Jamaica: Monitoring the situation of children and women: Multiple Indicator Cluster Survey 2005

Publication date: 2006

The survey has been conducted as part of the third round of the Multiple Indicator Cluster Surveys (MICS), 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 the year 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. © Statistical Institute of Jamaica (STATIN), 2007 STATIN, 7 Cecelio Avenue, Kingston, Jamaica United Nations Children’s fund (UNICEF), 2007 UNICEF, Pan Caribbean Building 60 Knutsford Boulevard, Kingston, Jamaica Jamaica MICS 2005 final report i Summary Table of Findings Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Jamaica, 2005 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1 13 Under-five mortality rate 31 per thousand 2 14 Infant mortality rate 26 per thousand NUTRITION Breastfeeding 45 Timely initiation of breastfeeding 63 Percent 15 Exclusive breastfeeding rate 15 Percent 16 Continued breastfeeding rate at 12-15 months at 20-23 months 49 24 Percent Percent 17 Timely complementary feeding rate 36 Percent 18 Frequency of complementary feeding 15 Percent 19 Adequately fed infants 15 Percent Low birth weight 9 Low birth weight infants 12 Percent 10 Infants weighed at birth 97 Percent CHILD HEALTH Immunization 25 Tuberculosis immunization coverage 94 Percent 26 Polio immunization coverage 80 Percent 27 DPT immunization coverage 82 Percent 28 15 Measles immunization coverage 87 Percent 31 Fully immunized children 63 Percent Tetanus toxoid 32 Neonatal tetanus protection 65 Percent Care of illness 35 Received ORT or increased fluids, and continued feeding 39 Percent 23 Care seeking for suspected pneumonia 75 Percent 22 Antibiotic treatment of suspected pneumonia 52 Percent ENVIRONMENT Water and Sanitation 11 30 Use of improved drinking water sources 94 percent 13 Water treatment 53 percent 12 31 Use of improved sanitation facilities 97 percent 14 Disposal of child's faeces 36 percent REPRODUCTIVE HEALTH Maternal and newborn health 20 Antenatal care 91 percent 44 Content of antenatal care 99 percent 4 17 Skilled attendant at delivery 97 percent 5 Institutional deliveries 94 percent CHILD DEVELOPMENT Child development 46 Support for learning 86 percent 47 Father's support for learning 41 percent 48 Support for learning: children’s books 57 percent 49 Support for learning: non-children’s books 87 percent 50 Support for learning: materials for play 49 percent 51 Non-adult care 4 percent Jamaica MICS 2005 final report ii Topic MICS Indicator Number MDG Indicator Number Indicator Value EDUCATION Education 52 Pre-school attendance 86 percent 53 School readiness 100 percent 54 Net intake rate in primary education 89 percent 55 6 Net primary school attendance rate 97 percent 56 Net secondary school attendance rate 89 percent 57 7 Children reaching grade five 99 percent 58 Transition rate to secondary school 97 percent 59 7b Primary completion rate 82 percent 61 9 Gender parity index primary school secondary school 1.00 1.04 ratio ratio Literacy 60 8 Adult literacy rate 98 percent CHILD PROTECTION Birth registration 62 Birth registration 89 percent Child labour 71 Child labour 6 percent 72 Labourer students 98 percent 73 Student labourers 6 percent Child discipline 74 Child discipline Any psychological/physical punishment 87 percent Early marriage 67 Marriage before age 15 Marriage before age 18 1.2 10 percent percent 68 Young women aged 15-19 currently married/in union 5 percent 69 Spousal age difference 20-24 years 25 percent Domestic violence 100 Attitudes towards domestic violence 6 percent Disability 101 Child disability 15 percent Jamaica MICS 2005 final report iii Topic MICS Indicator Number MDG Indicator Number Indicator Value HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED AND VULNERABLE CHILDREN HIV/AIDS knowledge and attitudes 82 19b Comprehensive knowledge about HIV prevention among young people 58 percent 89 Knowledge of mother- to-child transmission of HIV 59 percent 86 Attitude towards people with HIV/AIDS 20 percent 87 Women who know where to be tested for HIV 89 percent 88 Women who have been tested for HIV 49 percent 90 Counselling coverage for the prevention of mother- to-child transmission of HIV 83 percent 91 Testing coverage for the prevention of mother-to- child transmission of HIV 84 percent Support to orphaned and vulnerable children 75 Prevalence of orphans 5 percent 78 Children’s living arrangements 14 percent 76 Prevalence of vulnerable children 7 percent 81 External support to children orphaned and made vulnerable by HIV/AIDS 15 percent Jamaica MICS 2005 final report iv Table of Contents Summary Table of Findings . i Table of Contents . iv List of Tables . vi List of Figures . viii List of Abbreviations . ix Acknowledgements . x Executive Summary . xi I. Introduction Background . 1 Survey Objectives . 4 II. Sample and Survey Methodology Sample Design . 5 Questionnaires . 5 Training and Fieldwork . 7 Data Processing . 8 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage . 9 Characteristics of Households . 9 Characteristics of Respondents . 11 IV. Child Mortality . 12 V. Nutrition Breastfeeding . 14 Low Birth Weight . 16 VI. Child Health Immunization . 18 Tetanus Toxoid . 19 Oral Rehydration Treatment . 20 Care Seeking and Antibiotic Treatment of Pneumonia . 21 Sources and Costs of Supplies . 22 VII. Environment Water and Sanitation . 23 VIII. Reproductive Health Antenatal Care . 26 Assistance at Delivery . 27 IX. Child Development . 28 Jamaica MICS 2005 final report v X. Education Pre-School Attendance and School Readiness . 30 Primary and Secondary School Participation . 30 Distance from Household to Primary and Secondary School………………….32 Adult Literacy . 32 XI. Child Protection Birth Registration . 33 Child Labour . 33 Child Discipline . 34 Early Marriage . 35 Domestic Violence. 37 Child Disability . 37 XII. HIV/AIDS, and Orphaned and Vulnerable Children Knowledge of HIV Transmission . 39 Orphans and Vulnerable Children . 42 List of References . 44 Statistical Tables………………………………………………………………….….45 -107 Appendix A. Sample Design . 108 Appendix B. List of Personnel Involved in the Survey . 112 Appendix C. Estimates of Sampling Errors . 115 Appendix D. Data Quality Tables . 121 Appendix E. MICS Indicators: Numerators and Denominators . 128 Appendix F. Questionnaires . 132 Jamaica MICS 2005 final report vi List of Tables Table HH.1: Results of household and individual interviews . 45 Table HH.2: Household age distribution by sex . 46 Table HH.3: Household composition . 47 Table HH.4: Women's background characteristics . 48 Table HH.5: Children's background characteristics . 49 Table CM.1: Child mortality . 50 Table CM.2: Children ever born and proportion dead . 50 Table NU.1: Initial breastfeeding . 51 Table NU.2: Breastfeeding . 52 Table NU.3: Adequately fed infants . 53 Table NU.4: Low birth weight infants . 54 Table CH.1: Vaccinations in first year of life . 55 Table CH.2: Vaccinations by background characteristics . 56 Table CH.3: Neonatal tetanus protection . 57 Table CH.4: Oral rehydration treatment . 58 Table CH.5: Care seeking for suspected pneumonia . 59 Table CH.6: Antibiotic treatment of pneumonia . 60 Table CH.7: Knowledge of the two danger signs of pneumonia . 61 Table EN.1: Use of improved water sources . 62 Table EN.2: Household water treatment . 63 Table EN.3: Time to source of water . 64 Table EN.4: Person collecting water . 65 Table EN.5: Use of sanitary means of excreta disposal . 66 Table EN.6: Disposal of child's faeces . 67 Table EN.7: Use of improved water sources and improved sanitation . 68 Table RH.1: Antenatal care provider . 69 Table RH.2: Antenatal care . 70 Table RH.3: Assistance during delivery . 71 Table CD.1: Family support for learning . 72 Table CD.2: Learning materials . 73 Table CD.3: Children left alone or with other children . 74 Table ED.1: Early childhood education . 75 Table ED.2: Primary school entry . 76 Table ED.3: Primary school net attendance ratio . 77 Table ED.4: Secondary school net attendance ratio . 78 Table ED 4W Secondary school age children attending primary school . 79 Table ED.5: Children reaching grade 5 . 80 Table ED.6: Primary school completion and transition to secondary education . 81 Table ED.7: Education gender parity . 82 Table ED 8: Distance to nearest Primary School…………………………………………….83 Table ED.9: Distance to nearest Secondary School………………………………………….84 Table ED.10: Adult literacy . 85 Table CP.1: Birth registration . 86 Table CP.2: Child labour by type of work . 87 Table CP.2W Child labour, currently working.88 Table CP.3: Labourer students and student labourers . 89 Jamaica MICS 2005 final report vii Table CP.4: Child discipline . 90 Table CP.5: Early marriage . 91 Table CP.6: Spousal age difference . 92 Table CP.7: Attitudes toward domestic violence . 93 Table CP.8: Child disability . 94 Table HA.1: Knowledge of preventing HIV transmission . 95 Table HA.2: Identifying misconceptions about HIV/AIDS . 96 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission . 97 Table HA.4: Knowledge of mother-to-child HIV transmission . 98 Table HA.5: Attitudes toward people living with HIV/AIDS . 99 Table HA.6: Knowledge of a facility for HIV testing . 100 Table HA.7: HIV testing and counselling coverage during antenatal care . 101 Table HA8: Women who believe or not that there are drugs they can take to reduce the risk of HIV/AIDS transmission to their babies.…………………………….102 Table HA.9: Women’s views on whether or not a child with HIV/AIDS who is not sick, should be allowed to attend school.……………………….103 Table HA.10: Children's living arrangements and orphanhood . 104 Table HA.11: Prevalence of orphanhood and vulnerability among children . 105 Table HA.12: School attendance of orphaned and vulnerable children . 106 Table HA.13: Support for children orphaned and vulnerable due to AIDS . 107 Jamaica MICS 2005 final report viii List of Figures Figure HH.1: Age and sex distribution of household population . 10 Figure CM.1 Trend in Under-5 Mortality Rates, Jamaica, 2005 .13 Figure NU.1: Percentage of mothers who started breastfeeding within one hour and within one day of birth . 15 Figure NU.2: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group . 16 Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccination by 12 months . 19 Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus . 20 Figure EN.1: Percentage distribution of household members by source of drinking water . .24 Figure HA.1: Percent of women who have comprehensive knowledge of HIV/AIDS transmission . 40 Jamaica MICS 2005 final report ix List of Abbreviations AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) DPT Diphteria Pertussis Tetanus EPI Expanded Programme on Immunization HIV Human Immunodeficiency Virus MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoH Ministry of Health NAR Net Attendance Rate ppm Parts Per Million SPSS Statistical Package for Social Sciences 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 Jamaica MICS 2005 final report x Acknowledgements The Statistical Institute of Jamaica (STATIN) expresses its appreciation to UNICEF for involving the Institute in another round of the Multiple Indicators Cluster Survey (MICS). In particular we would like to acknowledge the technical assistance and guidance as well as administrative and financial support provided during this process. We are especially thankful for the financial and administrative support that was provided by the other UN member organizations of the Steering Committee in particular UNAIDS, UNDP and UNESCO. We express our gratitude for the contributions made by the individuals who guided us in the finalization of the questionnaires and served on the steering committee. The organizations represented on the Steering Committee were: the Cabinet Office, Early Childhood Commission, Planning Institute of Jamaica, Sir Arthur Lewis Institute of Social and Economic Science, Caribbean Child Development Centre of the University of West Indies, UNFPA, PAHO, Child Development Agency and the Ministry of Health. We would also like to make special mention of the doctors and nurses from the Ministry of Health, who assisted in the training of the interviewers in the health related modules of the questionnaires. Finally, the help and assistance offered on the MICS project by the various units and divisions within STATIN are also acknowledged. These include the Corporate Services Division, the Cartography Unit, the STATIN Printing Unit, the Communications and Marketing Unit, the Information and Technology Division and the Research, Design and Evaluation Division. The Field Services Unit also assisted in the areas of training, logistic support and in providing office space during the interviewing and training phases of the survey. It is with gratitude that we extend thanks and appreciation to all the individuals who have contributed in making this survey a success. Sonia Jackson Director General Jamaica MICS 2005 final report xi Executive Summary I. Objectives of the survey The objectives of the Jamaica Multiple Indicator Cluster Survey were: ! To provide up-to-date information for assessing the situation of children and women in Jamaica; ! To furnish data needed for monitoring progress toward goals established by 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 Jamaica and to strengthen technical expertise in the design, implementation, and analysis of such systems. II. Sample Coverage and the Characteristics of Households and Respondents It was a nationally representative sample survey of 4,767 households, 3,647 women (age 15- 49) and 1,427 children under age five. Overall response rates of 82.1 and 84.1 percent were calculated for the women’s and under-5’s interviews respectively. The majority of households (59.1 percent) were headed by males and were found in the urban areas (58.7 percent). About one-quarter (26.1 percent) were single member households with another one-third having between 2 and 3 members and 16.0 percent had 6 or more members. The majority of women (61 percent) resided in an urban area. Just a little over one half (53 percent) of the women were either previously or currently married or in a common- law union. However, nearly 70 percent had ever given birth. The majority of women (78.6 percent) had received a secondary level education. Some 56 percent of children lived in an urban area. III. Child Mortality Using the Brass method (United Nations, 1983; 1990a; 1990b), the infant mortality rate was estimated at 26 per thousand, while the probability of dying under-5 mortality rate (U5MR) was around 31 per thousand. Infant and under-5 mortality rates were lowest in the rural areas and highest in other towns. These estimates of child mortality are higher than earlier estimates and highlight the need for further research. IV. Nutrition Breastfeeding Approximately 62 percent of all mothers reported that breastfeeding had been initiated within the first hour of their baby’s life and 84 percent within the first day. Approximately 15 percent of children aged less than six months were exclusively breastfed. At age 6-9 months, 36 percent of children were receiving breast milk and solid or semi-solid Jamaica MICS 2005 final report xii foods. By age 12-15 months, 49 percent of children were still being breastfed and by age 20- 23 months, 24 percent were still breastfed. Overall, the adequacy of infant feeding is low. Adequate complementary feeding although slightly higher, was also low among infants 6-8 months (22.5 percent) and even lower among children 9-11 months old. As a result of these feeding patterns, only 15 percent of children aged 6-11 months were being adequately fed. Low Birth Weight The majority of births in Jamaica occur in hospital and as a result, overall, ninety-seven percent of births were weighed at birth. Approximately 12 percent of infants were estimated to weigh less than 2,500 grams at birth. V. Child Health Immunisation Approximately 94 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 91 percent. The percentage was similar for the second dose of DPT but declined to 82 percent for the third dose of DPT. Similarly, 96 percent of children received Polio 1 by age 12 months and this declines to 80 percent by the third dose. The coverage for measles vaccine by 12 months was 87 percent. As a result, the percentage of children who had all the recommended vaccinations by their first birthday was 63 percent. Some 65 percent of women who had a birth within the last 12 months were protected against tetanus. Oral Rehydration Treatment Overall, only 34 children, representing 2.4 percent of under five children had diarrhoea in the two weeks preceding the survey. Care Seeking and Antibiotic Treatment of Pneumonia Some 6.5 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, 75 percent were taken to an appropriate provider. In Jamaica, 52 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Amoxil was the antibiotic of choice. Overall, 22.5 percent of women knew of the two danger signs of pneumonia. The most commonly identified symptom for taking a child to a health facility was developing a fever with 62.8 percent. Jamaica MICS 2005 final report xiii VI. Environment Water and Sanitation Overall, 94 percent of the population was using an improved source of drinking water – 97 percent in urban areas and 88 percent in rural areas. The main source of water in the urban areas was water piped in house or yard. In rural areas, 28 percent also obtained water from rainwater collections. The time spent in rural areas in collecting water was slightly higher than in urban areas. In the majority of households, an adult was usually the person collecting the water, when the source of drinking water was not on the premises. Ninety-seven percent of the population of Jamaica lived in households using improved sanitation facilities. In rural areas, the population was mostly using pit latrines with slabs while the most common facilities in urban areas were flush toilets. Approximately one-third of children’s diapers were properly disposed of. However, there was some difference by area. In the urban areas, the garbage was used by nearly 70 percent but only 40 percent of rural children had their diapers disposed in the garbage. Over ninety percent of households have both adequate water and sanitation. VII. Reproductive health Antenatal care Coverage of antenatal care (by a doctor, nurse, or midwife) was very high in Jamaica with 91 percent of women receiving antenatal care by skilled personnel at least once during the pregnancy. Over 95 percent of women had blood and urine samples taken, had their blood pressure checked and were weighed at least once during pregnancy. Assistance at Delivery About 97 percent of births occurring in the year prior to the MICS survey were delivered by skilled personnel. VIII. Child Development For almost 86 percent of under-five children, an adult engaged in more than four activities that promote learning and school readiness during the 3 days preceding the survey. Father’s involvement with one or more activities was only 41 percent. Some 87 percent of children were living in households where at least 3 non-children’s books were present. However, only 57 percent of children aged 0-59 months have children’s books. Forty-nine percent of children aged 0-59 months had 3 or more playthings, while 8 percent had none. Overall, 4 percent of children were left with inadequate care during the week preceding the survey. Jamaica MICS 2005 final report xiv IX. Education Pre-School Attendance and School Readiness Eighty-six percent of children aged 36-59 months were attending pre-school. There were urban-rural differentials – 89 percent in urban areas, compared to 81 percent in rural areas. Primary and Secondary School Participation Of children who were of primary school entry age (age 6), 89 percent were attending the first grade of primary school. The majority of children of primary school age were attending school (97 percent). Secondary level school attendance was lower than at primary school. Eighty-nine percent of the children of secondary school age were attending secondary school. Attendance was lower among boys (87 percent) than among girls (91 percent). The majority of children starting grade one of (99 percent) will eventually reach grade five. Very few children repeated grades because there are too few places in school to accommodate repeaters. Transition to secondary was almost universal with 97 percent of the children that completed successfully the last grade of primary school were attending the first grade of secondary school. The Gender Parity Index (GPI) i.e. ratio of girls to boys for both primary and secondary school was close to 1.00. Distance from Household to Primary and Secondary School Some 68 percent of households lived within one mile of a primary school, with 97 percent living less than five miles. Overall more households lived further from the nearest secondary school than a primary school. For both primary and secondary schools the distance was greater in the rural than in the urban areas. Adult Literacy Literacy was assessed on the ability of women to read a short simple statement or an educational level of secondary or higher as it is assumed that women with secondary level education are literate. Only 2 percent of women 15-24 were illiterate based on these criteria for literacy. X. Child Development Birth Registration The births of 89 percent of children under five years in Jamaica have been registered. There were no significant variations in birth registration across sex or area of residence. The percentage of births registered was strongly correlated with age of child. Thus, while only 71 percent of births were registered for children less than one year, this percentage rose to 94 by age 36-47 months. Among those whose births were not registered, cost was main reason. Jamaica MICS 2005 final report xv Child Labour Overall, 6.1 percent of children 5-14 years were reported to be involved in child labour. The percentage of boys involved in child labour was slightly higher than for girls. Schooling was almost universal for these children. Therefore, being in child labour appears not to affect being in school but is likely to affect the quality of the participation and learning. Child Discipline Some 87 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. More importantly, 8 percent of children were subjected to severe physical punishment. On the other hand, there were 36 percent of mothers/caretakers who believed that children should be physically punished. Male children were subjected more to both minor and severe physical discipline than female children. Younger children were more likely to be subjected to minor physical punishment while older children experienced more psychological punishment. Early Marriage In Jamaica, although legal marriage may be low, females are often in a union at an early age Fewer than 2 percent of the women stated that they were married/in union before the age of 15 years and 10 percent were married/in union before the age of eighteen. The percentage of females 15-19 years currently married or in a union was 4.5 percent. More rural females in this age group were married or in a union. Among women aged 20-24 years who were currently married or in a union, 24 percent were 10+ years younger than their partners. Domestic Violence Nationally, 6.1 percent of women felt that a husband or male partner was justified in beating his wife/partner under particular situations. For most of the reasons put forward in the questionnaire, less than 2 percent of the women support beating. However, nearly 5 percent thought that the beating was justifiable if the woman neglected her children. Child Disability Some 15 percent of children 2-9 years have at least one disability. Disabilities most frequently reported are: not understanding instructions (4.9 percent), mentally backward, dull or slow (4.7 percent) and not speaking, cannot be understood in words (3.9 percent). More women with primary education only reported disabilities in their children aged 2-9 years. Some 11.7 percent of children 3-9 years were reported to have delayed speech, while 9.3 percent of children aged 2 years could not name at least one object. XI.HIV/AIDS, Sexual Behaviour, and Orphaned and Vulnerable Children Knowledge of HIV Transmission and Condom Use Almost all of the interviewed women (99 percent) have heard of AIDS. However, the percentage of women who know of all three main ways of preventing HIV transmission was Jamaica MICS 2005 final report xvi 69 percent. Eighty-three percent of women know of having one faithful uninfected sex partner, 89 percent know of using a condom every time, and 87 percent know of abstaining from sex as main ways of preventing HIV transmission. Fewer than 2 percent do not know any of the three ways. More women with lower levels of education i.e. none or primary, do not know of any of the three ways. Of the interviewed women, 76 percent rejected the two most common misconceptions and knew that a healthy-looking person can be infected. More women with higher level of education reject misconceptions concerning HIV. Overall, 59 percent of women were found to have comprehensive knowledge i.e. knew two ways of preventing HIV transmission and rejected three common misconceptions. As expected, the percent of women with comprehensive knowledge increased with the woman’s education level. Overall, 95 percent of women knew that HIV can be transmitted from mother to child. The percentage of women who knew all three ways of mother-to-child transmission was 59 percent, while 5 percent of women did not know of any specific way. Stigmatism is high in Jamaica with 80 percent agreeing with at least one discriminatory statement. While less than ten percent stated that they would not care for a family member who was infected with AIDS, over half (58 percent) said that they would keep it a secret. The majority of women (89 percent) knew where to be tested. Among women who had given birth within the two years preceding the survey, 83 percent had received information about HIV prevention during ANC visit, while 90 percent had been tested for HIV and 84 percent had received the results. Some 72 percent of women believed that there were drugs they can take to reduce the risk of HIV/AIDS transmission to their babies, while a significant 19 percent did not know and 9 percent did not believe. The percentage who did believe was lowest among older women and those with primary level schooling only. The majority of women (85 percent) felt that a child with HIV/AIDS who is not sick, should be allowed to attend school. Orphans and Vulnerable Children Some 34 percent of children were living with both parents, while 45.3 percent were living with mother only, 6 percent with father only and 13 percent live with neither parent. However, more children living in the rural areas lived with both parents and as age increased the percentage of children living with both parents decreased. Overall, 5 percent were orphaned with another 7.4 percent being vulnerable. Less than one percent of children aged 10-14 have lost both parents. Only 15.4 percent reported receiving any support from community-based organizations or government agencies. Jamaica MICS 2005 survey report 1 I. Introduction Background This report is based on the Jamaica Multiple Indicator Cluster Survey (MICS3), conducted in 2005. The survey provides valuable information on the situation of children and women in Jamaica, and was based, in large part, on the need to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by the 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 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). 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.” Jamaica MICS 2005 survey report 2 In an effort to fully honour the international agreements to which Jamaica is a signatory, the main goal of the Government of Jamaica - UNICEF Country Programme 2002 – 2006 was to strengthen national, community and family capabilities to promote, protect and fulfill the rights of all children and to ensure opportunities to meet and sustain their full potential. Within the framework of this Country Programme, UNICEF and partners focused on the areas of Early Childhood Development, Adolescent Development and Participation and Policy, Advocacy and Special Care and Protection, all aimed at improving conditions for Jamaican children. The above-mentioned Country Programme resulted in strengthened legislative, policy, monitoring and institutional frameworks, as exemplified by the following: (a) the passing of the Child Care and Protection Act, the Early Childhood Commission Act, and the Early Childhood Act; (b) the development and dissemination of the National Youth Policy, and the National Policy for HIV/AIDS Management in Schools; (c) the formulation of national plans such as the National Framework of Action for Children, the National Plan of Action on Child Justice, the National Plan of Action for an Integrated Response to Children and Violence, the National Plan on Children Orphaned and Made Vulnerable by HIV/AIDS, the National Plan on Youth Development, and the National Strategic Plan on HIV/AIDS; (d) the establishment and strengthening of institutions such as the Child Development Agency (CDA), the Early Childhood Commission, the Office of the Children’s Advocate, and the Jamaica Early Childhood Association; and (e) enhanced national capacity to monitor the situation of children’s rights and the Millennium Development Goals through the adaptation of DevInfo into JamStats (Jamaica Statistics), now used by all Government and a number of non-governmental organizations (NGOs) and civil society organizations (CSOs). Young children and their parents benefited from model interventions, such as Parent Support Advisory Teams and the Roving Caregivers Programme, that have informed the development of national policies towards improving parenting practices and child development. Adolescents benefited from outreach models informed by participatory action research, such as Youth Information Centres (YICs) and “Bashment Bus” (“party bus” in patois). These services provide adolescent- friendly and gender-specific information on HIV/AIDS and voluntary confidential counselling and testing (VCCT) for HIV, and foster the development of life skills. Pioneering approaches in the areas of early childhood development (ECD) and HIV/AIDS have been used to leverage resources from the private sector, the World Bank and the Global Fund on AIDS, Tuberculosis and Malaria. Beyond Jamaican borders, the approaches have helped Caribbean countries to develop their own policies. In HIV/AIDS prevention, treatment, care and support, the provision by UNICEF of critical technical assistance has contributed to the development and implementation of the Policy on Management of HIV/AIDS in Schools and the PMTCT-plus Protocol Jamaica MICS 2005 survey report 3 for Health Workers, and has also enabled more than 40,000 adolescents to improve their knowledge of rights and HIV/AIDS and to positively change their behaviours. Approximately 400,000 persons were reached every week through a television series researched, designed and hosted by teens on reproductive health and child rights. In ECD, in addition to the establishment of the Early Childhood Commission, UNICEF has strengthened the capacity of Early Childhood Development Centres (ECDCs) through the development of operations manuals, and has helped the Ministry of Education and Youth to develop a national curriculum. The national capacity for emergency preparedness and response has been strengthened through the development and implementation of Guidelines for Child- Friendly Disaster Management and Response, the training of district-level professionals, the design of a psychosocial toolkit for professionals, and the production of gender and age specific hygiene kits for children, with private sector support. Emergency relief was provided during the 2004 and 2005 hurricane seasons for approximately 5,000 children. Significant efforts undertaken in advocacy and partnership-building have resulted in the increased visibility of children issues in the media and in political discourse, as well as the building of coalitions and partnerships around children’s issues. The GOJ – UNICEF Country Programme Action Plan for the period 2007-2011 (CPAP), further builds upon results achieved during the previous programme of cooperation. The contents and strategies of its four major programmes: i) Advocacy, Public Policy and Partnerships; ii) Children and HIV/AIDS, iii) Child Protection and iv) Quality Education and Early Childhood Development, will contribute towards improved fulfilment of children’s rights to survival, development, protection and participation in Jamaica. The main findings of the MICS3 will complement other baseline data and will be used to monitor the progress to achieving the planned results of the CPAP as well as the MDGs, the Millennium Declaration, and the outcomes of A World Fit for Children (WFFC). Jamaica MICS 2005 survey report 4 Survey Objectives The 2005 Jamaica Multiple Indicator Cluster Survey has as its primary objectives: ! To provide up-to-date information for assessing the situation of children and women in Jamaica; ! To furnish data needed for monitoring progress toward goals established by 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 Jamaica and to strengthen technical expertise in the design, implementation, and analysis of such systems. Jamaica MICS 2005 survey report 5 II. Sample and Survey Methodology Sample Design The sample for the Jamaica Multiple Indicator Cluster Survey (MICS) was designed to provide estimates on a large number of indicators on the situation of children and women at the national level, as well as urban and rural areas. Parishes were identified as the main sampling domains and were divided into sampling regions of equal sizes. The sample was selected in two stages. Within each sampling region, two census enumeration areas/Primary Sampling Units (PSUs) were selected with probability proportional to size. Using the household listing from the selected PSUs a systematic sample of 6,276 dwellings was drawn. Five of the selected enumeration areas were not visited because they were inaccessible due to flooding during the fieldwork period. Sample weights were used in the calculation of national level results. A more detailed description of the sample design can be found in Appendix A. Table 2.1 Distribution of dwellings per parish Parish Sampling regions per parish PSU Sampled in survey Final number of dwellings selected Kingston 10 20 360 St. Andrew 55 110 990 St. Thomas 10 20 360 Portland 8 16 336 St. Mary 11 22 330 St. Ann 15 30 360 Trelawny 7 14 336 St. James 17 34 408 Hanover 7 14 336 Westmoreland 14 28 336 St. Elizabeth 14 28 336 Manchester 18 36 432 Clarendon 22 44 528 St. Catherine 46 92 828 254 508 6,276 Questionnaires Three sets of questionnaires were used in the survey: Jamaica MICS 2005 survey report 6 1) a household questionnaire which was used to collect information on all de jure household members, the household, and the dwelling; 2) an individual women’s questionnaire administered in each household to all women aged 15-49 years; and 3) a questionnaire for children under five, administered to mothers or caretakers of all children under 5 years living in the household. The questionnaires included the following modules: Household Questionnaire o Household listing o Education o Water and Sanitation o Support for Orphaned and Vulnerable Children o Child Labour o Child Discipline o Disability o Salt Iodization1 The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: o Basic characteristics o Child Mortality o Tetanus Toxoid o Maternal and Newborn Health o Marriage Module o Attitudes towards Domestic Violence o HIV/AIDS The Questionnaire for Children Under Five was administered to mothers or caretakers of children under 5 years of age2 living in the households. Normally, the questionnaire was administered to mothers of under-5 children, but in instances when the mother was not listed in the household roster, the primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: o Information panel o Birth Registration and Early Learning o Child development o Breastfeeding o Care of Illness + Source and Cost of ORS and Antibiotics o Immunization 1 Unable to implement salt iodization evaluation because the kits were not received. 2 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. Jamaica MICS 2005 survey report 7 The questionnaires are based on the MICS3 model questionnaire. From the MICS3 model English version, the questionnaires were modified for local usage and were pre-tested during August, 2005. A team consisting of 4 interviewers and one supervisor was recruited and trained for the pre-test that was carried out in urban and rural sections of the parish of Clarendon. Based on the results of the pre-test, modifications were made to the wording of the questionnaires. A copy of each of the questionnaire is provided in Appendix F. Training and Fieldwork Training for the fieldwork was conducted at four locations, namely Kingston, St Ann’s Bay, Mandeville and Savanna-la-mar with a total of 97 persons selected for training. The Kingston class was held from September 13 to 21, 2005 and included the trainees from Kingston, St Andrew, St Thomas and the Portmore area of St Catherine. The trainers were the four persons who were trained in Panama, along with a representative from the UNICEF Regional Office. Personnel from the Statistical Institute of Jamaica (STATIN) also attended this training class. Included among these were the Assistant Coordinator and two of STATIN’s senior field supervisors who were specially selected to assist with the training at the three other centres. Training at those three centres was conducted during the period September 27 to October 5, 2005. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking the relevant questions. Towards the end of the training period, the trainees spent one day in practice interviewing. These practice interviews were conducted in areas close to the training centres. At the end of the training, the trainees were tested and based on the test results, observation and participation in the training sessions, 83 persons were offered employment on the project. In the Kingston Metropolitan Area (KMA), staff worked together in teams comprising of interviewers, one editor and a supervisor. In all other areas the interviewers worked on their own with regular visits from their supervisors. Overall, there were 6 female and 7 male field supervisors, while all 66 interviewers and field editors were female. It was anticipated that the fieldwork would begin on the Monday following the training. The persons trained in Kingston were expected to start working on September 26, but the start date was delayed, due to logistical reasons3. As a result of the delay, a one-day refresher course was held on October 10, for the persons who were trained in Kingston. Interviewing began in all areas during the week of October 10, 2005 and ended in late November 2005. Implementation was hampered by heavy rains and flooding in the first two weeks of fieldwork. There were also other 3 The Salt Testing kits had not arrived. At the end of the rural area training sessions, the kits were still not in the country and it was then discovered that the wrong kits had been ordered; hence the decision was taken to omit the module from the Jamaica survey. Jamaica MICS 2005 survey report 8 problems which negatively affected the implementation and subsequent outcome of the survey, including: ! Violence in some sections of Kingston, St. Andrew and St. Catherine. ! Interviewers were forced to leave some Enumeration District (EDs). ! Vacant dwellings ! Upper income communities that have gated communities and to which access was not granted by security personnel. Consequently the number of households surveyed was less than the number of dwellings in the original sample design. Data Processing Data were entered using the Census and Survey Processing System (CSPro), a public-domain software package for entering, editing, tabulating and mapping census and survey data. Entry was done on seven microcomputers and carried out by 7 data entry operators and 2 data entry supervisors. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were carried out. Procedures and standard programs developed under the global MICS3 project and adapted to the Jamaica questionnaire were used throughout. The data entry exercise started in November 2005, approximately three weeks after the start of data collection, and was completed in March 2006. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 14, and the model syntax and tabulation plans developed by the UNICEF Headquarters for this purpose. Jamaica MICS 2005 survey report 9 III. Sample Coverage and the Characteristics of Households and Respondents Sample Coverage In the 6,276 dwellings selected for the sample, 5,604 households were found to be occupied (Table HH.1). Of these, 4,767 were successfully interviewed for a household response rate of 85.1 percent. The reason for this lower response rate is given in the previous section. In the interviewed households, 3,777 women (age 15- 49) were identified. Of these, 3,647 were successfully interviewed, yielding a response rate of 96.6 percent. In addition, 1,444 children under age five were listed in the household questionnaire. Of these, questionnaires were completed for 1,427 which correspond to a response rate of 98.8 percent. Overall response rates of 82.1 and 84.1 percent were calculated for the women’s and under-5’s interviews respectively. Note that the response rates for the Kingston Metropolitan Area (KMA) were lower than in other urban areas and in the rural area. Two factors contributed to this – more dwellings were vacant, often as a result of urban violence, and in the upper income areas access to dwellings was more difficult. In the rural areas, the rains prevented access to some households as some roads were inundated. 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 pyramid in Figure HH.1. In the 4.767 households successfully interviewed in the survey, 15,698 household members were listed. Of these, 7,889 were males, and 7,809 were females. These figures also indicate that the survey estimated the average household size at 3.29. The percentage of the population less than 15 years was 30.7 percent, while 60.3 percent were in the age group 15-64 years and 8.6 percent were 65 years and over. There were no major differences in the age distribution by sex. The population distribution obtained by this study was similar to the 2001 census in which 32 percent of the population was less than 15 years, 60 percent was 15-64 years and 7.7 percent was 65 years and over. Both population pyramids show a relatively broad base with some narrowing in the lowest age ranges. The main difference lies in the sex ratio (M:F) which favoured males in this study i.e. 101.0 males per 100 females, but favoured females i.e. 96.9 males per 100 females, in the 2001 census. Jamaica MICS 2005 survey report 10 Figure HH.1: Age and sex distribution of household population, Jamaica, 2005 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Percent Males Females Table HH.3 provides basic background information on the households. Within households, the sex of the household head, urban/rural status, and number of household members are shown in the table. In Jamaica, the categories used for location are: KMA, Other Towns and Rural. In addition, the two urban locations are grouped into “Total Urban”. These background characteristics are also used in subsequent tables in this report; the figures in the table are also intended to show the number of observations by major categories of analysis in the report. The weighted and unweighted numbers of households are the same, since sample weights were normalized (See Appendix A). The table also 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. It also shows that the majority of households (59.1 percent) were headed by males and that 58.7 percent of households were in the urban areas. Just over one-quarter (26.1 percent) were single member households with another one-third having between 2 and 3 members and 16.0 percent had 6 or more members. A little over half of the households had at least one child under 18 years, (54 percent), while 58.0 percent had at least one woman 15-49 years and about one–quarter had at least one child under 5 years (23.5 percent). Jamaica MICS 2005 survey report 11 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. 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 urban-rural areas, age, marital status, motherhood status, and education4. The majority of women (61 percent) resided in an urban area. They were fairly evenly distributed by age group but decreased with age from a high of 18.2 percent in the age group 15-19 years to a low of 10.6 percent for the age group 45- 49 years. Just a little over one half (53 percent) of the women were either previously or currently married or in a common-law union. However, nearly 70 percent of all women had ever given birth. The majority of women (78.6 percent) had received a secondary level education and as a result, there were very few women in the other education categories. Therefore, the results obtained for the other categories should be interpreted cautiously. Some background characteristics of children under 5 are presented in Table HH.5. These include distribution of children by sex, and area of residence, age in months, and mother’s or caretaker’s education. The children were equally distributed by sex. Some 56 percent lived in an urban area and for the majority (81.2 percent), their mother/caretaker had at least some secondary education. 4 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. Jamaica MICS 2005 survey report 12 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 is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. In the MICS3 survey, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women. The technique converts these data into probabilities of dying by taking 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. The model assumes: • A constant patterns and level of mortality have prevailed in the recent past • Fertility has been roughly constant in the recent past • Child mortality has been changing in a linear way in the recent past It then places a country into a particular group (North, South, East or West) based on previous information on mortality. For Jamaica, the West model life table was selected as most appropriate. The West Model is based on the largest number and broadest variety of mortality experiences. For this reason it is believed that the West Model represents the most general mortality pattern and is often recommended as a first choice to represent mortality in countries where data is lacking thus preventing a more appropriate choice of model. The life expectancy in the tables used to derive this model ranges from 38.6 years in the Province of Taiwan, 1921 and 75.2 years in Sweden, 1959. 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 infant mortality rate was estimated at 26 per thousand, while the probability of dying under-5 mortality rate (U5MR) was around 31 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to mid Jamaica MICS 2005 survey report 13 2003. There was some difference between the probabilities of dying among males and females. Infant and under-5 mortality rates were lowest in the rural areas and highest in urban areas (excluding KMA). There were also significant differences in mortality in terms of educational levels of the mother. The probabilities of dying among infants and children under 5 years of uneducated women were more than twice that of women with at least a secondary education. It should be noted that these estimates of child mortality are higher than an earlier estimate5. These earlier studies used a direct method of estimation for calculating the rates and so results cannot be compared. The MICS 2000 Jamaica also found much lower estimates for similar periods (Figure CM.1) and highlights the need for further analyses. Figure CM.1: Trend in Under-5 Mortality Rates, Jamaica, 2005 0 5 10 15 20 25 30 35 40 45 1982 1986 1990 1994 1998 2002 2006 Year P er 1 ,0 00 MICS2000 MICS2005 5 McCaw-Binns, Affette Kristin Fox, Karen Foster-Williams, Deanna Ashley & Beryl Irons. 1996. "Registration of Births, Stillbirths and Infant Deaths in Jamaica". International Journal of Epidemiology. Vol. 25. No. 4. Jamaica MICS 2005 survey report 14 V. Nutrition Children’s nutritional status is a reflection of their overall health. When children have access to adequate food supply are not exposed to repeated illnesses, and are well cared for, they reach their growth potential and are considered well nourished. In Jamaica, protein energy malnutrition is no longer a serious problem and in any event data on weights and measurements of children are collected regularly through the Jamaica Survey of Living Conditions. Therefore for this MICS3, Jamaica did not collect anthropometric measurements but collected information on breastfeeding and infant feeding practices and birth weight. 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.1 and Figure NU.1 provide the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth (which includes those who started within one hour). Approximately 62 percent of all mothers reported that breastfeeding had Jamaica MICS 2005 survey report 15 been initiated within the first hour of their baby’s life and 84 percent within the first day. Early initiation was higher in urban areas than rural areas (66 percent versus 57 percent respectively). Figure NU.1 Percentage of mothers who started breastfeeding within one hour and within one day of birth, Jamaica, 2005 82.2 87.4 83.4 85 87.9 81.7 91.9 84.3 83.1 61.9 65.9 66.4 57.2 67.5 65.2 58.1 73.3 62.6 60.1 41.6 0 10 20 30 40 50 60 70 80 90 100 KMA Other Urban Rural < 6 months 6-11 months 12-23 months Primary Secondary Higher Non- standard curriculum Pe rc en t Within one day Within one hour In Table NU.2, breastfeeding status is based on the reports from mothers/caretakers of their 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. Approximately 15 percent of children aged less than six months were exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 36 percent of children were receiving breast milk and solid or semi-solid foods. By age 12-15 months, 49 percent of children were still being breastfed and by age 20-23 months, 24 percent were still breastfed. Girls were more likely to be exclusively breastfed than boys. Feeding patterns in urban and rural areas were similar. Figure NU.2 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages, the majority of children were receiving liquids or foods other than breast milk. By the end of the sixth month, the percentage of children exclusively breastfed was well below 10 percent. Less than 20 percent of children were receiving breast milk after 2 years. Jamaica MICS 2005 survey report 16 Figure NU.2 Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group, Jamaica, 2005 0 10 20 30 40 50 60 70 80 90 100 0- 1 2- 3 4- 5 6- 7 8- 9 10 -1 1 12 -1 3 14 -1 5 16 -1 7 18 -1 9 20 -2 1 22 -2 3 24 -2 5 26 -2 7 28 -2 9 30 -3 1 32 -3 3 34 -3 5 Age (in Months) Pe rc en t Weaned (not breastfed) Breastfed and complementary foods Breastfed and other milk/ formula Breastfed and non-milk liquids Breastfed and plain water only Exclusively breastfed The adequacy of infant feeding in children under 12 months is provided in Table NU.3. 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 breastmilk and complementary food at least two times per day, while infants aged 9-11 months are considered to be adequately fed if they are receiving breastmilk and eating complementary food at least three times a day. Exclusive breastfeeding was low. Adequate complementary feeding although slightly higher, was also low among infants 6-8 months (22.5 percent) and even lower among children 9-11 months old. As a result of these feeding patterns, only 15 percent of children aged 6-11 months were being adequately fed. Adequate feeding among all infants (aged 0-11) was similar. Slightly more girls than boys and more children of women with higher education were adequately fed but there were no obvious differences by area of residence. 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 Jamaica MICS 2005 survey report 17 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, 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 health facilities, and those who are, represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may represent a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the weight as recorded on a health card if the child was weighed at birth6or the mother’s recall of the child’s weight. The majority of births in Jamaica occur in hospital and as a result, overall, ninety- seven percent of babies were weighed at birth. Approximately 12 percent of infants were estimated to weigh less than 2500 grams at birth (Table NU.4). 6 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. Jamaica MICS 2005 survey report 18 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 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 UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. Jamaica has adopted those guidelines. During the Jamaica MICS3 mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the MICS3 questionnaire. 314-0338 Overall, more than 70 percent of children had immunization cards (Table CH.1). If the child did not have a card, the mother was asked to recall whether or not the child had received BCG, Polio, DPT or measles vaccination. For those receiving DPT and Polio the number of dosage received was recorded. The percentage of children aged 18-29 months who received each of the vaccinations is shown in Table CH.1 and CH. 1c. 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 top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday, as recommended, are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. Approximately 94 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 91 percent. The percentage was similar for the second dose of DPT but declined to 82 percent for the third dose of DPT (Figure CH.1). Similarly, 96 percent of children received Polio 1 by age 12 months and this declines to 80 percent by the third dose. The coverage for measles vaccine by 18 months was 87 percent. As a result, the percentage of children who had all the recommended vaccinations by their first birthday (and by 18 months Jamaica MICS 2005 survey report 19 for measles) was 63 percent. Some 4 percent of children have not received any vaccinations Figure CH.1 Percentage of children aged 18-29 months who received the recommended vaccinations by 12 months (and by 18 months for measles), Jamaica, 2005 94.3 91.4 90.9 81.5 95.7 93.1 80.1 86.8 62.9 0 10 20 30 40 50 60 70 80 90 100 BCG DPT1 DPT2 DPT3 Polio1 Polio2 Polio3 Measles All Pe rc en t Tables CH.2 show vaccination coverage rates among children 18-29 months by background characteristics. These figures represent children 18-29 months who have received 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. There was little difference by background characteristics. The percentage of these children who were fully immunized at the time of the survey was 78 percent. Tetanus Toxoid 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. One method of prevention of maternal and neonatal tetanus is to ensure that all pregnant women receive at least two doses of tetanus toxoid vaccine. However, women who did not receive two doses of the vaccine during their pregnancy, they (and their newborn), were considered to be protected if the following conditions are met: ! Received at least two doses of tetanus toxoid vaccine, the last within the prior 3 years; ! Received at least 3 doses, the last within the prior 5 years; Jamaica MICS 2005 survey report 20 ! 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 a live birth within the last 24 months. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. Some 65 percent of women who had a birth within the last 24 months were protected against tetanus. Protection status varied by area of residence, age and education of the woman with more women in rural areas being protected It should be noted that Jamaica has not had any cases of neonatal tetanus reported since 2001. Figure CH.2 Percentage of women with a live birth in the last 24 months who are protected against neonatal tetanus Jamaica, 2005 57.7 66.5 70.1 53.4 65.1 69.6 65.4 69.9 62.5 100 68.2 49.2 65.3 0 20 40 60 80 100 Regions KMA Urban Rural Mother's age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Mother's education Secondary Higher Jamaica Percent 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 re-hydration salts (ORS) or a recommended home 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. Jamaica MICS 2005 survey report 21 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 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 re-hydration therapy (ORT) ! Home management of diarrhoea ! (ORT or increased fluids) AND continued feeding In the MICS3 questionnaire, mothers (or caretakers) were asked to report whether their child had an episode of 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, only 34 children, representing 2.4 percent of under five children had diarrhoea in the two weeks preceding the survey. Diarrhoea prevalence was slightly higher in the rural areas. The peak of diarrhoea prevalence occurred in the weaning period, among children age 6-23 months. 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 Table CH.5 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of the care. Some 6.5 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, 75 percent were taken to an appropriate provider. Due to the small number of cases further disaggregation of the results cannot be shown in the table. Jamaica MICS 2005 survey report 22 Table CH.6 presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, and area of residence. In Jamaica, 52 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. The table also shows that antibiotic treatment of suspected pneumonia was lower for males than females. There was no difference by area of residence or educational level of the mother. Amoxil was the antibiotic of choice. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.7. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, 23 percent of women knew of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility immediately was ‘developing a fever’ (63 percent). Some 31 percent of mothers identified fast breathing and 50 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. More mothers in the rural areas were able to identify two danger signs of pneumonia than their urban counterparts. Sources and cost of supplies The majority of mothers (67 percent) bought the antibiotics at private pharmacies but more persons in the urban areas (75 percent) used private pharmacies than in the rural areas (58 percent). At neither government nor private facilities, was the medication free, but the median cost of the antibiotics at private pharmacies ($950) was almost twice that of government facilities ($593). The source and cost of supplies for oral rehydration salts (ORS) for children under five years of age could not be assessed because only 12 children received ORS so further analysis of the data was not possible. However, it should be noted that government policy is that ORS should be provided free to children attending its facilities but the mothers would be asked to pay a registration fee. In the private sector, generic ORS is sold at nominal cost. Jamaica MICS 2005 survey report 23 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, especially in rural areas, may be particularly important for women and children who bear the primary responsibility of fetching the water, often over 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 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 collecting drinking water Sanitation • Use of improved sanitation facilities • Sanitary disposal of child’s faeces The distribution of the 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, 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. Jamaica MICS 2005 survey report 24 Figure EN.1 Percentage distribution of household members by source of drinking water Jamaica, 2005 68% 8% 1% 16% 3% 1% 3% Piped into dwelling, yard or plot Public tap/standpipe Protected well/spring Other improved Unprotected well or spring Surface water Other unimproved Overall, 94 percent of the population was using an improved source of drinking water – 97 percent in urban areas and 88 percent in rural areas (Table EN.1). The main source of water in the urban areas was water piped in house or yard but a significant percentage of households in the rural areas (29 percent) also obtained water from rainwater collections. Use of in-house water treatment is presented in Table EN.2. Households were asked about the methods used for treating water at home to make it safer for drinking. Boiling, adding bleach or chlorine, using a water filter, and using solar disinfection 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 and for households using improved and unimproved drinking water sources. Some 53 percent of households with improved drinking water used other in-house water treatment and there was no significant variation by area of residence or educational level of mothers. Similarly, fifty-three percent of those using water from unimproved sources used appropriate in-house water treatment. Urban households with unimproved water were less likely to use in- house water treatments than those in rural areas. The amount of time it takes to obtain water is presented in Table EN.3 and the person who usually collected the water in Table EN.4. Note that these results refer to one roundtrip from home to the drinking water source. Information on the number of trips made in one day was not collected. Table EN.3 shows that for 85 percent of households, the drinking water source is on the premises. For 11 percent of all households, it took less than 30 minutes to get to the water source and bring water, while 1 percent of households spent more than 1 hour for this purpose. Excluding those households with water on the premises, the Jamaica MICS 2005 survey report 25 average time to the source of drinking water was 20 minutes. The time spent in rural areas in collecting water was slightly higher than in other urban areas (18 minutes versus 21 minutes) and lowest in the KMA (15 minutes). Table EN.4 shows that for the majority of households, an adult (15 years and older) was usually the person collecting the water, when the source of drinking water was not on the premises. Adult men collected water in 57 percent of cases, while adult females collect water in 32 percent of households. In fewer than 10 percent of households, children under age 15 collected the water. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities for excreta disposal include: flush or pour flush to a piped sewer system, septic tank, or latrine; ventilated improved pit latrine, pit latrine with slab, and composting toilet. Ninety-seven percent of the population of Jamaica lived in households using improved sanitation facilities (Table EN.5). Although there was no difference in the percentage of improved sanitation facilities by area of residence, there were differences in terms of the types of facilities available to households. In rural areas, half the population was mostly using pit latrines with slabs (50 percent) and 45 percent are using flush toilets with connection to a sewage system or absorption tank. In contrast, the most common facilities in urban areas were flush toilets with connection to a sewage system or absorption tank (45 percent) and flush toilets to a piped sewer system (30 percent). Safe disposal of a child’s faeces for the purpose of this survey is if the last stool by the child was disposed of by use of a toilet or rinsed into toilet or latrine. Disposal method of faeces of children 0-2 years of age is presented in Table EN.6. Approximately one-third of children’s diapers were properly disposed of (36 percent). The majority, 56 percent, were placed in the garbage. However, there was some difference by area. In the urban areas, the garbage was used by nearly 70 percent but only 39 percent of rural children had their diapers disposed in the garbage. This can be explained by the fact that fewer rural households have their garbage collected so may need to find a more permanent method of disposal. An overview of the percentage of households with improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.7. Just over ninety percent of households have adequate water and sanitation. Jamaica MICS 2005 survey report 26 VIII. Reproductive Health 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 prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of sexually transmitted infections (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., malaria and 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 anemia ! Weight/height measurement (optional) The type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding is presented in Table RH.1. Coverage of antenatal care (by a doctor, nurse, or midwife) was very high in Jamaica with 91 percent of women receiving antenatal care by skilled personnel at least once during the pregnancy. Antenatal care coverage does not vary by area of residence, age or educational level of woman. The medical doctor was the main provider of antenatal care, followed by the nurse/midwife and together they represent 90 percent of persons who provide antenatal care. As the age of the woman increases, the percentage of medical doctors Jamaica MICS 2005 survey report 27 providing antenatal care also increases. Also, more women with higher education visit the medical doctor compared to women with secondary education. The types of services pregnant women received are shown in Table RH.2. Over 95 percent of women have blood and urine samples taken, have their blood pressure checked and were weighed at least once during pregnancy. 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 MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. About 97 percent of births occurring in the year prior to the MICS survey were delivered by skilled personnel (Table RH.3). There was no variation by area of residence, age or educational level of woman. About 47 percent of the births in the year prior to the MICS survey were delivered with assistance by a nurse/midwife. Doctors assisted with the delivery of 41 percent of births and auxiliary midwives assisted with 9 percent. More women in the urban areas, especially the Kingston Metropolitan Area, were assisted by a medical doctor (63 percent), compared with women in rural areas (56 percent) as they were more likely to see a nurse or midwife. Jamaica MICS 2005 survey report 28 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, or drawing things. For almost 86 percent of under-five children, an adult engaged in more than four activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.1). The average number of activities that adults engaged in with children was 5. The table also indicates that the father’s involvement in such activities was somewhat limited. Father’s involvement with one or more activities was only 41 percent. This is not surprising because 51 percent of children were living in a household without their fathers. There were no gender differentials in terms of adult activities with children; however, a slightly larger proportion of fathers engaged in activities with male children (43 percent) than with female children (38 percent). Slightly larger proportions of adults engaged in learning and school readiness activities with children in urban areas (88 percent) than in rural areas (83 percent). Also more adults were engaged in these activities with older children i.e. those 24-59 months (94 percent) than those 0-23 months (73 percent). Father’s involvement showed a similar pattern in terms of adults’ engagement in such activities. More educated mothers and fathers engaged in such activities with children than those with less education. 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. In Jamaica, 87 percent of children were living in households where at least 3 non- children’s books were present (Table CD.2). However, only 57 percent of children aged 0-59 months have 3 or more children’s books. The median number of children’s books was low (3 books). While no large gender differentials were observed, urban children appear to have more access to children’s books than those living in rural Jamaica MICS 2005 survey report 29 households. Sixty-four percent of under-5 children living in urban areas live in households with more than 3 children’s books, while the figure was 47 percent in rural households. The presence of both non-children’s and children’s books was positively correlated with the child’s age; in the homes of 91 percent of children aged 24-59 months, there were 3 or more non-children’s books, while the figure was 81 percent for children aged 0-23 months. The differential, in terms of children’s books, was even sharper that is; 67 percent for children 24-59 months compared with 39 percent for children 0-23 months. Table CD.2 also shows that 49 percent of children aged 0-59 months had 3 or more playthings to play with in their homes, while 8 percent had none of the playthings asked to the mothers/caretakers (Table CD.2). The playthings in MICS included household objects, homemade toys, toys that came from a store, and objects and materials found outside the home. It is interesting to note that 86 percent of children play with toys that come from a store; however, the percentage for other types of toys was 36 percent. The proportion of children who have 3 or more playthings to play with was 52 percent among male children and 46 percent among female children. Urban-rural differentials were also observed with 44 percent of urban children having 3 or more playthings compared with 55 percent of children living in rural areas. There was also a strong positive correlation between the number of playthings children have and the age of the child, a somewhat expected result. Thus, 59 percent of children 24-59 months had 3 or more playthings compared with only 32 percent of children 0-23 months. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS, 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 that 3 percent of children aged 0-59 months were left in the care of other children under 10 years of age, while 1 percent were left alone during the week preceding the interview. Combining the two care indicators, it is calculated that 4 percent of children were left with inadequate care during the week preceding the survey. Small differences were observed by the sex of the child or between urban and rural areas. Jamaica MICS 2005 survey report 30 X. Education Pre-School Attendance and School Readiness Attendance to pre-school education 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. Eighty-six percent of children aged 36-59 months were attending pre-school (Table ED.1). There were urban-rural differentials – the figure was 89 percent in urban areas, compared to 81 percent in rural areas. This differential was much greater when Kingston Metropolitan Area (KMA) was compared with the other areas. Ninety five percent of children living in KMA compared with 81 percent of children in other towns and the rural areas were attending pre-school. Small gender differential exists, but differentials by educational level of the mother were observed. Ninety-three percent of children of mothers with higher education attend pre-school, while the figure drops to 85 percent for mothers with secondary education. It is interesting to note that the proportions of children attending pre-school increases sharply from 77 percent at ages 36-47 months to 94 percent at 48-59 months. The table also shows the proportion of children in the first grade of primary school who attended pre-school the previous year (Table ED.1), an important indicator of school readiness. Overall, 100 percent of children who were currently age 6 and attending the first grade of primary school were attending pre-school the previous year. 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. The indicators for primary and secondary school attendance7 include: ! Net intake rate in primary education ! Net primary school attendance rate ! Net secondary school attendance rate ! Net primary school attendance rate of children of secondary school age ! Female to male education ratio (GPI) The indicators of school progression include: 7 It should be noted that these definitions of attendance are not the same as those used by the Ministry of Education in Jamaica. Therefore, the results of this survey cannot be compared with those statistics. Jamaica MICS 2005 survey report 31 ! Survival rate to grade five ! Transition rate to secondary school ! Net primary completion rate Of children who were of primary school entry age (age 6) in Jamaica, 89 percent were attending the first grade of primary school (Table ED.2). Sex differentials do not exist; nor were there differentials by area of residence. Table ED.3 provides the percentage of children of primary school age (6 to 11 years) attending primary or secondary school. The majority of children of primary school age were attending school (97 percent). There was no difference by sex or area of residence. Attendance increased as age increased from 89.7 percent among children aged 6 years to 99.3 percent among those aged 11 years. The secondary school net attendance ratio is presented in Table ED.4. Secondary level school attendance was lower than at primary school. Ninety-one percent of the children of secondary school age (12 to 16 years) were attending secondary school. Of the remaining, some of them were either out of school or attending primary school. Attendance was lower among boys (89 percent) than among girls (93 percent). There was no difference by area of residence but there was a higher level of attendance among children whose mothers have a higher level of education. The primary school net attendance ratio of children of secondary school age is presented in Table ED.4W. Five percent of the children of secondary school age were still attending primary school. The remaining 4 percent were not attending school at all. They were children out of school since we already indicated that 91 percent of them were attending secondary school. However, the majority of these would be 16 years and may have completed secondary school. The percentage of children entering first grade who eventually reached grade 5 is presented in Table ED.5. Of all children starting grade one, the majority of them (99 percent) will eventually reach grade five. Notice that very few children repeated grades. This is because there are too few places in school to accommodate repeaters and therefore children tend to be automatically moved up to the next grade even if they are not performing adequately at the lower level. The net primary school completion rate and transition rate to secondary education is presented in Table ED.6. At the moment of the survey, 82 percent of the children of primary completion age (11 years) were attending the last grade of primary education. This value should be distinguished from the gross primary completion ratio which includes children of any age attending the last grade of primary. The percentage of children in rural areas at primary completion level was slightly lower than in the urban areas. Also, children whose mother had a higher level of education had a higher net primary completion rate. Transition to secondary was almost universal with 99 percent of the children that successfully completed the last grade of primary school were found at the moment Jamaica MICS 2005 survey report 32 the survey to be attending the first grade of secondary school. The transition rate was slightly lower in the rural areas but there were no other observable differences. The ratio of girls to boys attending primary and secondary education is 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 attendance ratios rather than gross attendance ratios. The last ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children attending primary education tend to be boys. The table shows that gender parity for both primary and secondary school was close to 1.00, indicating no difference in the attendance of girls and boys to either level. This was true regardless of area of residence or education of mother. Distance from Household to Primary and Secondary School Distance to nearest school is one measure of access to education. Distance to primary school is provided in Table ED.8. Some 68 percent of households lived within one mile of a primary school, with 97 percent living less than five miles. However, there were differences by area with 51 percent of rural households living within one mile of the school compared with 92 percent of households in KMA being within one mile of a primary school. Overall more households lived further from the nearest secondary school than a primary school (Table ED.9). Some 42 percent were less than one mile from the nearest secondary school, with 86 percent being less than 5 miles. Differences by area were even more marked as only 11 percent of rural households lived within one mile compared with 84 percent of households in KMA being within one mile of the nearest secondary school. Adult Literacy One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s questionnaire was administered, the results are based only on females age 15-24. Literacy was assessed on the ability of women to read a short simple statement or an educational level of secondary or higher as it is assumed that women with secondary level education are literate. However, it should be noted that in a study of children 10-15 years attending school, 4 percent of the girls attending secondary school were illiterate8. The percent literate is presented in Table ED.10. Only 2 percent of women 15-24 were illiterate. 8 Fox, K. and Gordon-Strachan, G. Jamaican Youth Risk and Resiliency Behaviour Survey 2005. www.cpc.unc.edu/measure/publications/pdf/tr-07-58.pdf Jamaica MICS 2005 survey report 33 XI. Child Protection Birth Registration The United Nations 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. The births of 89 percent of children under five years in Jamaica have been registered (Table CP.1). There were no significant variations in birth registration across sex or area of residence. The percentage of births registered was strongly correlated with age of child. Thus, while only 71 percent of births were registered for children less than one year, this percentage rose to 94 percent by age 36-47 months. Among those whose births were not registered, issues of cost were cited as the main reasons; 57 percent of caretakers stated that they owed hospital fees and 32 percent said that the cost for registration was too much. A similar pattern of birth registration has been observed by the Jamaica Survey of Living Conditions (PIOJ/STATIN: 2005). Child Labour Article 32 of the Convention on the Rights of the Child states: "States 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 MICS 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: at least one hour of economic work or 28 hours of domestic work per week. ! Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiation of child labour from child work to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the 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 Jamaica MICS 2005 survey report 34 numbers specified in the criteria explained before. Table CP.2 presents the results of child labour by the type of work as reported by the mother/caretaker. Overall, 6.1 percent of children 5-14 years were reported to be involved in child labour. More children in the younger age group 5-11 years were involved in child labour than the age group 12-14 years (8 percent versus 2 percent respectively). It must be emphasised that this does not mean that younger children were more likely to be employed but rather, they are more likely to be involved in child labour based on the definition used in this report. It must also be noted that mothers/caretakers are often unaware of what older children are doing so the prevalence of child labour among children 12-14 years may be underestimated. The percentage of boys involved in child labour was slightly higher than for girls (7 percent versus 5 percent respectively). Overall, 2.9 percent were involved in unpaid labour outside the home with more young children (4.3 percent) being involved in such labour compared with older children (0.1 percent). Table CP.3 presents the percentage of children classified as student labourers or as labourer students. Student labourers are the children attending school that were involved in child labour activities at the moment of the surveys. More specifically, of the 99 percent of the children 5-14 years of age attending school, 6 percent were also involved in child labour activities. Furthermore, of the 6 percent of the children classified as child labourers, the majority of them were also attending school (98 percent). Therefore, being in child labour appears not to affect being in school but is likely to affect the quality of the participation and learning. 