Guyana Monitoring the Situation of Children and Women Multiple Indicator Cluster Survey 2014

Publication date: 2015

GUYANA Monitoring the situation of children and women Multiple Indicator Cluster Survey 2014 Guyana Monitoring the Situation of Children and Women Multiple Indicator Cluster Survey 2014 The Guyana Multiple Indicator Cluster Survey Round 5 (MICS5) was carried out in 2014 by the Bureau of Statistics,as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF, the Inter-American Development Bank (IDB) and the Government of Guyana provided financial support. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. The Guyana MICS 2014 results will be critically important for final MDG reporting in 2015, and are expected to form part of the baseline data for the post-2015 era. Suggested citation: Bureau of Statistics, Ministry of Public Health and UNICEF. 2015. Guyana Multiple Indicator Cluster Survey 2014, Final Report. Georgetown, Guyana: Bureau of Statistics, Ministry of Public Health and UNICEF. Summary Table of Survey Implementation and the Survey Population, Guyana, 2014 Survey implementation Sample frame - Updated Guyana 2012 Population and Housing Census February-March 2014 Questionnaires Household Women (age 15-49) Men (age 15-49) Children under five Interviewer training March 2014 Fieldwork April-July 2014 Survey sample Households - Sampled - Occupied - Interviewed - Response rate (Per cent) 5,904 5,526 5,077 91.9 Children under five - Eligible - Mothers/caretakers interviewed - Response rate (Per cent) 3,482 3,358 96.4 Women - Eligible for interviews - Interviewed - Response rate (Per cent) 5,809 5,076 87.4 Men - Eligible for interviews - Interviewed - Response rate (Per cent) 2,526 1,682 66.6(+) (+) Due to the low response rate among men further analysis will be done and results should be interpreted with caution. Survey population Average household size 3.8 Percentage of population living in - Urban areas - Rural areas - Barima-Waini (Region 1) - Pomeroon-Supenaam (Region 2) - Essequibo Islands-West Demerara (Region 3) - Demerara-Mahaica (Region 4) - Mahaica-Berbice (Region 5) - East Berbice-Corentyne (Region 6) - Cuyuni-Mazaruni& Potaro-Siparuni (Regions 7&8) - Upper Takutu-Upper Essequibo (Region 9) - Upper Demerara-Berbice (Region 10) 27.2 72.8 1.9 5.5 15.7 44.3 6.8 14.7 2.7 3.4 5.0 Percentage of population under: - Age 5 - Age 18 9.6 36.0 Percentage of women age 15-49 years with at least one live birth in the last 2 years 15.2 Housing characteristics Household or personal assets Percentage of households with - Electricity - Finished floor - Finished roofing - Finished walls 86.9 81.2 97.0 93.2 Percentage of households that own - A television - A refrigerator - Agricultural land - Farm animals/livestock 88.0 78.1 13.6 18.8 Mean number of persons per room used for sleeping 1.87 Percentage of households where at least a member has or owns a - Mobile phone - Car or truck 88.6 23.1 iiiMultiple indicator cluster survey 2014 | Summary Table of Findings1 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Guyana, 2014 CHILD MORTALITY Early childhood mortalitya MICS Indicator Indicator Description Value 1.1 Neonatal mortality rate Probability of dying within the first month of life 23 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 32 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 9 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 8 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 39 aRates refer to the 5-year period preceding the survey. NUTRITION Nutritional status MICS Indicator Indicator Description Value 2.1a 2.1b MDG 1.8 Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard 8.5 2.2 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height for age of the WHO standard 12.0 3.4 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard 6.4 1.7 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard 5.3 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 89.0 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 49.2 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 23.3 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishmentduring the previous day 36.2 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 55.6 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 40.9 2.11 Median duration of breastfeeding The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 14.1 1 See Appendix E for a detailed description of MICS indicators iv 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 40.5 2.13 Introduction of solid, semi- solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day 80.9 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day 83.9 2.15 Minimum meal frequency Percentage of children age 6-23 months who received solid, semi-solid and soft foods (plus milk feeds for non-breastfed children) the minimum number of times or more during the previous day 61.6 2.16 Minimum dietary diversity Percentage of children age 6–23 months who received foods from 4 or more food groups during the previous day 65.2 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children age 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children age 6–23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 30.1 54.0 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 69.5 Salt iodization 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of iodide/iodate 19.8 Low-birthweight 2.20 Low-birthweight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 13.6 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 93.9 CHILD HEALTH Vaccinations MICS Indicator Indicator Description Value 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 94.5 3.2 Polio immunization coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 90.2 3.3 3.5 3.6 Diphtheria, pertussis and tetanus (DPT), Hepatitis B (HepB) and Haemophilus influenzae type B (Hib) immunization coverage (Pentavalent) Percentage of children age 12-23 months who received the third dose of DPT vaccine (DPT3), Hepatitis B (HepB) and Haemophilus influenzae type B (Hib) by their first birthday 89.4 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 24-35 months who received measles vaccine by their second birthday 93.4 3.7 Yellow fever immunization coverage Percentage of children age 24-35 months who received yellow fever vaccine by their second birthday 92.3 3.8 Full immunization coverage Percentage of children age 24-35 months who received all vaccinations recommended in the national immunization schedule by their first birthday (measles and yellow fever by second birthday) 68.9 CHILD MORTALITY Early childhood mortalitya MICS Indicator Indicator Description Value 1.1 Neonatal mortality rate Probability of dying within the first month of life 23 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 32 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 9 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 8 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 39 aRates refer to the 5-year period preceding the survey. NUTRITION Nutritional status MICS Indicator Indicator Description Value 2.1a 2.1b MDG 1.8 Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard 8.5 2.2 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height for age of the WHO standard 12.0 3.4 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard 6.4 1.7 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard 5.3 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 89.0 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 49.2 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 23.3 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishmentduring the previous day 36.2 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 55.6 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 40.9 2.11 Median duration of breastfeeding The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 14.1 1 See Appendix E for a detailed description of MICS indicators vMultiple indicator cluster survey 2014 | Tetanus toxoid 3.9 Neonatal tetanus protection Percentage of women age 15-49 years with a live birth in the last 2 years who were given at least two doses of tetanus toxoid vaccine within the appropriate interval prior to the most recent birth 22.3 Diarrhoea - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 8.3 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 60.9 3.S1 Diarrhoea treatment with oral rehydration salts (ORS) Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS 42.5 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 28.9 Acute Respiratory Infection (ARI) symptoms - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 2.2 3.13 Care-seeking for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 83.6 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 30.9 Solid fuel use 3.15 Use of solid fuels for cooking Percentage of household members in households that use solid fuels as the primary source of domestic energy to cook 6.9 Malaria / Fever - Children with fever Percentage of children under age 5 with fever in the last 2 weeks 13.7 3.16a 3.16b Household availability of insecticide-treated nets (ITNs) Percentage of households with (a) at least one ITN (b) at least one ITN for every two people 5.3 2.8 3.18 MDG 6.7 Children under age 5 who slept under an ITN Percentage of children under age 5 who slept under an ITN the previous night 7.4 3.19 Population that slept under an ITN Percentage of household members who slept under an ITN the previous night 3.8 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 70.7 3.21 Malaria diagnostics usage Percentage of children under age 5 with fever in the last 2 weeks who had a finger or heel stick for malaria testing 12.0 3.22 MDG 6.8 Anti-malarial treatment of children under age 5 Percentage of children under age 5 with fever in the last 2 weeks who received any antimalarial treatment 7.4 3.23 Treatment with Artemisinin-based Combination Therapy (ACT) among children who received anti- malarial treatment Percentage of children under age 5 with fever in the last 2 weeks who received ACT (or other first-line treatment according to national policy) (0.0) 3.24 Pregnant women who slept under an ITN Percentage of pregnant women who slept under an ITN the previous night 6.9 () Based on 25-49 unweighted cases MIC S indicator 3.11 is not REPORTED because Zinc in Guyana is not provided as standard treatment for diarrhea. Instead, indicator 3.S1 is included to report the single treatment with ORS which is the recommended treatment. vi WATER AND SANITATION MICS Indicator Indicator Description Value 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 94.2 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 27.4 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 86.9 4.4 Safe disposal of child’s faeces Percentage of children age 0-2 years whose last stools were disposed of safely 43.0 4.5 Place for handwashing Percentage of households with a specific place for hand washing where water and soap or other cleansing agent are present 78.8 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent 79.4 REPRODUCTIVE HEALTH Contraception and unmet need MICS Indicator Indicator Description Value - Total fertility rate Total fertility ratefor women age 15-49 years 2.6 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rate for women age 15-19 years 74 5.2 Early childbearing Percentage of women age 20-24 years who had at least one live birth before age 18 15.8 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method 34.1 5.4 MDG 5.6 Unmet need Percentage of women age 15-49 years who are currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception 28.0 Maternal and newborn health 5.5a 5.5b MDG 5.5 MDG 5.5 Antenatal care coverage Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 90.7 86.7 5.6 Content of antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 93.6 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 92.4 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 92.7 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 16.9 viiMultiple indicator cluster survey 2014 | Post-natal health checks 5.10 Post-partum stay in health facility Percentage of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years 98.0 5.11 Post-natal health check for the newborn Percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery 95.4 5.12 Post-natal health check for the mother Percentage of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live birth in the last 2 years 93.0 CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 61.0 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 87.2 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 15.9 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 54.8 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 47.3 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 68.5 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 5.0 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social-emotional, and learning 85.6 LITERACY AND EDUCATION MICS Indicator Description Value 7.1 MDG 2.3 Literacy rate among young people Percentage of young people age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education (a) women (b) men 98.0 97.7 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 84.9 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 83.3 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 97.0 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 84.5 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 96.4 Indicator viii Post-natal health checks 5.10 Post-partum stay in health facility Percentage of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years 98.0 5.11 Post-natal health check for the newborn Percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery 95.4 5.12 Post-natal health check for the mother Percentage of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live birth in the last 2 years 93.0 CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 61.0 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 87.2 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 15.9 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 54.8 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 47.3 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 68.5 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 5.0 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social-emotional, and learning 85.6 LITERACY AND EDUCATION MICS Indicator Description Value 7.1 MDG 2.3 Literacy rate among young people Percentage of young people age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education (a) women (b) men 98.0 97.7 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 84.9 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 83.3 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 97.0 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 84.5 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 96.4 Indicator 7.7 Primary completion rate Number of children attending the last grade of primary school (excluding repeaters) divided by number of children of primary school completion age (age appropriate to final grade of primary school) 109.1 7.8 Transition rate to secondary school Number of children attending the last grade of primary school during the previous school year who are in the first grade of secondary school during the current school year divided by number of children attending the last grade of primary school during the previous school year 95.9 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 1.00 7.10 MDG 3.1 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 1.08 CHILD PROTECTION Birth registration MICS Indicator Indicator Description Value 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 88.7 Child labour 8.2 Child labour Percentage of children age 5-17 years who are involved in child labour 18.3 Child discipline 8.3 Violent discipline Percentage of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month 69.7 Early marriage and polygyny 8.4 Marriage before age 15 Percentage of people age 15-49 years who were first married or in union before age 15 (a) Women (b) Men 4.4 1.0 8.5 Marriage before age 18 Percentage of people age 20-49 years who were first married or in union before age 18 (a) Women (b) Men 26.9 6.6 8.6 Young people age 15- 19 years currently married or in union Percentage of young people age 15-19 years who are married or in union (a) Women (b) Men 13.3 13.4 8.7 Polygyny Percentage of people age 15-49 years who are in a polygynous union (a) Women (b) Men 3.3 4.2 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older, (a) among women age 15-19 years, (b) among women age 20-24 years 15.5 15.1 ixMultiple indicator cluster survey 2014 | Attitudes towards domestic violence 8.12 Attitudes towards domestic violence Percentage of people age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food (a) Women (b) Men 10.2 9.6 Children’s living arrangements 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 10.0 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 7.0 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 5.7 HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes MICS Indicator Indicator Description Value - Have heard of AIDS Percentage of people age 15-49 years who have heard of AIDS (a) Women (b) Men 97.5 97.4 9.1 MDG 6.3 Knowledge about HIV prevention among young people Percentage of young people age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission (a) Women (b) Men 51.5 40.2 9.2 Knowledge of mother- to-child transmission of HIV Percentage of people age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV (a) Women (b) Men 52.5 34.6 9.3 Accepting attitudes towards people living with HIV Percentage of people age 15-49 years expressing accepting attitudes on all four questions toward people living with HIV (a) Women (b) Men 23.2 23.0 HIV testing 9.4 People who know where to be tested for HIV Percentage of people age 15-49 years who state knowledge of a place to be tested for HIV (a) Women (b) Men 90.0 87.6 9.5 People who have been tested for HIV and know the results Percentage of people age 15-49 years who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 26.3 24.9 9.6 Sexually active young people who have been tested for HIV and know the results Percentage of young people age 15-24 years who have had sex in the last 12 months, who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 40.8 26.5 x 9.7 HIV counselling during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 66.7 9.8 HIV testing during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 84.8 Sexual behaviour 9.9 Young people who have never had sex Percentage of never married young people age 15-24 years who have never had sex (a) Women (b) Men 79.0 55.8 9.10 Sex before age 15 among young people Percentage of young people age 15-24 years who had sexual intercourse before age 15 (a) Women (b) Men 4.9 12.6 9.11 Age-mixing among sexual partners Percentage of women age 15-24 years who had sex in the last 12 months with a partner who was 10 or more years older 11.8 9.12 Multiple sexual partnerships Percentage of people age 15-49 years who had sexual intercourse with more than one partner in the last 12 months (a) Women (b) Men 1.9 13.8 9.13 Condom use at last sex among people with multiple sexual partnerships Percentage of people age 15-49 years who report having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex (a) Women (b) Men 42.2 59.0 9.14 Sex with non-regular partners Percentage of sexually active young people age 15-24 years who had sex with a non-marital, non-cohabitating partner in the last 12 months (a) Women (b) Men 12.0 36.7 9.15 MDG 6.2 Condom use with non- regular partners Percentage of young people age 15-24 years reporting the use of a condom during the last sexual intercourse with a non-marital, non-cohabiting sex partner in the last 12 months (a) Women (b) Men 57.2 87.5 ACCESS TO MASS MEDIA AND ICT Access to mass media MICS Indicator Indicator Description Value 10.1 Exposure to mass media Percentage of people age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television (a) Women (b) Men 39.9 41.3 Use of information/communication technology 10.2 Use of computers Percentage of young people age 15-24 years who used a computer during the last 12 months (a) Women (b) Men 62.2 67.6 xiMultiple indicator cluster survey 2014 | 10.3 Use of internet Percentage of young people age 15-24 years who used the internet during the last 12 months (a) Women (b) Men 66.6 66.5 SUBJECTIVE WELL-BEING MICS Indicator Indicator Description Value 11.1 Life satisfaction Percentage of young people age 15-24 years who are very or somewhat satisfied with their life, overall (a) Women (b) Men 93.0 95.1 11.2 Happiness Percentage of young people age 15-24 years who are very or somewhat happy (a) Women (b) Men 93.6 92.6 11.3 Perception of a better life Percentage of young people age 15-24 years whose life improved during the last one year, and who expect that their life will be better after one year (a) Women (b) Men 81.9 83.3 TOBACCO AND ALCOHOL USE Tobacco use MICS Indicator Indicator Description Value 12.1 Tobacco use Percentage of people age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month (a) Women (b) Men 2.1 20.7 12.2 Smoking before age 15 Percentage of people age 15-49 years who smoked a whole cigarette before age 15 (a) Women (b) Men 1.7 9.4 Alcohol use 12.3 Use of alcohol Percentage of people age 15-49 years who had at least one alcoholic