Ghana Multiple Indicator Cluster Survey 2006: Preliminary Report

Publication date: 2007

Monitoring the Situation of Children and Women Findings from the Ghana Multiple Indicator Cluster Survey 2006 PRELIMINARY REPORT February 2007 Summary Table of Findings MICS and MDG Indicators, Ghana, 2006 TOPIC MICS INDICATOR NUMBER MDG INDICATOR NUMBER INDICATOR VALUE UNIT Child Mortality 1 13 Under-five mortality rate 111 2 14 Infant mortality rate 71 Per 1,000 live births 6 4 Underweight prevalence 18 Percent 7 Stunting prevalence 23 Percent 8 Wasting prevalence 5 Percent 15 Exclusive breastfeeding rate 54 Percent 16 Continued breastfeeding rate 58 Percent Nutrition 17 Timely complementary feeding rate 56 Percent 26 Polio immunization coverage 83 Percent 27 DPT (Hep B Hib) immunization coverage 84 Percent 28 15 MMR coverage 85 Percent 22 Antibiotic treatment of suspected pneumonia 33 Percent 24 29 Solid fuels 86 Percent 37 22 Under-fives sleeping under insecticide-treated nets 22 Percent 38 Under-fives sleeping under mosquito nets 33 Percent 39 22 Antimalarial treatment (under-fives) 48 Percent 41 Iodized Salt Consumption 32 Percent Child health 11 30 Use of improved drinking water sources 78 Percent Environment 12 31 Use of improved sanitation facilities 61 Percent 21 19c Contraceptive prevalence 17 Percent 4 17 Skilled attendant at delivery 49 Percent Reproductive health 5 Institutional deliveries 49 Percent 55 6 Net primary school attendance rate (girls) 64 Ratio Education 61 8 Net primary school attendance rate (boys) Gender parity index (primary) 63 1 Ratio Index Gender parity index (secondary) 1 Index 62 Birth registration 51 Percent 67 Marriage before age 15 2.1 Percent 68 Marriage before age 18 Young women aged 15-19 currently married/in union 22 11 Percent Percent Child protection 82 19b Comprehensive knowledge about HIV prevention among women aged 15-24 25 Percent 83 19a Comprehensive knowledge about HIV prevention among men aged 15-24 Condom use with non-regular partners among women aged 15-24 33 42 Percent Percent 85 77 20 Condom use with non-regular partners among men aged 15-24 Higher risk sex in the last year among women aged 15-24 Higher risk sex in the last year among men aged 15-24 School attendance of orphans versus non-orphans 56 52 88 1 Percent Percent Percent Ratio HIV/AIDS, Sexual behaviour, and orphaned and vulnerable children ii Contents Summary Table of Findings . ii Contents . iii List of Tables . iv Acknowledgements.v 1 Background and Objectives .1 1.1 Introduction.1 1.2 Survey Objectives .2 2 Sample and Survey Methodology .2 2.1 Sample Design .2 2.2 Questionnaires .3 2.3 Fieldwork and Processing .4 2.4 Sample Coverage .4 3 Results .5 3.1 Child Mortality .5 3.2 Nutritional Status .6 3.3 Breastfeeding .8 3.5 Immunization.9 3.6 Antibiotic Treatment and Medical Consultations for Children with Suspected Pneumonia.10 3.7 Solid Fuel Use.11 3.8 Malaria.11 3.9 Water and Sanitation.14 3.10 Contraception.15 3.11 Assistance at Delivery.16 3.12 Primary School Attendance .16 3.13 Birth Registration.18 3.14 Early Marriage and Polygyny .19 3.15 Knowledge of HIV/AIDS Transmission and Condom Use .21 3.16 Orphans School Attendance.24 APPENDIX .25 iii List of Tables Table HH.1: Results of household and individual interviews . 3 Table CM.1: Child mortality. 6 Table NU.5: Salt Iodization. 9 Table CH.7: Antibiotic treatment and consultations for pneumonia . 11 Table CH.10: Availability of mosquito and insecticide treated nets . 12 Table CH.11: Children sleeping under bednets. 13 Table ED.3: Primary school net attendance ratio. 17 Table ED.7: Education gender parity. 18 Table CP.5.1: Early marriage . 19 Table CP.5.2: Polygyny . 20 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission. 22 Table HA.9.1: Sexual activity among youth . 23 Table HA.12: Orphaned and vulnerable children school attendance. 24 Appendix Table HH.1: Results of household and individual interviews . 27 Table NU.1: Child malnourishment . 28 Table NU.3: Breastfeeding. 29 Table CH.1: Vaccinations in first year of life . 30 Table CH.2: Vaccinations by background characteristics. 31 Table CH.8: Solid fuel use . 32 Table CH.12: Treatment of children with anti-malarial drugs . 33 Table EN.1: Use of improved water sources. 34 Table EN.5: Use of sanitary means of excreta . 35 Table RH.1: Use of contraception. 36 Table RH.5: Assistance during delivery. 37 Table CP.1: Birth registration. 38 Table CP.5.1A: Early marriage . 39 Table HA.9.2: High-risk sex and condom use at last high-risk sex.40-41 iv Acknowledgements The Ghana Multiple Indicator Cluster Survey (MICS) 2006 was successfully conducted through the invaluable assistance given by all collaborating agencies, institutions, organisations and individuals to whom we owe a great deal of gratitude. We are very grateful to the Ministry of Health (MoH) for sourcing substantial funds for the survey, releasing staff to serve on the secretariat and fieldwork as well as providing the logistical support needed to carry out the exercise. We also acknowledge the Dutch Government for providing funds through MoH for the MICS 2006. The MICS project was initiated by UNICEF and the organisation of the survey has involved the staff from the New York and Ghana offices throughout the period. We sincerely thank them for their immense and diverse contributions ranging from expert visits, international training programmes, local technical assistance, procurement and administration. The International training opportunities provided by UNICEF, which made it possible for the MICS team to meet and work with colleagues from the other National Statistics offices conducting the survey at the same period, is greatly appreciated. In implementing the Ghana MICS, we also had a chance to continue our long and fruitful relationship with MEASURE DHS/Macro International, Inc. and USAID. Under the US President’s Emergency Plan for AIDS Relief (PEPFAR), technical assistance and funding was provided with regard to the inclusion of the male questionnaire, which is much appreciated. We thank the Ghana AIDS Commission, which laboured behind the scene to expand on the HIV/AIDS module of the survey and made the obvious connection possible. We are very grateful to the MICS 2006 Steering Committee for their immense contribution towards the successful completion of the survey. We also thank the entire project staff of the MICS 2006, for their tireless work, dedication to duty and other contributions in the different phases of the survey. We give our sincerest gratitude to the field survey personnel for their dedication and professionalism that has produced data of very good quality. The contribution of other staff in the Statistical Service who worked behind the scene in various ways to assist the Secretariat is acknowledged. The final and sincere thanks go to all respondents who readily made themselves available to be interviewed and making the MICS 2006 successful. v vi 1 Background and Objectives 1.1 Introduction This preliminary report presents findings from the Ghana Multiple Indicator Cluster Survey (MICS), conducted in 2006 by the Ghana Statistical Service (GSS) in collaboration with Ministry of Health (MoH) of Ghana. The survey was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see Box 1). Box 1 A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” Ghana in its drive to fight poverty has embarked on a national strategy, Ghana Poverty Reduction Strategy (GPRS I), from 2002-2005 and is currently implementing the policies and objectives as outlines in the Growth and Poverty Reduction Strategy II (GPRS II), 2006-2009. Findings from MICS would provide up-to-date information in monitoring progress towards goals established by the national strategy. In addition to the national strategy, donor-specific programmes were also implemented including High Impact Rapid Delivery (HIRD), 1 Integrated Management of Childhood Illness (IMCI), The USG President’s Emergency Plan for AIDS Relief, etc. This preliminary report presents selected results on some of the principal topics covered in the survey and on a subset of indicators1. The results in this report are preliminary and are subject to change, although major changes are not expected. A comprehensive full report is scheduled for publication in May 2007. 1.2 Survey Objectives The 2006 Ghana MICS has as its primary objectives: • To provide up-to-date information for assessing the situation of children, women and basic information on men in Ghana; • To further present the current level of knowledge and behavioural indicators regarding HIV/AIDS and Malaria; • To furnish data needed for monitoring progress toward goals established by the Millennium Development Goals, the goals of A World Fit For Children (WFFC) as a basis for future action; • To contribute to the formation of baselines of the GPRS II, the MoH Plan of Work 2007- 2009, and provide progress monitoring for any other policy or programme in Ghana; • To contribute to the improvement of data and monitoring systems in Ghana and to strengthen technical expertise in the design, implementation, and analysis of such systems. 2 Sample and Survey Methodology 2.1 Sample Design Table HH.1 presents information on the results of the household and individual interviews. A total of 6,302 households were selected for the MICS sample. Of these 6,264 were found to be occupied. Interviews were completed for 5,939 households which represent 95 percent response rate. A total of 6,240 women (age 15-49) and 1,909 eligible men (age 15-49) from every third household were identified for the individual interviews. Interviews were successfully completed for 5,891 women and 1,743 men, yielding a response rate of 94 percent and 91 percent respectively. In addition, 3,545 children under age five were listed in the household listing. Of these, questionnaires were completed for 3,466 which corresponds to a response rate of 98 percent. Overall response rates of 90 percent, 93 percent and 87 percent are calculated for the women’s, children under- five year and selected men’s interviews respectively. The preliminary tabulations in the next section summarise the main demographic and health findings from eligible women, under-five children and men where applicable. 1 For more information on the definitions, numerators, denominators and algorithms of Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) indicators covered in the survey: see Chapter 1, Appendix 1 and Appendix 7 of the MICS Manual – Multiple Indicator Cluster Survey Manual 2005: Monitoring the Situation of Children and Women, also available at www.childinfo.org 2 Table HH.1: Results of household and individual interviews Number of households, number of individual interviews and response rate, by place of residence, Ghana, 2006 Residence Result Urban Rural Total Number of households Sampled households 2,480 3,822 6,302 Occupied households 2,470 3,794 6,264 Interviewed households 2,327 3,612 5,939 Household response rate 94.2 95.2 94.8 Number of women Eligible women 2,546 3,694 6,240 Interviewed women 2,385 3,506 5,891 Women response rate 93.7 94.9 94.4 Women's overall response rate 88.3 90.4 89.5 Number of men Eligible men 739 1,170 1,909 Interviewed men 660 1,083 1,743 Men response rate 89.3 92.6 91.3 Men's overall response rate 84.1 88.1 86.6 Number of children under 5 Eligible children under 5 1,030 2,515 3,545 Mother/Caretaker Interviewed 1,012 2,454 3,466 Child response rate 98.3 97.6 97.8 Children's overall response rate 92.6 92.9 92.7 2.2 Questionnaires Four questionnaires were used in the survey. In addition to a household questionnaire which was used to collect information on all household members, the household, and the dwelling characteristics, questionnaires were administered to women aged 15-49; mothers or caretakers of under 5 children were identified in each household, and these persons were interviewed about children under 5. The fourth questionnaire was administered to men age 15-49 in every third selected household. The questionnaires included the following modules: • Household Questionnaire o Household Listing o Education o Water and Sanitation o Household Characteristics o Child Labour o Salt Iodization • Questionnaire for Individual Women aged 15-49 o Child Mortality o Tetanus Toxoid o Maternal and Newborn Health o Marriage/Union o Contraception o HIV/AIDS 3 • Questionnaire for Children Under Five o Birth Registration and Early Learning o Vitamin A o Breastfeeding o Care of Illness o Immunization o Anthropometry • Questionnaire for Individual Men aged 15-49 o Marriage/Union o Contraception o HIV/AIDS and other STIs The questionnaires were based on the MICS model questionnaires and modified to fit Ghanaian survey standards and conditions. The age range for women was expanded to the 15- 49 age range for Marriage/Union and Sexual activity modules, a questionnaire for men aged 15-49 was added and a number of questions were added to gain further knowledge on sexual behaviour and HIV/AIDS among general population. The questionnaires were pre-tested in June 2006. Based on the results of the pre-test, further modifications were made to wording and flow of the questions. 