Jmaica - Multiple Indicator Cluster Survey - 2011

Publication date: 2011

2 MICS is an international household survey programme developed by UNICEF. The Jamaica MICS was conducted as part of the fourth global round of MICS surveys (MICS4). MICS provides up-to-date information on the situation of children and women and measures key indicators that allow countries to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. Additional information on the global MICS project may be obtained from www.childinfo.org. Copyright © Statistical Institute Of Jamaica (STATIN), 2013 United Nations Children’s Fund (UNICEF), 2013 All rights reserved. Statistical Institute of Jamaica 7 Cecelio Ave., Kingston 10, Jamaica Telephone: (876) 926-5311 Fax: (876) 926-1138 Website: www.statinja.gov.jm Email: info@statinja.gov.jm United Nations Children’s Fund 60 Knutsford Boulevard, Kingston 5, Jamaica Telephone: (876) 926-7584 Fax: (876) 929-8084 Website: http://www.unicef.org/jamaica/ Email: kingston@unicef.org NATIONAL LIBRARY OF JAMAICA CATALOGUING IN PUBLICATION DATA JAMAICA MULTIPLE INDICATOR CLUSTER SURVEY 2011: FINAL REPORT ISBN#: 978-976-8213-91-4 Statistical Institute of Jamaica (STATIN) and United Nations Children’s Fund (UNICEF) 2013. Jamaica Multiple Indicator Cluster Survey 2011: Final Report. Kingston, Jamaica: STATIN and UNICEF. This report is the intellectual property of the Statistical Institute of Jamaica (STATIN) and the United Nations Children’s Fund (UNICEF). Permission is granted for this material to be reproduced free of charge without requiring specific permission. This is subject to the information being reproduced accurately and not in a misleading context. The source and copyright should also be acknowledged in all third party productions. The Jamaica Multiple Indicator Cluster Survey (MICS) was carried out in 2011 by the Statistical Institute of Jamaica. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and other UN partners. Table of Contents . . . . . . . . . . . . . . . . . . . . . . . 1 2Summary Table of Findings List of Tables List of Figures List of Abbreviations Acknowledgements Executive Summary . 5 i iii iv I. Introduction . 14 Background . 14 Survey Objectives . 15 II. Sample and Survey Methodology . 18 Questionnaires . 19 Recruitment and Training of Field Staff . 20 Fieldwork . 20 Data Processing . 20 III. Sample Coverage and the Characteristics of Households and Respondents. 24 24Sample Coverage . Characteristics of Households . 25 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 28 IV. Nutrition . 34 Nutritional Status . 34 Breastfeeding and Infant and Young Child Feeding . 34 Low Birth Weight . 42 V. Child Health . 46 Vaccinations . 46 Neonatal Tetanus Protection . 50 Oral Rehydration Treatment . 52 Care Seeking and Antibiotic Treatment of Pneumonia . 55 Solid Fuel Use . 57 VI. Water and Sanitation . 62 Use of Improved Water Sources . 62 Use of Improved Sanitation Facilities . 69 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hand Washing . 74 VII. Reproductive Health . 80 Fertility . 80 Early Childbearing . 82 Antenatal Care . 85 Assistance at Delivery . 89 Place of Delivery . 91 VIII. Child Development . . 94 Early Childhood Education and Learning . . 94 Early Childhood Development . . 99 IX. Literacy and Education . 104 Literacy Among Young Women . 104 School Readiness . 104 Primary and Secondary School Participation . 105 X. Child Protection . 114 Child D Child Labour iscipline . 118 .114 Early Marriage . 118 Domestic Violence . 124 XI. Life Satisfaction XII. Appendices . 128 Life Satisfaction among Young Women . 128 Satisfaction with Family Life . 128 Satisfaction with Friendship and Satisfaction with School . 128 Satisfaction with Living Environment and Satisfaction with Current Job . 128 Life Overall . 130 Satisfied with Income . 130 Life Satisfaction and Happiness . 130 Perception of a Better Life . 132 . 136 Appendix A: Sample Design . 136 Appendix B: List of Personnel Involved in the Survey . 141 Appendix C: Estimates of Sampling Errors . 143 Appendix D: Data Quality Tables . 148 Appendix E: MICS Indicators – Numerators and Denominators . 155 Appendix F: Questionnaires . 160 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hand Washing . 74 VII. Reproductive Health . 80 Fertility . 80 Early Childbearing . 82 Antenatal Care . 85 Assistance at Delivery . 89 Place of Delivery . 91 VIII. Child Development . . 94 Early Childhood Education and Learning . . 94 Early Childhood Development . . 99 IX. Literacy and Education . 104 Literacy Among Young Women . 104 School Readiness . 104 Primary and Secondary School Participation . 105 X. Child Protection . 114 Child D Child Labour iscipline . 118 .114 Early Marriage . 118 Domestic Violence . 124 XI. Life Satisfaction XII. Appendices . 128 Life Satisfaction among Young Women . 128 Satisfaction with Family Life . 128 Satisfaction with Friendship and Satisfaction with School . 128 Satisfaction with Living Environment and Satisfaction with Current Job . 128 Life Overall . 130 Satisfied with Income . 130 Life Satisfaction and Happiness . 130 Perception of a Better Life . 132 . 136 Appendix A: Sample Design . 136 Appendix B: List of Personnel Involved in the Survey . 141 Appendix C: Estimates of Sampling Errors . 143 Appendix D: Data Quality Tables . 148 Appendix E: MICS Indicators – Numerators and Denominators . 155 Appendix F: Questionnaires . 160 List of Tables Table SD.1: Distribution of enumeration divisions (EDs) by parish . 20 Table HH.1: Results of household and individual interviews . 26 Table HH.2: Household age distribution by sex . 27 Table HH.3a: Household composition (i) . 29 Table HH.3b: Household composition (ii) . 30 Table HH.4: Women’s background characteristics . 32 Table HH.5 Children’s background characteristics . 33 Table NU.1: Initial breastfeeding . 37 Table NU.2: Breastfeeding . 38 Table NU.3: Duration of breastfeeding . 40 Table NU.4: Age appropriate breastfeeding . 41 Table NU.5: Introduction of solid, semi-solid or soft food . 42 Table NU.6: Minimum meal frequency . 43 Table NU.7: Bottle feeding . 44 Table NU.8: Low birth weight infants . 44 Table CH.1: Vaccinations in first year of life . 48 Table CH.2: Vaccinations by background characteristics . 51 Table CH.3: Neonatal tetanus protection . 52 Table CH.4: Oral rehydration solutions and recommended homemade fluids . 56 Table CH.5: Feeding practices during diarrhoea . 57 Table CH.6: Oral rehydration therapy with continued feeding and other treatments………………….58 Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia . 60 Table CH.9: Solid fuel use . …………………………………………………………………………62 Table CH.10: Solid fuel use by place of cooking . 63 Table WS.1a: Use of improved water sources (i) . 67 Table WS.1b: Use of improved water sources (ii) . 68 Table WS.2: Household water treatment . 70 Table WS.3: Time to source of water . 71 Table WS.4: Person collecting water . 73 Table WS.5: Types of sanitation facilities . 75 Table WS.6: Use and sharing of sanitation facilities. 76 Table WS.7: Disposal of child’s faeces . 78 Table WS.8: Drinking water and sanitation ladders . 80 Table WS.9: Water and soap at place for hand washing . 81 Table WS.10: Availability of soap . 82 Table RH.1a: Fertility . 86 Table RH.1b: Adolescent fertility . 87 Table RH.2: Early childbearing . 88 Table RH.3: Trends in early childbearing . 90 Table RH.4: Antenatal care provider . 92 Table RH.5: Number of antenatal care visits . 93 Table RH.6: Content of antenatal care . 94 Table RH.7: Assistance during delivery . 97 Table RH.8: Place of delivery . 99 i . . . . . Table CD.1: Early childhood education . . Table CD.2: Support for learning. Table CD.3: Learning materials. Table CD.4: Inadequate care . Table CD.5: Early child development index . Table ED.1: Literacy among young women . 