drink at any time during the last one month (a) Women (b) Men 26.0 63.0 12.4 Use of alcohol before age 15 Percentage of people age 15-49 years who had at least one alcoholic drink before age 15 (a) Women (b) Men 5.1 20.0 9.7 HIV counselling during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 66.7 9.8 HIV testing during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 84.8 Sexual behaviour 9.9 Young people who have never had sex Percentage of never married young people age 15-24 years who have never had sex (a) Women (b) Men 79.0 55.8 9.10 Sex before age 15 among young people Percentage of young people age 15-24 years who had sexual intercourse before age 15 (a) Women (b) Men 4.9 12.6 9.11 Age-mixing among sexual partners Percentage of women age 15-24 years who had sex in the last 12 months with a partner who was 10 or more years older 11.8 9.12 Multiple sexual partnerships Percentage of people age 15-49 years who had sexual intercourse with more than one partner in the last 12 months (a) Women (b) Men 1.9 13.8 9.13 Condom use at last sex among people with multiple sexual partnerships Percentage of people age 15-49 years who report having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex (a) Women (b) Men 42.2 59.0 9.14 Sex with non-regular partners Percentage of sexually active young people age 15-24 years who had sex with a non-marital, non-cohabitating partner in the last 12 months (a) Women (b) Men 12.0 36.7 9.15 MDG 6.2 Condom use with non- regular partners Percentage of young people age 15-24 years reporting the use of a condom during the last sexual intercourse with a non-marital, non-cohabiting sex partner in the last 12 months (a) Women (b) Men 57.2 87.5 ACCESS TO MASS MEDIA AND ICT Access to mass media MICS Indicator Indicator Description Value 10.1 Exposure to mass media Percentage of people age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television (a) Women (b) Men 39.9 41.3 Use of information/communication technology 10.2 Use of computers Percentage of young people age 15-24 years who used a computer during the last 12 months (a) Women (b) Men 62.2 67.6 xii Summary Table of Survey Implementation and Survey Population. iii Summary Table of Findings . iv Table of Contents . xiii List of Tables .xv Appendices . xxi List of Figures .xxiii List of Abbreviations . xxv Foreword . xxvi Message from the Ministry of Public Health . xxvi Message from the Ministry of Finance .xxviii Message from the Bureau of Statistics . xxix Message from the United Nations Children’s Fund (UNICEF) . xxx Acknowledgements.xxxii Executive Summary.xxxiii I. Introduction .45 Background .45 Survey Objectives .46 II. Sample and Survey Methodology .49 Sample Design.49 Questionnaires.50 Training and Fieldwork .51 Data Processing .51 III. Sample Coverage and the Characteristics of Households and Respondents .53 Sample Coverage.53 Characteristics of Households .55 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under-5 .58 Housing characteristics, asset ownership, and wealth quintiles .63 IV. Child Mortality .69 V. Nutrition .77 Low Birth Weight.77 Nutritional Status .80 Breastfeeding and Infant and Young Child Feeding .84 Salt Iodization.99 Contents xiiiMULTIPLE INDICATOR CLUSTER SURVEY 2014 | VI. Child Health.103 Vaccinations .103 Neonatal Tetanus Protection .109 Care of Illness .111 Diarrhoea .113 Acute Respiratory Infection .121 Solid Fuel Use .125 Malaria Fever .130 VII. Water and Sanitation .147 Use of Improved Water Sources .147 Use of Improved Sanitation .156 Handwashing .167 VIII. Reproductive Health .173 Fertility.173 Contraception .179 Unmet Need .183 Antenatal Care .186 Assistance at Delivery .189 Place of Delivery .194 Post-natal Health Checks .196 IX. Child Development .209 Early Childhood Care and Education .209 Quality of Care .211 Developmental Status of Children .217 X. Literacy and Education .221 Literacy among Young Women and Men .221 School Readiness .221 Primary and Secondary School Participation .224 XI. Child Protection .239 Birth Registration .239 Child Labour .242 Child Discipline .248 Early Marriage and Polygyny .253 Attitudes toward Domestic Violence .264 Children’s Living Arrangements .269 XII. HIV/AIDS and Sexual Behaviour .271 Knowledge about HIV Transmission and Misconceptions about HIV .271 Accepting Attitudes toward People Living with HIV .279 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care .283 Sexual Behaviour Related to HIV Transmission .292 HIV Indicators for Young Women and Young Men .293 Contents xiv XIII. Access to Mass Media and Use of Information/Communication Technology .307 Access to Mass Media .307 Use of Information/Communication Technology .310 XIV. Subjective Well-being.315 XV. Tobacco and Alcohol Use .327 Tobacco Use .327 Alcohol Use .335 appendices: Appendix A. Sample Design .339 Appendix B. List of Personnel Involved in the Survey .343 Appendix C. Estimates of Sampling Errors.345 Appendix D. Data Quality Tables .363 Appendix E. MICS5 Indicators: Numerators and Denominators .383 Appendix F. Questionnaires .395 LIST OF TABLES Table HH.1: Results of household, women’s, men’s and under-5 interviews . 54 Table HH.2: Age distribution of household population by sex . 55 Table HH.3: Household composition . 57 Table HH.4: Women’s background characteristics . 60 Table HH.4M: Men’s background characteristics . 61 Table HH.5: Under-5’s background characteristics . 62 Table HH.6: Housing characteristics . 64 Table HH.7: Household and personal assets . 66 Table HH.8: Wealth quintiles . 67 Table CM.1: Early childhood mortality rates . 69 Table CM.2: Early childhood mortality rates by socioeconomic characteristics . 71 Table CM.3: Early childhood mortality rates by demographic characteristics . 72 Contents xvMULTIPLE INDICATOR CLUSTER SURVEY 2014 | Table NU.1: Low birth weight infants . 78 Table NU.2: Nutritional status of children . 81 Table NU.3: Initial breastfeeding . 86 Table NU.4: Breastfeeding . 89 Table NU.5: Duration of breastfeeding . 91 Table NU.6: Age-appropriate breastfeeding . 93 Table NU.7: Introduction of solid, semi-solid, or soft foods . 94 Table NU.8: Infant and young child feeding (IYCF) practices . 95 Table NU.9: Bottle feeding . 97 Table NU.10: Iodized salt consumption . 99 Table CH.1: Vaccinations in the first years of life . 104 Table CH.2: Vaccinations by background characteristics . 107 Table CH.3: Neonatal tetanus protection . 110 Table CH.4: Reported disease episodes . 112 Table CH.5: Care-seeking during diarrhoea . 114 Table CH.6: Feeding practices during diarrhoea . 115 Table CH.7: Oral rehydration solutions . 116 Table CH.8: Oral rehydration therapy with continued feeding and other treatments . 118 Table CH.9: Source of ORS . 120 Table CH.10: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) . 122 Table CH.11: Knowledge of the two danger signs of pneumonia . 123 Table CH.12: Solid fuel use . 126 Table CH.13: Solid fuel use by place of cooking . 129 Contents xvi Table CH.14: Household availability of insecticide treated nets .131 Table CH.15: Access to an insecticide treated net (ITN) - number of household members .132 Table CH.16: Access to an insecticide treated net (ITN) - background characteristics .133 Table CH.17: Use of ITNs .135 Table CH.18: Children sleeping under mosquito nets .136 Table CH.19: Use of mosquito nets by the household population .137 Table CH.20: Care-seeking during fever .138 Table CH.21: Treatment of children with fever .140 Table CH.22: Diagnostics and anti-malarial treatment of children .142 Table CH.23: Pregnant women sleeping under mosquito nets .144 Table WS.1: Use of improved water sources .148 Table WS.2: Household water treatment .151 Table WS.3: Time to source of drinking water .154 Table WS.4: Person collecting water .155 Table WS.5: Types of sanitation facilities .157 Table WS.6: Use and sharing of sanitation facilities .158 Table WS.7: Drinking water and sanitation ladders .163 Table WS.8: Disposal of child’s faeces .165 Table WS.9: Water and soap at place for handwashing .168 Table WS.10: Availability of soap or other cleansing agent .170 Table RH.1: Fertility rates .173 Table RH.2: Adolescent birth rate and total fertility rate .175 Table RH.3: Early childbearing .176 Contents xviiMULTIPLE INDICATOR CLUSTER SURVEY 2014 | Table RH.4: Trends in early childbearing . 177 Table RH.5: Use of contraception . 180 Table RH.6: Unmet need for contraception . 184 Table RH.7: Antenatal care coverage . 185 Table RH.8: Number of antenatal care visits and timing of first visit . 187 Table RH.9: Content of antenatal care . 190 Table RH.10: Assistance during delivery and caesarean section . 192 Table RH.11: Place of delivery . 195 Table RH.12: Post-partum stay in health facility . 197 Table RH.13: Post-natal health checks for newborns . 199 Table RH.14: Post-natal care visits for newborns within one week of birth . 202 Table RH.15: Post-natal health checks for mothers . 203 Table RH.16: Post-natal care visits for mothers within one week of birth . 206 Table RH.17: Post-natal health checks for mothers and newborns . 207 Table CD.1: Early childhood education . 210 Table CD.2: Support for learning . 212 Table CD.3: Learning materials . 215 Table CD.4: Inadequate care . 216 Table CD.5: Early child development index . 218 Table ED.1: Literacy (young women) . 222 Table ED.1M: Literacy (young men) . 223 Table ED.2: School readiness . 224 Table ED.3: Primary school entry . 225 Contents xviii Table ED.4: Primary school attendance and out of school children . 226 Table ED.5: Secondary school attendance and out of school children . 229 Table ED.6: Children reaching last grade of primary school . 231 Table ED.7: Primary school completion and transition to secondary school . 233 Table ED.8: Education gender parity . 234 Table ED.9: Out of school gender parity . 235 Table CP.1: Birth registration . 240 Table CP.2: Children’s involvement in economic activities . 243 Table CP.3: Children’s involvement in household chores . 245 Table CP.4: Child labour . 247 Table CP.5: Child discipline . 249 Table CP.6: Attitudes toward physical punishment . 252 Table CP.7: Early marriage and polygyny (women) . 254 Table CP.7M: Early marriage and polygyny (men) . 256 Table CP.8: Trends in early marriage (women) . 258 Table CP.8M: Trends in early marriage (men) . 260 Table CP.9: Spousal age difference . 263 Table CP.10 Attitudes toward domestic violence (women) . 265 Table CP.10M: Attitudes toward domestic violence (men) . 266 Table CP.11: Children’s living arrangements and orphanhood . 268 Table CP.12: Children with parents living abroad . 269 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) . 272 Contents xixMULTIPLE INDICATOR CLUSTER SURVEY 2014 | Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (men) . .274 Table HA.2: Knowledge of mother-to-child HIV transmission (women) . 277 Table HA.2M: Knowledge of mother-to-child HIV transmission (men) . 278 Table HA.3: Accepting attitudes toward people living with HIV (women) . 280 Table HA.3M: Accepting attitudes toward people living with HIV (men) . 281 Table HA.4: Knowledge of a place for HIV testing (women) . 282 Table HA.4M: Knowledge of a place for HIV testing (men) . 286 Table HA.5: HIV counselling and testing during antenatal care . 289 Table HA.6: Sex with multiple partners (women) . 291 Table HA.6M: Sex with multiple partners (men) . 293 Table HA.7: Key HIV and AIDS indicators (young women) . 296 Table HA.7M: Key HIV and AIDS indicators (young men) . 298 Table HA.8: Key sexual behaviour indicators (young women) . 300 Table HA.8M: Key sexual behaviour indicators (young men) . 302 Table MT.1: Exposure to mass media (women) . 308 Table MT.1M: Exposure to mass media (men) . 309 Table MT.2: Use of computers and internet (women) . 311 Table MT.2M: Use of computers and internet (men) . 312 Table SW.1: Domains of life satisfaction (women) . 316 Table SW.1M: Domains of life satisfaction (men) . 318 Table SW.2: Overall life satisfaction and happiness (women) . 321 Table SW.2M: Overall life satisfaction and happiness (men) . 322 Contents xx Table SW.3: Perception of a better life (women) . 323 Table SW.3M: Perception of a better life (men) . 324 Table TA.1: Current and ever use of tobacco (women) . 328 Table TA.1M: Current and ever use of tobacco (men) . 330 Table TA.2: Age at first use of cigarettes and frequency of use (women) . 333 Table TA.2M: Age at first use of cigarettes and frequency of use (men) . 335 Table TA.3: Use of alcohol (women) . 337 Table TA.3M: Use of alcohol (men) . 338 APPENDICES Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Strata . 340 DQ.1: Age distribution of household population . 363 DQ.2: Age distribution of eligible and interviewed women . 364 DQ.3: Age distribution of eligible and interviewed men . 365 DQ.4: Age distribution of children in household and under-5 questionnaires . 365 DQ.5: Birth date reporting: Household population . 366 DQ.6: Birth date and age reporting: Women . 367 DQ.7: Birth date and age reporting: Men . 367 DQ.8: Birth date and age reporting: Under-5s . 368 DQ.9: Birth date reporting: Children, adolescents and young people . 368 DQ.10: Birth date reporting: First and last births . 369 DQ.11: Completeness of reporting . 370 DQ.12: Completeness of information for anthropometric indicators: Underweight . 371 Contents xxiMULTIPLE INDICATOR CLUSTER SURVEY 2014 | DQ.13: Completeness of information for anthropometric indicators: Stunting . 371 DQ.14: Completeness of information for anthropometric indicators: Wasting . 372 DQ.15: Heaping in anthropometric measurements . 373 DQ.16: Observation of birth certificates . 374 DQ.17: Observation of vaccination cards . 374 DQ.18: Observation of women’s health cards . 375 DQ.19: Observation of bednets and places for handwashing . 376 DQ.20: Respondent to the under-5 questionnaire . 376 DQ.21: Selection of children age 1-17 years for the child labour and child discipline modules . 377 DQ.22: School attendance by single age . 378 DQ.23: Sex ratio at birth among children ever born and living . 379 DQ.24: Births in years preceding the survey . 380 DQ.25: Reporting of age at death in days . 381 DQ.26: Reporting of age at death in months . 382 Table SE.1: Indicators selected for sampling error calculations . 346 Table SE.2: Sampling errors: Total sample . 347 Table SE.3: Sampling errors: Urban . 348 Table SE.4: Sampling errors: Rural . 349 Table SE.5: Sampling errors: Coastal . 350 Table SE.6: Sampling errors: Urban Coastal . 351 Table SE.7: Sampling errors: Rural Coastal . 352 Table SE.8: Sampling errors: Interior . 353 Table SE.9: Sampling errors: Region 1 . 354 Contents xxii Table SE.10: Sampling errors: Region 2 . 355 Table SE.11: Sampling errors: Region 3 . 356 Table SE.12: Sampling errors: Region 4 . 357 Table SE.13: Sampling errors: Region 5 . 358 Table SE.14: Sampling errors: Region 6 . 359 Table SE.15: Sampling errors: Regions 7&8 . 360 Table SE.16: Sampling errors: Region 9 . 361 Table SE.17: Sampling errors: Region 10 . 362 LIST OF FIGURES Figure HH.1: Age and sex distribution of household population . Figure CM.1: Early child mortality rates . 70 Figure CM.2: Under-5 mortality rates by area and region . 73 Figure CM.3: Trend in under-5 mortality rates . 74 Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe) . 84 Figure NU.2: Initiation of breastfeeding . 88 Figure NU.3: Infant feeding patterns by age . 90 Figure NU.4: Consumption of iodized salt . 100 Figure CH.1: Vaccinations by age 12 months (measles by 24 months) . 105 Figure CH.2: Children under-5 with diarrhoea who received ORS . 117 Figure CH.3: Percentage of household population with access to an ITN in the household . 134 Figure WS.1: Percent distribution of household members by source of drinking water . 150 Figure WS.2: Percent distribution of household members by use and sharing of sanitation facilities .162 Contents xxiiiMULTIPLE INDICATOR CLUSTER SURVEY 2014 | Figure WS.3: Use of improved drinking water sources and improved sanitation facilities by household members .164 Figure RH.1: Age-specific fertility rates by area .174 Figure RH.2: Differentials in contraceptive use .182 Figure RH.3: Person assisting at delivery .191 Figure ED.1: Education indicators by sex .236 Figure CP.1: Children under-5 whose births are registered .241 Figure CP.2: Child disciplining methods, children age 1-14 years .250 Figure CP.3: Early marriage among women .262 Figure HA.1: Women and men with comprehensive knowledge of HIV transmission .276 Figure HA.2: Accepting attitudes toward people living with HIV/AIDS .283 Figure HA.3: Sexual behaviour that increases the risk of HIV infection, young people age 15-24 .304 Figure TA.1: Ever and current smokers .332 Appendix: Figure DQ.1: Number of household population by single ages .364 Figure DQ.2: Weight and height/length measurements by digits reported for the decimal points .373 Contents AIDS Acquired Immune Deficiency Syndrome ANC Antenatal care ASFR Age-specific fertility rate BCG Bacillis-Cereus-Geuerin (Tuberculosis) BoS Bureau of Statistics CBR Crude birth rate CNCD Chronic non-communicable disease CRC Committee on the Rights of the Child CSPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus ED Enumeration District EPI Expanded Programme on Immunization GARPR Global AIDS Response Progress Reporting GFR General fertility rate GPI Gender Parity Index GRO General Register Office HepB Hepatitis B Hib Haemophilus influenzae type b HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders ILO International Labour Organization IPT Intermittent Preventive Treatment IPV Inactivated Poliovirus Vaccine ITN Insecticide Treated Net IUD Intrauterine Device JMP Joint Monitoring Programme LLIN Long-lasting insecticidal treated net Contents MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Clusters Surveys programme MMR Measles, Mumps, and Rubella MoPH Ministry of Public Health MTCT Mother-to-child transmission NAR Net Attendance Rate OPV Oral Poliovirus Vaccine ORS Oral rehydration salts ORT Oral rehydration treatment PLHA People living with HIV PNC Post-natal care PNHC Post-natal health check ppm Parts Per Million SP Sulfadoxine-Pyrimethamine SPSS Statistical Package for Social Sciences STI Sexually transmitted infection TFR Total fertility rate UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit for Children WHO World Health Organization LIST OF ABBREVIATIONS xxvMULTIPLE INDICATOR CLUSTER SURVEY 2014 | FOREWORD Budgeting for the social sector remains a priority for our Government as we address issues of poverty reduction while bridging the divide between the coast and hinterland. Notably, Budget 2016 allocated one third of the budget to the health and education sectors, in recognition of both sectors being critical to national development and essential for the development of our children – our future. As the Government of Guyana pursues national development, the data collected by the Multiple Indicator Cluster Survey (MICS) will be integral in identifying within sectors and cross-sectoral strategic goals, and informing planning, implementing, monitoring and evaluating related development programmes and projects. Our Government is moving to results-based budgeting and intends to develop robust monitoring and evaluation systems to support these reforms. The limited data sets within CARICOM and our country remain an area of serious concern for informing policy formulation. Indeed, the availability and use of sound data must be driven by robust methodologies and systems for collecting, collating and analyzing data. As such, the Bureau of Statistics must play a strong leadership role in the data generation and statistical presentation as our Government expects to drive policy from an evidence- based platform. In this regard, every effort is undertaken to strengthen the Bureau of Statistics in terms of structure, resources capabilities, and capacity to ensure a strong, dynamic institution that leads the effort to provide an evidence based platform. The release of the most recent Census coupled with the upcoming Labour Force and other surveys, which are targeted over the next twelve months are some of the initiatives to support availability of data for the national evidence-led performance initiative. Indeed, the release of the MICS, conducted during 2014, will add to the suite of data available, inter alia, to Government, private sector, civil society, researchers and students. The next budget is at hand. The related planning initiative will be undergirded by the use of data supplied by the MICS from which the national budget will be culled. Our Government will craft policies that refine and target programmes and projects with greater confidence in outcomes to benefit our people across our ten regions in keeping with the UN’s Sustainable Development Goals (SDGs). I extend my thanks to UNICEF for its support in the conduct of this survey, as well as to the Bureau of Statistics and the Ministry of Health for their technical leadership in conducting the survey and the completion of the report. We encourage and support the use of the MICS report. Honourable Minister of Finance Mr. Winston Jordan xxvi MESSAGE FROM THE MINISTRY OF PUBLIC HEALTH GOVERNANCE AND IMPLEMENTATION OF THE MICS The Ministry of Public Health is pleased to be one of the leaders in the conduct of the Multiple Indicator Cluster Survey (MICS) round 5 in Guyana. Previously, Guyana implemented rounds 1 and 3, and had sufficiently experienced the capacity of this survey in monitoring human development. For