Iran Multiple Indicator Cluster Survey 1995

Publication date: 1996

In the Name of GOD The Compassionate, The Merciful Ministry of Health And Medical Education Under Secretary for Public Health Of the Islamic Republic of Iran UNICEF Tehran The Multiple Health Indicator Cluster Survey of The Islamic Republic of Iran 23-27 September 1995 Undertaken as a Joint Project by Ministry of Health and Medical · & UNICEF Tehran 22 April 1996 Final Draft For Distribution to All Table of Contents I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 II. Brief Background Information and Definitions . 2 Ill. The Objectives and Target Population . 4 IV. The Sampling Methodology and the Questionnaire . 0 • 0 0 •• 0 0 •••• 0 • 0 •• 0 0 ••• 5 V. The Results . 0 • 0 0 0 0 ••••••• 0 ••• 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 •• 0 0 •• 0 0 0 0 0 0 0 0 0 0 8 VI. Conclusion . 0 0 0 0 0 0 0 0 0 0 0 • 0 0 0 • 0 0 • 0 • 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • 0 49 Annex One List of Mid-Decade and End-Decade Goals 0 0 0 0 0 0 0 0 • 0 0 0 0 0 0 0 0 0 0 0 0 • 0 •• 0 50 Annex Two A List of Mid-Decade Goals Indicator Values 0 0 0 0 0 0 0 0 0 • 0 0 • 0 0 0 0 0 0 0 • 0 • • • 54 Annex Three The MHICS Questionnaire Unofficial Translation and Farsi Version 0 0 0 0 0 0 0 0 61 ·-. - . _____ ._ __ , <~1-!.~z·~~c;:.c_ ; ·· · . --~;~i~it=fu: · ~~~r~ 8.747 million (13~ of total) ~f'V ·· -, · 30.4 mDiion (46~ of total) • ~· ' ·. . ' . . _:i~~\ :· . :;::~~(:".Lr:IMR, uSMR, MMR . -~j:· · .nec.deo.ilaticidon.cmdeat) ''F3''·7~r;:;Annual Popn. Growth Rate (1995) . ·.· • !:,~~- •; 't!,;:·::·f~~~: ;: . · · • • · ~--~~ c~ of Popn. Urbanized · ;,o711 ·' · · ·Av. Growth Rate of Urban Popn. 4.9~ . -~· . . ::Total Fertility Rate ~- · · 3.3 * · ·. '·(Sources: SOWC 1996; HIUIIIIn DevL RpL, 1995; (*)=Fomily Pliinning Quster SU!vey,May '951 MOH&ME) . . ·· ' ' . 1995 Mm-DiCAim COAL INDICAIQRS: Ggall: .Goa1.l:. . Goal 10; Goalll; ==·;o,•,•,·.•.•.•.-.•,•,•,•,•••.·,·.·.·.•. ,•,•.•,•.•.•.•.•,•,•.·.·.·.· a. . ,. . . . ''t-"'·~ - Raising Immunization Coverage to at least 80% OPV3: 97% (1995; MICS Rptl MOH&ME EPI Cluster Survey'95) . Measles: 95% (1995,· MICS Rptl MOH&ME EPI Cluster Survey '95) TT2: 82% (1995,· MJCS Rptl MOH&ME EPI Cluster Survey'95) Elimination of Neooatal Tetanus NNT cases 10 (1995,· WHO/UNICEF Reg.Directors' Meeting, Alex., Feb., '96) _Eradication of Polio in Key Areas -·Polio Cases 90 (1995; WHOIUNICEFPoliafax, Feb.'96) Reduction in Measles Deaths & Cases Measles Cases 287 (1995; WHO/UNICEF Reg.Directors' Meeting, Alex., Feb., '96) Measles Deaths 0 (1994; CRING '95: MOH&ME) Virtual Elimination of Vitamin A Deficiency V AD problem does not exist (1994,· UNICEF HQ & Tehran MOH&ME) Routine Vit. A distnbution to U2's (Vit.A&D drops) through the PHC system. Universal Salt Iodization Iodized Salt Availability Iodized Salt Consumption T /U fR 70% (1994,· Nutrition Section, UNICEF HQ) 82%/87%/765'o (1995; MICS Rpt.l MOH&ME) Increasing ORT use to 80% to Control Dian'boea ORT Use 69.1% (1995,· MJCS Rpt.l MICS 1995) ORS Use 80% (CRING '951 WHOICDD '94 unpublished report) Eradication of Guinea-Wonn Disease (Dracunculiasis) Dracunculiasis has been eradicated in Iran BFHI implementation in key major hospitals/ maternity facilities & banning BMS BMS banned #Hospitals targeted for 1995 # Hospitals certified as BFH Ratification of CRC by all countries 300 (1995,· CRING '951 MOHME- conjinned) 250 (1995,· MICS Rpt.l MOH&ME) CRC was ratified/deposited by Iran in July of 1994 Monitoring of CRC Implementation planned Reduotionof~ubition Underweight (moderate & severe) 16% (1992; CRING '95: " The HlJh Sitn, af mothers & children in Iran " ) •.·.·.•.·.•.·.·.w.w.-.••.,•.•,•.••.-.-.-.-•.•.•,•,•. ·.·•.-.••.•:•:•;•.-••;···-·,·.-:·:···········:····w.•.•.w.-.•.•.•,•.•:•.•.•.·.·~··:·~0 · . ~-'··· . -- .: . ·:: . -~: :· •:"f· Net Emolmem Rate TIMIF 96% 199%193% * (1994,· MICS Rpt.l MOE) ({·· ,,. GrossEnrolmemRateTIM/F, :·,·: ',<. . . ··. 110/117/105* . (19.94,·MICSRpt.IMOE) _ -~- -~:~ - ~~ -~- =->·~ . -~)-.-·.::~ ~;., : . . .":. --~ · ~~ :: . _ . - .•. . _., __ _ t : . '; .• -, -:~· . : ,. - : : YEAB 2000/ DECAPE fyQAL INDICATQR5: · · . . . . ' . . ·. · ··' . ;·:·,·n> · chDd& ·i.t.tm.,~V- · · ., . . :-., -: . ;j·>:., ·-\:~:~: · ':·l· ·-. ~~;~_:. : . . . . Reduction of 1MR by 113 or SO per 1,000 Uve births; ReduCtion of USMR by 113 or 70; :, . · · · ·. ·Reduction of MMR by 112 per 1,~ live births · · ·· : · · . IMR · 31/1,000 live births · (1995: Cluster Survey on Family Planning, USMR_.::: .35/1,000 live births-. MOR &: It!£, May 1995) . . · :.·- ~~ _ MMR . 54/ 100,000 (1991: UNICEF .& 1991 MOHME Survey, Annex '93) · (l) MaiDmduon . · · ~-:-~ -~- -Reduction of Severe and Moderate & Severe Malnutrition Among US's by 112; Reduction of Low Birth- Weight ( <2.5kg) to <10%; ElimiMtion of Micronutrient Disorders: IDD & VAD . · % Low Binh-Weight Babies 8% .(1991; UNICEF/ MOHME 1991 Survey 1991) Goitre Prevalence · 33% (Dec. '94 IDD Study !UNICEF, Tehran update) (see MDG Indicators) · (3) Auaemia & ARI Reduction of Anaemia in Women by 1/3 its 1990 value; Reduction of US ARI Deaths by 1/3 IDA prevalence in females 40% . # ARI Deaths 12,600 (1991,· MOHME 1991 Survey) ARI Deaths as% of US deaths 19.4% (1991,· MOHME 1991 Sufvey) (4) ORT/CDD Achievement of 80% ORT Use & Reduction in Diarrhoea-Related Diseases by 1/2 · -· II Diarrhoea Episodes in US's · 2 · # Diarrhoeat-related Deaths - 9,084 (1991; MOHME 1991 Survey) Diarrhoea Mortality Rate (US's) 16% (1991; MOHME 1991 Survey) (see MDG indicators) (5) Materna) Bealtb Care Empowerment to Breastfeeding; Speclal Attention to Female Health/ Nutrition; Access' to FamDy ·. ·· . - · . / . . • ' Planning For All; Access to Prenatal Care Access to Prenatal Health Care % Hospital Deliveries % Binbs Attended by Trained Health Personnel Exclusive Breastfeedillg Rate ( < 6mths) Timely Complementary Feeding Rate (6-12mths) Contd. Breastfeeding Rate at 2 yrs (> 12mths) 70% (UNICEF!MOH '91 Surv., 60% (MENARO, CSD Unit est) 70% (1983-94,· sowc 1996) 45.8% (1995,· MICS'95 & MOR. 54% (;991,· Annex A, '94 based 40% on 1991 MOHME Survey. (6) Education & Literacy Universal Access to Basic Education; At Least 80% Primary Education Completion Rate; Reduction of Adult Dliteracy rate to at least 112 its 1990 level- Empbasis on Female Literacy Drop Out Rate TIMIF 3% (1994; MICS Rpt/ MOE) Repetition Rate TIM/F 9%/10%/7% • Adult Dliteracy Rate T IMIF 46%1 35%1 51% • (7) Water & Sanjtation (8) I.mpmye Life Skills (see MDG Indicators) (9) Ac;c:eptance and Observance of CRC (10) Improved Protection for CEDC ARJ: Aeule Re"""'*" blfldi.otU BFHI: Btlbf Frkll41] Hotp/1111 blllilllive BFH: Btlbf FtWII41! Ht~lflllills CDD: OMirol •I a-tMd lJUuu CEDC: Cllilllu a~ Di/Jinlll ~u CRC: c.-r.r. M tiM lltr~ •filM CltiJ4 1&: ,.,. Dejldaq __,. IDD: Wile Dejld~MJ DUtHUn IMR: btl., Molflllil] Rde MDG: Mi4-DeCIIIlt God MMR: M__. Mllrllllll] lli1U NNT: N-.1111 T-IU ORS: tirlllbll]tltr11W• Stllb ORT: Orrllillll]tltr11W• nmrp,p VSMR: VIIMr S Mtltltlllq lli1U ' Y.W: ""-"'A~ ii • 199~ !J:t1!4: IIENAROI ~ Ullil, 1995 . _ • . SH/MIIrda 6lh 1996 . . ~f -~·:·::~:-:~- .-·;-.!·. ··· : .· · :·· ,. > ~: .v.• .•.•. -••.•.• ,,.,•.·•.•,• • . • •• ,., . ·.•.·.•.•.•.••.,.,.,.,._.,.,. •• ,., .,~-:--.y.,.-.-;-r. ,;. -;.,-;:.;r.,;o»~::.&w;.,. ··'""'· ·"~;F .• ~ . '•>' ' '. ~' ~._<.>.-«:~x.:.: \ <.;.o:«~~~-Y.'I' !;."~>:~'Me.~ ~to;.,._ . .,.,.,~ • .-. "' • < V ~ '>)o~~ ._,.,_.,.,.<·~ ~:'><»';.-.< :0'".<,~"':.:.- .~,, ,. --.~< :_ :_-.,.~.:.wi~;- . . -_::;:~ f:·.; ~ -~--:~-~--. :.::.~ .• . . ,: . ~, . - ·-. : __ : .; .:, . ,·; . : . .,.;- .·.- .:,._· · ·~ . ~ . . :.