Guyana - Multiple Indicator Cluster Survey - 2007

Publication date: 2007

Guyana Monitoring the situation of children and women Multiple Indicator Cluster Survey 2006 Bureau of Statistics United Nations Children’s Fund MICS Guyana Monitoring the situation of children and women Multiple Indicator Cluster Survey 2006 The Guyana Multiple Indicator Cluster Survey (MICS) was carried out by the Bureau of Statistics in collaboration with the United Nations Children’s Fund (UNICEF). The survey has been conducted as part of the third round of MICS surveys (MICS3), carried out around the world in more than 50 countries, in 2005–2006, following the first two rounds of MICS surveys that were conducted in 1995 and 2000. Survey tools are based on the models and standards developed by the global MICS project, designed to collect information on the situation of children and women in countries around the world. Additional information on the global MICS project may be obtained from www.childinfo.org Suggested citation: Bureau of Statistics and UNICEF. 2008. Guyana Multiple Indicator Cluster Survey 2006, Final Report. Georgetown, Guyana: Bureau of Statistics and UNICEF. Multiple Indicator Cluster Survey 2006 © Bureau of Statistics 57 High Street, Kingston, Georgetown Phone: 227-1155 © United Nations Children’s Fund (UNICEF) 72 Brickdam, Stabroek, Georgetown Phone: 225-9993 Cover photo: © UNICEF/Guyana Design and layout: luCa Design, www.lucadesign.ca i GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 i Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Guyana, 2006 TopIC MICS INDICATor NUMber MDG lINkAGe INDICATor VAlUe IN 2000 VAlUe IN 2006 UNIT CHIlD MorTAlITY Child mortality 1 13 Under-five mortality rate 72.01 47.0 per thousand 2 14 Infant mortality rate 54.01 37.0 per thousand NUTrITIoN Nutritional status 6 4 Underweight prevalence 13.6 12.4 percent 7 Stunting prevalence 10.8 13.7 percent 8 Wasting prevalence 10.6 7.6 percent Breastfeeding 45 Timely initiation of breastfeeding (within 1 hour) NA 43.1 percent 15 Exclusive breastfeeding rate (under 6 months) 15.32 21.4 percent Low birth weight 9 Low birth weight infants 11.2 18.9 percent CHIlD HeAlTH Immunization 25 Tuberculosis immunization coverage 97.33 96.0 percent 28 15 MMR immunization coverage 91.74 89.7 percent Care of illness 33 Use of oral rehydration therapy (ORT) 69.35 51.7 percent 23 Care seeking for suspected pneumonia 77.6 64.1 percent Malaria 38 Under-fives sleeping under mosquito nets 6.5 69.7 percent eNVIroNMeNT Water and Sanitation 11 30 Use of improved drinking water sources 83.3 91.2 percent 13 Water treatment NA 49.8 percent 12 31 Use of improved sanitation facilities NA 97.5 percent Solid fuel use 24 29 Wood and charcoal use NA 10.6 percent reproDUCTIVe HeAlTH Contraception and unmet need 21 19c Prevalence of contraceptive use 37.56 34.2 percent 98 Unmet need for family planning NA 32.4 percent 99 Demand satisfied for family planning NA 51.4 percent Maternal and newborn health 20 Antenatal care (at least once) 80.97 81.4 percent 4 17 Skilled attendant at delivery 85.67 83.3 percent 5 Institutional deliveries NA 82.6 percent 1 This value was referenced to 1997 2 The value in 2000 was for less than 4 months old 3 This value was for children immunized before their 1st birthday at age 12-23 months in 2000 but for age 18-29 months in 2006 4 This value was for children immunized by age 23 months in 2000 but for age 18-29 months immunized before age 18 months in 2006 5 ORT and appropriate household solutions were recorded for 2000 while ORT and/or appropriate household solutions in 2006 6 In 2000 this value was for women only while in 2006 it was for both the woman or her partner 7 In 2000 this value was for women who had given birth within the last year while in 2006 it was for the past two years ii GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 TopIC MICS INDICATor NUMber MDG lINkAGe INDICATor VAlUe IN 2000 VAlUe IN 2006 UNIT CHILD DEVELOPMENT Child development 46 Support for learning (4 or more activities) NA 82.3 percent 47 Father’s support for learning NA 51.2 percent 48 Support for learning: children’s books NA 54.4 percent 49 Support for learning: non-children’s books NA 55.4 percent 50 Support for learning: materials for play NA 40.0 percent 51 Non-adult care (without adult supervision) NA 11.3 percent EDUCATION9 Education 52 Pre-school enrolment 35.1 49.2 percent 53 School readiness NA 65.0 percent 54 Net intake rate in primary education NA 78.7 percent 55 6 Net primary school enrolment rate 97.7 96.2 percent 56 Net secondary school enrolment rate NA 69.4 percent 57 7 Children reaching grade five 97.0 96.8 percent 58 Transition rate to secondary school NA 67.0 percent 59 7b Primary completion rate NA 71.4 percent 61 9 Gender parity index primary school 1.1 1.0 ratio secondary school NA 1.1 ratio CHILD PROTECTION Birth registration 62 Birth registration 96.5 93.3 percent Child labour 71 Child labour 27.0 16.4 percent Child discipline 74 Any psychological/physical punishment NA 73.8 percent Support to orphaned children 75 Prevalence of orphans 5.1 5.9 percent 78 Children living without a biological parent 8.5 10.2 percent Early marriage 68 Young women aged 15-19 currently married/in union NA 14.4 percent Domestic violence 100 Attitudes of acceptance towards domestic violence NA 17.9 percent HIV/AIDS HIV/AIDS knowledge and attitudes 82 19b Comprehensive knowledge about HIV prevention among young people (15-24 years) 53.1 50.3 percent 89 Knowledge of mother-to-child transmission of HIV 42.3 57.7 percent 86 Non-discriminatory attitude towards people with HIV/AIDS 39.2 35.8 percent 87 Women who know where to be tested for HIV 69.0 80.6 percent 88 Women who have been tested for HIV 15.7 31.8 percent 90 Counselling coverage for the prevention of mother-to-child transmission of HIV NA 67.0 percent 91 Testing coverage for the prevention of mother-to-child transmission of HIV NA 55.8 percent 9 Enrolment includes attendance at least once in the previous year 10 In 2000 child labour was defined as working 4 or more hours while in 2006 it was defined as 28 hours of domestic work or at least one hour of economic work for those aged 5-11 or 14 hours of economic work for those aged 12-14 11 In 2000 comprehensive knowledge referred to knowing 3 ways to prevent HIV transmission and to be able to correctly identify 3 misconceptions about HIV transmission while in 2006 it was to identify 2 ways of preventing HIV transmission and reject three common misconceptions about HIV transmission iii GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 iii Table of ConTenTs List of Tables . iii List of Figures .vii List of Abbreviations .viii Acknowledgements . ix Executive Summary . x I. Introduction . 1 Background . 1 Survey Objectives . 3 II. Sample and Survey Methodology . 5 Sample Design . 3 Questionnaires . 5 Training and Fieldwork . 7 Data Processing . 7 III. Sample Coverage and the Characteristics of Households and Respondents . 9 Sample Coverage . 9 Characteristics of Households . 9 Characteristics of Respondents . 12 IV. Child Mortality . 15 V. Nutrition . 19 Nutritional Status . 19 Breastfeeding . 22 Low Birth Weight . 24 VI. Child Health . 27 Immunization . 27 Tetanus Toxoid (Diphtheria) . 28 Oral Rehydration Treatment . 30 Care Seeking and Antibiotic Treatment of Pneumonia . 32 Solid Fuel Use . 34 Malaria . 34 Sources and Costs of Supplies . 35 VII. Environment . 37 Water and Sanitation . 37 iv GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 VIII. Reproductive Health . 43 Contraception . 43 Unmet Need . 44 Antenatal Care . 45 Assistance at Delivery . 47 IX. Child Development . 49 X. Education . 53 Pre-School Enrolment and School Readiness . 53 Primary and Secondary School Participation . 53 XI. Child Protection . 59 Birth Registration . 59 Child Labour . 59 Child Discipline . 60 Orphanhood and Living Arrangements of Children . 61 Early Marriage/Cohabitation . 62 Domestic Violence . 64 XII. HIV/AIDS Knowledge and Awareness . 67 Knowledge of HIV Transmission and Condom Use . 67 References . 72 Tables . 73 Appendix A. Sample Design . 144 Appendix B. List of Personnel Involved in the Survey . 149 Appendix C. Estimates of Sampling Errors . 152 Appendix D. Data Quality Tables . 164 Appendix E. MICS Indicators: Numerators and Denominators . 172 Appendix F. Questionnaires . 175 v GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 v lisT of Tables Table HH.1: Results of household and individual interviews . 73 Table HH.2: Household age distribution by sex . 74 Table HH.3: Household composition . 75 Table HH.4: Women’s background characteristics . 76 Table HH.5: Children’s background characteristics . 78 Table CM.1: Child mortality . 79 Table CM.2: Children ever born and proportion dead . 80 Table NU.1: Child malnourishment . 81 Table NU.2: Initial breastfeeding . 82 Table NU.3: Breastfeeding . 83 Table NU.4: Adequately fed infants . 84 Table NU.5: Low birth weight infants . 85 Table CH.1: Vaccinations in first year of life . 86 Table CH.2: Vaccinations by background characteristics . 87 Table CH.3: Neonatal tetanus protection . 88 Table CH.4: Oral rehydration treatment . 89 Table CH.5: Home management of diarrhoea . 90 Table CH.6: Care seeking for suspected pneumonia . 91 Table CH.7: Antibiotic treatment of pneumonia . 92 Table CH.7A: Knowledge of the two danger signs of pneumonia . 93 Table CH.8: Solid fuel use . 95 Table CH.9: Children sleeping under mosquito nets . 97 Table EN.1: Use of improved water sources . 98 Table EN.2: Household water treatment . 100 Table EN.3: Time to source of water . 102 Table EN.4: Person fetching water . 103 Table EN.5: Use of sanitary means of excreta disposal. 104 Table EN.6: Disposal of child’s faeces . 105 Table EN.7: Use of improved water sources and improved sanitation. 106 Table RH.1: Use of contraception . 107 Table RH.2: Unmet need for contraception . 109 Table RH.3: Antenatal care provider . 110 Table RH.4: Antenatal care . 111 Table RH.5: Assistance during delivery . 112 vi GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table CD.1: Family support for learning . 114 Table CD.2: Learning materials . 116 Table CD.3: Children left alone or with other children . 117 Table ED.1: Early childhood education . 118 Table ED.2: Primary school entry . 119 Table ED.3: Primary school net enrolment ratio . 120 Table ED.4: Secondary school net enrolment ratio . 121 Table ED 4W Secondary school age children enrolled in primary school. 122 Table ED.5: Children reaching grade 5 . 123 Table ED.6: Primary school completion and transition to secondary education . 124 Table ED.7: Education gender parity . 125 Table CP.1: Birth registration . 126 Table CP.2: Child labour . 127 Table CP.3: Labourer students and student labourers . 128 Table CP.4: Child discipline . 129 Table CP.5: Child’s living arrangements and orphanhood . 130 Table CP.6: Early marriage/cohabitation . 132 Table CP.7: Spousal age difference . 133 Table CP.9: Attitudes toward domestic violence . 135 Table HA.1: Knowledge of preventing HIV transmission . 136 Table HA.2: Identifying misconceptions about HIV/AIDS . 138 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission . 139 Table HA.4: Knowledge of mother-to-child HIV transmission . 140 Table HA.5: Attitudes toward people living with HIV/AIDS . 141 Table HA.6: Knowledge of a facility for HIV testing . 142 Table HA.7: HIV testing and counselling coverage during antenatal care . 143 vii GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 vii lisT of figures Figure HH.1: Age and sex distribution of household population . 11 Figure CM.1: Under-5 mortality rates by background characteristics . 16 Figure CM.2: Trend in under-5 mortality rates . 17 Figure NU.1: Percentage of children under-5 who are undernourished . 21 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth . 23 Figure NU.3: Percentage of infants weighing less than 2500 grams at birth . 25 Figure CH.1: Percentage of children aged 12-23 months who received the recommended . vaccination by 12 months . 28 Figure CH.2: Percentage of women with a live birth in the last 12 months who are . protected against neonatal tetanus . 30 Figure CH.3: Percentage of children aged 0-59 months with diarrhoea who received ORT or increased fluids, AND continued feeding . 32 Figure EN.1: Percentage distribution of household members by source of drinking water 38 Figure HA.1: Percent of women who have comprehensive knowledge of HIV/AIDS . transmission . 69 viii GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 exeCuTive summary The Guyana Multiple Indicator Survey 2006 (MICS3) is the second of its kind in Guyana; the first being in 2000. It is a nationally representative sample survey of households and was designed to provide estimates on a large number of indicators on the situation of children and women at the national level, for urban and rural areas as well as interior and coastal areas. The objectives of the survey were as follows: To provide up-to-date information for assessing the situation of children and women in • Guyana; To furnish data needed for monitoring progress toward the Millennium Development • Goals, the goals of A World Fit For Children (WFFC), and other internationally agreed upon goals, as a basis for future action; To contribute to the improvement of data and monitoring systems in Guyana and to • strengthen technical expertise in the design, implementation, and analysis of such systems. The survey targeted 5,280 households of which 5,229 were found to be occupied. Of those occupied, 5,008 were successfully interviewed resulting in a response rate of 96 percent. The response rates of women and children were 96 and 98 percent respectively. The main findings of the Guyana MICS3 are as follows: HouseHold ComposiTion Although children under 5 years of age are equally spread out in coastal (1,269) and interior (1,231) areas yet 85 percent reside in rural Guyana (Table HH.1). This survey established the average household size as 4.05 with equal gender distribution (10,088 males and 10,176 females). Almost one half (42 percent) of the population is below 18 years of age (Table HH.2) and 70 percent of the sampled households are headed by males (Table HH.3). Almost one third (29 percent) of all children under 5 years are living in a household without their biological father (Table CD.1). One in three children (30 percent) comes from the poorest quintile whereas one in eight (13 percent) comes from the richest quintile. infanT and under-five morTaliTy raTes Using the WEST method the probability for a child to die before its first birthday or infant mortality rate (IMR) was estimated at 37 per thousand live births, while the probability of dying before teaching its fifth birthday or under-5 mortality rate (U5MR) was 47 per thousand live births. Infant and under-5 mortality rates were lowest in Regions 2 and 3 and highest in the hinterland regions such as Regions 1, 7, 8 and 9 (Table CM.2). These estimates of child mortality are lower than earlier estimates and highlight the change in a positive direction. For example IMR and U5MR fell by 17 and 25 percentage points between 2000 and 2006. ix GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 ix CHild malnuTriTion Results indicate that 12 percent of children under age five-years were underweight or too thin for their age and 14 percent were stunted or too short for their age (Table NU.1). Approximately twice as many children from the interior areas (21 percent) are stunted compared with children from the coastal (12 percent) areas. Children under the age of 6 months were least likely to be undernourished than older children (6-59 months). When compared to the survey results of 2000 no large differences were observed in 2006. breasTfeeding Over two in five women (43 percent) started breastfeeding within the recommended period of one hour of birth while three out of every four (75 percent) started within one day (Table NU.2). However only one of every five children under six-months of age were exclusively breastfed while the percentage of those under three months of age were higher with roughly one in three children exclusively breastfed. Breastfeeding is maintained throughout early childhood as noted by 20 percent of children aged 6-11 months receiving breast milk and complementary food with the value increasing to every other child (48 percent) receiving breastmilk and appropriate food at the 20-23 month age range. low birTH weigHT Birth weight was estimated as low for every fifth infant (19 percent) on average with the interior area having a slightly higher figure of 24 percent (Table NU.5). There is little or no variation within the coastal areas. This survey has recorded an increase of 7 percentage points compared to the 2000 survey. immunizaTion Coverage Approximately 96 percent of children aged 18-29 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 95 percent with 90 percent and 74 percent receiving the subsequent doses respectively (Table CH.1). In Guyana protection against measles is provided by the MMR (Measles, Mumps and Rubella) vaccine. Guyana’s immunization schedule indicates that children should be given the MMR and yellow fever vaccinations at age 12 months. The survey indicates that approximately 90 percent of the children aged 18-29 months received the MMR vaccine by age 18 months and just over 88 percent received the yellow fever vaccine. There is little difference in the vaccination coverage by any of the background variables collected in the survey and 75 percent of the children reportedly had a health card. According to the data collected 44 percent of mothers with at least one birth within the 24 months prior to the survey were protected against tetanus. x GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 diarrHoea Approximately half (52 percent) of the children with diarrhoea received one or more of the recommended treatments such as ORS or the recommended homemade fluid while only 6 percent of children received increased fluids and continued eating as recommended (Table CH.4). The value is higher for those under-five years old that were reported to have had diarrhoea in the two weeks preceding the interview with 28 percent increasing ORT or increased fluids and continued feeding/eating once contracting diarrhoea. aCuTe respiraTory infeCTion/pneumonia Some 6 percent of children aged 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey (Table CH.6). Overall, 64 percent were taken to an appropriate health provider. One in five mothers (19 percent) was aware of at least two of the danger signs of pneumonia. Women who reside in the interior regions of Guyana are five times less likely to have knowledge of two of the danger signs of pneumonia than other women. solid fuel While only 10 percent of the households surveyed across the country used solid fuel for cooking, approximately half (48 percent) of the households in the interior areas utilise this source of energy (Table CH.8). malaria In Guyana, the coastal areas are considered to be malaria free while the interior areas are considered to be high-risk malaria areas. As such, the MICS3 measured malaria related indicators only in the interior areas and found that approximately 70 percent of children under the age of 5 years slept under a mosquito net, a large increase from only 11 percent in 2000 (Table CH.9). waTer and saniTaTion Overall access to improved water sources increased between 2000 and 2006 from 83 percent to 91 percent. However important regional differences remain with only 52 percent of the population in the interior accessing similar sources (Table EN.1). According to international standards/MICS rain water collection is considered to be an improved drinking water source and 22 percent employ this method in Guyana. Only 29 percent of households that use unimproved sources of drinking water use an appropriate water treatment method with this practice least prevalent in the interior. Sanitary means of excreta disposal is almost universal (98 percent) and 53 percent using traditional pit latrines as well as 40 percent employing septic tanks. Pit latrines are considered to be a sanitary means of excreta disposal according to international standards/MICS. xi GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 xi ConTraCepTion Current use of contraception was reported by a third (34 percent) of married or in union women (Table RH.1). The most common method used was the pill (13 percent) with condoms and inter-uterine devices at 6 percent each. Just over half (51 percent) of women aged 15-49 years who were currently married or were in a union, reported that their demand for contraception was satisfied. prenaTal Care Four fifths (81 percent) of women in Guyana who had at least one birth in the 24 months prior to the survey received some type of antenatal care from skilled personnel (doctor, nurse/midwife, auxiliary midwife, medex) (Table RH.3). However, the proportion of women who had their antenatal care delivered by skilled personnel was not uniform among the strata of society. Women from the coastal areas had substantially higher proportions (87 percent) attended to by skilled personnel compared with women from the interior regions (57 percent). assisTanCe aT delivery Skilled personnel (doctor, nurse/midwife, auxiliary midwife, medex) delivered 83 percent of births that