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 Jamaica MICS3 survey, mothers/caretakers of children age 2-14 years were asked a series of questions on the methods the parents tend to use to discipline their children when they misbehave. Note that for the child discipline module the questions were administered for one child aged 2-14 per household selected randomly during fieldwork. The questions were adapted from the Parent-Child Conflict Tactic Scale (CTS-PC), an epidemiological instrument widely used to assess the treatment of children9. It includes items to measure a wide range of responses from non-violent forms of discipline to psychological aggression and severe physical means of disciplining and punishing children. From these questions, the indicators used to describe aspects of child discipline are: 1) the number of children 2-14 years that experience psychological aggression10 as punishment or minor physical punishment11 or severe physical punishment12; and 2) the number of 9 Straus, M.A., Hamby, S.L., Finkelor, D. Moore, D.W. 7 Runyan, D. 1998. Identification of Child Maltreatment with the Parent-Child Conflict Tactic Scale: Development and psychometric data for a national sample of American parents. Child Abuse and Neglect 22(4):247-270 10 If child was shouted, yelled or screamed at and/or called dumb, lazy or other name like that. 11 If child was shaken, spanked, hit or slapped on bottom with bare hand and/or hit anywhere on the body with a hard instrument and/or hit/slapped on arm, leg or hand. Jamaica MICS 2005 survey report 35 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. In Jamaica, 87 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 (Table CP.4). More importantly, 8 percent of children were subjected to severe physical punishment. On the other hand, there were 36 percent of mothers/caretakers who believed that children should be physically punished, which implies an interesting contrast with the actual prevalence of physical discipline. More male children were subjected to both minor and severe physical discipline (75 and 10 percent) than female children (71 and 5 percent). Younger children were more likely to be subjected to minor physical punishment while older children experienced more psychological punishment. Women with higher educational levels resorted more to non-violent discipline and less to psychological and minor physical punishment than women with secondary level education. Early Marriage Marriage 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 hopes 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 other rights - such as the right to express their views freely, the right to protection from all forms of abuse, and the 12 If child is hit/slapped on the face, head or ears and/or beat with an instrument over and over as hard as one could. Jamaica MICS 2005 survey report 36 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 - 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 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 lead to very low condom use among such couples. In Jamaica, although the occurrence of legal marriages may be low, females are often in a union at an early age Therefore, the two indicators are combined to estimate the percentage of women married/in union before 15 years of age and percentage Jamaica MICS 2005 survey report 37 married/in union before 18 years of age. The percentage of women married/in union at various ages is provided in Table CP.5. Just over 1 percent of the women stated that they were married/in union before the age of 15 years and 10 percent were married/in union before the age of eighteen. The percentage of females 15-19 years currently married or in a union was 4.5 percent. More rural females in this age group were married or in a union compared to their urban counterparts (6 percent versus 4 percent respectively). Another component is the spousal age difference with an indicator being the percentage of married/in union women with a difference of 10 or more years of age compared to their current spouse. Table CP.6 presents the results of the age difference between husbands and wives. Only 30 women aged 15-19 years were currently married or in a union and of these, 32 percent were 10+ years younger than their partners. Among women aged 20-24 years who were currently married or in a union, 24 percent were 10+ years younger than their partners. 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 who 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.7. Nationally, 6.1 percent of women felt that a husband or male partner was justified in beating his wife/partner partner for at least one of the various scenarios. For most of the reasons put forward in the questionnaire, less than 2 percent of the women support beating. However, nearly 5 percent thought that the beating was justifiable if the woman neglected her children. Child Disability One of the World Fit for Children goals is to protect children against abuse, exploitation, and violence, including the elimination of discrimination against children with disabilities. For children age 2 through 9 years, a series of questions were asked to assess a number of disabilities/impairments, such as sight impairment, deafness, and difficulties with speech. This approach rests in the concept of functional disability developed by WHO and aims to identify the implications of any impairment or disability for the development of the child (e.g. health, nutrition, education, etc.). Table CP.8 presents the results of these questions. Based on the reports of mothers/caretakers, some 15 percent of children 2-9 years have at least one disability. Disabilities most frequently reported are: not Jamaica MICS 2005 survey report 38 understanding instructions (4.9 percent), mentally backward, dull or slow (4.7 percent) and not speaking, cannot be understood in words (3.9 percent). Some 11.7 percent of children 3-9 years were reported to have delayed speech, while 9.3 percent of children aged 2 years could not name at least one object. Jamaica MICS 2005 survey report 39 XII. HIV/AIDS and Orphaned and Vulnerable Children Knowledge of HIV Transmission 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 United Nations General Assembly Special Session on HIV/AIDS indicator is the percent of young women who have comprehensive and correct knowledge of HIV prevention and transmission. Women were asked whether they knew of the three main ways of HIV transmission – having only one faithful uninfected partner, using a condom every time, and abstaining from sex. The results are presented in Table HA.1. In Jamaica, almost all of the interviewed women (99 percent) have heard of AIDS. However, the percentage of women who know of all three main ways of preventing HIV transmission was 69 percent. Eighty-three percent of women know of having one faithful uninfected sex partner, 89 percent know of using a condom every time, and 87 percent know of abstaining from sex as main ways of preventing HIV transmission. Fewer than 2 percent do not know any of the three ways. Table HA.2 presents the percent of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Jamaica, that HIV can be transmitted by sharing food and mosquito bites and a healthy looking person cannot be infected. The table also provides information on whether women know that ‘HIV cannot be transmitted by supernatural means, and that ‘HIV can be transmitted by sharing needles’. Of the interviewed women, 76 percent reject the two most common misconceptions and know that a healthy-looking person can be infected. Ninety- percent of women know that ‘HIV cannot be transmitted by sharing food’, but 81 percent of women know that ‘HIV cannot be transmitted by mosquito bites’, while 96 percent of women know that ‘a healthy-looking person can be infected’. More women with higher level of education reject misconceptions concerning HIV. Jamaica MICS 2005 survey report 40 Table HA.3 summarizes information from Tables HA.1 and HA.2 and presents the percentage of women who know 2 ways of preventing HIV transmission and reject three common misconceptions. Comprehensive knowledge of HIV prevention methods and transmission was still fairly low. Overall, 59 percent of women were found to have comprehensive knowledge. As expected, the percent of women with comprehensive knowledge increases with the woman’s education level and comprehensive knowledge also peaks in the age group 20-24 years (61 percent) (Figure HA.1). Figure HA.1 Percent of women who have comprehensive knowledge of HIV/AIDS transmission, Jamaica, 2005 65 75 80 75 51 72 57 74 35 57 67 58 0 10 20 30 40 50 60 70 80 90 Primary Secondary Higher Jamaica Pe rc en t Knows 2 ways to prevent HIV Identify 3 misconceptions Comprehensive knowledge Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they become pregnant to avoid infection in 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. Overall, 95 percent of the women knew that HIV can be transmitted from mother to child. The percentage of women who knew all three ways of mother-to-child transmission was 59 percent, while 5 percent of women did not know of any specific way. There were marked differences in knowledge by area. Generally, more women in the KMA could correctly identify means of HIV transmission than in either the other urban areas or rural areas. Also, more women in all the urban areas (62.4 percent) knew all three ways of HIV transmission when compared with women living in rural areas (52.9 percent). Jamaica MICS 2005 survey report 41 The indicators on attitudes toward people living with HIV 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 AIDS; 2) would buy fresh vegetables from a vendor 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. Table HA.5 presents the attitudes of women towards people living with HIV/AIDS. Stigmatism is high in Jamaica with 80 percent agreeing with at least one discriminatory statement. While less than ten percent stated that they would not care for a family member who was infected with AIDS, over half (58 percent) said that they would want to keep it a secret. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. The majority of women (89 percent) know where to be tested, while 49 percent have actually been tested. Of these, a large proportion has been told the result (90 percent). Among women who had given birth within the two years preceding the survey, the percent who received counselling and HIV testing during antenatal care is presented in Table HA.7. Most of the women (83 percent) had received information about HIV prevention during ANC visit, while 90 percent had been tested for HIV and 84 percent had received the results. The difference in percentage of women tested among those in the urban and rural areas is approximately 6 percentage points (93 percent and 87 percent respectively). However, the difference in results received is considerably larger (14 percentage points) as only 76 percent of women in rural areas received their results compared with 90 percent of urban women. These findings point to the problems experienced by rural health centres in receiving diagnostic results in a timely manner. In the Jamaica MICS, information was sought about whether women believed that there were drugs they can take to reduce the risk of HIV/AIDS transmission to their babies (Table HA.8). Some 72 percent of women believed that drugs are available while a significant 19 percent did not know and 9 percent did not believe. The percentage who did believe, was lowest among older women and those with primary level schooling only. The majority of women (85 percent) felt that a child with HIV/AIDS who is not sick, should be allowed to attend school (Table HA.9). Women with primary level education were less likely to hold this view than women with higher education (74 percent versus 90 percent respectively). Jamaica MICS 2005 survey report 42 Orphans and Vulnerable Children As the HIV epidemic progresses, more and more children are becoming orphaned and vulnerable because of AIDS. Children who are orphaned or in vulnerable households may be at increased risk of neglect or exploitation if the parents are not available to assist them. Monitoring the variations in different outcomes for orphans and vulnerable children and comparing them to their peers gives us a measure of how well communities and governments are responding to their needs. To monitor these variations, a measurable definition of orphaned and vulnerable children needed to be created. The UNAIDS Monitoring and Evaluation Reference Group developed proxy definition of children who have been affected by adult morbidity and mortality. This should capture many of the children affected by AIDS in countries where a significant proportion of the adults are HIV infected. This definition classifies children as orphaned and vulnerable if they have experienced the death of either parent, if either parent is chronically ill, or if an adult (aged 18-59) member of the household either died (after being chronically ill) or was chronically ill in the year prior to the survey. The frequency of children living with neither parent, mother only, and father only is presented in Table HA.10. Some 34 percent were living with both parents, while 45.3 percent were living with mother only, 6 percent with father only and 13 percent live with neither parent. There was no difference by sex of child. However, more children living in the rural areas live with both parents and as age increases the percentage of children living with both parents decreases. Table HA.11 shows the percentage of orphaned and vulnerable children aged 0-17 years. Overall, 5 percent were orphaned with another 7.4 percent being vulnerable. There were no differences by sex or area of residence. One of the measures developed for the assessment of the status of orphaned and vulnerable children relative to their peers looks at the school attendance of children 10-14 for children who have lost both parents (double orphans) versus children whose parents are alive (and who live with at least one of these parents). If children whose parents have died do not have the same access to school as their peers, then families and schools are not ensuring that these children’s rights are being met. In Jamaica, less than one percent of children aged 10-14 have lost both parents (Table HA.12). All are currently attending school. Among the children ages 10-14 who have not lost a parent and who live with at least one parent, 99 percent are attending school. This would suggest that double orphans are at no disadvantage compared to the non-orphaned children in terms of school attendance. In many countries few services are available to families that have taken in children who are orphaned or vulnerable. Community-based organizations and governments need to be sure that families are supported to care for these children. Jamaica MICS 2005 survey report 43 The level and types of support provided to households caring for children orphaned and vulnerable is presented in Table HA.13. Generally, support was low with only 15.4 percent reporting any support, the main one being educational (8.9 percent). Jamaica MICS 2005 survey report 44 List of 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. Chatman, L., Salihu, H., Roofe, M., Wheatle, P., Henry, D., Jolly, P. (2004) Influence of Knowledge and Attitudes on Exclusive Breastfeeding Practice Among Rural Jamaican Mothers. Birth 31 (4), 265–271. doi:10.1111/j.0730-7659.2004.00318.x 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. McCaw-Binns, Affette Kristin Fox, Karen Foster-Williams, Deanna Ashley & Beryl Irons. 1996. "Registration of Births, Stillbirths and Infant Deaths in Jamaica". International Journal of Epidemiology. Vol. 25. No. 4. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. Straus, M.A., Hamby, S.L., Finkelor, D. Moore, D.W. 7 Runyan, D. 1998. Identification of Child Maltreatment with the Parent-Child Conflict Tactic Scale: Development and psychometric data for a national sample of American parents. Child Abuse and Neglect 22(4):247-270 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. 45 Table HH.1: Results of household and individual interviews Numbers of households, women and children under 5 by results of the household, women's and under-five's interviews, and household, women's and under-five's response rates, JAMAICA, 2005 Area Total KMA Urban Rural Sampled households 1626 1785 2839 6250 Occupied households 1436 1610 2558 5604 Interviewed households 1147 1367 2253 4767 Household response rate 79.9 84.9 88.1 85.1 Eligible women 988 1069 1720 3777 Interviewed women 952 1038 1657 3647 Women response rate 96.4 97.1 96.3 96.6 Women's overall response rate 77.0 82.4 84.9 82.1 Eligible children under 5 322 400 722 1444 Mother/Caretaker Interviewed 319 395 713 1427 Child response rate 99.1 98.8 98.8 98.8 Children's overall response rate 79.1 83.8 87.0 84.1 46 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, JAMAICA, 2005 Sex Total Male Female Number Percent Number Percent Number Percent Age 0-4 721 9.1 723 9.3 1445 9.2 5-9 820 10.4 787 10.1 1606 10.2 10-14 902 11.4 867 11.1 1770 11.3 15-19 780 9.9 702 9.0 1483 9.4 20-24 689 8.7 594 7.6 1283 8.2 25-29 561 7.1 500 6.4 1061 6.8 30-34 506 6.4 543 7.0 1049 6.7 35-39 488 6.2 569 7.3 1057 6.7 40-44 496 6.3 529 6.8 1025 6.5 45-49 406 5.1 407 5.2 814 5.2 50-54 351 4.4 385 4.9 736 4.7 55-59 274 3.5 267 3.4 541 3.4 60-64 209 2.6 206 2.6 415 2.6 65-69 170 2.2 177 2.3 346 2.2 70+ 475 6.0 530 6.8 1005 6.4 Missing/DK 42 (.5) 22 (*) 64 .4 Dependency age groups <15 2443 31.0 2377 30.4 4821 30.7 15-64 4758 60.3 4703 60.2 9462 60.3 65+ 645 8.2 706 9.0 1351 8.6 Missing/DK 42 (.5) 22 (*) 64 .4 Age Children aged 0-17 2971 37.7 2804 35.9 5775 36.8 Adults 18+/Missing/DK 4918 62.3 5005 64.1 9923 63.2 Total 7889 100.0 7809 100.0 15698 100.0 47 Table HH.3: Household composition Percent distribution of households by selected characteristics, JAMAICA, 2005 Weighted percent Number of households weighted Number of households unweighted Sex of household head Male 59.1 2819 2852 Female 40.9 1948 1915 Area KMA 33.2 1585 1147 Urban 25.5 1216 1367 Rural 41.3 1967 2253 Number of household members 1 26.1 1243 1272 2-3 33.6 1603 1599 4-5 25.3 1206 1183 6-7 10.4 498 487 8-9 3.1 146 148 10+ 1.5 72 78 At least one child aged < 18 years 54.0 4767 4767 At least one child aged < 5 years 23.5 4767 4767 At least one woman aged 15- 49 years 58.0 4767 4767 Total 100.0 4767 4767 48 Table HH.4: Women's background characteristics Percent distribution of women aged 15-49 years by background characteristics, JAMAICA, 2005 Weighted Percent Number of women weighted Number of women unweighted Area KMA 36.2 1319 952 Urban 25.0 910 1038 Rural 38.9 1417 1657 Age 15-19 18.2 665 664 20-24 15.3 558 557 25-29 13.2 480 478 30-34 14.1 516 531 35-39 14.8 539 535 40-44 13.8 503 485 45-49 10.6 386 397 Marital/Union status Currently married/ In union 38.9 1418 1427 Formerly married/ In union 14.1 514 537 Never married/ In union 47.0 1715 1683 Motherhood status Ever gave birth 69.1 2521 2542 Never gave birth 30.9 1126 1105 Woman’s education level None (*) 6 5 Primary 2.1 76 94 Secondary 78.6 2865 2841 Higher 17.2 628 619 Non- standard curriculum 2.0 72 88 Total 100.0 3647 3647 49 Table HH.5: Children's background characteristics Percent distribution of children under five years of age by background characteristics, JAMAICA, 2005 Weighted percent Number of under-5 children weighted Number of under-5 children unweighted Sex Male 50.0 713 706 Female 50.0 714 721 Area KMA 31.1 444 319 Urban 24.8 353 395 Rural 44.1 630 713 Age < 6 months 9.6 138 129 6-11 months 8.7 124 129 12-23 months 19.0 271 283 24-35 months 22.0 314 304 36-47 months 19.9 285 283 48-59 months 20.7 296 299 Woman's education level Primary 4.2 61 71 Secondary 81.2 1158 1147 Higher 13.1 187 182 Non-standard curriculum (1.5) 22 27 Total 100.0 1427 1427 50 Table CM.1: Child mortality Infant and under-five mortality rates by background and demographic characteristics [BASED ON WEST], JAMAICA, 2005 Infant Mortality Rate* Under-five Mortality Rate** Sex Male 28 33 Female 24 30 Area Total Urban 29 36 - KMA 26 33 - Urban 33 40 Rural 21 25 Mother's education Primary, None, Non-Std, Dk 51 67 Secondary 22 26 Total Total 26 31 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 Table CM.2: Children ever born and proportion dead Mean number of children ever born and proportion dead by age of women, Jamaica, 2005 Mean number of children ever born Proportion dead Number of women Age 15-19 .077 .027 665 20-24 .397 .025 558 25-29 .844 .029 480 30-34 1.209 .036 516 35-39 1.529 .043 539 40-44 1.653 .050 503 45-49 1.833 .050 386 Total 1.005 .042 3647 51 Table NU.1: 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, Jamaica, 2005 Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with live birth in the two years preceding the survey Area Total Urban 66.1 84.5 297 - KMA 65.9 82.2 164 - Urban 66.4 87.4 133 Rural 57.2 83.4 228 Months since last birth < 6 months 67.5 85.0 140 6-11 months 65.2 87.9 123 12-23 months 58.1 81.7 262 Woman's education level Primary (*) (*) 11 Secondary 62.6 84.3 436 Higher 60.1 83.1 70 Non-standard curriculum (*) (*) 7 Total 62.3 84.0 525 * MICS indicator 45 52 Table NU.2: Breastfeeding Percent of living children according to breastfeeding status at each age group, JAMAICA, 2005 Children 0-3 