2.3 Fieldwork and Processing The field staff was trained for 14 days in mid July 2006. The data were collected by nine teams; each comprising four interviewers, one driver, one editor/measurer and a supervisor. Fieldwork began in August 2006 and concluded in early October 2006. Data were entered on computers using the CSPro software. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programmes developed under the global MICS project and adapted to the Ghana questionnaires were used throughout. Data entry and editing began simultaneously with data collection in August 2006 and finished in November 2006. Data were analysed using the SPSS software programme and the model syntax and tabulation plans developed for this purpose. 2.4 Sample Coverage The sample for the 2006 Ghana Multiple Indicator Cluster Survey (MICS) covered the population residing in private households in the country. A representative probability sample of 6,302 households was selected nationwide. The list of enumeration areas (EAs) from the Ghana Living Standard Survey (GLSS5) served as a frame for the MICS sample. The frame was first stratified into the 10 administrative regions in the country, then into urban and rural EAs. The sample was designed in a manner to provide estimates on a large number of indicators on the situation of children and women at the national level, for each of the 10 regions in Ghana, as well as for separate urban and rural areas. In addition, the design called for the selection of a sub-sample of eligible men aged 15-49 from selected households to be interviewed. The 2006 MICS used a two-stage stratified sample design. At the first stage of sampling, 300 census enumeration areas (124 urban and 176 rural EAs) were selected for the MICS sample; these are a sub-sample of the 660 EAs (281 urban and 379 rural) selected for the GLSS 5. The clusters in each region were selected using a systematic sampling with probability proportional to their size. The distribution of EAs between regions is not proportional to the 4 2000 Population and Housing Census, mainly due to over-sampling in the number of EAs for Northern, Upper East and Upper West. A complete household listing exercise covering all the GLSS 5 EAs was carried out May through July 2005 with a few selected EAs listed early 2006. At the second stage of selection, a systematic sampling of households was done from such list. The MICS households were selected systematically from the household listing provided by GLSS 5 after eliminating from the list households previously (15 regular with 5 replacement) selected by the GLSS 52. Twenty households per EA were selected in all the regions except in Northern, Upper East and Upper West regions, where 20 households per EA were selected in urban EAs and 25 households selected in rural EAs. The objective of this exercise was to ensure an adequate number of complete interviews to provide estimates for important population characteristics with acceptable statistical precision per region. Due to the disproportional number of EAs and different sample sizes selected per EA among regions, the MICS 2006 household sample is not self-weighted at the national level. 3 Results 3.1 Child Mortality One of the overarching goals of the MDGs and the World Fit for Children is to reduce infant and under-five mortality. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. On the other hand, using direct measures of child mortality from birth histories is time consuming and complicated. Demographers have devised ways to measure childhood mortality indirectly. These ‘indirect methods’ minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate is the probability of dying before the first birthday. The under five mortality rate is the probability of dying before the fifth birthday. In MICS 2006, infant and under five mortality rates are calculated based on an indirect estimation technique, the Brass method, for the 5 year period. The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five year age groups of women. The technique converts these data into probabilities of dying by taking account of both the mortality risks to which children are exposed and their length of exposure to the risk of dying. Table CM.1 provides estimates of child mortality by various background characteristics. The infant mortality rate is estimated at 71 per thousand, while under five mortality rate, is 111 deaths per 1,000 live births. This means that one in nine children born in Ghana dies before its fifth birthday. Approximately two-thirds of all deaths to children under five occur during their first year of life. 2 The GLSS 5 interviews (takes 33 days for each EA) are long and demanding for respondents. It therefore seemed preferable to keep the two household samples separate in order to avoid respondent fatigue and possible high rates of refusal in the households falling in both samples as they were being conducted concurrently. 5 There seems a marked difference between the probabilities of dying among males and females. Under-five mortality rate experienced by female children (89 deaths per 1,000 live births) is almost two-thirds of what is experienced by male children (131 deaths per 1,000) of the same cohort. The biological advantage enjoyed by female children over male children in the first few years of life may account for this. Mortality among children of rural residence is consistently higher than for children of urban residence with respect to both infant and under-five mortality. At the regional level, differences in mortality are also quite marked, although these figures, in particular, should be interpreted with caution since sampling errors associated with mortality estimates are large. The infant mortality rate varies from 45 to 114 deaths per 1,000 live births. Infant and under-5 mortality rates are lowest in the Western region (infant = 45 per 1000 live births; under-5 = 66 per 1000 live births), while the figures for Upper West region (infant = 114 per 1000 live births; under-5 = 191 per 1000 live births) are almost three times as much that of Western region. There are also significant differences in mortality in terms of mothers’ educational level and socio-economic status of the household in general. There appears to be decreasing levels of probabilities of dying among infants and under-5s with increasing levels of mothers’ education. Children of mothers with no education are more likely to die in infancy (78 deaths per 1,000 live births) than children of women with some form of education (52 to 65 deaths per 1,000 live births). Mothers’ with secondary or higher education seem to have high rates due to small sample sizes. Table CM.1: Child mortality Infant and under-five mortality rates, Ghana, 2006 Infant mortality rate* Under-five mortality rate** Sex Male 84 131 Female 56 89 Region Western 45 66 Central 69 108 Greater Accra 60 92 Volta 57 86 Eastern 61 93 Ashanti 72 113 Brong Ahafo 88 142 Northern 83 133 Upper East 68 106 Upper West 114 191 Area Urban 68 106 Rural 72 114 Mother's education None 78 124 Primary 65 102 Middle/JSS 52 77 Secondary+ 65 101 Wealth index quintiles Poorest 75 118 Second 79 126 Middle 65 100 Fourth 65 101 Richest 64 100 Total 71 111 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 3.2 Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. In a well-nourished population, there is a standard distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference distribution. The reference population used here is the WHO/CDC/NCHS reference, which is recommended for use by UNICEF and the World 6 Health Organization. Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of this reference population. Weight for age is a measure of both acute and chronic malnutrition. Children whose weight for age is more than two standard deviations below the median of the reference population are considered underweight while those whose weight for age is more than three standard deviations below the median are classified as severely underweight. Height for age is a measure of linear growth. Children whose height for age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as stunted. Those whose height for age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight for height is more than two standard deviations below the median of the reference population are classified as wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Table NU.1 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, i.e. those children whose weight for height is above 2 standard deviations from the median of the reference population. Almost one in five children under age five in Ghana is underweight (18percent) and three percent are classified as severely underweight (See Appendix, Table NU.1). Twenty-two percent of children are stunted or too short for their age and five percent are wasted or too thin for their height. However, very few of under-five children in Ghana are overweight. Children in the Upper East region are more likely to be underweight and wasted than children in the other regions. In contrast, the percentage stunted is highest in the Northern region. Those children whose mothers have secondary or higher education are the least likely to be underweight, stunted, and wasted compared to children of mothers with no education. Boys appear to be slightly more likely to be underweight, stunted, and wasted than girls. The age pattern shows that a higher percentage of children aged 12-23 months are undernourished according to all three indices in comparison to children who are younger and older (Figure 1). This pattern is expected and is related to the age at which many children cease to be breastfed and are exposed to contamination in water, food, and environment. 7 Figure 1. Percentage of children age 0-59 months who are undernourished, Ghana, 2006 12-23 24-35 36-47 48-59 Age (months) 0 1515 20 25 30 Percent 20 25 30 Percent 0 5 10 < 6 6-11 5 10 Height for age Weight for Height Weight for age 3.3 Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continue breastfeeding with safe, appropriate and adequate complementary eding up to 2 years of age and beyond. imately 54 percent of children aged less than six months are exclusively breastfed, a vel considerably lower than recommended. At age 6-9 months, 58 percent of children are receiving breast milk and sol 12-15 months, 95 percent of 6 percent are still breastfed. Girls were more likely to be exclusively brea ad higher levels than girls or timely complementary feeding. 