occurred in the two years prior to the MICS survey (Table RH.5). Again, the proportions were lower in the interior (56 percent) compared with the coast (89 percent). More than eighty percent (83 percent) of the births that occurred within the 2 years preceding the survey were delivered in a health facility. CHild developmenT In Guyana, over 82 percent of the children under the age of 5 years reside in households in which the adult household members are engaged in at least four activities that promote learning and school readiness (Table CD.1). This proportion was found to be 20 percentage points lower in the interior (66 percent) than in the other areas of Guyana. The father’s involvement with their under-5 children in at least one activity that promotes learning and school readiness was found to be limited to every other child (51 percent). eduCaTion Half (49 percent) of children in Guyana aged 36-59 months were enrolled in some form of organized early childhood education programme in 2006 (Table ED.1). This is an improvement of 14 percentage points compared to 2000. There was little difference in the enrolment of boys and girls while marked differences existed by place of residence with coastal urban at 57 percent, coastal rural at 50 percent and interior areas at 37 percent. Two thirds (65 percent) xii GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 of children enrolled in first grade at primary school at the time of the survey had been enrolled in preschool programmes in the previous year. While the percentage of children of primary school age enrolled in school at the national level is very high (96 percent) only 69 percent of children of secondary school age are enrolled at secondary school. More females (73 percent) than males (66 percent) of secondary school age are enrolled in secondary or higher school at the national level. Approximately 97 percent of children who enter the first grade of primary school eventually reached grade five while 71 percent of 11 year olds (age appropriate to grade 6 at primary school) completed the primary level education and only 67 percent went on to secondary level education. birTH regisTraTion The births of approximately 93 percent of children under-five years were reported as having been registered (Table CP.1). Of those births reported as not registered, the most common reason given for non-registration was distance to registration centre. Children born to mothers with no formal education had lower proportions registered as compared with those mothers with higher levels of education. Children from the interior also had somewhat lower proportions registered (86 percent) relative to children from the coast (95 percent). CHild labour In MICS3 a child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey they did 28 hours of domestic work or at least one hour of economic work for those aged 5-11 or 14 hours of economic work for those aged 12-14. It was found that over 16 percent of children aged 5-14 years are engaged in child labour activities (Table CP.2). The highest proportion (10 percent) did family work on farms or businesses. Unpaid work and paid work for a non-household member accounted for 5 percent and 2 percent respectively while those children who spend 28 or more hours per week doing household chores accounted for less than 1 percent. Children from the interior were more than 10 times and 4 times as likely as those from the urban coast and the rural coast respectively to have worked on family farms or businesses. It is important to note child labour activities were not found to impact school enrolment to a large extent. CHild disCipline The percentage of children aged 2-14 years subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members is very high in Guyana (74 percent) (Table CP.4). Severe punishment, minor physical punishment, and psychological punishment accounted for 16 percent, 59 percent and 63 percent respectively with only 8 percent not being subjected to discipline or punishment at all. xiii GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 xiii aTTiTudes Towards domesTiC violenCe Approximately one in every five women (18 percent) believed that a husband/partner is justified in beating his wife/partner (Table CP.8). This belief was most prevalent among women who reside in interior areas (39 percent) where the proportion with this belief was also double that on the rural coast (20 percent) and five times that in the urban coast (8 percent). Education and household wealth seem to influence women’s attitude towards domestic violence. The richer the household and the more educated the woman, the less likely she is to agree that a husband is justified in beating his wife/partner. Hiv/aids More than half (55%) of women aged 15-49 knew all three main ways to prevent HIV transmission (i.e. having only one uninfected sex partner, using a condom every time, and abstaining from sex) (Table HA.1). Similarly, 58 percent of those aged 15-49 years knew all three ways of preventing mother to child transmission. One third (36 percent) of women of child bearing age expressed no discriminatory attitude towards people living with HIV/AIDS with this accepting attitude increasing with women’s education and household wealth. Two thirds (61 percent) of women correctly identified three misconceptions about HIV transmission (i.e. that HIV can be transmitted through sharing food, that it can be transmitted through mosquito bites, and that a healthy looking person cannot be infected). Since 2000 there has been a 12 percentage point increase with 81 percent of women of reproductive age knowing where to get tested for HIV. Twice as many (32 percent compared to 16 percent) women in this age group have received testing in 2006 as compared to the 2000 survey. The percentage of women who have comprehensive knowledge of HIV transmission and who know where to get tested for HIV increase dramatically as women’s education level increases. xiv GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 lisT of abbreviaTions AIDS Acquired Immune Deficiency Syndrome AIS AIDS Indicator survey ANC Antenatal Care BCG Bacillis-Cereus-Geuerin (Tuberculosis) CSPro Census and Survey Processing System CDC Centre for Disease Control DPT Diphtheria Pertussis Tetanus ED Enumeration Districts EPI Expanded Programme on Immunization GPI Gender Parity Index HIV Human Immunodeficiency Virus IMR Infant Mortality Rate ITN Insecticide Treated Net IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoH Ministry of Health MTCT Mother to Child Transmission NCHS National Centre for Health Statistics ORT Oral Rehydration Treatment PLWHA People Living with HIV/AIDS PMTCT Prevention of mother to child transmission SPSS Statistical Package for Social Sciences U5MR Under-Five Mortality 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 xv GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 xv aCknowledgemenTs The Guyana 2006 Multiple Indicator Cluster Survey (MICS) was implemented by the Bureau of Statistics. This report describes the key findings and represents the combined efforts of many institutions and individuals without which the successful completion of the entire project would not have been possible. It is important to acknowledge the training and technical support provided during this survey process by UNICEF staff from New York and Guyana as well as TACRO, the UNICEF Regional Office. The collaboration of multiple Ministries and Departments in Guyana is also deeply appreciated. Furthermore the invaluable assistance of consultants on this project is noted as was the decisive role in the adaptation of the MICS3 questionnaires and manuals by the members of the Technical Steering Committee. It is expected that this situation survey will pave the way for periodic monitoring of the situation of children and women living in Guyana. © UNICEF/Guyana/2008 i. inTroduCTion The survey provides valuable information on the situation of children and women in Guyana. 1 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 1 i. inTroduCTion baCkground Guyana is situated on the north-eastern shoulder of South America and is bordered on the north by the Atlantic Ocean, on the east by Suriname, on the south by Brazil and on the west by Venezuela. With an area of 214,969 sq. kilometres and a population of 751,223 persons (Guyana Population & Housing Census 2001), the country has a population density of 3.5 persons per sq. km. Over 90 percent however, live on the narrow coastal plain, approximately 485 km long and on average approximately 13 km in depth. This report is based on the Guyana Multiple Indicator Cluster Survey, conducted in 2006 by the Bureau of Statistics. The survey provides valuable information on the situation of children and women in Guyana, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). 2 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” This final report presents the results of the indicators and topics covered in the survey.1 1 For more information on the definitions, numerators, denominators and algorithms of Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) indicators covered in the survey: see Chapter 1, Appendix 1 and Appendix 7 of the MICS Manual – Multiple Indicator Cluster Survey Manual 2005: Monitoring the Situation of Children and Women, also available at www.childinfo.org 3 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 3 survey objeCTives The 2006 Guyana Multiple Indicator Cluster Survey has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Guyana; • To furnish data needed for monitoring progress toward goals established in the Millennium Development Goals, the goals of A World Fit For Children (WFFC), and other internationally agreed upon goals, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Guyana and to strengthen technical expertise in the design, implementation, and analysis of such systems. © UNICEF/Guyana/2008/L. O’Toole ii. sample and survey meTHodology This survey is designed to provide estimates on a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and interior and coastal areas. 5 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 5 ii. sample and survey meTHodology sample design The sample for the Guyana Multiple Indicator Cluster Survey (MICS3) was designed to provide estimates on a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and interior and coastal areas. In considering the urban/rural distinction, it should be borne in mind that all the urban areas of the country are located within the coastal region and the entire interior region is considered to be rural. Coastal and interior areas were identified as the main sampling domains and the sample was selected in two stages. Within the coastal and interior areas, 160 and 60 census enumeration district areas respectively were selected with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a circular systematic sample of twenty- four (24) households was drawn. All of the selected enumeration areas were visited during the fieldwork period. The sample was stratified by urban and rural area and is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. QuesTionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members, the household, and the dwelling; 2) a women’s questionnaire administered in each household to all women aged 15-49 years; and 3) an under-5 questionnaire, administered to mothers or caretakers of all children under 5 living in the household. The questionnaires included the following modules: The Household Questionnaire included the following modules: • Household (Extended) Listing2 • Education • Water and Sanitation • Household Characteristics • Insecticide Treated Nets (administered only in the high-risk malaria areas i.e. interior of Guyana) • Child Labour • Child Discipline 2 Unlike in the case of the standard MICS3 Extended Household Listing module, where the ethnicities and the reli- gious denominations of only the household heads were collected, the Guyana MICS3 Household (extended) listing module included the ethnicities and the religious denominations of all the household members. 6 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: • Child Mortality • Diphtheria Tetanus (administered to women who had at least one live birth within the 2 years prior to interview) • Maternal and Newborn Health (administered to women who had at least one live birth within the 2 years prior to interview) • Marriage/Union Status • Contraception and Unmet Needs • Attitudes Towards Domestic Violence • HIV/AIDS Knowledge and Awareness The Questionnaire for Children Under Five was administered to mothers or caretakers of children under 5 years of age3 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Birth Registration and Early Learning • Child Development • Breastfeeding • Care of Illness • Malaria (administered only in the high-risk malaria areas i.e. interior of Guyana) • Immunization • Anthropometry The Guyana MICS3 questionnaires are based on the English version of the MICS3 model questionnaire4. These model questionnaires were adapted and modified, with consultation with the Guyana MICS3 Technical Steering Committee, to reflect national situations. The modified version of the questionnaires was pre-tested in six clusters in both urban and rural areas during February, 2006. However, malaria related modules were not tested since the pre-test focused on the coast of Guyana where malaria is largely considered non-existent. Based on the results of the pre-test further modifications were made to the wording and the response categories of the questionnaires. A copy of the Guyana MICS questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams measured the weights and heights of children age under 5 years. Details and findings of these measurements are provided in the respective sections of the report. 3 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 4 The model MICS3 questionnaire can be found at www.childinfo.org, or in UNICEF, 2006. 7 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 7 Training and fieldwork Training for the fieldwork was conducted for 10 days in March, 2006. Training included instruction on interviewing techniques, the administration of the questionnaires and the listing and mapping procedures. The trainees were also involved in case study exercises as well as mock interviews among trainees. They were also encouraged to practice (at home) the administration of the questionnaires as well as their interviewing skills on their family members and neighbours. The data were collected by twelve teams; of which, ten were comprised of four interviewers, one driver, one editor/measurer and a supervisor, while two teams were without an editor. In the latter cases, the supervisors also performed the task of editor/measurer. It should be noted that due to the limited number of appropriate female field staff, a male field staff was assigned to each team in a supervisory capacity in most cases. Fieldwork on the coast began toward the end of March, 2006 and concluded in the first week in June, 2006 while fieldwork in the Interior Regions commenced in mid May, 2006 and concluded early January, 2007. It is worthwhile noting that the fieldwork in the Interior Regions was carried out generally by one team resulting in the long fieldwork period. daTa proCessing Data were entered using the CSPro software. The data were entered on three microcomputers and carried out by three data entry operators and one data entry supervisor. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS3 project and adapted to the Guyana questionnaire were used throughout. Data processing began in June, 2006, some three months after the start data collection and was completed in January, 2007. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 14, and the model syntax and tabulation plans developed by UNICEF for this purpose. © UNICEF/Guyana/2008/L. O’Toole iii. sample Coverage and THe CHaraCTerisTiCs of HouseHolds and respondenTs More than 40% of Guyana’s population is below 18 years of age. 9 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 9 iii. sample Coverage and THe CHaraCTerisTiCs of HouseHolds and respondenTs sample Coverage Table HH.1 shows that of the 5,280 households selected for the sample, 5,229 were found to be occupied. Of these, 5,008 were successfully interviewed for a household response rate of 96 percent. In the interviewed households, 5,253 women (age 15-49) were identified. Of these, 5,035 were successfully interviewed, yielding a response rate of 96 percent. In addition, 2,541 children under age five were listed in the household questionnaire. Questionnaires were completed for 2,500 of these children, which corresponds to a response rate of 98 percent. Overall response rates of 92 percent and 94 percent are calculated for the women’s and under-5’s interviews respectively (Table HH.1). Differentials in response rates were similar across regional groupings and areas. CHaraCTerisTiCs of HouseHolds The age and sex distribution of survey population is provided in Table HH.2. The distribution is also used to produce the population pyramids in Figure HH.1a. In the 5,008 households successfully interviewed in the survey, 20,295 household members were listed. Of these5, 10,088 were males, 10,176 were females. These figures also indicate that the survey estimated the average household size at 4.05. Table HH.2a below shows the age and sex distribution of the survey population as well as the 2002 Population and Housing Census. From all indications, the 2006 MICS distribution is highly reflective of the 2002 census, suggesting that the survey sample was fairly good. For instance, the percentage distribution either for the five year age groups or the broad functional age group is not very different between the 2002 census and 2006 MICS. Sex ratios, which are defined as the number of males to every 100 females, are shown at the bottom of Table HH.2a and portray a similar trend. 5 For 31 cases, sex was not recorded 10 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table HH.2a: Percent Distribution of Population by Age, Sex, Selected Age Groups and Sex Ratio, Guyana: MICS 2006 and Census 2002 Age Group Number/MICS 2006 Number/2002 Census Males Females Total Males Females Total 0-4 10.6 9.4 10 12 11.6 11.8 5-9 13.2 12.4 12.8 13.1 12.7 12.9 10-14 12.9 12.5 12.7 11 10.7 10.8 15-19 9.6 9.9 9.7 8.9 8.9 8.9 20-24 7.1 7.8 7.4 8.5 8.7 8.6 25-29 6.9 7.3 7.1 8 8.2 8.1 30-34 7.1 7.5 7.3 7.7 7.7 7.7 35-39 7 7 7 7 7 7 40-44 6.1 6.2 6.2 6.2 6.2 6.2 45-49 5.3 5.2 5.3 4.8 4.8 4.8 50-54 4.4 4.6 4.5 3.8 3.7 3.7 55-59 3.1 3.1 3.1 2.4 2.4 2.4 60-64 2.1 2.1 2.1 1.9 2.1 2 65-69 1.5 1.9 1.7 1.5 1.6 1.6 70+ 2.7 3 2.8 2.3 2.9 2.6 Not stated 0.3 0.1 0.2 0.9 0.7 0.8 Total % 100 100 100 100 100 100 <15 36.7 34.3 35.5 36.1 35.3 35.8 15-64 58.8 60.7 59.7 59.8 60.1 59.9 65+ 4.2 4.9 4.5 3.8 4.6 4.2 Children aged 0-17 43 40.6 41.8 42.1 41 41.5 Adults 18+ 43 40.6 58.2 57.9 59 58.5 Total Number 10,088 10,176 *20,295 376,034 375,189 751,223 Sex Ratio 99.1 100.2 * 31 cases excluded-sex not stated Age pyramids have also been constructed to compare the feature of the age and sex structure, as produced by the survey (Figure HH.1a) and the 2002 census (Figure HH.1b) respectively. These pyramids show common features, for example, narrow base and slightly broader top, indicating declining fertility and increasing longevity. Table HH.2 shows that 35.6 percent of the population is below 15 years, while 4.5 percent represents those 65 years and over. At the same time, those 18 years and over comprises 58.2 percent of the total population, compared to 41.8 percent who fall below the age of 18 years. 11 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 11 Figure HH.1a: Population Pyramid Guyana MICS3, 2006 20 10 0 10 20 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Percent FemalesMales Figure HH.1a: Population Pyramid Guyana Census, 2002 20 10 0 10 20 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Percent FemalesMales 12 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table HH.3 provides basic background information on the households. Within households, the sex of the household head, regional groupings, urban/rural status, interior/coastal status, and number of household members are shown in the table. These background characteristics are also used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). Table HH.3A shows the proportions of households where at least one child under 18, at least one child under 5, and at least one eligible woman age 15-49 were found. As detailed in Table HH.3, 70 percent of the sampled households are headed by males while 30 percent are headed by a female. The largest portion of the sample came from Region 4 (44 percent) followed by Regions 5 and 6 (23 percent), and then by Regions 2 and 3 (20 percent). The smallest number of households came from Region 10 (5 percent) and Regions 1, 7, 8 and 9 (7 percent). Over 91 percent of the sample came from the coast and just 9 percent came from the interior. Almost one third (29 percent) of all children under 5 years are living in a household without their biological father (Table CD.1). Results from Table HH.3 indicate two-thirds of the sampled households (66.1 percent) consisted of 2-5 persons. Households with 6-7 persons accounted for 15 percent of the sample, those with only one person accounted for 12 percent and those with 8-9 persons and more than 10 persons accounted for 5 percent and 2 percent respectively. Most of the sampled households had at least one woman aged 15-49 years (75 percent) and at least one child younger than 18 years of age (68 percent). Only 30 percent had at least one child under 5 years of age. CHaraCTerisTiCs of respondenTs Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5 respectively. In both tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to regional groupings, urban/rural status, interior/coastal status, age, marital status, motherhood status, education6, 6 Unless otherwise stated, “education” refers to educational level attained by the respondent throughout this report when it is used as a background variable. 