~~~ . . _ ".;,; I • I i. MICS, September 1995 LR.Iran I. Introduction: In order to ascertain the achievement of the Mid Decade Goals (MDG) and the present situation with respect to End Decade Goals, a Multiple Indicator Cluster Survey (MICS) was undertaken from 23 September to 27 September 1995. The intersectoral committee made up of the Ministry of Health and Medical Education (MOH&ME), the Statistical Center of Iran (SCI), the Ministry of Education, and the Ministry of Agriculture was formed to finalize a Declaration of Achievement for the MDG. This committee decided.that surveys in the past nine months had ascertained the indicator levels for the MDG, except for some health indicators. Therefore, the task of the field work and the analysis of the MICS was given to the MOH&ME. A member from the MOH&ME and one from the SCI had been sent to Amman to participate in the MICS workshop of March 1995. The strong background of the MOH&ME personnel in surveys coupled with their strong presence in the field had also been factors in delegating the task of the implementation of the MICS to the MOH&ME. The Under Secretary for Public Health of the MOH&ME, Dr. Malekafzali, is a professor of bio-statistics in Tehran, University of Medical Science and Health Services, and acted as an overall supervisor and resource person for this project. Dr. Naghavi, epidemiologist of MOH&ME, was assigned as the joint-project coordinator and performed the analysis presented in this report . . The Under Secretary for Public HeaJthand other top officials ofthe government, made the · MICS a high priority item on the agenda of the government and MOH&ME. The Under Secretary was personally involved in the formulation of the final questionnaire, the training of the provincial supervisors and the supervision of the implementation. The provincial staff of the MOH&ME involved in this project included 28 provincial supervisors; 924 personnel making up 107 urban and 201 rural teams; and 226 personnel making up 113 local supervisor teams. In addition to these staff 25 supervisors of MOH&ME Central Level were trained in the UNICEF office and sent to each one of the provinces for the monitoring of the MICS. The total personnel of the MOH&ME involved in the project exceeded 1250 persons. The field work took approximately five days, the data entry three days, and the analysis of the data two weeks, all performed by the staff of the MOH&ME. These results could not have been obtained without the utmost commitment of the government of the Islamic Republic of Iran and its Ministry of Health to the MDG and End Decade Goals. The basis for the methodology of the survey was derived from the MICS package distributed in the above mentioned workshop. The package includ~d Monitoring progress toward the goals of the World Summit for Children, A practical handbook for multiple-indicator surveys (Jan. 1995) of UNICEF, diskettes containing the Quattro Pro worksheet for margin of error and sample size calculations, EPI Info packages of WHO, and sample data entry software written for EPI Info. A new and improved data entry software was designed, made and distributed to the provinces for distributed data entry. 1 MICS, September 1995 LRiran The relevant parts of this book was translated into Farsi and distributed to the members of the intersectoral committee. The committee reviewed and adapted the material to be used in the MICS. The detailed background information relevant to this survey can be found in the above mentioned book. The sampling framework was derived from SCI's framework, updated with this year's Polio National Immunization Day household registry. Whenever a more current update to the framework could be obtained, it was used. The Islamic Republic of Iran, with an area of 1 ,648,000 square kilometers and a population of about 59.6 million, is located in the Middle East. It is bounded on the north by the Republics of Azerbaijan and Armenia and Turkmenistan as well as the Caspian sea; on the east by Afghanistan and Pakistan and on the west by Turkey and Iraq and on the south by the Persian Gulf and the Oman Sea. Iran has a variable climate. About one-half of the country is mountainous and a quarter, desert, leaving only 25 percent as arable land. The population is rather young; 41.5% being under 15 years of age and only 3% over 65. The population growth rate is currently 1.75% per year. The population of the country is comprised of 57% urban, 42% rural and 1% nomadic. The literacy rate, which was only 47.5% in 1976, presently stands at about 80%. In 1976, the infant mortality rate(IMR) was 104 per 1 ,000 live births and life expectancy was 52 years. At present, the IMR is 30 per 1,000 live births and life expectancy has increased up to 69 years. The present administrative structure divides the country into 25 provinces, 237 districts, 630 -- - - - ~ub-districts,- 612 -cities and~ver70;000-viliages and hamlets: ---- 11. Brief Background Information and Definitions: The Islamic Republic of Iran is a signatory of the World Summit for Children (WSC) declaration. In 1990 the WSC was held with the participation of 71 heads of state and government and 88 senior officials from the countries around the world. The participants committed themselves to the attainment of certain goals to ensure the well being of children. National Plans of Action were drawn up in 158 countries to pave the path for the attainment of these goals. In order to maintain a sense of urgency, most of the developing world's governments have agreed to try to reach a limited number of goals by the middle of the decade. The list of these goals is presented in Annex One of this report. The Islamic Republic of Iran had been monitoring the MDG in the past years. The level of achievement with respect to some of these goals is beyond thEi targets set for 1995 and close to the year 2000 targets. This has been indicated in many of government's, UNICEF Tehran's and the Middle East and North Africa Regional Office's (MENARO) reports . Examples of such reports are Girls' Drop-Out from Primary Schooling in the Middle East and North Africa: Challenges and Alternatives for the education indicators from MENARO, The State of the World Children Report for the immunization indicators from 2 I MICS, September 1995 LR.Iran UNICEF Headquarters in NY, and The Declaration of the Achievement of the MDG Goals from UNICEF Tehran and the government of Iran for many other indicators. A listing of the indicators and their values is presented in Annex Two. Since 1985, several studies have been conducted in order to establish indicators related to death, birth, immunization coverage, degree of awareness and practice of mothers in management of dianhoeal diseases of children under-five. There have also been studies on breastfeeding rates and nutritional status of Iranian children. In the 1988 survey, conducted prior to the launching of the Child Survival Campaign, baseline data pertaining to immunization coverage, management of diarrhoeal diseases, breastfeeding and supplementary food were obtained. Immediately after the completion of the third round of the campaign, a comprehensive survey showed the effectiveness of the campaign adivities in increasing the immunization coverage and increasing the level of awareness of mothers in the above mentioned areas. In the October 1991 survey, which covered 108,000 households, it was shown that the target achievements have been sustained. This survey, in conjunction with other surveys conducted in the past twelve months, will ascertain the achievement of the MDG. Some of the definitions used in this survey are as follows: 1-A househeld is -a greup people living u_nder the -same roof, :eating from the ~arne tabte . . and sharing a single pool of income. 2-Under-five children are children born from 22 September 1990 to 27 September 1995 or date of questioning. 3-Under 36 month old children are children born from 22 September 1992 to 27 September 1995 or date of questioning. 4-Under two year old children are children born from 22 September 1993 to 27 September 1995 or date of questioning. S-Under-six month old children are children born from 22 March 1995 to 27 September 1995 or date of questioning. 6- Under-four month old children are children born from 22 May 1995 to 27 September 1995 or date of questioning. 