3.4 Salt Iod Iodine Deficiency Diso ) ’s d c of tardation an aired otor d men n its eme iodine ciency causes cretinism It also stillbirth and iage in nant wo . Iodine de ncy is visibly ociated fe In Table NU.3, (See Appendix), breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk and vitamins, mineral supplements, or medicine. The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12- 15 and 20-23 months of age. Approx le id or semi-solid foods. By age children are still being breastfed and by age 20-23 months, 5 stfed than boys, while boys h f ization rders (IDD psychom is the world evelop lea t in yo ing ung ause childr preventable mental most extrre d imp en. I form, d ief . cin reases the risks of miscarr preg men ficie most commonly and ass 8 with goitre. IDD takes its greatest toll in impaired mental growth and development, uting in to poo hool perfor ce, reduced intellectual ability, and impaired erform . The ator measuring the g elimina iodine is t ercentag household nsumi t salt ( arts per . to d n Table N S 2006 le. The salt was tested for iodine test kits and testing e presenc potassi dide and p ssium iodate content, and only in 8 percent of re was lt availabl a third of households (32 percent), salt was 15 parts per million (ppm) or more of iodine and in 1 in 5 households-less than 15 parts per million (ppm); in 2 in 5 households salt was not iodized. Use of salt with 15 west in Northern, Volta and Upper East regions (around 12 percent), and contrib turn r sc man work p ance indic pro ress towards ting deficiency he p e of s co ng adequa ely iodized >- p million) rdingAcco a ita U.5, salt used for cooking was tested in 92 percent of households in MIC samp content by using salt for th e of um io ota the households t ound to contain he no sa e. In f or more ppm was lo highest in Brong Ahafo, Greater Accra and Ashanti regions (around 50 percent). The likelihood of using adequately iodized salt is twice as high in urban areas compared to rural areas. Table NU.5: Iodized salt consumption Percentage of households consuming adequately iodized salt, Ghana, 2006 Percent of households with salt test result in which salt was tested Number of households interviewed Percent of households with no salt Not iodized < 15 PPM 15+ PPM* Total Number of households in which salt was tested or with no salt Percent of households Region Western 89.9 617 8.4 39.9 11.6 40.0 100.0 606 Central 88.3 576 11.1 48.4 23.9 16.7 100.0 571 Greater Accra 88.9 1,004 10.4 19.2 21.2 49.3 100.0 997 Volta 93.5 486 6.0 77.9 4.0 12.0 100.0 483 Eastern 93.5 758 6.1 58.6 16.4 18.9 100.0 754 Ashanti 89.3 988 9.8 23.1 19.4 47.7 100.0 978 Brong Ahafo 91.9 552 7.3 17.7 22.2 52.8 100.0 546 Northern 97.3 630 2.7 71.1 14.8 11.4 100.0 630 Upper East 94.8 202 4.6 61.7 21.5 12.3 100.0 201 Upper West 97.8 126 1.8 18.1 59.2 20.8 100.0 126 Area Urban 88.2 2692 11.0 26.5 17.9 44.6 100.0 2,668 Rural 94.3 3,247 5.1 53.9 18.8 22.2 100.0 3,225 Total 91.5 5,939 7.7 41.5 18.4 32.4 100.0 5,893 * MICS Indicator 41 3.5 Immunization ICS 2006 information on vaccinations aretakers’ r children According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis; three doses of (DPT)HH to protect against diphtheria, pertussis, tetanus, and hepatitis B; three doses of polio vaccine, and a measles, mumps and rubella (MMR) vaccination by the age of 12 months. In the M coverage was obtained in two ways – from health cards and from mothers’ or c verbal reports. All mothers or caretakers were asked to provide vaccination cards fo under the age of five. Interviewers copied vaccination information from the cards onto the MICS 2006 questionnaire. If a vaccination was not recorded on the card, the mother or caretaker was asked to recall whether particular vaccination had been given and how many times. 9 The percentage of children aged 12 to 23 months who received each of the vaccinations before the age of 12 months is shown in Table CH.1 (See Appendix). The denominator for the table is comprised of children aged 12-23 months so that only children who are old enough to be fully vaccinated are counted. Approximately 94 percent of children aged 12-23 months received a BCG vaccination by the ge of 12 months and the first dose of (DPT)HH was given to 94 percent. The percentage ports, 73 percent of children 12-23 months ave all the required vaccinations. Predictably, children in wealthier households are much 95 percent in Ashanti region. Overall, there is a strong association between mother’s level of education and residence and the likelihood of child’s receiving vaccinations: larger percentages of children 12-23 months with mothers with at least primary education and children residing in urban areas have necessary vaccinations by the time they are 1 year old. 3.6 Antibiotic Treatment and Medical Consultations for Children with Suspected Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were due to a problem either in the chest, or in the chest and a blocked nose. These symptoms, though compatible with pneumonia, are subjective (i.e. mother’s perception of illness) and not validated by medical examination, which is the reason why it is important to look at whether children with symptoms were taken to a health facility. Questions on consultation and treatment of pneumonia were limited to children who had suspected pneumonia within the previous two weeks. Findings in Table CH.7 show the percentage of children treated for pneumonia symptoms with antibiotics or taken to a private or public health facility or in under-5s by sex, area and socioeconomic factors. In Ghana, more than half of children with suspected pneumonia are taken to a health facility for advice and treatment. Thirty-three percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Notably, variations by urban-rural residence are not as substantial. The table also shows that the likelihood of antibiotic treatment of suspected pneumonia is very low among the poor households. a declines for subsequent doses of (DPT)HH to 89 percent for the second dose, and 81 percent for the third dose. Similarly, 96 percent of children received Polio 1 by age 12 months and this declines to 80 percent by the third dose. As presented in Table CH.2 (See Appendix), based on either the health cards or mothers/caretakers’ re h more likely to have all the necessary vaccinations. Additionally, 84 percent of children were vaccinated against yellow fever, ranging from the lowest 61 percent in the Central region to the highest 10 3.7 Solid Fuel Use Cooking with solid fuels (biomass and coal) leads to high levels of indoor pollution and is a major cause of ill-health in the world, particularly among under-5 children, in the form of acute respiratory illness. Table CH.8 (See Appendix), presents the distribution of households by type of cooking fuel. The three main sources of cooking fuel in the country are wood (50 percent), charcoal (35 percent) and LPG (10 percent). Overall, 86 percent of households in Ghana are using solid fuels for cooking. Use of solid fuels varies across the 10 regions of the country from 60 percent in Greater Accra to 97 percent in Northern region. In addition the use of solid fuel for cooking is slightly lower in urban areas (75 percent) than rural households, where almost every household (96percent) uses solid fuel for cooking. Use of solid fuels differentials with respect to the educational level of the head of household and household wealth index is also significant. The higher the educational level of the household head, the lower the use of solid fuels for cooking. In addition, the table clearly shows that the percentage is high due to high level use of charcoal and firewood for cooking purposes. CH.7: Antibiotic treatment and Consultations for Pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment or who were taken to a health facility, Ghana, 2006 Among children aged 0-59 with suspected pneumonia: Percentage of children who received antibiotics in the last two weeks 1 Percentage of children who sought advice/treatment from a health facility2 Number of children aged 0-59 months with suspected pneumonia in the two weeks prior to the survey Sex Male 32.3 58.9 85 Female 33.4 50.3 89 Area Urban (30.4) (28.8) 47 Rural 33.7 80.4 128 Mother's education None 27.7 38.2 68 Primary (44.6) (36.4) 48 Middle/JSS 28.0 31.3 55 Secondary+ * * 4 Wealth Index Quintiles Poorest (29.6) (23.5) 46 Second 30.4 35.8 55 Middle (35.1) (30.8) 43 Fourth (44.8) (12.4) 30 Richest (31.2) (6.7) 30 Total 32.9 54.5 175 1 MICS indicator 22 2 Excludes pharmacy, shop, and traditional practitioner. Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 3.8 Malaria Malaria continues to be a major public health concern. It is one of the leading causes of morbidity ad mortality, especially among children under age five and pregnant women in Ghana. It also contributes to anemia in children and is a common cause of school absenteeism. Preventive measures, especially the use of mosquito nets treated with insecticide (ITNs), can dramatically reduce malaria mortality rates among children. In areas where malaria is common, international recommendations suggest treating any fever in children as if it were malaria and immediately giving the child a full course of recommended anti-malarial tablets. Children with severe malaria symptoms, such as fever or convulsions, should be taken to a health facility. 11 The MICS 2006 survey incorporated questions on the use of bednets, both at household level and among children under five years of age, as well as anti-malarial treatment, and intermittent preventive therapy for malaria. Due to the fact that field-work was done in the lean season, after the rainy season, the use of mosquito nets is not as high as it would be during the rainy season. According to data in Table CH.10 in Ghana almost a third of households have at least one mosquito net (30 percent) and 19 percent have at least one insecticide treated net (ITN). The likelihood of possessing a mosquito net or an ITN is 15 percent higher in rural areas than in urban areas. Table CH.11 indicates that 33 percent of children under the age of five slept under any mosquito net the night prior to the survey and 22 percent slept under an insecticide treated net. The use of bednets among children under five declines steadily with age and in rural areas the prevalence of using the ITNs or bednets is higher than in urban areas. There were no significant gender disparities in bednet and ITN use among children under five. Questions on the prevalence and treatment of fever were asked for all children under age five. About a fifth (23 percent) of under five children were ill with fever in the two weeks preceding the interview (Table CH.12). Fever prevalence was lowest among infants 0-11 months old, and peaked at 12-35 months (27 percent) (See appendix). Regional differences in fever prevalence are not large, with higher prevalence in Upper East and West, and Northern regions (25 percent and up) and lowest in Greater Accra and Central regions (15 percent). Mothers and caretakers were asked to report all of the medicines given to a child to treat the fever, including both any medicine given at home and medicines given or prescribed at a health facility. Overall, 61 percent of children with fever in the last two weeks were treated with an “appropriate” anti-malarial drug and 48 percent received anti-malarial drugs within 24 hours of onset of symptoms. Table CH.10: Availability of mosquito and insecticide treated nets Percent of households with at least one insecticide treated net (ITN), Ghana, 2006 Percentage of households with at least one mosquito net Percentage of households with at least one ITN* Number of house- holds Region Western 10.7 8.0 617 Central 21.2 14.7 576 Greater Accra 19.1 12.9 1,004 Volta 60.7 23.0 486 Eastern 28.0 17.0 758 Ashanti 24.5 20.0 988 Brong Ahafo 39.7 28.3 552 Northern 43.0 24.0 