13 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 13 wealth index quintiles7, and ethnicity. The largest proportion of women sampled resides in Region 4 (44 percent) and the smallest proportion resides in Region 10 (5 percent). Women in the rural areas accounted for 70 percent of the sample and those on the coast accounted for 91 percent of the sample. With regards to marital status, 59 percent were currently married/in union and 32 percent were never married/in union. Nearly one third (31 percent) had never given birth. In terms of ethnicity, East Indians accounted 45 percent while Africans accounted 28 percent, mixed 18 percent and Amerindian 8 percent. Approximately half (47 percent) of the women had upper secondary and post secondary education, followed by 28 percent with lower secondary education, and 19 percent with primary level education. Only 3 percent had university level education. Some background characteristics of children under 5 are presented in Table HH.5. These include distribution of children by several attributes: sex, regional groupings, urban/rural status, interior/coastal status, age in months, mother’s/caretaker’s education level, household wealth, and ethnicity. The table outlines that 47 percent of the children under 5 years were female. Roughly one in five children fell into the age groups 24-35 months, 36-47 months and 48-59 years old. Nineteen percent was under one year old. Mothers of 45 percent of the under-5 children had upper post secondary education and higher. In addition, 30 percent of children were from the poorest homes and 13 percent were from the richest. The largest ethnic group amongst children under five represented was the East Indian (32 percent) followed by Mixed (29 percent) then African (23 percent) and finally Amerindians (16 percent). 7 Principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to each household asset, and obtain wealth scores for each household in the sample (The assets used in these calculations were as follows: number of rooms for sleeping per member; floor, roof and walls material of dwelling; type of water and sanitations; the type of fuel used for cooking; radio, mobile, phone, fridge, washing machine, dishwasher, computer, and car). Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels, and the wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, and Filmer and Pritchett, 2001. © UNICEF/Guyana/2008/V. Wilson iv. CHild morTaliTy These estimates of child mortality are lower than earlier estimates and highlight the change in a positive direction. 15 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 15 iv. CHild morTaliTy One of the overarching goals of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate (IMR) is the probability of dying before the first birthday. The under-five mortality rate (U5MR) is the probability of dying before the fifth birthday. In MICS surveys, infant and under five mortality rates are calculated based on Trusell version of the Brass indirect estimation technique (United Nations, 1983; 1990a; 1990b). The data used in the estimation are: the mean number of children ever born (average parity) for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women. The technique converts these data into probabilities of dying by taking into account both the mortality risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Guyana, the ‘West’ model, from the Coale-Demeny model life table was selected as most appropriate. The age groups used to produce the mortality estimates were 25-29 years and 30-34 years8. Table CM.1 provides estimates of child mortality by various background characteristics, while Table CM.2 provides the basic data used in the calculation of the mortality rates for the national total. The probability of dying before age 1 (IMR) is estimated at 37 per thousand, while the probability of dying under 5 years of age (U5MR) is around 47 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to mid 2003. Results from Table CM.1 indicate there is a difference between the probabilities of dying among males and females. The IMR among boys is 40 and among girls 35 while the under-five mortality 8 In the previous MICS in Guyana (MICS 2000), the 20-25 and 25-29 years age groups were used. However, considering the declining fertility rates in Guyana as in many other countries, it was recommended that the age group be increased to 25-29 years and 30-34 years. 16 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 rate among boys is 49, compared to 44 per thousand among girls. Infant and under-5 mortality rates are lowest in Regions 2 and 3 (26 percent and 31 percent respectively), and highest in Regions 1, 7, 8 and 9 (52 percent and 68 percent respectively). There was very little difference among other regional groupings. As household wealth increases, infant and under-5 mortality rates decrease. Furthermore, education level of mothers has very little impact on child mortality among children whose mothers’ level of education is higher than primary. Additionally, the probability of dying before the first birthday and before the fifth birthday respectively is lowest among East Indian children than among children of the other ethnicities. There are differences in mortality in regards to place of residence. Rural children outnumber urban children by 12 and 16 percentage points as it relates to IMR and U5MR respectively. Differentials in under-5 mortality rates by background characteristics are shown in Figure CM.1. Figure CM.1: Under-5 mortality rates by background characteristics, Guyana, 2006 49 44 68 31 49 47 45 34 50 49 44 45 47 43 47 0 20 40 60 80 SEX Male Female REGIONAL GROUPING Regions 01, 07, 08, 09 Regions 02, 03 Regions 05, 06 Region 04 Region 10 AREA Urban Rural MOTHER'S EDUCATION Nursery/None/Primary Lower Secondary (F1 - 3) Upper Secondary F4 - 5 & Post Sec/University HH WEALTH Poorest 60 % Richest 40 % Total Per 1000 17 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 17 Figure CM.2 below shows the U5MR estimates from different sources (MICS2, MICS3 and indirect and direct estimates from the AIS9 2005). These estimates are based on responses of women in different age groups, and referring to various points in time, thus showing the estimated trend in U5MR based on the survey. As shown in the graph, for the early-to-mid 1990s, MICS3 estimates are considerably lower than those from MICS2000 (10-20 per thousand). Estimates for late 1990s to mid-2000s from MICS3 appear to be continuing the trend implied by the MICS2 estimates. The “increase” in mortality shown by the MICS3 for the latest period should be considered with caution, since this estimate is produced from data based on women age 20-24, and children born to women of young ages are known to experience elevated mortality, not representative of the prevailing mortality levels during the period in question, due to selection factors operating. The final estimate from MICS3, calculated from the average of estimates derived from data based on women age 25-29 and 30-34, is 47 per 1000 live births, and this rate, compared to the estimates from MICS2 implies that U5MR has declined from 60s to 40s (per thousand) between the mid-1990s and early 2000s. However, further qualification of these apparent differences as well as its determinants should be taken up in a more detailed and separate analysis. Figure CM.2: Trends in Under 5 Mortality Rates, Guyana 0 10 20 30 40 50 60 70 80 90 100 1985 1990 1995 2000 2005 Year P er 1 ,0 00 MICSi2 AISd2005 AISi2005 MICSi3 9 AIDS Indicator survey © UNICEF/Guyana/2008 v. nuTriTion Stunting is common in the interior with 1 in every 5 children under 5 years of age shorter than they should be, while it is half as much elsewhere in Guyana. 19 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 19 v. nuTriTion nuTriTional sTaTus Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of all children deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. While the Millennium Development targets do not explicitly mention stunting and wasting, the goal is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. The World Fit for Children goal is to reduce the prevalence of malnutrition among children under five years of age by at least one-third (between 2000 and 2010), with special attention to children under 2 years of age. A reduction in the prevalence of malnutrition will assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is the WHO/ CDC/NCHS reference, which was recommended for use by UNICEF and the World Health Organization at the time the survey was implemented. The three most commonly used anthropometric indices to assess the growth status of children are weight-for-age, height-for- age and weight-for- length or height. Each of these three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight- for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. 20 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In MICS, weights and heights of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF (UNICEF, 2006). Findings in this section are based on the results of these measurements. It is important to note Guyana has just initiated training in the area of stunting and wasting. Table NU.1 shows the prevalence of underweight, stunting and wasting based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are classified as overweight, or whose weight for height is above 2 standard deviations from the median of the reference population. Approximately 8 percent of children in the sample were not weighed and measured. Children whose measurements are outside a plausible range or whose birth dates are not known are excluded from the analyses presented in Table NU.1. The findings indicate that 12 percent of children under the age of five years are moderately underweight while 2 percent are severely underweight (Table NU.1). More than one in seven (14 percent) are moderately stunted or too short for their age and one in twenty are considered severely stunted (5 percent). Approximately 8 percent of the children are moderately wasted or too thin for their height, 2 percent are severely wasted and 5 percent are classified as overweight. Further, as shown in Table NU.1, there appears to be hardly any difference between sexes. Children in Region 10 are the least likely to be underweight and wasted than other children in Guyana. Children in Region 4 are the least likely to be stunted than their counterparts in other Regional groupings in Guyana. Children who reside in Regions 1, 7, 8 & 9 are the most likely to be stunted and least likely to be overweight. Furthermore, children who reside in the interior are twice as likely as their coastal counterparts to be stunted while half as likely to be wasted. 21 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 21 Figure NU.1: Percentage of children under-5 who are undernourished, Guyana, 2006 0 5 10 15 20 25 0 6 12 18 24 30 36 42 48 54 60 Underweight Stunted Wasted Age (in months) P er ce nt More children aged 12-23 months tend to be stunted than wasted or underweight (Figure NU.1). Additionally, the age pattern shows that a higher percentage of children aged 12-23 months are undernourished according to all three indices in comparison to children who are younger and older. This pattern is expected and is related to the age at which many children cease to be breastfed and are exposed to contamination in water, food, and environment. Those children whose mothers have upper secondary or post secondary education are the least likely to be underweight or stunted compared to children of mothers with lower levels of education. Mother’s education level was found to have little or no impact on children’s nutritional status in terms of wasting and being overweight. According to the results in Table NU.1 there seems to be no distinct relationship between household wealth and children under five years being underweight, stunted, wasted and overweight. The highest proportion of moderately or severely stunted children is found amount the poorest households (22 percent) while that lowest proportion is found among children from the middle class households (8 percent). This same pattern was exhibited in terms of severely stunted children. 22 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 breasTfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continue to be breastfed with safe, appropriate and adequate complementary feeding for up to 2 years of age and beyond. WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators of recommended child feeding practices are as follows: • Exclusive breastfeeding rate (< 6 months & < 4 months) • Timely complementary feeding rate (6-9 months) • Continued breastfeeding rate (12-15 & 20-23 months) • Timely initiation of breastfeeding (within 1 hour of birth) • Frequency of complementary feeding (6-11 months) • Adequately fed infants (0-11 months) Table NU.2 provides the proportion of women aged 15-49 years with a birth in the two years preceding the survey who started breastfeeding their infants within one hour of birth, and those who started breastfeeding within one day of birth (which includes those who started within one hour). Over two in five women (43 percent) started breastfeeding within the recommended period of one hour of birth while three out of every four women (75 percent) started within one day as shown in Table NU.2. There are hardly any variations among women who started to breastfeed within one day of birth by any of the background variables except for ‘months since last birth’. Women who had their last birth 6-11 months prior to the survey are least likely to initiated breastfeeding with one day of birth as compared to other women. Timely initiation of breastfeeding is most prevalent among women who reside in the rural coastal areas, who had their last birth some 12 to 23 months prior to the survey and among those who reside in households that are considered to be in the middle wealth quintile (Table NU2). 23 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 23 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Guyana, 2006* 77 76 80 72 77 71 77 77 75 76 35 40 58 43 25 42 44 35 45 43 0 10 20 30 40 50 60 70 80 90 R eg io ns 0 1, 0 7, 0 8, 0 9 R eg io ns 0 2, 0 3 R eg io ns 0 5, 0 6 R eg io n 04 R eg io n 10 U rb an R ur al In te ro r C oa st al To ta l P er ce nt Within one day Within one hour * Estimates for Region 10 are based on less than 50 cases (see Table NU.2) In Table NU.3, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. Results from Table NU.3 detail that approximately 31 percent of children aged less than four months are exclusively breastfed. This percentage dropped to 21 percent among children under 6 months old. At age 6-9 months, 34 percent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 month and 20-23 months 65 percent and 48 percent of children respectively, are still being breastfed. The practice of exclusive breastfeeding seems to be the same regardless of sex of child and residence of child in terms of the rural/urban distinction. As household wealth increases, prevalence of exclusive breastfeeding appears to decrease (Table NU.3). While one in every three (34 percent) children under the age of 6 months from the poorest households is exclusively breastfed, one in five of those from households in the second and third quintiles (20 percent) and approximately one in ten of those from the fourth 24 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 and richest quintiles (11 percent) have the same experience. It is not clear, as a result of a small numbers of cases reported, if a child’s place of residence or household wealth has an impact on whether or not they received timely complementary feeding (Table NU.3). The adequacy of infant feeding in children less than 12 months is provided in Table NU.4. Different criteria of adequate feeding are used depending on the age of the child: • For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding, • Infants aged 6-8 months are considered to be adequately fed if they are receiving breast milk and complementary food at least two times per day, and • Infants aged 9-11 months are considered to be adequately fed if they are receiving breast milk and eating complementary food at least three times a day. As shown in Table NU.4, sex of infants has little or no influence on them being adequately fed. However, in relation to place of residence (in terms of interior/coastal distinction), the variations were present. Approximately 27 percent of children 6-8 months old in the interior were adequately fed compared to only 17 percent of those on the coast. Furthermore, children with mothers of mixed ethnicity are more than twice as likely as other children to be adequately fed. A similar pattern was found among children aged 9-11 months. As a result of these feeding patterns, only 19 percent of children aged 6-11 months and 20 percent of all infants (aged 0-11) are being adequately fed. Adequate feeding practice of infants was most prevalent among infants of Amerindian ethnicity, who reside in the poorest wealth quintile households, particularly in the interior. low birTH weigHT Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, 25 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 25 diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are, represent only a selected sample of all births. Seventy-eight percent of births in Guyana were weighed at birth and 19 percent of infants are estimated to weigh less than 2500 grams at birth (Table NU.5). The variations (in low birth weight infants) among regional groupings were almost non-existent except for Regions 1, 7, 8 & 9, and Regions 2 & 3 (Figure NU.3). Furthermore, more babies with low birth weight are born to women in the interior district than to women in the coastal district. Low birth weight infants are more prevalent among Amerindian women than other women. Mother’s education level and household wealth does not seem to have much impact on whether or not a child is born weighing less than 2500 grams (Table NU. 5). Figure NU.3: Percentage of Infants Weighing Less Than 2500 Grams at Birth, Guyana, 2006* 24 15 19 19 20 19 0 5 10 15 20 25 30 P er ce nt R eg io ns 01 , 0 7, 08 ,0 9 R eg io ns 02 , 0 3 R eg io ns 05 , 0 6 R eg io ns 04 R eg io ns 10 Total * Estimate for Region 10 is based on less than 50 cases (see Table NU.5) © UNICEF/Guyana/2008/L. O’Toole vi. CHild HealTH 90 percent of the children aged 18-29 months received the MMR vaccine by age 18 months and just over 88 percent received the yellow fever vaccine. 27 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 27 vi. CHild HealTH immunizaTion The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the more than three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. According to the immunisation schedule of the Ministry of Health, Guyana, a child should receive: BCG vaccination to protect against tuberculosis, three doses of Pentavalent (Penta) to protect against hepatitis, diphtheria, pertussis, and tetanus, and three doses of polio vaccine by the age of 6 months. It is worthwhile noting that the Pentavalent vaccine (given in three doses) is a combination vaccine that includes HepB and DPT antigens. It was introduced in Guyana in 2001 as a replacement for the DPT vaccines. A child must also receive a MMR and a yellow fever vaccine at age 12 months. Mothers were asked to provide vaccination cards for children under the age of five years. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Mothers were also probed to report any vaccinations the child received that did not appear on the card for some reason or another. Overall, 75 percent of children had health cards (Table CH.2). If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and in doing so, a short description of each vaccine was read. For Pentavalent and Polio, the mother was required to indicate the number of doses the child received. The percentage of children aged 18 to 29 months who received a BCG, the three doses of Polio, MMR and yellow fever vaccinations is shown in Table CH.1. The denominator for the table is comprised of children aged 18-29 months so that only children who are old enough to be fully vaccinated are counted. In the first three rows of the table, the numerator includes all children aged 18-29 months who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the last row, however, only those who were vaccinated before their first birthday (for BCG), and by 18 months of age (for MMR and yellow 28 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 fever), as recommended, are included. For children without vaccination cards, the proportions of vaccinations given before the first birthday (for BCG) and by 18 months of age (for MMR and yellow fever) are assumed to be the same as for children with vaccination cards. Figure CH.1: Percentage of children aged 18-29 months who received the recommended vaccinations by 12 months, Guyana, 2006 96 90 88 0 10 20 30 40 50 60 70 80 90 100 BCG MMR Yellow Fever P er ce nt In Guyana, yellow fever vaccine is also recommended as part of the immunization schedule and was introduced in 1999. According to the schedule, a child should receive the yellow fever vaccination at age 12 months. It was found that just over 88 percent of children aged 18-29 months have received the yellow fever vaccine by age 18 months (Table CH.1). Table CH.2 shows vaccination coverage rates among children 18-29 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/ caretakers’ reports. Little or no variations in immunisation coverage by the background variables were found. TeTanus Toxoid (dipHTHeria) One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. In Guyana, a woman is considered fully immunized against tetanus if she has received 5 doses of diphtheria tetanus vaccine throughout her childbearing age. However, if women have not 29 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 29 received two doses of the vaccine during the pregnancy, they (and their newborn) are also considered to be protected if the following conditions are met: • Received at least 2 doses of diphtheria tetanus vaccine, the last within the prior 3 years; • Received at least 3 doses, the last within the prior 5 years; • Received at least 4 doses, the last within 10 years; • Received at least 5 doses during lifetime. Table CH.3 shows the protection status from tetanus of women who have had at least one live birth within the 24 months prior to survey. Only 44 percent of the births in Guyana were protected against neonatal tetanus. The large proportion of these women (32 percent) received at least two doses of diphtheria tetanus during their last pregnancy. Just over 11 percent received 2 doses within the last 3 years prior to the survey. Less than 1 percent received at least 3 doses, within the last 5 years prior to the survey. Figure CH.2 shows the proportion of women protected against neonatal tetanus by major background characteristics. Women who reside in Region 4, in the urban coast and belong to the richest households are most likely to be protected. The difference between the urban and rural areas is quite large with 11 percent more women reportedly protected against neonatal tetanus in the urban areas than in the rural areas. There are no differences in coverage in the interior compared to the coast (45 percent in each case). Furthermore, there seem to be better protection against neonatal tetanus in the interior than on the rural coast. There was little difference in the rate of protection among women with lower secondary education and those with upper secondary or post secondary education. However, a third less women with only primary education were protected against neonatal tetanus than those with higher levels of education. 30 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Figure CH.2: Percentage of women with a live birth in the last 24 months who are protected against neonatal tetanus, Guyana, 2006* 45 31 42 50 41 52 41 44 53 40 45 31 46 48 42 39 42 44 58 44 0 20 40 60 REGIONS Regions 01, 07, 08, 09 Regions 02, 03 Regions 05, 06 Region 04 Region 10 RESIDENCE Urban Rural Coastal Urban Coastal Rural Coastal Rural Interior WOMAN'S EDUCATION Primary Lower Secondary (F1-3) Upper Secondary F4-5 & Post Sec WEALTH INDEX Poorest Second Middle Fourth Richest Total Percent *Estimate for Region 10 is based on less than 50 cases (see Table CH.3) oral reHydraTion TreaTmenT Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended homemade fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality 31 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 31 rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • ORT or increased fluids AND continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 9 percent of under five children had diarrhoea in the two weeks preceding the survey (Table CH.4). Diarrhoea prevalence was highest in Regions 1, 7, 8 and 9, with 15 percent followed by Regions 2 and 3, with 11 percent, and lowest in Regions 5 and 6 (3 percent). The peak of diarrhoea prevalence occurs in the weaning period, among children age 6-11 months. The highest proportion of children who had diarrhoea in the two weeks prior to the survey was found among Amerindian children (16 percent) and the lowest proportion was found among African children (6 percent). Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers/caretakers were allowed to name more than one type of liquid, as applicable, the percentages do not necessarily add to 100. Of those children who had diarrhoea during the two-week reference period, more than 31 percent received fluids from ORS packets; 13 percent received pre-packaged ORS fluids, and 16 percent received RHF. Overall, approximately 52 percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF), while 48 percent received no treatment. Children of mothers with upper secondary and post secondary education are less likely to receive oral rehydration treatment (ORT) than other children. There were no variations in the ORT use rate by place of residence. In both Interior and Coastal areas, only 51 percent of the children with diarrhoea were treated with some kind of ORT. Table CH.5 shows the percentage of children aged 0-59 months with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode. Only 13 percent of under five children with diarrhoea drank more than usual while 83 percent drank the same or less (Table CH.5). Fifty percent ate somewhat less, same or more (continued feeding), and 46 percent ate much less or ate almost none. Given these figures, only 6 percent children received increased fluids and at the same time continued feeding (practiced home management 32 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 of diarrhoea). Combining the information in Table CH.5 with those in Table CH.4 on oral rehydration therapy, it is observed that 28 percent of children received ORT or increased fluid intake and continued feeding as is the recommended course of action (Table CH.5). Variations by residence (interior/coastal) and mother’s education level are approximately 7 percent (Figure CH.3). It should be noted that analysis by the other background variables is not possible due to the low number of cases observed with diarrhoea during the two weeks preceding the survey. Figure CH.3: Percentage of children aged 0-59 with diarrhoea who received ORT or increased fluids, and continued feeding, Guyana, 2006 23 30 27 30 32 24 29 28 0 10 20 30 40 AREA Interior Coastal SEX Male Female MOTHER'S EDUCATION Primary Lower Secondary (F1-3) Upper Secondary F4-5 & Post Sec Total Percent Care seeking and anTibioTiC TreaTmenT of pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one- third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were NOT due to a problem in the chest and a blocked nose. The indicators are: • Prevalence of suspected pneumonia • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the danger signs of pneumonia 33 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 33 In the MICS3 questionnaire, children with acute respiratory infection are defined as those who had an illness with a cough accompanied by rapid or difficult breathing, and whose symptoms were due to a problem in the chest, or both a problem in the chest and a blocked nose, or whose mother did not know the source of the problem. Table CH.6 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of that care. Approximately 6 percent of children aged 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 64 percent were taken to an appropriate provider (i.e. all private and public sector health provider). The most common health provider used was the government hospitals (27 percent) followed by the government health centre (16 percent). Only 6 percent were taken to a pharmacy and 5 percent to the Community Health Worker and private hospital respectively. The sex of child has little impact on whether or not a child with suspected pneumonia is taken to an appropriate health provider with 68 percent of females and 62 percent of males receiving care. Similarly to the situation of diarrhoea the small number of cases of suspected pneumonia among children during the two weeks preceding the survey does not allow for analysis by the other background variables. Table CH.7 presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, place of residence, and ethnicity of mother. In Guyana, 20 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. It should be noted that due to the small number of reported cases of suspected pneumonia during the two weeks prior to the survey, further analysis is not possible. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.7A. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, every fifth woman knows of the two danger signs of pneumonia – fast and difficult breathing. 26 percent of mothers identified fast breathing and 38 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. The most commonly identified symptom (60 percent) for taking a child to a health facility is if the child develops a fever while the least common is if child is not (or poorly) drinking or breastfeeding (12 percent). There are large variations by regional groupings and place of residence (coastal/interior) in recognizing the two danger signs of pneumonia. While 30 percent of mothers/caretakers in Region 4 recognized the two danger signs, only 3 percent of those in Regions 1, 7, 8, and 9 recognized the same. A similar pattern was found among coastal and interior mothers/caretakers, with 23 percent compared with 4 percent respectively. Women/caretakers of Amerindian ethnicity and those from the poorest quintile were found to be least able to recognize the two danger signs. 34 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 solid fuel use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. As shown in Table CH.8, more than one in ten households (10 percent) in Guyana use solid fuels such as wood and charcoal for cooking. It should be noted that in the Guyana MICS3, use of solid fuels is measure by the percentage of households that use wood and/or charcoal as the major type of fuel used for cooking. Use of solid fuels for cooking is extremely low in urban areas (2 percent) compared with 14 percent in rural areas. Differentials with respect to household wealth and the educational level of the household head are large. The proportion of households that use solid fuels for cooking rapidly decreases from 51 percent among poorest households to less than 2 percent among the middle class, while hardly any rich households use solid fuel for cooking. The findings also show that use of solid fuels is most common among households in Regions 1, 7, 8, and 9, among Amerindian households and among the bottom poorest 20 percent of households. The table also clearly shows that the use of solid fuel in the interior is approximately 7 times that of the coast. The most common fuels used for cooking among Guyanese households are gas and kerosene, with 48 percent and 39 percent respectively. Only 2 percent use electricity and less than 1 percent use charcoals for cooking purposes. malaria Malaria contributes to anaemia and is a leading cause of death of children under age five years of age in some countries (UNICEF, 2006). It could also negatively affect school attendance. Preventive measures, especially the use of mosquito nets treated with insecticide (ITNs), can dramatically reduce malaria rates of infection and malaria related mortality rates among children. In areas where malaria is common, international recommendations suggest treating any fever in children as if it were malaria and immediately giving the child a full course of recommended anti-malarial tablets (UNICEF, 2006). In Guyana, the Community Health Workers (CHWs) in the high-risks areas are trained to test for malaria using blood spears before treatment is given to misdiagnosis. Furthermore, international recommendations suggest that children with severe malaria symptoms, such as fever or convulsions, should be taken to a health facility. Also, children recovering from malaria should be given extra liquids and food. It is also important for younger 35 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 35 children to continue breastfeeding. In the Guyana MICS3, the malaria related questions were administered only in high-risk malaria areas such as the interior areas10. The MICS3 questionnaire incorporates questions on the availability and use of mosquito nets, both at the household level and among children under five years of age, as well as anti-malarial treatment. In Guyana, the survey results indicate that while 80 percent of the households in the high-risk malaria areas (interior) have at least one mosquito net, only 35 percent of them have at least one insecticide treated net. Due to the relatively small sample size it is not possible to disaggregate that figure further (table not shown). Furthermore, although 70 percent of children under the age of five years slept under a mosquito net the night prior to the survey interview, only 32 percent slept under an insecticide treated net (Table CH.9). Questions on the prevalence and treatment of fever were asked for all children under age five who resided in the malaria high-risk areas. More than one in seven (15 percent) children under age five was ill with fever in the two weeks prior to the survey. There was no distinct pattern in fever prevalence by age of child and mother’s education level. It should be noted that the low number of children who had fever in the two weeks prior to the survey does not allow for analysis by the other background variables (table not shown). Questions on the prevalence and treatment of fever were asked for all children under age five. Furthermore, mothers were asked to report all of the medicines given to a child to treat the fever, including both medicines given at home and medicines given or prescribed at a health facility. However, due to the small number of cases reported, analysis is not possible and the table is not shown in the report. sourCes and CosTs of supplies In Guyana MICS, questions were included to collect information on the sources and costs of four types of supplies: insecticide treated nets, antimalarials, antibiotics, and oral rehydration salts. Such information is very important in the sense that it makes possible a population- based assessment of the reach of programs and the extent to which particular target groups are covered by the programs. Such information is also useful for monitoring the provision of free or subsidized supplies, and for the assessment of costs of supplies, since prices of supplies can be a barrier to use of the supplies. For programme managers who want to find out public and private shares in the provision of the supplies, and of the relative importance of each source, information on sources and costs of supplies can be crucial. However, the tables are excluded and analysis at disaggregate level is not possible due to the low number of cases observed for each category. 10 The interior areas are comprised of Regions 1, 7, 8, 9 and the non-coastal part of Region 10. © UNICEF/Guyana/2008/L. O’Toole vii. environmenT More than 95% of those who live on the coast have access to improved sources of water while only half the people in the interior have similar access. 37 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 37 vii. environmenT waTer and saniTaTion Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who (in many countries) bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS are as follows: Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person fetching drinking water Sanitation • Use of improved sanitation facilities • Sanitary disposal of child’s faeces The distribution of the household population by source of drinking water is shown in Table EN.1 and Figure EN.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, yard or plot), public tap/standpipe, tubewell/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes such as hand washing and cooking. 38 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Figure EN.1: Percentage distribution of household members by source of drinking water, Guyana, 2006 Public Tap/Standpipe/ Bore Hole 3%Protected Well or Spring 2% Unprotected Well or Spring 2% Surface Water 5% Rainwater Collection 22% Bottled Water 17% Other Unimproved 2% Piped Into Dwelling, Yard or Plot 47% Overall, 91 percent of the population is using an improved source of drinking water with 97 percent in urban areas and 89 percent in rural areas (Table EN.1). The differentials found by interior/coastal disaggregation, is large with 96 percent of the population on the coast compared to only 52 percent of those in the interior areas using an improved source of drinking water. Furthermore, the prevalence is highest in Region 4 (97 percent) and lowest in Regions 1, 7, 8 and 9 (53 percent). The use of improved sources of drinking water seems to increase with the education level of individuals (81 percent of individuals with less than primary school education compared to 96 percent for individuals with an upper secondary education and post secondary education). The same is true with household wealth (97 percent of individuals in the upper four quintiles use an improved source compared to only 66 percent in the bottom wealth quintile). Amerindians seem to have the least access to improved drinking water source, with only one in every two, compared with over 90 percent of the other ethnicities, have access. The source of drinking water for the population varies strongly by place of residence (Table EN.1). In coastal areas, 52 percent of the population uses drinking water that is piped into their dwelling or into their yard or plot, compared to only 11 percent for interior areas. The region in which a person lives contributes to the drinking water source used. In the regional grouping, Regions 1, 7, 8, and 9, only 7 percent of the population has their drinking water piped into their dwelling or into their yard or plot. Furthermore, the most common source of drinking water for that population is rain water (30 percent) followed by surface water such as rivers, streams, creeks, lakes, ponds, canals (25 percent) and finally by unprotected well or spring (21 percent). Similarly the most common source of drinking water in Regions 2 and 3 is rainwater collection (52 percent). Only one in three residents of Regions 2 and 3, uses piped water as the main source of drinking water. Piped water as the main source of drinking water is most prevalent in Regions 5 and 6 (77 percent) followed by Region 10 (61 percent) then by 39 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 39 Region 4 (48 percent). It is worthwhile noting that one in three (32 percent) residents of Region 4 use bottled water as the main source of drinking water. Furthermore, while 53 percent of the urban population use piped water for drinking, 27 percent use bottled water and 14 percent use rainwater collection. Use of in-house water treatment is presented in Table EN.