7 -Weight is measured without shoes and least amount of clothing with standardized and calibrated scales in kilograms, with an accuracy of 5 grams. 3 MICS, September 1995 LR.Iran 8-Height is measured without shoes and with under two year olds lying down, and above two year olds standing next to a wall, in metric units, with an accuracy of up to one centimeter. \ 9-The final definition for a sanitary latrine was that the latrine should possess all of the . i following characteristics: latrine area in a room protected from all sides and having a door, water available next to the latrine and in the latrine room, floor having a slope towards a sanitary water exi~ and washable cement or tiles extending at least 45 em from the ground should cover all walls, the ground should be made of nonpermeable material. Ill. The Objectives and Target Population: The main objective of the survey was to monitor the present level of the indicators, that recent data was not available for, and that pertained to the Mid-Decade and End-Decade goals of the World Summit for Children. The indicator values that had been ascertained with cluster surveys in the past nine months were not included in the present undertaking. The questions of the MICS had the following sub-objectives and target populations: -~ 1A: To aeteririine the proportion of population wlthaccess· to an adeqi.iate amounfofsafe · ---· drinking water located within a convenient distance from the user's dwelling, disaggregated by rural and urban population. 1 8- Target population was the household, questions were asked from the head of the household or the mother of the children of the household. 2A- To determine the proportion of population with access to a sanitary facility for human excreta disposal in the dwelling or located within a convenient distance from the user's dwelling, disaggregated by rural and urban population. 28- Target population was the household, questions were asked from the head of the household or the mother of the children of the household. 3A- To determine the malnutrition rate in the country; stunting (height for age}, underweight (weight for age) and wasting (weight for height), disaggregated by rural and urban population. 38- Target population was under five children, children were measured on site. 4A- To determine the level of ORS use rate as part of diarrhoea case management, disaggregated by rural and urban population. 48- Target population was under five children who had diarrhoea in the past two weeks, questions were asked from mothers who had children in the target group. 4 . I I . [ I I MICS, September 1995 LR.Iran SA- To determine the prevalence of diarrhoea, disaggregated by rural and urban population. 58- Target population was under five children who had diarrhoea in the past two weeks, questions were asked from mothers who had children in the target group. 6A- To determine the level of ORT use rate as part of diarrhoea case management , disaggregated by rural and urban population. 68- Target population was under five children who had diarrhoea in the past two weeks, questions were asked from mothers who had children in the target group. 7 A- To determine the exclusive breast-feeding rate in children less than four and six months old. 78- Target population is under six mt>nth children, questions were asked from mothers who had children in the target group. SA- To determine the proportion of children up to 36 months of age who are breast-feed. 88- Target population was under 36 month children, questions were asked from mothers who had children in the target group. 9A- To determine the infant formula usage rate in under 36 month old children. · 98- Target population was under 36 month Children, • questions were asked from mothers · who had children in the target group. 1 OA- To determine the percent of children starting complimentary feeding at the proper age. 108- Target population was under 36 month children, questions were asked from mothers who had children in the target group. IV. The Sampling Methodology and the Questionnaire: The population under study was optimized for children under 6 months of age, i.e. for the exclusive breast-feeding indicator. Based on the recommendation of the package Monitoring progress toward the goals of the Wor1d Summit for Children, A practical handbook for multiple-indicator surveys, design effects for each one of the indicators was determined. The sample size was calculated as follows,. optimizing for under-six month olds: n=sample size= (Z**2(P)(Q)(DE))/d**2 where Z**2 is Z squared, and d**2 is d squared. Z with 95% confidence level is 1.96; Z**2=3.8416 P=Prevalence of exclusive breast-feeding in 6 month Olds=0.20 5 MICS, September 1995 LR.Iran Q=1-P=0.80 DE=Design Effect=2 d=Margin of error=O.OS The calculations on page five resulted in a sample size (n) of 491.7 six month olds. Therefore, we have to find at least 492 six month olds in the country. Since six month olds make up one percent of the population, we have to survey 49,170 persons to find 492 six month olds. Given that each family contains five persons, 9,834 families are to be surveyed in rural areas, and the same number in urban areas. Table One shows the distribution of clusters, interviewers, and supervisors per province. T bl 0 T a e ne: b fCI he num ero uster, T earns an dS uperv1sors per p rov1nce POPULATION '91 #OF CLUSTERS #OF TEAMS #OF SUPER VISOR PROVINCE CODE URBAN RURAL URBAN RURAL URBAN RURAL TEAMS AZARB. East 1 1807000 1471000 57 61 6 12 6 AZARB. West 2 1083000 1201000 34 50 4 10 5 ESFAHAN 3 2450000 1233000 77 51 8 10 6 I LAM 4 211000 230000 7 10 1 2 1 ARDEBIL 5 488000 653000 15 27 2 5 3 OOPIRAN 6 2655000 647000 83 27 9 5 5 BUSHEHR 7 356000 338000 11 14 1 3 2 DOPTEHRAN 8 ·2530000 362000 79 15 8 3 4 -···-··-· ------- ·· cH. MA.&BA. . • . . . . . -- . 9 277000 470000 9 20 ·1 . " 1- 2 KHORASAN 10 3067000 2946000 96 123 10 25 12 KHUZESTAN 11 1930000 1245000 61 52 6 10 6 ZAN JAN 12 426000 595000 13 25 2 5 3 SEMNAN 13 282000 176000 9 7 1 21 1 SIST.&BALUCH. 14 630000 825000 20 34 2 7 3 OOP SH. BEHSHT 15 3488000 300000 110 12 11 3i 5 FARS 16 1886000 1658000 59 69 : 6j 14: _ ___]_ GHAZVIN 17 395000 360000 12 I 3! 15i 11 2 KORDESTAN 18 585000 648000 18· 271 2: 51 _ _l KERMAN 19 851000 1012000 271 42 l 3 9 4 KOHK.&BOYER 21 151000 346000 5 141 1 3' 2 GILAN 22 883000 1321000 281 5s ! 3 11 5 LORESTAN 23 761000 741000 24 31 i 31 6 3 MAZANDARAN 24 1539000 2254000 48 94 1 5 19i 8 MARKAZI 25 591000 591000 19 25 2 5! 3 HORMOZG. 26 382000 543000 12 231 2 5 3 HAMED AN 27 697000 955000 22 40! 2 8j 4 YAZD 28 470000 221000 15 9 2 2i 2 TOTAL 31834000, 24001000, 1000. 1000! 107 201 113 6 - MICS, September 1995 LR.Iran As it can be observed from Table One, the number of families was rounded to 10,000 families in each area. The sample was divided into 1,000 clusters in urban and 1,000 clusters in rural areas. In each cluster ten families or households are to be surveyed. It was assumed that each team can cover one cluster in the rural areas and two clusters in the urban areas per day. The teams were made up of a male and a female interviewer and a driver. For each three teams, one supervisor was selected. The supervisor team consisted of the supervisor and a driver. Local provincial focal points were assigned to each province. The provincial focal were invited to Tehran and trained. So were the data entry personnel. The provincial focal points in turn trained the interviewers and the supervisors locally. It was of utmost importance that the personnel being trained in Tehran · had extensive cluster survey experience in the past. This was checked before the invitations were sent and during the training. This is to ensure uniformity of teaching in the provinces. The listing of households was available at the provinces. During the last round of the polio campaign, all urban households were registered and listings of them