112 Table ED.2: School readiness . 113 Table ED.3: Primary school entry . 114 Table ED.4: Primary school attendance . 115 Table ED.5: Secondary school attendance . 116 Table ED.6: Children reaching last grade of primary school . 117 Table ED.7: Primary school completion and transition to secondary school . 118 Table ED.8: Education gender parity . 119 Table CP.1a: Child labour by type of work . 123 Table CP.1b: Child labour, currently working . 124 Table CP.2: Child labour and school attendance. 125 Table CP.3: Child discipline . 127 Table CP.4: Early marriage . 130 Table CP.5a: Trends in early marriage: Percentage of women who were first married or entered into a marital union before age 15 . 131 Table CP.5b: Trends in early marriage: Percentage of women who were first married or entered into a marital union before age 18 . 132 Table CP.6: Spousal age difference . 133 Table CP.7: Attitudes towards domestic violence . 134 Table SW.1: Domains of life satisfaction . 139 Table SW.2: Life satisfaction and happiness . 141 Table SW.3: Perception of a better life . 143 Table SD.2: Estimated sample sizes based on two indicators . 147 Table SD.3: Allocation of Sample Clusters (Primary Sampling Units) by Parish and Area . 148 102 103 105 107 108 Table SE.1: Sampling errors: Total sample . 153 Table SE.2: Sampling errors: Kingston Metropolitan Area (KMA) . 154 Table SE.3: Sampling errors: Urban Areas . 155 Table SE.4: Sampling errors: Other Towns . 156 Table SE.5: Sampling errors: Rural Areas . 157 Table DQ.1: Age distribution of household population . 158 Table DQ.2: Age distribution of eligible and interviewed women . 159 Table DQ.3: Age distribution of under-5s in household and under-5 questionnaires 160 Table DQ.4: Observation of places for hand washing . 160 Table DQ.5: Observation of women's health cards . 161 Table DQ.6: Observation of vaccination cards . 162 Table DQ.7: Presence of mother in the household and the person interviewed for the under-5 Questionnaire . 162 Table DQ.8: Selection of children age 2-14 years for the child discipline module . 163 Table DQ.9: School attendance by single age . 164 ii 13 List of Figures Figure HH.1: Age and sex distribution of household population . 28 Figure NU.1: Per cent distribution of children under age 2 by feeding pattern by age, Jamaica, 2011 . 39 Figure CH.1: Percentage of children aged 18-23 months who received the recommended vaccinations by 18 months, January, 2011 . 49 Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus, January, 2011 . 54 iii 14 BCG Bacillis-Cereus-Geuerin (Tuberculosis) CSPro Census and Survey Processing System DPT Diphtheria Pertussis Tetanus ECDI Early Child Development Index EPI Expanded Programme on Immunization GPI Gender Parity Index HepB Hepatitis B HiB Haemophilus Influenzae HIV Human Immunodeficiency Virus ILO International Labour Organization IQ Intelligence Quotient JMP Joint Monitoring Programme KMA Kingston Metropolitan Area LPG Liquefied Petroleum Gas MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MOH Ministry of Health NAR Net Attendance Ratio ORS Oral Rehydration Salts ORT Oral Rehydration Therapy PAHO Pan American Health Organization Polio Poliomyelitis pps Probability Proportional to Size PSU Primary Sampling Unit RHF Recommended Home Fluid SPSS Statistical Package for Social Sciences STATIN Statistical Institute of Jamaica STI Sexually Transmitted Infection UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNESCO United Nations Educational, Scientific and Cultural Organization UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund WFFC World Fit For Children WHO World Health Organization List of Abbreviations iv Jamaica Multiple Indicator Cluster Survey 20111 15 Acknowledgement We are especially thankful for the support that was provided by the other UN member organizations of the Steering Committee in particular UNAIDS, UNFPA, 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, Caribbean Child Development Centre of the West Indies, PAHO, Child Development Agency, the Ministry of Health, the National HIV/AIDS Prevention Programme, the Ministry of Education, the ILO, Children’s First, the Dispute Resolution Foundation and the Jamaica Youth Advocacy and Participation Initiative. We would also like to make special mention of the personnel 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 Surveys Division who spearheaded the project, 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 & Evaluation Division. The Field Services Unit also assisted by providing logistics 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. Carol Coy Director General We are especially thankful for the support that was provided by the other UN member organizations of the Steering Committee in particular UNAIDS, UNFPA, 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, Caribbean Child Development Centre of the West Indies, PAHO, Child Development Agency, the Ministry of Health, the National HIV/AIDS Prevention Programme, the Ministry of Education, the ILO, Children First, the Dispute Resolution Foundation and the Jamaica Youth Advocacy and Participation Initiative. We would also like to make special mention of the personnel 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 Surveys Division who spearheaded the project, 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 & Evaluation Division. The Field Services Division also assisted by providing logistics 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. Acknowledgement 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. Jamaica Multiple Indicator Cluster Survey 2011 2 15 Acknowledgement We are especially thankful for the support that was provided by the other UN member organizations of the Steering Committee in particular UNAIDS, UNFPA, 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, Caribbean Child Development Centre of the West Indies, PAHO, Child Development Agency, the Ministry of Health, the National HIV/AIDS Prevention Programme, the Ministry of Education, the ILO, Children’s First, the Dispute Resolution Foundation and the Jamaica Youth Advocacy and Participation Initiative. We would also like to make special mention of the personnel 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 Surveys Division who spearheaded the project, 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 & Evaluation Division. The Field Services Unit also assisted by providing logistics 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. Carol Coy Director General We are especially thankful for the support that was provided by the other UN member organizations of the Steering Committee in particular UNAIDS, UNFPA, 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, Caribbean Child Development Centre of the West Indies, PAHO, Child Development Agency, the Ministry of Health, the National HIV/AIDS Prevention Programme, the Ministry of Education, the ILO, Children First, the Dispute Resolution Foundation and the Jamaica Youth Advocacy and Participation Initiative. We would also like to make special mention of the personnel 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 Surveys Division who spearheaded the project, 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 & Evaluation Division. The Field Services Division also assisted by providing logistics 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. Acknowledgement 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. 