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, and using a water filter were considered as proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. Results from Table EN.2 indicate that overall, approximately 50 percent of the population treats their water using an appropriate method. More than half those in Region 4 (57 percent) treat water to make it safer while only a quarter (28 percent) of those in Regions 1, 7, 8 and 9 population does the same. Unfortunately, the use of unimproved water sources does not necessarily correspond to water treatment. Only 29 percent of the population that uses unimproved water sources treats their water appropriately. Meanwhile, 52 percent of those who access water from improved sources treat their water using an appropriate method. The educational level of the head of the household has some positive influence on practicing appropriate water treatment. Ethnicity is a strong predictor of water treatment, regardless of source as detailed in Table EN.2. Two thirds (62 percent) of the African population treats their water, while only a quarter (27 percent) of the Amerindian population does so, with East Indian and mixed individuals found in between. This ranking remains the same whether looking at improved or unimproved water sources. For all ethnic groups, as with the population in general, treatment is far less frequent with households that use unimproved water sources. These trends suggest that the problem of people using unimproved sources is compounded by the fact that they fail to treat their water once collected. The amount of time it takes to obtain water is presented in Table EN.3 and the person who usually fetched the water in Table EN.4. Note that these results refer to one roundtrip from home to drinking water source. That is, the time it takes to get to the water source, get the water and return. Information on the number of trips made in one day was not collected. Table EN.3 shows that for 86 percent of households, the drinking water source is on the premises. For 10 percent of all households, it takes less than 30 minutes to get to the water source and bring water back, while only 2.5 percent spend more than 30 minutes doing so. Excluding those households with water on the premises, the average time to the source of drinking water is 20 minutes. The time spent fetching water in the coastal areas (26 minutes) is more than double that in the interior (12 minutes). There is little difference between urban and rural coastal areas (29 and 25 minutes, respectively). Households in the urban areas take 40 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 10 minutes more, on average, than those in the rural areas to their source of drinking water. Households in Region 4 (28 minutes), and Regions 5 and 6 (30 minutes) take the longest time, on average to the water source compared with those from the other regional groupings. Households in Region 10, on the other hand, reported that it takes only 10 minutes to go to the water source, get water and return. There is no consistent correlation between time to fetch water and either wealth or education. Consistent with the geographical relationships, Amerindians usually must leave their property to fetch water (only 45 percent have water on the premises) yet will spend the least amount of time doing so (14 minutes). Table EN.4 shows that when the source of drinking water is not on the premises, adult males are most likely to fetch the water. Of all the households for which water is not on the premises, 43 percent are fetched by adult males, 34 percent by adult females, 6 percent by male children and 5 percent by female children. The man-woman gap is most pronounced in urban areas particularly the urban coastal areas where men outnumber women by approximately 20 percentage points. The converse is true in Regions 1, 7, 8 and 9 where water is more often fetched by women than men (44 percent versus 38 percent). However there are hardly any differences by sex in Region 4 and in the interior. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Almost all the people (98 percent) in Guyana use some form of improved sanitation facility (Table EN.5). Amerindians, reflecting the geography, lie outside this norm with 88 percent using sanitary methods. Improved sanitation facilities include: flush toilets connected to sewage systems, septic tanks or pit latrines, ventilated improved pit latrines and pit latrines with slabs, and composting toilets. There is hardly any variation in the use of improved sanitation facilities by place of residence except for those residing in the interior (Regions 1, 7, 8 and 9). While only 82 percent of these residents use such facilities, more than 97 percent of those in the other areas use the same. Only the poorest households lie outside of the 99-100 percent range, with 90 percent using improved facilities. As with wealth, only those with the lowest levels of education (less than primary) lie outside the norm, with 91 percent using sanitary means of excreta disposal. Results from Table EN.5 outline that pit latrines account for 52 percent of Guyana’s population use of waste disposal while 43 percent use flush toilets with connection to a sewage system or septic tank. Only 2 percent use pour flush latrine and less than one percent use ventilated improved pits. The use of flush toilets increases drastically with education and wealth respectively. In terms of the former, only 19 percent of those with no education use flush toilet while over 76 percent of those with upper secondary or post secondary education use the same. A similar pattern is found for the latter, in which case 1 percent of the poorest population verses 94 percent of the richest population use flush toilets. On the other hand, the use of pit latrine is inversely related to education and wealth. Furthermore, the majority of Amerindians (82 percent) use pit latrine with and 11 percent do not use any toilet at all. 41 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 41 Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet or by rinsing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table EN.6. Overall, faeces are disposed of safely for 72 percent of children in Guyana, 69 percent of children in urban areas and 73 percent in rural areas. The proportion varies depending on whether the child resides in the interior or on the coast, with the practice in the interior being 14 percentage points less prevalent than on the coast. The more educated the mother, the more likely she would practice safe disposal of her child’s faeces. Household wealth, on the other hand, does not seem to have an influence on this practice. The proportion of children whose stools are disposed of safely varies from 65 percent among those in the poorest quintile to 84 percent among those in the second quintile. Of the ethnic groups, African children are most likely to have their stools disposed of safely (79 percent) and Amerindian children least likely (61 percent). From Table EN.6 it is clear that the most common practice of faeces disposal is that of disposal via latrine (thrown in the latrine/toilet) at 65 percent. Additionally, it was reported that in 7 percent of the cases, the children used the toilet or latrine directly. On the other hand, the stool of one in every 10 children is thrown into the garbage and 6 percent is thrown in the drain. There is also 3 percent that are thrown outside the yard. The practice of disposing of child’s faeces in the garbage is most prevalent among the more educated women as well as among the wealthier households (perhaps along with disposable diapers). Unfortunately, 14 percent of Amerindian women use the unsafe practice of disposing of their child’s faeces by throwing it outside the yard. An overview of the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.7. In general, 90 percent of Guyana’s population use both improved sources of drinking water and sanitary means of excreta disposal. While the use of both is most common in Region 4 (97 percent), it is least common in Regions 1, 7, 8 and 9 (46 percent). Residents in the interior are only half as likely as their coastal counterparts to use both improved sources of drinking water and sanitary methods of excreta disposal (47 percent versus 96 percent). © UNICEF/Guyana/2008 viii. reproduCTive HealTH Four fifths (81 percent) of women in Guyana who had at least one birth in the 24 months prior to the survey received some type of antenatal care from skilled personnel (doctor, nurse/midwife, auxiliary midwife, medex). 43 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 43 viii. reproduCTive HealTH ConTraCepTion Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. A World Fit for Children goal is access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. Family planning could also helps to limit the number of abortions a woman may otherwise have because of unwanted or unplanned pregnancies. In the MICS, contraceptive prevalence (current use of contraception) is defined as the proportion of women aged 15-49 years who were either married or in union, who were using (or whose partner was using) a contraceptive method (either modern or traditional). It is worth noting that although currently pregnant women were not asked about their contraceptive use, they were included in the calculation (denominator) of the contraceptive prevalence rates. Furthermore, the MICS questionnaire allowed for respondents to indicate all the methods they were using at the time of the interview. In the cases where respondents indicate more than one method, the method used in the calculation of the indicator (contraceptive prevalence) was the first method appearing in the list of response categories for the variable. In Guyana, a third of women (35 percent) reported use of any method of contraception with 33 percent employing any modern method and 2 percent utilising any traditional method (Table RH.1). The most common method reported was the pill which accounts for 13 percent of all contraceptive use in Guyana. The use of the male condom and IUD is similar at 6 percent. Injections accounts for 4 percent, implants accounts for 3 percent and female sterilization accounts for 2 percent of women. Less than one percent use female condoms, diaphragms, foam, jelly, periodic abstinence, withdrawal, male sterilization, or the lactational amenorrhea method (LAM). Contraceptive prevalence is lowest among women from the interior (29 percent) compared to women from the urban coast (34 percent) and rural coast (35 percent) (Table RH.1). Contraceptive use by Regions ranged from 34 percent to 39 percent except for Regions 1, 7, 8 and 9, where only one in every four women reported the use of some method of contraception. Between 35-44 percent of married or in union women aged 20-39 years currently use a method of contraception, compared to only 20 percent of 15-19 year olds and 22-27 percent of 40-49 year olds. The largest proportions of pill users and condom users were found among women aged 25-29 years (20 percent) and 20-24 years (8 percent) respectively. The smallest proportions were among those 45-49 years (4 percent) and 40-44 years (3 percent) respectively. 44 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 The number of children a woman has seems to have some impact on the use of contraceptives. However, this is true only for women with up to three children. Contraceptive prevalence is the lowest among women with no children (11 percent) and highest among those with 3 children (42 percent). Only 34 percent of married/in union women with four or more children were using some form of contraception. There are no large variations in overall contraceptive use across education categories. However, the use of the pill, as a contraceptive, increases with women’s education level. One in every ten women in Guyana with only primary education (10 percent) uses the pill compared to one in four of those with university education (25 percent). Furthermore, there are only slight variations by wealth. Additionally, the highest prevalence of contraceptive use was found among East Indian women (37 percent) while the lowest was found among Amerindian women (22 percent). unmeT need Unmet need11 for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth or who wish to stop childbearing altogether. Unmet need is identified in the MICS3 by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Women in unmet need for spacing includes women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to space their births. Pregnant women are considered to want to space their births when they did not want the child at the time they got pregnant. Women who are not pregnant are classified in this category if they want to have a(nother) child, but want to have the child at least two years later, or after marriage. Women in unmet need for limiting are those women who are currently married (or in union), fecund, currently not using contraception, and want to limit their births. The latter group includes women who are currently pregnant but had not wanted the pregnancy at all, and women who are not currently pregnant but do not want to have a(nother) child. Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for limiting. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS3 data. Percentage of demand for contraception 11 Unmet need measurement in MICS is somewhat different than that used in other household surveys, such as the Demographic and Health Surveys (DHS). In DHS, more detailed information is collected on additional variables, such as postpartum amenor- rhoea, and sexual activity. Results from the two types of surveys are strictly not comparable. 45 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 45 satisfied is defined as the proportion of women currently married or in union who are currently using contraception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Table RH.2 shows the results of the survey on contraception, unmet need, and the demand for contraception satisfied. Among all women who are currently married or in union one third have an unmet need for contraception (7 percent for spacing and 25 percent for limiting purposes). Overall, only half (51 percent) of the demand for family planning is satisfied. Generally there is very little variation by background variables in unmet need for contraception and the percentage of demand for contraception which is satisfied among Guyanese women. However, the most disadvantaged group, as it relates to demand for contraception which is satisfied, are those who reside in the interior, those who are 15-19 years old, those who are from the poorest households, or of Amerindian ethnicity. anTenaTal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life-saving for both the mother and infant. The management of anaemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women’s nutritional status and prevent infections (e.g. STIs) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: • Blood pressure measurement • Urine testing for bateriuria and proteinuria • Blood testing to detect syphilis and severe anaemia 46 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 • Weight/height measurement (optional) Female respondents aged 15-49 years who had at least one live birth in the two years prior to the survey were asked if they had received antenatal care for their last live birth and, if so, who (type of person) had provided the care. If the woman indicated that care was provided by more than one person, all were recorded in the questionnaire. Table RH.3 shows the percent distribution of women aged 15-49 years who gave birth in the two years preceding the survey by type of personnel providing antenatal care. If the respondent indicated that more than one person provided care, then she is categorized as having seen the most skilled person mentioned. Table RH.3 indicates that coverage of antenatal care by skilled personnel (doctor, nurse, midwife, or medex12) is high in Guyana with 81 percent of women receiving antenatal care at least once during the pregnancy. Mothers received antenatal care from a doctor for 34 percent of live births, from a nurse or midwife for 39 percent of live births, from a medex for 8 percent, and from a Community Health Worker (CHW) for 10 percent of live births. The other providers accounted for less than 1 percent of live births. Mothers received no antenatal care for over 4 percent of live births. Variations in receipt of antenatal care are not large among the regional groupings (87 percent) except for Regions 1, 7, 8 and 9 where care was provided for only half (54 percent) of all live births. Antenatal care coverage is some 7 percentage points higher in urban areas than in rural areas. However, the coverage in the interior areas is approximately 30 percentage points less than that on the coast. There is no clear pattern of use of antenatal services by household wealth. However, the highest proportion of women who received antenatal care was among those in the richest households (92 percent) and the lowest proportion was among those from the poorest households (66 percent). East Indian women are the most likely and Amerindian women are the least likely to have received antenatal care during their last pregnancy. Complications during pregnancy are an important cause of maternal and child morbidity and mortality. Detecting and monitoring these complications is a crucial component of safe motherhood. In order to gauge the quality of care received during pregnancy, the MICS3 included a series of questions on the content of care. Women, who had given birth during the two years preceding the survey, were asked whether they received each service during at least one of their antenatal visits. The types of services pregnant women received are shown in Table RH.4. Results from Table RH.4 indicate that the majority of pregnant women (96 percent) received antenatal care (ANC) at least once during their pregnancy. Of those, 89 percent had their blood pressure tested, 87 percent had their weight taken, 85 percent had a urine specimen taken and 81 percent had a blood sample taken. There are hardly any variations in ANC access, as a whole, among pregnant women by place of residence, age, education level, ethnicity and household wealth. 12 In Guyana, a Medex is a medical extension worker with prescription and diagnostic rights. 47 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 47 assisTanCe aT delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS3 included a number of questions to assess the proportion of births attended by a skilled attendant. In the Guyana MICS3, skilled attendants include doctors, nurses/midwives, medics, or auxiliary midwives. According to Table RH.5 83 percent of births occurring in the two years prior to the MICS3 survey were delivered by skilled personnel and in a health facility respectively. This percentage is roughly similar for all births except those occurring in the interior, among the poorest households, and among Amerindian women. Over one in every two births (52 percent) in the two years prior to the Guyana MICS3 survey was delivered with assistance by a nurse or midwife. Doctors assisted with 29 percent of births and medics assisted with only 2 percent. Overall, deliveries by traditional birth attendants accounted for only 2 percent of the births in Guyana, Community Health Workers (CHW) accounted for 3 percent, and deliveries assisted by relatives or friends accounted for 5 percent of all births. Over 1 percent of the births were delivery by the mother herself. It is worthwhile noting that in Regions 1, 7, 8 and 9, approximately one quarter of births were delivered by relatives or friends and 4 percent were delivered by the mothers themselves. © UNICEF/Guyana/2008/L. Thompson ix. CHild developmenT In Guyana, over 82 percent of the children under the age of 5 years reside in households in which the adult household members are engaged in at least four activities that promote learning and school readiness. 49 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 49 ix. CHild developmenT It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, adult activities with children, presence of books in the home, for the child, and the conditions of care are important indicators of quality of home care. A World Fit for Children goal is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, and/or drawing things. Table CD.1 shows the percentage of under-five children for whom household members are engaged in activities that promote learning and school readiness. More than four-fifths of under-five children (82 percent) were engaged by an adult in four or more activities that promote learning and school readiness during the 3 days preceding the interview. The average number of activities that adults engaged with children was 5. The table also indicates that one out of every two fathers (51 percent) was involved in one or more of such activities and the average number of activities that a father is engaged with his child is 2. Additionally, one-third (29 percent) of children were living in a household without their fathers. Table CD.1 further outlined that there are no sex differentials in adult activities with children or father’s involvement in such activities with children. Adult engagement in learning and school readiness activities with children was higher in the urban areas (86 percent) than in the rural area (81 percent) while father’s involvement was higher in the rural areas (54 percent) than in the urban area (44 percent). Children in the older age group (89 percent) are more likely than their younger counterparts (71 percent) to benefit from adult household members’ involvement in four or more learning and school readiness activities. However, neither age of child nor mother’s education level seem to have any effect on father’s involvement in one or more activities that promote learning and school readiness. There is no distinct pattern in adults’ involvement in learning and school readiness activities with children by the father’s and mother’s education levels. Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance and IQ scores. 