created. The rural household listings were obtained from the yearly census of the health houses and cross- checked with the Malaria Form2 listings. The total number of households in each area, being rural or urban, was divided by the number of clusters required, to obtain the sampling interval. Next, a random number less than the sampling interval was chosen. ··-··-- ·· ----·- --------·-:Th1s-was-thEflirslnousenoldto··be visited~in . thefirsfcfuster: The sa-mpling interval· was added to this random number to obtain the first household of the second cluster. This method was followed until all of the clusters were exhausted. Once the first household of each cluster was determined, the next nine households were also interviewed, to obtain ten household per cluster. The rough translation of the questionnaire is presented in Annex Three. The photocopy of the Farsi questionnaire is also presented in the same Annex. The questionnaire was based on the MICS package, adopted to the local language. Indicators that we had ascertained a value for in the past nine months were not included in the questionnaire, which was made up of 37 questions, six modules, and two pages, printed on both sides. The modules were the water and sanitation module, the diarrhoea module, the breast- feeding for under-one module, exclusive breast-feeding for under-six months module, and the anthropometric module. A source of bias can be originating in the questioning teams. This is because the implementors of the health programmes were asked to asses themselves. If we take an outside view of this process, the fact stands that the implementing Ministry is assessing itself. But, if we take an inside view, one that the supervisors are monitoring and evaluating the implementors, namely the behvarzes, the source of bias might be minimized. The questioning teams were usually made up of the supervisors of the 7 MICS, September 1995 LR.Iran behvarzes. The behvarzes are the health workers of the rural areas. The behvarzes were sometimes present to introduce the teams and facilitate the interactions between the interviewers and interviewees. V. The Results: The national results of the survey is presented in the table two below. The results are for a 95% confidence interval. The margin of error is stated next to each figure. The margins of error were calculated with the EPI6 package. V.1 General Results: Table two presents the general results of the MICS. The sample size is presented in each cell in the format of SS is equal to the figure corresponding to the sample size. The average family size in our sample for urban, rural, and country areas was 4.8, 5.6, and 5.2 respectively. T bl T a e wo: G enera I R It f th MICS S esu so e I 1 s· amp1e IZe = ss . . - - indicator values are in Perc-ent Urban% _, Rural% - · Country % :· . . . - Proportion of households using safe drinking water 98.4±0.4 82.0±1.0 90.2±0.6 ~Proportion of ho~sehold wHh access to an adequate amount SS=10065 SS=10034 SS=20099 98.3±0.4 79.8_±1.1 89.0_±0.6 · of safe drinking water within 15 minutes of dwelling or in SS=10065 SS=10034 SS=20099 dwelling Proportion of households with access to a sanitary facility I 86.0_±2.2 I 73.7_±2.8 80.5_±1.8 I I ! for human excreta disposal ! SS=10065 I SS=10034 SS=20099 I I f Proportion of children under 5 years with diarrhoea during I 12.8±1.4 I 16.9±1.3 15.2±1.0 the past 2 weeks from the date of interview i SS=4762 i SS=6953 I SS=11715 I I I Proportion of children under 5 years with diarrhoea I I I 34.9_±5.5 38.0_±4.1 ! 36.9_±3.3 I receiving ORS for treatment I SS=611 SS=1173 SS=1784 I I i I I l I i ; ! I ! I i ; ! I I I I ----, I Proportion of children under 5 years with diarrhoea i receiving ORS or increased fluids I . Proportion of children under 5 years with diarrhoea J receiving breast milk more or the same amount as before the [ 1 illness 8 68.1±5.3. ss 611 = 71.0_±5.2 SS=611 65.4±3.9 ss 1173 = 65.8_±3.9 SS=1173 66.3_±3.2 ss 1784 = 69.1_±3.1 SS=1784 I I MICS, September 1995 LR.Iran Table Two: Gen. Results of the MICS (continued) Urban% Rural% Country% Proportion of children under 5 years with diarrhoea 54.5;!:5.7 50.2;!:4.1 51.7;!:3.4 receiving water and liquids more or In the same amount as 5S=611 SS=1173 55=1784 before Proportion of children under 5 years with diarrhoea 49.0;!:5.7 51.8;!:4.1 50.8±3.4 receiving more food or the same amount of food 55=611 55=1173 5S=1784 Proportion of children under 36 months who were never 5.5±1.3 4.4±0.9 4.8;!:0.8 breast .fed 5S=2637 55=3957 55=6594 Proportion of children under 36 months who were breast- 79.1±2.2 85.4±1.6 83.0±1.3 feed for at least one year SS=2637 5S=3957 5S=6594 Proportion of Infants less than 6 months of age exclusively 33.7;!:6.5 47.3;!:5.9 41.5;!:4.4 breast-fed within past 24 hours 55=427 SS=579 5S=1006 Proportion of infants less than 4 months of age exclusively 45.8±9.0 59.0±7.5 53.4±5.7 breast-fed within past 24 hours 5S=262 55=356 5S=618 Proportion of infants less than 6 months of age exclusively 66.0;!:6.5 75.5;!:5.1 71.2;!:4.0 or predominantly breast-fed within past 24 hours 55=427 SS=579 SS=1006 . . ···········--· .•. . . ······-·· ······· ·-········ --· - . · -·- . . . . ····- -· . ·-· · · · ···•····· . . . . _______ , . . . ----------- ---- Proportion of Infants less than 4 months of age exclusively 81 ~3±7 .6 86.8±5.7 84.5±4.6 or predominantly breast-fed in the past 24 hours S5=262 SS=356 SS=618 Proportion of infants who had started weaning food between 76.0;!:7.9 70.7;!:7.0 72.0;!:5.3 I the age of 41 months S5=238 SS=338 SS=576 I Table Three: Anthropometric Results of the MIC5: Percent Under Two Standard Deviations From NCHS Standards, Urban- Rural 1 Indicators Urban i Rural : %Male %Female %Total %Male ! %Female %Total ' Sample Size 2417 2345 4762 3530 i 3423 6953 : I I Height for Age 10.9±1.8 13.3±2.0 12.2±1.4 25.3±2.1 ! 24.2;!:2.1 I 24.8;!:1.5 i j_ Weight for Age 12.1±1.9 14.4;!:2.0 13.3;!:1.4 19.0;!:1 .9 i 18.3;!:1.9 18.7;!:1.3 ' I l I Weight for 6.9;!:1.5 8.6;!:1.6 ! 7.8;!:1.1 l 5.7;!:1.1 6.3;!:1.2 6.0;!:0.8 Height i : L. 9 MICS, September 1995 LRiran Table Four: Anthropometric Results of the MICS: Percent Under Two Standard Deviations From NCHS Standards Total Male and Female Indicator %Male %Female %Total Sample Size 5947 5768 11715 Height for Age 19.5±1.5 18.4±1.5 18.9±1.0 Weight for Age 15.0±1 .3 16.3±1.4 15.7±1.0 Weight for Height 6.1±0.9 7.1±1.0 6.6±0.7 T bl F P a e 1ve: ercentage o fS evere an d M d t St f U d . h dW . o era e un mg, n erwe1g1 t, an ast1ng All figures in Percent TB TG Tot. UB UG UT RB RG RT Stunting Sever 5.2 5.3 5.3 2.6 3.2 2.9 8.4 7.8 8.1 Stunting Moderate 14.3 13.1 13.6 8.3 10.1 9.3 16.9 16.4 16.7 Stunting 19.5 18.4 18.9 10.9 13.3 12.2 25.3 24.2 24.8 · Severe & Mocterate - - --------·· . - ---·· ····----------- -- - - ·· -··· ---· ---·-·---- ·-·. -----·-···- . - ·- -. ---- Underweight Sever 2.7 3.1 2.9 1.8 1.8 1.8 3.8 3.8 3.8 ! Underweight 12.3 13.2 12.8 10.3 12.6 11.5 15.2 14.5114.9 ! Moderate ! Underweight 15.0 16.3 15.7 12.1 14.4 13.3 , 19.0 18.3 18.7 i Sever & Moderate I I Wasting Sever 0.4 0.8 0.6 0.8 0.9 0.8 I I 0.1 0.7 I I 0.4 i Wasting Moderate 5.7 6.3 6.0 6.8 5.3 6.1 4.9 7.1 l 6.0 i Wasting 6.1 7.1 6.6 7.6 6.2 6.9 5.0 I 7.8 16.4 ! j Sever & Moderate · l I ' -'--- Please Note: TB= Total Boys; TG =Total Girls; Tot.=Total; UB=Urban Boys;·uG =Urban Girls; UT= Urban Total; RB = Rural Boys; RG = Rural Girls; RT = Rural Totai.