many countries, MICS surveys are among the most important sources of data used for policy decisions and programme interventions, and for influencing public opinion on the situation of children and women. Since 1995, UNICEF has supported the implementation of Multiple Indicator Cluster Surveys (MICS), assisting countries in generating high quality data on the situation of children and women in areas such as Health, Education and Protection, especially for the most disadvantaged. For Guyana, prior to the conduct of MICS 5 most household and other national surveys had their own unique designs. For instance, the AIDS Indicator Survey 2005 (National), MICS 2006 (disaggregated by region clusters) and Demographic and Health Survey 2009 (disaggregated by the 10 regions), thus posing data harmonization issues. In 2013, when the MICS 5 survey was being designed, deliberate steps were taken to ensure that the content and disaggregation mirrored, as much as possible, the Demographic and Household Survey. A decision was taken that it would be recommended that all other national surveys be harmonised accordingly. As a consequence, in the MICS 5 survey, all ten Administrative Regions were engaged; a questionnaire on men was included and the data are disaggregated by individual regions, for most regions. Government’s commitment to the implementation of the MICS survey was demonstrated through its financial and in-kind support. A suitable space, renovated by the MoPH and furnished by UNICEF, was used exclusively as a research centre for the conduct of the MICS 5 survey. In future, National level surveys will be managed from this centre. As part of the recommended governance structure for MICS, two Technical Committees were established, one with oversight for the conduct of the MICS, and one comprising of subject matter experts. Both committees were chaired by the Chief Medical Officer. The survey targeted 6000 households which were subdivided into 300 clusters, i.e. 20 households per cluster. However, due to refusals and other challenges during the fieldwork, 5904 households were enumerated from 1 April, 2014 to 10 July, 2014. For this survey, four questionnaires were used; Households, Men aged 15-49, Women aged 15-49 and Children under five, thus ensuring data for all critical populations in Guyana. The findings of the MICS 5 Survey will be used to inform the planning, implementation, monitoring and evaluation of health related programmes at the national and subnational levels. Hon. Dr. Karen Cummings Minister of Public Health xxviiMULTIPLE INDICATOR CLUSTER SURVEY 2014 | MESSAGE FROM THE MINISTRY OF FINANCE Addressing the issues of social development within the communities across our country and ensuring their economic viability remains a priority focus within our Government’s national development agenda. As stated in our manifesto, our Government committed to rebuild Guyana’s family structure and support Guyana’s children. In order to achieve our goals effectively we must understand the problems on the ground by way of evidence. The data in this report is an important step forward in being able to determine and address the challenges more effectively. The findings within the MICS will aid the analysis of the situation of our children in several areas including, inter alia, child health, nutrition, child development and child development. Further, it will support our ability to assess our achievements within the context of the MDGs and more especially, the SDGs as we go forward. My thanks to the UNICEF and GOG teams for their work in completing this important exercise. Honourable Minister within the Ministry of Finance Mr. Jaipaul Sharma xxviii MESSAGE FROM THE BUREAU OF STATISTICS It is with a significant sense of satisfaction that I acknowledge the completion of the Multiple Indicator Cluster Survey (MICS) Report of the 2014 which will be symbolically acknowledged with the formal launch and dissemination of the Report. This is the third occasion in which the Bureau of Statistics, as the Central Statistical Organization of Government has been centrally involved in the planning, design and execution of this Survey, a road that began some sixteen (16) years ago when the Bureau, with the full support of UNICEF, Guyana Office, was able to first observe the organization and operations of the MICS in the Dominican Republic and was able to return and recommend to Government that Guyana should get fully involved in this international household survey programme that generates such a plethora of key indicators on a significant portion of a country’s population. The Bureau has now participated in three (3) rounds of the MICS, in years 2000, 2006 and 2014 and every Round of participation has further strengthened the strong working relationship with its sister and lead-agency in this exercise, the Ministry of Health as well as with UNICEF’s Office in Georgetown. Needless to say, one direct spin-off has been the institutional memory and capacity that the Bureau has been able to build over the years in this particular sphere of survey activity, aided by the Technical support provided by the UNICEF Georgetown Office. This is the first time that the Survey in Guyana has contained a module for Men and even though the response rate has been lower than expected a start has been made. It is also the first time in the three (3) Surveys now completed that a Survey commenced under one Administration and the formal presentation of the results is being effected under another. It would therefore be remiss of me not to mention the individuals who were central to the team work which saw the latest MICS to a successful conclusion, among them being Mr. Michael Gillis, Technical Specialist, UNICEF Georgetown, Dr. Shamdeo Persaud, Chief Medical Officer, Ministry of Public Health and Mr. Ian Manifold, Head of Division, Surveys, Bureau of Statistics. The results and interpretation of the Survey’s findings will be further complemented by the results of Census 2012 when roll-out commences later this year. Lennox Benjamin, Chief Statistician. xxixMULTIPLE INDICATOR CLUSTER SURVEY 2014 | MESSAGE FROM THE UNITED NATIONS CHILDREN’S FUND (UNICEF) Making sure that we reach all children, especially the most disadvantaged is at the heart of UNICEF’s work and programming. MICS 5 provides us with the up to date evidence needed to analyse the situation of children and women, to make informed policy decisions and influence public opinion. This new round of MICS data reveals a compelling story about the issues that impact children’s lives and wellbeing in the areas of health, education and protection among others, and allows us as a country office to effectively focus resources on programmes which respond to their needs and make a difference for them. MICS 5 has enabled Guyana to produce statistically sound and internationally comparable estimates on a range of child-related indicators in the areas of child health, education, protection, water and sanitation and HIV and AIDS. The leadership of the Government of Guyana, through the Bureau of Statistics and the Ministry of Public Health, has been essential in ensuring the prioritisation of children issues during this round of MICS. We are also pleased to acknowledge the partnership with other UN agencies and developmental partners, who provided technical and financial support for this survey. Children’s rights to survival, development, protection and participation are enshrined in the Convention of the Rights of the Child (CRC), and the inalienable rights of women are articulated in the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW). UNICEF continues to work towards the realisation of these rights, which remain at the centre of the post-2015 agenda. The completion of MICS is a fundamental step towards eradicating inequities and enhancing inter- generational equity. It is also an essential tool in strengthening children’s ability to reach their full potential as productive, engaged, and capable citizens. UNICEF envisages a future where the data generated by the MICS surveys in Guyana is at the heart of decision making in health, education, child protection and other critical areas, and that this data is used to actively inform sustainable programmes for the wellbeing of children and women, in all ten administrative regions of Guyana. Marianne Flach Representative for Guyana and Suriname United Nations Children’s Fund (UNICEF) xxx @UNICEF Guyana xxxiMULTIPLE INDICATOR CLUSTER SURVEY 2014 | The Guyana Multiple Indicator Cluster Survey round 5 (MICS5) was carried out in 2014 by the Government of Guyana, through the Bureau of Statistics and the Ministry of Health, as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF, the Inter- American Development Bank (IDB) and the Government of Guyana provided financial support. It is important to acknowledge the training and technical support provided during this survey process by UNICEF staff from the global MICS Office in New York, the Regional Office for Latin America and the Caribbean, in Panama and the Guyana and Suriname Country Office. The collaboration of multiple Government Ministries and Departments in Guyana is also deeply appreciated. Furthermore the invaluable assistance of consultants on this project is noted. The decisive role in the adaptation of the MICS 5 questionnaires and manuals, by the members of the Technical Steering Committee as well as the overall management of the survey by the MICS 5 steering committee is also noteworthy. It is expected that this situation survey will pave the way for periodic monitoring of the situation of children and women living in Guyana. ACKNOWLEDGEMENTS xxxii EXECUTIVE SUMMARY The Multiple Indicator Cluster Survey (MICS) is an international household survey programme developed by UNICEF in the 1990s. MICS is designed to collect statistically sound, internationally comparable estimates of key indicators that are used to assess the situation of children, women and men in the areas such as health, education, child protection, and HIV/AIDS. MICS also provides a tool to monitor the progress towards national goals and global commitments aimed at promoting the welfare of children, including the Millennium Development Goals (MDGs).2 Since the inception of MICS, four rounds of survey have been carried out globally in 1995, 2000, 2005-6 and 2009 respectively. The current round (MICS5) was launched in 2012. MICS5 was conducted in Guyana in 2014 by the Guyana Bureau of Statistics and the Ministry of Public Health, with technical support from UNICEF. The Guyana Multiple Indicator Survey 2014 (Guyana MICS5 2014) is the third of its kind in Guyana, the first being in 2000 and the second being in 2006. Guyana MICS5 2014 is a nationally representative sample survey of households and was designed to provide statistically reliable estimates on a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for the two geographic sub-areas defined as interior areas and coastal areas. The main objectives of the survey included the following: • Collect internationally comparable data on a wide range of indicators on the situation of children and women; • Generate data for use in policies and programmes; • Monitor progress towards the Millennium Development Goals (MDGs). Four types of questionnaires – a household questionnaire, a questionnaire for women aged 15-49 years, a questionnaire for men aged 15-49 years and a questionnaire for children under 5 – were used to conduct face-to-face interviews. The respondent to the household questionnaire was any knowledgeable adult member (i.e. aged 15 years or older) living in 2Additional information on the global MICS project can be obtained via http://mics.unicef.org/ the household. Women and men questionnaires were administered to eligible women and selected eligible men living in the household respectively. The questionnaire for children under age five was administered to the mother/caretaker of the child. The survey initially targeted 6,000 households in 300 Enumeration Districts (EDs), i.e. 20 households per ED. However, four of the targeted EDs located in the interior areas were inaccessible during the fieldwork period. At the end, the survey sampled 5,904 households, of which 5,526 were found to be occupied. Of those occupied, 5,077 were successfully interviewed, resulting in a household response rate of 92 percent. The response rates for women, men and children were 87, 67 and 96 percent, respectively. HOUSEHOLD COMPOSITION  In the 5,077 households interviewed, 19,321 household members (9,326 males and 9,995 females) were listed, indicating a mean household size of 3.8.  Seventy-two (72) percent of households are from the rural areas. Just 12 percent are from the interior areas. Almost two-thirds (64%) of the population are aged 15-65 years while only six (6) percent are 65 years and older. Over one-third (36%) of the population is below 18 years of age. About one- third (34%) of the sampled households are headed by females. CHILD MORTALITY Based on the methodology used, the survey provides estimates for the five years preceding the survey.  The probability of a child dying before his/her first birthday (i.e. infant mortality rate - IMR) is estimated at 32 per 1,000 live births, while the probability of dying within the first month of life (i.e. neonatal mortality rate - NMR) is 23 deaths per 1,000 live births. Therefore, the post-neonatal mortality rate (i.e. the difference between infant and neonatal mortality rates) is 9 per 1,000 live births. The IMR and the NMR are much lower in the urban and interior areas than in the rural and the coastal areas xxxiiiMultiple indicator cluster survey 2014 | respectively.  The probability of a child dying between birth and his/her fifth birthday (i.e. under-five mortality rate - U5MR) is 39 deaths per 1,000 live births. Considering the above-mentioned IMR, 82 percent of under-five deaths are infant deaths.  Childhood mortality rates are higher among boys and children born to mothers younger than 20 years of age than among other children.  The estimates from this survey, in line with previous surveys in Guyana, indicate stabilization in childhood mortality during the last 15 years. NUTRITION Low birth weight  Overall, 94 percent of births in Guyana were weighed at birth and approximately one in seven (14 %) infants is estimated to have low birth weight, i.e. they weigh less than the recommended 2,500 grams at birth. There are only small disparities in the prevalence of low birth weight by the various background characteristics covered in this survey. nutritional status  Children under age five in Guyana are more likely to be stunted (i.e. too short for their age) than underweight (i.e. low weight for age), wasted (i.e. low weight for height) or overweight (i.e. high weight for height). Twelve (12) percent of children are moderately or severely stunted, nine (9) percent moderately or severely underweight, six (6) percent moderately or severely wasted, and five (5) percent overweight. Stunting is more prevalent among boys, children from the interior areas, those who live in the poorest households and those whose mother has no education. There are only small variations by the various background characteristics covered in this survey, in the prevalence of underweight, wasting or overweight among under-five children. Breastfeeding and infant feeding  While close to nine in ten (89%) last-born children in the two years preceding the survey were ever breastfed, only about half (49%) are breastfed for the first time within one hour of birth and over three- quarters (77%) within one day. The recommended practice of breastfeeding within one hour of birth is most prevalent in the interior areas. While this practice is similar among births delivered at home and those delivered at a health facility, newborns delivered in public health facilities are almost three times more likely to be breastfed within one hour of birth than those delivered in private health facilities.  Nationally, less than one in four children (23%) younger than six months are exclusively breastfed, while more than one in three are predominantly breastfed (36%). Compared to the national average, exclusive breastfeeding is nearly double in the regional grouping 1, 7, 8 and 9, and 11 percentage points higher in the interior areas.  Among children younger than three years, the median duration for any breastfeeding is 14.1 months, for exclusive breastfeeding 0.6 month, and for predominant breastfeeding 1.4 months.  Children aged 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid, semi-solid or soft foods. In Guyana, only 46 percent of children of this age group are appropriately fed, primarily due to low prevalence of breastfeeding.  Solid, semi-solid, or soft foods were given to 81 percent of infants aged 6-8 months at least once during the day preceding the survey. Infants currently being breastfed are less likely to receive these foods than those who are not.  Sixty-two (62) percent of the children aged 6-23 months received solid, semi-solid and soft foods (plus milk feeds for non-breastfed children) four times or more during the day preceding the survey (i.e. minimum meal frequency), while approximately two-thirds (65%) received foods from four or more food groups during the day preceding the survey (minimum dietary diversity3). Only four out of ten (40%) achieved the minimum acceptable diet.  Bottle-feeding is prevalent, with 70 percent of children aged 0-23 months being fed using a bottle with a nipple. This practice is most prevalent among children 6-23 months, those who reside in Regions 3 and 4, and those in the richest households. Salt iodization  The level of iodine contained in salt consumed in the households was found to be appropriate (i.e. contain 15 parts per million (ppm) or more) in 20 percent of households in Guyana. The use of iodized salt increases with the household wealth, 3The indicator is based on consumption of any amount of food from at least 4 out of the 7 following food groups: 1) grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. xxxiv 4It should be noted that the administrative records at the Ministry of Public Health (MoPH) in Guyana, relative to tetanus vaccination coverage, are based on information on women aged 15-40 years, whereas the MICS5 targets women aged 15-49 years. and was found to be lowest in Region 9 (3%) and highest in Regions 3 and 7 & 8 (27% in each case). CHILD HEALTH Vaccinations  Overall, 95 percent of children aged 12-23 months received their BCG vaccination by the age of 12 months and 96 percent received the first dose of DPT, while 94 percent and 89 percent received the subsequent doses respectively. The same proportion of children who received the three doses of DPT also received the three doses of Hepatitis B and Haemophilus influenzae type b (Hib) vaccines, since in Guyana, protection against DPT, Hepatitis B and Hib antigens is provided via the Pentavalent vaccine. Additionally, 90 percent received the three doses of Polio vaccine, 88 percent received the three doses of rotavirus vaccine, and 87 percent received the three doses of pneumococcal vaccine.  In Guyana, protection against measles is provided by the MMR (Measles, Mumps and Rubella) vaccine, and the national immunization schedule requires that children be given the MMR and yellow fever vaccinations at or after age 12 months, but before age 24 months. Approximately 93 percent of the children aged 24-35 months received the MMR vaccine and 92 percent received the yellow fever vaccine by age 24 months.  For each vaccine, the coverage increases with mother’s education and is lower in the interior areas than on the coast. Overall, 69 percent of children aged 24-35 months had all the recommended vaccinations by their second birthday (fully vaccinated). The percentage of children receiving no vaccinations at all is three (3) percent of children aged 12-23 months and two (2) percent of children aged 24-35 months. neonatal tetanus protection4  Just over one in five women (22%) who had a live birth within the two years preceding the survey were protected against tetanus.The coverage was highest among women in the interior areas (27%), those in the richest households (28%) and those with higher education (26%). Care of Illness Diarrhoea  Diarrhoea is a leading cause of death among children under five worldwide. Most diarrhoea- related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. In the present survey, eight (8) percent of under-five children were reported to have had an episode of diarrhoea in the two weeks preceding the survey. More than twice as many cases were reported in the interior areas (16%) compared to the coast (6%). Of the diarrhoea cases reported, 82 percent of those reported in the interior were seen by a health facility or provider compared to only 46 percent of those on the coast. Overall, 61 percent of cases were seen by a health facility or provider.  Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) – can prevent many of these deaths. Forty-three (43) percent of children with diarrhoea received the recommended treatment. This was more common in interior areas (52%) than coastal areas (36%). Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. Twenty-nine (29) percent of children received ORT (ORS or increased fluids) and continued feeding. Acute Respiratory Infections (ARI)  Symptoms of ARI were collected in the present survey to capture pneumonia disease, the leading cause of death in children under five, globally. Overall, two (2) percent of under-five children were reported to have had symptoms of ARI in the two weeks preceding the survey. Eighty-four (84) percent of children aged 0-59 months with symptoms of ARI in the two weeks preceding the survey were taken to a qualified provider, and 31 percent were given antibiotics.  Thirty-eight (38) percent of mothers/caretakers know at least one of the two danger signs of pneumonia – fast and/or difficult breathing. xxxvMultiple indicator cluster survey 2014 | Malaria/Fever  Malaria is a major cause of death of children under age five worldwide. Preventive measures and treatment with an effective antimalarial can dramatically reduce malaria mortality rates among children. In Guyana, the coastal areas are considered to be malaria-free, while the interior areas are considered to be high-risk malaria areas. At the country level, five (5) percent of households have at least one insecticide treated net (ITN), and three (3) percent have at least one ITN for every two household members. During the night preceding the survey, 72 percent of ITNs were used, and four (4) percent of household members, seven (7) percent of children under five, and seven (7) percent of pregnant women slept under an ITN.  In the high-risk regions (1, 7, 8 and 9), 53 percent of households have at least one ITN and 27 percent have at least one ITN for every two household members. During the night preceding the survey, 70 percent of ITNs were used, and 33 percent of household members, 42 percent of children under five, and 45 percent of pregnant women slept under an ITN.  Overall, 14 percent of children under five reported an episode of fever in the two weeks preceding the survey, this period-prevalence being 21 percent in interior areas and 12 percent in coastal areas. Among these children, 71 percent sought advice from a health facility or a qualified health care provider, and 12 percent had blood taken from a finger or heel for malaria testing. Seven (7) percent received an antimalarial, and three (3) percent were treated the same day the fever started or the next, but none of them was treated with an artemisinin- based combination therapy (ACT).  In the high-risk regions (1, 7, 8, and 9), 86 percent children under five with fever sought advice from a health facility or a qualified health care provider, and nearly one-third of children were tested for malaria (31%).Five (5) percent were given antimalarial drugs, four (4) percent the same day the fever started or the next, but none of them was treated with an ACT. Solid fuel use  Overall, only seven (7) percent of the household population use solid fuels for cooking. Almost one-third (31%) of households in the interior areas utilise this source of energy, compared to three (3) percent in coastal areas.  Thirty-one (31) percent of the population living in households using solid fuels for cooking, cook in a separate room that is used as a kitchen and 28 percent cook in a separate building. WATER AND SANITATION use of improved water sources  Overall, 94 percent of the population use an improved source of drinking water,5 albeit with differences between the areas and location of residence (99% urban, 93% rural, 98% coastal and 71% interior).The situation in Region 9 is considerably worse than in other the Regions with only 42 percent in this Region compared to over 65 percent in each of the other regions and regional grouping. The drinking water source is on premises for 92 percent of the household population. For one (1) percent of the household population, it takes the household 30 minutes or more to go and get drinking water from the source.  Only 27 percent of households that use unimproved sources of drinking water use an appropriate water treatment method, with this practice being similar between coastal and interior areas. use of improved sanitation  Ninety-five (95) percent of the population are living in households using improved sanitation facilities,6 with differences between the areas and location of residence (98% urban, 94% rural, 97% coastal and 86% interior). Forty-three (43) percent of children aged 0-2 years had their stools disposed safely.7 The most common means of disposal of child’s faeces in Guyana is throwing into garbage (42%), which is currently not classified as a safe means of disposal. 5The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, to neighbour, public tap/standpipe), tube well/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for handwashing and cooking. 6Improved sanitation facilities for excreta disposal are flush or pour flush to a piped sewer system, septic tank, or pit latrine; ventilated improved pit latrine, and pit latrine with slab. 7Safe disposal is defined as disposing of the stool, by the child using a toilet or by rinsing the stool into a toilet or latrine. Note that putting disposable diapers in the garbage is not considered a safe method of disposal of a child’s faeces in MICS5. xxxvi  Eighty-three (83) percent of household population have access to both an improved source of drinking water and an improved sanitation facility, with considerable differences between the areas and location of residence (90% urban, 81% rural, 88% coastal and 55% interior). Handwashing  The majority of households (79%) in Guyana have a specific place for handwashing where water and soap or other cleansing agent are present. This proportion is higher by 15 percentage points in the coastal areas (81%) than in the interior areas (66%), and highest in Region 5 (91%) and lowest in Regions 7 & 8 and 10 (58% in each case).  Seventy-nine (79) percent of households reported availability of soap or other cleansing agent anywhere in the dwelling. This proportion is higher on the coast (with 81% compared with 72% in the interior), and in Regions 5, 6 and 9 (with 90-92% compared with 62-83% in the other regions). REPRODUCTIVE HEALTH Fertility  The total fertility rate (TFR) for the three years (2012-2014) preceding the Guyana MICS5 is 2.6 births per woman, with notable differences between the areas and location of residence (2.3 urban, 2.7 rural, 2.4 coastal and 4.3 interior). Fertility is relatively low among adolescents (15-19 years) at 74 births per 1,000 women, increases to a peak of 148 births per 1,000 among women aged 20-24 years, and declines thereafter to 2 births per 1,000 women for the 45-49 age group. The adolescent birth rate in the regional grouping 1, 7, 8 and 9 is almost three times that of other regions/regional grouping, at 187 births per 1,000 women.  Fifteen (15) percent of women aged 15-19 years have begun childbearing: 11 percent have already had a birth, and four (4) percent are pregnant with their first child. Less than one percent (0.3%) of women aged 15-19 years have had a live birth before age 15; however, 16 percent of women aged 20-24 years have had a live birth before age 18.  The percentage of women aged 20-24 years who have had a live birth before age 18 is twice as high in interior areas (29%) than in coastal areas (14%). Contraception  In Guyana, the proportion of women currently married or in union who are using (or whose partner is using) a modern or traditional contraceptive method is more than one in three (34%). The most common contraception method used is the male condom, with nine (9) percent, followed by the pill, with eight (8) percent. Twenty-eight (28) percent of women aged 15-49 years currently married or in union have unmet need for contraception/ family planning. Of these, 16 percent have unmet need for spacing, and 12 percent for limiting. The demand for contraception is satisfied for 55 percent of women. antenatal care (anC)  Overall, 91 percent of women with a live birth in the two years prior to the survey were attended at least once by skilled health personnel8 during their last pregnancy, and a majority (87%) of these had at least four visits.  The vast majority (94%) of pregnant women who received ANC, received it in compliance with WHO guidelines, i.e. they had their blood pressure measured and samples of urine and blood taken. In addition, 41 percent of women have been tested for malaria (54% of those in interior areas and 37 % on the coast). assistance during delivery  Ninety-two (92) percent of births in the two years preceding the survey were delivered by skilled personnel, though the figure drops to 72 percent in interior areas.  Seventeen (17) percent of women who delivered in the two years preceding the survey had a C-section. C-sections are three times (25%) more likely among women aged 35-49 than those younger than 20 years. Forty-two (42) percent of the births in private health facilities were delivered by C-section compared to 14 percent in public facilities. Place of delivery  Ninety-three (93) percent of births are delivered in a health facility; only six (6) percent of births take place at home. In interior areas, 74 percent of deliveries take place in a health facility, and 25 percent at home. 8In Guyana MICS5, skilled health personnel refer to any of the following health professionals: medical doctor, nurse/midwife, single midwife or Medex. xxxviiMultiple indicator cluster survey 2014 | Post-natal health checks  Almost all the women (98%) who gave birth in a health facility stay 12 hours or more in the facility after delivery.  For 92 percent of live births, both the mothers and their newborns received either a health check following birth or a timely post-natal care (PNC) visit (i.e. visit within 2 days of birth), whereas for four (4) percent of births, neither received health checks or timely visits. For 15 percent of births in interior areas, neither the mother nor the newborn received any post-natal health check. Nearly half of home births (46%) did not receive any post-natal health checks. CHILD DEVELOPMENT Early childhood care and education  Sixty-one (61) percent of children aged 36-59 months are attending an organised early childhood education programme. Children in the older age group (85% versus 38% aged 36-47 months), and those on the coast (64% versus 49% in the interior) are more likely than others to attend such programmes. Quality of care  For almost nine out of ten (87%) children aged 36- 59 months, an adult household member engaged in four or more activities that promote learning and school readiness during the three days preceding the survey, with a mean number of activities of 5.1. The father’s involvement in four or more activities was somewhat limited (16%), with a mean number of 1.3 activities, compared to that of the mother (55%), with a mean number of 3.4 activities.  Almost one-half (47%) of children aged 0-59 months live in households where at least three children’s books are present for the child. Sixty- nine (69) percent of children aged 0-59 months had two or more types of playthings to play with in their homes.  A total of five (5) percent of children under five years of age were left with inadequate care during the past week, either by being left alone or in the care of another child for more than an hour. Developmental status of children  According to the Early Childhood Development Index (ECDI), 86 percent of children aged 36-59 months are developmentally on track. The analysis of four domains of child development shows that 97 percent of children are on track in the physical domain, 95 percent in the learning domain, but much less on track in social-emotional (75%) and literacy-numeracy (63%) domains. LITERACY AND EDUCATION Literacy9 among young women and men  The great majority (98%) of young women and men aged 15-24 years were found to be literate. School readiness  Eighty-five (85) percent of children, regardless of age, who are currently attending the first grade of primary school10 attended nursery school the previous year. Primary and secondary school participation  Of children who are of primary school entry age (i.e. 6 years old), 83 percent have attended the first grade of primary school at least once in the school year of the survey. The proportion of children entering primary school at the entry age is slightly higher in rural areas (85%) than in urban areas (78%). Additionally, the great majority of children (97%) of primary school age (i.e. ages 6 to 11 years) have attended school at least once in the school year of the survey. Secondary school attendance (i.e. percentage of children of secondary school age who are currently attending or have attended secondary or higher education at least once in the current school year) is not as high as for primary school, with 85 percent.  Of all children starting grade 1, the majority (96%) will eventually reach grade 6. Primary school completion rate is 109 percent. Ninety-six (96) percent of the children who were attending the last grade of primary school in the previous school year were found to be attending the first grade of secondary school in the school year of the survey. Gender Parity Index (GPI) for primary school is 1.00, 9In Guyana MICS5 2014, the literacy rate among young people is defined as the percentage respondents (women and men) aged 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education. 10In MICS5, school attendance is considered to be the percentage of children who were attending school regardless of the frequency of attendance. 11In MICS5, a child is considered to be involved in child labour activities if, during the week preceding the survey, he/she performed: i. age 5-11: 1 hour or more of economic work OR 28 hours or more of household chores OR ANY hazardous work per week; ii. age 12-14: 14 hours or more of economic work OR 28 hours or more of household chores OR ANY hazardous work per week; iii. age 15-17: 43 hours or more of economic work OR 43 hours or more of household chores OR ANY hazardous work per week work. 12It should be noted that the percentages do not add up to the total child labour figures, since children may be involved in both economic activities and household chores. xxxviii indicating no difference in the participation of girls and boys to primary school. The indicator increases to 1.08 for secondary education, indicating a slightly higher participation of girls than boys. CHILD PROTECTION Birth registration  The births of 89 percent of children under five years have been registered, while one (1) percent of children are registered, but do not have a birth certificate. Children living in the interior areas (81%), those in the poorest households (84%) and those in Region 1 (67%) are less likely than others to have their births registered.  Sixteen (16) percent of mothers or caretakers of children whose birth was not registered know how to register births. Mothers or caretakers of unregistered children living in the interior areas (20%) are more likely than those living in the coastal areas (14%) to have knowledge of how to register a child. Child labour11  Overall, 18 percent of children aged 5-17 years are engaged in child labour activities. Ten (10) percent are involved in economic activities above the age-specific threshold, one (1) percent performs household chores above the age-specific threshold, and 13 percent work under hazardous conditions.12 Children living in interior areas are more likely to be engaged in all forms of labour activities than other children, resulting in 37 percent of them engaged in child labour, with 30 percent working under hazardous conditions. Child discipline  Seventy (70) percent of children aged 1-14 years were subjected to at least one form of psychological or physical punishment by household members during the month prior to the survey. While 58 percent of children experienced psychological aggression, 51 percent experienced physical punishment, and six (6) percent of children were subjected to the most severe forms of physical punishment.13 Only one in five children experienced only non-violent discipline.  Twenty (20) percent of respondents believe that physical punishment is a necessary part of child-rearing. This perception is prevalent among mothers (22%) and among more educated persons (24% with higher education versus 14% with no education). Early marriage14 and polygyny15  In Guyana, the proportion of young women aged 15-19 years who are currently married/ in union is the same as that of young men in the same age group (13%). Women are more likely than men to be married/in union at a young age: four (4) percent of women aged 15-49 years compared to one (1) percent of men in the same age group were married before age 15; 27 percent of women aged 20-49 years compared to seven (7) percent of men in the same age group were married before age 18.  Polygynous unions concern four (4) percent of men aged 15-49 years and three (3) percent of women aged 15-49 years.  Among women aged 15-19 years and 20-24 years who are currently married/in union, approximately one in six (16% and 15%, respectively) has a husband or partner who is ten years or more older. For women aged 15-19 years, the proportion of women married to/in union with a man older by ten years or more is greater in urban areas (22%) than rural areas (13%), but is similar between coastal and interior areas (16% for both). For women aged 20-24 years, there are no notable urban-rural and coastal-interior differences. attitude towards domestic violence  Attitude towards domestic violence in Guyana is the same regardless of the sex of the respondent. Ten (10) percent of women and the same proportion of men feel that a husband is justified in hitting or beating his wife/partner in at least one of the following five situations: neglecting children, arguing with the husband, going out without telling him, refusing to have sex with him, or burning the food. This belief is most prevalent among both women and men in the rural areas as well as interior areas. 13In MICS5, the most severe forms of physical punishment include hitting or slapping the child on the head, ears or face, or hitting the child repeatedly as hard as one could. 14Early marriage, or child marriage, is defined as marriage or informal union before the age of 18. 15In MICS5, polygyny is the practice of having more than one spouse/partner at the same time. xxxixMultiple indicator cluster survey 2014 | Children’s living arrangements  A little over half (55%) of children aged 0-17 years live with both their parents, 28 percent live with mothers only, and four (4) percent live with fathers only. Eight (8) percent live with neither of their biological parents while both of them are alive. Almost one in four children (24%) live with their mothers only while the biological father is alive, and only three (3) percent live with their fathers only while the biological mother is alive. Older children are less likely than younger children to live with both parents and are more likely than younger children to live with neither biological parent.  Seven (7) percent of children aged 0-17 years have lost one or both parents, and one (1) percent has lost both parents. The percentage of children who have lost one or both parents is lowest in Region 9 (2%) and highest in Regions 5 and 6 (9% in each case).  Six (6) percent of children aged 0-17 years have one or both parents living abroad: four (4) percent have a father living abroad, one (1) percent have a mother living abroad, and the remaining one (1) percent have both mother and father living abroad. The highest percentages of children with at least one parent living abroad are in Region 10 (13%), in urban areas (9%), among children in the richest households (10%), and among those living in households with an African (9%) or mixed race (8%) household head. For all background characteristics, however, the proportion of children with both parents living abroad remains very small, and fathers being abroad are more common than mothers being abroad. HIV/AIDS AND SEXUAL BEHAVIOR Knowledge about HIV transmission and misconceptions about HIV  A large majority of women and men aged 15-49 years have heard of AIDS - 98 percent and 97 percent, respectively. However, the percentage of those who know of both main ways of preventing HIV transmission – having only one faithful uninfected partner and using a condom every time – is only 75 percent for women and 74 percent for men. Knowledge of both main ways to prevent HIV transmission is lower in interior areas (66% for women, 67% for men) than coastal areas (76% for women, 75% for men), and in rural areas (73% for women, 72% for men) than urban areas (82% 16People who have comprehensive knowledge of HIV prevention include those who know of the two main ways of HIV prevention (having only one faithful uninfected partner and using a condom every time), who know that a healthy looking person can be HIV positive, and who reject the two most common misconceptions in Guyana (HIV can be transmitted by mosquito bites and by sharing food with someone with HIV). for women, 79% for men). For both women and men, the percentages of those who know of both main ways to prevent HIV transmission increase with the level of education and the socio-economic status of the household.  Overall, comprehensive knowledge of HIV prevention16 is higher among females aged 15-49 years than among their male counterparts, with 56 percent of female and 49 percent of male. Men who were never married/in union (40%) are less likely to have comprehensive knowledge of HIV prevention than those who were ever married/in union (53%). In the case of women, marital status shows little or no correlation with comprehensive knowledge.  