months Children 0-5 months Children 6-9 months Children 12-15 months Children 20-23 months Percent exclusively breastfed Number of children Percent exclusively breastfed * Number of children Percent receiving breastmilk and solid/mushy food ** Number of children Percent breastfed*** Number of children Percent breastfed *** Number of children Sex Male (13.1) 46 10.3 64 (26.3) 34 (49.0) 36 (22.2) 43 Female (29.9) 45 19.5 73 (44.3) 36 49.1 55 25.6 48 Area Total Urban 19.9 61 14.5 87 (27.0) 39 (50.4) 40 (17.3) 50 - KMA (16.7) 39 (11.1) 58 (*) 25 (*) 20 (*) 16 - Urban (*) 22 (21.4) 29 (*) 14 (*) 20 (15.6) 33 Rural (24.4) 30 16.3 50 (46.5) 31 48.1 51 32.0 41 Woman's education level Primary (*) 3 (*) 4 (*) 2 (*) 3 (*) 4 Secondary 18.4 77 12.7 116 38.5 57 47.6 80 26.6 69 Higher (*) 9 (*) 15 (*) 11 (*) 8 (*) 13 Non-standard curriculum (*) 2 (*) 2 (*) 0 (*) 0 (*) 4 Total 21.4 91 15.2 138 35.6 70 49.1 91 24.0 91 * MICS indicator 15 ** MICS indicator 17 *** MICS indicator 16 53 Table NU.3: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times yesterday and percentage of infants adequately fed, Jamaica, 2005 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 Male 10.3 17.1 11.2 13.6 11.9 122 Female 19.5 27.1 9.4 16.6 18.1 140 Area Total Urban 14.5 17.7 11.4 14.0 14.3 156 - KMA 11.1 10.0 12.7 11.5 11.3 97 - Urban 21.4 29.5 9.8 17.3 19.3 59 Rural 16.3 28.5 8.8 16.7 16.5 106 Woman's education level Primary (*) (*) (*) (*) (*) 7 Secondary 12.7 24.4 10.4 16.3 14.4 219 Higher (33.0) (11.6) (12.8) (12.3) (22.0) 33 Non-standard curriculum (*) (*) (*) (*) (*) 3 Total 15.2 22.5 10.2 15.2 15.2 262 * MICS indicator 18; ** MICS indicator 19 54 Table NU.4 : Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Jamaica, 2005 Percent of live births below 2500 grams * Percent of live births weighed at birth ** Number of live births Area Total Urban 12.2 98.2 297 - KMA 12.0 99.0 164 - Urban 12.3 97.1 133 Rural 12.0 95.0 228 Woman's education level Primary (*) (*) 11 Secondary 12.6 97.2 436 Higher 9.8 96.0 70 Non-standard curriculum (*) (*) 7 Total 12.1 96.8 525 * MICS Indicator 9 ** MICS Indicator 10 55 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 (18 months for measles), JAMAICA, 2005 BCG * DPT 1 DPT 2 DPT 3 ** Polio 1 Polio 2 Polio 3 **** Measles **** All ***** None Number of children aged 18-29 months Vaccination card 74.0 74.5 74.7 72.9 74.4 75.1 73.0 70.0 66.6 .0 298 Mother's report 22.1 21.6 18.1 14.0 21.5 19.9 13.2 21.1 11.4 3.6 298 Either 96.1 96.1 92.8 86.9 95.9 94.9 86.2 91.1 78.0 3.6 298 Vaccinated by 12 months of age 94.3 91.4 90.9 81.5 95.7 93.1 80.1 86.8 62.9 3.8 298 * MICS Indicator 25 ** MICS Indicator 26 *** MICS Indicator 27 **** MICS Indicator 28 ; MDG Indicator 15 ***** MICS Indicator 31 56 Table CH.2: Vaccinations by background characteristics Percentage of children aged 18-29 months currently vaccinated against childhood diseases, JAMAICA, 2005 BCG DPT1 DPT2 DPT3 Polio 1 Polio 2 Polio 3 MMR All None Percent with health card Number of children aged 18-29 months Sex Male 97.9 97.2 94.9 89.4 97.2 97.2 85.1 92.5 78.9 2.1 76.0 148 Female 94.3 94.9 90.8 84.4 94.6 92.6 87.4 89.7 77.1 5.0 72.2 150 Area Total Urban 94.1 93.4 90.2 84.2 94.1 93.1 85.8 87.9 77.5 5.9 72.1 - KMA 91.2 91.2 89.3 82.3 91.2 89.3 79.9 83.7 73.4 8.8 63.9 73 - Urban 96.7 95.4 91.0 86.0 96.7 96.6 91.1 91.7 81.2 3.3 79.4 83 Rural 98.3 99.0 95.8 89.8 98.0 96.9 86.7 94.6 78.6 1.0 76.3 142 Woman's education level Primary (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 14 Secondary 96.3 95.8 92.1 86.7 95.7 94.8 87.1 91.0 79.2 3.7 76.5 239 Higher (93.2) (95.6) (95.3) (86.4) (95.7) (95.5) (79.4) (89.7) (67.1) (4.3) (54.0) 39 Non- standard curriculum (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 5 Total 96.1 96.1 92.8 86.9 95.9 94.9 86.2 91.1 78.0 3.6 74.1 298 57 Table CH.3: Neonatal tetanus protection Percentage of mothers with a birth in the last 24 months protected against neonatal tetanus, Jamaica, 2005 Received at least 2 doses during last pregnancy Received at least 2 doses, the last within prior 3 years Received at least 3 doses, the last within 5 years Received at least 4 doses, the last within 10 years Protected against tetanus * Number of mothers Area Total Urban 40.2 19.8 .4 1.2 61.6 297 - KMA 40.3 17.4 .0 .0 57.7 164 - Urban 40.1 22.8 .8 2.7 66.5 133 Rural 40.6 27.4 1.6 .3 70.1 228 Age 15-19 40.3 12.0 1.1 .0 53.4 67 20-24 42.1 20.6 .7 1.7 65.1 134 25-29 43.7 25.1 .8 .0 69.6 120 30-34 35.1 28.1 2.1 .0 65.4 100 35-39 43.4 23.3 .0 3.2 69.9 66 40-44 (32.1) (30.5) (.0) (.0) (62.5) 36 45-49 (*) (*) (*) (*) (*) 2 Woman's education level Primary (*) (*) (*) (*) (*) 11 Secondary 42.1 24.1 1.1 .8 68.2 436 Higher 30.7 17.2 .0 1.3 49.2 70 Non-standard curriculum (*) (*) (*) (*) (*) 7 Total 40.4 23.1 .9 .8 65.3 525 * MICS Indicator 32 58 Table CH.4: Oral rehydration treatment Percentage of children aged 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Jamaica, 2005 Had diarrhoea in last two weeks Number of children aged 0- 59 months Number of children aged 0- 59 months with diarrhoea Sex Male 2.8 713 20 Female 2.0 714 14 Area Total Urban 1.8 797 14 - KMA 1.2 444 6 - Urban 2.5 353 9 Rural 3.1 630 20 Age < 6 months 1.5 138 2 6-11 months 4.3 124 5 12-23 months 4.4 271 12 24-35 months 1.1 314 3 36-47 months 2.0 285 6 48-59 months 1.9 296 6 Woman's education level Primary 1.8 61 1 Secondary 2.8 1158 32 Higher .0 187 0 Non-standard curriculum (2.8) 22 1 Total 2.4 1427 34 * MICS Indicator 33 59 Table CH.5: Care seeking for suspected pneumonia Percentage of children aged 0-59 months in the last two weeks taken to a health provider, Jamaica, 2005 Had acute respira- tory infection Number of children aged 0- 59 months Any appropriate provider * Number of children aged 0-59 months with suspected pneumonia Sex Male 6.8 713 (73.1) 49 Female 6.2 714 (77.4) 44 Area Total Urban 6.4 797 (74.9) 52 Rural 6.5 630 (75.5) 41 Total 6.5 1427 75.1 93 * MICS indicator 23 60 Table CH.6: Antibiotic treatment of pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, Jamaica, 2005 Percentage of children aged 0-59 months with suspected pneumonia who received antibiotics in the last two weeks * Amoxil Ampicillin Bactrim Number of children aged 0-59 months with suspected pneumonia in the two weeks prior to the survey Sex Male (39.7) (36.6) (1.5) (1.6) 49 Female (64.8) (63.2) (.0) (1.6) 44 Area Total Urban (50.2) (47.4) (1.4) (1.4) 52 Rural (53.3) (51.4) (.0) (1.9) 41 Total 51.6 49.2 .8 1.6 93 * MICS indicator 22 61 Table CH.7: Knowledge of the two danger signs of pneumonia Percentage of mothers/caretakers of children aged 0-59 months by knowledge of types of symptoms for taking a child immediately to a health facility, and percentage of mothers/caretakers who recognize fast and difficult breathing as signs for seeking care immediately, Jamaica, 2005 Percentage of mother/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child: Mothers/ caretakers who recognize the two danger signs of pneumonia Number of mothers/ caretakers of children aged 0-59 months Is not able to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has difficulty breathing Has blood in stool Is drinking poorly Has other symptoms Area Total Urban 9.6 20.8 66.8 28.7 50.2 30.0 11.1 51.6 18.9 797 - KMA 8.4 19.5 70.2 27.6 49.9 30.2 9.0 37.7 14.7 444 - Urban 11.2 22.4 62.6 30.1 50.7 29.7 13.7 69.1 24.1 353 Rural 15.3 25.4 57.7 33.7 50.0 36.2 13.7 61.4 27.2 630 Woman's education level Primary 9.7 25.3 65.4 37.0 61.5 42.8 12.7 64.4 30.8 61 Secondary 12.2 22.6 62.2 30.5 49.4 32.7 12.0 54.3 22.2 1158 Higher 12.1 23.1 68.6 33.8 52.9 30.1 14.4 63.8 24.2 187 Non- standard curriculum (14.5) (25.6) (37.0) (13.1) (35.0) (28.0) (2.7) (52.5) (2.8) 22 Total 12.1 22.8 62.8 30.9 50.1 32.7 12.2 55.9 22.5 1427 62 Table EN.1: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household members using improved drinking water sources, Jamaica, 2005 Main source of drinking water Total Improved source of drinking water Number of household members Improved sources Unimproved sources Piped into dwelling Piped into yard or plot Public tap/ standpipe Protect- ed well Protected spring Rainwater collection Bott- led water Unpro- tected well Unpro- tected spring Tanker- truck Surface water Bottled water Other Area Total Urban 58.6 28.6 4.0 .0 .1 3.6 2.4 .0 .5 .6 .3 .0 1.2 100.0 97.3 9080 - KMA 65.4 29.4 .9 .0 .1 .4 2.7 .0 .0 .6 .0 .1 .5 100.0 98.8 5160 - Urban 49.7 27.5 8.2 .0 .1 7.8 2.1 .0 1.1 .4 .7 .0 2.1 100.0 95.5 3921 Rural 24.2 20.3 12.8 .5 1.3 28.6 .6 .3 5.0 2.5 1.9 .3 1.9 100.0 88.2 6618 Education of household head None (30.0) (23.0) (19.9) (.0) (.0) (21.2) (.0) (.0) (.3) (2.1) (.0) (.0) (3.5) (100.0) (94.0) 143 Primary 37.2 26.9 8.5 .2 1.1 18.8 .1 .2 3.4 1.4 1.1 .0 1.2 100.0 92.8 4185 Secondary 42.4 26.8 8.3 .3 .5 13.3 1.5 .1 2.4 1.5 1.0 .1 1.9 100.0 93.1 9529 Higher 73.9 8.9 1.1 .0 .2 6.7 7.1 .0 .0 .6 .6 .9 .0 100.0 97.9 1538 Non- standard curriculum 52.4 33.0 4.2 .0 .0 7.5 .0 .0 2.1 .8 .0 .0 .0 100.0 97.1 129 Missing/DK (46.9) (26.7) (6.6) (.0) (.0) (10.9) (.0) (.0) (3.2) (.0) (5.8) (.0) (.0) (100.0) (91.0) 173 Total 44.1 25.1 7.7 .2 .6 14.1 1.6 .1 2.4 1.4 1.0 .1 1.5 .0 100.0 93.5 15698 * MICS indicator 11; MDG indicator 30 63 Table EN.2: Household water treatment Percentage distribution of household population according to drinking water treatment method used in the household and percentage of household members that applied an appropriate water treatment method, Jamaica ,2005 Water treatment method used in the household None Boil Add bleach/ chlorin e Strain through a cloth Use water filter Solar dis- infection Let it stand and settle Other All drinking water sources: Appropriate water treatment method * Number of household members Improved drinking water sources: Appropriate water treatment method Number of household members Unimproved drinking water sources: Appropriate water treatment method Number of household members Area Total Urban 48.2 39.0 22.9 .4 3.0 .0 2.1 .3 51.1 9080 51.2 8839 47.8 241 - KMA 47.8 40.5 22.5 .5 3.5 .0 2.2 .1 51.6 5160 51.8 5096 (*) 64 - Urban 48.7 37.0 23.4 .4 2.3 .1 1.8 .4 50.5 3921 50.5 3743 50.4 177 Rural 43.3 32.6 39.0 .9 .6 .0 1.4 .4 56.1 6618 56.3 5838 54.8 779 Educatio n of househol d head None (61.9 ) (26.8 ) (25.8) (.0) (.0) (.0) (2.1) (2.1) (36.0) 143 (35.2) 135 (*) 9 Primary 46.6 35.1 31.3 .9 1.0 .1 1.9 .3 52.7 4185 53.3 3884 44.8 300 Secondary 46.0 36.0 31.0 .6 1.1 .0 1.9 .3 53.2 9529 53.0 8870 56.6 660 Higher 43.4 41.8 17.7 .7 9.5 .2 .8 .7 56.5 1538 56.4 1506 (*) 33 Non- standard curriculum 32.4 51.9 26.3 .0 7.9 .0 5.7 1.3 67.6 129 69.7 126 (*) 4 Missing/D K (58.3 ) (27.3 ) (29.9) (.0) (1.1) (.0) (.0) (.0) (41.7) 173 (39.4) 157 (*) 16 Total 46.1 36.3 29.7 .7 2.0 .0 1.8 .3 53.2 15698 53.2 14677 53.1 1021 * MICS indicator 13 64 Table EN.3: Time to source of water Percent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, Jamaica, 2005 Time to source of drinking water Total Mean time to source of drinking water (excluding those on premises) Number of households Water on premises Less than 15 minutes 15 minutes to less than 30 minutes 30 minutes to less than 1 hour 1 hour or more DK/ Mising Area Total Urban 93.0 3.2 1.9 1.5 .2 .2 100.0 17.8 2800 - KMA 97.9 1.1 .3 .4 .0 .2 100.0 15.0 1585 - Urban 86.6 5.8 4.0 2.8 .5 .3 100.0 18.3 1216 Rural 73.7 10.6 8.6 4.9 1.6 .6 100.0 21.3 1967 Education of household head None (80.8) (7.2) (3.6) (2.4) (2.7) (3.4) (100.0) (23.7) 41 Primary 81.6 6.2 6.1 4.0 1.4 .7 100.0 24.6 1341 Secondary 84.3 7.2 4.8 2.8 .6 .2 100.0 18.3 2752 Higher 97.2 1.6 .6 .4 .0 .2 100.0 14.2 546 Non-standard curriculum (86.9) (7.8) (3.2) (1.1) (.0) (1.1) (100.0) (10.0) 46 Missing/DK (87.6) (3.3) (5.3) (2.6) (.0) (1.2) (100.0) (19.4) 41 Total 84.9 6.3 4.7 2.9 .8 .4 100.0 20.4 4767 65 Table EN.4: Person collecting water Percent distribution of households according to the person collecting water used in the household, Jamaica, 2005 Person collecting drinking water Total Number of households Adult woman Adult man Female child (under 15) Male child (under 15) DK/Missin g Area Total Urban 36.4 53.2 1.4 4.1 4.9 100.0 191 - KMA (*) (*) (*) (*) (*) (*) 32 - Urban 38.4 51.0 1.7 4.9 3.9 100.0 159 Rural 30.6 57.8 4.8 3.7 3.2 100.0 515 Education of household head None (*) (*) (*) (*) (*) (*) (*) Primary 26.6 62.8 3.5 3.5 3.7 100.0 246 Secondary 33.7 54.5 4.1 4.3 3.4 100.0 426 Higher (*) (*) (*) (*) (*) (*) (*) Non-standard curriculum (*) (*) (*) (*) (*) (*) (*) Missing/DK (*) (*) (*) (*) (*) (*) (*) Total 32.2 56.5 3.8 3.8 3.7 100.0 706 66 Table EN.5: Use of sanitary means of excreta disposal Percent distribution of household population according to type of toilet used by the household and the percentage of household members using sanitary means of excreta disposal, Jamaica, 2005 Type of toilet facility used by household Improved sanitation facility Unimproved sanitation facility Flush to piped sewer system Flush to septic tank Flush to absorption pit Ventilated Improved Pit latrine (VIP) Pit latrine with slab Flush to somewhere else Flush to unknown place/not sure/DK where Pit latrine without slab/open pit No facilities or bush or field Other/ Missing Total Percentage of population using sanitary means of excreta disposal * Number of households members Area Total Urban 29.8 5.1 45.3 .3 17.3 .2 .5 .9 .5 .1 100.0 97.8 9080 - KMA 44.3 6.9 41.6 .1 5.3 .2 .8 .1 .6 .2 100.0 98.2 5160 - Urban 10.7 2.6 50.1 .5 33.2 .0 .2 1.9 .5 .1 100.0 97.2 3921 Rural 1.8 1.7 42.2 .2 50.3 .0 .1 2.9 .7 .1 100.0 96.2 6618 Education of household head None (1.2) (2.8) (42.5) (.0) (50.9) (.0) (.0) (2.2) (.3) (.0) (100.0) (97.4) 143 Primary 13.0 2.9 43.9 .1 37.6 .1 .1 2.0 .3 .1 100.0 97.5 4185 Secondary 17.0 3.4 43.9 .3 32.3 .1 .3 1.9 .7 .1 100.0 96.9 9529 Higher 39.4 6.7 44.1 .5 6.7 .0 1.0 .4 .7 .6 100.0 97.4 1538 Non-std curriculum 20.9 8.4 49.1 .0 13.8 .0 .0 .5 7.3 .0 100.0 92.2 129 Missing/DK (15.3) (2.3) (46.9) (.0) (33.3) (.0) (.0) (1.4) (.8) (.0) (100.0) (97.8) 173 Total 18.0 3.6 44.0 .3 31.2 .1 .3 1.7 .6 .1 100.0 97.1 15698 * MICS Indicator 12; MDG Indicator 31 67 Table EN.6: Disposal of child's faeces Percent distribution of children aged 0-2 years according to place of disposal of child's faeces, and the percentage of children aged 0-2 years whose stools are disposed of safely, Jamaica, 2005 What was done to dispose of the stools Total Proportion of children whose stools are disposed of safely * Number of children aged 0-2 years Child used toilet/latrine Put/rinsed into toilet or latrine Put/rinsed into drain or ditch Thrown into garbage (solid waste) Buried Left in the open Other DK/ Missing Area Total Urban 12.6 14.0 .2 69.3 .5 .0 1.8 1.6 100.0 26.6 470 - KMA 14.3 8.5 .0 74.4 .0 .0 1.1 1.7 100.0 22.9 255 - Urban 10.6 20.4 .5 63.2 1.1 .0 2.6 1.6 100.0 31.0 215 Rural 8.5 39.0 2.3 39.0 2.9 .4 6.5 1.4 100.0 47.5 385 Woman's education level Primary (7.5) (45.2) (.0) (34.3) (2.9) (3.0) (7.0) (.0) (100.0) (52.8) 34 Secondary 11.0 25.8 1.3 55.4 1.7 .1 3.6 1.0 100.0 36.8 694 Higher 10.5 14.9 .4 66.0 .9 .0 4.4 3.1 100.0 25.4 114 Non-standard curriculum (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 14 Total 10.7 25.3 1.1 55.7 1.6 .2 3.9 1.6 100.0 36.0 855 * MICS indicator 14 68 Table EN.7: Use of improved water sources and improved sanitation Percentage of household population using both improved drinking water sources and sanitary means of excreta disposal, Jamaica, 2005 Percentage of household population using improved sources of drinking water * Percentage of household population using sanitary means of excreta disposal ** Percentage of household population using improved sources of drinking water and using sanitary means of excreta disposal Number of household members Area Total Urban 97.3 97.8 95.3 9080 - KMA 98.8 98.2 97.0 5160 - Urban 95.5 97.2 93.0 3921 Rural 88.2 96.2 85.0 6618 Education of household head None (94.0) (97.4) (91.8) 143 Primary 92.8 97.5 90.7 4185 Secondary 93.1 96.9 90.4 9529 Higher 97.9 97.4 95.3 1538 Non-standard curriculum 97.1 92.2 89.3 129 Missing/DK (91.0) (97.8) (88.8) 173 Total 93.5 97.1 90.9 15698 * MICS indicator 11; MDG indicator 30 ** MICS indicator 12; MDG indicator 31 69 Table RH.1: Antenatal care provider Percent distribution of women aged 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Jamaica, 2005 Person providing antenatal care Total Any skilled personnel * Number of women who gave birth in the preceding two years Medical doctor Nurse/ midwife Community health worker Other/ missing No antenatal care received Area Total Urban 58.7 30.6 7.7 1.5 1.6 100.0 89.3 297 - KMA 62.5 24.4 10.1 1.0 2.0 100.0 86.9 164 - Urban 54.0 38.2 4.8 2.0 1.0 100.0 92.2 133 Rural 56.7 35.5 5.9 1.9 .0 100.0 92.2 228 Age 15-19 53.7 34.8 10.4 1.1 .0 100.0 88.5 67 20-24 52.1 38.5 7.2 1.6 .6 100.0 90.6 134 25-29 60.0 32.8 6.5 .7 .0 100.0 92.7 120 30-34 57.9 32.1 8.3 .0 1.7 100.0 90.0 100 35-39 61.8 30.7 2.5 2.5 2.5 100.0 92.5 66 40-44 (71.1) (12.9) (5.5) (9.2) (1.3) (100.0) (84.0) 36 45-49 (*) (*) (*) (*) (*) (*) (*) 2 Woman's education level Primary (*) (*) (*) (*) (*) (*) (*) 11 Secondary 54.1 35.7 7.4 1.8 1.1 100.0 89.8 436 Higher 84.1 9.9 6.0 .0 .0 100.0 94.0 70 Non-std curriculum (*) (*) (*) (*) (*) (*) (*) 7 Total 57.8 32.7 6.9 1.7 .9 100.0 90.5 525 * MICS indicator 20 70 Table RH.2: Antenatal care content Percentage of pregnant women receiving antenal care among women aged 15-49 years who gave birth in two years preceding the survey and percentage of pregnant women receiving specific care as part of the antenatal care received, Jamaica, 2005 Percent of pregnant women receiving ANC one or more times during pregnancy* Percent of pregnant women who had: Number of women who gave birth in two years preceding survey Blood sample taken Blood pressure measured Urine specimen taken Weight measured Area Total Urban 98.4 96.6 97.4 97.4 97.1 297 - KMA 98.0 97.0 97.0 97.0 97.0 164 - Urban 99.0 96.1 98.0 98.0 97.3 133 Rural 100.0 96.9 98.1 96.1 97.7 228 Age 15-19 100.0 98.9 98.9 97.4 98.9 67 20-24 99.4 98.8 98.8 98.1 98.8 134 25-29 100.0 95.3 99.3 97.9 97.6 120 30-34 98.3 97.9 98.3 98.3 98.3 100 35-39 97.5 95.0 95.0 95.0 95.0 66 40-44 (98.7) (89.5) (89.5) (89.5) (89.5) 36 45-49 (*) (*) (*) (*) (*) 2 Woman's education level Primary (*) (*) (*) (*) (*) 11 Secondary 98.9 96.5 97.5 96.4 97.2 436 Higher 100.0 100.0 100.0 100.0 100.0 70 Non-standard curriculum (*) (*) (*) (*) (*) 7 Total 99.1 96.7 97.7 96.9 97.3 525 * MICS indicator 44 71 Table RH.3: Assistance during delivery Percent distribution of women aged 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery, Jamaica,2005 Person assisting at delivery Total Any skilled personnel * Delivered in health facility ** Number of women who gave birth in preceding two years Medical doctor Nurse/ midwife Auxiliary midwife Relative/ friend Other/ missing No attendant Area Total Urban 47.7 40.3 10.4 .5 1.0 .0 100.0 98.5 95.1 297 - KMA 57.3 30.1 11.5 .0 1.0 .0 100.0 99.0 99.0 164 - Urban 35.8 53.0 9.0 1.2 1.0 .0 100.0 97.8 90.3 133 Rural 32.3 55.3 6.9 2.7 2.3 .6 100.0 94.4 93.5 228 Age 15-19 30.0 58.4 6.3 2.9 1.1 1.3 100.0 94.7 95.3 67 20-24 38.7 50.0 10.0 .0 1.3 .0 100.0 98.7 96.4 134 25-29 45.8 44.1 7.4 2.0 .7 .0 100.0 97.3 95.9 120 30-34 39.2 45.9 12.0 2.4 .0 .5 100.0 97.1 93.6 100 35-39 51.1 39.5 6.9 .0 2.5 .0 100.0 97.5 92.5 66 40-44 (41.2) (36.8) (10.1) (2.7) (9.2) (.0) (100.0) (88.0) (85.4) 36 45-49 (*) (*) (*) (*) (*) (*) (*) (*) (*) 2 Woman's education level Primary (*) (*) (*) (*) (*) (*) (*) (*) (*) 11 Secondary 38.9 48.7 9.1 1.5 1.5 .3 100.0 96.7 94.2 436 Higher 55.5 34.5 7.2 1.4 1.4 .0 100.0 97.2 97.0 70 Non-standard curriculum (*) (*) (*) (*) (*) (*) (*) (*) (*) 7 Total 41.0 46.8 8.9 1.5 1.6 .2 100.0 96.7 94.4 525 * MICS indicator 4; MDG indicator 17 ** MICS indicator 5 72 Table CD.1: Family support for learning Percentage of children aged 0-59 months for whom household members are engaged in activities that promote learning and school readiness, Jamaica, 2005 Percentage of children aged 0-59 months For whom household members engaged in four or more activities that promote learning and school readiness* Mean number of activities household members engage in with the child For whom the father engaged in one or more activities that promote learning and school readiness** Mean number of activities the father engaged in with the child Living in a household without their natural father Number of children aged 0-59 months Sex Male 86.3 5.0 42.8 1.5 51.8 713 Female 85.4 5.0 38.3 1.5 50.9 714 Area Total Urban 88.3 5.2 41.4 1.7 51.2 797 - KMA 88.8 5.3 44.7 1.9 49.0 444 - Urban 87.8 5.1 37.3 1.4 53.9 353 Rural 82.7 4.8 39.4 1.3 51.5 630 Age 0-23 months 72.6 4.4 39.1 1.3 51.4 533 24-59 months 93.8 5.4 41.4 1.6 51.3 894 Woman's education level Primary 77.9 4.6 33.1 .9 58.8 61 Secondary 85.3 5.0 39.9 1.4 52.4 