630 Upper East 42.4 30.6 202 Upper West 51.6 31.7 126 Area Urban 21.4 15.3 2,692 Rural 36.7 21.6 3,247 Education of household head None 31.5 16.3 1,830 Primary 30.0 18.0 802 Middle/JSS 27.5 18.1 2,203 Secondary+ 31.4 24.5 1,104 Total 29.8 18.7 5,939 * MICS Indicator 36 “Appropriate” anti-malarial drugs include chloroquine, SP/Fansidar, Armodiaquine, Quinine, artimisine combination drugs, etc. In Ghana, the most widely used were Chloroquine (45 percent of children with fever were given) and Armodiaquine (12 percent). Around one percent received SP/Fansidar or Quinine and 3 percent used artemisinin combination therapy. Almost ninety percent of children were given other types of medicines that are not anti- 12 malarials, including paracetamol (78 percent), aspirine and ibuprofen (around 3percent) and other medications (16percent). Overall, children with fever in Greater Accra, Western, Northern and Upper East regions are the most likely (7 in 10) to have received an appropriate anti-malarial drug while those in the Upper West region are least likely (4 in 10) to have received an appropriate drug. Urban children are more likely than rural children (72 versus 58 percent) to be treated appropriately. The higher the mother’s education, the more likely was the child to have received an anti- malarial drug. Little difference was noted between boys and girls in receiving appropriate anti-malarial drugs. Table CH.11: Children sleeping under bednets Percentage of children aged 0-59 months who slept under an insecticide treated net(ITN) during the previous night, Ghana, 2006 Slept under a bednet * Sleep under an ITN** Slept under an untreated net Slept under a net but don't know if treated Don't know if slept under a net Did not sleep under a bednet Number of children aged 0-59 months Sex Male 33.3 11.3 10.3 2.5 1.0 58.5 1,789 Female 31.8 21.6 11.3 0.4 0.2 68.0 1,678 Region Western 15.0 11.5 3.2 0.3 0.7 84.3 347 Central 25.8 19.8 6.0 0.0 1.0 73.2 302 Greater Accra 24.2 16.3 6.7 1.2 0.0 75.8 448 Volta 54.2 21.5 30.0 2.7 0.0 45.8 261 Eastern 32.2 24.9 6.7 0.5 0.0 67.8 463 Ashanti 26.5 21.8 4.2 0.5 0.2 73.3 506 Brong Ahafo 39.3 25.7 13.6 0.0 0.0 60.7 311 Northern 36.7 21.9 14.4 0.4 0.0 63.3 579 Upper East 51.5 39.3 11.3 0.9 0.2 48.2 146 Upper West 55.0 37.1 16.3 1.5 0.0 45.0 105 Area Urban 22.4 16.4 5.4 0.6 0.2 77.5 1,236 Rural 38.3 24.8 12.7 0.7 0.2 61.5 2,231 Age 0-11 months 37.9 27.8 9.3 0.9 0.0 62.1 715 12-23 months 36.2 24.5 10.9 0.8 0.3 63.5 706 24-35 months 31.3 19.6 11.0 0.8 0.2 68.5 667 36-47 months 29.9 20.6 8.9 0.4 0.3 69.8 718 48-59 months 27.3 16.3 10.5 0.5 0.2 72.5 661 Wealth index quintiles Poorest 41.4 24.4 16.4 0.7 0.0 58.5 786 Second 34.5 22.2 11.9 0.5 0.4 65.1 830 Middle 29.0 19.2 9.3 0.5 0.3 70.7 684 Fourth 29.0 20.8 6.7 1.5 0.0 71.0 623 Richest 25.7 22.2 3.3 0.2 0.2 74.1 544 Total 32.6 21.8 10.1 0.7 0.2 67.2 3,467 *MICS indicator 38 **MICS indicator 37; MDG indicator 22 13 3.9 Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, particularly in rural areas, who bear the primary responsibility for carrying water, often for long distances. The distribution of the population by source of drinking water is shown in Figure 2. The main sources of drinking water are piped water (13 percent) and public tap or standpipe (25 percent), borehole (29 percent), and stream/river accounting for 11 percent. The population using improved drinking water sources are those who use any of the following types of supply: piped water, public tap, borehole, protected well, protected spring, bottled or sachet water. Table EN.1 (See Appendix), shows that overall, 78 percent of the population has access to improved drinking water sources – 91 percent in urban areas and 69 percent in rural areas; with almost half of the rural dwellers drinking from either borehole or protected well. Even though, the population with access to improved source of drinking water is encouraging, more than a fifth of all households still drink from unimproved water sources. Figure 2: Percentage distribution of the population by source of drinking water, Ghana, 2006 Piped water/public tap/standpipe 38% Borehole 29% Other/Missing 1% Protected well/spring 6% Bottled/Sachet water 5% River/stream 11% Unprotected Well 6% Dam/Pond/Lake 2% Rainwater/Tanker truck 2% The source of improved drinking water for the population varies strongly by region ranging between 53 and 95 percent (See Appendix). The situation in the Volta region is considerably worse than in other regions; only half of the population in this region gets its drinking water from an improved source. In the Upper West region, 95 percent of all households have access to improved drinking water sources, with nearly nine out of every ten households drinking from borehole or protected well. In the Greater Accra and Ashanti regions, though over 88 percent of households have access to improved drinking water source, only 61 and 47 percent respectively use piped water. The proportion of households with access to improved source of drinking water increased with the level of education of the household head. The same can be said for the socio-economic status of the household in relation to access to improved source of drinking water (See Appendix). 14 Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Table EN.5 (See Appendix), shows the percentage distribution of households and household characteristics by the type of toilet facility used. Sanitary facilities used by the household were reclassified into improved and unimproved sanitation facilities. Improved sanitation facilities include: flush toilets connected to sewage systems or septic tanks, ventilated improved pit latrines and pit latrines with slabs. Sixty-one percent of the population is using improved sanitation facilities. The Table also shows that improved sanitation is more prevalent in urban areas (83 percent); whereas only close to half of the rural population have access to improved sanitary facilities. Differentials at the regional level are significant. Use of improved sanitary facilities is highest among Ashanti, Greater Accra, Brong Ahafo, Western and Central regions. Residents of the three northern regions are significantly less likely than others to use improved facilities. The majority of population in these regions use bush, fields, or have no toilet facilities. In addition, households in which the head had some form of education were more likely to have access to improved sanitary facilities. 3.10 Contraception The level of current use of contraceptive methods indicates the progress in the family planning programmes and is often used as a measure in analysing the determinants of fertility. Table RH.1 (See Appendix), shows the percent distribution of currently married or cohabiting Ghanaian women who are currently using any contraceptive method, by age and other characteristics. The survey findings indicate that as many as 83 percent of women are not currently using any methods of family planning. Among those using contraceptive methods, the most popular method is injections used by 6 percent of married or cohabiting women in Ghana, with the next most popular method being the pill, which accounts for 5 percent. Close to two percent of women reported use of the male condom by partner and periodic abstinence. Less than one percent use IUDs, implants, female condom, diaphragm/foam/jelly, withdrawal, female sterilization, or the lactational amenorrhea method (LAM). The prevalence of using any contraceptive method is highest in the Central (23 percent) and Greater Accra (29 percent) regions, with the lowest contraceptive use reported in Northern (8 percent) regions (See Appendix). Similar patterns are apparent in the use of modern contraception, with Eastern and Brong Ahafo reporting almost the same high contraceptive prevalence (16 percent) as in Central and Great Accra regions (19 and 17 percent, respectively). The use of modern contraceptives is most rare in the Western region - only seven percent of married women reported using any modern method. Adolescents are far less likely to use contraception than older women. Only 8 percent of married or in union women aged 15-19 currently use any method of contraception compared to 15 percent of 20-24 year olds and about 20 percent of women aged 25-39. Women’s education level is strongly associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 9 percent among those with no education to 17 percent among women with primary education, and to 20 percent and above among women with secondary or higher education. The same pattern is true for the use of modern contraception. In addition to differences in prevalence, the method mix varies by education. Among contraceptive users with no or primary education use the pill and injections are most popular; while contraceptive users with middle, secondary or higher education use male condom and periodic abstinence almost at the same rate as the pill and injections. The level of household wealth is associated with the likelihood of using 15 contraception in the similar way as education. Notably, women with no children are less likely to use contraception than women with children. 3.11 Assistance at Delivery The provision of delivery assistance by skilled attendants can greatly improve outcomes for mothers and infants by the use of technically appropriate procedures, and accurate and speedy diagnosis and treatment of complications. Skilled assistance at delivery is defined as assistance provided by a doctor, nurse, midwife, auxiliary midwife or a community health worker. About half of births occurring in the two years prior to the MICS survey were delivered by skilled personnel or a health facility, including 9 percent delivered by a medical doctor (Table RH.5, See Appendix). This percentage of deliveries assisted by a medical doctor is highest in the Greater Accra region at 29 percent, with the next highest 15 percent in Ashanti region and lowest 1-2 percents in Western, Northern and Upper East regions. Forty-one percent of births in the two years prior to the MICS survey were delivered with assistance by a nurse, midwife, auxiliary midwife or a community health worker. These skilled staff assisted in close to 50 percent of deliveries in the Greater Accra, Ashanti and Brong Ahafo regions, and only in 25-30 percent of deliveries in Eastern and Upper West regions. Women in urban areas are twice as likely to have their births assisted by a medical personnel or deliver at a health facility, compared to women in rural areas. Additionally, the more educated a woman is, the more likely she is to have delivered with the assistance of a medical doctor or other skilled medical personnel. A higher percentage of women with none or only primary education and those from less wealthy households had their deliveries assisted by traditional birth attendants or relatives and friends in the 2 years preceding the survey. 3.12 Primary School Attendance Sixty-four percent of children of primary school age in Ghana are attending primary school or secondary school (Table ED.3). The regional differentials show at least six out of every ten children aged 6 -11 are in either primary or secondary schools except in Northern and Upper West regions. School attendance in the Northern and Upper West regions is significantly lower than in the rest of the Ghana at approximately 50 percent. Net attendance ratio for females is higher than for males in all regions except Western, Volta, Northern, and Eastern regions, with the equal 71 percent at Ashanti region. In urban areas, 77 percent of children attend school while in rural areas 63 percent attend. Children from the wealthiest households are twice as likely to be in school (87 percent), than children from poorest households (43 percent). At the national level, there is virtually no difference between male and female primary or secondary school attendance. The ratio of girls to boys attending primary and secondary education is provided in Table ED.7. The table shows that gender parity for primary school is 1.0, indicating no difference in the attendance of girls and boys to primary school. However, the indicator value increases slightly to 1.1 for secondary education. The disadvantage of girls is particularly pronounced in the Volta region, while the disadvantage of boys is evident in Upper East and Upper West, Western and Brong Ahafo regions. 