4 MULTIPLE INDICATOR CLUSTER SURVEYS (MICS) AND MILLENNIUM DEVELOPMENT GOALS (MDG) INDICATORS, JAMAICA, 2011 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value NUTRITITION Breastfeeding and infant feeding 2.4 Children ever breastfed 95.4 per cent 2.5 Early initiation of breastfeeding 64.7 per cent 2.6 Exclusive breastfeeding under 6 months 23.8 per cent 2.7 Continued breastfeeding at 1 year 44.4 per cent 2.8 Continued breastfeeding at 2 years 31.2 per cent 2.9 Predominant breastfeeding under 6 months 42.5 per cent 2.10 Duration of breastfeeding 12.5 Months 2.11 Bottle feeding 69.4 per cent 2.12 Introduction of solid, semi-solid or soft foods 54.6 per cent 2.13 Minimum meal frequency 42.0 per cent 2.14 Age-appropriate breastfeeding 31.2 per cent 2.15 Milk feeding frequency for non-breastfed children 77.3 per cent Low-birth weight 2.18 Low-birth weight infants 16.4 per cent 2.19 Infants weighed at birth 96.5 per cent CHILD HEALTH Vaccinations 3.1 Tuberculosis immunization coverage 99.5 per cent 3.2 Polio immunization coverage 91.1 per cent 3.3 Immunization coverage for diphtheria, pertussis and tetanus (DPT) 89.9 per cent 3.4 4.3 Measles immunization coverage 91.7 per cent 3.5 Hepatitis B immunization coverage 84.5 per cent Tetanus toxoid 3.7 Neonatal tetanus protection 38.2 per cent Care of illness 3.8 Oral rehydration therapy with continued feeding 43.3 per cent SUMMARY TABLE OF FINDINGS 5 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value 3.9 Care seeking for suspected pneumonia 82.3 per cent 3.10 Antibiotic treatment of suspected pneumonia 58.5 per cent Solid fuel use 3.11 Solid fuels 13.7 per cent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 94.6 per cent 4.2 Water treatment 49.7 per cent 4.3 7.9 Use of improved sanitation 86.5 per cent 4.4 Safe disposal of child's faeces 28.2 per cent 4.5 Place for hand washing 80.1 per cent 4.6 Availability of soap 88.5 per cent REPRODUCTIVE HEALTH Fertility 5.1 5.4 Adolescent Birth Rate 70 per 1000 women 5.2 Early Childbearing 14.9 per cent Total Fertility Rate 2.2 Births Maternal and newborn health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 97.7 85.6 per cent per cent 5.6 Content of antenatal care 97.4 per cent 5.7 5.2 Skilled attendant at delivery 99.1 per cent 5.8 Institutional deliveries 98.6 per cent 5.9 Caesarean section 21.2 per cent CHILD DEVELOPMENT Child development 6.1 Support for learning 87.6 per cent 6.2 Father's support for learning 27.5 per cent 6.3 Learning materials: children’s books 54.7 per cent 6.4 Learning materials: playthings 60.7 per cent Jamaica Multiple Indicator Cluster Survey 20113 5 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value 3.9 Care seeking for suspected pneumonia 82.3 per cent 3.10 Antibiotic treatment of suspected pneumonia 58.5 per cent Solid fuel use 3.11 Solid fuels 13.7 per cent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 94.6 per cent 4.2 Water treatment 49.7 per cent 4.3 7.9 Use of improved sanitation 86.5 per cent 4.4 Safe disposal of child's faeces 28.2 per cent 4.5 Place for hand washing 80.1 per cent 4.6 Availability of soap 88.5 per cent REPRODUCTIVE HEALTH Fertility 5.1 5.4 Adolescent Birth Rate 70 per 1000 women 5.2 Early Childbearing 14.9 per cent Total Fertility Rate 2.2 Births Maternal and newborn health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 97.7 85.6 per cent per cent 5.6 Content of antenatal care 97.4 per cent 5.7 5.2 Skilled attendant at delivery 99.1 per cent 5.8 Institutional deliveries 98.6 per cent 5.9 Caesarean section 21.2 per cent CHILD DEVELOPMENT Child development 6.1 Support for learning 87.6 per cent 6.2 Father's support for learning 27.5 per cent 6.3 Learning materials: children’s books 54.7 per cent 6.4 Learning materials: playthings 60.7 per cent 6 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value 6.5 Inadequate care 1.8 per cent 6.6 Early child development index 89.1 per cent 6.7 Attendance to early childhood education 91.5 per cent EDUCATION Literacy and education 7.1 2.3 Literacy rate among young women 99.6 per cent 7.2 School readiness 93.6 per cent 7.3 Net intake rate in primary education 88.9 per cent 7.4 2.1 Primary school net attendance rate (adjusted) 98.0 per cent 7.5 Secondary school net attendance rate (adjusted) 91.5 per cent 7.6 2.2 Children reaching last grade of primary 99.3 per cent 7.7 Primary completion rate 112.3 per cent 7.8 Transition rate to secondary school 95.0 per cent 7.9 Gender parity index (primary school) 1.02 Ratio 7.10 Gender parity index (secondary school) 1.02 Ratio CHILD PROTECTION Child Labour 8.2 Child labour 10.6 per cent 8.3 School attendance among child labourers 100.0 per cent 8.4 Child labour among students 10.7 per cent Child discipline 8.5 Violent discipline 84.5 per cent Early marriage and polygamy 8.6 Marriage before age 15 1.1 per cent 8.7 Marriage before age 18 8.4 per cent 8.8 Young women age 15-19 currently married or in union 3.4 per cent 8.10a 8.10b Spousal age difference Women age 15-19 Women age 20-24 18.9 28.9 per cent per cent Domestic violence 8.14 Attitudes towards domestic violence 4.9 per cent 5 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value 3.9 Care seeking for suspected pneumonia 82.3 per cent 3.10 Antibiotic treatment of suspected pneumonia 58.5 per cent Solid fuel use 3.11 Solid fuels 13.7 per cent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 94.6 per cent 4.2 Water treatment 49.7 per cent 4.3 7.9 Use of improved sanitation 86.5 per cent 4.4 Safe disposal of child's faeces 28.2 per cent 4.5 Place for hand washing 80.1 per cent 4.6 Availability of soap 88.5 per cent REPRODUCTIVE HEALTH Fertility 5.1 5.4 Adolescent Birth Rate 70 per 1000 women 5.2 Early Childbearing 14.9 per cent Total Fertility Rate 2.2 Births Maternal and newborn health 5.5a 5.5b 5.5 Antenatal care coverage At least once by skilled personnel At least four times by any provider 97.7 85.6 per cent per cent 5.6 Content of antenatal care 97.4 per cent 5.7 5.2 Skilled attendant at delivery 99.1 per cent 5.8 Institutional deliveries 98.6 per cent 5.9 Caesarean section 21.2 per cent CHILD DEVELOPMENT Child development 6.1 Support for learning 87.6 per cent 6.2 Father's support for learning 27.5 per cent 6.3 Learning materials: children’s books 54.7 per cent 6.4 Learning materials: playthings 60.7 per cent Jamaica Multiple Indicator Cluster Survey 2011 4 6 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value 6.5 Inadequate care 1.8 per cent 6.6 Early child development index 89.1 per cent 6.7 Attendance to early childhood education 91.5 per cent EDUCATION Literacy and education 7.1 2.3 Literacy rate among young women 99.6 per cent 7.2 School readiness 93.6 per cent 7.3 Net intake rate in primary education 88.9 per cent 7.4 2.1 Primary school net attendance rate (adjusted) 98.0 per cent 7.5 Secondary school net attendance rate (adjusted) 91.5 per cent 7.6 2.2 Children reaching last grade of primary 99.3 per cent 7.7 Primary completion rate 112.3 per cent 7.8 Transition rate to secondary school 95.0 per cent 7.9 Gender parity index (primary school) 1.02 Ratio 7.10 Gender parity index (secondary school) 1.02 Ratio CHILD PROTECTION Child Labour 8.2 Child labour 10.6 per cent 8.3 School attendance among child labourers 100.0 per cent 8.4 Child labour among students 10.7 per cent Child discipline 8.5 Violent discipline 84.5 per cent Early marriage and polygamy 8.6 Marriage before age 15 1.1 per cent 8.7 Marriage before age 18 8.4 per cent 8.8 Young women age 15-19 currently married or in union 3.4 per cent 8.10a 8.10b Spousal age difference Women age 15-19 Women age 20-24 18.9 28.9 per cent per cent Domestic violence 8.14 Attitudes towards domestic violence 4.9 per cent 6 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value 6.5 Inadequate care 1.8 per cent 6.6 Early child development index 89.1 per