Ninety-two (92) percent of women and 84 percent of men know that HIV can be transmitted from mother to child. However, only 53 percent of women and 35 percent men know all three ways of mother-to-child transmission (MTCT). Additionally, six (6) percent of women and 13 percent of men did not know of any specific way. The least known method of MTCT among both women and men is during transmission during delivery, with 62 percent and 50 percent respectively. accepting attitudes towards people living with HIV  Only 23 percent of women and men respectively expressed accepting attitudes towards people living with HIV based on all four statements (would care for a family member with AIDS in own home; would buy fresh vegetables from a vendor who is HIV positive; thinks that a female teacher who is HIV positive should be allowed to teach in school; and would not want to keep it a secret if a family member is HIV positive). However, the great majority of women (98%) and men (99%) who have heard of AIDS agree with at least one accepting statement. Knowledge of a place for HIV testing, counselling and testing during antenatal care  Ninety (90) percent of women and 88 percent of men knew where to get tested for HIV, while 64 percent and 56 percent, respectively, have actually been tested, and 61 percent of women and 52 percent of men, know the result of their most recent test.  Sixty-seven (67) percent of women who had a live birth in the last two years received HIV counselling during antenatal care and 85 percent were tested xl for HIV during antenatal care and received the results. Sexual behaviour related to HIV transmission  Two (2) percent of women and 14 percent of men aged 15-49 years report having sex with more than one partner in the last 12 months. Of those, 42 percent of women and 59 percent of men report using a condom when they had sex the last time. HIV indicators for young women and young men  Comprehensive knowledge, knowledge of mother- to-child transmission, knowledge of a place to get tested, and accepting attitudes towards people living with HIV are generally less prevalent in the population age 15-24 years than that of age 15-49 years as a whole.  Forty-one (41) percent of young women and 27 percent of young men who are sexually active, have been tested for HIV in the last 12 months and know the result.  A larger proportion of young men (13%) than young women (5%) reported having sex before age 15, and also a much larger proportion of young men (15%) than young women (2%) reported having multiple sex partners in the 12 months preceding the survey. Twelve (12) percent of the young women and 37 percent of the young men who had sex in the 12 months preceding the survey reported that it involved a non-marital, non-cohabiting partner; of those, 57 percent of women and 88 percent of men used a condom the last time. Twelve (12) percent of women aged 15-24 years had sex with a man ten or more years older in the last 12 months. ACCESS TO MASS MEDIA AND USE OF INFORMATION/COMMUNICATION TECHNOLOGY access to mass media  Exposure/access to mass media is similar among women and men aged 15-49 years. The majority of women and men (95% in each case) are exposed to at least one type of media, while 40 percent of women and 41 percent of men are exposed to all three types of media (newspaper/magazine, radio, television) on a weekly basis, and five (5) percent of each sex do not have regular exposure to any of the three media. For both women and men, exposure to all three types of media tends to increase with household wealth and education. Women and men who reside in the rural areas and in the interior areas are less likely than others to be exposed to all three types of media. use of Information/Communication Technology  The use of computers and the internet is similar among young women and men aged 15-24 years. Fifty-two (52) percent of young women and 55 percent of young men have used one at least once a week during the month preceding the survey. In addition, 74 percent of young women and 73 percent of young men have ever used the internet, while 67 percent of young women and the same proportion of young men have used it during the year preceding the survey, and 58 percent of young women and 56 percent of young men have used it at least once a week during the month prior to the survey. SUBJECTIVE WELL-BEING  High proportions of young women (87-95%) and men (91-96%) aged 15-24 years report being very or somewhat satisfied in different areas of their lives, in particular the way they look, their health, and their family life. The great majority of young women and men are also very or somewhat satisfied with school for those attending school (95 and 93%, respectively), with their job for those who have a job (89% in each case), and with their current income for those who have an income (80 and 82%, respectively).  Ninety-three (93) percent of young women and 95 percent of young men are satisfied with their life overall, and 94 percent of young women and 93 percent of young men report being very or somewhat happy. Overall life satisfaction and happiness among young women as well as among young men do not seem to have any clear relationship with household wealth.  The proportions of women and men aged 15-24 years who think that their lives improved during the last one year and who expect that their lives will get better after one year are similar, with 82 percent of women and 83 percent of men. Perception of a better life differs by area and location of residence among both women and men: it is slightly higher among coastal women (82%) and coastal men (85%) than those in the interior areas (78 and 73%, respectively). 17In MICS5, current tobacco users are those who smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the last one month. xliMultiple indicator cluster survey 2014 | TOBACO USE AND ALCOHOL USE Tobacco use  Ever and current use of tobacco products17 is much more common among men than among women: 21 percent of men and two (2) percent of women are current tobacco users. Close to nine in ten women (87%) and one-half of men (50%) have never smoked cigarettes or used any other tobacco products.  Nine (9) percent of men and two (2) percent of women smoked a whole cigarette for the first time before age 15. Education level does not appear to be associated with smoking before age 15 for women, as almost the same proportion with no education and those with higher education smoked a cigarette before age 15 (4% versus 3%). On the other hand, men with up to primary education are twice as more likely than more educated men to smoke a cigarette before age 15 (16% versus 8-9% with secondary or higher education).  Among women and men who are current smokers, seven (7) percent of women and 22 percent of men smoked more than 20 cigarettes in the last 24 hours. alcohol use  Alcohol use is considerably higher among men than among women. Twenty-six (26) percent of women and 63 percent of men had at least one drink of alcohol on one or more days during the month prior to the survey.  Five (5) percent of women and 20 percent of men had at least one drink of alcohol before the age of 15. The proportion of women in the youngest age group (15-19 years) who had at least one drink of alcohol before age 15 is much higher than among the older age groups (13% versus 1-5% among the other age groups). Similarly, the proportion of men in the youngest age group (15-19 years) who had at least one drink of alcohol before age 15 is higher than among the older age groups (30% versus 11-24% among the other age groups).  Alcohol use is similar across levels of education, for both women and men. Though there is no clear pattern with regards to the household wealth, use of alcohol is most prevalent in the richest households for both women and men. xlii @UNICEF Guyana xliiiMultiple indicator cluster survey 2014 | @UNICEF Guyana I. INTRODUCTION Background This report is based on the Guyana Multiple Indicator Cluster Survey Round 5 (Guyana MICS5), conducted in 2014 by the Bureau of Statistics (BoS) and the Ministry of Public Health. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). 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 of the World Fit for Children (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.” 45MULTIPLE INDICATOR CLUSTER SURVEY 2014 | In Guyana, commitments to national, regional and global priorities have been demonstrated through development and implementation of plans and strategies such as Health Vision 2020, a National Health Strategy for Guyana 2013-2020, National Education Strategic Plan 2014-2019, the Child Protection, Sexual Offences and Prevention of Violence Acts, the Strategic Plan of Action for Prevention and Control of Non Communicable Diseases for countries of the Caribbean Community (2011-2015),the Regional Health Framework of the Caribbean Cooperation in Health III (CCH III) 2010 - 2015, the Health Agenda for the Americas 2008 - 2017, and the MDGs for 2015. MICS findings will provide data for monitoring and reporting on progress towards these goals and commitments. The Guyana MICS5 2014 results will be critically important for final MDG reporting in 2015, and are expected to form part of the baseline data for the post- 2015 era. Guyana MICS5 2014 is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end child deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women’s and Children’s Health. This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The Guyana MICS5 2014 has as its primary objectives:  To provide up-to-date information for assessing the situation of children and women in Guyana;  To generate data for the critical assessment of the progress made in various areas, and to put additional efforts in those areas that require more attention;  To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action;  To collect disaggregated data for the identification of disparities, to allow for evidence based policy- making aimed at social inclusion of the most vulnerable;  To contribute to the generation of baseline data for the post-2015 agenda;  To validate data from other sources and the results of focused interventions. 46 @UNICEF Guyana 47Multiple indicator cluster survey 2014 | @UNICEF Guyana 48 Sample Design The sample for the Guyana Multiple Indicator Cluster Survey Round 5 2014 (Guyana MICS5 2014) was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas separately and for the two geographic sub-areas defined as interior and coastal areas. Relative to the urban/rural and interior/coastal distinction, it should be noted that all the urban areas are located on the coast and all the interior areas are considered rural. The coastal and interior areas were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census Enumeration Districts (EDs)/ Primary Sampling Units (PSUs) were selected systematically with probability proportional to size. Before the fieldwork commenced, listing of the households in the selected EDs was conducted from the 27th of January to 30th of March 2014, for the EDs in the coastal areas. For the EDs in the interior areas, the household listing was carried out by the data collection teams and the household sample was drawn in the field, prior to conducting the interviews. Note that EDs that fell in the sample with less than 100 households were combined with neighbouring ED/EDs to form PSUs. The listing process allowed the division of households into two (2) groups as follows: households with children under five years and households without children under five years. From these two groups, twelve (12) and eight (8) households respectively were selected using random systematic sampling, giving a total of 20 households per ED. A total of 6,000 households, i.e. 20 households per ED, were selected for interviews in 300 EDs. Four (4) of the selected EDs/PSUs in the interior areas were not visited because they were inaccessible during the fieldwork period due to administrative issues with the local authority, very low water levels in the access rivers, relocation of entire communities as a result of a shift in economic activities, and extremely high travel costs due to a sparse population spread. The sample was stratified by region and interior and coastal areas, and was not self- weighted. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A, Sample Design. II. SAMPLE AND SURVEY METHODOLOGY 49Multiple indicator cluster survey 2014 | The Household Questionnaire was used to collect basic demographic information on all de jure household members (usual residents), the household, and the dwelling, and included the following modules:  List of Household Members  Education  Child Labour  Child Discipline  Household Characteristics  Insecticide Treated Nets  Water and Sanitation  Handwashing  Salt Iodization The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules:  Woman’s Background  Access to Mass Media and Use of Information/ Communication Technology  Fertility/Birth History  Desire for Last Birth  Maternal and Newborn Health  Post-natal Health Checks  Illness Symptoms  Contraception  Unmet Need  Attitudes Toward Domestic Violence  Marriage/Union  Sexual Behaviour  Prevention  HIV/AIDS  Tobacco and Alcohol Use  Chronic Illness Control  Life Satisfaction The Questionnaire for Individual Men was administered, in ten (10) of the 20 households, to all men aged 15-49 years as follows: six (6) of the 12 households in each ED, with children under five years and four (4) of the eight (8) households without children under five years, and included the following modules: 18The model MICS5 questionnaires can be found at http://www.childinfo.org/mics5_questionnaire.html 19The terms “children under five”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. Questionnaires The questionnaires are based on the MICS5 model questionnaire18. From the MICS5 model English version, the questionnaires were customised and were pre-tested in three (3) locations in both urban and rural areas including a community in the interior areas during February 2014. Based on the results of the pre-test, modifications were made to the wording of the questionnaires. A copy of the Guyana MICS5 2014 questionnaires is provided in Appendix F. Four (4) sets of questionnaires were used in the survey: 1) a household questionnaire; 2) a questionnaire for individual women; 3) a questionnaire for individual men; and 4) a questionnaire for children under five years of age19.  Man’s Background  Access to Mass Media and Use of Information/ Communication Technology  Fertility  Attitudes Toward Domestic Violence  Marriage/Union  Sexual Behaviour  HIV/AIDS  Tobacco and Alcohol Use  Chronic Illness Control  Life Satisfaction The Questionnaire for Children Under Five was administered to mothers (or caretakers) of children under five years of age living in the households. Normally, the questionnaire was administered to mothers of under-five children; however, in cases when the mother was not a member of the household (i.e. was not listed in the household roster), a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules:  Age  Birth Registration  Early Childhood Development  Breastfeeding and Dietary Intake  Immunization  Care of Illness  Anthropometry For children aged 0-2 years with a completed Questionnaire for Children Under Five, whose clinic card was not available at home at the time of the interview and whose mother/primary caretaker indicated that a copy of the card was at the health facility, an additional form, the Questionnaire Form For Vaccination Records At Health Facility, was used to record vaccinations from the registers at health facilities. 50 Training and Fieldwork Training for the fieldwork was conducted for 15 days (three work-weeks) between the 25th of February and 18th of March 2014. The training methodologies included lectures on interviewing techniques utilising each of the questionnaires and role-play modelling the various functions interchangeably. As part of the selection process, participants were observed during the role-plays and scored. Quizzes were also administered to participants. Once the questionnaires were finalised and the teams were selected, the survey implementation was piloted. During this process, trainees spent a day in the field in six (6) locations in both urban and rural areas, to ensure that the processes of the fieldwork would work as close as possible to how it was envisioned during the training. Both the pilot and training were conducted in the coastal regions and therefore the interior areas were visited at the time of the listing and enumeration. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing, and measured the weights and heights of children age under five years. Details and findings of these observations and measurements are provided in the respective sections of the report. The data were collected by 14 teams; each was comprised of four (4) interviewers, one (1) editor, one (1) measurer, one (1) supervisor and one (1) driver. Fieldwork began in April 2014 and concluded in July 2014. Data Processing The data were entered using the CSPro software, Version 5.0. The data were entered on nine (9) desktop computers and carried out by nine (9) data entry operators and one (1) data entry supervisor. For quality assurance purposes, all questionnaires were double-entered and internal consistency checks were conducted. The procedures and standard programs developed by the global MICS programme, informed the adaption of Guyana MICS5 2014 questionnaires, and guided the process throughout. Data processing began just after the second week of data collection in April 2014 and was completed in mid-December 2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 21. The model syntax and tabulation plans developed by UNICEF were customised and used for this purpose. 51Multiple indicator cluster survey 2014 | III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS@UNICEF Guyana 52 Sample Coverage Of the 5,904 households selected for the sample, 5,526 were found to be occupied. Of these, 5,077 were successfully interviewed for a household response rate of 91.9 percent. In the interviewed households, 5,809 women (age 15-49 years) were interviewed. Of these, 5,076 were successfully interviewed, yielding a response rate of 87.4 percent within the interviewed households. The survey also sampled men (age 15-49 years), but required only a subsample. All men (age 15-49 years) were identified in every other household. Two thousand five hundred and twenty-six (2,526) men (age 15-49 years) were listed in the household questionnaires. Questionnaires were completed for 1,682 eligible men, corresponding to a response rate of 66.6 percent within eligible interviewed households. There were 3,482 children under age five listed in the household questionnaires. Questionnaires were completed for 3,358 of these children, which corresponds to a response rate of 96.4 percent within the households that were interviewed. Overall response rates of 80.3 percent, 61.2 percent, and 88.6 percent are calculated for the individual interviews of women, men, and under-five’s, respectively (Table HH.1). As can be seen in Table HH.1, response rates for women, men, children under five as well as for households, were slightly lower in urban areas compared to rural areas, and in interior areas compared to coastal areas. Region 1 had consistently lower response rates compared to other regions, except for that of children under five in Regions 7 & 8, which was slightly lower with 92 percent compared to 96 percent in Region 1. Men’s response rates were generally very low, ranging from 52 to 76 percent across areas and location of residence, and from 30 to 79 percent across regions. This is partly due to the absence of men in the households at the time of interview, even though they were there at the time of listing and in many cases more than the three standard call-backs were made. Results for men should therefore be interpreted with caution. In addition, response rates of less than 85 percent were experienced for women in interior areas (80%), Regions 1 (69%), 7 & 8 (77%) and 9 (83%); therefore, these should also be interpreted with caution. Except for results for under-five children, all disaggregated results for Region 1 should generally be interpreted with caution. The regions are defined as follows: Barima-Waini (Region 1) Pomeroon-Supenaam (Region 2) Essequibo Islands-West Demerara (Region 3) Demerara-Mahaica (Region 4) Mahaica-Berbice (Region 5) East Berbice-Corentyne (Region 6) Cuyuni-Mazaruni (Regions 7) Potaro-Siparuni (Regions 8) Upper Takutu-Upper Essequibo (Region 9) Upper Demerara-Berbice (Region 10) III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Map of Guyana Showing Regions 53Multiple indicator cluster survey 2014 | N um be r o f h ou se ho ld s, w om en , m en , a nd c hi ld re n un de r 5 b y re su lts o f t he h ou se ho ld , w om en 's , m en 's a nd u nd er -5 's in te rv ie w s, a nd h ou se ho ld , w om en 's , m en 's a nd u nd er -5 's re sp on se ra te s, G uy an a M IC S 5, 2 01 4 To ta l A re a Lo ca tio n R eg io n U rb an R ur al C oa st al U rb an C oa st al R ur al C oa st al In te rio r R eg io n 1 R eg io n 2 R eg io n 3 R eg io n 4 R eg io n 5 R eg io n 6 R eg io ns 7 & 8 R eg io n 9 R eg io n 10 H ou se ho ld s S am pl ed 5, 90 4 1, 