16 Table ED.3: Primary school net attendance ratio Percentage of children of primary school age** attending primary or secondary school (NAR), Ghana, 2006 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio* Number of children Region Western 68.6 210 63.9 197 66.3 495 Central 60.4 174 69.7 170 65.0 403 Greater Accra 74.6 236 78.9 242 76.8 584 Volta 64.5 160 58.6 168 61.5 387 Eastern 76.1 214 71.4 226 73.7 533 Ashanti 71.0 325 70.9 291 70.9 734 Brong Ahafo 58.6 227 64.9 175 61.3 474 Northern 49.5 344 45.0 351 47.2 807 Upper East 57.4 113 62.7 105 60.0 261 Upper West 47.6 65 52.3 61 49.9 150 Area Urban 71.8 719 74.3 728 73.0 1,762 Rural 59.7 1,350 58.0 1,258 58.9 3,066 Age 6 29.7 407 27.7 385 28.7 791 7 47.9 366 48.8 338 48.3 704 8 65.5 311 71.6 351 68.7 662 9 80.1 326 78.5 313 79.3 639 10 82.5 391 81.0 341 81.8 732 11 88.8 268 87.5 258 88.1 526 Wealth index quintiles Poorest 45.2 512 41.4 462 43.4 1,127 Second 59.8 478 59.3 432 59.6 974 Middle 66.8 417 71.0 424 68.9 841 Fourth 74.7 355 74.1 360 74.4 715 Richest 84.8 308 82.9 308 83.9 616 Total 63.9 2,069 64.0 1,986 63.9 4,055 * MICS indicator 55; MDG indicator 6 17 Table ED.7: Education gender parity Ratio of girls to boys attending primary education and ratio of girls to boys attending secondary education, Ghana, 2006 Primary school net attendance ratio (NAR), girls* Primary school net attendance ratio (NAR), boys* Gender parity index (GPI) for primary school NAR** Secondary school net attendance ratio (NAR), girls Secondary school net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school NAR** Region Western 63.4 67.9 0.9 47.0 35.8 1.3 Central 69.7 60.4 1.2 46.4 40.7 1.1 Greater Accra 78.1 73.9 1.1 53.4 55.6 1.0 Volta 58.6 63.9 0.9 21.0 34.6 0.6 Eastern 71.4 76.1 0.9 38.5 38.7 1.0 Ashanti 70.2 70.3 1.0 44.3 44.5 1.0 Brong Ahafo 63.8 57.8 1.1 38.4 29.8 1.3 Northern 44.7 48.8 0.9 21.1 24.0 0.9 Upper East 62.3 57.4 1.1 21.1 17.0 1.2 Upper West 52.3 46.4 1.1 19.1 16.0 1.2 Area Urban 73.4 71.1 1.0 48.9 48.9 1.0 Rural 57.9 59.2 1.0 29.9 28.6 1.0 Wealth index quintiles Poorest 41.3 45.0 0.9 11.6 13.7 0.9 Second 59.3 59.3 1.0 29.5 29.1 1.0 Middle 70.5 66.3 1.1 35.8 36.4 1.0 Fourth 74.1 74.0 1.0 44.2 45 1.0 Richest 81.1 83.7 1.0 61.9 64.5 1.0 Total 63.6 63.3 1.0 38.8 36.6 1.1 * MICS Indicator 55; MDG Indicator 6 ** MICS Indicator 61; MDG Indicator 9 3.13 Birth Registration The International Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The births of 51 percent of children under five years in Ghana have been registered (Table CP.1, See Appendix). There are no significant variations in birth registration across gender of children, but a significant discrepancy between urban and rural, at 69 and 42 percent registration respectively. Children in Greater Accra are more likely to be registered than children in all other regions. However, only Eastern Region is remarkably low with just 38 percent of births registered. The likelihood of birth registration is heavily skewed towards higher educational level and household wealth (not shown). Only 41 percent of births of mothers with no education are registered. Asked to identify reasons for not registering births, respondents identify cost of registration, travel distance, and lack of knowledge as main reasons. Cost is particularly 18 dominant in urban areas, whereas travel distance and lack of knowledge play equally significant roles in rural areas. 3.14 Early Marriage and Polygyny Child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. Women married at younger ages are more likely to dropout of school, experience higher levels of fertility, domestic violence, and maternal mortality. In MICS 2006, information on age at first marriage was obtained by asking women the month and the year, or age, at which they started living with their first partner. Older female respondents are less likely to recall with accuracy marriage dates and ages, therefore, the data for older respondents should be interpreted with caution. Information on women married by various ages is provided in Table CP.5.1. With regards to the age at first marriage, only 2 percent of women 15-19 years of age were married before the age of 15, compared to 4 percent of women 20-29 years of age, and 5 percent and more for women who are currently 30- 44 years of age. The same trend is apparent when one looks at the percentage of women married by the exact age of 18: twenty-two percent of women 20-29 first got married before they were 18 years old, while 30 percent of those 30-44 married before the age of 18. Notably, the percentage of women married before the ages of 15 and 18 in the 45-49 age group is practically the same (3 and 24 percent, respectively) as for women in the 15-19 and 20-24 age groups. Such factors as residing in rural areas, having lower levels of education and being in a lower household wealth bracket are positively associated with getting married at a younger age. Table CP.5.1: Early marriage Percentage of women aged 15-49 years in marriage or union before their 15th birthday, percentage of women aged 20-49 years in marriage or union before their 18th birthday, Ghana, 2006 Percentage married before age 15 * Number of women aged 15-49 years Percentage married before age 18 * Number of women aged 20-49 years Area Urban 3.3 2,775 20.5 2,174 Rural 5.3 3,115 30.6 2,498 Age 15-24 3.1 2,293 na na 15-19 2.1 1,218 na na 20-24 4.3 1,075 22.0 1,075 25-29 3.8 987 22.0 987 30-34 7.7 777 31.0 777 35-39 5.1 746 29.9 746 40-44 6.3 577 30.1 577 45-49 2.7 509 23.6 509 Education None 7.1 1,549 34.6 1,441 Primary 5.5 1,162 32.4 861 Middle/JSS 3.0 2,237 22.9 1,673 Secondary+ 1.8 942 7.3 697 Total 4.4 5,890 25.9 4,672 * MICS Indicator 67 * MICS Indicator 67 As seen in table CP.5.2, while there is a general trend towards later marriage, by the age of 25 more than half of the women are married or cohabiting with a partner, and after 30 years of age over 90 percent of women are in union. For men, by the age of 30 half of them are married or cohabiting, and only after the age of 45, ninety percent are married or cohabiting with a woman. 19 Table CP.5.2: Polygyny Percentage of women and men aged 15-49 currently married or in union, and the percentage of married or in union women in a polygynous marriage or union, Ghana 2006 Women Men Percentage of women 15-49 years married/in union * Number of women aged 15-49 years Percentage of women aged 15-49 years in polygynous marriage/ union ** Number of women aged 15-49 currently married/in union Percentage of men aged 15- 49 currently married/in union* Number of men aged 15- 49 years Percentage of men aged 15- 49 years in polygynous marriage/ union Number of men aged 15-49 currently married/ in union Region Western 70.3 593 13.0 345 50.3 176 3.4 89 Central 70.0 455 15.9 251 42.0 122 6.3 51 Greater Accra 58.3 1,125 14.7 518 35.4 311 6.0 110 Volta 80.0 426 23.0 315 48.1 135 15.1 65 Eastern 68.0 741 18.9 414 44.4 210 4.4 93 Ashanti 69.8 888 13.2 526 47.4 310 3.0 147 Brong Ahafo 66.4 569 16.2 294 40.1 154 13.1 62 Northern 78.9 745 39.5 551 50.3 231 23.4 116 Upper East 74.6 218 39.3 150 44.2 62 (17) 27 Upper West 82.0 130 44.4 100 (53.6) 35 * 19 Area Urban 63.4 2,775 15.1 1,412 39.0 767 6.9 299 Rural 74.8 3,115 26.1 2,053 49.0 977 11.5 479 Age 15-24 32.2 2,293 9.4 613 5.2 761 (7.1) 40 15-19 10.9 1,218 9.7 98 1.4 471 * 7 20-24 56.3 1,075 9.3 514 11.3 290 (8.5) 33 25-29 84.6 987 18.3 737 50.6 249 2.7 126 30-34 93.0 777 20.1 646 74.7 229 8.2 171 35-39 96.9 746 26.4 608 87.1 181 12.5 158 40-44 98.5 577 28.4 462 84.2 164 9.7 138 45-49 99.1 509 34.1 399 91.1 160 15.5 146 Education None 90.3 1,549 35.9 1,258 62.9 253 21.4 159 Primary 71.6 1,162 17.1 676 39.2 265 13.6 104 Middle/JSS 65.1 2,237 12.8 1,200 43.2 816 6.2 352 Secondary+ 42.9 942 8.8 331 39.7 411 3.6 163 Wealth index quintiles Poorest 78.5 954 34.1 682 49.3 313 17.7 154 Second 76.6 1,037 27.0 703 50.2 287 13.4 144 Middle 72.3 1,149 20.8 657 41.5 330 9.0 137 Fourth 68.2 1,298 17.3 712 41.6 415 5.3 173 Richest 57.3 1,451 9.5 711 42.6 400 4.6 170 Total 69.4 5,890 21.6 3,456 44.8 1,745 9.8 777 * MICS Indicator 68 ** MICS Indicator 70 for women aged 15-24 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases Polygyny (the practice of having more than one wife at the same time) has implications for the frequency of sexual activity and fertility. Married and cohabiting women were asked whether their husbands had other wives, and men were asked if they had more than one wife or cohabiting partner. Table CP.5.2 shows that 22 percent of currently married women report being in polygynous unions, while 10 percent of men report having other wives/partners. The 20 level of polygyny increases with age for women, but not for men; rural women and men are more likely to be in polygynous unions than their urban counterparts. Regional variations are also noticeable: women in Northern, Upper West and East regions are at least 15 percent more likely to report being in polygynous unions than those in other regions; men in Northern region have higher likelihood than others to have more than one wife or cohabiting partner. 3.15 Knowledge of HIV/AIDS Transmission and Condom Use One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. However, misconceptions about HIV are common and can confuse population and hinder prevention efforts. Therefore, correct information is the first step toward raising awareness and giving people the tools to protect themselves from infection. The most common routes of HIV/AIDS transmission are through the exchange of body fluids during the sexual intercourse, hence many AIDS prevention programmes focus their messages and efforts on such important aspects of behaviour as limiting the number of sexual partners/staying faithful to one partner and use of condoms (the AB message). To ascertain whether programmes have effectively communicated these messages, in MICS 2006, respondents were asked whether it is possible to reduce the chance of getting the AIDS virus by having just one faithful sexual partner and using a condom at every sexual encounter. Table HA.3 presents information about women and men 15-49 years, who know 2 ways of preventing HIV transmission: condom use and being faithful. Approximately 6 in 10 women and 7 in 10 men indicate that the chances of getting the AIDS virus can be reduced by limiting sex to one uninfected partner who has no other partners and through condom use. As shown in Table HA.1, across respondents’ background characteristics there are notable differences in knowledge of HIV/AIDS prevention behaviours, and the level of knowledge among youth 15- 24 years old is around 70 percent for both women and men. There is practically no difference in the level of knowledge on HIV/AIDS prevention methods between urban and rural residents, with a slight difference in women: rural women are less likely to know HIV prevention methods. As one would expect, women and men with education are more likely than those with no schooling to be aware of preventive methods. Regionally, the lowest level of knowledge of HIV prevention behaviours among women and men aged 15-49 can be found in Upper West regions (35 and 41 percent, respectively), while the highest - in Greater Accra for women (72 percent) and Eastern and Brong Ahafo regions for men (80 percent). Different countries are likely to have variations in