cent 6.7 Attendance to early childhood education 91.5 per cent EDUCATION Literacy and education 7.1 2.3 Literacy rate among young women 99.6 per cent 7.2 School readiness 93.6 per cent 7.3 Net intake rate in primary education 88.9 per cent 7.4 2.1 Primary school net attendance rate (adjusted) 98.0 per cent 7.5 Secondary school net attendance rate (adjusted) 91.5 per cent 7.6 2.2 Children reaching last grade of primary 99.3 per cent 7.7 Primary completion rate 112.3 per cent 7.8 Transition rate to secondary school 95.0 per cent 7.9 Gender parity index (primary school) 1.02 Ratio 7.10 Gender parity index (secondary school) 1.02 Ratio CHILD PROTECTION Child Labour 8.2 Child labour 10.6 per cent 8.3 School attendance among child labourers 100.0 per cent 8.4 Child labour among students 10.7 per cent Child discipline 8.5 Violent discipline 84.5 per cent Early marriage and polygamy 8.6 Marriage before age 15 1.1 per cent 8.7 Marriage before age 18 8.4 per cent 8.8 Young women age 15-19 currently married or in union 3.4 per cent 8.10a 8.10b Spousal age difference Women age 15-19 Women age 20-24 18.9 28.9 per cent per cent Domestic violence 8.14 Attitudes towards domestic violence 4.9 per cent 7 Topic MICS4 Indicator Number MDG Indicator Number Indicator Value SUBJECTIVE WELL-BEING SW1 Life Satisfaction 73.0 per cent SW2 Happiness 87.6 per cent SW3 Perception of a better life 63.7 per cent Jamaica Multiple Indicator Cluster Survey 20115 16 The Multiple Indicator Cluster Survey (MICS) is an international household survey programme developed by UNICEF. MICS is designed to collect statistically sound, internationally comparable estimates of key indicators that are used to assess the situation of children and women in the areas of health, education, child protection and HIV/AIDS. MICS also provides a tool to monitor the progress towards national goals and global commitments aimed at promoting the welfare of children, including the Millennium Development Goals (MDGs). Since the inception of MICS, three survey rounds have been carried out (1995, 2000 and 2005-6). As part of the global effort to increase the availability of high quality data, UNICEF launched the 4th round of MICS surveys (MICS4) in 2009. MICS4 helps countries to capture rapid changes in key indicators as the MDG target year 2015 approaches and aims to expand the evidence-base for policies and programmes. Jamaica participated in the second, third and this, the fourth round of the Multiple Indicator Cluster Survey in 2000, 2005 and 2011 respectively. As a signatory to the Millennium Declaration (MDG) and the World Fit for Children Declaration and Plan of Action, Jamaica participated in the MICS with the following objectives: To assess the situation of women and children. 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. To assist with monitoring the progress towards the GOJ-UNICEF Country Programme Action Plan. The Jamaica MICS4 was based on a nationally representative sample which was designed to provide estimates at the national and area level (i.e. urban, rural, KMA). A total of 7,289 households were selected in the sample for the Jamaica MICS4, of which 6,300 were found to be occupied. Within these occupied households, 5,960 household interviews were successfully completed yielding a household response rate of 94.6 per cent. In the 5,960 households interviewed, 18,947 household members were listed, indicating a mean household size of 3.2. Of these, 9,226 were males, and 9,721 were females. A total of 5,143 eligible women (aged 15-49 years old) were identified in these households, of which 5,032 women participated in the survey. This resulted in a response rate of 97.8 per cent for women. One thousand, six hundred and fifty-one (1,651) eligible children under-5 were identified and 1,639 questionnaires completed on their behalf, yielding a response rate of 99.3 per cent. The majority of households were located in urban areas (55.6%) and headed by males (53.8%). Approximately 60 per cent of household heads indicated having received secondary education and close to 17 per cent having tertiary education. The data also revealed that a large percentage of women were never married or in a union (48.1%) but had given birth (65.7%), though not within the past two years (87.8%). The majority of these women had also attained secondary education (72.6%) and lived in urban Executive Summary To provide data to monitor the country’s progress towards the MDG and the World Fit For Children Declaration. Sample Coverage and The Characteristics of Household and Respondents Jamaica Multiple Indicator Cluster Survey 2011 6 17 areas (58.2%). The majority of children under-5 were male (52.1%), and had mothers who were educated to the secondary level (75.3%). The data also revealed that the majority of children under-5 were located in urban areas (56.6%) and the least found in other towns (19.6%).Almost all mothers (96.5%) of children less than five years old had secondary level education. Nutrition BREASTFEEDING Breastfeeding at birth is associated with improved child health. The survey showed 64.7 per cent of babies were breastfed for the first time within one hour of birth, while 82.5 per cent of newborns started breastfeeding within one day of birth. The proportion of newborns who received a pre-lacteal feed during the first three days after delivery was 22.0 per cent at the national level. LOW BIRTH WEIGHT Overall, 96.5 per cent of births were weighed at birth and approximately 16.4 per cent of infants were estimated to weigh less than 2500 grams at birth. IMMUNIZATION In Jamaica, 86.1 per cent of children had received all vaccinations at the time of the survey (excluding Hib). However, 79.8 per cent were fully vaccinated by 12 months. A higher percentage of children from rural areas had received all vaccinations (88.9%) than those from urban areas (83.8%).Vaccination cards were seen for 78 per cent of children aged 18-29 months. Almost all children (99.5%) 18-29 months received the BCG vaccine by 12 months of age. Coverage for Polio and DPT by 12 months was also above 90 per cent. Approximately 38 per cent of women who had a live birth within the last two years were protected against tetanus. Regional distribution saw higher coverage outside the KMA (29.2%) with other towns and rural areas at 45.4 per cent and 40.5 per cent respectively. The data also revealed that the richest quintile recorded the lowest percentage of recent mothers who were protected from tetanus (29.5%) and the poorest quintile the highest 48.1%). CHILDREN AGE 0-59 MONTHS WITH DIARRHOEA IN THE LAST TWO WEEKS Diarrhoea is the second leading cause of death among children under five worldwide. Approximately six per cent (5.7%) of the children under age five had diarrhoea in the two weeks preceding the survey. The recommended treatment for diarrhoea in children is oral rehydration therapy (ORS packet recommended homemade fluid or increased fluids) with continued feeding. Forty-three per cent of children with diarrhoea received this treatment. This was more common in rural areas (53.2 per cent) than urban areas (35.7 per cent). Child Health Jamaica Multiple Indicator Cluster Survey 20117 18 Five per cent (5.2 per cent) of children under age five had symptoms consistent with pneumonia during the two weeks preceding the survey. Overall, 58.5 per cent of children with suspected pneumonia received antibiotics. Liquefied Petroleum Gas (LPG) was the primary fuel used for cooking, with 82.2 per cent of households mainly using this fuel. This was followed by wood (7.8%), charcoal (5.0%) and electricity (3.4%). WATER More than 94 per cent of households in Jamaica use an improved water