(Continued) Stunting = Height for Age; Underweight = Weight for Age; Wasting = Weight for Height. Severe = Below -3SD; Moderate = Between -2SD and -350; Mod. & 5ev. = Below -250 10 MICS, September 1995 LR.Iran To obtain the national averages in the anthropometric modules, a sample from the totality was obtained, since EPI Info's anthropometric section could not handle more than 2500 children at a time. There is a section in the EPI Info software that automatically draws a random sample from the larger sample in its memory. Therefore, the analysis for each anthropometric section has been done on a drawn sample of 2500 from the sample sizes mentioned in the tables. The margins of error for table five were not calculated. But, it is understood that as the sample size becomes smaller, the margins of error generally increases. Provincial data from the survey can be obtained, but with a larger margin of error. They will be used for comparative analysis. The provincial data, although not presented in this final version of the MICS report, is available at the MOH&ME. The provincial results of the Access to Safe Drinking Water indicator is presented in a map on page twelve. The specific results from the MICS will be presented in the next sections of this report. 11 MICS, September 1995 LR.Iran · V.2. Specific Results: V.2.1. Water and Sanitation: Map One: The safe drinking water module results are presented below. ACCESS TO SAFE DRINKING WATER MICS OF I.R.IRA,.N; SEPTEMBER, 1995 12 I< ·J 67.0 to 84.0 ~ 84.1 to 90.0 ~ 90.1 to 95.0 ~ 95.1 to 100.0 MICS, September 1995 LRiran T bl s· A a e IX: ccessto ae nn 1ng Sf D. k. W ater 1n ura, . R I Urb an an dT ota areas. Indicator Urban Rural Total Access to Piped Water 96.1% 65.7% 80.9% Access to Sanitized Well 2.0% 14.5% 8.2% or Spring Chlorinated or Boiled 0.3% 1.7% 1.0% Water Non-sanitary Water 1.6% 18.1% 9.8% Total 100% 100% 100% T bl S a e even: T ·t t k t lmel a es oge t S f D . k. W t . R ae nn 1ng a er 1n ura an dUb r an areas. In House <5Min. 5-15 Min. 15-30 Min 0.5-1Hour >1 Hour I Urban 98.3% 0.8% 0.6% 0.1% 0.1% 0.1% Rural ·····-- -·· -77.3% . 9.1% . . . ·-- 8.9% ·2A% . . . ·····1,3% . . . 1,1% ----·--------- . V.2.2 Breastfeeding Results: The following three charts show the breastfeeding results of the MICS. The graphs show the survival pattern of breastfeeding in infants, disaggregated by location and sex. The graphs were derived using the SPSS version 5 package, Survival Analysis section. The difference between the trends in boys and girls, and urban and rural areas, is not statistically significant. Until one years of age, more than 80% of children are stiil breastfed. Until 24 months of age, this figure declines to 50%. 13 . ---- - ··- - . - - ----- . ···--·- --- Porpotion at ·lntants Less tnan ~ IVIontns: t:xc1us1ve1y 8reas~fPa Islamic Republic of Iran 70 60 50 40 30 20 10 I I , --- --s9 ___ _ -- .- - -- -- .-- - ------- . 53.4 o~~----~~~~~~~~~~~------~ :, Rural Urban Total Boys Girls Total · Source: ~''listry of Health and Medical Ed11cation; MICS of 1995 Probability of Continued Breastfe~ding for Ever-Breastfed Childi\\1) Islamic Republic of Iran · i Probability I ' 1.2 r--------------;------- ---·--------------, . 1 . - . . - - - - - - . . - ·- - - - - . - - - . 0.8 0.6 -. •.-- . --.- . . --- . --.- . 0.4 . -. . -. -.- --- . . -.--. 0.2 . . • . -. -. . . --. - . :· . . --.-. ---- -.- . --.-. -. . -- -- -- I, o~------~----------~----------------~ 0 5 10 . MICS of Sept. 1995, I.R. Iran 15 : 20 Age in :Months 1-~ Boys + Girls I 25 30 35 Probability of Continued Breastfe~ding In Ever-Breastfed Childr~n Islamic Republic of Iran ·Probability 1.2 .------------~------··· - - ·· · ·· · ··········-·---·-----·-------------- 0.8 0.6 0.4 . . -. . . . . . . . . . . -. · . . . . . . . 0.2 . . -. . . . . . . . . . -. . . . 0~----------------~~------------------~ 0 5 10 15 20 25 30 35 MICS, September 1995 LR.Iran V.2.3 Complementary Feeding Results: The two graphs show the cumulative probability of initiating complementary feeding. They show that until six months of age more than 80 percent of children have initiated complementary feeding. The difference between the trends in boys and girls, rural and urban areas, is not statistically significant. 17 ; ; Probability of Initiating Qomplementary Feeding Islamic Republic of Iran ----------- ---- -- --· - ·· ----- ·- · . . . . . . . . . . . . -- ·· ··- ----------- Probability 1 2 ,--------- ---------------- - --····--·-····-· -------·-··· ·· ·--- - · · ··--·· · · · · ·· - -· -- - - - -- ~-- --·-·· · -·· . . ---- . - 0.8 -- --- ----- - --- -- ---- ------------ '_---- -- ---- . . . . --- . . . -. -. - ---- 0.6 ---- ------------- - ------ ----.---- -. ------ . . -. 0.4 ---- :·· ·------ ·------ --- ----- ----- -- -- . . ---- . ----- . . . . -. . . -. . . -. -. . -. 0.2 -- -. - . ----. ---.-- . . -- -- . -. -- .•- . -- --. . --- . . -. . . - -. . . 0 5 10 15 20 25 30 35 Age in Months ------~l ; oys -+-- Girls -------~_j_ ____ __________ _ MICS of Sept. 1995, I.R. Iran ' Probability of Initiating ¢omplementary Feedin~ Islamic Rep~blic of Iran ----- Probability 1.2.--- l 0.8 . . . . . -. . . -.- -. . . . . . . ;.' . . . . . . . . . . . 0.6 -. . -.- . . --- . . . . . . . . . ·1 · : - . . -. - . . . . . . . . -++ + + --1 - 0.4 ' . . . -- . . . . . . . . . . . . . . ! . . . . . . . . . . . . . . . . . . . . 0.2 . ·.:.- . -- . . -. -. -. . . -. --. . . -- . . -. . . -. . . . . . . . . --. . . . . . . 0 5 10 15 : 20 I 25 30 35 Age i~ Months -- Urban i -+-Rural [ ·, __________ : __ ____ __ j MICS of Sept. 1995, I.R. Iran MICS, September 1995 LRiran V.2.4 Infant Formula Feeding Results: These two graphs show the cumulative probability of initiating infant formula feeding for each age group. The probability of initiating infant formula feeding at birth is less than five percent, and increases to a maximum of 23 percent at age of 12 months. The difference between the trends in boys and girls is not statistically significant. However, there is a statistically significant difference between the trend of initiating infant formula feeding in rural versus urban areas. In urban areas this cumulative probability reaches a maximum of 27 percent in urban areas, while it reaches only 18 percent in rural areas. This maximum value is reached at 12 months of age. 20 Probability of Initiating ~nfant Formula Feediri~ Islamic Rep1Jblic of Iran . . - ----·- -------·----- ------ · --·· ··- - --····- · · -- ----------------- --------------- i Probability 0.25r--- ----------· - ----- ----·----;-:-- ---------------·---·· ·- ··· ··· ······ ·--. . . -· . ·····------· ···---- . . ··-· -·-----1 ______,.-~=r~-~:r=t:~-=r--:r=r-~r~=-r:=r~--r==r - - 0.15 . -. . . . . . . . . . . · . . . . . . . ;_: . . . . . . . . 0.1 -- - . . . . . . . . . . . . . . . . -. . . ·.- . . . . . . . . . 0.05 . -. . . -. . . . . . . . -. . . . ·,· . -. . . . . . . . . '; '' 0 '------- ----.:.;__ - 0 5 10 15 i: 20 Age in Months ~oy~ 7~~irls I MICS of Sept. 1995, I.R. Iran I I ___________ __________ j 25 30 35 Probability of Initiating ~hfant Formula Feeding Islamic Rep~blic of Iran i ---- ---- ----- -- - -- - - -------- ----- ----------------- -··- ---- --- ------- ---- --- -- ----- . i Probability 0.35r----- i i. ' - - - ---- ----- -------------- ----- ------- ---- - ---· -- --- ------------ --- ---1 ; I ! • I 0 3 . --. -. . -. . . -. -. . . -. _! : . . . . . . :_,.11 - -'- -a~-----'---'---'--il-~11---'-a- -'-ll'- -'-111 '--'-' • It- • . • -- •• -.-~ ~ 0.25 ------- --- -. . . -. . . . . . . . . . -. . . . 0.2 --.- . . . --. -- -- --- . . . -- . . . : -. -. . . . . . . . . . . . . . ___.---.---vJ- I i I I [.1 I I I I I I - -t--+---f-t-t-+--+--~--+-1- --+ 0.15 . -. -- .- - -- . --- . . -.- . --- --. - . '- ----. -. . --.- . . -. -. . . . . -. . . . . 0.1 ---- -. -- -- --·-.--- ---.- . --- . . . :. -. . . . . . --. -. . . . . . -. -. . 0.05 - - - - - - - - - . - - - - - - - . - - . - - - - - . -. . , - - - - - . - - . - - - - - - . '. o~------------- -~-----~- o 5 10 15 20 25 30 35 ; Age it:l Months i [~ - Urban : + Rural ---- -- 1 MICS of Sept. 1995, I.R. Iran I: i i ! i MICS, September 1995 LR.Iran V.2.5 Anthropometric Results: The anthropometric results are presented in four categories: - Underweight disaggregated by gender and area - Growth trend is presented disaggregated by gender and area - Wasting disaggregated by gender and area - Stunting disaggregated by gender and area. The growth trend is shown by plotting the median of the weight of all children of the each age group on a standard growth monitoring chart. The 97, 50, and third percentile lines are shown as a solid line. These are reference lines. The survey result is shown as a dotted line. In the draft versions of this report, the mean of each age group was plotted. In this final version, the median of the age group is plotted, and a best fitted line is passed through the points. The fitted line method resulted in a smooth line. While if we were to connect the age group dots one by one, we would have a jagged line. It is interesting to note that the median and the mean of the age groups are very close together. 