1158 Higher 92.1 5.3 47.4 2.1 42.2 187 Non-std curriculum (87.1) (5.3) (38.0) (1.6) (51.4) 22 Father's education level None (*) (*) (*) (*) (*) 3 Primary (80.1) (4.6) (69.4) (2.0) (.0) 38 Secondary 85.7 5.1 73.8 2.8 .0 555 Higher 93.1 5.4 89.2 4.3 .0 84 Father not in HH 85.6 5.0 7.6 .2 100.0 733 Non- standard curriculum (*) (*) (*) (*) (*) 6 Missing/DK (*) (*) (*) (*) (*) 10 Total 85.9 5.0 40.6 1.5 51.3 1427 * MICS indicator 46 ** MICS indicator 47 73 Table CD.2: Learning materials Percentage of children aged 0-59 months living in households containing learning materials, Jamaica, 2005 3 or more non- childr en's books * Median number of non- children's books 3 or more children's books ** Median number of children's books Child plays with: 3 or more types of plaything *** Number of children aged 0-59 months HH objects Objects and materials found outside the home Home- made toys Toys that came from store No playthingm entioned Sex Male 88.1 10 57.6 4 54.2 59.5 37.2 86.6 7.6 52.4 713 Female 85.9 10 55.4 3 50.0 52.5 34.6 84.7 8.4 45.5 714 Area Total Urban 86.8 10 64.2 5 49.5 50.3 34.8 86.3 8.5 44.4 797 - KMA 86.6 10 68.7 6 49.8 47.7 35.7 83.6 10.3 43.7 444 - Urban 87.0 10 58.6 4 49.1 53.5 33.6 89.6 6.2 45.2 353 Rural 87.3 10 46.8 2 55.3 63.2 37.3 84.9 7.4 54.7 630 Age 0-23 months 81.2 10 39.0 1 41.0 33.3 22.2 74.1 20.2 32.0 533 24-59 months 90.5 10 66.9 5 58.7 69.5 44.0 92.5 .7 59.0 894 Woman's education level Primary 80.1 10 43.4 2 55.9 67.3 40.8 86.2 7.0 55.5 61 Secondary 86.0 10 53.5 3 51.4 56.2 36.8 85.1 8.1 48.9 1158 Higher 95.9 10 78.0 10 55.2 50.7 29.5 89.7 7.6 47.2 187 Non-standard curriculum 83.8 10 70.7 8 (49.2) (59.2) (30.7) (78.7) (8.8) (48.7) 22 Total 87.0 10 56.5 3 52.1 56.0 35.9 85.7 8.0 48.9 1427 * MICS indicator 49; ** MICS indicator 48; *** MICS indicator 50 74 Table CD.3: Children left alone or with other children Percentage of children age 0-59 months left in the care of other children under the age of 10 years or left alone in the past week, Jamaica, 2005 Left in the care children under the age of 10 years in past week Left alone in the past week Left with inadequate care in past week * Number of children aged 0-59 months Sex Male 3.1 1.3 4.0 713 Female 2.3 .8 2.9 714 Area Total Urban 2.5 .9 3.5 797 - KMA 2.6 .9 3.6 444 - Urban 2.4 .9 3.3 353 Rural 3.0 1.2 3.5 630 Age 0-23 1.9 .8 2.5 533 24-59 3.3 1.2 4.0 894 Woman's education level Primary 1.6 .0 1.6 61 Secondary 3.0 1.3 3.9 1158 Higher .3 .0 .3 187 Non-standard curriculum (12.4) (.0) (12.4) 22 Total 2.7 1.1 3.5 1427 * MICS indicator 51 75 Table ED.1: Early childhood education Percentage of children aged 36-59 months who are attending some form of organized early childhood education programme and percentage of first graders who attended pre-school, Jamaica, 2005 Percentage of children aged 36-59 months currently attending early childhood education* Number of children aged 36-59 months Percentage of children attending first grade who attended preschool program in previous year** Number of children attending first grade Sex Male 83.7 293 100.0 126 Female 87.7 288 100.0 113 Area Total Urban 89.0 332 100.0 126 - KMA 94.8 191 (100.0) 66 - Urban 81.1 141 100.0 60 Rural 81.4 249 100.0 113 Age of child 36-47 months 77.4 285 (*) 0 48-59 months 93.8 296 (*) 0 6 years (*) 0 100.0 239 Woman's education level Primary (85.9) 27 (100.0) 22 Secondary 84.4 473 100.0 191 Higher 92.5 73 (*) 22 Non-standard curriculum (*) 7 (*) 3 Total 85.7 580 100.0 239 * MICS Indicator 52 ** MICS Indicator 53 76 Table ED.2: Primary school entry Percentage of children of primary school entry age attending grade 1, Jamaica, 2005 Percentage of children of primary school entry age currently attending grade 1 * Number of children of primary school entry age Sex Male 88.5 161 Female 89.3 141 Area Total Urban 88.9 161 - KMA 90.9 84 - Urban 86.7 77 Rural 88.9 140 Age 6 88.9 302 Woman's education level Primary (82.3) 27 Secondary 89.4 244 Higher (89.2) 27 Non-standard curriculum (*) 3 Total 88.9 302 * MICS Indicator 54 77 Table ED.3: Primary school net attendance ratio Percentage of children of primary school age attending primary school or secondary school (NAR), Jamaica, 2005 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio Number of children Area Total Urban 96.6 564 97.7 520 97.2 1083 - KMA 96.6 327 97.7 278 97.1 605 - Urban 96.6 237 97.7 242 97.2 478 Rural 98.1 457 97.1 437 97.6 894 Age 6 89.9 161 89.3 141 89.7 302 7 98.2 155 98.5 157 98.3 312 8 98.7 163 98.4 166 98.5 329 9 98.5 185 99.5 157 99.0 342 10 98.8 194 98.6 178 98.7 372 11 99.2 162 99.4 158 99.3 320 Woman's education level None (*) 2 (*) 3 (*) 6 Primary 95.9 88 96.2 87 96.0 176 Secondary 97.6 806 97.3 755 97.5 1561 Higher 95.6 112 99.1 94 97.2 206 Non-standard curriculum (*) 11 (*) 18 (100.0) 28 Missing/DK (*) 1 (*) 0 (*) 1 Total 97.3 1020 97.5 957 97.4 1977 * MICS indicator 55; MDG indicator 6 78 Table ED.4: Secondary school net attendance ratio Percentage of children of secondary school age attending secondary or higher school (NAR), Jamaica, 2005 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio Number of children Area Total Urban 88.1 529 93.8 465 90.8 994 - KMA 90.1 291 94.9 264 92.4 556 - Urban 85.7 237 92.4 201 88.8 438 Rural 89.0 380 91.7 353 90.3 733 Age 12 71.2 192 81.2 198 76.3 390 13 98.8 165 99.7 174 99.3 339 14 95.1 189 98.8 159 96.8 348 15 95.3 186 96.3 140 95.7 327 16 83.5 176 90.8 147 86.8 323 Woman's education level None (*) 2 (*) 2 (*) 4 Primary 86.2 88 94.8 99 90.7 187 Secondary 88.1 616 92.9 548 90.4 1164 Higher 92.6 84 95.2 63 93.7 147 Mother not in household 89.2 109 89.9 93 89.5 202 Non-standard curriculum (*) 8 (*) 11 (*) 19 Missing/DK (*) 1 (*) 1 (*) 3 Total 88.5 909 92.9 818 90.6 1727 * MICS indicator 56 79 Table ED.4w: Secondary school age children attending primary school Percentage of children of secondary school age attending primary school, Jamaica, 2005 Male Female Total Percent attending primary school Number of children Percent attending primary school Number of children Percent attending primary school Number of children Area Total Urban 6.1 529 3.5 465 4.9 994 - KMA 5.9 291 2.1 264 4.1 556 - Urban 6.4 237 5.4 201 6.0 438 Rural 4.5 380 5.9 353 5.1 733 Age 12 25.7 192 18.8 198 22.2 390 13 .0 165 .0 174 .0 339 14 .0 189 .0 159 .0 348 15 .0 186 .0 140 .0 327 16 .0 176 .0 147 .0 323 Woman's education level None (*) 2 (*) 2 (*) 4 Primary 8.3 88 4.5 99 6.3 187 Secondary 6.1 616 5.3 548 5.7 1164 Higher 4.0 84 3.2 63 3.7 147 Mother not in household .0 109 .0 93 .0 202 Non-standard curriculum (*) 8 (*) 11 (*) 19 Missing/DK (*) 1 (*) 1 (*) 3 Total 5.4 909 4.5 818 5.0 1727 80 Table ED.5: Children reaching grade 5 Percentage of children entering first grade of primary school who eventually reach grade 5, Jamaica, 2005 Percent attending 2nd grade who were in 1st grade last year Percent attending 3rd grade who were in 2nd grade last year Percent attending 4th grade who were in 3rd grade last year Percent attending 5th grade who were in 4th grade last year Percent who reach grade 5 of those who enter 1st grade * Sex Male 100.0 100.0 99.4 100.0 99.4 Female 100.0 99.3 100.0 100.0 99.3 Area Total Urban 100.0 99.4 99.4 100.0 98.9 - KMA 100.0 100.0 100.0 100.0 100.0 - Urban 100.0 98.8 98.8 100.0 97.6 Rural 100.0 100.0 100.0 100.0 100.0 Woman's education level None 100.0 . . 100.0 . Primary 100.0 100.0 100.0 100.0 100.0 Secondary 100.0 99.6 99.6 100.0 99.2 Higher 100.0 100.0 100.0 100.0 100.0 Non-standard curriculum 100.0 100.0 100.0 100.0 100.0 Missing/DK . . . 100.0 . Total 100.0 99.7 99.7 100.0 99.4 * MICS Indicator 57 ; MDG Indicator 7 81 Table ED.6: Primary school completion and transition to secondary education Primary school completion rate and transition rate to secondary education, Jamaica, 2005 Net primary school completion rate * Number of children of primary school completion age Transition rate to secondary education ** Number of children who were in the last grade of primary school the previous year Sex Male 81.2 162 97.9 180 Female 82.0 158 99.5 196 Area Total urban 83.4 163 99.2 224 - KMA 85.0 91 98.7 130 - Urban 81.5 72 100.0 94 Rural 79.7 157 97.9 152 Woman's education level None (*) 0 (*) 0 Primary (75.3) 30 98.2 52 Secondary 81.2 240 99.0 288 Higher (85.8) 46 (96.7) 30 Non-standard curriculum (*) 5 (*) 4 Missing/DK (*) 0 (*) 1 Total 81.6 320 98.7 376 * MICS Indicator 59; MDG Indicator 7b ** MICS Indicator 58 82 Table ED.7 : Education gender parity Ratio of girls to boys attending primary education and ratio of girls to boys attending secondary education, Jamaica, 2005 Primary school net attendance ratio (NAR), girls Primary school net attendance ratio (NAR), boys Gender parity index (GPI) for primary school NAR* Secondary school net attendance ratio (NAR), girls Secondary school net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school NAR* Area Total Urban 97.7 96.6 1.01 93.8 88.1 1.06 - KMA 97.7 96.6 1.01 94.9 90.1 1.05 - Urban 97.7 96.6 1.01 92.4 85.7 1.08 Rural 97.1 98.1 .99 91.7 89.0 1.03 Woman's education level None 100.0 100.0 1.00 50.0 100.0 .50 Primary 96.2 95.9 1.00 94.8 86.2 1.10 Secondary 97.3 97.6 1.00 92.9 88.1 1.05 Higher 99.1 95.6 1.04 95.2 92.6 1.03 Mother not in household . . . 89.9 89.2 1.01 Non-standard curriculum 100.0 100.0 1.00 95.9 87.6 1.09 Missing/DK . 100.0 . 100.0 100.0 1.00 Total 97.5 97.3 1.00 92.9 88.5 1.05 * MICS Indicator 61; MDG Indicator 9 83 Table ED.8: Distance to nearest Primary School Percent distribution of households according to the Distance to the nearest Primary School from the household, Jamaica, 2005. Distance to nearest Primary School Total Number of households 1 MILE OR LESS > 1 TO < 5 MILES 5 TO < 10 MILES 10 OR MORE/MI SSING Area Total Urban 79.6 18.1 .2 2.0 100.0 2800 - KMA 91.9 5.5 .0 2.6 100.0 1585 - Urban 63.5 34.6 .5 1.4 100.0 1216 - Rural 51.3 44.8 2.0 1.9 100.0 1967 Education of household head None (70.5) (26.9) (2.7) (.0) (100.0) 41 Primary 62.8 33.9 1.0 2.4 100.0 1341 Secondary 68.2 29.0 1.0 1.8 100.0 2752 Higher 77.9 20.3 .3 1.5 100.0 546 Non-standard curriculum 73.4 21.7 1.0 3.8 100.0 46 Missing/DK (76.0) (17.3) (.0) (6.7) (100.0) 41 Total 67.9 29.2 1.0 1.9 100.0 4767 84 Table ED.9: Distance to nearest Secondary School Percent distribution of households according to the Distance to the nearest Secondary School from the household, Jamaica, 2005. Distance to nearest Secondary School Total Number of households 1 MILE OR LESS > 1 TO < 5 MILES 5 TO < 10 MILES 10 OR MORE/MISSI NG Area Total Urban 63.4 32.1 1.8 2.6 100.0 2800 - KMA 83.8 13.3 .3 2.7 100.0 1585 - Urban 36.9 56.8 3.8 2.6 100.0 1216 - Rural 11.4 63.6 19.2 5.8 100.0 1967 Education of household head None (44.5) (40.6) (13.8) (1.1) (100.0) 41 Primary 33.3 51.7 10.7 4.2 100.0 1341 Secondary 42.6 44.2 9.2 4.0 100.0 2752 Higher 59.2 33.8 4.8 2.2 100.0 546 Non-standard curriculum 48.6 44.2 3.4 3.8 100.0 46 Missing/DK (40.5) (48.8) (.0) (10.8) (100.0) 41 Total 41.9 45.1 9.0 3.9 100.0 4767 85 Table ED.10: Adult literacy Percentage of women aged 15-24 years that are literate, Jamaica, 2005 Percentage literate * Percentage not known Number of women aged 15- 24 years TOTAL URBAN TOTAL URBAN 98.4 .9 738 Area - KMA 98.8 .3 419 - Urban 98.0 1.7 320 Rural 97.6 1.1 485 Woman's education level None (*) (*) 4 Primary (*) (*) 4 Secondary 100.0 .0 972 Higher 100.0 .0 209 Non-standard curriculum (53.1) (35.1) 35 Age 15-19 98.9 .6 665 20-24 97.1 1.5 558 Total 98.1 1.0 1223 * MICS Indicator 60; MDG Indicator 8 86 Table CP.1: Birth registration Percent distribution of children aged 0-59 months by whether birth is registered and reasons for non-registration, Jamaica, 2005 Birth is registered * Number of children aged 0-59 months Number of children aged 0-59 months without birth registration Sex Male 88.8 713 48 Female 88.5 714 43 Area Total urban 89.2 797 51 Rural 87.9 630 40 Total 88.6 1427 92 * MICS Indicator 62 87 Table CP.2: Child labour Percentage of children aged 5-14 years who are involved in child labour activities by type of work, Jamaica, 2005 Working outside household Household chores for 28+ hours/week Working for family business Total child labour * Number of children aged 5- 14 years Paid work Unpaid work Sex Male 1.3 2.8 1.3 1.9 6.8 1722 Female .5 3.1 .9 1.4 5.4 1654 Area Total Urban 1.1 2.8 .8 1.6 5.8 1890 - KMA 1.3 2.5 .3 1.6 5.0 1059 - Urban .9 3.3 1.5 1.5 6.8 830 Rural .6 3.1 1.5 1.8 6.6 1486 Age 5-11 years 1.3 4.3 .8 2.3 7.9 2299 12-14 years .1 .1 1.8 .3 2.3 1077 School participation Yes .9 2.9 1.1 1.7 6.1 3330 No (3.0) (4.4) (.0) (.0) (7.4) 46 Woman's education level None (*) (*) (*) (*) (*) 11 Primary .9 2.2 1.2 1.5 5.8 345 Secondary 1.0 3.1 1.1 1.7 6.3 2642 Higher .0 3.0 1.6 1.4 5.8 331 Non-standard curriculum (.0) (1.1) (.0) (3.9) (4.9) 44 Missing/DK (*) (*) (*) (*) (*) 3 Total .9 2.9 1.1 1.7 6.1 3376 * MICS Indicator 71 88 Table CP.2w: Child labour Percentage of children aged 5-14 years who are currently working and the percentage who are involved in child labour activites (to be eliminated), by type of work, Jamaica, 2005 Any paid child work outside the household Paid labour (to be eliminated) outside the household Any unpaid child work outside the household Unpaid labour (to be eliminated) outside the household Any Household chores Household chores for 28+ hours/week Any child work for family business Any child labour (to be eliminated) for family business Any child work Total child labour * Number of children 5-14 years of age Sex Male 1.9 1.3 4.6 2.8 74.6 1.3 4.0 1.9 10.8 6.8 1722 Female 1.0 .5 4.3 3.1 77.8 .9 2.4 1.4 8.0 5.4 1654 Area Total Urban 1.8 1.1 4.1 2.8 74.7 .8 2.9 1.6 8.5 5.8 1890 - KMA 1.9 1.3 3.3 2.5 75.5 .3 3.2 1.6 7.4 5.0 1059 - Urban 1.7 .9 5.1 3.3 73.8 1.5 2.5 1.5 9.8 6.8 830 Rural 1.0 .6 4.9 3.1 78.1 1.5 3.7 1.8 10.6 6.6 1486 Age 5-11 years 1.3 1.3 4.3 4.3 69.8 .8 2.3 2.3 7.9 7.9 2299 12-14 years 1.9 .1 4.9 .1 89.7 1.8 5.2 .3 12.6 2.3 1077 School participation Yes 1.4 .9 4.4 2.9 76.5 1.1 3.2 1.7 9.3 6.1 3330 No (3.0) (3.0) (9.2) (4.4) (54.9) (.0) (6.3) (.0) (14.8) (7.4) 46 Woman's education level None (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 11 Primary 2.2 .9 4.3 2.2 83.8 1.2 3.4 1.5 10.9 5.8 345 Secondary 1.6 1.0 4.6 3.1 75.8 1.1 3.3 1.7 9.5 6.3 2642 Higher .0 .0 4.2 3.0 71.9 1.6 2.0 1.4 7.3 5.8 331 Non-std curriculum .0 .0 1.1 1.1 74.3 .0 7.7 3.9 8.8 4.9 44 Missing/DK (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 3 Total 1.5 .9 4.5 2.9 76.2 1.1 3.2 1.7 9.4 6.1 3376 * MICS Indicator 71 89 Table CP.3: Labourer students and student labourers Percentage of children aged 5-14 years who are labourer students and student labourers, Jamaica, 2005 Percentage of children in child labour * Percentage of children attending school *** Number of children aged 5-14 Percentage of child labourers who are also attending school ** Number of child labourers aged 5-14 Percentage of students who are also involved in child labour **** Number of students aged 5-14 Sex Male 6.8 98.8 1722 98.0 117 6.7 1701 Female 5.4 98.5 1654 98.9 90 5.5 1630 Area Total Urban 5.8 99.3 1890 96.9 109 5.6 1876 - KMA 5.0 99.4 1059 (100.0) 53 5.0 1053 - Urban 6.8 99.2 830 94.0 57 6.5 823 Rural 6.6 97.8 1486 100.0 97 6.7 1454 Age 5-11 years 7.9 98.6 2299 98.9 182 7.9 2267 12-14 years 2.3 98.8 1077 (*) 25 2.2 1064 Woman's education level None (*) (*) 11 (*) 0 (*) 11 Primary 5.8 98.6 345 (*) 20 5.9 340 Secondary 6.3 98.5 2642 97.9 165 6.2 2601 Higher 5.8 99.7 331 (*) 19 5.8 330 Non-standard curriculum 4.9 100.0 44 (*) 2 4.9 44 Missing/DK (*) (*) 3 (*) 0 (*) 3 Total 6.1 98.6 3376 98.4 207 6.1 3330 ** MICS Indicator 72 **** MICS Indicator 73 90 Table CP.4: Child discipline Percentage of children aged 2-14 years according to method of disciplining the child, Jamaica, 2005 Percentage of children 2-14 years of age who experience: Mother/caretaker believes that the child needs to be physically punished Number of children aged 2- 14 years** Only non- violent discipline Psychological punishment Minor physical punishment Severe physical punishment Any psychological or physical punishment * No discipline or punishment/Missing Sex Male 7.9 77.2 74.8 9.5 88.4 3.7 34.3 1180 Female 9.1 73.2 70.8 5.4 85.8 5.1 32.6 1063 Area Total Urban 8.3 75.3 72.3 7.3 87.2 4.5 31.6 1315 - KMA 7.0 75.3 74.0 7.6 87.9 5.0 27.1 762 - Urban 10.0 75.3 69.9 6.9 86.1 3.8 37.9 553 Rural 8.6 75.3 73.8 7.9 87.2 4.2 36.1 928 Age 2-4 years 7.8 68.7 82.5 3.5 87.5 4.7 33.8 466 5-9 years 5.9 77.6 81.0 7.9 91.0 3.1 35.0 843 10-14 years 11.0 76.6 60.8 9.2 83.6 5.5 32.0 933 Woman's education level None (*) (*) (*) (*) (*) (*) (*) 8 Primary 11.3 73.1 71.0 6.4 83.7 5.0 38.4 225 Secondary 7.2 77.2 74.8 8.3 88.5 4.3 34.8 1697 Higher 14.0 66.2 63.1 4.0 81.9 4.1 23.6 281 Non-std curriculum (9.6) (66.8) (69.5) (3.2) (85.5) (4.9) (15.9) 30 Missing/DK (*) (*) (*) (*) (*) (*) (*) 2 Total 8.4 75.3 72.9 7.5 87.2 4.4 33.5 2243 * MICS Indicator 74; ** Table is based on children aged 2-14 years randomly selected during fieldwork (one child selected per household, if any children in the age range) for whom the questions on child discipline were administered 91 Table CP.5: Early marriage Percentage of women aged 15-49 in marriage or union before their 15th birthday, percentage of women aged 20-49 in marriage or union before their 18th birthday, percentage of women aged 15-19 currently married or in union, Jamaica, 2005 Percentage married before age 15 * Number of women aged 15-49 years Percentage married before age 18 * Number of women aged 20-49 years Percentage of women 15-19 years married/in union ** Number of women aged 15-19 years Area Total Urban 1.1 2230 9.4 1837 3.5 392 - KMA .5 1319 8.1 1093 3.8 227 - Urban 2.0 910 11.3 744 2.9 166 Rural 1.3 1417 12.1 1145 6.1 272 Age 15-19 .3 665 (*) 0 4.5 665 20-24 .6 558 8.6 558 (*) 0 25-29 1.6 480 11.4 480 (*) 0 30-34 .9 516 12.0 516 (*) 0 35-39 2.2 539 12.0 539 (*) 0 40-44 2.0 503 9.0 503 (*) 0 45-49 .9 386 9.4 386 (*) 0 Woman's education level None (*) 6 (*) 3 (*) 3 Primary 3.4 76 13.6 76 (*) 0 Secondary 1.3 2865 12.3 2295 4.9 570 Higher .5 628 2.7 549 1.7 79 Non-standard curriculum 1.4 72 5.4 59 (*) 13 Total 1.2 3647 10.4 2982 4.5 665 * MICS Indicator 67; ** MICS Indicator 68; *** MICS Indicator 70 92 Table CP.6: Spousal age difference Percent distribution of currently married/in union women aged 15-19 and 20-24 according to the age difference with their husband or partner, Jamaica, 2005 Percentage of currently married/in union women aged 20-24 whose husband or partner is: Total Number of women aged 20- 24 years currently married/in union Younger 0-4 years older 5-9 years older 10+ years older * Husband/partner's age unknown Area Total Urban 2.2 30.8 36.0 26.3 4.6 100.0 87 - KMA 1.6 (40.4) (35.4) (17.4) (5.2) (100.0) 46 - Urban 2.9 (20.1) (36.8) (36.3) (3.9) (100.0) 41 Rural 3.1 31.5 43.8 21.6 .0 100.0 45 Total 2.5 31.1 38.7 24.7 3.0 100.0 132 * MICS Indicator 69 93 Table CP.7: Attitudes toward domestic violence Percentage of women aged 15-49 years who believe a husband is justified in beating his wife/partner in various circumstances, Jamaica, 2005 Percentage of women aged 15-49 years who believe a husband is justified in beating his wife/partner. Number of women aged 15- 49 years When she goes out without telling him When she neglects the children When she argues with him When she refuses sex with him When she burns the food For any of these reasons* Area Total Urban .6 3.8 .9 .7 .6 4.5 2230 - KMA .2 2.6 .5 .4 .4 3.1 1319 - Urban 1.3 5.5 1.5 1.1 1.0 6.6 910 Rural 1.3 6.4 1.3 1.5 2.4 8.6 1417 Age 15-19 1.2 4.9 1.0 .7 1.5 6.4 665 20-24 1.1 5.0 .4 .6 1.3 6.2 558 25-29 1.0 6.6 .5 1.7 1.7 8.3 480 30-34 1.5 3.8 1.4 1.2 1.5 5.3 516 35-39 .4 4.9 1.1 1.0 1.1 5.8 539 40-44 .4 4.4 2.1 .9 1.1 5.7 503 45-49 .6 3.6 .7 1.2 1.0 4.8 386 Marital/Un ion status Currently married /In union .8 4.7 1.5 1.5 1.5 6.2 1418 Formerly married/In union 1.4 6.4 1.7 2.2 2.2 8.7 514 Never married/In union .8 4.4 .4 .3 .9 5.3 1715 Woman's education level None (*) (*) (*) (*) (*) (*) 6 Primary 1.1 1.9 1.3 .0 .8 5.1 76 Secondary .9 5.5 1.1 1.2 1.5 7.0 2865 Higher .6 2.1 .4 .3 .4 2.6 628 Non-standard curriculum 1.2 2.0 2.0 1.2 2.0 2.0 72 Total .9 4.8 1.0 1.0 1.3 6.1 3647 * MICS Indicator 100 94 Table CP.8: Child disability Percentage of children 2-9 years of age with disability reported by their mother or caretaker according to the type of disability, Jamaica, 2005 Percentage of children aged 2-9 years with reported disability Numb er of childr en aged 2-9 years Speec h is not norm al Numb er of childre n aged 3-9 years Cannot name at least one object Numb er of childre n aged 2 years Delay in sitting standin g or walkin g Difficu lty seeing, either in the daytim e or at night Appea rs to have difficul ty hearin g No under- standing of instructi ons Difficult y in walking