misconceptions although some appear to be universal. The MICS 2006 asked respondents whether they think it is possible for a healthy- looking person to have the AIDS virus and whether a person can get AIDS by mosquito bites, by supernatural means and through sharing food with an HIV infected person. Column 3 in Table HA.3 presents information on the proportion of population that correctly rejects the most common misconceptions, that people infected with HIV do not necessarily show signs of infection, that a person can get AIDS by mosquito bites, and through sharing food. Only a third of Ghanaian women and a 40 percent of men can correctly identify misconceptions about HIV transmission. Older women are more likely to have misconceptions than younger women, while there are no age variations for men. However, women and men with at least middle level of schooling are more likely than others not to have misbeliefs about HIV transmission. A larger proportion of urban than rural women (37 versus 21 percent) correctly reject misconceptions, consistent with a difference in men (49 versus 35 percent). Regionally, misconceptions are most prevalent in Upper West and Northern regions among women and in Volta and Upper West regions among men. 21 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission Percentage of women and men aged 15-49 years who have comprehensive knowledge of HIV/AIDS transmission, Ghana, 2006 Percentage of women, who: Percentage of men, who: Know 2 ways to prevent HIV trans- mission Correctly identify 3 mis- conceptions about HIV transmission Have comprehen- sive knowledge (identify 2 prevention methods and 3 mis- conceptions) * Number of women Know 2 ways to prevent HIV trans- mission Correctly identify 3 mis- conceptions about HIV transmission Have comprehen- sive knowledge (identify 2 prevention methods and 3 mis-conceptions) * Number of men Region Western 69.2 25.4 20.6 593 70.5 39.5 28.1 176 Central 68.5 24.9 19.9 455 78.0 46.8 30.8 122 Greater Accra 72.0 41.9 32.9 1,125 74.8 52.7 43.1 311 Volta 61.5 22.2 17.1 426 56.5 29.1 18.9 135 Eastern 66.6 26.6 19.8 741 80.1 36.6 30.1 210 Ashanti 58.4 29.9 18.5 888 61.1 48.9 30.5 310 Brong Ahafo 69.9 26.3 20.8 569 79.3 44.1 37.9 154 Northern 52.9 20.1 14.2 745 66.5 33.7 29.2 231 Upper East 61.6 26.8 20.3 218 73.0 31.9 25.8 62 Upper West 35.3 18.3 8.7 130 (41.3) (27.5) (19.3) 35 Area Urban 67.6 36.5 27.5 2,775 72.0 49.4 38.1 767 Rural 61.0 21.2 15.5 3,115 68.3 35.0 26.6 977 Age 15-24 67.1 33.4 25.1 2,293 71.3 42.2 33.0 761 15-19 68.2 34.3 26.4 1,218 69.5 40.8 32.2 471 20-24 66.0 32.3 23.5 1,075 74.3 44.4 34.4 290 25-29 63.5 26.4 20.9 987 73.5 47.6 37.2 249 30-34 65.1 28.3 20.7 777 70.5 36.4 27.6 229 35-39 61.6 23.4 18.1 746 68.3 44.7 33,4 181 40-44 61.8 24.0 16.6 577 64.9 32.5 25.3 164 45-49 57.0 22.4 14.4 509 63.9 39.8 26.7 160 Education None 51.4 12.9 9.0 1,549 55.5 15.7 10.6 253 Primary 62.7 19.9 13.8 1,162 67.8 22.2 17.5 265 Middle/JSS 71.5 31.8 24.7 2,237 74.7 41.6 32.8 816 Secondary+ 69.5 56.4 41.7 942 70.8 68.8 51.5 411 Total 64.2 28.5 21.2 5,890 69.9 41.3 31.7 1,745 * MICS Indicator 82; MDG indicator 19b Note: Figures in parentheses are based on 25-49 unweighted cases. The critical role of sexual partners’ behaviours for reducing HIV prevalence makes condom use, especially with non-regular partners, and limiting the number of sexual partners especially important. Table HA.9.1 shows data on sexual activity among youth aged 15-24. Over half of new HIV infections are among young people thus a change in behaviour among this age group will be especially important to reduce new infections. In Ghana, 3 in 5 young women and 2 in 5 young men have ever had sex, and half of women and a third of all young 22 respondents surveyed had sex in the last 12 months. While young women were more likely than young men to have had sex in the year preceding the survey, a larger proportion of men had sex with more than one partner (6 percent) compared to women (2 percent). Table HA.9.1: Sexual activity among youth Percentage of young women and men aged 15-24 who have ever had sex, had sex in the last 12 months and who had sex with more than one partner in the last 12 months, Ghana, 2006 Percentage of young women, who: Percentage of young men, who: Ever had sex Had sex in the last 12 months Had sex with more than one partner in the last 12 months Number of women aged 15-24 Ever had sex Had sex in the last 12 months Had sex with more than one partner in the last 12 months Number of men aged 15-24 Region Western 63.1 48.8 0.8 238 49.3 33.2 5.3 71 Central 59.1 55.6 0.0 187 43.1 33.0 5.8 63 Greater Accra 50.1 38.5 2.9 464 39.4 31.9 9.1 125 Volta 67.7 57.8 0.0 168 27.1 22.8 0.0 65 Eastern 61.7 49.9 2.9 296 48.2 39.1 7.4 96 Ashanti 59.9 47.7 2.4 344 27.8 18.8 2.1 122 Brong Ahafo 56.5 47.9 1.8 224 48.3 38.9 9.0 76 Northern 63.0 52.8 0.5 261 39.3 32.6 3.3 100 Upper East 57.5 44.3 0.0 72 44.1 41.9 (9.8) 30 Upper West 55.9 40.6 (0.7) 39 20.2 14.1 * 14 Area Urban 51.1 40.4 1.5 1,098 38.4 29.3 6.6 333 Rural 66.1 54.9 1.8 1,195 40.4 32.3 4.8 761 Age 15-19 35.7 28.3 1.9 1,218 21.8 15.0 1.9 471 20-24 85.2 70.3 1.4 1,075 68.4 56.9 11.5 290 Education None 73.0 63.0 0.4 295 46.3 43.0 3.7 73 Primary 63.4 53.0 1.6 502 28.3 22.7 3.7 143 Middle/JSS 57.2 46.7 1.7 975 43 32.6 7.1 363 Secondary+ 49.7 37.0 2.5 520 38.6 29.4 4.9 182 Total 58.9 48 1.7 2,293 39.5 31.0 5.6 761 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. Prevalence of sex with partners other than wives and husbands or live-in partners (non- marital, non-cohabiting) and condom use in these encounters was assessed in all respondents aged 15-49 who had sex in the previous year (Table HA.9.2, See Appendix). Men were two times more likely than women to engage in higher-risk sex (22 compared to 40 percent). For youth, while half of women aged 15-24 reported having sex with a non-marital, non- cohabiting partner in the last 12 months before the Ghana MICS, as many as 9 in 10 young men did. With regards to the condom use, a third of women reported condom use during last higher-risk sexual encounter in the year preceding the survey, and almost a half (45 percent) of men did. Overall condom use is higher among youth than in general population, and the difference between women and men aged 15-24 in reported condom use rate at last sex with a non-marital, non-cohabiting partner is similar (42 and 56 percent, respectively). The likelihood of engaging in higher-risk sex and using a condom significantly increases with the respondents’ level of education. Twenty-five percent of women and 33 percent of men with 23 primary education used a condom during last higher risk sex encounter in the year before the MICS, while 48 percent of women and 60 percent of men with secondary and higher levels of education used a condom at such sex. 3.16 Orphans School Attendance To ascertain if there has been an upsurge in the number of orphans due to death of parents from various causes, the MICS 2006 sought information on orphanhood and fostering. Children who are orphaned or living away from their parents may be at increased risk of neglect or exploitation if the parents are not available to assist them. Monitoring the variations in educational outcomes for children who have lost both parents (double orphans) versus children whose parents are alive (and who live with at least one of these parents) is one way to ensure that children’s rights are being met even after their parents have died or are no longer able to care for them. Table HA.12: School attendance of orphaned children School attendance of children aged 10-14 years by orphanhood status, Ghana, 2007 Percent of children whose mother and father have died School attendance rate of children whose mother and father have died Number of children whose mother and father have died Percent of children of whom both parents are alive and child is living with at least one parent School attendance rate of children of whom both parents are alive and child is living with at least one parent Number of children of whom both parents are alive and child is living with at least one parent Double orphans to non orphans school attendance ratio* Total number of children aged 10-14 years Sex Male (1.5) (87.8) 26 76.9 86.7 1,315 1.0 1,710 Female (1.6) (90.1) 26 70.9 84.7 1,162 1.1 1,639 Region Western * * 7 73.8 94.9 262 1.1 354 Central * * 2 69.7 89.6 179 1.1 257 Greater Accra * * 11 69.4 96.0 317 1.0 457 Volta * * 3 69.0 87.5 169 1.1 245 Eastern * * 2 67.3 97.9 274 1.0 408 Ashanti * * 14 71.2 97.9 360 1.0 506 Brong Ahafo * * 4 73.3 88.0 245 0.7 334 Northern * * 7 88.4 59.5 458 0.9 518 Upper East * * 2 80.3 73.0 145 1.2 180 Upper West * * 0 76.2 72.2 67 - 88 Area Urban * * 20 69.3 95.4 931 0.9 1,344 Rural (1.6) (89.0) 32 77.1 80.0 1,545 1.1 2,004 Wealth index Poorest * * 6 84.9 58.6 605 0.3 712 Second * * 11 75.0 90.4 478 1.1 638 Middle * * 9 72.3 94.8 513 1.1 709 Fourth * * 8 70.3 94.7 461 1.1 656 Richest * * 18 66.4 98.8 420 1.0 633 Total 1.6 88.9 52 74.0 85.8 2,476 1.0 3,348 * MICS Indicator 77, MDG Indicator 21 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. In Ghana, 1.6 percent of children aged 10-14 have lost both parents (Table HA.12). Among these 90 percent are currently attending school. Among the children age 10-14 who have both parents alive and living with at least one parent, 86 percent are attending school. 24 Appendix 25 26 27 Table HH.1: Results of household and individual interviews Number of households, women, men and children under 5 by results of the household, women's, men's and under-five's interviews, and household, women's and under-five's response rates, Ghana, 2006 Residence Region Total Urban Rural Western Central Greater Accra Volta Eastern Ashanti Brong Ahafo Northern Upper East Upper West Number of households Sampled households 2,480 3,822 580 520 861 480 641 940 480 710 580 510 6,302 Occupied households 2,470 3,794 577 520 856 478 637 936 476 706 574 504 6,264 Interviewed households 2,327 3,612 561 510 802 447 589 881 442 673 561 473 5,939 Household response rate 94.2 95.2 97.2 98.1 93.7 93.5 92.5 94.1 92.9 95.3 97.7 93.8 94.8 Number of women Eligible women 2,546 3,694 560 434 939 414 606 850 471 824 632 510 6,240 Interviewed women 2,385 3,506 537 426 859 375 565 808 452 790 598 481 5,891 Women response rate 93.7 94.9 95.9 98.2 91.5 90.6 93.2 95.1 96.0 95.9 94.6 94.3 94.4 Women's overall response rate 88.3 90.4 93.2 96.3 85.7 84.7 86.2 89.5 89.1 91.4 92.5 88.5 89.5 Number of men Eligible men 739 1,170 165 121 277 133 176 303 133 260 193 148 1,909 Interviewed men 660 1,083 154 118 237 117 163 272 120 248 179 135 1,743 Men response rate 89.3 92.6 93.3 97.5 85.6 88.0 92.6 89.8 90.2 95.4 92.7 91.2 91.3 Men's overall response rate 84.1 88.1 90.7 95.6 80.2 82.3 85.6 84.5 83.8 90.9 90.6 85.6 86.6 Number of children under 5 Eligible children under 5 1,030 2,515 319 263 330 245 346 426 245 595 399 377 3,545 Mother/Caretaker Interviewed 1,012 2,454 316 262 326 236 337 415 242 576 389 367 3,466 Child response rate 98.3 97.6 99.1 99.6 98.8 96.3 97.4 97.4 98.8 96.8 97.5 97.3 97.8 Children's overall response rate 92.6 92.9 96.3 97.7 92.6 90.1 90.1 91.7 91.7 92.3 95.3 91.4 92.7 28 Table NU.1: Child malnourishment Percentage of children aged 0-59 months who are severely or moderately malnourished, Ghana, 2006 Weight for age Height for age Weight for Height Percenta ge below -2 SD* Percenta ge below -3 SD* Percent- age below -2 SD** Percent- age below -3 SD** Percent- age below -2 SD*** Percent- age below -3 SD*** Percent- age above +2 SD Number of children 0-59 months1 Sex Male 18.3 3.4 23.0 7.4 5.6 1.0 1.0 1,642 Female 17.1 2.8 21.7 7.2 5.1 0.7 1.7 1,524 Region Western 14.6 1.1 20.7 5.5 6.5 0.5 0.9 326 Central 16.3 1.6 26.4 4.6 3.7 0.0 1.6 267 Greater Accra 7.7 1.7 9.8 2.7 3.1 1.1 1.3 406 Volta 20.3 5.4 20.9 8.1 4.8 2.1 0.4 231 Eastern 17.8 3.3 22.0 9.1 4.4 0.3 0.7 430 Ashanti 17.3 2.6 22.6 6.8 5.9 0.8 1.5 468 Brong Ahafo 13.3 1.7 22.2 4.9 3.1 0.5 3.5 288 Northern 26.8 5.9 30.5 12.4 7.1 1.1 1.1 529 Upper East 29.1 5.9 28.4 12.4 11.6 2.8 1.6 127 Upper West 19.1 2.6 22.5 6.0 7.7 0.3 1.4 94 Area Urban 11.5 1.8 13.2 3.4 4.9 1.0 1.7 1,159 Rural 21.4 3.9 27.8 9.6 5.7 0.8 1.1 2,007 Age < 6 months 2.4 0.7 5.0 1.6 3.9 0.1 5.5 361 6-11 months 18.2 3.8 8.6 2.7 8.7 1.6 1.2 322 12-23 months 28.1 4.3 27.6 8.0 11.1 1.3 1.2 667 24-35 months 22.1 5.3 28.1 10.0 4.1 1.2 0.3 632 36-47 months 15.7 2.6 25.2 8.9 2.4 0.7 0.3 629 48-59 months 12.5 1.2 26.0 8.2 2.3 0.2 1.2 554 Mother's education None 23.2 4.8 29.9 11.3 6.2 1.1 1.1 1,210 Primary 16.7 2.8 20.1 6.0 6.1 1.1 0.8 693 Middle/JSS 14.1 2.2 18.2 5.1 4.3 0.5 1.9 1,038 Secondary+ 8.1 0.0 8.7 0.9 3.7 0.6 1.8 225 Wealth index quintiles Poorest 24.8 5.1 30.9 12.0 6.7 1.1 1.5 685 Second 21.3 3.8 29.4 10.7 5.5 0.8 1.3 763 Middle 19.8 3.1 23.0 5.6 5.6 0.6 0.3 626 Fourth 11.2 2.0 15.5 3.9 4.8 0.7 1.8 594 Richest 7.8 0.9 7.4 2.0 3.6 1.1 1.9 498 Total 17.8 3.1 22.4 7.3 5.4 0.9 1.3 3,166 * MICS indicator 6; MDG or 4 ** MICS indicator 7 *** MICS indicator 8 1 Excludes children who were not weighed and measured, those whose measurements are outside a plausible range, and children whose birth dates are not known. Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at each age group, Ghana, 2006 Children 0-3 months Children 0-5 months Children 6-9 months Children 12-15 months Children 20-23 months Percent exclusively breastfed Number of children Percent exclusively breastfed1 Number of children Percent receiving breastmilk and solid/mushy food2 Number of children Percent breastfed Number of children Percent breastfed3 Number of children Sex Male 64.2 113 52.8 202 63.5 125 96.6 112 55.4 106 Female 65.9 106 56.1 181 53.0 107 92.6 121 56.7 116 Area Urban 68.4 89 59.9 148 66.3 73 85.6 70 34.2 72 Rural 62.7 130 50.9 235 55.2 159 98.4 163 66.6 150 Mother's education None 68.8 91 61.1 135 45.8 86 94.9 87 73.3 84 Primary (65.3) 42 53.3 73 62.4 63 95.0 62 (58.0) 38 Middle/JSS 60.7 77 51.2 143 68.8 74 96.9 71 41.8 86 Secondary+ 61.7 10 (43.2) 32 * 10 * 13 * 14 Wealth index quintiles Poorest (76.2) 44 60.8 80 40.4 55 97.5 58 (75.5) 49 Second 53.1 58 45.3 100 58.6 57 97.9 51 65.1 51 Middle (60.6) 42 54.1 63 (73.9) 40 (100) 46 (66.3) 47 Fourth (64.8) 46 51.6 81 60.1 54 (85.6) 44 (33.1) 48 Richest (78.5) 29 64.9 59 (71.2) 26 (88.7) 34 (27.2) 27 Total 65.0 219 54.4 381 57.9 228 94.5 233 56.1 222 1 MICS indicator 15 2 MICS indicator 16 3 MICS indicator 17 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 29 Table CH.1: Vaccinations in first year of life Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Ghana, 2006 Percentage of children who received: BCG* Number of children aged 12-23 months Yellow feverPolio0 Polio1 Polio2 Polio3*** MMR**** (DPT)HH1 (DPT)HH2 (DPT)HH3** All***** None Vaccinated at any time before the survey According to: Vaccination card 83.4 53.0 83.9 81.8 76.4 74.5 84.0 81.8 77.8 69.7 73.9 0.0 706 Mother’s report 10.8 8.2 12.3 9.7 6.1 10.9 10.2 8.5 5.7 3.7 10.5 2.4 706 Either 94.3 61.2 96.2 91.5 82.4 85.4 94.2 90.3 83.5 73.4 84.4 2.5 706 Vaccinated by 12 months of age 94.2 77.7 61.1 95.8 90.5 80.1 93.8 89.2 81.4 64.4 76.7 2.5 706 30 Table CH.2: Vaccinations by background characteristics Percentage of children aged 12-23 months currently vaccinated against childhood diseases, Ghana, 2006 BCG Polio 0 Polio 1 Polio 2 Polio 3 MMR (DPT)HH1 (DPT)HH2 (DPT)HH3 All Yellow fever Percent with health card Number of children aged 12-23 months Sex Male 92.8 59.3 95.6 91.2 81.8 85.7 92.2 89.2 82.5 73.7 85.0 82.5 351 Female 95.7 63.1 96.7 91.8 83.1 85.1 96.1 91.4 84.5 73.1 83.8 87.8 355 Region Western 92.1 67.1 96.7 93.3 86.0 91.5 94.1 90.2 86.1 81.6 91.5 81.8 78 Central (85.3) (60.3) (88.2) (83.3) (69.1) (68.6) (87.6) (81.4) (71.0) 61.8 (61.1) (84.5) 45 Greater Accra 98.1 79.0 99.5 92.2 80.8 89.4 96.2 94.8 85.0 74.4 89.4 70.9 84 Volta (86.0) (51.9) (88.7) (75.4) (63.7) (76.3) (87.9) (73.3) (64.2) 55.7 (72.2) (70.3) 48 Eastern 93.9 51.2 93.9 92.0 88.3 83.1 93.9 92.0 85.1 76.2 83.8 87.9 102 Ashanti 98.6 71.4 100.0 98.8 90.6 95.4 98.6 95.8 91.9 83.2 95.4 91.1 110 Brong Ahafo 97.9 58.5 97.9 93.4 80.5 78.4 95.5 95.5 89.4 65.0 78.4 91.4 56 Northern 93.4 48.7 97.1 90.6 79.6 83.2 93.1 87.5 78.3 67.7 81.3 89.3 135 Upper East (96.3) (62.8) (95.4) (91.5) (88.5) (88.2) (95.4) (92.7) (92.7) 82.6 (89.6) (93.8) 31 Upper West * * * * * * * * * 86.5 * * 18 Area Urban 96.7 74.1 98.8 94.1 85.4 88.1 95.8 92.9 87.6 77.6 86.7 81.6 237 Rural 93.1 54.8 94.9 90.1 80.9 84.0 93.3 89.0 81.4 71.2 83.3 87.0 469 Mother's education None 89.7 51.2 92.7 86.5 75.0 80.2 89.3 84.0 77.2 65.7 79.7 83.0 264 Primary 94.0 55.1 96.8 92.1 83.6 82.3 94.3 89.6 83.2 69.4 79.9 82.8 160 Middle/JSS 98.4 70.7 98.9 95.2 87.9 91.9 98.4 96.2 88.1 82.0 91.2 88.0 236 Secondary+ 100.0 91.4 100.0 98.7 93.3 92.3 100.0 98.7 96.9 86.9 92.3 91.7 46 Wealth index quintiles Poorest 88.7 46.4 92.5 86.6 76.7 78.6 89.2 83.9 75.7 62.1 78.5 85.7 162 Second 91.5 49.4 94.3 87.6 77.1 83.1 92.0 86.2 79.0 71.7 80.6 83.7 159 Middle 95.8 60.1 96.5 95.1 86.4 86.4 96.3 93.6 87.3 76.2 86.4 86.8 151 Fourth 98.1 78.2 99.6 93.5 87.1 84.6 95.8 93.0 88.1 75.8 82.7 87.5 129 Richest 100.0 83.2 100.0 97.1 88.1 98.7 100.0 98.3 91.3 86.4 98.7 81.3 104 Total 94.3 61.2 96.2 91.5 82.4 85.4 94.2 90.3 83.5 73.4 84.4 85.2 706 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 31 Table CH.8: Fuel used for cooking Percent distribution of households according to type of cooking fuel, Ghana, 2006 Percentage of households using: Electricity Liquefied Petroleum Gas (LPG) Biogas Kerosene Charcoal Wood Crop residue/ sawdust None, no cooking Other Total Solid fuels for cooking * Number of households Region Western 0.0 7.7 0.4 0.5 37.7 51.2 0.0 2.5 0.0 100 88.9 617 Central 0.2 6.3 0.0 0.7 31.9 56.3 0.1 4.5 0.0 100 88.3 576 Greater Accra 0.6 31.4 0.5 1.9 58.5 2.3 0.0 4.9 0.0 100 60.8 1,004 Volta 0.0 5.9 0.0 26.6 65.2 0.4 1.6 0.0 100 92.2 486 Eastern 0.0 5.8 0.0 0.3 31.4 60.4 0.0 2.2 0.0 100 91.7 758 Ashanti 0.1 10.4 0.0 0.6 37.4 45.8 0.0 5.4 0.2 100 83.2 988 Brong Ahafo 0.0 5.0 0.0 0.3 28.6 64.3 0.5 1.3 0.0 100 93.5 552 Northern 0.0 0.7 0.0 0.0 19.7 78.3 0.2 1.1 0.0 100 98.2 630 Upper East 0.2 0.6 0.0 0.0 16.3 66.1 15.5 1.2 0.0 100 97.9 202 Upper West 0.0 3.1 0.0 0.3 11.6 84.2 0.0 0.8 0.0 100 95.8 126 Area Urban 0.3 19.7 0.2 1.3 57.7 15.8 0.2 4.8 0.0 100 73.7 2,692 Rural 0.0 2.5 0.0 0.1 15.9 78.6 1.0 1.7 0.1 100 95.5 3,247 Education of household head None 0.1 1.1 0.0 0.0 22.2 73.7 1.5 1.4 0.0 100 97.4 2,817 Primary 0.0 2.2 0.0 0.1 35.6 58.4 0.5 3.2 0.0 100 94.5 544 Middle/JSS 0.0 8.6 0.2 0.8 42.4 43.8 0.1 4.0 0.1 100 86.3 868 Secondary+ 0.6 35.0 0.3 1.7 40.2 17.7 0.4 4.1 0.0 100 58.3 281 Wealth index quintiles Poorest 0.0 0.0 0.0 0.0 0.7 96.6 2.3 0.4 0. 100 99.6 949 0 Second 0.0 0.0 0.0 0.0 5.9 91.4 0.9 1.7 0.0 100 98.3 1,147 Middle 0.0 0.5 0.1 0.2 36.7 58.3 0.2 3.8 0.2 100 95.3 1,285 Fourth 0.0 5.1 0.1 1.1 70.4 18.4 0.1 4.8 0.0 100 88.8 1,341 Richest 0.7 44.1 0.4 1.8 47.7 1.4 0.1 3.8 0.0 100 49.2 1,217 Total 0.1 10.3 0.1 0.6 34.8 50.2 0.6 3.1 0.0 100 85.6 5,939 * MICS indicator 24; MDG indicator 29 32 Table CH.12: Treatment of children with anti-malarial drugs Percentage of children aged 0-59 months who were ill with fever in the last two weeks who received anti-malarial and other medications, Ghana, 2006 Children with a fever in the last two weeks who were treated with: Anti-malarials Other medications Had a fever in last two weeks Number of children aged 0-59 months SP/ Fansi- dar Chloro- quine Armodia- quine Qui- nine Artemi- sin based combina- tions Other anti- malarial Any appropriat e anti- malarial drug Any appropri ate anti- malarial drug within 24 hours of onset of sympto ms * Parace- tamol/ Panadol/ Acetamino- phan Aspi -rin Ibu- profen Other Don't know Number of children with fever in last two weeks Age 0-11 months 14.7 712 0.0 35.2 8.6 0.0 1.9 1.9 45.7 28.6 74.3 1.0 1.0 16.2 1.0 105 12-23 months 27.3 715 1.0 48.7 13.8 0.5 4.1 4.6 68.2 54.9 77.9 2.1 0.5 16.9 2.6 195 24-35 months 27.6 664 0.5 50.8 7.7 1.6 2.2 2.7 62.8 53.6 79.8 0.5 2.2 16.9 2.2 183 36-47 months 23.9 728 1.1 39.7 12.6 2.9 4.6 2.9 58.6 46 77.6 1.7 3.4 14.9 1.7 174 48-59 months 21.4 649 0.0 46.0 15.8 1.4 3.6 2.9 64.0 49.6 79.1 0.7 2.2 12.2 3.6 139 Total 23.0 3,468 0.6 45.0 11.8 1.4 3.4 3.1 61.2 48.2 78.0 1.5 4.5 18.2 1.5 796 *MICS indicator 39; MDG indicator 22 33 EN. 1: Use of Improved Water Sources and Improved Sanitation Percent distribution of household population according to main source of drinking water and percentage of households using improved drinking water sources, Ghana, 2006 Main source of drinking water: Improved sources Unimproved sources Piped into dwelling Piped into yard or plot Public tap/ stand- pipe Bore- hole Protec- ted well Spring Sachet water Bottled water Un- protected well Rain- water collec- tion Tanker- truck River/ stream Dam/lake/pond/canal/ irrigation channel Other Total Improved source of drinking water* Number of households Region Western 3.6 7.3 35.5 22.2 11.1 2.4 1.1 0.0 8.5 0.0 1.1 6.9 0.3 0.0 100.0 83.2 2,451 Central 3.9 7.4 48.7 12.5 4.0 0.1 3.3 0.3 2.7 0.4 0.0 15.5 1.1 0.0 100.0 80.2 2,024 Greater Accra 15.1 15.0 30.4 0.8 0.2 0.0 25.9 0.8 0.1 0.2 4.7 1.8 0.0 5.0 100.0 88.1 3,911 Volta 2.2 3.8 27.7 15.8 0.6 0.8 1.8 0.0 17.4 4.4 0.0 12.7 6.1 6.6 100.0 52.7 1,978 Eastern 1.1 9.3 14.1 31.7 7.3 0.0 3.0 0.0 4.2 0.6 0.1 23.0 5.7 0.0 100.0 66.4 3,099 Ashanti 5.0 10.1 32.1 32.6 8.5 0.8 1.0 0.0 3.2 0.0 1.4 4.9 0.4 0.0 100.0 90.0 3,854 Brong Ahafo 2.9 4.2 24.9 32.3 5.7 0.0 1.7 0.0 7.0 0.2 0.0 21.1 0.0 0.0 100.0 71.7 2,295 Northern 0.9 6.4 11.9 47.7 5.6 0.5 0.0 0.0 6.4 0.1 0.1 17.1 3.1 0.1 100.0 73.0 3,549 Upper East 1.4 2.6 3.9 65.9 9.0 0.1 0.3 0.0 14.8 0.0 0.0 1.9 0.2 0.0 100.0 83.1 1,134 Upper West 0.5 1.0 2.9 86.8 1.8 1.5 0.4 0.0 1.0 0.0 0.2 2.2 1.7 0.0 100.0 94.8 652 Area Urban 10.1 16.8 38.8 6.5 6.6 0.3 11.3 0.3 3.5 0.2 2.4 0.7 0.0 2.4 100.0 90.7 10,315 Rural 0.7 2.0 15.8 44.1 4.7 0.7 1.0 0.0 7.3 0.7 0.2 18.9 3.2 0.6 100.0 69.1 14,632 Education of household head None 0.7 3.8 20.4 42.6 4.7 0.8 0.8 0.1 7.2 0.5 0.4 14.1 2.8 1.0 100.0 74.0 8,832 Primary 2.7 4.1 27.6 25.7 4.0 0.7 3.5 0.0 7.9 0.5 1.4 15.4 3.3 3.3 100.0 68.2 3,327 Middle/JSS 4.7 9.1 30.9 22.9 7.2 0.4 5.3 0.1 4.9 0.6 1.6 9.9 1.2 1.3 100.0 80.6 8,665 Secondary+ 14.3 18.5 22.3 12.7 4.8 0.2 16.4 0.4 2.5 0.4 1.3 5.4 0.3 0.5 100.0 89.6 4,123 Wealth index quintiles Poorest 0.0 0.1 1.9 56.8 3.6 1.7 0.0 0.0 7.4 0.3 0.0 21.6 6.6 0.0 100.0 64.1 4,992 Second 0.0 0.5 14.0 41.1 7.9 0.6 0.0 0.0 8.8 0.5 0.0 23.7 2.0 1.0 100.0 64.1 4,984 Middle 0.3 1.8 38.3 28.2 7.1 0.3 0.9 0.0 8.8 1.2 1.5 8.6 0.8 2.2 100.0 76.9 4,991 Fourth 3.9 12.2 45.4 15.1 6.8 0.1 5.1 0.0 3.2 0.4 2.3 3.0 0.0 2.5 100.0 88.6 4,995 Richest 18.7 26.1 27.1 1.6 2.0 0.0 20.4 0.7 0.6 0.2 1.7 0.0 0.0 0.9 100.0 96.6 4,986 Total 4.6 8.1 25.3 28.6 5.5 0.5 5.3 0.1 5.7 0.5 1.1 11.4 1.9 1.3 100.0 78.1 24,947 * MICS indicator 11 34 Table EN.5: Use of sanitary means of excreta disposal Percent distribution of household population according to type of toilet facility used by the household, and the percentage of household members using sanitary means of excreta disposal, Ghana, 2006 Type of toilet facility used by household Improved sanitation facility Unimproved sanitation facility Flush to piped sewer system Flush to septic tank Flush to pit (latrine) Ventilated Improved Pit latrine (VIP) Pit latrine with slab Pit latrine without slab/ open pit Bucket No facilities/ bush/ field Other/Missing Total Percentage of population using sanitary means of excreta disposal * Number of household members Region Western 0.5 8.2 0.4 29.5 37.3 11.3 0.0 12.8 0.0 100.0 75.9 2,451 Central 1.4 5.9 1.0 29.6 24.8 17.9 1.3 18.1 0.0 100.0 62.7 2,024 Greater Accra 5.4 19.6 13.0 36.3 11.0 5.4 0.8 8.1 0.3 100.0 85.4 3,911 Volta 0.9 2.9 0.7 25.5 8.9 30.1 0.3 30.8 0.0 100.0 38.8 1,978 