23 MICS, September 1995 LR.Iran V.2.5.1 Underweight disaggregated t.;y gender and area 24 - -· - -- ------ - - - --- -- - -- - ·--- - --- - ~ -- --· -- -- --~- --- - ····- - - ---· - -~ -- - ---- ·-- - Underweight Below T~o Standard Deviatioms Islamic Rep~blic of Iran Percent 25 20 .• 15 10 5' ---·-·--··--- o~==~~~~~~~~~~~~~~ 12 - 23 :24 - 35 36 - 4 7 48 - 60 0-5 6- 11 MICS of Snpt. 1995, I.R. Iran I Age in Months ~Boys •rzzJ Girls I ' l ' ' I - --- -- - ·· - --- -- ~-- - -- --· - -- - - --· - · - - ·-··-· - --· -- - --· -- - -- - ···- ---- - ·· · - -- ·· - - ·- . . Underweight Below T~o Standard DeviatioAs Islamic Rep~blic of Iran i ; _________ .____r--1. ---- -- --·----------·---· I Percent 30 . 25 . · . 20. 0 - 5 6 - 11 12 - 23 24 - 35 36 - 4 7 48 - 60 I Age in M,onths i; I• Rural ~ Urbaij iv'liCS of S . ot. 1995, I.R. Iran - - ~ - - -- - -- -- - -- - - - ---- - - - - - - - - - -- - - ---- - - - - - ' -. ~ \.; Underweight Below Two St~ndard Deviations - Urblin Islamic Republic of Iran -----------·------------- Percent 25 19.3 . 20 15 ' 10 . 5 0 0-5 6 - 11 12 - 23 24 - 35 36 - 4 7 48 - 60 Age in Mpnths I• Boys ~Girls I MICS of s~ot. 1995, I.R. Iran unaerwe1gnt tselow 1wo ~ . naara uev1at1ons·- Hural Islamic Rep ~ blic of Iran ; . ··--~----------+-.,.--------·-----·-·--- ----- Percent 15 10 5 0 IV11CS of SP.pt. 1995, I.A. Iran Age in [ • Boy~~~ iris ; ! : ! I i i ; 36-47 48- 60 1 _. ~ MICS, September 1995 LR.Iran V.2.5.2 Growth trend disaggregated by gender and area 29 .:: 2 131415161718192021222324 I I • • I I I • • • I • Ll_l _ __Ll_j _ _LI I I I J ! SECOND i I } ~ 3 4 s 6 7 8 9 1011 12 u_t 1 __ 1 I. _Ll I I I I J FIRST 1 i ' YICAH r·· --r---- lFJo: ----- --- -- -- 1 2 3 4 5 6 7 8 9 10 11 12 i. l 1 I .I I I ll I I I I YEAR OF :LIFF FTR' 2 ' r-t- 131415161718192021222324 111•~1 I IIIlA I IIIII Ll_Ll I I I I l__ll_J SECOND Ul 2 3 4 5 6 7 8 9 1011 12 I ' __ I LJ_l__LLUJ THIRD i ' . ' YkAL l ll-'1:: ------ 2r-t-t-++-4--+-1~~---!-J 131415161718192021222324 1 Ia • • 1 1 1 I • 1 1 LJ_L.l.l I I I I I I I SECOND } ~ 3 4 56 7 8 9101112 _1_1 L.l J_L! I I I I I FTR"'T' l·'OURTH+ F IF Ill THIRD YEAR ( .lFE _.,. ___ _ -- --------------------- ------------- --- ---- --- ---·- - -- -- - ·- · - -- -- ·• ~ '· -:~ i' ~:~ ~ ·--~: . ~~: ; :- .•· ii: i;· ; ' ·' . ·· ~: !:~ 15 . . ~:.~;. J) 14 '-:· · 13 . ;, 12 E-<1 ·' ;I:! I 01 ll HI !:ill ~· 10 9 8 7 6 5 (' ! I l ! l! l i . I: 4 i. I' I I 'l i i II' • I 1' FOURTH + F If' Il-l 4 3 2 'I~ ,--T- 252627282930313233343536 n,t-v-t-t---t-t-++-+-+-+-+--+L. u.lta' •.u•w•u.ll.I••JJ•LL•ll.U a.,ili Ul I I I I I lllJ ·t-+-t-t-+--4-+--+-+--+-~-1131415161718192021222324: ' THIRD , tla Ia • • • I • • • Ia ; • I I I I I I I I I I I I SECOND 1 2 3 4 5 6 7 8 9 10 11 12 ~I ___LL L I I I I I l J yg~- LIFE FIRST i. ' ' 1. \ -{ 15 14 13 12 11 10 E-<1 9 :X: I c.!> I HI 8 ~~ 7 6 5 4 3 '2 --- ------- ---- -- ·------- -- -------- ------ -- -- -- --- -- -- -- --- -- -- - - -- ---- -------- -- ----- --- -------- ----- ---- --- --- I I Islamic Republic of Iran Rural Under Five Girls Median Weight of Age Group MICS of September 1995 19 ;s . ~,~lf rrr rrr ···~ 1 7 . . - - --- i ! I I ' I v 16 -i -- -~ t . I . . I ' I l -r- - J,V rT·- ~ - -. ~- - ·: ~ Jl +-·- ··--· i.U . j~l l PfT ··r r - - --~ -- ·· 1 - -r- - , -\ - -~ l ~-- r J • (.-V : . I I : ! . ' ~ -+ --~- . ~-:-~ - -- -i j, v ,_.v L--"~-"- _i I ; j i I, ' ' ' t -- -- - 1 v ' , I I I: I I I ' v~ --t-- ,_ _ --+- - --~~ k-- -- T r- t-- ,+_.J_ --t-- ~ I .L ~ U ~;- I --~·-·.v RTftf-!./~ ~ - ~-. -- -- -t- ~-I ·:_.:·:;_'1--r- f- - -- ·· -jl Trr- v vv~}t---i- ~ J:o~H/~ . ;, · :;II l-j' r-->- v / - -< e it 1 ' I ' I I 7 \ .-- - n- -· -· -r-~ - 1· · r r I ~ j ;. '-J v v - - - 1.-~J- I ! ! I : I i I I I 1/ _,{_- - - -_.vv [±T -+JL:-JTj+Tt+tl H lf - - vi--' L I . ' m I : 1 I j 1 1-l . IV,'Y "-~ - ·t ±i-- ±t+~rH I ' v til - lrn. L . I I ~ I ' I Y .,., . I I .tJJ±l Ttl-'ITt'/3t?J43n 131415161718192021222324 THIRD It I• I. I I I •• • • I I LU_llll!LliJ SECOND i Lll 3 4 5 6 7 8 9 1011 12 _j l .L_LLLI I I I ., ·-. YEAR Of ·1~ ---"1"""~--- . RST FOURTII + F lF l H ; · Islamic Republic of Iran Rural Under Five Boys Median Weight of Age Group MICS of September 1995 '2r-r-r-t-t-+-+--+-+-+-+-+-J 131415161718192021222324 I,. I • I I I •• I• • Ul I I I I I I l I I SECOND 1 1 2 3 4 5 6 7 8 9 1011 12 I I I I I I I I I I I THIRD YEAR OF L' _____ .;. ___ _ i i i I . ' . FOURTH+ flfiH -··--- --- - ·- - ··-~ __ . _ ---· ._ ____ ----- ------ ------ --- - . · · ---- 15 14 13 12 11 10 , .;I ;J:!l 9 :.:>1 .-ll ·~ ':0:1 8 7 6 5 4 3 '2 t-t-+-t-+-+-+-+-+---+-4----4----1 13 14 15 16 l 718 l 9 2 0 2 12 2 2 3 2 4 ltliii I. I I I• • I II • Ul_l I l_l__LiJ_Jj SECOND I l 2 3 4 5 6 7 8 9 1011 12 I I . I I i__ ! I I I l J ~Tt· • THIRD i' l Yl:AR Or~ LIF1 -------;---- . ·· , \ ' ' . ' . . · ~ : ~- 15 14 ., 13 12 HI P::l 11 c.!) I HI ~~ 10 9 8 7 . , .' ·~·.' · : ~ - 6 5 4 3 2 THltW ·1-+-+-+--4--4--+--l-l -+-+--+---4 13 14 15 16 l 7 18 l 9 2 0 2 12:?. 2 3 2 ,, ' I I l• • • • I • • - . ' • I I I LJ_j_l_j_j_J__ll_Llj S£COND u_ 1 2 :. 4 5 6 7 8 9 10 11 12 I 1_1 Jj_J I I I I I Yr:ARC :I --- - - -- --- --- MICS, September 1995 LR.Iran V.2.5.3 Wasting disaggregated by gender and area 39 . . Wasting Below Two ~tandard Deviatiofis · Islamic Rep~blic of Iran Percent 12 10 . 8 ' 6 4 2 ' o~~~==~~~~~~~~~--~~ 0-5 6-11 12-23 124-35 36-47 48-60 MICS of s~pt. 1995, I.A. Iran Age in ~onths I• Boys '~ Girls I i . ! I ' '. '' i: i. Wasting Below Two !Standard Deviation:s Islamic Repiublic of Iran ! Percent . . . . . . ·····-··············· . . ::: ::::::::::::::::::::::::::::::::. '" ,. """'7s·· , """ . . : 8~·/: , .• ···~· . . 10~ 8 6 4 2 0~~~~~~~~ MICS of S~pt. 1995, I.A. Iran Age in Months I• Rural ~~Urban I .:::::::: : . ::::::::: . . . ········· . . ~~:~:~~~~: :;~~~:~;~~~~::~: . . . < • Wasting Below Two Stancfard Deviations - Urbln Islamic Rep~blic of Iran Percent 12 ::, 10 :': 8 !::'i!~!! l L!!!!! 6 '!:U~ ~ 4 2 0 - 5 6 - 11 12 - 23 !24 - 35 36 - 4 7 48 - 60 i. ' Age in fv1pnths ; ' I• Boys ~ ~Girls I MICS of s~pt. 1995, I.A. Iran '' : Wasting Below Two St~ndard Deviation - Rur,al Islamic Rep 1 ublic of Iran 12 10 Percent 8 ; 6: 4' 2= 0 :. ::::::::::::::::::::::::::::::::::::::::::::::::::: ::.····:::::··· :::::·:::··:·:·::·. ::···:::::::::::: ::::::::::::::::::::::::: . ., . ,. '----->l'"''"'''··j'i·i~Ji:·······~~·G·j .••. :····1·····~ :~···~·=·~·••~••~·••~•• i••"'••H••t••::•. 0 - 5 6- 11 12 - 23 :24- 35 36 - 47 48 - 60 MICS of ~qpt. 1995, I.A. Iran Age in Months I• Boys @Girls I ~--------~ MICS, September 1995 LR.Iran V.2.5.4 Stunting disaggregated by gender and area 44 Stunting Below Twoj Standard DeviatiG)n Islamic ReplJblic of Iran Percent . . . . . ; ; ; ::::::::::::::::::::. ::::;: :::::::: :; : :::~:::::: . : :: ~ ~:~ ~ ~; ~: : ; ~ ~ ~ ~ ::: :; :: . >:: :::::••.::·:: , •••.• . , •••••••••• ::: ·:·: : •• :.:::••-.:·:·::::: ··········· ~ · -:•••:•.•:: :::•:::•• :•: , .•••.••.•• : . . ::::: . . . . ·:: ~ ~: ~:~:: ; ; ~ ~~~~ ~ ~ ~ ~~ ~~::~~~~ 15 . . •:::••::::::::::::::::::::.::• 10 ·: :. -~~~~ 5 • 0~~~~~~~~~~~~~~~ MICS of Sept. 1995, I.R. Iran 12 - 23 24 - 35 36 - 4 7 ; ; Age in Months l•soys i ~Girls I · ·- ·- -· ··-··- ·- ··~ . -- --- ·-·- -- . · ··--- -········ ·~ . --- - ·· •··· ··- Stunting Below Two jStandard Devii:ltiOAS Islamic Rep~blic of Iran 35 30. ' 25 20. 15 . . 10' ·· '~ .J--- 5 i 27.9 -- :" . "23.6 -. 