50 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Results from Table CD.2 detail that in Guyana, approximately one in every two children under age 5 is living in households where at least 3 non-children’s books and at least 3 children’s books respectively are present (over 54 percent in each case). The median number of non-children’s books (4) as well as the median number of children’s books (3) is high. There are hardly any gender differentials in the exposure to either type of books. The highest proportion of children who are living in households with 3 or more non-children books was found in Region 10 (70 percent) while the lowest proportion was found in Regions 1, 7, 8 and 9 (37 percent). As it relates to access to children’s books, again children in Regions 1, 7, 8 and 9 (29 percent) seem to be least fortunate while those in Region 4 (71 percent) seem to be most fortunate. More urban children appear to have access to both types of books than those living in the rural areas. Here 68 percent of under-5 children live in urban areas with more than 3 non-children’s books, while 51 percent do so in rural households. The proportion of under-5 children who have 3 or more children’s books is 73 percent in urban areas, compared with 48 percent in rural areas. A similar variation in access to both types of books was found between children who reside in the interior and coastal areas with interior children having less access. The presence of children’s books is positively correlated with the child’s age; in the homes of 58 percent of children aged 24-59 months, there are 3 or more non-children’s books, while the figure is 52 percent for children aged 0-23 months. Similar differentials exist in terms of children’s books. As mother’s education and household wealth increases, access to the both types of books correspondingly increases. Table CD.2 also shows that 40 percent of children aged 0-59 months had 3 or more playthings to play with in their homes, while 7 percent had none of the playthings indicated in the questionnaire. The playthings in the MICS3 included household objects, homemade toys, toys that came from a store, and objects and materials found outside the living quarters. It is interesting to note that 83 percent of children play with toys that come from a store; however, the percentages for other types of toys is below 50 percent. The proportion for males is 4 percentage points higher than for females. The highest proportion was found in Regions 2 and 3 (50 percent) while the lowest proportions were found in Regions 5 and 6 (35 percent). Children who have 3 or more playthings are similar in the rural coastal areas (42 percent) and urban areas (38 percent). The age of the child appears to have a very strong correlation with the number of playthings he or she has, an expected result. Differentials are small by socioeconomic status of the households, and mother’s education. Leaving children alone or in the care of other young children is known to increase the risk of accidents. In the MICS3, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.3 shows the percentage of children aged 0-59 years left in the care of other children under the age of 10 years or left alone in the week prior to the survey. It was found that during the week preceding the interview; almost 10 percent of children were left in the care of other 51 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 51 children, while 6 percent were left alone. Combining the two care indicators, it is calculated that 11 percent of children were left with inadequate care during the week preceding the survey. In the MICS3, inadequate care is defined as the percentage of children aged 0-59 months that were left alone or in the care of another child younger than 10 years in the week prior to the interview. Children left with inadequate care varied only slightly by sex and age of child. However, the proportion of children who were left with inadequate care in Regions 1, 7, 8 and 9 is approximately 10 times larger than that in Region 10. The prevalence of children left with inadequate care on the coast (8 percent) is twice that of the interior (17 percent). Furthermore, while approximately 15 percent of children whose mothers had no education were left with inadequate care, only 8 percent of those with mothers with at least upper secondary or post secondary education faced the same situation. No differences are observed in regard to household wealth in the three middle quintiles in which case, prevalence of inadequate care range between 8 and 9 percent. However, inadequate care among the poorest households was more than 3 times (19 percent) that among the richest households (6 percent). © UNICEF/Guyana/2008/L. O’Toole x. eduCaTion Pre-school enrolment has increased from 1 in 3 children in 2000 to 1 in 2 children in 2006. 53 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 53 x. eduCaTion pre-sCHool enrolmenT13 and sCHool readiness Pre-school attendance in an organized learning or child education program is important for the readiness of children to school. One of the World Fit for Children goals is the promotion of early childhood education. Results from Table ED.1 detail that in Guyana, less than 50 percent of children aged 36-59 months are enrolled in pre-school. There is a 10 percentage point difference between urban and rural areas (with 57 percent of urban pre-school aged children enrolled, dropping to 47 percent in rural areas) and a 15 percentage point difference between coastal and interior (with 52 percent of coastal pre-school aged children enrolled, dropping to 37 percent in interior areas). The percentage also varies among regional groupings, with Region 4 reaching nearly 56 percent enrolled and Regions 1, 7, 8 and 9 achieving only 39 percent. The enrolment by other regional groupings ranged between 47 and 52 percent. There are hardly any differentials by sex of child and mother’s education levels. Household wealth seems to predict pre-school enrolment with the proportion enrolled increasing consistently with household wealth. Only 33 percent of children from the poorest households enrol in pre-school while the richest households send 78 percent of their pre-school-aged children to pre-school. Pre-school enrolment also varies by ethnicity. African children are most likely to enrol (58 percent) followed by mixed children (51 percent) then East Indian children (46 percent) trailed by Amerindian (41 percent). Of the children of pre-school age, older children (48-59 months) are three times as likely as their younger counterparts (36-47 months) to enrol in pre-school. The table also shows the proportion of children in the first grade of primary school who enrolled in pre-school the previous year, an important indicator of school readiness. Overall, 65 percent of children who are currently age 6 and enrolled in the first grade of primary school were enrolled in pre-school the previous year. There are no differentials in school readiness by sex or place of residence (urban-rural). primary and seCondary sCHool parTiCipaTion Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. 13 In MICS3, pre-school attendance is considered to be the number of children who were reported to have been attending pre- school regardless of frequency of attendance. 54 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 The indicators for primary and secondary school enrolment include: • Net intake rate in primary education • Net primary school enrolment rate • Net secondary school enrolment rate • Net primary school enrolment rate of children of secondary school age • Female to male education ratio (or Gender Parity Index- GPI) • The indicators of school progression include: • Survival rate to grade five • Transition rate to secondary school • Net primary completion rate Table ED.2 indicates that of children who are of primary school entry age (age 6) in Guyana, 79 percent are enrolled in the first grade of primary school. There are little or no variations by sex or ethnicity of child. However, a large difference exists in relation to place of residence both by urban-rural and interior-coastal areas. Children’s participation to primary school is larger in urban areas (85 percent) than in rural areas (76 percent). Of households in coastal areas, a higher percentage of urban children (85 percent) enrol in primary school than rural children (77 percent) while interior households lag behind with 73 percent of 6 year-olds primary school enrolment. The percentage of children of primary-school entry age (who are currently enrolled in first grade) in most of the regional groupings are close to the national average except for in Regions 1, 7, 8 and 9, in which case 69 percent of 6 year-olds enrol. Table ED.3 provides the percentage of children of primary school age enrolled in primary or secondary school. A vast majority (96 percent) of children of primary school age are enrolled in school regardless of the sex. In general, the likelihood of primary school age children to enrol in school is similar for both sexes regardless of place of residence, age of child, level of education of mother, household wealth or ethnicity of child. The secondary school net enrolment ratio is presented in Table ED.4. Differences in enrolment begin to emerge when looking at the net enrolment ratio for secondary school. Rather than 96 percent enrolment, as in primary school, secondary school enrolment is lower at 69 percent. The remaining children are either still enrolled in primary school or drop out altogether. The enrolment rates vary considerably by place of residence with urban (79 percent), rural (66 percent), interior (63 percent), and coastal (70 percent). The enrolment rate is higher for females (73 percent) than for males (66 percent). Table ED.4 suggests that secondary school enrolment is influenced by household wealth and mother’s education level. In the poorest households, 54 percent of secondary school-aged children are enrolled, rising to 85 percent for households in the richest quintile. Similarly, 82 percent of those children with upper secondary and post secondary-educated mothers are enrolled in secondary school while those with mothers with a primary school education send 55 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 55 only 61 percent of their children to secondary school. Furthermore African children maintain the highest enrolment rates with 81 percent, followed by mixed children with 70 percent enrolment, trailed by East Indian then Amerindian with 64 percent and 56 percent respectively. Of considerable concern is both the attrition rate between primary and secondary school-aged children (96 percent of 11 year-olds enrol in primary school according to Table ED.3, while only 81 percent of 12 year-olds enrol in secondary school according to Table ED.4) and the rapid deterioration of participation as children get older (from 81 percent of 12 year-olds to 51 percent for 16 year-olds according to Table ED.4). The primary school net enrolment ratio of children of secondary school age is presented in Table ED.4W. Some 5 percent of children of secondary school age are enrolled in primary school with the remaining 26 percent not enrolled in school at all. A large percentage is out of school as previously indicated while only 69 percent were enrolled in secondary school. Secondary school age children enrolled in primary school is most prevalent in Regions 1, 7, 8 and 9 as well as Regions 5 and 6 with 9 percent and 8 percent respectively. This practice seems to be positively associated with mother’s education and negatively associated with age of child. There is no clear pattern by household wealth. The largest proportion of children of secondary school age who are enrolled in primary school was found among the poorest households with 8 percent and among Amerindians with 11 percent. Overall, there is no variation by sex in the proportion of secondary school age children enrolled in primary school. However, variations are evident in Regions 5 and 6 and among Amerindian children. In both cases, boys out-numbered girls by approximately 6 percentage points. The percentage of children entering first grade who eventually reach grade 5 is presented in Table ED.5. Note that this indicator is calculated using transition probabilities for the cohort of children in the sample. Of all children starting grade one, the majority of them (97 percent) eventually reached grade 5. This number includes children that repeat grades and eventually move up to reach grade 5. There are hardly any differences by sex, place of residence, mother’s education, household wealth and child’s ethnicity in the percentage of children entering first grade of primary school who eventually reach grade 5. The net primary school completion rate and transition rate to secondary education are presented in Table ED.6. At the moment of the survey, 71 percent of children of primary completion age (11 years) were enrolled in the last grade of primary education (this value should be distinguished from the gross primary completion ratio which includes children of any age enrolled in the last grade of primary). There are hardly any variations by sex, place of residence, household wealth and ethnicity of child. However, a higher percentage of 11 year olds in the urban areas (85 percent) than those in the rural areas (66 percent) enrolled in grade 6 of primary school at the time of the survey. For the regional grouping, Regions 5 and 6, show the lowest completion rate (59 percent) while Region 4 maintains the highest completion rate (79 percent). The net completion rate increases with mother’s education. For mothers with only a primary school 56 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 education, only 66 percent of their children complete primary school, while for those with upper- secondary or post secondary education, 76 percent of children complete primary school. Table ED.6 also shows that 67 percent of children who completed the final grade of primary school in the year prior to the survey are enrolled in the first grade of secondary school at the moment the survey was conducted. This proportion is highest in Region 4 and lowest in Regions 5 and 6. Furthermore, transition rate to secondary education is higher among children living in the urban areas to than those living in the rural areas. There was no marked difference by sex, ethnicity, mother’s education and household wealth The ratio of girls to boys enrolled in primary education and ratio of girls to boys enrolled in secondary education are provided in Table ED.7. These ratios are better known as the Gender Parity Index (GPI). Notice that the ratios included here are obtained from net enrolment ratios rather than gross enrolment ratios. The latter ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children enrolled in primary education tend to be boys. The table shows that gender parity for primary school is close to 1.00, indicating no difference in the enrolment of girls and boys to primary school. This parity remains effectively constant for all background variables. However, the indicator increases to 1.1 for secondary education (indicating higher enrolment ratios for girls). This figure increases to 1.2 among children who reside in Regions 5 and 6, whose mother has only primary education and those of Amerindian ethnicity. 57 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 57 © UNICEF/Trinidad and Tobago/2008 xi. CHild proTeCTion 3 in every 4 children aged 2-14 years of age experience psychological or physical punishment. 59 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 59 xi. CHild proTeCTion birTH regisTraTion The Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The indicator is the percentage of children under 5 years of age whose birth is registered. Table CP.1 indicates the births of 93 percent of children under five years in Guyana have been registered. However, children in the interior areas had lower proportions registered (86 percent) compared with those on the coast (95 percent). Furthermore, children in the poorest households in Guyana and those of Amerindian ethnicity as well as those who reside in the interior areas are less likely than other children to have their births registered. Furthermore, the proportion of children under age one year (0-11 months) who are registered is 4 to 8 percentage points lower than the other age groups. This could suggest that some births are registered after the child reaches 1 year of age. The main reasons given for non-registration of births were travel distance and lack of knowledge of how to register (not shown in table). CHild labour Article 32 of the Convention on the Rights of the Child states: “State parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development.” The World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS3 questionnaire, a number of questions addressed the issue of child labour, that is, children 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: • Ages 5-11 years: at least one hour of economic work or 28 hours of domestic work per week. • Ages 12-14 years: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiating child labour from child work so as to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the 60 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 prevalence of child labour since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained above. Table CP.2 presents the results of child labour activities among children 5-14 by the type of work. The percentages do not add up to the total child labour as children may be involved in more than one type of work. In Guyana, more than one in every seven (16 percent) children is involved in child labour activities, mostly unpaid and working for family businesses. There are hardly any variations by sex or school participation. There are strong correlations between child labour and various background variables of place of residence, age, household wealth and ethnicity. Children living in the interior (36 percent) are three times as involved in child labour activities as their coastal counterparts (13 percent). The disparity is even wider by age of child, in which case, four times as many children in the younger age group (21 percent) are involved in these activities as those in the older age group (5 percent). Household wealth also seems to play a very important role in whether or not a child is involved in child labour activities. The proportion of children in the poorest households (29 percent) who are involved in child labour activities is more than seven times that of children from the richest households (4 percent). Furthermore, children’s involvement in family work (farm or business) is most prevalent among the poorest households. Table CP.3 presents the percentage of children classified as student labourers and labourer students. Student labourers are the children attending school that were involved in child labour activities at the moment of the surveys. More specifically, 16 percent of children who attend school are also involved in child labour activities. As detailed in Table CP3, being involved in child labour activities does not affect school attendance. There is no large variation in school participation of student labourers compared with general school participation by sex, place of residence, household wealth, mother’s education and mother’s ethnicity. CHild disCipline As stated in A World Fit for Children, “children must be protected against any acts of violence …” and the Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In the Guyana MICS3 survey, mothers/caretakers of children aged 2-14 years were asked a series of questions on the ways parents tend to discipline their children when they misbehave. (Note that for the child discipline module, one child aged 2-14 per household was selected randomly during fieldwork). Out of these questions, the two indicators used to describe aspects of child discipline are: 1) the number of children 2-14 years that experience non-violent discipline or psychological aggression as punishment or minor physical punishment or severe physical punishment; and 2) the number of parents/caretakers of children 2-14 years of age that believe that in order to raise their children properly, they need to physically punish them. 61 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 61 Note the follow definitions: • non-violent discipline - if as a form of discipline, the only methods used were the following: - privileges were taken away from child, something child liked was forbidden, or child was not allowed to leave house OR - mother/caretaker explained why the behaviour was wrong OR - mother/caretaker gave child something else to do as a distraction. • psychological aggression as punishment- if as a form of discipline, child was shouted at, hollered or screamed at OR if child was called stupid, good for nothing, dumb, lazy, etc. by mother/caretaker • minor physical punishment- if as a form of discipline, child was shook OR spanked, hit or slap on bottom with bare hand OR lash or hit on the bottom or other parts of the body with something like a stick, wood, belt, hairbrush or any other hard object OR hit or slapped on hand, arm, or leg with bare hand. • severe physical punishment- if as a form of discipline, child was hit or slapped on face, head or ear with bare hand OR beat/hit with something (an object) over and over as hard as one could. In Guyana, as shown in Table CP.4, 23 percent of mothers/caretakers believed that children should be physically punished in order to raise a child properly. However, in practice, 74 percent of children aged 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. Two thirds of those children were exposed to psychological punishment, 58 percent of them to minor physical punishment and 15 percent were subjected to severe physical punishment. Non-violent methods were used on every seventh child (15 percent) and 8 percent of children have neither been punished nor disciplined. Male children were subjected more than their female counterparts to psychological (65 percent versus 60 percent) and minor physical (62 percent versus 54 percent) punishments. But in the cases of severe physical punishment and non-violent disciple, sex was found to have little effect. The place of residence of a child has an impact on how he/she is disciplined with 87 percent of children in the interior subjected to at least one form of psychological or physical punishment compared with 72 percent of those on the coast (Table CP.4). Furthermore, it should be noted that severe physical punishment is equally common in Regions 1, 7, 8 & 9 as it is in Region 4 (18 percent in each case). However, non-violent discipline was less prevalent in Regions 1, 7, 8 and 9 than in Region 4 (9 percent compared to 16 percent). There were very small variations in child discipline practices by age of child, mother’s education and household wealth. 