39 8 4, 50 6 4, 11 7 1, 20 9 32 0 72 0 34 0 39 8 O cc up ie d 5, 52 6 1, 31 0 4, 21 6 3, 89 2 1, 13 0 29 8 68 2 31 8 37 6 In te rv ie w ed 5, 07 7 1, 16 5 3, 91 2 3, 63 2 99 3 29 7 66 4 31 2 34 8 H ou se ho ld re sp on se ra te 91 .9 88 .9 92 .8 93 .3 87 .9 99 .7 97 .4 98 .1 92 .6 W om en E lig ib le 5, 80 9 1, 36 7 4, 44 2 4, 15 5 1, 14 7 30 0 77 3 34 0 39 5 In te rv ie w ed 5, 07 6 1, 16 7 3, 90 9 3, 76 0 96 9 29 5 71 6 31 9 34 9 W om en 's re sp on se ra te 87 .4 85 .4 88 .0 90 .5 84 .5 98 .3 92 .6 93 .8 88 .4 W om en 's o ve ra ll re sp on se ra te 80 .3 75 .9 81 .7 84 .4 74 .2 98 .0 90 .2 92 .1 81 .8 M en E lig ib le 2, 52 6 55 4 1, 97 2 1, 76 0 47 1 14 7 30 8 14 9 14 3 In te rv ie w ed 1, 68 2 36 4 1, 31 8 1, 28 2 30 6 11 3 23 7 10 6 96 M en 's re sp on se ra te 66 .6 65 .7 66 .8 72 .8 65 .0 76 .9 76 .9 71 .1 67 .1 M en 's o ve ra ll re sp on se ra te 61 .2 58 .4 62 .0 68 .0 57 .1 76 .6 74 .9 69 .8 62 .1 C hi ld re n un de r 5 E lig ib le 3, 48 2 73 3 2, 74 9 2, 25 1 60 7 17 4 35 6 21 7 25 1 M ot he rs /c ar et ak er s in te rv ie w ed 3, 35 8 68 7 2, 67 1 2, 18 2 57 1 17 3 34 9 21 4 23 7 U nd er -5 's re sp on se ra te 96 .4 93 .7 97 .2 96 .9 94 .1 99 .4 98 .0 98 .6 94 .4 U nd er -5 's o ve ra ll re sp on se ra te 88 .6 83 .4 90 .2 90 .5 82 .7 2, 90 8 2, 76 2 2, 63 9 95 .5 3, 00 8 2, 79 1 92 .8 88 .7 1, 28 9 97 6 75 .7 72 .3 1, 64 4 1, 61 1 98 .0 93 .6 1, 78 7 1, 63 4 1, 44 5 88 .4 1, 65 4 1, 31 6 79 .6 70 .4 76 6 40 0 52 .2 46 .2 1, 23 1 1, 17 6 95 .5 84 .5 42 0 41 8 32 6 78 .0 39 5 27 1 68 .6 53 .5 17 9 53 29 .6 23 .1 28 2 26 8 95 .0 74 .1 99 .1 95 .4 2, 06 1 1, 95 5 1, 75 7 89 .9 2, 08 2 1, 80 8 86 .8 78 .0 87 7 60 5 69 .0 62 .0 1, 12 1 1, 07 3 95 .7 86 .0 96 .8 76 0 72 1 68 3 94 .7 73 3 69 3 94 .5 89 .6 32 8 25 9 79 .0 74 .8 42 4 41 7 98 .3 93 .2 48 8 43 1 38 5 89 .3 47 4 36 3 76 .6 68 .4 23 9 12 0 50 .2 44 .9 36 1 33 3 92 .2 82 .4 39 7 32 7 30 5 93 .3 31 7 26 2 82 .6 77 .1 15 6 93 59 .6 55 .6 29 6 29 4 99 .3 92 .6 87 .4 Ta bl e H H .1 : R es ul ts o f h ou se ho ld , w om en 's , m en 's a nd u nd er -5 in te rv ie w s 54 Table HH.2: Age distribution of household population by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Guyana MICS5, 2014 Total Males Females Number Percent Number Percent Number Percent Total 19,321 100.0 9,326 100.0 9,995 100.0 Age 0-4 1,851 9.6 948 10.2 903 9.0 5-9 1,857 9.6 960 10.3 898 9.0 10-14 1,931 10.0 960 10.3 971 9.7 15-19 11.1 1,071 11.5 1,072 10.7 20-24 1,677 8.7 811 8.7 866 8.7 25-29 1,440 7.5 704 7.5 737 7.4 30-34 1,151 6.0 534 5.7 617 6.2 35-39 1,237 6.4 579 6.2 658 6.6 40-44 1,287 6.7 599 6.4 687 6.9 45-49 1,039 5.4 459 4.9 580 5.8 50-54 1,089 5.6 527 5.7 562 5.6 55-59 800 4.1 379 4.1 421 4.2 60-64 554 2.9 252 2.7 303 3.0 65-69 483 2.5 245 2.6 238 2.4 70-74 299 1.5 116 1.2 183 1.8 75-79 177 0.9 68 0.7 110 1.1 80-84 144 0.7 49 0.5 95 0.9 85+ 109 0.6 43 0.5 66 0.7 Missing/DK 53 0.3 23 0.2 30 0.3 Dependency age groups 0-14 5,639 29.2 2,868 30.8 2,771 27.7 15-64 12,418 64.3 5,915 63.4 6,504 65.1 65+ 1,211 6.3 521 5.6 691 6.9 Missing/DK 53 0.3 23 0.2 30 0.3 Child and adult populations Children age 0-17 years 6,959 36.0 3,508 37.6 3,451 34.5 Adults age 18+ years 12,310 63.7 5,795 62.1 6,515 65.2 Missing/DK 53 0.3 23 0.2 30 0.3 2,143 Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1 below. In the 5,077 households successfully interviewed in the survey, 19,321 household members were listed. Of these, 9,326 were males, and 9,995 were females. It should be noted that extensive oversampling and under sampling of households were done as part of the sample design. Oversampling was carried out in the rural areas particularly in the interior areas, specifically in Regions 1, 7, 8, 9 and 10, while under sampling was carried out in the other regions. As shown in Table HH.2 above, there are no variations in the sex distribution of the population by five-year age groups. The predominant group consists of people in the 15-19 age group (11%) followed by 10-14, 5-9 and 0-4 age groups, with ten (10) percent in each case. Almost two-thirds of the population in Guyana (62% total: 64% males and 61% females) is under 35 years of age and one-third (33% total: 33% males and 33% females) is between the ages of 15 and 35 years (youth). The distribution of age groups 0-14 (29% total: 31% males and 28% females), 15-64 (64% total: 63% males and 65% females) and 65+ (6% total: 6% males and 7% females) is in line with the results of the DHS 200920 findings, with 34, 61 and six (6) percent, respectively. Children under 18 years of age make up 36 percent of the population - 38 percent males and 35 percent females. 20 Ministry of Health, Bureau of Statistics, and ICF Macro.2010. Guyana Demographic and Health Survey 2009. 55Multiple indicator cluster survey 2014 | 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Per cent Age Males Females Note: 53 household members with missing age and/or sex are excluded Figure HH.1: Age and sex distribution of household population, Guyana MICS5, 2014 Tables HH.3, HH.4, HH.4M and HH.5 provide basic information on the households, female respondents aged 15- 49 years, male respondents aged 15-49 years, and children under five years of age respectively. Both unweighted and weighted numbers are presented, which are essential for the interpretation of findings presented later in the report and provide background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers.21 Table HH.3 provides basic background information on the households, including the sex of the household head, region, area, number of household members, education of household head, and ethnicity22 of the household head. Data disaggregated by region has been included in the report, despite the fact that regions were not considered as reporting domains in the sample design. Hence, regional estimates must be taken with extreme caution considering the large sampling errors for some regions due to their low sample sizes. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. 21See Appendix A: Sample Design, for more details on sample weights. 22This is based on the ethnic group identified by the respondent of the Household Questionnaire to be that of the household head. 56 Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Guyana MICS5, 2014 Weighted percent Number of households Weighted Unweighted Total 100.0 5,077 5,077 Sex of household head Male 65.6 3,330 3,490 Female 34.4 1,747 1,587 Region Region 1 1.3 66 326 Region 2 5.6 287 297 Region 3 16.2 821 664 Region 4 44.2 2,244 1,757 Region 5 6.8 343 312 Region 6 16.1 817 683 Regions 7 & 8 2.1 105 385 Region 9 2.5 127 305 Region 10 5.3 267 348 Area Urban 27.6 1,404 1,165 Rural 72.4 3,673 3,912 Location Coastal 87.6 4,448 3,632 Urban Coastal 24.0 1,218 993 Rural Coastal 63.6 3,231 2,639 Interior 12.4 629 1,445 Number of household members 1 12.7 644 408 2 17.1 871 588 3 19.3 978 871 4 19.0 963 1,000 5 13.9 703 823 6 8.2 417 563 7 4.5 227 336 8 2.3 119 197 9 1.4 70 125 10+ 1.7 85 166 Education of household head None 2.1 108 110 Primary 32.1 1,632 1,597 Secondary 53.4 2,713 2,797 Higher 10.0 510 455 Missing/DK 2.2 114 118 Ethnicity of household heada East Indian 45.8 2,323 1,851 African 31.5 1,598 1,419 Amerindian 6.3 320 786 Mixed Race 15.9 809 993 Others/Missing/DK (0.6) 28 28 Mean household size 3.8 5,077 5,077 a This is based on the ethnic group identified by the respondent of the Household Questionnaire to be that of the household head. 57Multiple indicator cluster survey 2014 | The ‘weighted’ and ‘unweighted’ total numbers of households are equal, since sample weights were normalized.4 The table also shows the weighted mean household size estimated by the survey. Two-thirds of the households are headed by males (66%) and one-third by females (34%). The largest proportion of the households is in Region 4 (44%), followed by Regions 3 and 6 (16% in each case) and then by Region 5 (7%). Each of the other Regions account for less than six (6) percent with the smallest proportion of household in Region 1 (1%). Almost three-quarters of households (72%) are found in rural areas and just over a quarter are found in the urban areas. Whereas 88 percent of households are on the coastal areas (24% in the urban coastal and 64% in the rural coastal), only 12 percent of households are in interior areas. More than half of households (53%) have a household head with a secondary education and almost one-third (32%) with primary education. Only one-tenth has higher education, while two (2) percent have no education. Nearly one-half of the households are headed by an East Indian (46%), one- third by an African (32%), 16 percent by a person of mixed race, and six (6) percent by an Amerindian. The most common household composition is three or four persons, with 19 percent in each case. More than eight out of ten households (82%) have between one and five persons. The mean household size is 23 Ministry of Health (MOH), Bureau of Statistics (BOS), and ICF Macro. 2010. Guyana Demographic and Health Survey 2009. Georgetown, Guyana: MOH, BOS, and ICF Macro. 24 Bureau of Statistics. 2014. Guyana Population and Housing Census 2012 Preliminary Report. Georgetown, Guyana (http://www.statisticsguyana.gov. gy/census.html; accessed on 26 May 2015). 3.8, which is in line with the DHS 200923 (3.7) and 2012 Census24 finding (3.6). It noteworthy that the household composition found in this MICS relative to sex of household head and number of household members is generally similar to that found in DHS 20096. Characteristics of Female and Male Respondents 15-49 years of age and Children under Five Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female and male respondents 15-49 years of age and of children under age five respectively. In all three tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized).4 In addition to providing useful information on the background characteristics of women, men, and children under age five, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. The background characteristics of female respondents aged 15-49 years are presented in Table HH.4. It includes information on the distribution of women according to region, area, age, marital/union status, motherhood status, births in last two years, education25, wealth index quintiles26, 27, and ethnicity of the household head. 25Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when it is used as a background variable. 26The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth index values. Each household in the total sample is then assigned a wealth score based on the assets owned by that household and on the final factor scores obtained as described above. The survey household population is then ranked according to the wealth score of the household they are living in, and is finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). In Guyana MICS5 2014, the following assets were used in these calculations: main material of dwelling’s floor, roof and exterior walls, main types of fuel used for cooking, presence in the household of electricity, a radio, landline telephone, refrigerator, stop that works with solar energy, computer (desktop, laptop, tablet), connection to cable TV, land dredge for mining, tractor/combine, mattress for sleeping, set of table and chairs, solar panel, generator, washing machine; ownership by a household member of a watch, mobile telephone, bicycle, motorcycle or scooter, car or truck, boat with a motor, bus, digital photo camera; possession of a bank account; source of drinking water, location of water source; type of sanitation facility, presence of water and soap at place for handwashing. Urban and rural factor scores also include possession of agricultural land and animals. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D. and Pritchett, L., 2001. “Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India”. Demography 38(1): 115-132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro and Rutstein, S.O., 2008. The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Papers No. 60. Calverton, Maryland: Macro International Inc. 27When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as for instance “women in the richest population quintile”, which is used interchangeably with “women in the wealthiest survey population”, “women living in households in the richest population wealth quintile”, and similar. 58 @UNICEF Guyana 59Multiple indicator cluster survey 2014 | Table HH.4: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Guyana MICS5, 2014 Weighted percent Number of women Weighted Unweighted Total 100.0 5,076 5,076 Region Region 1 1.5 75 271 Region 2 5.0 253 295 Region 3 17.4 883 716 Region 4 44.8 2,274 1,808 Region 5 6.3 322 319 Region 6 15.1 767 693 Regions 7 & 8 2.5 128 363 Region 9 2.4 123 262 Region 10 4.9 251 349 Area Urban 27.3 1,387 1,167 Rural 72.7 3,689 3,909 Location Coastal 87.5 4,442 3,760 Urban Coastal 23.7 1,201 969 Rural Coastal 63.9 3,241 2,791 Interior 12.5 634 1,316 Age 15-19 20.2 1,025 916 20-24 16.6 843 959 25-29 14.1 718 889 30-34 11.7 594 722 35-39 12.8 648 602 40-44 13.3 673 546 45-49 11.3 575 442 Marital/Union status Currently married/in union/visiting relationship 68.0 3,450 3,758 Widowed 1.7 88 52 Divorced 0.9 45 32 Separated 4.4 225 222 No longer in a visiting relationship 2.7 139 135 Never married/in union 22.2 1,128 877 Motherhood and recent births Never gave birth 34.5 1,752 1,303 Ever gave birth 65.5 3,324 3,773 Gave birth in last two years 15.2 769 1,258 No birth in last two years 50.3 2,555 2,516 Education None 1.1 57 81 Primary 13.5 683 750 Secondary 73.8 3,744 3,726 Higher 11.7 592 519 Wealth index quintile Poorest 17.0 864 1,330 Second 18.5 938 949 Middle 19.8 1,007 892 Fourth 22.3 1,132 962 Richest 22.4 1,135 943 Ethnicity of household heada East Indian 45.6 2,314 1,857 African 30.1 1,526 1,428 Amerindian 6.8 344 721 Mixed Race 17.3 877 1,051 Others/Missing/DK 0.3 16 19 a This is based on the ethnic group identified by the respondent of the Household Questionnaire to be that of the household head. Almost three-quarters (73%) of the women aged 15-49 years reside in the rural areas, while just over one-quarter (27%) resides in the urban areas. Close to nine out of ten women (88%) are from the coastal areas, with 24 percent from the urban coastal areas and 64 percent from the rural coastal areas. Just 12 percent are from the interior areas. The largest percentage of women is in Region 4 (45%), followed by Regions 3 (17%) then by Region 6 (15%). Each of the other regions account for five (5) percent or less with the smallest percentage in Region 1 (2%). The percentage of women in each age group decreases with age. Women aged 15-19 years represent one-fifth (20%) of the total number of women aged 15- 49 years, while the other age groups range from 11 to 17 percent. Whereas 68 percent of women are currently married, in a union or in a visiting relationship, 22 percent have never been married or in union. Two-thirds of women (66%) have given birth, of which 15 percent have given birth in the two years preceding the survey. The majority of women are from households headed by an East Indian (46%), an African (30%) and a person of mixed race (17%), while seven (7) percent are from households headed by an Amerindian. Almost three- quarters of women (74%) have secondary education, and 12 percent have higher education. Only one (1) percent has no education, and 14 percent have primary education. 60 Table HH.4M: Men's background characteristics Percent and frequency distribution of men age 15-49 years by selected background characteristics, Guyana MICS5, 2014 Weighted percent Number of men Weighted Unweighted Total 100.0 1,682 1,682 Region Region 1 1.6 27 53 Region 2 5.4 90 113 Region 3 16.5 278 237 Region 4 44.9 755 605 Region 5 7.3 122 106 Region 6 15.1 254 259 Regions 7 & 8 2.4 40 120 Region 9 2.6 43 93 Region 10 4.4 74 96 Area Urban 26.2 441 364 Rural 73.8 1,241 1,318 Location Coastal 87.7 1,475 1,282 Urban Coastal 23.2 390 306 Rural Coastal 64.5 1,085 976 Interior 12.3 207 400 Age 15-19 22.3 374 335 20-24 15.2 255 224 25-29 15.1 253 271 30-34 11.5 194 263 35-39 13.4 226 254 40-44 12.6 212 186 45-49 10.0 168 149 Marital/Union status Currently married/in union/visiting 59.6 1,002 1,124 Widowed 0.1 1 2 Divorced 0.4 7 5 Separated 2.7 45 38 No longer in a visiting relationship 2.7 45 42 Never married/in union 34.6 582 470 Missing 0.0 1 1 Fatherhood status Has at least one living child 50.4 848 1,014 Has no living children 49.5 833 665 Missing/DK 0.1 1 3 Education None 0.5 9 15 Primary 13.6 229 238 Secondary 71.9 1,210 1,231 Higher 13.8 232 197 Missing/DK 0.1 2 1 Wealth index quintile Poorest 18.2 307 414 Second 22.1 372 348 Middle 20.6 347 314 Fourth 16.5 278 283 Richest 22.5 378 323 Ethnicity of household heada East Indian 47.9 806 722 African 30.2 508 434 Amerindian 7.2 122 241 Mixed Race 14.1 238 274 Others/Missing/DK 0.5 9 11 a This is based on the ethnic group identified by the respondent of the Household Questionnaire to be that of the household head Similarly, Table HH.4M provides background characteristics of male respondents 15-49 years of age. The table shows information on the distribution of men according to region, area, age, marital status, fatherhood status, education, wealth index quintiles, and ethnicity of the household head. The background characteristics of males are similar to women’s relative to area, location, region, and age group. Almost three- quarters (74%) of the men aged 15-49 years reside in the rural areas, while just over one-quarter (26%) resides in the urban areas. As was the case with women, close to nine out of ten men (88%) are from the coastal areas, with 23 percent from the urban coastal areas and 65 percent from the rural coastal areas; 12 percent are from the interior areas. The largest percentage of men is in Region 4 (45%), followed by Region 3 (17%) then by Region 6 (15%). Each of the other regions account for seven (7) percent or less, with the smallest percentage in Region 1 (2%). The largest proportion of men is aged 15-19 years with 22 percent, followed by those aged 20- 24 and 25-29 years, with 15 percent in each case. The percentages of men in the other age groups range from 10 to 13 percent. While 60 percent of men are currently married, in a union or in a visiting relationship, 35 percent have never been married or in union. One- half of them (50%) have at least one living child. Ethnicity of household head 61Multiple indicator cluster survey 2014 | Table HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Guyana MICS5, 2014 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 3,358 3,358 Sex Male 51.3 1,722 1,702 Female 48.7 1,636 1,656 Region Region 1 2.9 96 268 Region 2 5.5 185 173 Region 3 13.5 452 349 Region 4 41.1 1,382 1,073 Region 5 7.0 236 214 Region 6 13.2 443 417 Regions 7 & 8 4.9 164 333 Region 9 5.9 198 294 Region 10 6.0 202 237 Area Urban 24.9 838 687 Rural 75.1 2,520 2,671 Location Coastal 78.4 2,634 2,182 Urban Coastal 21.2 711 571 Rural Coastal 57.3 1,923 1,611 Interior 21.6 724 1,176 Age 0-5 months 9.7 326 290 6-11 months 10.8 362 346 12-23 months 20.4 686 688 24-35 months 19.3 648 684 36-47 months 20.3 683 672 48-59 months 19.5 653 678 Respondent to the under-5 questionnaire Mother 92.2 3,095 3,129 Other primary caretaker 7.8 263 229 Mother’s educationa None 1.9 64 88 Primary 14.4 483 573 Secondary 74.0 2,485 2,385 Higher 9.6 321 307 Missing/DK 0.1 4 5 Wealth index quintile Poorest 29.9 1,003 1,264 Second 22.5 755 640 Middle 18.3 616 524 Fourth 14.5 486 463 Richest 14.8 497 467 Ethnicity of household headb East Indian 33.3 1,118 997 African 30.9 1,037 868 Amerindian 14.6 492 766 Mixed Race 20.7 697 713 Others/Missing/DK 0.5 15 14 a In this table and throughout the report, mother's education refers to educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. b This is based on the ethnic group identified by the respondent of the Household Questionnaire to be that of the household head. and men’s educational background are similar to those of women: 72 percent of men have secondary education, and 14 percent have higher education. Only one (1) percent has no education, and 14 percent have primary education. The majority of men are from households headed by an East Indian (48%), an African (30%) and a person of mixed race (17%), while seven (7) percent are from households headed by an Amerindian. Background characteristics of children under five are presented in Table HH.5. These include the distribution of children by several attributes: sex, region and area, age in months, respondent type, mother’s (or caretaker’s) education, household wealth and ethnicity of household head. The proportions of male and female children under five years of age are 51 and 49 percent, respectively. The age distribution of children is quite balanced among all age groups, with 19-20 percent in each group. Three-quarters (75%) of children reside in the rural areas. While 78 percent are from the coastal areas, with 21 percent from the urban coastal areas and 57 percent from the rural coastal areas, 22 percent are from the interior areas. The largest percentage of children is in Region 4 (41%) and the smallest percentage is in Region 1 (3%). The majority (74%) of children have a mother with secondary education; ten (10) percent and 14 percent have a mother with higher education and primary education respectively; only two (2) percent have a mother with no education. The largest proportions of children are from households headed by an East Indian (33%), an African (31%) and a person of mixed race (21%), while 15 percent are from households headed by an Amerindian. As for wealth quintiles, larger proportions of children live in poorer households, with 30 percent living in the poorest households, 23 percent in the second quintile, and between 15 and 18 percent living in the remaining quintiles. 