25,8. . . . . . . . 0 - 5 6 - 11 12 - 23 24 - 35 36 - 4 7 48 - 60 I• Rural ~~ Urban I ! ! MICS of 8~pt. 1995, I.R. Iran ! ' '; ! : Stunting Below Two Stardard uev1at1ons - Hu'-al Islamic Rep:ublic of Iran Percent 40 20 10 0 - 5 6 - 11 12 - 23 24 - 35 36 - 4 7 48 - 60 Age in ~onths I• Boys :·~ Girls I MICS of S~pt. 1995, I.A. Iran ----- ------- - -------. - - - ---- - - - ----- - ··-- ------------ -- ····· -· ··--··- -- Stunting ·Below Two ~taniaara uev1at1or 1:s - ·ul uaa• Islamic RepYblic of Iran ____________ __;.__ ________ ----------- - Percent a~~~~~~~~~~~~~~~~~~ 6-11 12-23 :24-35 36-47 48-60 0-5 ! Age in Months :: !•Boys / ~Girls I MICS of ~ept. 1995, I.A. Iran I ! ' I ' ' MICS, September 1995 LR.Iran VI. Conclusion: As can be seen from the results of the MICS and the annexes to this report, alt of the Mid- Decade Goals have been reached except the achievement of 80% usage of ORT as part of COD. We are approximately 10 percentage points away from this goal. A concentration of efforts to attain a higher usage of ORT must be organized if this goal is to be attained. The results shows that the incidence of diarrhoea is 15.2 percent in the past two week of the survey. This figure translates to 4 episodes per child per year (15.2 x 26%=3.95). The 1991 cluster survey showed 3.6 episodes per child per year and that of 1987 five episodes. All of the indications point to the fact that the COD programme of Iran should redouble its efforts to achieve this Mid-Decade Goal. The achievements in immunization has been exceptional. With the help of this feat, Iran has been able to establish a barrier in front of the importation of polio and other EPI diseases from the neighboring countries. Afghanistan and Pakistan, two of the neighboring countries, have the highest incidence of polio rates in the world. It is believed that the work of the MOH&ME has been exceptional on all fronts of the MDG . . . . The . achiev~m~nt ot t11ese goals . has. been. due to lhe exceptionaL dedication oL!be . _ - personnel of this ministry and those government organizations collaborating with this ministry. Almost all achievements have been sustained, bringing the Year 2000 goals within easy reach of the Islamic Republic of Iran. 49 MICS, September 1995 LR.Iran " i Annex One List of Mid-Decade and End-Decade Goals 50 MICS, September 1995 LRiran MID-DECADE GOALS In order to maintain a sense of urgency, most of the developing world's governments have agreed to try to reach a limited number of goals by the middle of the decade. The following were considered achievable by the end of 1995: *Elimination of neonatal tetanus * Reduction of measles morbidity by 90% * Reduction of measles mortality by 95% * Achievement of 80% ORT use for diarrhoeal disease *Eradication of polio (certain countries) * Elimination of iodine deficiency disorders * Success of the 'baby-friendly hospital initiative' - ··-:- * EliminationofvitamlrrAde1iciency·- ------- --------- --- * Elimination of guinea worm * Achievement of 80% immunization in all countries The following is the full list of goals, to be attained by the year 2000, which were adopted by the World Summit for Children on 30 September 1990. These goals were characterized as being technically and financially feasible. Overall goals 1990-2000 *A one-third reduction in under-five death rates (or a reduction to below 70 per 1,000 live births- whichever is lower). *A halving of maternal mortality rates. *A halving of severe and moderate malnutrition among the world's under-fives. 51 MICS, September 1995 LRiran • Safe water and sanitation for all families. • Basic education for all children and completion of primary education by at least 80%. • A halving of the adult illiteracy rate and the achievement of equal educational opportunity for males and females. • Protection for the many millions of children in especially difficult circumstances and the acceptance and observance, in all countries, of the recently adopted Convention on the Rights of the Child. In particular, the 1990s should see rapidly growing acceptance of the idea of special protection for children in time of war. Protection for girls and women • Family planning education and services to be made available to all couples to empower them to prevent unwanted pregnancies and births which are 'too many and too close' and to women who are 'too young or too old'. Such services should be adapted to each country's cultural, religious, and social traditions. * All women to have access to prenatal care, a trained attendant during childbirth and -:_ ~--- -feferralfacilities for-high~risk pregnancies and obstetric emergencies: ·--- -· -··· -- ------· -··· • Universal recognition of the special health and nutritional needs of females during early childhood, adolescence, pregnancy, and lactation. Education In addition to the expansion of primary school education and its equivalents, today's essential knowledge and life skills could be put at the disposal of all families by mobilizing today's vastly increased communications capacity. Nutrition *A reduction in the incidence of low birth weight (under 2.5 kg.) to less than 10%. *A one-third reduction in iron deficiency anaemia among women. *Virtual elimination of vitamin A deficiency and iodine deficiency disorders. • All families to know the importance of supporting women in the task of exclusive breast- feeding for the first four to six months of a child's life. 52 MICS, September 1995 LR.Iran *Growth monitoring and promotion to be institutionalized in all countries. *Dissemination of knowledge to enable all families to ensure household food security. Child health *The eradication of polio. *The elimination of neonatal tetanus (by 1995). *A 90% reduction in measles cases and a 95% reduction in measles deaths, compared to pre-immunization levels. *Achievement and maintenance of at least 90% immunization coverage of one-year-old children and universal tetanus immunization for women in the childbearing years. • A halving of child deaths caused by diarrhoea and a 25% reduction in the incidence of diarrhoeal diseases. • A one-third reduction in child deaths caused by acute respiratory infections. * The elimination of guinea worm disease. 53 MICS, September 1995 LR.Iran --- - -- -- - -- ---- ----- --- ---- -:-Annex Two A List of Mid-Decade Goals Indicator Values 54 MICS, September 1995 Base Line and Final Values for MDG Indicators Islamic Republic of Iran Oct. 1995 1. Immunizations 1989* 1990** 1993' 1995" BCG 95% 91% 99% 99% OPT3 93% 88% 99% 97% Polio3 91% 88% 99% 97% Measles 83% 84% 96% 95% Tetanus• 47% 77% 50%++ 82% *Pregnant women ++Please note that definition was changed in this time period. LR.Iran (Ref: *SOWC 1992, -sowc 1993,'SOWC 1995," MOH&ME EPI Cluster Survey of 1995) ~ NNT 1990 1992 1993 1994 Incidence rate/1000 live births 0.056 0.014 0.014 0.015 No. Of Cases 26 18 12 21 The district of Zahedan has the highest cases of NNT; incidence rate is 0.7 per 1000 live births. (Ref: Mid-Decade Goals, Declaration of Achievements in the Islamic Republic of Iran. 1995; The Government of the Islamic Republic of Iran.) 55 MICS, September 1995 3. Measles: 1984 1989 1990 1991 1992 1993 1994 1995 Incidence rate/100,000 75.4 10.0 9.5 10.4 8.8 7.9 1.0 0.5 (549 cases reported) (287 cases reported as of Sept. 95) LR.Iran (Ref: A brief report of EPI target diseases & Polio NIDs, IR.IRAN 1993, Dr. M. Azmoudeh and Dr. P. Vazirian, and for 1994 MOH&ME and MTR for Immunization Programmes of MOH&ME, 1995) Reported mortality due to measles in 1994 was zero cases. 4. Polio Eradication Polio cases** AFP 1991 55 67 1992 45 83 1993 108 177 1995 71 229. *As of September 1995 -These figures include the non-lranians seeking cure in the I. R. of Iran. (Ref: Mid-Decade Goals, Declaration of Achievements in the Islamic Republic of Iran. 1995; The Government of the Islamic Republic of Iran.) ~ Vitamin A Iran is not a Vitamin A deficient area. (Ref: MOH&ME) 56 . . . ·--· . ·---·----------- MICS, September 1995 ~ IDD: Universal Salt lodization: Adequately iodized salt at the household level. 