5-6 year olds only) If yes: has the child attended pre-school institution this year*? 1 Yes, state-owned 2 Yes, private 3 No 9 Don’t know G7. Has the child ever attended school? 1 Yes 2 No ß Go to next child G8. Has he/she attended school this year? 1 Yes, state-owned 2 Yes, private 3 No ÞGo to Q.10 9 Don’t know Þ Q.10 G9. Which grade has he/she attended this year? 99 Don’t know G10. Did he/she attended school last year? 1 Yes, state-owned 2 Yes, private 3 No ß Go to next child 9 Don’t know ß next child G11. Which grade did he/she attended last year? 99 Don’t know 1 2 1 2 3 9 1 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 2 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 3 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 4 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 5 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 6 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 7 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 8 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 9 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) 1 2 1 2 3 9 10 2 ß 1 2 3 9 Þ10 Þ10 _____________ (grade) 1 2 3 9 ß ß _____________ (grade) * ‘This year’ means 1998-1999 schooling year. 77 CHILD LABOR MODULE H H1 Cluster No _____ H2 Household No _____ To be administered to the caretakers of all 5-14 year-old children. See HH list form and copy the line No to G3 and the name of a child to G4. Interviewer: Now I would like to ask about any work children in this household may do. H 3. L in e N o H4. Name H5. Did the child do any king of work for pay during the past week? (cash or in kind) 1 YesÞQ.7 2 No H6. If yes: Since last day of the week about how many hours did he/she work for pay? No. hours or 99 Don’t know H7. Does the child regularly help with households chores/house keeping at home? 1 Yes ÞQ. 9 2 No H8. If yes: About how many hours, since this time yesterday? No. hours or 99 Don’t know H9. Is the child regularly engaged in any other unpaid family work (on the farm or in business)? 1 Yes ÞGo to next child 2 No H10. If yes: Since last day of the week, about how may hours did he/she work? No. hours or 99 Don’t know 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 1 2 _____________ (No of hours) 78 IIMMMMUUNNIIZZAATTIIOONN MMOODDUULLEE II II11. CCLLUUSS TTEERR NNOO . ____ ____ ____ II22. HHOO UUSS EEHHOO LLDD NNOO . ____ ____ II33. CCAARREETTAAKKEERR LLIINNEE NNOO . ____ ____ II44. CCHHIILLDD LLIINNEE NNOO . ____ ____ If an immunization card is available, copy the dates for each type of immunization below. If the child received any vaccinations not recorded on the card, or if no card is available, use probing questions to find out if the child received each vaccination, and if so, how many doses she/he received. Record the caretaker’s response for each vaccine dose in the space provided. I5. Could you tell me why your children need to be immunised? Protects from disease 1 Incorrect answer 2 Do not know 9 I6. Do you get any information about immunisation? Yes 1 No 2ðQ8 I7. If yes: where do you get the information from? TV, radio, newspaper 1 Posters 2 Heard from others 3 Health workers 4 Other (specify)_________ 5 I8. Has your child been immunised? Yes (fully) 1ðQ10 Yes (partially) 2 Yes (but don’t know fully or part.) 3ðQ10 No 4 Do not know 5ðQ10 I9. If “No” or partially – what is the main reason for this? (if the child is not immunised finish this module and go to next module) _________________________________ _________________________________ I10. Do you have vaccination record card at home for the child? Yes 1 No 2ðQ11b Do not know 9ðQ11b Date of immunization (day/ month /year) Copy the dates of all vaccinations from the card a. card at home b. card/record at policlinic I11. BCG I12. DPT1 I13. DPT2 I14. DPT3 I15. DPT4 I16. OPV1 I17. OPV2 I18. OPV3 I19. OPV4 I20. MEASLES Continue on next page 79 I21. Check left shoulder (most common site) for BCG scar Present…………………………1 Absent………………………….2 Unable to examine/can’t tell….9 I22. Has the child ever been given a BCG vaccination against tuberculosis – that is an injection in the left shoulder that caused a scar? Yes…………………………….1 No………………………………2 Don’t know…………………….9 I23. Has the child ever been given “vaccination injections” – that is an injection in the thigh or buttocks- to prevent him/her from getting tetanus, whooping cough, diphtheria? If yes how many times? Yes…………………………….1 No………………………………2 Don’t know…………………….9 Number of times: __ I24. Has the child ever been given “vaccination drops” – to protect him/her from getting Polio? If yes how many times? Yes…………………………….1 No………………………………2 Don’t know…………………….9 Number of times: __ I25. Has the child ever been given “vaccination injections” – that is an injection in the thigh or buttocks- to prevent him/her from getting measles? Yes…………………………….1 No………………………………2 Don’t know…………………….9 80 BIRTH REGISTRATION AND EARLY LEARNING J Cluster no. ____ Household no. ____ Caretaker line no. ____ Child line no. _____ A separate form should be filled in for each child under 5 years listed in the Household