source. For 86.5 per cent of households, the drinking water source was on the premises. Improved sources of drinking water include piped water, tube well/borehole, protected well or spring, or 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 handwashing and cooking. Across wealth quintiles, poorer quintiles were less likely to have water piped into their dwellings, yards or plots than those in richer households (65.9% of households in the poorest quintile as opposed to 97.8% in the richest).In 59.6 per cent of households, an adult male was usually the person collecting the water, when the source of drinking water is not on the premises. Adult females collected water in 32.6 per cent of the cases. IMPROVED SANITATION FACILITIES An improved sanitation facility hygienically separates human excreta from human contact. Overall, 86.5 per cent of households use an improved sanitation facility. While there was no marked difference in urban versus rural areas, it was observed that a noticeably higher proportion of urban households (91.1 per cent) had flushed toilet piped to sewer or septic tank than those in rural areas (62.4 per cent). Safe disposal of children’s faeces occurred in approximately 28 per cent of all households. This low occurrence is due to the high use of disposable diapers by caretakers which are usually disposed of in the garbage (66.5%). Whereas in the poorest quintile, 40.4 per cent of children’s stool was disposed of safely, in the richest quintile, 28.1 per cent children’s stool was disposed of safely. HAND WASHING WITH WATER AND/OR SOAP The percentage of households who allowed the interviewer to observe the place for hand washing was 65.5 per cent. Of those observed, 80.1 per cent had both water and soap at the place for hand washing. EARLY CHILDBEARING The data revealed that 8.9 per cent of women aged 15-19 years old had a live birth, with poorer households (11.4%) having more live births in this age group than richer households (3.7%). Less than 1 per cent have had a live birth before age 15. Solid Fuel Use Water and Sanitation Reproductive Health ANTIBIOTIC TREATMENT OF SUSPECTED PNEUMONIA Jamaica Multiple Indicator Cluster Survey 2011 8 19 Fewer than 15 per cent of women in the 20-24 years age group reported that they had a live birth before age 18. In the poorest quintile, 23.7 per cent of women between 20 and 24 years old indicated that they had a live birth before the age of 18 years. This proportion declined as wealth increased, with the richest quintile recording 2.2 per cent. ANTENATAL CARE Ninety-eight per cent of women age 15-49 years with a live birth in the two years preceding the survey received antenatal care (ANC) at least once by skilled personnel and 85.6 per cent received ANC at least 4 times by any provider. Mothers from the poorest households (77.3%) are less likely than more advantageous mothers (89.3 %) to receive antenatal care four or more times. Among those women who have given birth to a child during the two years preceding the survey, 97.4 per cent reported that a blood test was taken during antenatal care visits, 98.4 per cent reported that their blood pressure was checked, and, in 98 per cent of cases, urine specimen was taken. ASSISTANCE AT DELIVERY About 99.1 per cent of births occurring in the two years preceding the MICS survey were delivered by any skilled personnel: 54.3 per cent were delivered with assistance by a nurse /midwife; and doctors assisted with the delivery of 44.3 per cent of births. Some 98.6 per cent of births in Jamaica are delivered in either a public or private health facility: 90.2 per cent of deliveries occurred in public sector facilities and 8.4 per cent occurred in private sector facilities. Among women aged 15–49 years who had a live birth in the two years preceding the survey, 21.2 per cent were delivered by C-section. Some 20.8 per cent of women in the 20-34 age groups reported a delivery by C-section, while 14.3 per cent of those less than 20 years had a C-section. EARLY CHILDHOOD EDUCATION AND LEARNING Among children aged 36-59 months, 91.5 per cent were attending an early childhood institution; 93.8 per cent in rural areas and 87.9 per cent in the other towns. Young children’s development in four key domains was assessed in the survey: literacy-numeracy, physical, social-emotional and learning. The Early Child Development Index (ECDI) is the percentage of children who are developmentally on track in at least three of these four domains. In Jamaica, the overall ECDI score is 89.1 per cent; with 65.5 per cent for literacy-numeracy, 98.4 per cent for physical, 78.5 per cent for social-emotional and 97.2 per cent for learning. In each individual domain, the higher score is associated with children living in the richest households, with children attending preschool, older children, and among girls. The ECDI was lower for boys (85.9%) than girls (93.0%). Higher ECDI is seen in children attending pre- school (90.2% compared with 77.8% for those who are not attending pre-school). Children living in poorest households have lower ECDI (79.1%) compared with children living in richest households (97.1%). Child Development Jamaica Multiple Indicator Cluster Survey 20119 20 FATHER’S ENGAGEMENT IN ACTIVITIES LITERACY AMONG YOUNG WOMEN Literacy was assessed on the ability of women, aged 15- 24 years, to read a short simple statement or on school attendance i.e. young women who completed grade nine or higher in secondary school were assumed to be literate. Women who could not read the sentence at all were classified as illiterate. 94.4 per cent of the young women 15-24 years were found to be literate, based on these criteria. SCHOOL READINESS Overall, 93.6 per cent of children who are currently attending the first grade of primary school attended pre-school the previous year. The proportion among males (94.6%) is slightly higher than females (92.4%). SCHOOL ATTENDANCE The net attendance ratio in Jamaica is high for both the primary and secondary level. Ninety-eight per cent of children of primary school age are attending primary school and 91.5 per cent of children of secondary school age are attending secondary school. The data revealed that there was a small gender disparity in primary and secondary school attendance; the Gender Parity Index (GPI) is 1.02 for both levels. The net intake rate for primary schools refers to the proportion of children of primary school entry age entering grade 1. Age 6 is the official school starting age in Jamaica. The net intake rate for primary school was 88.9 per cent. A higher proportion of females (91.7%) than males (86.5%) attended at this level. The survival rate to grade six was 99.3 per cent, indicating that almost all children who enter grade 1 continue their education to grade 6.The transition rate to secondary school however declines to 95.0 per cent, indicating that only 95 per cent of children who complete primary school go on to secondary school. The transition rate to secondary school is higher among males (98.2%) than females (91.6%). Literacy and Education In Jamaica, 57.8 per cent of the children aged 36-59 months were not living with their natural fathers. On average, 27.5 per cent of fathers were engaged in one or more activities with their children in the 36-59 months age group. There was an upward trend in the proportion of fathers who engaged their 36-59 month old children, with 15.5 per cent in the poorest quintile and 46.3 per cent in the richest. The average number of activities which the father engaged in with the child was 1.0, compared with 5.3 for any adult household member. Only 54.7 per cent of children under-5 years were living in households where at least 