Eastern 1.3 3.3 0.5 24.2 20.3 42.0 2.9 5.5 0.0 100.0 49.6 3,099 Ashanti 4.1 9.9 0.6 46.4 26.1 9.0 0.5 3.4 0.1 100.0 87.0 3,854 Brong Ahafo 0.6 1.4 0.6 40.4 36.0 14.5 0.0 6.4 0.0 100.0 79.1 2,295 Northern 0.0 0.5 0.8 19.7 4.1 1.1 0.9 72.9 0.0 100.0 25.1 3,549 Upper East 0.0 0.4 0.0 11.3 5.7 0.6 0.0 81.9 0.0 100.0 17.5 1,134 Upper West 0.0 6.0 0.2 6.6 4.5 3.4 0.0 78.7 0.7 100.0 17.2 652 Area 0.0 Urban 3.8 14.9 5.3 46.5 12.0 7.0 1.7 8.7 0.1 100.0 82.6 10,315 Rural 0.6 1.2 0.6 19.0 23.8 19.0 0.2 35.5 0.1 100.0 45.3 14,632 Education of household head 0.0 None 0.4 1.8 0.7 22.8 14.7 12.4 0.0 47.1 0.0 100.0 40.4 8,832 Primary 0.4 4.5 1.2 30.4 24.6 17.5 0.8 20.4 0.4 100.0 60.9 3,327 Middle/JSS 1.9 7.0 2.4 37.1 23.7 16.4 1.3 10.1 0.1 100.0 72.1 8,665 Secondary+ 6.6 19.6 7.8 32.6 13.3 9.7 1.4 9.0 0.0 100.0 79.9 4,123 Wealth index quintiles Poorest 0.0 0.0 0.0 1.3 15.7 15.6 0.0 67.4 0.0 100.0 17.0 4,992 Second 0.0 0.0 0.0 16.4 29.4 24.2 0.0 30.0 0.1 100.0 45.7 4,984 Middle 0.3 0.8 0.6 43.6 22.8 17.4 0.5 13.7 0.3 100.0 68.1 4,991 Fourth 1.2 5.4 2.2 53.3 18.7 9.2 1.6 8.3 0.1 100.0 80.9 4,995 Richest 8.1 28.2 9.9 37.4 8.1 3.6 2.0 2.6 0.0 100.0 91.7 4,986 Total 1.9 6.9 2.6 30.4 18.9 14.0 0.8 24.4 0.1 100.0 60.7 24,947 * MICS indicator 12; MDG indicator 31 35 Table RH.1: Use of contraception Percentage of women aged 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Ghana, 2006 Percent of women (currently married or in union) who are using: Percentage not using any method Female sterilisation Pill IUD Injec- tions Im- plants Male Condom Female condom Diaphragm/ foam/jelly LAM Periodic absti- nence With- drawal Other Total Any modern method Any traditional method Any method* Number of women currently married or in union Region Western 91.4 0.2 3.7 0.5 2.2 0.2 0.0 0.0 0.0 1.0 0.6 0.3 0.0 100 6.7 1.8 8.6 345 Central 77.4 0.4 8.2 0.7 7.8 1.7 0.1 0.0 0.0 1.4 0.6 1.0 0.7 100 18.9 3.7 22.6 251 Greater Accra 71.2 0.6 4.0 1.3 6.5 1.2 2.9 0.1 0.7 0.5 9.6 0.4 1.1 100 17.3 11.6 28.8 518 Volta 86.6 0.5 2.1 7.8 0.6 1.0 0.0 0.6 0.0 0.9 0.0 0.0 100 12.5 0.9 13.4 315 Eastern 82.1 0.3 4.9 0.0 6.5 0.4 3.7 0.0 0.5 0.0 1.3 0.0 0.3 100 16.3 1.6 17.9 414 Ashanti 81.8 0.8 7.1 0.0 4.4 0.3 2.2 0.0 0.2 0.5 2.2 0.2 0.2 100 15.0 3.2 18.2 526 Brong Ahafo 82.9 0.4 8.0 0.0 5.5 0.5 1.4 0.0 0.0 0.9 0.0 0.0 0.5 100 15.7 1.4 17.1 294 Northern 91.7 0.1 2.2 0.2 5.2 0.0 0.3 0.3 0.0 0.0 0.0 0.0 0.0 100 8.3 0.0 8.3 551 Upper East 85.0 0.0 3.5 0.0 10.4 0.6 0.5 0.0 0.0 0.0 0.0 0.0 0.0 100 15.0 0.0 15.0 150 Upper West 90.7 0.0 2.6 0.3 6.1 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100 9.3 0.0 9.3 100 Total 83.3 0.4 4.7 0.3 5.8 0.6 1.5 0.1 0.3 0.4 2.1 0.2 0.3 100 13.6 3.1 16.7 3,456 * MICS indicator 21; MDG indicator 19c 36 37 Table RH.5: Assistance during delivery Percent distribution of women aged 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery and the place of delivery, Ghana, 2006 Medical doctor Nurse/ midwife/ Auxiliary Midwife/ Community Health Worker Trained Traditional birth attendant Untrained Traditional birth attendant Relative/ friend Other No attendant Total Any skilled personnel * Delivered in health facility ** Number of women who gave birth in preceding two years Region Western 2.0 37.6 42.3 9.2 5.8 0.7 2.3 100 39.6 39.4 144 Central 5.9 37.7 35.1 7.1 8.7 1.9 3.6 100 43.6 45.0 105 Greater Accra 28.7 54.3 3.7 1.0 8.8 0.0 3.6 100 83.0 83.1 167 Volta 9.6 35.0 7.0 8.2 31.0 4.2 5.0 100 42.7 41.7 97 Eastern 8.3 30.5 26.5 16.0 15.4 0.0 3.3 100 37.8 39.5 182 Ashanti 14.5 46.0 23.5 6.6 6.7 0.0 2.8 100 60.5 59.6 207 Brong Ahafo 4.1 54.0 21.1 4.9 10.7 0.0 5.2 100 58.1 57.2 107 Northern 1.0 37.1 16.1 17.7 26.0 1.6 0.6 100 38.0 34.4 260 Upper East 2.2 41.8 17.3 10.8 19.8 5.8 2.2 100 44.1 42.3 58 Upper West (4.0) (25.1) (27.1) (1.6) (38.4) (3.2) (0.6) 100 (29.1) (28.4) 37 Area Urban 19.6 57.4 10.2 3.1 6.4 0.5 2.8 100 76.9 77.1 468 Rural 3.3 32.2 27.2 13.0 19.9 1.5 2.8 100 35.1 33.9 897 Age 15-19 4.7 31.9 21.3 10.5 20.1 1.8 9.6 100 36.6 41.7 89 20-24 4.4 44.2 25.2 10.6 13.6 1.0 1.0 100 48.3 49.0 317 25-29 10.6 44.4 16.8 8.9 16.9 1.4 0.9 100 55.1 51.8 380 30-34 9.1 42.8 23.7 7.7 11.1 1.1 4.4 100 51.2 49.6 269 35-39 13.8 34.5 22.1 10.5 15.6 0.6 3.0 100 48.3 47.7 210 40-44 12.5 34.9 22.4 7.6 16.9 0.7 5.1 100 46.0 47.3 75 45-49 (0.0) (23.3) (10.3) (23.8) (34.1) (3.5) (5.1) 100 (23.3) (26.1) 25 Education 0.0 None 3.6 27.8 20.5 16.8 24.7 2.4 4.2 100 31.4 29.7 503 Primary 6.7 40.9 25.4 7.9 16.4 0.3 2.4 100 46.6 45.9 300 Middle/JSS 11.9 51.1 22.5 4.7 7.1 0.6 2.1 100 62.8 63.4 465 Secondary+ 28.2 59.2 9.0 0.9 2.6 0.0 0.0 100 87.4 85.2 97 Total 8.9 40.8 21.4 9.6 15.3 1.1 2.8 100 49.4 48.7 1,365 * MICS indicator 4; MDG indicator 17 ** MICS indicator 5 Note: Figures in parentheses are based on 25-49 unweighted cases. Table CP.1: Birth registration Percent distribution of children aged 0-59 months by birth registration status and reasons for non-registration, Ghana, 2006 Birth is not registered because: Birth is regis- tered * Don't know if birth is regis- tered Num- ber of child- ren aged 0-59 months Costs too much Must travel too far Didn't know child should be regis- tered Late, didn't want to pay fine Doesn't know where to register Other Don't know Total Number of children aged 0-59 months without birth regist- ration Sex Male 52.2 0.7 1,789 26.6 20.3 17.1 2.8 12.4 15.9 4.9 100 868 Female 50.7 0.8 1,678 28.3 20.2 19.0 3.1 11.8 13.6 4.0 100 830 Region 0.0 Western 48.3 0.2 347 23.8 21.8 18.2 11.6 14.4 6.0 4.3 100 180 Central 52.3 0.6 302 27.2 21.4 14.2 7.6 12.0 16.0 1.6 100 144 Greater Accra 71.8 0.7 448 35.9 23.0 3.5 3.3 6.7 21.6 6.1 100 127 Volta 46.5 1.9 261 19.6 22.3 7.4 0.0 13.9 24.9 12.0 100 141 Eastern 38.3 0.8 463 27.7 12.3 15.2 0.3 12.4 28.5 3.7 100 288 Ashanti 56.2 0.5 506 30.9 19.4 16.1 0.8 9.6 20.4 2.8 100 224 Brong Ahafo 49.4 0.7 311 35.5 21.7 17.7 5.8 10.4 6.6 2.2 100 158 Northern 46.6 0.7 579 20.1 25.3 30.0 0.5 16.8 3.2 4.2 100 313 Upper East 53.2 2.0 146 38.6 21.1 23.1 0.4 5.0 3.5 8.5 100 70 Upper West 50.1 0.3 105 30.7 11.3 37.8 0.5 8.9 7.5 3.2 100 52 Area Urban 68.5 0.5 1,236 33.8 14.9 10.1 4.0 7.7 25.8 3.7 100 393 Rural 42.0 0.9 2,231 25.6 21.9 20.4 2.6 13.4 11.5 4.7 100 1,305 Age 0-11 months 44.1 0.0 715 21.1 21.8 15.0 1.2 11.6 26.4 2.8 100 404 12-23 months 59.8 0.2 706 25.1 22.1 22.1 2.8 10.5 14.4 3.1 100 289 24-35 months 57.1 1.3 667 29.9 16.7 18.5 4.9 12.5 11.8 5.7 100 288 36-47 months 51.9 0.6 718 28.7 21.9 17.6 2.4 14.1 9.9 5.4 100 347 48-59 months 44.3 1.8 661 33.2 18.2 18.1 3.9 11.8 9.2 5.5 100 370 Mother's education None 41.4 0.8 1,343 25.7 19.9 26.4 2.6 14.3 7.2 3.9 100 792 Primary 48.0 1.3 753 27.8 20.0 12.0 2.3 13.5 19.6 5.0 100 395 Middle/JSS 59.5 0.5 1120 29.4 20.1 10.4 4.1 8.1 22.4 5.5 100 458 Secondary+ 79.4 0.0 251 35.2 29.4 3.9 1.7 3.6 26.2 0.0 100 53 Total 51.4 0.8 3,467 27.5 20.2 18.0 2.9 12.1 14.8 4.5 100 1,698 * MICS Indicator 62 38 39 Table CP.5.1A: Early marriage Percentage of women aged 15-49 years in marriage or union before their 15th birthday, percentage of women aged 20-49 years in marriage or union before their 18th birthday, Ghana, 2006 Percentage married before age 15 * Number of women aged 15-49 years Percentage married before age 18 ** Number of women aged 20-49 years Region Western 4.2 593 27.4 459 Central 2.9 455 22.2 357 Greater Accra 3.0 1,125 17.8 883 Volta 8.0 426 30.1 Eastern 2.1 741 20.5 578 Ashanti 4.3 888 27.5 697 Brong Ahafo 6.0 569 31.0 448 Northern 5.8 745 31.0 624 Upper East 5.7 218 36.3 175 Upper West 5.4 130 36.9 107 Wealth index quintiles Poorest 5.6 954 32.5 770 Second 7.0 1,037 34.5 835 Middle 5.2 1,149 29.0 894 Fourth 2.8 1,298 23.8 1,046 Richest 2.4 1,451 14.6 1,127 Total 4.4 5,876 26.0 4,660 * MICS Indicator 67 ** MICS Indicator 67 Table HA.9.2A: Higher risk sex and condom use at last high-risk sex Women and men age 15-49 who had sexual intercourse in the past 12 months, the among those who higher risk sexual intercourse in the past 12 months, and among those having higher-risk intercourse, percentage of who used condom at the last higher-risk sex in the last 12 months, Ghana 2006 Women Men Percent who had higher-risk intercourse in the past 12 months 1 Number of women who had sex in last 12 months Percentage reporting condom use at last higher risk sex 2 Number of women who had higher risk intercourse in the past 12 months Percent who had higher-risk intercourse in the past 12 months 1 Number of men who had sex in last 12 months Percentage reporting condom use at last higher risk sex 2 Number of men who had higher risk intercourse in last 12 months Area Urban 27.6 1,722 33.5 475 46 471 56.9 217 Rural 17.2 2,239 33.2 386 35.6 635 50.1 226 Age 15-24 51.5 1101 41.8 567 87.9 236 55.7 207 15-19 81 345 40.8 279 96.1 71 59.7 68 20-24 38.1 756 42.4 288 84.3 165 53.8 139 25-29 16.1 790 22.9 127 48 206 64.7 99 30-34 9.3 660 17.7 61 28.7 198 43.3 57 35-39 8 597 (10.9) 48 25.1 168 (47.3) 42 40-44 7.6 455 (16.4) 35 16.5 148 * 24 45-49 6.7 358 * 24 8.8 150 * 13 Education None 9 1,189 20.4 107 27.2 186 30.9 51 Primary 21.8 787 24.7 172 36.1 143 32.7 52 Middle/JSS 25.7 1,485 33 382 42 530 59.8 223 Secondary+ 40.6 500 48.4 201 47.9 246 60.2 118 Total 21.7 3,961 33.4 861 40.1 1,106 53.5 443 1 MICS indicator 85 for Women 15-24 and UNAIDS Sexual Behavior Indicator 1 'Higher risk sex in the last year' 2 MICS indicator 83; MDG indicator 19a for Women 15-24 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases 40 Table HA.9.2B: Higher risk sex and condom use at last high-risk sex in the past 12 months Among women and men age 15-49 who had sexual intercourse in the past 12 months, the percentage who higher risk sexual intercourse in the past 12 months, and among those having higher-risk intercourse, percentage of who used condom at last 12 months, Ghana 2006 Women Men Percent who had higher-risk intercourse in the past 12 months 1 Number of women who had sex in last 12 months Percentage reporting condom use at last higher risk sex 2 Number of women who had higher risk intercourse in the past 12 months Percent who had higher-risk intercourse in the past 12 months 1 Number of men who had sex in last 12 months Percentage reporting condom use at last higher risk sex 2 Number of men who had higher risk intercourse in last 12 months Region Western 23.5 399 22.7 94 33.3 124 (61.6) 41 Central 24.2 324 35.2 78 46.4 78 (24.1) 36 Greater Accra 29.4 687 37.7 202 51.9 194 53.1 101 Volta 15.7 322 34.2 50 28.7 74 * 21 Eastern 24.2 486 39.6 118 43.3 137 48.6 59 Ashanti 21 610 23.1 128 32.4 189 54.2 61 Brong Ahafo 27.5 388 27.2 107 48.1 100 (73.2) 48 Northern 11.5 522 45.7 60 35.6 152 42.3 54 Upper East 13.7 143 * 20 45.3 39 * 18 Upper West 6.6 82 * 5 16.2 19 * 3 Wealth index quintiles Poorest 12.8 685 26 88 34.3 201 38.5 69 Second 17.6 752 28.9 132 28.6 184 42 53 Middle 24.1 787 24.7 190 40.5 204 55.3 83 Fourth 26.6 849 35.2 226 50.6 251 60.1 127 Richest 25.4 888 44.3 226 42 266 59.2 112 Total 21.7 3,961 33.4 861 40.1 1,106 53.5 443 1 MICS indicator 85 for Women 15-24 and UNAIDS Sexual Behaviour Indicator 1 'Higher risk sex in the last year' 2 MICS indicator 83; MDG indicator 19a for Women 15-24 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25- 49 unweighted cases. 41 Summary Table of Findings Contents List of Tables Acknowledgements 1 Background and Objectives 1.1 Introduction 1.2 Survey Objectives 2 Sample and Survey Methodology 2.1 Sample Design 2.2 Questionnaires 2.3 Fieldwork and Processing 2.4 Sample Coverage 3 Results 3.1 Child Mortality 3.2 Nutritional Status 3.3 Breastfeeding 3.5 Immunization 3.6 Antibiotic Treatment and Medical Consultations for Child 3.7 Solid Fuel Use 3.8 Malaria 3.9 Water and Sanitation 3.10 Contraception 3.11 Assistance at Delivery 3.12 Primary School Attendance 3.13 Birth Registration 3.14 Early Marriage and Polygyny 3.15 Knowledge of HIV/AIDS Transmission and Condom Use 3.16 Orphans School Attendance Appendix

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