1994 1995 Rural 52 76 Urban 76 87 Total 65 82 LR.Iran Iodizes salt needs within the country: 240,000 MTON/year (4 kg per capita) Iodized salt produced within the country: 396,000 MTON/year by 52 companies. (Ref: MOH&ME) 7. ORT Deaths associated with Diarrhoea "" 1987 1988 1991 1995 34,000 13,200 10,000 4,000 ORT Use Rate 71 (SOWC 1992) 69.1 (MICS 1995) ORT use rate as part of COD ·1995 (Ref: MICS 1995) Urban Rural Total 68.1 65.4 66.3 ORS use rate as part of COD -1995 (Ref: MICS 1995) Urban Rural Total 34.9 38.0 36.9 (For all non stated reference, Ref: MOH&ME) 57 I . ~-· : .1· I Percentage of Diarrhoea Cases in Age Groups ~~t ;C\~\ ······ · ·········· · · I . . . . ·- · ~· · ·· ·- ··· ·-··· ·-·1 I ···12oi ·········· ··· ~ ____ j ---- ---·- -·- --------- - ---- ~ ~ ~ 15 t ·· ··· . '~ 101 ~ 1 ~~ 5 L . -----f-: -- -~-------- ' 0 2 3 4 Age in Years ::~ . J I i ! - -----·- - ·----- -- ·- --------------- • I I MICS, September 1995 12. Basic Education Number of Boys and Girls In Primary School 1990 1995 No. Of Girls 3718098 4670563 No. Of Boys 4544343 5266806 %Gap 10 6 LR.Iran In 1993, 90% of female students and 92% of male students reached grade four, end of primary education. Female Male Total 1994 Gross Enrolment 105 117 110 1994 Net Enrolment 93 99 96 1994 Grade IV Completion Rate 93 94 93 1994 Grade V Completion Rate -- -··· -so ·92 . -- 91 •·- Drop out rate by grade 4 in 1994 was 3 percent. (Ref: Ministry of Education) 13. Water and Sanitation: 1987 (Ref.: SOWC 1990) 1990 (Ref: SOWC 1992) 1995 (Ref: MICS of 1995) 88-91 (Ref: SOWC 1994) 1995 (Ref: MICS of 1995) Access to Safe Drinking Water Rural Urban Total 55 76 82.0 95 98 98.4 Access to Sanitation 76 89 90.2 Rural Urban T ot'al 35 73.7 59 100 36.0 71 80.5 MICS, September 1995 LR.Iran 14. Other Survey Results: P I f I d' & U f I d. d S It OPU a 10n n IceS sageo 0 IZe a INDICATORS URBAN RURAL TOTAL Crude Birth Rate 20.4 25.4 22.5 General Fertility Rate 84.2 121.3 100.9 Total Fertility Rate 2.7 4.2 3.3 Population Growth Rate 1.5 2 1.75 Neonatal Mortality Rate /1000 L.B. 17.6 23.7 20.3 Infant Mortality Rate /1000 L.B. 20.3 38.3 28 Under Five Mortality Rate /1000 L.B. 25.2 48 35 %of contraceptive use rate: I -Pills 19.8 26.9 22.8 -Condoms 6.6 4.5 5.7 ·I.U.D. 9 4.6 7.1 -Tubal Ligation 13.8 13.5 13.7 -Vasectomy 1.8 0.7 1.3 -Norplant & Injections 0.7 2.2 I 1.3 i -All Effective Methods . 51.7 . 52,4 I . 52 r ·- I . . i Percentage of Total Population using Iodized Salt 87 I 76 82.3 Source: . Cluster survey on Famrly Plannrng, Mrnrstry of Health & Medical Education; May 1995. Immunization Coverage (Percentage) in under one-year old Children and Pregnant Women: ANTIGEN URBAN RURAL TOTAL BCG 99.3 98.7 99 ----------~------------~ DPT3 ! 96.5 98.5 97.4 '--t"" ------ ·· OPV3 I 96.5 98.5 97.4 ---+ ---·---- ------- -- Measles 94.7 95 94.8 ··----- - ---·- - -- - -- - ' L HBV3 75.8 -----: ---- 87.3_ _ ___ __ --·-- -- - --~0.6 . . . j TI2 pregnant women 72.9 l 93.9 82 Source: Cluster survey on Immunization for under one-year old children and pregnant women, Ministry of Health & Medical Educat;on; April1995. 60 I ! ' I • I - ---- - --- -- -----~- MICS, September 1995 -· ·- Annex Three The MICS Questionnaire Unofficial Translation and Farsi Version 61 LR.Iran ~­--~ .,.,. i . ·· ·· ·- ·· ·· ····· MICS, September 1995 IN THE NAME OF GOD Questionnaire for the Survey of the MDG in the Islamic Republic of Iran, September of 1995 Date ID <idnum> CODE il!lfi!IJJJillf! AA- FAMILY INFORMATION SECTION {1} Province ## Name of District Name of City ___ _ Name of Subdistrict-~~--- {2} Residency (1-Urban; 2-Rural) # {3} Cluster Number### {4} Family Number in Cluster## LR.Iran {5} Presence of the Family (1-lnterview took place;2-lnterview did not take place after three visits to the location) # Household Address------------- Name and Surname of the Head of Household---------- BB - ENVIRONMENTAL HEALTH SECTION ·:··---:- {6-}F-amilySize -## -··· ----- -- - --- ··- -- --- - --- - - --·· ------ ----- --· -- -- ------ - ----- --- --· - ---- ---- -- ------------- ----- {7} How do you provide your water supply # (1- Use from piped water;2-Use from a sanitary source such as covered and chlorinated well;3- Boiled water and cooled or chlorinated water;4-0ther mentioning source ) {8} How much time do you need to get water (in minutes)## If water accessible in the house use the code "00" and if more than 99 minutes use the code "99". {9} Whether the household has a toilet with all of the conditions or not: # According to the latest instructions from Water and Sanitation Department of MOH&ME. Tehran (1-Yes, Sanitary; 2-Yes, Non-sanitary; 3- No) {10} Do you have any under five children (1- Yes; 2- No) # {11} How many under five children (Born after 22 September 1990) do you have # (12) Please fill out the following table for all under five children : Child NO. Name and Surname Sex Actual date of Birth 1 2 3 4 5 1 Girl 2-Boy Day Month Year 62 Age in Months i I , MICS, September 1995 ID <idnum> CODE il!!f!l'lil!fi!H CC - UNDER-FIVE SECTION Please fill out the following sections for once for each under five child you find. {1} Age (According to Question 12 of last section)## {2}Sex of underfive child (1- Girl; 2- Boy) # {3} WEIGHT (in kilo grams)##.### {4} HEIGHT ( in centimeters)### {5} Did the child get diarrhoea during last two weeks(1-Yes; 2-No) # IF Response of Question (5) is YES Please indicate the amount of each item below consumed by the child relative to prior to diarrhoea: {6} Breast milk(1-Totally stopped;2-Less than before;3-Same as before;4-More than before) # {7} Water and Liquid(1-Totally stopped;2-Less than before;3-Same as before;4-More than before) # {8} Food (1-Totally stopped;2-Less than before;3-Same as before;4-More than before) # ________ _ . __ - " ____ Jotbecss_ethat thequestion.does.noLapply,-suchthatthe-chiiddoes-net <irinkmHk. ~ithe:r -- -- ·- . · before or after the diarrhoea incidence, please wdte the code 9 next to the item. To cure the diarrhoea what did you use: {9} ORS (1-Yes; 2-No) # {10} Anti-diarrhoea drugs (1-Yes; 2-No) # (11} Home remedy (1-Yes; 2-No) # {12} Intravenous serum (1-Yes; 2-No) DO - UNDER 36 MONTH SECTION {13} Age (According to Question 12 of last section)## {14}Sex of under five child (1- Girl; 2- Boy) # {15} Did you feed your child by breast feeding (1-Yes;2-No) # {16} If yes till what age (in months)## {17} Did you feed your child by formula (1-Yes;2-No) # If a negative answer was given, record 99 for question 18 and go to question 19. {18} If yes how old was your child when you first initiated formula" feeding ## {19} How old was your child when you first started complementary feeding ## If the child is being fed only with breastmilk, please record 99 for this question . EE- UNDER SIX MONTH SECTION {20} Age (According to Question 12 of last section)## 63 . - · -·~· :.:--. ·~ ., ; . . MICS, September 1995 In the past 24 hours, which of the following has been fed to your child: (21)Breast milk(1-Yes;2-No) # (22} Vitamins or ORS or Drugs(1-Yes;2-No) # (23} Sugar water or Water or Juice or Tea or other liquids(1-Yes; 2-No) # (24} Animal Milk or Formula(1-Yes;2-No) # (25} Solid or Semi-solid Food(1-Yes;2-No) # LR.Iran (Please note that the questionnaire was in two pages, printed on both sides, with the 10# and CODE# written on both page.) 64 00 0 DOD DO 0 CJ:J 0 - ---------llllliiiiiiiiiiiiiiiiliiiia ~l,;.t. r . c)l.r.l u-'~1 lS.J~ .)~ U.) c)'=" ~I.J.AI .sl.f~l:. t.r".JJ'. 401;.!. f. \r'Vf ol. # [ \Y'V'f /VI . j .r.;-IS <ID NUMBER> ~L.l.r. ~.).) •;W . . . . . .:>l:.trt-' · · · · · · · «Jl:.A.) i~; · · · · · · · · · · · · · · · · · *' rL · · · · · · · · · · · .:>l:. k- rL - ••.•.••. l:.JJ(\; . . . . . . . ;:_.;\.>. :.rJ,;~ -, [ ).;L> L~ . ~1-4: .;.,~.&-)1.::,'. -· '":"' . ~ (~ -r .>- .J. • J.:.:S _. 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