Module – check Q10 on HH listing. Fill in the line number of each child, the line number of the child’s mother or caretaker and the cluster and household numbers in the space at the top of each page. J5. Child’s name J6. Child’s age: J6a years J6b months _______ (Years) _______ (Months) J7. What is the child’s birth date? ____ ____ ____ Day Month Year J8. Do you have child’s birth certificate? Yes, seen 1 ð go to question 12 Yes, not seen 2 No 3 Don’t know 9 J9. If no birth certificate is shown ask: Has child’s been registered? Yes 1 ð go to question 12 No 2 Don’t know 3 ð go to question 12 J10. Why is the child’s birth not registered? Costs too much 1 Must travel too far 2 Did not know it should be registered 3 Late, and did not want to pay fine 4 Does not know where to register 5 Other 6 Don’t know 9 J11. Do you know where to register your child’s birth? Yes 1 No 2 Don’t know 9 J12. If the child is over 3 years, ask: Does the child attend any organised learning or early childhood education programme? State owned 1 Privately owned 2 No 3 Don’t know 9 81 BREASTFEEDING MODULE K Cluster no. ____ Household no. ____ Caretaker line no. ____ Child line no. _____ K1. Has the child ever been breastfed? Yes 1 No 2ð go to Q.4 Don’t know 9ð go to Q.4 K2. Is he/she still breastfeeding? Yes 1 No 2 Don’t know 9 K3. Since this time yesterday, did he/she receive any of the following? K3a. Vitamin, mineral supplements or medicine K3b. Plain water K3c. Sweetened, flavored water or fruit juice or tea or infusion K3d. Oral rehydration solution (ORS) K3e. Tinned, powdered or fresh milk or infant formula K3f. Any other liquids (specify)___________________ K3g. Solid or semi-solid (mushy) food Yes No DK K3a 1 2 9 K3b 1 2 9 K3c 1 2 9 K3d 1 2 9 K3e 1 2 9 K3f 1 2 9 K3g 1 2 9 K4. Since this time yesterday, has the child been given anything to drink from a bottle with a nipple or teat? Yes 1 No 2 Don’t know 9 82 CARE OF ILLNESS MODULE L L1. Has the child had diarrhea in the last L1a. 2 weeks since [indicate the exact day of the week], (diarrhea is determined as perceived by mother, or as three or more loose or watery stool/day or blood in stool.) L1b. 1 month since [indicate the exact day of the month] Yes 1ð go to Q.3 No 2 Don’t know 9 Yes 1ð go to Q.3 No 2 Don’t know 9 L2. In the last two weeks, has the child had any other illness or health problem? Yes 1ð go to Q.4 No 2ð go to Q.11 Don’t know 9ð go to Q.11 L3. During the last episode of diarrhoea, did the child drink any of the following? L3a. breast milk L3b. gruel or soup L3c. other home fluids (e.g. tea, yougurt, etc.) L3d. ORS packet solution L3e. other milk or infant formula L3f. water with feeding during some part of the day L3g. water alone L3h. other liquides (specify) L3i. nothing (circle 1 in Q.4 and go on to Q.6) Yes No DK L3a 1 2 9 L3b 1 2 9 L3c 1 2 9 L3d 1 2 9 L3e 1 2 9 L3f 1 2 9 L3g 1 2 9 L3h 1 2 9 L4. During the child’s illness, did he/she drink much less, about the same, or more than usual? None or much less 1 About the same or somewhat less 2 More 3 Don’t know 9 L5. During the child’s illness, did he/she eat much less, about the same, or more than usual? None 1 Much less 2 Somewhat less 3 About the same 4 More 5 Don’t know 9 L6. Has the child had an illness with a cough at any time in the last two weeks, that is, since [day of the week] of the week before last? Yes 1 No 2 ðgo to Q.11 Don’t know 9 ðgo to Q.11 L7. When the child had an illness with a cough, did he/she breathe faster than usual with short, quick breaths? Yes 1 No 2 Don’t know 9 L8. Did you seek advice of treatment for the illness outside the home? Yes 1 No 2 ðgo to Q.10 Don’t know 9 ðgo to Q.11 83 L9. From where did you seek care? anywhere else? L9a. Hospital L9b. Health center L9c. Dispensary L9d. MCH clinic L9e. Emergency L9f. Private physician L9g. Pharmacy or drug seller L9h. Traditional healer L9i. Relative or friend L9j. Other (specify) (go to Q.11) Yes No L9a. 1 2 L9b. 1 2 L9c. 1 2 L9d. 1 2 L9e. 1 2 L9f. 1 2 L9g. 1 2 L9h. 1 2 L9i. 1 2 L10. If no: why (name the reason)? I am a physician 1 Family member is a physician 2 Did not consider necessary 3 Other (specify) 4 Don’t know 9 L11. What types of symptoms would cause you to take your child to a health facility right away? L11a. Child not able to drink or breastfed L11b. Child becomes sicker L11c. Child develops a fever L11d. Child has fast breathing L11e. Child has difficulty breathing L11f. Child has three or more loose or watery stool/day L11g. Child has a blood in stool L11h. Other (specify) L11i. Other (specify) L11j. Other (specify L11k. Other (specify (keep asking for more signs/symptoms until the caretaker can not recall any additional ones) Yes No L11a. 1 2 L11b. 1 2 L11c. 1 2 L11d. 1 2 L11e. 1 2 L11f. 1 2 L11g. 1 2 L11h. 1 2 L11i. 1 2 L11j. 1 2 L11k. 1 2 84 ANTROPOMETRY MODULE M M1. Check age: For children under 2 years length (lying) For children aged 2 or more years Height (standing) (cm) (cm) M2. Weight (kg) M3. Result: Measured 1 Not present 2 Refused 3 Other 8 M4. Measurer’s code

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