62 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 orpHanHood and living arrangemenTs of CHildren Children who are orphaned or living away from their parents may be at increased risk of impoverishment, discrimination, denial of rights to inheritance and various forms of abuse. Monitoring the level of orphanhood and the living arrangements of children assists in identifying those who may be at risk as well as in tracking changes over time. The frequency of children living with neither parent, mother only, and father only is presented in Table CP.5. In Guyana, over 10 percent of children aged 0-17 years are not living with a biological parents. Over 16 percent of children 15-17 years of age are living in households without their biological parents compared with only 4 percent of those under five years of age. In terms of ethnicity, African children outnumbered other children by 4 to 6 percentage points. Six percent of children reportedly suffered the loss of one or both parents. There are little variations by background variables except by age of child. The older the child the more likely he/she will suffer the lost of one or both parent/s. Furthermore, one in five children (21 percent) is living with their mothers only even though their fathers are alive. This pattern is most prevalent among children who reside in the urban coast, particularly in Region 10, and those who are of African ethnicity. early marriage/CoHabiTaTion Marriage/cohabitation before the age of 18 is a reality for many young girls. According to UNICEF’s worldwide estimates, over 60 million women aged 20-24 were married/in union before the age of 18. Factors that influence child marriage rates include: the state of the country’s civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. In many parts of the world parents encourage the marriage of their daughters while they are still children in the hope that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In actual fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. The right to ‘free and full’ consent to a marriage is recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be ‘free and full’ when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women mentions the right to protection from child marriage in article 16, which states: “The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage.” While marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to 63 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 63 other rights - such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices - and is frequently addressed by the Committee on the Rights of the Child. Other international agreements related to child marriage are the Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages and the African Charter on the Rights and Welfare of the Child and the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa. Child marriage was also identified by the Pan-African Forum against the Sexual Exploitation of Children as a type of commercial sexual exploitation of children. Young married girls are a unique, though often invisible, group. Required to perform heavy amounts of domestic work, under pressure to demonstrate fertility, and responsible for raising children while still children themselves, married girls and child mothers face constrained decision-making and reduced life choices. Boys are also affected by child marriage but the issue impacts girls in far larger numbers and with more intensity. Cohabitation (i.e. when a couple lives together as if married) raises the same human rights concerns as marriage. Where a girl lives with a man and takes on the role of caregiver for him, the assumption is often that she has become an adult woman, even if she has not yet reached the age of 18. Additional concerns due to the informality of the relationship - for example, inheritance, citizenship and social recognition - might make girls in informal unions vulnerable in different ways than those who are in formally recognized marriages. Research suggests that many factors interact to place a child at risk of marriage. Poverty, protection of girls, family honour and the provision of stability during unstable social periods are considered as significant factors in determining a girl’s risk of becoming married while still a child. Women who married at younger ages were more likely to believe that it is sometimes acceptable for a husband to beat his wife and were more likely to experience domestic violence themselves. The age gap between partners is thought to contribute to these abusive power dynamics and to increase the risk of untimely widowhood. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19, particularly among the youngest of this cohort. There is evidence to suggest that girls who marry at young ages are more likely to marry older men which puts them at increased risk of HIV infection. Parents seek to marry off their girls to protect their honour, and men in some countries often seek younger women as wives as a means to avoid choosing a wife who might already be infected. The demand for this young wife to reproduce and the power imbalance resulting from the age differential, leads to very low condom use among such couples. 64 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Two of the indicators as shown in Table CP.6 are to estimate the percentage of women married before 15 years of age and percentage married before 18 years of age. The percentage of women 15-19 years who were married/in union at the time of the survey is also provided in Table CP.6. The percentage of Guyanese women aged 15-19 years who were married or in union at the time of the survey is 14 percent. This practice was most prevalent in Regions 1, 7, 8 and 9 (21 percent) and least prevalent in Region 10 (10 percent) and Region 4 (11 percent). Furthermore, rural women in this age group outnumbered their urban counterparts by more than 10 percentage points. Women with only primary level education are approximately four times as likely as other women to be married at this age group. This proportion was highest among Amerindians (28 percent) and lowest among Africans (5 percent). Just over one in five (21 percent) East Indian women aged 15-19 years were married or in union at the time of the survey. Table CP.6 also identifies that 1 in every 20 women (5 percent) aged 15-49 years were married/ in union before age 15. The tendency towards early marriage is highest among women from the poorest 40 percent of the households, and among those with only primary education. One-fifth of the women (21 percent) aged 20-49 years were married/in union before age 18. Again, wealth and education of women seem to be important factors in early marriages. The more educated the women is the less likely she would be married before age 18. Likewise, the wealthier the woman the less likely she would have an early marriage. As it relates to ethnicity, Amerindian and East Indian women are more likely than their African counterparts to be married before age 18. Another component is the spousal age difference with an indicator being the percentage of married/in union women 10 or more years younger than their current spouse. Table CP.7 presents the results of the age difference between married/in union women (aged 15-19 years and 20-24 years) and their husbands/partner. The data suggests that 1 in every 5 women (20 percent), regardless of age, is married to/in union with a partner 10 years or more her senior. However, women in the younger age group (15-19 years) are more likely than those in the older age group (20-24 years) to have husbands/partners who are at 5-9 years older (48 percent versus 40 percent). domesTiC violenCe A number of questions were asked of women age 15-49 years to assess their attitudes towards whether husbands are justified to hit or beat their wives/partners for a variety of scenarios. These questions were asked to have an indication of cultural beliefs that tend to be associated with the prevalence of violence against women by their husbands/partners. The main assumption here is that women that agree with the statements indicating that husbands/partners are justified to beat their wives/partners under the situations described in reality tend to be abused by their own husbands/partners. The responses to these questions can be found in Table CP.8. 65 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 65 Results from Table CP.8 outline that 18 percent of women believed a husband is justified in beating his wife/partner mostly in cases when they neglect the children (13 percent). A high proportion of women believe that husbands/partners have a right to beat his wives/partners if they go out without telling him (7 percent) and if they argue with him (6 percent). Additionally, 1 in 20 women (5 percent) believe that a husband has the right to beat/hit with wife/partner if she refuses to have sex with him. Domestic violence is three times more prevalent among rural women than among urban women. Furthermore, currently married/in union (21 percent) women seem to be most accepting to domestic violence whiles those who were never married or in union (13 percent) were least accepting. Table CP.8 also indicates that wealth and education were found to be key factors in women’s attitudes toward domestic violence. The poorer the woman the more likely she is to have accepting attitudes towards domestic violence. Women from the poorest households (39 percent) are more than five times more likely to agree that a husband is justified to beat/ hit his wife or partner than those from the richest households (7 percent). One in four women (25 percent) with only primary education agreed that a husband has a right to beat/hit his wife/ partner compared to only one in twenty-five (4 percent) with university education. Amerindian women are twice as likely as their East Indian counterparts and six times as likely as their African counterparts to have accepting attitudes toward domestic violence. xii. Hiv/aids knowledge and awareness More than half (55 percent) of women aged 15-49 know three ways to prevent HIV transmission. © UNICEF/Guyana/2008/L. Thompson 67 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 67 xii. Hiv/aids knowledge and awareness knowledge of Hiv Transmission and Condom use One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. The HIV module was administered to women 15-49 years of age. One indicator which is both an MDG and UNGASS indicator is the percent of young women who have comprehensive and correct knowledge of HIV prevention and transmission. Women aged 15-49 years were asked whether they knew of the three main ways of HIV transmission – having only one faithful uninfected partner, using a condom correctly every time, and abstaining from sex. The results are presented in Table HA.1. In Guyana, 95 percent of the interviewed women have heard of AIDS yet 55 percent know all three main ways of preventing HIV transmission while 91 percent know at least one of the ways. Abstaining from sex (69 percent) is the least known way compared to the other two main (79 percent). One in 10 (9 percent) does not know any of the three main ways to contract HIV. Table HA.1 further stipulates that knowledge of all three ways is much more prevalent in Region 4 (62 percent) and Region 10 (64 percent) than in the other regional groupings where between 46 and 48 percent of women are knowledgeable. Additionally, women living in the urban areas are better informed about HIV prevention than those living in the rural areas (64 percent versus 51 percent). Furthermore, knowledge among Guyanese women, of the main ways of preventing HIV transmission increases with their education level and their household wealth respectively. The proportion of women of the poorest quintile, who do not know any main means (19 percent), is approximately five times that of the corresponding proportion of women of the richest quintile (4 percent). A similar ratio is true for women with primary and university education who do not know any means of transmission prevention (3 percent versus 16 percent). As it relates to ethnicity, five times as many Amerindians (20 percent) and twice as many East Indians (10 percent) do not know of any of the three main ways of preventing transmission compared to Africans (4 percent). 68 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table HA.2 shows the percentage of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Guyana: that HIV can be transmitted by mosquito bites, and sharing food of a person who has AIDS. The table also provides information on whether women know that HIV cannot be transmitted by supernatural means. Of the interviewed women, 61 percent reject the two most common misconceptions and know that a healthy-looking person can be infected. Also 79 percent of women know that HIV cannot be transmitted by sharing food and 75 percent know that HIV cannot be transmitted by mosquito bites while 85 percent of women know that a healthy-looking person can be infected. Furthermore, 83 percent of Guyanese women believe that HIV cannot be transmitted by supernatural means. Knowledge about the two misconceptions as well as the asymptomatic nature of HIV among women is more prevalent in the urban areas, and on the coast than in the other areas. Table HA.2 indicates that household wealth and mother’s educational level also seem to be important factors in women’s knowledge of HIV/AIDS. The wealthier and more educated the woman the more likely she would be to have knowledge of the two misconceptions and the asymptomatic nature of HIV. Only 43 percent of women in the poorest households are knowledgeable compared to 74 percent of their richest counterparts. A similar pattern was found by mother’s educational level. Additionally, women’s knowledge of AIDS varies greatly by ethnicity. The highest proportion of women with the correct knowledge of the two misconceptions as well as the asymptomatic nature of HIV was found among African and mixed ethnicities (69 percent in each case) while the lowest proportion was among Amerindians (46 percent). Only 56 percent of East Indian women have such knowledge. Table HA.3 shows the percentage of women aged 15-49 years who have comprehensive knowledge of HIV/AIDS prevention methods and transmission. In MICS3, women with such comprehensive knowledge are those who correctly identify 2 ways of preventing HIV transmission and reject three common misconceptions. Overall, 48 percent of women were found to have comprehensive knowledge, which was higher in urban areas (59 percent) and lower in the rural areas (43 percent). Furthermore, the lowest proportion of women with comprehensive knowledge was found among those who reside in Regions 1, 7, 8 and 9 (35 percent) and highest among those in Region 10 (59 percent). As expected, the percent of women with comprehensive knowledge increases with the woman’s education level (Figure HA.1) and household wealth. Additionally, the highest proportion of women with comprehensive knowledge was found among those aged 20-24 years (53 percent) while the lowest proportion was found among those 35-39 years (45 percent). 69 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 69 Figure HA.1: Percent of women who have comprehensive knowledge of HIV/AIDS transmission, Guyana, 2006 58 66 73 81 68 45 58 70 83 61 33 43 56 70 48 0 10 20 30 40 50 60 70 80 90 Knows 2 ways to prevent HIV Identify 3 misconceptions Comprehensive knowledge P er ce nt Primary Lower Sec (F1 - 3) Upper Sec (F4 - 5) and Post Sec University Total Knowledge of mother-to-child transmission (MTCT) of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection of the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeeding. The level of knowledge among women age 15-49 years concerning mother-to-child transmission is presented in Table HA.4. The majority (90 percent) of Guyanese women reported that HIV can be transmitted from mother to child. However, when questioned about the specific means of such transmission, 83 percent reported that transmission during pregnancy is possible, 77 percent knew about the possibility of transmission through breast milk, and 67 percent were aware that transmission is possible during delivery. Overall, 58 percent knew all three ways while 5 percent did not know of any specific way. Women who reside in the interior areas (51percent) are the less likely to know all three ways of mother-to–child transmission compared to those on the coast (58 percent). There is no distinct pattern in women’s knowledge of MTCT and household wealth, age group and education level. The indicators on attitudes toward people living with HIV/AIDS (PLWHA) measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) would care for family member sick with HIV/AIDS; 2) would buy fresh vegetables from a person who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status of a family member a secret. 70 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table HA.5 shows the attitudes of women (aged 15-49 years) towards PLWHA. Over a third of the respondents (36 percent) agreed with none of the discriminatory statements. This proportion was highest in the coastal (44 percent) areas and lowest in the interior areas (24 percent). The variations among the regional groupings were large and range from a high of 42 percent in Region 10 and Region 4 to a low of 22 percent in Regions 1, 7, 8 & 9. Clearly, there are nexuses between discriminatory attitude towards PLWHA and household wealth and women education level. The richer the woman the less likely she will express discriminatory attitudes toward PLWHA. Similar findings were found among the educated women. Additionally, discriminatory attitudes among Guyanese women vary by ethnicity. Amerindians were found to be the most discriminating and women of mixed and African ethnicity were found to be the least discriminating than the other women. Table HA.5 also shows that the more than half of the women (64 percent) agreed with at least one of the discriminatory statements. The most common discriminatory attitude is the unwillingness to buy fresh vegetables from a person with HIV/AIDS (39 percent), followed by the need to keep family member HIV status a secret (35 percent). Just over one in ten (11 percent) women admitted that they would not care for a family member who was sick with HIV/AIDS. As it relates to allowing an HIV positive female teacher to continue teaching in school, approximately one quarter (23 percent) of women expressed disagreement. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Voluntary testing for HIV, accompanied by counselling, allows for those infected to seek medical care and to prevent the infection of others. The indicators shown in table HA.6 are designed to monitor whether women are aware of places to get tested for HIV, the extent to which they have been tested, and the extent to which those tested have been told the result of the test. As shown in Table HA.6, 81 percent of women of reproductive age in Guyana reported that they knew of a place where they could be tested for HIV while 32 percent have actually been tested. Of these tested, a large proportion has been told the result (88 percent). As it relates to knowledge of a place to be tested, women living in the coastal areas (83 percent), in the richest households (91 percent), those aged 20-24 years (86 percent), those of African ethnicity (90 percent), and those with university education (95percent) are the most likely to know of such a place. A similar pattern was found among the women who have been tested for HIV. HIV testing is particularly important for pregnant women who can then take steps to prevent infecting their babies. The indicators shown in Table HA.7 are designed to determine whether antenatal care (ANC) provided by health professionals include providing information or counselling about HIV/AIDS, the extent to which HIV testing is provided, and the extent to which those tested have been told the result of the test. 71 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 71 As shown in Table HA.7, 81 percent of the women who had given birth within the two years preceding the survey, received antenatal care from a health professional. Of these, 67 percent (approximately two out of every three) were provided with information and/or counselling about HIV/AIDS and about the same proportion was tested (65 percent) as part of the ANC received with 56 percent receiving their results. Access to antenatal care from health professionals is the lowest among women of Amerindian ethnicity (53 percent), those in the poorest households (66 percent), those with only primary education (79 percent) and who resides in the interior areas (56 percent). Likewise, access to HIV prevention related information during ANC visits is lowest among women who live in the interior (44 percent), among women in the oldest age group of 35-49 years (62 percent), those from the poorest households (52 percent), those with low education level (59 percent), and those of Amerindian ethnicity (43 percent). 