3 children’s books were present; but this figure fell to 30.4 per cent for 10 or more children’s books. The data shows that 27.2 per cent of children aged 0-23 months had 3 or more children’s books, while 72.7 per cent of children aged 24-59 months had 3 or more children’s books. Some 60.7 per cent of children aged 0-59 months had 2 or more play things in their homes. The propor- tion of children who played with household objects or objects found outside was 59.7 per cent. Jamaica Multiple Indicator Cluster Survey 2011 10 21 Secondary school net attendance ratio: 91.5 per cent of children of secondary school age were attending school. Females (92.3%) had a higher attendance rate than their male counterparts (90.8%).Attendance rate is lowest at age 12 years (77.8%) and highest at age 14 years (98.6%). Net attendance rate: At the primary level, the adjusted net attendance rate (NAR) for girls is marginally higher (at 98.7) than for boys (97.2). CHILD LABOUR Children in the age group 5 -11 years are considered to be engaged in child labour if they were involved in economic activities for one or more hours per week or did household chores for 28 or more hours per week. Children aged 12 - 14 years are considered to be engaged in child labour if they were involved in economic activities for 14 or more hours or did household chores for 28 or more hours. In Jamaica, 10.6 per cent of children between the age of 5 and 14 years were engaged in child labour. The highest percentage (12.2%) was in the rural area, while in urban areas, the percentage was below the national average at 9.1 per cent. More children in the younger age group 5-11 years (15.2%) were involved in child labour than the age group 12-14 years (0.3%).The majority of the child labourers age 5-11 were involved in economic activity for at least one hour in the week prior to the survey. Nevertheless all of the children involved in child labour activities were also attending school. VIOLENT DISCIPLINE Overall, 84.5 per cent of children age 2-14 years experienced some form of violent discipline, which includes both psychological aggression and physical punishment. Comparing the findings for girls and boys, a slightly higher percentage of boys (86.2%) experienced violent discipline when compared with girls (82.1%). Children from poorer households were more likely to have experienced some form of violent discipline. The data showed that 90.1 per cent of children in the poorest quintile compared to 75.9 per cent of children in the richest quintile were subjected to violent disciple. In Jamaica, 71.9 per cent of children age 2-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. While only 27.0 per cent of mothers/caretakers believed that children need to be physically punished, the percentage of children who were subjected to physical punishment more than doubled this rate (68.4%) and only 5.7 per cent were subjected to severe physical punishment. This perception was more prevalent in the poorest two quintiles (poorest - 32.8%; second - 29.7%), than the richest two wealth quintiles (fourth - 25.7%; wealthiest - 17.7%). Male children were more likely to be subjected to both “any physical punishment” and “severe physical punishment” (71.4 and 6.7%) than female children (65.2 and 4.7%). EARLY MARRIAGE In Jamaica, 8.4 per cent of women aged 20-49 years were first married or in union (living together with a man as if married) before the age of 18 years. This practice was more prevalent in poorer households; where 15.1 per cent of women from the poorest households were married before age 18, compared to 3.6 per cent of women from the richest households. Child Protection Jamaica Multiple Indicator Cluster Survey 201111 22 Women who were married or in a union before age 15 years was 1.1 per cent. The percentage of women 15-19 years currently married/ in union is 3.4 per cent. DOMESTIC VIOLENCE Overall, 4.9 per cent of women in Jamaica feel that their husband/partner has a right to hit or beat them for at least one of a variety of reasons. These women in most cases agree and justify violence in instances when they neglect the children (4.0%), or if they demonstrate their autonomy, e.g. go out without telling their husbands (0.4%) or argue with them (0.9%). Life Satisfaction SATISFACTION WITH FAMILY LIFE Overall, 92.1 per cent of young women aged 15-24 years were very satisfied or somewhat satisfied with family life. Women in the age group 15-19 years had a higher percentage (94.2%) than those in the 20-24 years age group (89.5%). SATISFACTION WITH FRIENDSHIP AND SATISFACTION WITH SCHOOL The proportion of young women (15-24 years) who were very satisfied or somewhat satisfied with friendship or school in Jamaica was 92.9 per cent and 91.5 per cent, respectively. SATISFACTION WITH LIVING ENVIRONMENT AND SATISFACTION WITH CURRENT JOB Approximately 83 per cent of women aged 15-24 years were very satisfied or somewhat satisfied with their living environment, while 81 per cent were very satisfied or somewhat satisfied with their current job. LIFE OVERALL Some ninety-one per cent of women aged 15-24 who responded to the life satisfaction question say they were satisfied with life overall. However, those in the sub-group 15-19 years had a higher percentage (92.4%) than those in the 20-24 age group (88.3%). SATISFIED WITH INCOME The proportion of women aged 15-24 years who were very satisfied or somewhat satisfied with their income was 63.7 per cent, nationally. Also in the 15-24 age group, ever married/in union women had a higher level of satisfaction with their current income (65.8%) than those never married/in union (62.8%). Approximately 74 per cent of these young women did not have any income. LIFE SATISFACTION AND HAPPINESS Overall, 73 per cent of women had life satisfaction Eighty seven point six (87.6), per cent of women were happy or very happy; with women age 15-19 being more happy (90.5%) than women age 20-24 (84.0%). 23 PERCEPTION OF A BETTER LIFE Some 65 per cent of women in the age group 15-24 years were of the opinion that their life improved over the last one year. The proportion of young women (15-24 years) who believed that their life will get better after one year was 94.7 per cent. Jamaica Multiple Indicator Cluster Survey 2011 12 Jamaica Multiple Indicator Cluster Survey 201113 Jamaica Multiple Indicator Cluster Survey 2011 14 24 I. Introduction BACKGROUND This report is based on the Jamaica Multiple Indicator Cluster Survey, conducted in 2011 by the Statistical Institute of Jamaica (STATIN). The survey provides valuable information on the situation of children and women in Jamaica, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopt- ed by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). 