62 Housing characteristics, asset ownership, and wealth quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. Table HH.6 presents characteristics of housing, disaggregated by area, location and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. Overall, 87 percent of households in Guyana have electricity, and while the great majority of households in both urban and rural areas (94 and 84%, respectively) have electricity, only 56 percent of households in interior areas do, compared to 91 percent in coastal areas. Large differences are observed across regions: 25 percent in Region 9, 27 percent in Region 1, and 47 percent in Regions 7 & 8, compared with between 78 and 94 percent of households in the other regions. With respect to the main material for dwelling floors, the most prevalent type is finished floor (81%), followed by rudimentary floors (16%). Only two (2) percent of the households have natural floors. This pattern is similar by area and location, except that natural floors are generally only used in the interior areas and that only 62 percent of the households in the interior have finished floors. Households with finished floor in the urban areas outnumbered those in the rural areas by ten (10) percentage points, while such households in the coastal areas (84%) outnumbered those in the interior areas (62%) by 22 percentage points. The percentages are lower in Regions 1 (21%), Region 2 (42%), Regions 7 & 8 (55%) and Region 9 (42%), compared to the remaining regions (78-98%). Relative to the main roofing material of dwellings, 97 percent of households have finished roofing. While 99 to 100 percent of households in Regions 2, 3, 4, 5, 6, and 10 have finished roofing, Region 1, 7 & 8, and 9 have much lower percentages, with 74, 84 and 40 percent respectively. It is noteworthy that 60 percent of households in Region 9 have natural roofing, compared with 22 and 10 percent for Regions 1 and 7 & 8 respectively. As for the main material of exterior walls, similar trends relative to area, location and regions of residence are observed. While 93 percent of households in Guyana have finished walls and the percentage in the coastal areas is 95, that in interior areas is only 78. Lower proportions are found in Region 1 (79%), Regions 7 & 8 (80%), and Region 9 (42%), in contrast with the remaining regions that have between 92 and 99 percent of households with finished walls. In Region 9, more than half of households (52%) have rudimentary walls, as compared with 18 percent in Region 1 and ten (10) percent in Regions 7 & 8. Overall, 75 percent of households have two or more rooms used for sleeping (38% with 2 rooms and 36% with 3 or more rooms). There are no marked differences among those with two rooms based on area, location and region of residence. However, relative to households with three or more rooms, Region 4 has the largest proportion with 41 percent, and Regions 1, 7 & 8 and 9 have the smallest proportion, with 22- 23 percent in each case. While the mean number of persons per room used for sleeping is 1.9, it is higher in the interior areas (2.5) with Regions 1, 7 & 8, and 9 having more than three persons sleeping in a room. In Table HH.7, households are distributed according to ownership of assets by households and by individual household members. This also includes ownership of dwelling. Mattress is the most common item among households, with 98 percent of households owning a mattress. Other common items are television (88%), table and chairs (84%) and refrigerator (78%). For each of the other items, ownership ranges from one (1) to 58 percent. Lower percentages of ownership are observed in rural and interior households and in Regions 1, 7 & 8, and 9, for the following items: radio, television, landline telephone, refrigerator, computer (desktop, laptop or tablet), washing machine, and tables and chairs. Cable TV ownership follows a similar pattern, except that it is highest in Regions 7 & 8 (21%), well above the national average of 13 percent. On the other hand, some items are more commonly owned by rural and interior households: land dredge, solar panel and generator. A stove that works with solar energy is not a common item among households, regardless of the area, location or region of residence. In terms of land ownership, 14 percent of households own agricultural land, with twice the proportion in rural areas (16%) than in urban areas (8%), and almost four times the proportion in interior areas (39%) than in coastal areas (10%). Region 9 (63%) has the highest proportion of households with agricultural land, followed by Region 7 & 8 (52%), while the lowest proportion is in Region 4 (7%). Overall, 19 percent of households own farm animals or livestock, with greater ownership in rural (22%) than urban (10%) households, in interior (29%) than coastal (17%) households, and the highest ownership in Region 9 (70%). Watch (82%) and mobile telephone (89%) are assets commonly owned by at least one member of a 63Multiple indicator cluster survey 2014 | 59 Ta bl e H H .6 : H ou si ng c ha ra ct er is tic s P er ce nt d is tri bu tio n of h ou se ho ld s by s el ec te d ho us in g ch ar ac te ris tic s, a cc or di ng to a re a of re si de nc e an d re gi on s, G uy an a M IC S 5, 2 01 4 To ta l A re a Lo ca tio n R eg io n U rb an R ur al C oa st al U rb an C oa st al R ur al C oa st al In te rio r R eg io n 1 R eg io n 2 R eg io n 3 R eg io n 4 R eg io n 5 R eg io n 6 R eg io ns 7 & 8 R eg io n 9 R eg io n 10 El ec tr ic ity Ye s 86 .9 94 .4 84 .0 91 .2 94 .2 90 .1 92 .8 93 .7 N o 13 .0 5. 6 15 .9 8. 7 5. 8 9. 8 7. 1 6. 3 M is si ng /D K 0. 1 0. 0 0. 2 0. 1 0. 0 0. 2 0. 1 0. 0 Fl oo rin g N at ur al fl oo r 2. 3 0. 0 3. 2 0. 6 0. 0 0. 8 2. 3 0. 4 R ud im en ta ry fl oo r 16 .0 12 .0 17 .5 15 .1 13 .2 15 .8 5. 5 13 .9 Fi ni sh ed fl oo r 81 .2 87 .7 78 .8 83 .9 86 .7 82 .9 91 .8 85 .3 O th er 0. 1 0. 2 0. 1 0. 0 0. 0 0. 0 0. 2 0. 0 M is si ng /D K 0. 3 0. 1 0. 4 0. 3 0. 1 0. 4 0. 1 0. 4 R oo f N at ur al ro of in g 2. 1 0. 2 2. 8 0. 1 0. 2 0. 1 0. 2 0. 1 R ud im en ta ry ro of in g 0. 6 0. 2 0. 7 0. 5 0. 2 0. 7 0. 0 0. 9 Fi ni sh ed ro of in g 97 .0 99 .6 96 .0 99 .0 99 .5 98 .9 99 .6 98 .4 O th er 0. 2 0. 0 0. 3 0. 1 0. 0 0. 1 0. 0 0. 2 M is si ng /D K 0. 2 0. 0 0. 3 0. 2 0. 0 0. 3 0. 1 0. 4 Ex te rio r w al ls N at ur al w al ls 0. 2 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 R ud im en ta ry w al ls 6. 0 3. 4 7. 0 4. 3 3. 1 4. 8 7. 1 5. 0 Fi ni sh ed w al ls 93 .2 96 .1 92 .0 95 .3 96 .9 94 .7 92 .3 94 .7 O th er 0. 4 0. 5 0. 3 0. 1 0. 0 0. 1 0. 2 0. 0 M is si ng /D K 0. 3 0. 0 0. 4 0. 3 0. 0 0. 4 0. 4 0. 2 R oo m s us ed fo r s le ep in g 1 21 .6 16 .1 23 .7 20 .7 16 .1 22 .5 20 .4 18 .9 2 38 .4 39 .1 38 .1 38 .2 38 .5 38 .1 42 .5 36 .6 3 or m or e 36 .3 41 .6 34 .3 37 .4 41 .8 35 .7 32 .6 40 .7 M is si ng /D K 3. 7 3. 1 3. 9 3. 7 3. 6 3. 7 4. 5 3. 8 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f h ou se ho ld s 5, 07 7 1, 40 4 3, 67 3 4, 44 8 1, 21 8 3, 23 1 82 1 2, 24 4 M ea n nu m be r of p er so ns pe r r oo m u se d fo r s le ep in g 1. 9 1. 7 1. 9 1. 8 1. 7 1. 8 56 .2 43 .7 0. 1 14 .4 22 .3 62 .2 0. 7 0. 4 16 .0 0. 7 82 .2 0. 9 0. 2 1. 7 17 .4 77 .8 2. 8 0. 3 27 .7 39 .9 28 .7 3. 7 10 0. 0 62 9 2. 5 26 .5 73 .0 0. 5 0. 2 77 .9 20 .6 0. 8 0. 5 21 .9 1. 1 74 .2 2. 6 0. 2 2. 1 17 .6 79 .4 0. 2 0. 7 30 .7 39 .7 22 .8 6. 8 10 0. 0 66 3. 3 77 .6 22 .4 0. 0 0. 0 57 .6 42 .1 0. 0 0. 3 0. 3 0. 2 99 .5 0. 0 0. 0 0. 0 2. 1 97 .9 0. 0 0. 0 24 .0 41 .9 31 .2 3. 0 10 0. 0 28 7 1. 9 1. 8 1. 8 83 .3 16 .7 0. 0 0. 0 2. 2 97 .8 0. 0 0. 0 0. 0 0. 0 10 0. 0 0. 0 0. 0 0. 0 5. 2 94 .7 0. 1 0. 0 23 .2 37 .9 37 .8 1. 1 10 0. 0 34 3 1. 9 85 .7 13 .7 0. 6 0. 0 21 .8 77 .6 0. 0 0. 6 0. 0 0. 4 99 .6 0. 0 0. 0 0. 0 0. 9 98 .7 0. 0 0. 4 25 .2 36 .9 33 .9 4. 0 10 0. 0 81 7 1. 8 46 .9 53 .1 0. 0 16 .8 26 .0 55 .2 0. 7 1. 4 9. 9 2. 0 83 .7 3. 3 1. 1 4. 9 9. 9 79 .9 4. 2 1. 1 36 .6 30 .6 22 .7 10 .1 10 0. 0 10 5 3. 1 25 .2 74 .8 0. 0 56 .8 0. 8 42 .4 0. 0 0. 0 59 .0 1. 1 39 .9 0. 0 0. 0 2. 3 51 .8 42 .0 3. 9 0. 0 36 .8 37 .7 22 .4 3. 1 10 0. 0 12 7 3. 2 88 .4 11 .5 0. 1 0. 2 8. 8 89 .6 1. 3 0. 1 0. 0 0. 0 99 .8 0. 2 0. 0 0. 5 5. 2 91 .3 3. 1 0. 0 17 .0 44 .7 38 .0 0. 3 10 0. 0 26 7 1. 7 64 household, though to a lesser extent in interior areas including Regions 1, 7 & 8 and 9. Bicycles are owned by 55 percent of households, and more commonly owned by rural (59%) than urban (45%) households, and by coastal (57%) than interior (40%) households. It is most prevalent among households in Regions 9 (77%) and 6 (74%), and least prevalent in Region 1 (10%). One in ten households own a motorcycle or scooter (10%). This proportion is the same in interior and coastal areas. However, ownership among households in urban areas (13%) is greater those in rural areas (9%). Regions 9 (23%) and 2 (18%) have the highest proportions of households with a motorcycle or scooter, and Region 1 the lowest (6%). Only a very small proportion (2%) of households in Guyana own a cattle/donkey/horse cart. Ownership is found highest in Region 9, with 17 percent. As for car or truck, owned by 23 percent of households, it is more commonly owned by coastal (25%) than interior (11%) households. Regions 2, 3 and 4 have the highest proportions of households that own a car or truck with 27, 25 and 27 percent respectively, while Region 9 has the lowest proportion (5%). While only three (3) percent of households own a boat with a motor, this figure is tripled (9%) among households in the interior areas, and highest among households in Regions 1 and 7 & 8 (17-18%). Buses are only owned by three (3) percent of households, and ownership varies little across areas and location of residence. However, it is noteworthy that six (6) percent of households in Region 5 own a bus and that this proportion is more than doubled that in most of the other regions. Digital photo cameras are owned by 27 percent of households, with greater ownership in urban (35%) than rural (24%) households, and in coastal (28%) than interior (19%) households. Ownership is highest in Regions 4 (31%), 10 (29%), and 3 (27%),and lowest in Region 9 (10%) and 1 (12%). Bank accounts are owned by 68 percent of households, with greater ownership in urban (75%) than rural (65%) households, and in coastal (71%) than interior (45%) households. It is most prevalent in Region 6, with 79 percent, and least prevalent in Region 9, with 21 percent. More than three-quarters (77%) of dwellings are owned by a household member, while 12 percent are rented. Dwelling ownership is higher in rural (80%) than urban (71%) areas, and in interior (84%) than coastal (76%) areas. Over 90 percent of households in Regions, 1, 7 & 8, and 9 own their dwellings. The highest proportions of households with rented dwellings are in Regions 10 (16%) and 4 (15%), while the lowest is in Region 9 (2%). 65Multiple indicator cluster survey 2014 | Ta bl e H H .7 : H ou se ho ld a nd p er so na l a ss et s P er ce nt ag e of h ou se ho ld s by o w ne rs hi p of s el ec te d ho us eh ol d an d pe rs on al a ss et s, a nd p er ce nt d is tri bu tio n by o w ne rs hi p of d w el lin g, a cc or di ng to a re a of re si de nc e an d re gi on s, G uy an a M IC S 5, 2 01 4 To ta l A re a Lo ca tio n R eg io n U rb an R ur al C oa st al U rb an C oa st al R ur al C oa st al In te rio r R eg io n 1 R eg io n 2 R eg io n 3 R eg io n 4 R eg io n 5 R eg io n 6 R eg io ns 7 & 8 R eg io n 9 R eg io n 10 Pe rc en ta ge o f h ou se ho ld s th at o w n a R ad io 68 .9 52 .6 59 .5 69 .4 55 .7 40 .5 12 .4 60 .8 56 .3 62 .6 57 .3 53 .0 30 .6 25 .9 57 .9 Te le vi si on 92 .5 86 .3 91 .1 92 .9 90 .4 66 .4 63 .5 84 .3 93 .1 94 .1 82 .5 84 .5 56 .8 35 .4 86 .2 La nd lin e te le ph on e 73 .8 51 .4 61 .7 74 .1 57 .1 28 .4 6. 9 32 .2 44 .4 69 .4 55 .4 65 .9 14 .7 2. 9 59 .2 R ef rig er at or 85 .9 75 .2 81 .8 86 .1 80 .1 52 .3 47 .1 71 .9 83 .8 85 .4 69 .5 75 .0 41 .9 16 .6 78 .2 S to ve th at w or ks w ith s ol ar e ne rg y 0. 2 0. 4 0. 3 0. 2 0. 4 0. 3 0. 7 0. 0 0. 4 0. 5 0. 3 0. 0 1. 0 0. 8 0. 0 C om pu te r ( D es kt op /L ap to p/ Ta bl et ) 51 .7 36 .5 42 .5 51 .9 39 .0 27 .5 16 .2 37 .5 42 .2 47 .4 28 .4 34 .6 22 .2 11 .8 44 .6 C ab le T V 19 .6 9. 9 12 .9 21 .0 9. 9 10 .4 8. 5 15 .6 10 .3 16 .6 5. 6 6. 5 20 .8 9. 9 9. 5 La nd d re dg e 1. 4 1. 1 0. 8 1. 2 0. 6 3. 7 7. 5 0. 6 0. 3 1. 2 0. 2 0. 3 12 .5 0. 7 1. 8 Tr ac to r/C om bi ne 1. 2 2. 3 2. 0 1. 3 2. 3 1. 7 2. 0 10 .4 2. 0 0. 2 4. 6 3. 1 0. 7 2. 1 1. 8 M at tre ss 99 .5 97 .8 99 .2 99 .5 99 .1 91 .8 91 .5 98 .5 98 .5 99 .4 99 .0 99 .0 86 .2 80 .2 99 .4 Ta bl e an d ch ai rs 92 .2 81 .2 86 .5 92 .4 84 .3 68 .0 55 .8 91 .6 83 .6 87 .1 84 .3 84 .8 53 .3 50 .2 88 .1 S ol ar p an el 0. 9 8. 4 1. 7 0. 8 2. 1 38 .8 58 .5 9. 7 2. 2 1. 5 8. 7 0. 5 45 .1 86 .7 4. 0 G en er at or 8. 1 11 .0 8. 2 9. 0 7. 8 24 .8 59 .2 14 .2 7. 3 8. 0 10 .8 9. 8 31 .2 18 .8 9. 7 W as hi ng m ac hi ne 46 .9 29 .4 35 .5 46 .1 31 .5 25 .5 11 .0 32 .9 33 .3 37 .2 25 .1 35 .6 17 .8 6. 5 46 .8 Pe rc en ta ge o f h ou se ho ld s th at o w n A gr ic ul tu ra l l an d 7. 8 15 .9 10 .0 7. 3 11 .1 39 .3 38 .7 36 .1 11 .6 7. 0 16 .5 10 .4 51 .8 62 .6 13 .6 Fa rm a ni m al s/ Li ve st oc k 10 .2 22 .1 17 .3 8. 9 20 .5 29 .4 8. 1 34 .6 16 .9 11 .4 39 .9 18 .9 25 .5 70 .2 18 .0 Pe rc en ta ge o f ho us eh ol ds w he re a t le as t o ne m em be r o w ns o r h as a W at ch 82 .7 81 .4 83 .2 82 .7 83 .3 71 .9 61 .3 90 .8 86 .8 80 .3 81 .1 83 .9 70 .1 62 .3 82 .6 M ob ile te le ph on e 93 .6 86 .7 90 .5 94 .3 89 .1 74 .7 89 .5 93 .1 93 .3 91 .5 86 .2 84 .6 52 .3 53 .8 90 .0 B ic yc le 44 .9 59 .2 57 .4 45 .5 61 .9 39 .6 9. 8 53 .0 57 .2 49 .9 67 .6 73 .6 26 .1 76 .6 37 .0 M ot or cy cl e or s co ot er 12 .9 8. 7 9. 9 13 .4 8. 5 10 .1 6. 1 18 .0 9. 1 8. 4 8. 0 11 .5 8. 8 23 .1 9. 1 C at tle /D on ke y/ H or se C ar t 1. 2 2. 9 2. 3 1. 3 2. 6 3. 6 0. 3 1. 4 2. 1 1. 3 6. 9 2. 8 1. 3 16 .6 0. 8 C ar o r t ru ck 27 .1 21 .6 24 .9 29 .1 23 .3 10 .5 8. 3 26 .7 25 .0 27 .4 14 .3 20 .3 12 .5 5. 0 13 .9 B oa t w ith a m ot or 1. 7 4. 1 2. 6 1. 9 2. 9 9. 4 17 .6 5. 5 4. 7 1. 9 2. 9 2. 9 17 .2 3. 1 3. 9 B us 2. 0 3. 4 3. 1 2. 1 3. 5 2. 0 2. 2 2. 8 3. 0 3. 3 5. 9 1. 9 1. 8 0. 7 2. 1 D ig ita l p ho to c am er a 34 .8 23 .5 27 .7 35 .2 24 .8 19 .2 12 .2 22 .5 27 .4 31 .4 21 .8 20 .4 17 .6 9. 7 29 .0 B an k ac co un t 75 .0 64 .8 70 .8 74 .7 69 .4 44 .8 22 .4 66 .0 70 .9 69 .7 55 .4 78 .5 36 .4 20 .7 69 .2 O w ne rs hi p of d w el lin g O w ne d by a h ou se ho ld m em be r 70 .7 79 .7 76 .3 71 .0 78 .3 83 .6 91 .3 85 .0 79 .6 74 .3 85 .7 73 .4 90 .0 95 .0 69 .6 N ot o w ne d 29 .2 20 .1 23 .5 28 .9 21 .5 16 .3 8. 3 15 .0 20 .0 25 .5 14 .3 26 .6 10 .0 5. 0 30 .2 R en te d 17 .8 10 .3 12 .9 17 .6 11 .1 8. 7 6. 0 7. 4 10 .8 15 .3 5. 4 12 .1 6. 2 2. 4 16 .4 O th er 11 .4 9. 9 10 .7 11 .3 10 .4 7. 6 2. 4 7. 7 9. 2 10 .2 8. 9 14 .5 3. 8 2. 6 13 .8 M is si ng /D K 0. 1 0. 2 0. 2 0. 1 0. 2 0. 2 0. 4 0. 0 0. 4 0. 2 0. 0 0. 0 0. 1 0. 0 0. 3 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f h ou se ho ld s 57 .1 88 .0 57 .6 78 .1 0. 3 40 .7 12 .6 1. 1 2. 0 98 .3 84 .3 6. 3 10 .2 34 .3 13 .6 18 .8 81 .8 88 .6 55 .2 9. 9 2. 4 23 .1 3. 4 3. 0 26 .6 67 .6 77 .2 22 .6 12 .4 10 .3 0. 2 10 0. 0 5, 07 7 1, 40 4 3, 67 3 4 ,4 48 1, 21 8 3 ,2 31 62 9 66 28 7 82 1 2 ,2 44 34 3 81 7 10 5 12 7 26 7 66 Table HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintiles, according to area of residence and regions, Guyana MICS5, 2014 Wealth index quintiles Total Number of household members Poorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 19,321 Area Urban 13.3 16.8 18.6 25.1 26.2 100.0 5,263 Rural 22.5 21.3 20.5 18.1 17.7 100.0 14,058 Location Coastal 12.8 21.6 21.5 21.5 22.6 100.0 16,526 Urban Coastal 13.0 16.7 17.7 24.4 28.2 100.0 4,594 Rural Coastal 12.8 23.4 22.9 20.4 20.5 100.0 11,932 Interior 62.4 10.9 11.0 11.1 4.6 100.0 2,795 Region Region 1 85.6 10.7 2.5 1.0 0.3 100.0 358 Region 2 34.2 30.0 14.7 12.4 8.8 100.0 1,070 Region 3 10.5 21.1 23.7 23.6 21.0 100.0 3,040 Region 4 9.5 18.9 20.6 22.9 28.0 100.0 8,555 Region 5 21.4 27.6 23.2 16.9 10.9 100.0 1,322 Region 6 20.4 22.4 22.8 18.6 15.8 100.0 2,831 Regions 7 & 8 69.8 7.9 6.4 7.7 8.3 100.0 523 Region 9 93.1 2.9 1.3 2.1 0.7 100.0 648 Region 10 23.3 19.4 22.6 24.7 10.0 100.0 974 Table HH.8 shows how the household populations in areas and regions are distributed according to household wealth quintiles. Whereas 13 percent of the urban population and 23 percent of the rural population are in the poorest quintile, 26 percent of the urban population and 18 percent of the rural population are in the richest quintile. The contrast is greater between coastal and interior populations: 13 percent of the coastal population is in the poorest quintile, while 62 percent of the interior population is in the poorest quintile; only five (5) percent of the interior population is in the richest quintile, compared to 23 percent of the coastal population. Distribution across regions shows considerable inequalities among them: the population in the poorest quintile is concentrated in Region 9 (93%), Region 1 (86%), Region 7 & 8 (70%), while the population from the richest quintile is concentrated in Region 4 (28%). 67Multiple indicator cluster survey 2014 | @UNICEF Guyana 68 One of the overarching goals of the Millennium Development Goals (MDGs) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction of under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Mortality rates presented in this chapter are calculated from information collected in the birth histories of the Women’s Questionnaires. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died. In addition, they were asked to provide a detailed birth history of live births of children in chronological order starting with the firstborn. Women were asked whether births were single or multiple, the sex of the children, the date of birth (month and year), and survival status. Further, for children still alive, they were asked the current age of the child and, if not alive, the age at death. Childhood Table CM.1: Early childhood mortality rates Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, Guyana MICS5, 2014 Neonatal mortality rate1 Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Years preceding the survey 0-4 23 9 32 8 39 5-9 19 11 30 3 34 10-14 16 12 28 6 34 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Post-neonatal mortality rate2, a mortality rates are expressed by conventional age categories and are defined as follows: • Neonatal mortality (NN): probability of dying within the first month of life • Post-neonatal mortality (PNN): difference between infant and neonatal mortality rates • Infant mortality (1q0): probability of dying between birth and the first birthday • Child mortality (4q1): probability of dying between the first and the fifth birthdays • Under-five mortality (5q0): the probability of dying between birth and the fifth birthday Rates are expressed as deaths per 1,000 live births, except in the case of child mortality, which is expressed as deaths per 1,000 children surviving to age one, and post-neonatal mortality, which is described as the difference between infant mortality rate and neonatal mortality rate. Table CM.1 and Figure CM.1 present neonatal, post-neonatal, infant, child, and under-five mortality rates for the three most recent five-year periods before the survey. Neonatal mortality in the most recent five-year period is estimated at 23 per 1,000 live births, while the post-neonatal mortality rate is estimated at nine (9) per 1,000 live births. IV. CHILD MORTALITY 69Multiple indicator cluster survey 2014 | 16 12 28 6 34 19 11 30 3 34 23 9 32 8 39 Neonatal mortality rate Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-five mortality rate Years preceding the survey Note: Indicator values are per 1,000 live births 10-14 5-9 0-4 Figure CM.1: Ear ly chi ldhood mortal i ty rates, Guyana MICS5, 2014 The infant mortality rate in the five years preceding the survey is 32 per 1,000 live births and under-five mortality is 39 deaths per 1,000 live births for the same period, indicating that 82 percent of under-five deaths are infant deaths. The table and figure above also show generally low childhood mortality rates in Guyana that have been relatively stable at the national level, during the last 15 years, with under-five mortality at 34 per 1,000 live births during the 10-14 year period preceding the survey, and 39 per 1,000 live births during the most recent five-year period, roughly referring to the years 2009 - 2014. A similar pattern is observed in the other indicators except for post neo-natal mortality rates, where there was a declining trend from 12 to nine (9) deaths per 1000 live births over the past 15 years. 