72 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 referenCes Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. Blanc, A. and Wardlaw, T. 2005. “Monitoring Low Birth Weight: An Evaluation of International Estimates and an Updated Estimation Procedure”. WHO Bulletin, 83 (3), 178-185. 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. UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN WHO and UNICEF, 1997. The Sisterhood Method for Estimating Maternal Mortality. Guidance notes for potential users, Geneva. www.childinfo.org G U YA N A M U LT IP LE IN D IC AT O R C LU S TE R S U R V E Y 2 00 6 73 Ta bl e H H. 1: R es ul ts o f h ou se ho ld an d in di vid ua l in te rv iew s Nu m be r o f h ou se ho ld s, w om en , a nd c hi ld re n un de r 5 b y re su lts o f t he h ou se ho ld , w om en ’s a nd u nd er -fi ve ’s in te rv ie w s, a nd h ou se ho ld , w om en ’s a nd u nd er -fi ve ’s re sp on se ra te s, G uy an a, 2 00 6 Re sid en ce Re gi on al G ro up in g To ta l Ur ba n Ru ra l Ur ba n Co as tal Ru ra l Co as tal Ru ra l Int er ior Int er ior Co as tal Re gio ns 01 , 0 7, 08 , 0 9 Re gio ns 02 , 0 3 Re gio ns 05 , 0 6 Re gio n 04 Re gio n 10 Nu m be r o f h ou se ho ld s Sa mp led 1,2 24 4 ,05 6 1,2 24 2,6 15 1,4 40 1,4 40 3,8 38 1,2 48 88 8 1,0 07 1,7 75 36 0 5, 28 0 Oc cu pie d 1,2 17 4 ,01 2 1,2 17 2,5 78 1,4 33 1,4 33 3,7 94 1,2 43 87 1 99 9 1,7 58 35 6 5, 22 9 Int er vie we d 1,1 41 3 ,86 7 1,1 41 2,4 45 1,4 22 1,4 22 3,5 86 1,2 37 82 1 94 2 1,6 62 34 6 5, 00 8 Re sp on se ra te 93 .8 9 6.4 93 .8 94 .8 99 .2 99 .2 94 .5 99 .5 94 .3 94 .3 94 .5 97 .2 95 .8 Nu m be r o f w om en El igi ble 1,1 54 4 ,09 9 1,1 54 2,5 49 1,5 50 1,5 50 3,7 03 1,3 49 86 4 94 4 1,7 32 36 4 5, 25 3 Int er vie we d 1,1 35 3 ,90 0 1,1 35 2,4 51 1,4 49 1,4 49 3,5 86 1,2 63 82 8 91 4 1,6 88 34 2 5, 03 5 Re sp on se ra te 98 .4 9 5.1 98 .4 96 .2 93 .5 93 .5 96 .8 93 .6 95 .8 96 .8 97 .5 94 .0 95 .8 Ov er all re sp on se ra te 92 .2 9 1.7 92 .2 91 .2 92 .8 92 .8 91 .5 93 .2 90 .3 91 .3 92 .1 91 .3 91 .8 Nu m be r o f c hi ld re n un de r 5 El igi ble 38 0 2 ,16 1 38 0 91 8 1,2 43 1,2 43 1,2 98 1,1 33 29 3 35 5 58 3 17 7 2, 54 1 Mo the r/C ar eta ke r in ter vie we d 37 0 2 ,13 0 37 0 89 9 1,2 31 1,2 31 1,2 69 1,1 25 28 6 34 9 56 8 17 2 2, 50 0 Re sp on se ra te 97 .4 9 8.6 97 .4 97 .9 99 .0 99 .0 97 .8 99 .3 97 .6 98 .3 97 .4 97 .2 98 .4 Ov er all re sp on se ra te 91 .3 95 .0 91 .3 92 .9 98 .3 98 .3 92 .4 98 .8 92 .0 92 .7 92 .1 94 .4 94 .2 74 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, Guyana, 2006 Male Female Total 1 Number Percent Number Percent Number Percent Age 0-4 1,069 10.6 956 9.4 2,025 10.0 5-9 1,334 13.2 1,258 12.4 2,592 12.8 10-14 1,303 12.9 1,276 12.5 2,578 12.7 15-19 966 9.6 1,004 9.9 1,969 9.7 20-24 712 7.1 789 7.8 1,500 7.4 25-29 701 7.0 744 7.3 1,445 7.1 30-34 719 7.1 769 7.6 1,488 7.3 35-39 710 7.0 710 7.0 1,420 7.0 40-44 616 6.1 633 6.2 1,249 6.2 45-49 538 5.3 526 5.2 1,064 5.3 50-54 443 4.4 470 4.6 913 4.5 55-59 313 3.1 319 3.1 632 3.1 60-64 210 2.1 217 2.1 427 2.1 65-69 151 1.5 192 1.9 343 1.7 70+ 273 2.7 304 3.0 577 2.8 DON’T KNOW 28 (0.3) 9 (*) 38 (0.2) Dependency age groups <15 3,707 36.7 3,490 34.3 7,197 35.5 15-64 5,929 58.8 6,180 60.7 12,109 59.7 65+ 424 4.2 496 4.9 920 4.5 DON’T KNOW 28 (0.3) 9 (*) 38 (0.2) Children aged 0-17 4,341 43.0 4,128 40.6 8,469 41.8 Adults 18+Don’t know 5,746 57.0 6,048 59.4 11,795 58.2 Total 10,088 100.0 10,176 100.0 20,264 100.0 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 1 Excludes 31 persons for whom sex was unknown GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 75 Table HH.3: Household composition Percent distribution of households by selected characteristics, Guyana, 2006 Number of Households Weighted percent Weighted Un-weighted Sex of household head Male 70.0 3,508 3,640 Female 30.0 1,500 1,368 Regional Grouping Regions 01, 07, 08, 09 7.2 360 1,237 Regions 02, 03 20.3 1,017 821 Regions 05, 06 23.4 1,171 942 Region 04 43.8 2,194 1,662 Region 10 5.3 267 346 Residence Urban 30.2 1,514 1,141 Rural 69.8 3,494 3,867 Coastal 91.1 4,564 3,586 Urban Coastal 30.2 1,514 1,141 Rural Coastal 60.9 3,050 2,445 Interior 8.9 444 1,422 Number of household members 1 12.1 606 522 2-3 32.0 1,602 1,470 4-5 34.1 1,708 1,648 6-7 14.5 724 841 8-9 4.9 246 351 10+ 2.4 122 176 Total 100.0 5,008 5,008 At least one child aged < 18 years 67.7 5,008 5,008 At least one child aged < 5 years 30.1 5,008 5,008 At least one woman aged 15-49 years 74.9 5,008 5,008 76 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table HH.4: Women’s background characteristics Percent distribution of women aged 15-49 years by background characteristics, Guyana, 2006 Number of women Weighted percent weighted Un-weighted Regional Grouping Regions 01, 07, 08, 09 7.5 376 1,263 Regions 02, 03 20.4 1,029 828 Regions 05, 06 22.6 1,137 914 Region 04 44.2 2,225 1,688 Region 10 5.3 268 342 Residence Urban 30.0 1,509 1,135 Rural 70.0 3,526 3,900 Coastal 90.8 4,571 3,586 Urban Coastal 30.0 1,509 1,135 Rural Coastal 60.8 3,061 2,451 Interior 9.2 464 1,449 Age 15-19 19.3 971 1,001 20-24 15.1 760 776 25-29 14.4 724 738 30-34 15.0 757 745 35-39 13.7 690 656 40-44 12.3 617 612 45-49 10.3 516 507 Marital/Union status Currently married/in union 58.9 2,964 3,042 Formerly married/in union 9.0 452 426 Never married/in union 32.2 1,620 1,567 Motherhood status Ever gave birth 69.5 3,502 3,583 Never gave birth 30.5 1,533 1,452 Education Level Nursery/None/Non Standard Curriculum (*) 24 21 Primary 18.5 930 969 Lower Secondary (F1-3) 27.9 1,404 1,502 Upper Secondary F4-5 & Post Sec 46.7 2,350 2,206 University 3.4 169 130 DON’T KNOW 3.1 158 207 Wealth index quintiles Poorest 15.2 765 1,367 Second 19.2 965 876 Middle 20.7 1,045 912 Fourth 21.7 1,090 938 Richest 23.2 1,170 942 (Continued overleaf) GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 77 Table HH.4: Women’s background characteristics Percent distribution of women aged 15-49 years by background characteristics, Guyana, 2006 (continued) Number of women Weighted percent weighted unweighted Ethnicity of Individual1 African/Black 28.4 1,432 1,220 Amerindian 8.4 425 1,054 East Indian 44.7 2,251 1,808 Other2 (0.5) 26 25 Mixed 17.5 884 911 Total 100.0 5,035 5,035 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 1 Excludes the cases where the ethnicities were not stated 2 Includes cases where the ethnicities are other than those stated above (i.e. Chinese, White and Portuguese) 78 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table HH.5: Children’s background characteristics Percent distribution of children under five years of age by background characteristics, Guyana, 2006 Number of under-5 children Weighted percent Weighted Un-weighted Sex1 Male 52.4 1,311 1,298 Female 47.4 1,184 1,199 Regional Grouping Regions 01, 07, 08, 09 15.9 398 1,125 Regions 02, 03 18.4 460 286 Regions 05, 06 21.6 539 349 Region 04 37.7 942 568 Region 10 6.4 160 172 Residence Urban 24.8 619 370 Rural 75.2 1,881 2,130 Coastal 81.6 2,040 1,269 Urban Coastal 24.8 619 370 Rural Coastal 56.8 1,421 899 Interior 18.4 460 1,231 Age < 6 months 8.4 209 219 6-11 months 10.6 266 258 12-23 months 17.6 441 458 24-35 months 20.9 522 498 36-47 months 20.7 516 533 48-59 months 21.8 545 532 Mother’s education level Nursery/None/Non Standard Curriculum (*) 12 11 Primary 21.5 538 595 Lower Secondary (F1-3) 29.9 748 791 Upper Secondary F4-5 & Post Sec 43.2 1,079 948 University (1.9) 47 31 DON’T KNOW 3.0 75 124 Wealth index quintiles Poorest 29.9 747 1,251 Second 22.2 555 428 Middle 18.9 472 337 Fourth 16.0 401 276 Richest 13.0 325 208 Ethnicity of Individual2 African/Black 22.9 572 390 Amerindian 15.7 393 878 East Indian 31.6 790 494 Other3 (*) 13 10 Mixed 28.5 713 709 Total 100.0 2,500 2,500 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 1 Excludes 3 un-weighted cases where sex was not stated 2 Excludes 19 un-weighted cases of unknown ethnicity 3 Includes cases where the ethnicities are other than those stated above (i.e. Chinese, White and Portuguese) GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 79 Table CM.1: Child mortality Infant and under-five mortality rates by background and demographic characteristics [BASED ON WEST]. Guyana, 2006 Infant Mortality Rate* Under-five Mortality Rate** Sex Male 40 49 Female 35 44 Regional Grouping Regions 01. 07. 08. 09 52 68 Regions 02. 03 26 31 Regions 05. 06 39 49 Region 04 38 47 Region 10 36 45 Residence Urban 28 34 Rural 40 50 Coastal 35 43 Urban Coastal 28 34 Rural Coastal 38 47 Interior 49 64 Women’s Education Nursery/None/Primary 39 49 Lower Secondary (F1-3) 36 44 Upper Secondary F4-5 & Post Sec/University 36 45 Wealth index quintiles Poorest, Second, Middle 38 47 Fourth, Richest 35 43 Ethnicity African/Black 48 62 Amerindian 47 60 East Indian 28 34 Other1/Mixed 36 45 Total 37 47 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 1 Includes cases where the ethnicities are other than those stated above (i.e. Chinese, White and Portuguese) 80 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table CM.2: Children ever born and proportion dead Mean number of children ever born and proportion dead by age of women. Guyana, 2006 Mean number of children ever born Proportion dead Number of women Age 15-19 0.196 0.040 971 20-24 0.934 0.046 760 25-29 1.958 0.039 724 30-34 2.697 0.051 757 35-39 3.242 0.064 690 40-45 3.555 0.077 617 45-49 3.768 0.078 516 Total 2.132 0.062 5,035 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 81 Table NU.1: Child malnourishment Percentage of under-five children who are severely or moderately undernourished. Guyana, 2006 Weight for age Height for age Weight for height Number of children aged 0-59 months Percent below Percent below Percent above - 2 SD* - 3 SD* - 2 SD** - 3 SD** - 2 SD*** - 3 SD*** + 2 SD Sex Male 11.8 2.2 13.7 4.4 6.9 1.4 4.3 1,095 Female 13.0 2.5 13.6 4.8 8.4 1.6 5.3 949 Regional Grouping Regions 01. 07. 08. 09 11.4 2.1 22.7 6.5 3.7 0.7 2.9 360 Regions 02. 03 14.6 3.8 17.0 5.7 7.8 2.7 4.4 400 Regions 05. 06 13.1 3.0 12.5 4.1 8.7 1.2 6.6 438 Region 04 12.2 1.3 8.7 3.4 9.7 1.7 5.1 712 Region 10 7.0 1.3 9.7 3.8 2.7 0.0 3.2 135 Residence Urban 13.7 3.8 11.0 4.5 10.8 1.8 4.2 412 Rural 12.0 1.9 14.3 4.6 6.8 1.4 4.9 1,633 Coastal 12.8 2.4 11.7 4.2 8.7 1.7 5.1 1,630 Urban Coastal 13.7 3.8 11.0 4.5 10.8 1.8 4.2 412 Rural Coastal 12.5 2.0 11.9 4.1 7.9 1.7 5.4 1,219 Interior 10.6 1.9 21.3 6.1 3.3 0.6 3.3 414 Age < 6 months 8.3 2.3 9.4 6.8 9.3 3.8 11.0 134 6-11 months 13.5 3.6 11.6 3.7 6.8 3.3 10.7 201 12-23 months 16.2 3.6 21.3 8.0 11.5 2.5 5.3 366 24-35 months 11.8 2.2 11.7 3.8 8.1 0.7 3.5 447 36-47 months 13.0 1.0 14.9 4.1 3.5 0.4 3.8 444 48-59 months 10.0 2.0 10.2 2.8 7.8 1.1 2.0 451 Mother’s Education Level Primary or lower 14.4 3.7 16.6 5.5 6.4 1.6 5.8 458 Lower Secondary (F1-3) 14.5 2.5 15.5 5.5 8.4 1.4 3.5 636 Upper Secondary F4-5 & Post Sec 9.3 1.5 10.9 3.6 7.2 1.1 5.1 852 University (9.7) (0.0) (4.9) (0.0) (4.9) (0.0) (10.4) 32 Don’t Know 20.3 3.0 16.9 5.3 14.4 8.1 2.7 67 Wealth index quintiles Poorest 13.3 2.8 22.1 6.5 4.5 1.8 3.3 652 Second 15.8 2.2 11.9 4.2 9.2 0.4 6.0 452 Middle 11.5 1.7 7.6 3.1 10.8 1.1 5.2 388 Fourth 10.6 2.3 8.7 2.2 10.2 3.5 3.6 330 Richest 6.9 2.3 10.1 5.8 3.7 0.7 7.5 222 Ethnicity of Mother1 African/Black 7.4 0.3 8.0 3.3 5.5 0.7 5.0 434 Amerindian 11.6 1.4 25.8 7.1 2.0 0.3 2.2 369 East Indian 17.5 3.6 12.2 3.9 12.6 2.6 4.5 672 Mixed 10.8 2.5 11.6 4.4 6.2 1.4 6.9 538 Total 12.4 2.3 13.7 4.6 7.6 1.5 4.8 2,045 ( ) Figures that are based on 25–49 unweighted cases 1 Excludes 31 cases of unknown and other (Chinese, Portuguese or White) ethnicities 82 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table NU.2: Initial breastfeeding Percentage of women aged 15-49 years with a birth in the 2 years preceding the survey who breastfed their baby within one hour of birth and within one day of birth. Guyana, 2006 Percentage who started breast-feeding within one hour of birth* Percentage who started breast-feeding within one day of birth Number of women with live birth in the two years preceding the survey Regional Grouping Regions 01. 07. 08. 09 35.2 77.4 120 Regions 02. 03 39.7 76.4 133 Regions 05. 06 58.5 79.6 146 Region 04 43.0 72.4 296 Region 10 (25.3) (76.9) 46 Residence Urban 41.5 71.1 178 Rural 43.6 77.0 563 Coastal 45.0 75.3 600 Urban Coastal 41.5 71.1 178 Rural Coastal 46.4 77.0 422 Interior 35.1 77.1 141 Months since last birth < 6 months 41.9 78.5 184 6-11 months 40.7 68.6 221 12-23 months 45.3 78.7 336 Women’s Education level 1 Primary or lower 47.7 78.6 147 Lower Secondary (F1-3) 43.4 79.5 204 Upper Secondary F4-5 & Post Sec 42.3 73.9 350 Wealth index quintiles Poorest 45.4 75.9 232 Second 42.6 75.1 169 Middle 47.2 78.3 133 Fourth 42.4 77.2 111 Richest 33.5 70.3 96 Ethnicity of Woman 2 African/Black 47.1 72.7 187 Amerindian 41.4 75.8 146 East Indian 41.8 79.8 235 Mixed 41.2 71.2 162 Total 43.1 75.6 741 * MICS indicator 45 ( ) Figures that are based on 25–49 unweighted cases 1 Excludes 10 cases with university education and 30 cases where the education levels were unknown 2 Excludes 10 cases of unknown and other (Chinese, Portuguese or White) ethnicities G U YA N A M U LT IP LE IN D IC AT O R C LU S TE R S U R V E Y 2 00 6 83 Ta bl e NU .3 : B re as tfe ed in g Pe rc en t o f l iv in g ch ild re n ac co rd in g to b re as tfe ed in g st at us a t e ac h ag e gr ou p. G uy an a, 2 00 6 Ch ild re n 0- 3 m on th s Ch ild re n 0- 5 m on th s Ch ild re n 6- 9 m on th s Ch ild re n 1 2- 15 m on th s Ch ild re n 20 -2 3 m on th s Pe rce nt ex clu siv ely br ea stf ed Nu mb er of ch ild re n Pe rce nt ex clu siv ely br ea stf ed * Nu mb er of ch ild re n Pe rce nt re ce ivi ng br ea stm ilk an d so lid /m us hy foo d * * Nu mb er of ch ild re n Pe rce nt br ea stf ed *** Nu mb er of ch ild re n Pe rce nt br ea stf ed ** * Nu mb er of ch ild re n Se x Ma le 30 .5 69 20 .5 12 3 32 .5 87 64 .5 70 47 .5 68 Fe ma le 32 .2 54 22 .7 87 36 .7 95 66 .1 66 48 .4 72 Re sid en ce Ur ba n (3 1.6 ) 34 20 .9 61 (2 4.9 ) 48 (6 6.1 ) 27 (6 1.0 ) 31 Ru ra l 31 .2 89 21 .6 14 9 37 .8 13 5 65 .1 10 9 44 .3 10 9 Co as tal 24 .7 95 15 .2 16 7 33 .7 15 4 61 .6 10 4 46 .4 11 5 U rb an C oa sta l (3 1.6 ) 34 20 .9 61 (2 4.9 ) 48 (6 6.1 ) 27 (6 1.0 ) 31 R ur al Co as tal 20 .9 61 12 .0 10 6 37 .7 10 5 60 .0 77 41 .1 84 Int er ior (5 3.4 ) 28 (4 5.6 ) 43 (3 8.3 ) 30 (7 7.3 ) 32 (5 4.9 ) 25 W ea lth in de x Po or es t 49 .0 37 34 .3 62 27 .5 53 74 .7 58 (5 0.4 ) 39 Se co nd & m idd le 26 .9 47 20 .0 80 44 .2 86 (6 4.3 ) 45 43 .2 63 Fo ur th & ric he st 19 .8 39 11 .5 68 (2 3.8 ) 44 (5 0.5 ) 34 (5 3.4 ) 38 To ta l 31 .3 12 3 21 .4 20 9 34 .4 18 3 65 .3 13 6 48 .0 14 0 * M IC S in di ca to r 1 5 ** M IC S in di ca to r 1 7 ** * M IC S in di ca to r 1 6 ( ) F ig ur es th at a re b as ed o n 25 –4 9 un w ei gh te d ca se s 84 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table NU.4: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed. Percentage of 6-11 months breastfed and who ate solid food. Guyana, 2006 Percent of Infants 0-5 months exclusively breastfed 6-8 months who received breastmilk and complementary food at least 2 times in prior 24 hours 9-11 months who received breastmilk and complementary food at least 3 times in prior 24 hours 6-11 months who received breastmilk and complementary food at least the minimum recommended number of times per day* 0-11 months who were appropriately fed** Number of infants aged 0-11 months Sex 1 Male 20.5 16.7 21.9 19.2 19.9 244 Female 22.7 20.7 18.8 19.8 20.9 230 Regional Grouping Regions 01. 07. 08. 09 41.3 16.2 11.5 13.6 26.3 75 Regions 02. 03 (*) (*) (*) (30.8) 25.3 82 Regions 05. 06 (*) (*) (*) (21.6) 19.3 83 Region 04 (12.9) (11.7) (*) 9.9 11.4 197 Region 10 (*) (*) (*) (*) (47.1) 36 Residence Urban 20.9 (*) (*) (17.4) 19.1 124 Rural 21.6 18.4 21.9 20.0 20.7 351 Coastal 15.2 17.1 22.9 19.8 17.8 383 Urban Coastal (20.9) (*) (*) 17.4 19.1 124 Rural Coastal 12.0 16.0 (26.3) 20.7 17.2 259 Interior 45.6 26.7 9.9 17.9 30.7 92 Wealth index quintiles Poorest 34.3 14.1 26.9 20.0 26.0 147 Second (12.0) (*) (*) (19.5) 16.6 99 Middle (27.2) (*) (*) (16.0) 20.9 95 Fourth (12.3) (*) (*) (24.2) 18.4 74 Richest (*) (*) (*) (*) 13.9 60 Mother’s education level2 Primary 29.0 (13.2) (29.2) 20.7 24.0 91 Lower Secondary (F1-3) 25.4 (12.9) (16.5) 14.9 20.0 131 Upper Secondary F4-5 & Post Sec 18.5 23.0 (17.3) 20.7 19.8 229 Ethnicity of Mother3 African/Black 9.7 14.4 25.5 19.2 14.9 100 Amerindian 51.3 11.6 21.2 16.4 32.1 71 East Indian 9.6 12.1 22.4 17.5 14.6 138 Mixed 23.5 31.7 13.3 23.7 23.6 164 Total 21.4 18.7 20.2 19.4 20.3 475 * MICS indicator 18 ** MICS indicator 19 ( ) Figures that are based on 25–49 unweighted cases (*) Figures that are based on less than 25 unweighted cases 1 Excludes 1 unknown case 2 25 cases of unknown or university level not shown 3 Excludes 3 cases of unknown or other (Chinese, Portuguese or White) ethnicities GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 85 Table NU.5: Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth. Guyana, 2006 Percent of live births below 2500 grams * Percent of live births weighed at birth ** Number of live births Regional Grouping Regions 01. 07. 08. 09 24.2 61.7 120 Regions 02. 03 14.7 88.1 133 Regions 05. 06 18.6 82.0 146 Region 04 18.6 76.4 296 Region 10 (19.5) (85.4) 46 Residence Urban 17.3 72.9 178 Rural 19.3 79.4 563 Coastal 17.7 81.0 600 Urban Coastal 17.3 72.9 178 Rural Coastal 17.9 84.4 422 Interior 23.7 64.3 141 Women’s Education1 Primary or lower 21.4 75.8 147 Lower Secondary (F1-3) 19.9 77.8 204 Upper Secondary F4-5 & Post Sec 17.4 80.4 350 Don’t Know (18.4) (59.0) 30 Wealth index quintiles Poorest 20.5 70.5 232 Second 20.4 77.4 169 Middle 17.1 86.2 133 Fourth 16.7 79.0 111 Richest 17.2 83.2 96 Ethnicity of Woman2 African/Black 17.7 75.2 187 Amerindian 22.0 62.4 146 East Indian 18.4 88.4 235 Mixed 18.1 78.9 162 Total 18.9 77.8 741 * MICS Indicator 9 ** MICS Indicator 10 ( ) Figures that are based on 25–49 unweighted cases 1 10 cases of university level not shown 2 Excludes 10 cases of unknown or other (Chinese, Portuguese or White) ethnicities 86 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table CH.1: Vaccinations in first year of life Percentage of children aged 18-29 months immunized against childhood diseases at any time before the survey and before the first birthday (118 months for measles and Yellow fever). Guyana, 2006 Percentage of children who received: Number of children aged 18-29 months BCG * Polio 1 Polio 2 Polio 3 ** MMR *** Yellow Fever**** Vaccinated at any time before the survey According to: Vaccination card 75.7 76.5 76.5 76.4 77.1 75.0 488 Mother’s report 22.4 21.1 18.2 8.6 18.3 17.2 488 Either 98.1 97.6 94.8 85.0 95.4 92.1 488 Vaccinated by 12 months of age1 96.0 95.2 90.3 74.2 89.7 88.4 488 * MICS Indicator 25 ** MICS Indicator 27 *** MICS Indicator 28 ; MDG Indicator 15 **** MICS Indicator 30 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 87 Table CH.2: Vaccinations by background characteristics Percentage of children aged 18-29 months currently vaccinated against childhood diseases. Guyana, 2006 Percentage of children who received: Percent with health card Number of children aged 18-29 months BCG Polio 1 Polio 2 Polio 3 MMR Yellow Fever Sex Male 96.8 96.7 93.5 82.1 93.3 89.1 70.5 260 Female 99.4 98.6 96.2 88.3 97.9 95.6 80.4 229 Regional Grouping Regions 01. 07. 08. 09 97.8 97.0 94.3 81.2 96.6 95.1 72.9 75 Regions 02. 03 98.0 100.0 100.0 75.4 98.0 94.2 62.2 82 Regions 05. 06 94.5 92.9 88.4 85.8 94.3 89.0 80.9 111 Region 04 100.0 99.2 95.8 89.6 94.3 91.8 77.9 201 Region 10 (*) (*) (*) (*) (*) (*) (*) 20 Residence Urban 100.0 100.0 97.1 88.1 94.8 93.7 75.6 117 Rural 97.5 96.8 94.0 84.1 95.6 91.6 75.0 371 Coastal 98.1 97.7 94.8 85.6 95.2 91.8 75.9 407 Urban Coastal 100.0 100.0 97.1 88.1 94.8 93.7 75.6 117 Rural Coastal 97.3 96.7 93.8 84.6 95.4 91.0 76.0 290 Interior 97.9 97.2 94.7 82.2 96.4 93.8 71.4 81 Mother’s education level Reached1 Primary or lower 97.2 98.4 95.1 83.9 96.2 94.6 72.7 109 Lower Secondary (F1-3) 99.3 98.0 93.7 85.3 96.2 91.7 78.2 146 Upper Secondary F4-5 & Post Sec 97.6 96.9 95.0 85.6 94.2 91.5 74.8 216 Wealth index quintiles Poorest 96.1 94.4 91.6 80.2 94.3 89.9 71.9 131 Second 96.6 97.8 93.6 85.7 90.3 87.7 71.1 129 Middle 100.0 98.2 93.2 86.1 100.0 98.2 80.4 93 Fourth 100.0 100.0 100.0 87.5 96.2 90.0 78.4 59 Richest 100.0 100.0 100.0 89.0 100.0 97.5 78.4 77 Ethnicity of Mother2 African/Black 98.0 98.0 98.0 93.2 96.0 94.8 85.9 121 Amerindian 98.4 98.0 96.7 85.3 97.9 95.6 77.0 66 East Indian 99.0 98.0 92.9 82.4 96.9 91.8 72.0 159 Mixed 96.7 96.3 92.7 80.8 91.4 87.9 68.7 134 Total 98.1 97.6 94.8 85.0 95.4 92.1 75.1 488 (*) Figures that are based on less than 25 unweighted cases 1 17 cases of unknown or university level not shown 2 Excludes 9 cases of unknown or other (Chinese, Portuguese or White) ethnicities 88 GUYANA MULTIPLE INDICATOR CLUSTER SURVEY 2006 Table CH.3: Neonatal tetanus protection Percentage of mothers with at least one birth in the last 24 months protected against neonatal tetanus. Guyana, 2006 Percent of mothers with a birth in the las

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