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 objec- tives 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 sub-national 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 prepara- tion 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 implement- ing 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 Multiple Indicator Cluster Survey 201115 The Government of Jamaica (GoJ) continues to demonstrate its commitment under the Millennium Declara- tion and the World Fit for Children Declaration and Plan of Action to which it is a signatory. In partnership with agencies such as UNICEF, Jamaica has made progress towards achieving the goals set under these international treaties. The primary goal of the Government of Jamaica/UNICEF Country Programme 2007-2011 was to contribute to the realization of children’s rights to survival, development, protection and participation through the nurtur- ing of an enabling and protective environment. This Country Programme allowed for the strengthening of frameworks for policy, legislation, monitoring, knowledge generation and institutions. The following are some of the outcomes of the 2007-2011 GOJ/UNICEF Country Programme: monitoring, knowledge genera- tion and institutions, as exemplified in: (a) the development and implementation of the National Strategic Plan for Safe Motherhood and the National Strategic Plan for HIV/AIDS 2007-2012, which for the first time included orphans and children made vulnerable by HIV; (b) the development of the National Parenting Policy and National Safe Schools Policy; (c) the development of the National Strategic Plan for Pre-adoles- cent and Adolescent Health, which is the first such planning tool in the English-speaking Caribbean; (d) the establishment and operationalization of the Office of the Children’s Registry, an organization which receives reports on child abuse and makes appropriate referrals; (e) the institutionalization of JamStats (the Jamai- can DevInfo adaptation) and the use of DevInfo in data management by planning experts, other profession- als and students; (f) the development and annual organization of the Caribbean Child Research Confer- ence, which has strengthened links among academicians, professionals and practitioners, policy-makers and students, facilitated the exchange of information and best practices and engaged the meaningful partici- pation of children; and (g) the development of a standardized framework for training and certification of early childhood practitioners and community health workers for the benefit of children aged 0-6. The GOJ/UNICEF Country Programme for the period 2012-2016, continues to builds upon results achieved during previous programmes of cooperation. This country programme will support national efforts towards social inclusion of vulnerable and marginalized families and children, especially those living in poor rural communities, as well as boys and girls affected by violence and crime and other children whose rights are systematically violated. It will contribute towards improved fulfilment of children’s rights to survival, develop- ment, protection and participation in Jamaica. The main findings of the MICS4 will complement other baseline data and will be used to monitor the prog- ress to achieving the planned results of the GOJ/UNICEF Country Programme as well as the MDGs, the Millennium Declaration, and the outcomes of A World Fit for Children (WFFC). This final report presents the results of the indicators and topics covered in the survey. SURVEY OBJECTIVES The 2011 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 in the Millennium Declaration 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. • To generate data on the situation of children and women, including the identification of vulnerable groups and of disparities, to inform policies and interventions. Jamaica Multiple Indicator Cluster Survey 2011 16 Jamaica Multiple Indicator Cluster Survey 201117 Jamaica Multiple Indicator Cluster Survey 2011 18 27 II. The sample for the Jamaica Multiple Indicator Cluster Survey (MICS) was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, and for three regions of Jamaica: (a) the Kingston Metropolitan Area (KMA), comprising the whole of Kingston, St. Andrew urban, Spanish Town, and Portmore; (b) other towns; and (c) rural areas. The urban and rural areas within each parish were identified as the main sampling strata and the sample was selected in two stages. A sub-sample of the Jamaica master sample of enumeration districts (EDs), based on the 2001 Jamaica Census frame was selected systematically with probability proportional to size within each stratum. A total of 360 sample EDs were selected for the Jamaica MICS4.After a household listing was carried out within the sample EDs, a systematic sample of 20 households was selected in each ED, for a total sample size of 7200 households. The sample is not self-weighting. For reporting all survey results, sample weights are used. A more detailed description of the sample design and weighting procedures can be found in Appendix A. TABLE SD.1: DISTRIBUTION OF ENUMERATION DIVISIONS (EDS) BY PARISH Parish Greater KMA Other Urban Areas Rural Total Kingston 14 - - 14 St Andrew 66 - 6 72 St Thomas - 4 8 12 Portland - 2 8 10 St Mary - 6 8 14 St Ann - 6 14 20 Trelawny - 4 6 10 St James - 22 8 30 Hanover - 2 8 10 Westmoreland - 6 14 20 St Elizabeth - 4 14 18 Manchester - 14 14 28 Clarendon - 18 16 34 St Catherine 40 12 16 68 Total 120 100 140 360 Sample And Survey Methodology Jamaica Multiple Indicator Cluster Survey 201119 Modules Included Modules Excluded Household Questionnaire Household Listing Form Education Water and Sanitation Household Characteristics Child Labour Child Discipline Hand Washing Insecticide Treated Nets Indoor Residual Spraying Salt Iodization Woman’s Questionnaire Woman’s Background Child Mortality (Part of module) Desire for Last Birth Maternal and Newborn Health Attitude towards Domestic Violence Marriage and Union Life Satisfaction/Youth Female Genital Mutilation/Cutting (Not relevant) Sexual Behaviour(Covered in 2009 RHS) HIV/AIDS(Covered in 2009 RHS) Illness symptoms Contraception (Covered in 2009 RHS) Unmet need (Covered in 2009 RHS) Under-Five Questionnaire Age Early Child Development Breastfeeding Care of illness Immunization Malaria (Not relevant) Vitamin A (Not relevant) Birth Registration (Covered in 2008 JSLC) Anthropometry (Covered in 2008 JSLC) 1 The terms “children under 5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. 2 The model MICS4 ques onnaires can be found at www.childinfo.org/mics4_ques onnaire.html Questionnaires MICS uses three questionnaires; 1) a household questionnaire which was used to collect information on all de jure household members (usual residents), the household, and the dwelling; 2) a women’s questionnaire administered in each household to all women age 15-49 years; and 3) an under-5 questionnaire, adminis- tered to mothers or caretakers for all children under 5 living in the household . The modules included were first decided on by the Technical Committee from STATIN. These were later presented to the Steering Com- mittee for approval. The questionnaires were further refined based on the results of the pre-test and again submitted to and approved by the Steering Committee. The final version of the questionnaires included and excluded the modules listed below. Jamaica Multiple Indicator Cluster Survey 2011 20 RECRUITMENT Fieldwork staff was selected from a cadre of existing personnel strategically located across the island. These represent persons who have had experience working on previous household surveys including MICS3.The supervisors were chosen from the participants being trained, based on their mastery of the training content and their demonstrated administrative capabilities and good interpersonal skills. TRAINING OF FIELD STAFF In order to standardize the training for the main survey, a training of trainers was first conducted. These trainers were then deployed to train the prospective interviewers and supervisors at four locations during the period December 6 – 14, 2010. The four training locations were in Kingston, Linstead, Mandeville and Savanna-la-Mar. The class sizes varied between 20 to 30 trainees, based on the number of participants. Training included lectures on interviewing techniques and the content and concepts of the questionnaires and mock interviews between trainees and persons who volunteered their time so that good practice was obtained in asking the relevant questions. A test was administered at the end of the training session, and based on