70 Table CM.2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by socioeconomic characteristics, Guyana MICS5, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 23 9 32 8 39 Area Urban 6 1 7 (4) (11) Rural 28 11 39 9 48 Location Coastal 27 8 35 6 41 Urban Coastal 7 (0) (7) (0) (7) Rural Coastal 34 10 45 9 53 Interior 7 13 20 13 33 Mother's educationb None (*) (*) (*) (*) (*) Primary 64 13 77 18 93 Secondary or Higher 18 8 24 6 30 Wealth indexc Poorest 40% 23 11 33 5 38 Richest 60% 23 7 30 11 40 Ethnicity of household headd East Indian 43 5 48 6 55 African 15 9 24 4 29 Amerindian 3 15 18 12 30 Mixed Race 15 9 24 4 29 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates b Categories "Secondary" and "Higher" have been merged because of the small number of cases in individual categories c Wealth index have been grouped into two categories instead of five because of the small number of cases by quintile d This is based on the ethnic group identified by the respondent of the Household Questionnaire to be that of the household head ( ) Rates based on 250 to 499 unweighted exposed persons (*) Rates based on fewer than 250 unweighted exposed persons 71Multiple indicator cluster survey 2014 | Table CM.3: Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by demographic characteristics, Guyana MICS5, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2,a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 23 9 32 8 39 Sex of child Male 27 8 35 9 44 Female 18 10 28 7 35 Mother's age at birth Less than 20 41 8 49 10 59 20-34 12 9 21 5 26 35-49 (58) (9) (67) (*) (*) Birth order 1 29 6 35 8 42 2-3 14 7 20 5 25 4-6 40 13 53 (14) (67) 7+ (*) (*) (*) (*) (*) Previous birth intervalb < 2 years 29 10 40 6 45 2 years 2 12 14 (4) (18) 3 years (2) (7) (9) (0) (9) 4+ years 32 5 36 (18) (54) 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates b Excludes first order births ( ) Rates based on 250 to 499 unweighted exposed persons (*) Rates based on fewer than 250 unweighted exposed persons Tables CM.2 and CM.3 provide estimates of child mortality by socio-economic and demographic characteristics respectively. There are some differences in the probability of dying among children up to age five years based on certain background characteristics, such as place of residence, mother’s education, sex of child, and ethnicity of household head. Whereas childhood mortality rates in coastal areas show a similar pattern as the national averages, with infant deaths accounting for 85 percent of under-five deaths, in interior areas, infant deaths account for 61 percent of under-five deaths. whereas the post- neonatal mortality rate and child mortality rate (13 per 1,000 live births in each case) are higher in interior areas than in coastal areas (8 and 6 per 1,000 live births respectively). The under-five mortality rate is 33 per 1,000 live births in interior areas and 41 per 1,000 live births in coastal areas. As expected, mother’s education appears to play a major role in reducing childhood mortality. All the indicators of childhood mortality are much higher among children whose mothers only have primary education compared to those whose mothers have secondary or higher education. For example, neonatal mortality, infant mortality and under-five mortality rates among children with mothers with primary education are over three times higher than those with mothers with secondary or higher education. 72 The probabilities of dying among children are generally lower for females than for males. Children born to mothers aged less than 20 at the time of birth have much higher mortality rates than those born to mothers aged between 20 and 34 years. The neonatal mortality rate, infant mortality rate, child mortality rate and under-five mortality rate among children born to F igure CM.2: Under-5 morta l i ty rates by area, Guyana MICS5, 2014 ( ) Rates based on 250 to 499 unweighted exposed persons 39 (11) 48 41 (7) 53 33 0 10 20 30 40 50 60 Guyana Area Urban Rural Location Coastal Urban Coastal Rural Coastal Interior Under-5 Mortality Rates per 1,000 Births mothers aged less than 20 is more than two to three times higher than that among those born to mothers aged between 20 and 34 years. Mortality rates are generally low for children born second or third, whereas the highest mortality rates are found among those born fourth to sixth. 73Multiple indicator cluster survey 2014 | Figure CM.3 compares the findings of Guyana MICS5 2014 on under-five mortality rates with those from other data sources in Guyana, namely MICS 2000, MICS 2006, and DHS 2009. Guyana MICS5 2014 findings are obtained from Table CM.1. The Guyana MICS5 2014 estimates indicate stabilization in mortality during the last 15 years. The trend indicated by the MICS5 results is in broad agreement with those estimated in 2009 from the previous DHS survey (DHS 2009). It should be noted that while MICS5 and DHS surveys used direct estimates, previous MICS surveys (MICS2 2000, MICS3 2006) used indirect estimates. F igure CM.3: Trend in under -5 morta l i ty rates , Guyana 0 10 20 30 40 50 60 70 80 90 1982 1986 1990 1994 1998 2002 2006 2010 2014 Per 1,000 live births Year MICS2 2000 MICS3 2006 DHS 2009 MICS5 2014 74 @UNICEF Guyana 75Multiple indicator cluster survey 2014 | @UNICEF Guyana 76 Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing low birth weight babies. One of the major challenges in measuring the incidence of low birth weight is that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.28 28For a detailed description of the methodology, see Boerma J.T., Weinstein K.I., Rutstein S.O., Sommerfelt A.E.(1996). Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization 74(2):209-16. V. NUTRITION 77Multiple indicator cluster survey 2014 | Ta bl e N U .1 : L ow b irt h w ei gh t i nf an ts P er ce nt ag e of la st li ve -b or n ch ild re n in th e la st tw o ye ar s th at a re e st im at ed to h av e w ei gh ed b el ow 2 ,5 00 g ra m s at b irt h an d pe rc en ta ge o f l iv e bi rth s w ei gh ed a t b irt h, G uy an a M IC S 5, 2 01 4 Pe rc en t d is tr ib ut io n of b irt hs b y m ot he r's a ss es sm en t o f s iz e at b irt h To ta l Pe rc en ta ge o f l iv e bi rt hs : N um be r o f l as t liv e- bo rn c hi ld re n in th e la st tw o ye ar s V er y sm al l S m al le r t ha n av er ag e A ve ra ge La rg er th an a ve ra ge or v er y la rg e D K B el ow 2 ,5 00 gr am s1 W ei gh ed a t b irt h2 To ta l 8. 4 10 .3 59 .5 19 .6 2. 1 10 0. 0 13 .6 93 .9 76 9 M ot he r's a ge a t b irt h Le ss th an 2 0 ye ar s 11 .6 11 .6 56 .3 18 .8 1. 7 10 0. 0 15 .0 91 .6 15 1 20 -3 4 ye ar s 7. 1 9. 8 61 .2 19 .8 2. 1 10 0. 0 13 .0 94 .8 52 3 35 -4 9 ye ar s 10 .9 10 .6 55 .4 20 .1 3. 0 10 0. 0 14 .5 92 .1 95 B irt h or de r 1 7. 1 8. 1 64 .4 17 .9 2. 5 10 0. 0 12 .7 95 .4 25 6 2- 3 7. 8 10 .7 57 .2 22 .6 1. 7 10 0. 0 13 .3 93 .9 33 7 4- 5 9. 1 15 .4 60 .0 15 .5 0. 0 10 0. 0 14 .5 95 .7 11 5 6+ 16 .0 7. 3 51 .2 18 .5 7. 0 10 0. 0 16 .9 83 .8 61 R eg io n R eg io n 1 14 .9 9. 2 51 .3 23 .2 1. 4 10 0. 0 15 .4 80 .7 25 R eg io n 2 6. 5 2. 3 87 .3 3. 9 0. 0 10 0. 0 11 .2 96 .2 40 R eg io n 3 3. 6 10 .0 68 .0 16 .9 1. 5 10 0. 0 11 .4 95 .8 10 7 R eg io n 4 8. 5 10 .3 58 .9 19 .8 2. 5 10 0. 0 13 .7 95 .5 32 7 R eg io n 5 12 .9 4. 1 61 .7 21 .3 0. 0 10 0. 0 14 .1 95 .8 52 R eg io n 6 8. 6 11 .7 49 .3 26 .3 4. 0 10 0. 0 13 .9 92 .7 94 R eg io ns 7 & 8 8. 7 20 .1 53 .0 13 .9 4. 3 10 0. 0 16 .2 93 .7 36 R eg io n 9 15 .3 20 .0 42 .9 20 .6 1. 2 10 0. 0 17 .9 78 .0 44 R eg io n 10 5. 4 4. 6 63 .7 25 .4 .8 10 0. 0 11 .2 97 .8 44 A re a U rb an 5. 1 7. 8 60 .5 24 .4 2. 2 10 0. 0 11 .6 97 .6 18 4 R ur al 9. 5 11 .0 59 .2 18 .2 2. 1 10 0. 0 14 .2 92 .7 58 5 Lo ca tio n C oa st al 7. 5 9. 6 60 .4 20 .2 2. 2 10 0. 0 13 .1 95 .3 60 8 U rb an C oa st al 5. 2 8. 3 59 .2 24 .7 2. 6 10 0. 0 11 .7 97 .1 15 5 R ur al C oa st al 8. 3 10 .0 60 .8 18 .7 2. 1 10 0. 0 13 .6 94 .6 45 3 In te rio r 11 .8 12 .7 56 .3 17 .4 1. 7 10 0. 0 15 .4 88 .6 16 1 M ot he r’s e du ca tio n N on e 7. 4 30 .4 53 .9 8. 3 0. 0 10 0. 0 17 .0 95 .7 13 P rim ar y 10 .6 8. 6 59 .6 16 .0 5. 1 10 0. 0 14 .6 88 .6 95 S ec on da ry 8. 3 10 .3 59 .1 20 .4 1. 9 10 0. 0 13 .5 94 .0 59 0 H ig he r 6. 4 8. 2 64 .2 20 .6 .6 10 0. 0 11 .8 99 .0 71 W ea lth in de x qu in til e P oo re st 1 2. 0 12 .8 56 .4 16 .9 1. 8 10 0. 0 15 .4 90 .0 22 7 S ec on d 11 .0 8. 2 54 .3 25 .1 1. 3 10 0. 0 14 .2 93 .1 17 6 M id dl e 8. 4 10 .4 56 .4 22 .1 2. 7 10 0. 0 13 .6 96 .4 15 2 Fo ur th 3. 1 7. 9 71 .8 16 .0 1. 2 10 0. 0 11 .0 97 .4 10 4 R ic he st 2. 1 10 .2 66 .9 16 .6 4. 1 10 0. 0 11 .2 96 .2 11 0 Et hn ic ity o f h ou se ho ld h ea da , b E as t I nd ia n 9. 5 9. 5 60 .8 17 .0 3. 2 10 0. 0 14 .0 93 .7 25 4 A fri ca n 5. 7 8. 4 62 .9 22 .0 1. 0 10 0. 0 11 .9 97 .7 23 5 A m er in di an 13 .3 15 .1 50 .9 18 .6 2. 2 10 0. 0 16 .4 83 .8 11 3 M ix ed R ac e 7. 5 10 .9 58 .2 21 .2 2. 1 10 0. 0 13 .5 95 .3 16 4 1 M IC S in di ca to r 2 .2 0 - L ow -b irt hw ei gh t i nf an ts 2 M IC S in di ca to r 2 .2 1 - I nf an ts w ei gh ed a t b irt h a Th is is b as ed o n th e et hn ic g ro up id en tif ie d by th e re sp on de nt o f t he H ou se ho ld Q ue st io nn ai re to b e th at o f t he h ou se ho ld h ea d b C at eg or y "O th er s/ M is si ng /D K " h as b ee n su pp re ss ed fr om th e ta bl e du e to a s m al l n um be r o f u nw ei gh te d ca se s (C on tin ue d) 78 Ta bl e N U .1 : L ow b irt h w ei gh t i nf an ts P er ce nt ag e of la st li ve -b or n ch ild re n in th e la st tw o ye ar s th at a re e st im at ed to h av e w ei gh ed b el ow 2 ,5 00 g ra m s at b irt h an d pe rc en ta ge o f l iv e bi rth s w ei gh ed a t b irt h, G uy an a M IC S 5, 2 01 4 Pe rc en t d is tr ib ut io n of b irt hs b y m ot he r's a ss es sm en t o f s iz e at b irt h To ta l Pe rc en ta ge o f l iv e bi rt hs : N um be r o f l as t liv e- bo rn c hi ld re n in th e la st tw o ye ar s V er y sm al l S m al le r t ha n av er ag e A ve ra ge La rg er th an a ve ra ge or v er y la rg e D K B el ow 2 ,5 00 gr am s1 W ei gh ed a t b irt h2 To ta l 8. 4 10 .3 59 .5 19 .6 2. 1 10 0. 0 13 .6 93 .9 76 9 M ot he r's a ge a t b irt h Le ss th an 2 0 ye ar s 11 .6 11 .6 56 .3 18 .8 1. 7 10 0. 0 15 .0 91 .6 15 1 20 -3 4 ye ar s 7. 1 9. 8 61 .2 19 .8 2. 1 10 0. 0 13 .0 94 .8 52 3 35 -4 9 ye ar s 10 .9 10 .6 55 .4 20 .1 3. 0 10 0. 0 14 .5 92 .1 95 B irt h or de r 1 7. 1 8. 1 64 .4 17 .9 2. 5 10 0. 0 12 .7 95 .4 25 6 2- 3 7. 8 10 .7 57 .2 22 .6 1. 7 10 0. 0 13 .3 93 .9 33 7 4- 5 9. 1 15 .4 60 .0 15 .5 0. 0 10 0. 0 14 .5 95 .7 11 5 6+ 16 .0 7. 3 51 .2 18 .5 7. 0 10 0. 0 16 .9 83 .8 61 R eg io n R eg io n 1 14 .9 9. 2 51 .3 23 .2 1. 4 10 0. 0 15 .4 80 .7 25 R eg io n 2 6. 5 2. 3 87 .3 3. 9 0. 0 10 0. 0 11 .2 96 .2 40 R eg io n 3 3. 6 10 .0 68 .0 16 .9 1. 5 10 0. 0 11 .4 95 .8 10 7 R eg io n 4 8. 5 10 .3 58 .9 19 .8 2. 5 10 0. 0 13 .7 95 .5 32 7 R eg io n 5 12 .9 4. 1 61 .7 21 .3 0. 0 10 0. 0 14 .1 95 .8 52 R eg io n 6 8. 6 11 .7 49 .3 26 .3 4. 0 10 0. 0 13 .9 92 .7 94 R eg io ns 7 & 8 8. 7 20 .1 53 .0 13 .9 4. 3 10 0. 0 16 .2 93 .7 36 R eg io n 9 15 .3 20 .0 42 .9 20 .6 1. 2 10 0. 0 17 .9 78 .0 44 R eg io n 10 5. 4 4. 6 63 .7 25 .4 .8 10 0. 0 11 .2 97 .8 44 A re a U rb an 5. 1 7. 8 60 .5 24 .4 2. 2 10 0. 0 11 .6 97 .6 18 4 R ur al 9. 5 11 .0 59 .2 18 .2 2. 1 10 0. 0 14 .2 92 .7 58 5 Lo ca tio n C oa st al 7. 5 9. 6 60 .4 20 .2 2. 2 10 0. 0 13 .1 95 .3 60 8 U rb an C oa st al 5. 2 8. 3 59 .2 24 .7 2. 6 10 0. 0 11 .7 97 .1 15 5 R ur al C oa st al 8. 3 10 .0 60 .8 18 .7 2. 1 10 0. 0 13 .6 94 .6 45 3 In te rio r 11 .8 12 .7 56 .3 17 .4 1. 7 10 0. 0 15 .4 88 .6 16 1 M ot he r’s e du ca tio n N on e 7. 4 30 .4 53 .9 8. 3 0. 0 10 0. 0 17 .0 95 .7 13 P rim ar y 10 .6 8. 6 59 .6 16 .0 5. 1 10 0. 0 14 .6 88 .6 95 S ec on da ry 8. 3 10 .3 59 .1 20 .4 1. 9 10 0. 0 13 .5 94 .0 59 0 H ig he r 6. 4 8. 2 64 .2 20 .6 .6 10 0. 0 11 .8 99 .0 71 W ea lth in de x qu in til e P oo re st 1 2. 0 12 .8 56 .4 16 .9 1. 8 10 0. 0 15 .4 90 .0 22 7 S ec on d 11 .0 8. 2 54 .3 25 .1 1. 3 10 0. 0 14 .2 93 .1 17 6 M id dl e 8. 4 10 .4 56 .4 22 .1 2. 7 10 0. 0 13 .6 96 .4 15 2 Fo ur th 3. 1 7. 9 71 .8 16 .0 1. 2 10 0. 0 11 .0 97 .4 10 4 R ic he st 2. 1 10 .2 66 .9 16 .6 4. 1 10 0. 0 11 .2 96 .2 11 0 Et hn ic ity o f h ou se ho ld h ea da , b E as t I nd ia n 9. 5 9. 5 60 .8 17 .0 3. 2 10 0. 0 14 .0 93 .7 25 4 A fri ca n 5. 7 8. 4 62 .9 22 .0 1. 0 10 0. 0 11 .9 97 .7 23 5 A m er in di an 13 .3 15 .1 50 .9 18 .6 2. 2 10 0. 0 16 .4 83 .8 11 3 M ix ed R ac e 7. 5 10 .9 58 .2 21 .2 2. 1 10 0. 0 13 .5 95 .3 16 4 1 M IC S in di ca to r 2 .2 0 - L ow -b irt hw ei gh t i nf an ts 2 M IC S in di ca to r 2 .2 1 - I nf an ts w ei gh ed a t b irt h a Th is is b as ed o n th e et hn ic g ro up id en tif ie d by th e re sp on de nt o f t he H ou se ho ld Q ue st io nn ai re to b e th at o f t he h ou se ho ld h ea d b C at eg or y "O th er s/ M is si ng /D K " h as b ee n su pp re ss ed fr om th e ta bl e du e to a s m al l n um be r o f u nw ei gh te d ca se s Ta bl e N U .1 : L ow b irt h w ei gh t i nf an ts P er ce nt ag e of la st li ve -b or n ch ild re n in th e la st tw o ye ar s th at a re e st im at ed to h av e w ei gh ed b el ow 2 ,5 00 g ra m s at b irt h an d pe rc en ta ge o f l iv e bi rth s w ei gh ed a t b irt h, G uy an a M IC S 5, 2 01 4 Pe rc en t d is tr ib ut io n of b irt hs b y m ot he r's a ss es sm en t o f s iz e at b irt h To ta l Pe rc en ta ge o f l iv e bi rt hs : N um be r o f l as t liv e- bo rn c hi ld re n in th e la st tw o ye ar s V er y sm al l S m al le r t ha n av er ag e A ve ra ge La rg er th an a ve ra ge or v er y la rg e D K B el ow 2 ,5 00 gr am s1 W ei gh ed a t b irt h2 To ta l 8. 4 10 .3 59 .5 19 .6 2. 1 10 0. 0 13 .6 93 .9 76 9 M ot he r's a ge a t b irt h Le ss th an 2 0 ye ar s 11 .6 11 .6 56 .3 18 .8 1. 7 10 0. 0 15 .0 91 .6 15 1 20 -3 4 ye ar s 7. 1 9. 8 61 .2 19 .8 2. 1 10 0. 0 13 .0 94 .8 52 3 35 -4 9 ye ar s 10 .9 10 .6 55 .4 20 .1 3. 0 10 0. 0 14 .5 92 .1 95 B irt h or de r 1 7. 1 8. 1 64 .4 17 .9 2. 5 10 0. 0 12 .7 95 .4 25 6 2- 3 7. 8 10 .7 57 .2 22 .6 1. 7 10 0. 0 13 .3 93 .9 33 7 4- 5 9. 1 15 .4 60 .0 15 .5 0. 0 10 0. 0 14 .5 95 .7 11 5 6+ 16 .0 7. 3 51 .2 18 .5 7. 0 10 0. 0 16 .9 83 .8 61 R eg io n R eg io n 1 14 .9 9. 2 51 .3 23 .2 1. 4 10 0. 0 15 .4 80 .7 25 R eg io n 2 6. 5 2. 3 87 .3 3. 9 0. 0 10 0. 0 11 .2 96 .2 40 R eg io n 3 3. 6 10 .0 68 .0 16 .9 1. 5 10 0. 0 11 .4 95 .8 10 7 R eg io n 4 8. 5 10 .3 58 .9 19 .8 2. 5 10 0. 0 13 .7 95 .5 32 7 R eg io n 5 12 .9 4. 1 61 .7 21 .3 0. 0 10 0. 0 14 .1 95 .8 52 R eg io n 6 8. 6 11 .7 49 .3 26 .3 4. 0 10 0. 0 13 .9 92 .7 94 R eg io ns 7 & 8 8. 7 20 .1 53 .0 13 .9 4. 3 10 0. 0 16 .2 93 .7 36 R eg io n 9 15 .3 20 .0 42 .9 20 .6 1. 2 10 0. 0 17 .9 78 .0 44 R eg io n 10 5. 4 4. 6 63 .7 25 .4 .8 10 0. 0 11 .2 97 .8 44 A re a U rb an 5. 1 7. 8 60 .5 24 .4 2. 2 10 0. 0 11 .6 97 .6 18 4 R ur al 9. 5 11 .0 59 .2 18 .2 2. 1 10 0. 0 14 .2 92 .7 58 5 Lo ca tio n C oa st al 7. 5 9. 6 60 .4 20 .2 2. 2 10 0. 0 13 .1 95 .3 60 8 U rb an C oa st al 5. 2 8. 3 59 .2 24 .7 2. 6 10 0. 0 11 .7 97 .1 15 5 R ur al C oa st al 8. 3 10 .0 60 .8 18 .7 2. 1 10 0. 0 13 .6 94 .6 45 3 In te rio r 11 .8 12 .7 56 .3 17 .4 1. 7 10 0. 0 15 .4 88 .6 16 1 M ot he r’s e du ca tio n N on e 7. 4 30 .4 53 .9 8. 3 0. 0 10 0. 0 17 .0 95 .7 13 P rim ar y 10 .6 8. 6 59 .6 16 .0 5. 1 10 0. 0 14 .6 88 .6 95 S ec on da ry 8. 3 10 .3 59 .1 20 .4 1. 9 10 0. 0 13 .5 94 .0 59 0 H ig he r 6. 4 8. 2 64 .2 20 .6 .6 10 0. 0 11 .8 99 .0 71 W ea lth in de x qu in til e P oo re st 1 2. 0 12 .8 56 .4 16 .9 1. 8 10 0. 0 15 .4 90 .0 22 7 S ec on d 11 .0 8. 2 54 .3 25 .1 1. 3 10 0. 0 14 .2 93 .1 17 6 M id dl e 8. 4 10 .4 56 .4 22 .1 2. 7 10 0. 0 13 .6 96 .4 15 2 Fo ur th 3. 1 7. 9 71 .8 16 .0 1. 2 10 0. 0 11 .0 97 .4 10 4 R ic he st 2. 1 10 .2 66 .9 16 .6 4. 1 10 0. 0 11 .2 96 .2 11 0 Et hn ic ity o f h ou se ho ld h ea da , b E as t I nd ia n 9. 5 9. 5 60 .8 17 .0 3. 2 10 0. 0 14 .0 93 .7 25 4 A fri ca n 5. 7 8. 4 62 .9 22 .0 1. 0 10 0. 0 11 .9 97 .7 23 5 A m er in di an 13 .3 15 .1 50 .9 18 .6 2. 2 10 0. 0 16 .4 83 .8 11 3 M ix ed R ac e 7. 5 10 .9 58 .2 21 .2 2. 1 10 0. 0 13 .5 95 .3 16 4 1 M IC S in di ca to r 2 .2 0 - L ow -b irt hw ei gh t i nf an ts 2 M IC S in di ca to r 2 .2 1 - I nf an ts w ei gh ed a t b irt h a Th is is b as ed o n th e et hn ic g ro up id en tif ie d by th e re sp on de nt o f t he H ou se ho ld Q ue st io nn ai re to b e th at o f t he h ou se ho ld h ea d b C at eg or y "O th er s/ M is si ng /D K " h as b ee n su pp re ss ed fr om th e ta bl e du e to a s m al l n um be r o f u nw ei gh te d ca se s 79Multiple indicator cluster survey 2014 | Overall, 94 percent of births were weighed at birth and 14 percent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.1). The proportion of infants weighed at birth is lower in Regions 1 and 9 (81% and 78%, respectively) compared to other regions (93-98%). Infants born sixth in the family or after (83% compared with 93-96% of the other birth orders), from interior areas (87% compared with 95% from the coastal areas), and from households with an Amerindian household head (84% compared with 94-98% of the others), are slightly less likely to be weighed at birth than others. The likelihood of a child being weighed at birth increases with household wealth, with 96 percent of richest children measured compared with 90 percent of the poorest children. The prevalence of low birth weight decreases marginally with mother’s education and household wealth, and increases slightly with birth order. Region 9 has the highest percentage of low birth weight infants, with 18 percent of live births, while Regions 2, 3 and 10 have the lowest percentage, with 11 percent in each case. Nutritional Status Children’s nutritional status is a reflection of their overall health, feeding and care. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they are more likely to reach their growth potential and are considered well nourished. Undernutrition is associated with about half of all under- five deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target (1, C) is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards29. Each of the three nutritional status indicators – weight-for-age, height- for-age, and weight-for-height - can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a composite measure capturing acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for- height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. In MICS5, weights and heights of all children under five years of age were measured using the anthropometric equipment recommended30 by UNICEF. Findings in this section are based on the results of these measurements. Table NU.2 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators. 29http://www.who.int/childgrowth/standards/technical_report 30See MICS Supply Procurement Instructions here: http://www.childinfo.org/mics5_planning.html 80 Ta bl e N U .2 : N ut rit io na l s ta tu s of c hi ld re n P er ce nt ag e of c hi ld re n un de r a ge 5 b y nu tri tio na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t f or a ge , h ei gh t f or a ge , a nd w ei gh t f or h ei gh t, G uy an a M IC S 5, 2 01 4 W ei gh t f or a ge N um be r o f ch ild re n un de r a ge 5 H ei gh t f or a ge N um be r o f ch ild re n un de r a ge 5 W ei gh t f or h ei gh t N um be r o f ch ild re n un de r a ge 5 U nd er w ei gh t M ea n Z- S co re (S D ) St un te d M ea n Z- S co re (S D ) W as te d O ve rw ei gh t M ea n Z- S co re (S D ) P er ce nt b el ow P er ce nt b el ow P er ce nt b el ow P er ce nt a bo ve - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 + 2 S D 7 To ta l 8. 5 2. 2 -0 .4 3 ,1 31 12 .0 3. 4 -0 .4 3 ,0 57 6. 4 1. 7 5. 3 -0 .2 3 ,0 41 Se x M al e 9. 6 2. 1 -0 .4 1 ,6 03 13 .3 3. 6 -0 .5 1 ,5 65 6. 7 1. 7 5. 7 -0 .1 1 ,5 57 Fe m al e 7. 4 2. 2 -0 .4 1 ,5 28 10 .7 3. 2 -0 .4 1 ,4 93 6. 2 1. 7 4. 8 -0 .2 1 ,4 85 R eg io n R eg io n 1 6. 2 3. 3 -0 .3 7 6 18 .4 5. 7 -1 .0 7 3 3. 3 1. 0 7. 1 0. 3 7 2 R eg io n 2 4. 3 0. 7 -0 .2 1 78 15 .2 5. 3 -0 .6 1 70 3. 6 1. 0 8. 6 0. 0 1 66 R eg io n 3 9. 3 0. 7 -0 .4 4 30 11 .8 1. 8 -0 .4 4 33 8. 7 1. 5 5. 5 -0 .3 4 32 R eg io n 4 7. 8 2. 5 -0 .3 1 ,3 09 9. 4 2. 5 -0 .3 1 ,2 84 5. 8 1. 7 5. 4 -0 .2 1 ,2 81 R eg io n 5 9. 4 2. 5 -0 .2 2 19 11 .3 1. 9 -0 .4 2 14 6. 2 2. 2 3. 8 -0 .1 2 12 R eg io n 6 10 .1 2. 1 -0 .4 4 29 8. 4 3. 3 -0 .3 4 19 9. 1 2. 2 4. 2 -0 .3 4 14 R eg io ns 7 & 8 11 .6 5. 2 -0 .6 1 46 28 .0 11 .3 -1 .1 1 33 5. 3 1. 6 7. 3 0. 0 1 33 R eg io n 9 11 .6 2. 0 -0 .6 1 76 26 .6 9. 6 -1 .2 1 67 6. 5 1. 7 4. 1 0. 0 1 64 R eg io n 10 5. 8 1. 6 -0 .3 1 69 9. 5 1. 4 -0 .2 1 64 4. 2 1. 5 3. 4 -0 .2 1 67 A re a U rb an 7. 0 2. 1 -0 .3 7 57 9. 8 2. 6 -0 .3 7 35 5. 1 1. 6 6. 5 -0 .1 7 30 R ur al 8. 9 2. 2 -0 .4 2 ,3 75 12 .8 3. 7 -0 .5 2 ,3 23 6. 8 1. 8 4. 9 -0 .2 2 ,3 11 Lo ca tio n C oa st al 8. 5 2. 0 -0 .3 2 ,4 93 10 .0 2. 7 -0 .3 2 ,4 51 6. 8 1. 8 5. 3 -0 .2 2 ,4 35 U rb an C oa st al 7. 4 2. 0 -0 .3 6 41 10 .7 3. 0 -0 .4 6 23 5. 1 1. 5 7. 2 -0 .1 6 14 R ur al C oa st al 8. 9 2. 0 -0 .4 1 ,8 52 9. 7 2. 6 -0 .3 1 ,8 28 7. 3 1. 9 4. 7 -0 .2 1 ,8 21 In te rio r 8. 5 2. 6 -0 .5 6 38 20 .4 6. 5 -0 .9 6 07 5. 0 1. 5 4. 9 0. 0 6 06 A ge 0- 5 m on th s 10 .2 6. 6 -0 .4 2 99 14 .9 5. 3 -0 .3 2 88 7. 3 2. 3 4. 5 -0 .3 2 77 6- 11 m on th s 9. 5 0. 6 -0 .3 3 37 6. 4 2. 4 -0 .1 3 33 7. 7 1. 9 3. 3 -0 .3 3 34 12 -1 7 m on th s 6. 6 1. 0 -0 .1 3 40 13 .6 2. 5 -0 .5 3 31 6. 5 1. 9 6. 7 0. 1 3 30 18 -2 3 m on th s 5. 1 1. 7 -0 .3 3 06 15 .1 4. 5 -0 .7 2 98 3. 9 1. 4 4. 5 0. 1 2 97 24 -3 5 m on th s 8. 6 2. 4 -0 .3 6 08 13 .2 4. 1 -0 .5 5 89 5. 9 1. 2 9. 0 0. 0 5 83 36 -4 7 m on th s 8. 7 1. 9 -0 .5 6 45 12 .4 4. 3 -0 .5 6 34 5. 1 1. 1 6. 1 -0 .2 6 37 48 -5 9 m on th s 9. 6 1. 7 -0 .6 5 97 9. 9 1. 4 -0 .5 5 84 8. 5 2. 5 1. 7 -0 .5 5 82 M ot he r’s e du ca tio na N on e 12 .4 0. 8 -0 .8 6 1 17 .3 6. 7 -1 .1 5 8 8. 2 0. 0 5. 4 -0 .2 5 9 P rim ar y 10 .9 4. 4 -0 .6 4 47 15 .8 4. 6 -0 .7 4 34 5. 4 2. 1 3. 5 -0 .2 4 35 S ec on da ry 8. 4

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