moving, weaknes s or stiffness Have fits, become rigid, lose conscious ness Not learning to do things like other children his/her age No speakin g cannot be under- stood in words Appears mentall y backwar d, dull, or slow Percentage of children 2-9 years of age with at least one reported disability* Area Total Urban 1.6 1.6 1.3 5.8 .9 1.0 3.0 4.0 4.4 15.1 1400 12.5 1238 12.6 162 - KMA .9 1.3 .3 8.6 .8 1.1 3.9 4.4 3.7 16.1 788 12.3 699 13.8 89 - Urban 2.5 1.8 2.6 2.1 .9 .7 1.9 3.4 5.3 13.8 613 12.6 539 11.1 74 Rural 2.1 3.3 1.1 3.8 2.0 1.1 2.3 3.1 5.1 15.7 1097 10.7 951 5.6 146 Age of child 2-4 2.2 1.1 1.0 4.5 1.3 .9 2.6 3.7 3.8 13.1 891 13.8 583 9.3 309 5-6 1.8 1.9 .7 5.4 1.5 1.0 3.0 3.8 4.6 15.3 623 10.6 623 (*) 0 7-9 1.6 3.7 1.7 4.9 1.4 1.2 2.6 3.4 5.6 17.5 983 11.2 983 (*) 0 Woman's education level None (*) (*) (*) (*) (*) (*) (*) (*) (*) (*) 3 (*) 2 (*) 1 Primary 2.9 3.0 1.3 5.5 3.5 1.5 5.4 3.8 7.5 20.7 176 12.4 160 (*) 16 Secondary 1.8 2.2 1.3 4.9 1.2 1.0 2.5 3.6 4.9 15.1 2004 12.1 1759 8.5 245 Higher 1.5 2.4 .4 5.2 .7 .7 2.2 3.6 2.0 14.1 276 8.9 237 (15.6) 40 Non- standard curriculum 3.9 2.6 4.0 1.3 2.9 1.6 2.6 2.6 2.6 12.1 37 (10.0) 31 (*) 7 Total 1.8 2.3 1.2 4.9 1.4 1.0 2.7 3.6 4.7 15.4 2498 11.7 2189 9.3 309 * MICS Indicator 101 95 Table HA.1: Knowledge of preventing HIV transmission Percentage of women aged 15-49 years who know the main ways of preventing HIV transmission, Jamaica, 2005 Heard of AIDS Percentage who know transmission can be prevented by: Knows all three ways Knows at least one way Doesn't know any way Number of women Having only one faithful uninfected sex partner Using a condom every time Abstaining from sex Area Total Urban 99.6 81.6 90.2 88.9 68.8 98.8 1.2 2230 - KMA 99.5 79.0 88.7 86.8 64.6 98.4 1.6 1319 - Urban 99.7 85.3 92.4 92.0 74.8 99.3 .7 910 Rural 99.1 86.0 86.8 84.6 68.0 98.3 1.7 1417 Age 15-19 98.9 86.8 87.4 88.9 75.0 97.6 2.4 665 20-24 99.8 82.0 91.1 86.2 66.6 99.6 .4 558 25-29 99.6 80.0 89.7 85.5 65.6 98.4 1.6 480 30-34 99.6 82.1 88.6 87.8 65.2 99.3 .7 516 35-39 98.9 82.8 89.6 87.3 69.2 97.9 2.1 539 40-44 99.6 83.8 87.8 88.1 67.3 99.1 .9 503 45-49 99.5 84.9 88.0 86.4 68.4 98.2 1.8 386 Woman's education level None (*) (*) (*) (*) (*) (*) (*) 6 Primary 94.3 78.3 78.8 81.1 55.9 94.3 5.7 76 Secondary 99.6 83.6 88.3 86.1 67.2 98.8 1.2 2865 Higher 99.5 83.4 94.1 94.0 76.3 99.2 .8 628 Non-standard curriculum 99.0 79.4 84.9 86.8 68.3 93.8 6.2 72 Total 99.4 83.3 88.9 87.3 68.5 98.6 1.4 3647 96 Table HA.2: Identifying misconceptions about HIV/AIDS Percentage of women aged 15-49 years who correctly identify misconceptions about HIV/AIDS, Jamaica, 2005 Percent who know that: Reject two most common misconceptions and know a healthy-looking person can be infected HIV cannot be transmitted by supernatural means HIV can be transmitted by sharing needles Number of women HIV cannot be transmitted by sharing food HIV cannot be transmitted by mosquito bites A healthy looking person can be infected Area Total Urban 91.1 83.3 96.7 75.7 94.2 96.1 2230 - KMA 91.8 85.5 96.4 78.0 95.5 96.6 1319 - Urban 90.1 80.1 97.1 72.5 92.3 95.3 910 Rural 89.4 78.4 94.0 70.3 93.4 94.5 1417 Age 15-19 88.3 79.9 94.9 71.4 90.3 94.0 665 20-24 91.0 86.1 96.9 78.8 93.6 96.5 558 25-29 91.7 79.8 94.2 71.6 93.2 96.7 480 30-34 91.3 81.4 95.5 72.9 94.6 95.1 516 35-39 91.0 82.6 95.5 75.9 95.8 95.2 539 40-44 89.9 81.4 96.2 72.9 96.1 95.3 503 45-49 90.3 77.5 96.3 71.0 94.7 96.0 386 Woman's education level None (*) (*) (*) (*) (*) (*) 6 Primary 79.1 63.5 84.6 50.5 89.8 85.9 76 Secondary 89.8 81.0 95.9 72.4 93.6 95.4 2865 Higher 95.7 86.9 96.5 83.0 96.3 96.8 628 Non-standard curriculum 85.7 75.4 96.1 69.1 92.6 99.0 72 Total 90.4 81.4 95.6 73.6 93.9 95.5 3647 97 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission Percentage of women aged 15-49 years who have comprehensive knowledge of HIV/AIDS transmission, Jamaica, 2005 Knows 2 ways to prevent HIV transmission Correctly identify 3 misconceptions about HIV transmission Have comprehensive knowledge (identify 2 prevention methods and 3 misconceptions) * Number of women Area Total Urban 74.7 75.7 58.7 2230 - KMA 71.2 78.0 57.9 1319 - Urban 79.9 72.5 59.8 910 Rural 76.0 70.3 56.0 1417 Age 15-19 78.6 71.4 58.9 665 20-24 74.7 78.8 60.9 558 15-24 76.8 74.8 59.8 1223 25-29 72.8 71.6 54.1 480 30-34 72.5 72.9 56.1 516 35-39 75.9 75.9 59.7 539 40-44 75.0 72.9 55.9 503 45-49 76.1 71.0 56.9 386 Woman's education level None (*) (*) (*) 6 Primary 64.5 50.5 34.9 76 Secondary 74.8 72.4 56.5 2865 Higher 79.7 83.0 66.9 628 Non-standard curriculum 73.1 69.1 50.7 72 Total 75.2 73.6 57.7 3647 * MICS Indicator 82; MDG Indicator 19b 98 Table HA.4: Knowledge of mother-to-child HIV transmission Percentage of women aged 15-49 who correctly identify means of HIV transmission from mother to child, Jamaica, 2005 Know HIV can be transmitted from mother to child Percent who know HIV can be transmitted: Did not know any specific way Number of women During pregnancy At delivery Through breastmilk All three ways * Area Total Urban 95.2 87.0 76.8 79.7 62.4 4.4 2230 - KMA 96.6 90.0 80.9 80.7 66.2 3.0 1319 - Urban 93.3 82.8 70.9 78.1 56.9 6.4 910 Rural 93.8 85.0 67.7 76.0 52.9 5.3 1417 Age 15-19 92.4 83.8 70.3 79.5 58.0 6.5 665 20-24 94.9 87.6 71.3 80.6 59.9 4.9 558 25-29 95.3 84.0 76.4 80.4 59.7 4.2 480 30-34 95.5 84.4 72.0 79.5 56.1 4.1 516 35-39 94.9 87.3 78.6 76.4 61.4 3.9 539 40-44 94.8 88.6 70.6 76.7 58.4 4.8 503 45-49 95.9 89.4 74.9 73.0 56.8 3.6 386 Woman's education level None (*) (*) (*) (*) (*) (*) 6 Primary 88.2 78.8 68.2 75.8 59.0 6.1 76 Secondary 94.7 86.7 72.9 78.4 58.8 4.9 2865 Higher 96.2 85.4 76.4 78.0 58.1 3.3 628 Non-standard curriculum 93.4 88.8 70.9 80.2 62.3 5.6 72 Total 94.7 86.3 73.2 78.2 58.7 4.7 3647 * MICS Indicator 89 99 Table HA.5: Attitudes toward people living with HIV/AIDS Percentage of women aged 15-49 years who have heard of AIDS who express a discriminatory attitude towards people living with HIV/AIDS, Jamaica, 2005 Percent of women who: Number of women who have heard of AIDS Would not care for a family member who was sick with AIDS If a family member had HIV would want to keep it a secret Believe that a teacher with HIV should not be allowed to work Would not buy fresh veg. from a person with HIV/AIDS Agree with at least one discriminatory statement Agree with none of the discriminatory statements* Area Total Urban 8.1 59.4 10.3 42.7 78.5 21.5 2221 - KMA 7.1 62.4 9.7 36.0 77.5 22.5 1313 - Urban 9.5 55.0 11.3 52.4 80.1 19.9 908 Rural 9.4 56.2 17.1 53.6 81.5 18.5 1404 Age 15-19 8.3 67.0 15.2 57.6 86.5 13.5 658 20-24 8.4 64.9 12.9 45.5 83.2 16.8 557 25-29 9.5 59.8 12.1 46.3 80.8 19.2 478 30-34 9.0 51.4 11.9 39.6 72.0 28.0 514 35-39 9.5 51.1 12.6 43.5 74.5 25.5 533 40-44 8.1 54.7 12.4 47.6 79.6 20.4 501 45-49 7.2 54.5 12.7 45.1 78.9 21.1 384 Woman's education level None (*) (*) (*) (*) (*) (*) 2 Primary 14.9 60.1 25.3 60.9 87.2 12.8 71 Secondary 8.4 57.6 14.3 47.9 80.2 19.8 2855 Higher 8.3 61.2 5.7 41.4 76.8 23.2 624 Non-standard curriculum 12.2 52.3 9.6 43.0 75.9 24.1 72 Total 8.6 58.1 12.9 46.9 79.7 20.3 3625 * MICS Indicator 86 100 Table HA.6: Knowledge of a facility for HIV testing Percentage of women aged 15-49 years who know where to get an HIV test, percentage of women who have been tested and, of those tested the percentage who have been told the result, Jamaica, 2005 Know a place to get tested * Have been tested ** Number of women If tested, have been told result Number of women who have been tested for HIV Area Total Urban 90.9 53.0 2230 91.8 1181 - KMA 90.8 55.8 1319 92.4 736 - Urban 91.1 48.9 910 90.8 446 Rural 86.6 42.3 1417 87.2 599 Age 15-19 78.8 22.3 665 86.8 148 20-24 93.3 58.8 558 89.4 329 25-29 95.2 65.6 480 93.5 315 30-34 94.7 64.8 516 90.3 334 35-39 88.6 54.1 539 92.4 291 40-44 90.5 47.7 503 92.8 240 45-49 86.1 32.0 386 78.3 124 Woman's education level None (*) (*) 6 (*) 0 Primary 83.9 32.1 76 (78.8) 24 Secondary 88.2 47.3 2865 89.5 1355 Higher 95.7 58.1 628 93.2 365 Non-standard curriculum 89.0 51.1 72 (95.8) 37 Total 89.3 48.8 3647 90.2 1781 * MICS Indicator 87 ** MICS Indicator 88 101 Table HA.7: HIV testing and counseling coverage during antenatal care Percentage of women aged 15-49 years who gave birth in the two years preceding the survey who were offered HIV testing and counseling with their antenatal care, Jamaica, 2005 Percent of women who: Number of women who gave birth in two years preceding the survey Received antenatal care from a health professional for last pregnancy Were provided information about HIV prevention during ANC visit * Were tested for HIV at ANC visit Received results of HIV test at ANC visit ** Area Total Urban 89.3 80.8 92.6 89.5 297 - KMA 86.9 84.0 94.7 93.2 164 - Urban 92.2 76.8 90.0 85.0 133 Rural 92.2 86.8 86.8 76.1 228 Age 15-19 88.5 88.6 92.8 85.8 67 20-24 90.6 89.4 93.5 82.6 134 25-29 92.7 81.1 90.7 84.9 120 30-34 90.0 86.2 92.8 89.8 100 35-49 89.8 72.4 80.6 76.5 105 Woman's education level Primary (*) (*) (*) (*) 11 Secondary 89.8 83.3 89.2 82.6 436 Higher 94.0 82.9 97.3 94.5 70 Non-standard curriculum (*) (*) (*) (*) 7 Total 90.5 83.4 90.1 83.7 525 * MICS Indicator 90 ** MICS Indicator 91 102 Table HA8: Women who believe or not that there are drugs they can take to reduce the risk of HIV/AIDS transmission to their babies. Percent distribution of women aged 15-49 by whether or not they believe that there are drugs which can be taken to reduce the risk of HIV/AIDS transmission to their babies , Jamaica, 2005. Women who believe or not that there are drugs they can take to reduce the risk of HIV/AIDS transmission to their babies. Total Number of women YES NO DK Area Total Urban 72.8 8.2 18.9 100.0 2221 KMA 72.6 8.5 18.9 100.0 1313 Urban 73.2 7.9 18.9 100.0 908 Rural 69.9 10.1 19.9 100.0 1404 Age 15-19 72.2 9.4 18.4 100.0 658 20-24 76.5 7.3 16.2 100.0 557 25-29 75.2 9.7 15.1 100.0 478 30-34 74.3 7.4 18.3 100.0 514 35-39 70.6 8.3 21.1 100.0 533 40-44 66.3 9.8 23.9 100.0 501 45-49 64.7 11.7 23.6 100.0 384 Woman's education level None (*) (*) (*) (*) 2 Primary 59.3 9.8 31.0 100.0 71 Secondary 70.4 9.6 19.9 100.0 2855 Higher 78.2 6.4 15.4 100.0 624 Non-standard curriculum 79.8 4.6 15.7 100.0 72 Total 71.7 9.0 19.3 100.0 3625 103 Table HA.9: Women’s views on whether or not a child with HIV/AIDS who is not sick, should be allowed to attend school. Percent distribution of women aged 15-49 by whether or not they believe that a child with HIV/AIDS who is not sick should be allowed to attend school, Jamaica, 2005 Womens views on whether or not a child with HIV/AIDS who is not sick, should be allowed to attend school. Total Number of women YES NO DK Area Total Urban 87.3 9.3 3.4 100.0 2221 - KMA 87.0 8.6 4.3 100.0 1313 - Urban 87.6 10.3 2.2 100.0 908 - Rural 81.6 15.8 2.6 100.0 1404 Age 15-19 84.6 13.0 2.4 100.0 658 20-24 84.4 12.9 2.7 100.0 557 25-29 84.5 11.6 3.8 100.0 478 30-34 84.4 11.2 4.4 100.0 514 35-39 86.6 10.9 2.5 100.0 533 40-44 85.8 10.5 3.7 100.0 501 45-49 85.3 12.2 2.5 100.0 384 Woman's education level None (*) (*) (*) (*) 2 Primary 74.2 21.2 4.5 100.0 71 Secondary 84.2 12.9 3.0 100.0 2855 Higher 90.1 6.0 3.9 100.0 624 Non-standard curriculum 87.5 10.8 1.7 100.0 72 Total 85.1 11.8 3.1 100.0 3625 104 Table HA.10: Children's living arrangments and orphanhood Percent distribution of children aged 0-17 years according to living arrangments, percentage of children aged 0-17 years in households not living with a biological parent and percentage of children who are orphans, Jamaica, 2005 Living with neither parent Living with mother only Living with father only Total Not living with a biological parent * One or both parents dead ** Number of children Living with both parents Only father alive Only mother alive Both are alive Both are dead Father alive Father dead Mother alive Mother dead Impossible to determine Sex Male 34.6 .8 .7 11.3 .1 42.5 2.5 5.8 .3 1.5 100.0 12.8 4.4 2971 Female 33.4 .7 .5 13.1 .3 42.8 2.7 4.8 .4 1.3 100.0 14.6 4.6 2804 Area Total Urban 31.4 .5 .8 11.4 .2 43.6 3.6 6.5 .4 1.5 100.0 13.0 5.6 3242 - KMA 31.5 .2 1.1 10.2 .1 43.7 4.3 6.9 .1 2.0 100.0 11.6 5.9 1816 - Urban 31.2 .9 .5 13.1 .4 43.6 2.6 6.0 .8 1.0 100.0 14.8 5.2 1426 Rural 37.4 1.0 .3 13.1 .1 41.5 1.4 3.7 .3 1.2 100.0 14.6 3.1 2533 Age 0-4 years 45.4 .1 .0 5.6 .0 44.0 1.2 2.8 .2 .5 100.0 5.7 1.6 1445 5-9 years 32.3 .9 .2 12.9 .2 44.9 2.1 5.4 .0 1.1 100.0 14.2 3.4 1606 10-14 years 31.1 1.0 .8 13.9 .2 41.4 3.2 6.4 .6 1.3 100.0 16.0 5.9 1770 15-17 years 25.0 .9 1.6 17.6 .5 39.3 4.5 6.7 .7 3.3 100.0 20.6 8.2 954 Total 34.0 .7 .6 12.2 .2 42.7 2.6 5.3 .3 1.4 100.0 13.7 4.5 5775 * MICS Indicator 78 ** MICS Indicator 75 105 Table HA.11: Prevalence of orphanhood and vulnerability among children Percentage of children aged 0-17 years who are orphaned or vulnerable Jamaica, 2005 Chronically ill parent Adult death in household Chronically ill adult in household Vulnerable children * One or both parents dead ** Orphans and vulnerable children Number of children aged 0- 17 years Sex Male .8 .5 6.2 7.3 4.4 10.9 2971 Female 1.3 .3 6.1 7.5 4.6 11.5 2804 Area Total Urban 1.2 .3 6.0 7.3 5.6 12.0 3242 - KMA .9 .2 5.8 6.8 5.9 11.6 1816 - Urban 1.7 .4 6.2 7.9 5.2 12.5 1426 Rural .7 .5 6.4 7.5 3.1 10.2 2533 Age 0-4 years .4 .4 5.3 6.1 1.6 7.5 1445 5-9 years 1.1 .4 5.2 6.6 3.4 9.6 1606 10-14 years 1.3 .5 6.8 8.4 5.9 13.3 1770 15-17 years 1.1 .2 7.9 8.9 8.2 15.4 954 Total 1.0 .4 6.1 7.4 4.5 11.2 5775 * MICS Indicator 76 ** MICS Indicator 75 106 Table HA.12: School attendance of orphaned and vulnerable children School attendance of children aged 10-14 years by orphanhood and vulnerability Jamaica, 2005 Percent of children whose mother and father have died School attendance rate of children whose mother and father have died Percent of children of whom both parents are alive and child is living with at least one parent School attendance rate of children of whom both parents are alive and child is living with at least one parent Double orphans to non orphans school attendance ratio* Percent of children who are orphaned or vulnerable School attendance of children who are orphaned or vulnerable Percent of children who are not orphans or vulnerable School attendance of children who are not orphans or vulnerable Total number of children aged 10- 14 years Sex Male .2 100.0 79.1 98.8 1.01 13.2 98.1 86.8 98.9 902 Female .3 100.0 78.7 99.7 1.00 13.3 99.6 86.7 99.5 867 Area Total Urban .3 100.0 77.6 99.3 1.01 14.9 98.5 85.1 99.4 984 - KMA .0 . 77.3 99.6 . 15.5 98.0 84.5 99.6 553 - Urban .7 100.0 77.8 98.9 1.01 14.1 99.2 85.9 99.1 431 Rural .1 100.0 80.6 99.1 1.01 11.2 99.3 88.8 98.9 785 Number of children 10- 14 years of age .2 100.0 78.9 99.2 1.01 13.3 98.8 86.7 99.2 1770 * MICS Indicator 77; MDG Indicator 20 107 Table HA.13: Support for children orphaned and vulnerable Percentage of children aged 0-17 years orphaned or made vulnerable whose households receive free basic external support in caring for child, Jamaica, 2005 Percent of orphans and vulnerable children whose households Number of children orphaned or vulnerable aged 0-17 years Medical support (in last 12 months) Emotional and psychosocial support (in last 3 months) Social/ material support (in last 3 months) Educational support (in last 12 months) Any support * No support at all Sex Male 2.3 2.6 7.0 8.8 16.3 83.7 323 Female .9 1.6 5.4 8.9 14.5 85.5 322 Area Total Urban 1.0 2.8 5.8 8.8 15.3 84.7 388 - KMA 1.6 3.0 4.7 5.4 12.5 87.5 210 - Urban .3 2.5 7.1 12.7 18.6 81.4 178 Rural 2.5 1.0 6.8 9.0 15.6 84.4 257 Age 0-4 years .9 .0 5.3 .0 6.2 93.8 109 5-9 years 3.5 1.5 8.9 10.8 17.1 82.9 155 10-14 years .7 3.4 7.0 8.7 16.7 83.3 235 15-17 years 1.5 2.1 2.8 13.7 18.3 81.7 147 Total 1.6 2.1 6.2 8.9 15.4 84.6 646 * MICS Indicator 81 108 Appendix A. Sample Design The major features of sample design are described in this appendix. Sample design features include target sample size, sample allocation, sample frame and listing, choice of domains, sampling stages, stratification, and the calculation of sample weights. The primary objective of the sample design for the Jamaican Multiple Indicator Cluster Survey was to produce statistically reliable estimates of most indicators, at the national level, for urban Jamaica, i.e., Kingston Metropolitan Area (KMA) and Other Towns, and the Rural Areas. Urban and rural sampling units in each of the parishes were defined as the sampling domains. A multi-stage, stratified cluster sampling approach was used for the selection of the survey sample. Sample Size and Sample Allocation The target sample size for the Jamaican MICS was calculated as 5857 households. For the calculation of the sample size, the key indicator used was the Immunization rate (OPV) among children aged 12 – 23 months. The following formula was used to estimate the required sample size for these indicators: - n = [ 4 (r) (1-r) (f) (1.1) ] [ (0.12r)2 (p) (nh) ] Where ! n is the required sample size, expressed as number of households ! 4 is a factor to achieve the 95 per cent level of confidence ! r is the predicted or anticipated prevalence (coverage rate) of the indicator ! 1.2 is the factor necessary to raise the sample size by 20 per cent for non- response ! f is the shortened symbol for deff (design effect) ! 0.12r is the margin of error to be tolerated at the 95 per cent level of confidence, defined as 12 per cent of r (relative sampling error of r) ! p is the proportion of the total population upon which the indicator, r, is based ! nh is the average household size. For the calculation, r (Immunization rate) was assumed to be 70 percent. The value of deff (design effect) was taken as 1.75 based on estimates from previous surveys, p (percentage of children aged 12-23 months in the total population) was taken as 2 percent, and nh (average household size) was taken as 3.4 households. 109 The estimated sample calculated for the MICS survey was 5857 dwellings. This was revised to 6096 to ensure that an equal number of dwellings (12) is canvassed from each of the 508 primary sampling units (PSU) selected (See Table SD.1) (col. 4 x 12 = col. 5). This number was further adjusted to 6,276 dwellings (column 7) to take into account the relatively small number of dwellings in some of the 14 parishes which make up the country. Over-sampling in small parishes e.g., Kingston, Portland, St. Mary. (column 6) was necessary as these parishes did not have a sufficient number of dwellings in the sample frame to allow for an adequate sample to be selected. Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Domains Parish Region Population Sampling Regions Number of PSUs Initial Number Of Dwellings Adjustment Ratio Final Number Of Dwellings Dwellings Canvassed Per PSU Kingston 96,052 10 20 240 1.5 360 18 St. Andrew 555,827 55 110 1,320 0.75 990 9 St. Thomas 91,604 10 20 240 1.5 360 18 Portland 80,205 8 16 192 1.75 336 21 St. Mary 111,467 11 22 264 1.25 330 15 St. Ann 166,762 15 30 360 1.0 360 12 Trelawny 73,066 7 14 168 2.0 336 24 St. James 175,126 17 34 408 1.0 408 12 Hanover 67,037 7 14 168 2.0 336 24 Westmoreland 138,947 14 28 336 1.0 336 12 St. Elizabeth 146,404 14 28 336 1.0 336 12 Manchester 185,801 18 36 432 1.0 432 12 Clarendon 237,025 22 44 528 1.0 528 12 St. Catherine 482,308 46 92 1,104 0.75 828 9 Jamaica 2,607,633 254 508 6,096 6,276 In two large parishes (St. Andrew, St Catherine) there was more than an adequate number of dwellings and under-sampling was carried out in order to bring the final sample size as close as possible to the calculated one. There were deviations from the targeted sample of 12 dwellings per PSU as a result of the over-sampling and the under-sampling in different parishes (see column 7). A dwelling unit is any building or separate and independent part of a building in which a person or group of persons are living at the time of the survey. On the other hand, a household consists of one person who lives alone or a group of persons who, as a unit, jointly occupies the whole or part of a dwelling unit, who have common arrangements for housekeeping, and who generally share at least one meal. The household may contain related persons only, unrelated persons, or a combination of both. Sampling Frame and Selection of Clusters The 2001 census frame was used for the creation of the sampling regions and primary sampling units within sampling regions. Census enumeration areas (enumeration districts) were defined as primary sampling units (PSUs), and were selected from each of the sampling domains by using systematic pps (probability proportional to size) sampling procedures, based on the estimated sizes of the enumeration areas from the 2001 Population Census. The first stage of sampling was thus completed with the selectio

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