the test results and the trainees’ participation, 18 supervisors and 73 interviewers were selected. TRAINING OF FIELD SUPERVISORS The selected supervisors participated in an additional one day training on December 22, 2010 in order to make them aware of the task at hand, what is expected and how they were expected to carry out their duties and responsibilities. FIELDWORK Interviewing started on January 3, 2011, and ended on March 15, 2011. A total 5,960 household questionnaires, 5,032 individual women and 1,639 children under-five questionnaires was completed. There were, however, some problems during the period of the fieldwork, e.g. Violence in sections of St James and Westmoreland. Some upper income areas with gated communities did not grant access to interviewers. DATA PROCESSING The MICS4 data processing system was designed to deliver the first results of the survey within a few weeks of the completion of the field work, since the data was processed in tandem with the fieldwork. The questionnaires from the field were first manually edited/coded by four clerks who, based on predetermined standards, checked the questionnaires for completeness and thoroughness and, where necessary, inserted codes. After this process was completed, the questionnaires were sent to the data processing unit where the information was transferred to microcomputers by four data entry operators, supervised by two programmers using the software package CSPro. This process was started on January 31, 2011 and Recruitment and Training of Field Staff Jamaica Multiple Indicator Cluster Survey 201121 30 ended on April 4, 2011. In order to ensure accuracy and minimize data entry errors, the questionnaires were entered separately by two data clerks and the programme highlighted any inconsistency in the data entered. These inconsistencies were eliminated by checking with the original questionnaire and the clerk whose data was incorrect made the necessary correction(s). This process continued until both sets of data were identical. Internal consistency checks were then followed to ensure that the quality of the data was maintained. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, Version 18, and the model syntax and tabulation plans developed by UNICEF were used for this purpose. Jamaica Multiple Indicator Cluster Survey 2011 22 Jamaica Multiple Indicator Cluster Survey 201123 Jamaica Multiple Indicator Cluster Survey 2011 24 31 III. SAMPLE COVERAGE Of the 7,289 households selected for the sample, 6,300 were found to be occupied. Of these, 5,960 were successfully interviewed yielding a household response rate of 94.6 per cent. In the interviewed households, 5,143 women (age 15-49 years) were identified. Of these 5,032 were successfully interviewed, yielding a response rate of 97.8 per cent. In addition, 1,651 children under age five were listed in the household questionnaire. Questionnaires were completed for 1,639 of these children, which corresponds to a response rate of 99.3 per cent. Overall response rates of 92.6 and 93.9 were calculated for the women’s and under-5’s interviews respectively (Table HH.1). TABLE HH.1: RESULTS OF HOUSEHOLD, WOMEN'S AND UNDER-FIVE INTERVIEWS NUMBER 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, 2011 Region Area Total KMA Other towns Rural Urban Rural Households Sampled 2,452 2,013 2,824 4,465 2,824 7,289 Households Occupied 2,090 1,762 2,448 3,852 2,448 6,300 Households Interviewed 1,963 1,657 2,340 3,620 2,340 5,960 Household Response Rate 93.9 94.0 95.6 94.0 95.6 94.6 Women Eligible 1,817 1,405 1,921 3,222 1,921 5,143 Women Interviewed 1,782 1,372 1,878 3,154 1,878 5,032 Women Response Rate 98.1 97.7 97.8 97.9 97.8 97.8 Women's Overall Response Rate 92.1 91.8 93.4 92.0 93.4 92.6 Children under 5 Eligible 520 464 667 984 667 1,651 Children under 5 Mother/Caretaker Interviewed 517 458 664 975 664 1,639 Child Response Rate 99.4 98.7 99.6 99.1 99.6 99.3 Children's Overall Response Rate 93.4 92.8 95.2 93.1 95.2 93.9 The overall response rates were greater than 90% in all three areas, with the Rural Areas recording higher rates than the Kingston Metropolitan Area and Other Towns. Sample Coverage And The Characteristics Of Households And Respondents Jamaica Multiple Indicator Cluster Survey 201125 CHARACTERISTICS OF HOUSEHOLDS The weighted 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 5,960 households successfully interviewed in the survey, 18,947 household members were listed. Of these, 9,226 were males, and 9,721 were females. TABLE HH.2: HOUSEHOLD AGE DISTRIBUTION BY SEX PER CENT AND FREQUENCY DISTRIBUTION OF THE HOUSEHOLD POPULATION BY FIVE-YEAR AGE GROUPS, DEPENDENCY AGE GROUPS, BY CHILD (AGE 0-17 YEARS) AND ADULT POPULATIONS (AGE 18 OR MORE), BY SEX, JAMAICA, 2011 Males Females Total Number Per cent Number Per cent Number Per cent Age 0-4 826 9.0 750 7.7 1,576 8.3 5-9 849 9.2 878 9.0 1,726 9.1 10-14 948 10.3 981 10.1 1,929 10.2 15-19 946 10.3 910 9.4 1,856 9.8 20-24 708 7.7 738 7.6 1,447 7.6 25-29 642 7.0 736 7.6 1,378 7.3 30-34 543 5.9 671 6.9 1,215 6.4 35-39 636 6.9 746 7.7 1,382 7.3 40-44 590 6.4 707 7.3 1,297 6.8 45-49 578 6.3 591 6.1 1,169 6.2 50-54 452 4.9 497 5.1 949 5.0 55-59 378 4.1 330 3.4 708 3.7 60-64 293 3.2 270 2.8 563 3.0 65-69 205 2.2 238 2.4 443 2.3 70-74 190 2.1 213 2.2 402 2.1 75-79 172 1.9 189 1.9 361 1.9 80-84 106 1.2 125 1.3 231 1.2 85+ 70 0.8 126 1.3 197 1.0 Missing/DK 92 1.0 25 0.3 117 0.6 Dependency Age Groups 0-14 2,623 28.4 2,609 26.8 5,232 27.6 15-64 5,768 62.5 6,196 63.7 11,964 63.1 65+ 743 8.1 891 9.2 1,634 8.6 Missing/DK 92 1.0 25 0.3 117 0.6 Children and Adult Populations Children age 0-17 years 3,230 35.0 3,188 32.8 6,418 33.9 Adults age 18+ years 5,904 64.0 6,507 66.9 12,412 65.5 Missing/DK 92 1.0 25 0.3 117 0.6 Total 9,226 100.0 9,721 100.0 18,947 100.0 Table HH.2 shows the male/female difference across various characteristics. There are more males in certain categories, most notably in the 0-4 and, 15-19 age groups and in the dependency age (0-14) and child population (children age 0-17). A population pyramid of the number of males and females in each age group is presented in Figure HH.1 Jamaica Multiple Indicator Cluster Survey 2011 26 33 Table HH.3 - HH.5 provide basic information on the households, female respondents age 15-49, and children under-5 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women and children under-5 interviewed in the survey was essential for the interpretation of findings presented later in the report and also can provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about weighting. Table HH.3a provides basic background information on the households. Within households, the sex of the household head, area and education of the household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. Jamaica Multiple Indicator Cluster Survey 201127 34 TABLE HH.3A: HOUSEHOLD COMPOSITION PER CENT DISTRIBUTION OF HOUSEHOLDS BY SELECTED CHARACTERISTICS, JAMAICA, 2011 Weighted per cent Number of households weighted Number of households unweighted Sex of Household Head Male 53.8 3,209 3,186 Female 46.2 2,751 2,774 Area Urban KMA 35.0 2,084 1,963 Other towns 20.7 1,232 1,657 Urban total 55.6 3,316 3,620 Rural 44.4 2,644 2,340 Number of Household Members 1 25.2 1,504 1,474 2 19.2 1,144 1,137 3 18.0 1,076 1,050 4 16.0 956 928 5 9.3 553 596 6 5.2 309 339 7 3.1 183 186 8 1.9 115 119 9 0.6 39 47 10+ 1.3 80 84 Education of household head None/Primary 21.5 1,281 1,292 Secondary 60.2 3,589 3,660 Tertiary 16.9 1,005 919 Missing/DK 1.4 85 89 Total 100 5,960 5,960 The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table shows the proportions of households with at least one child under 18, at least one child under 5, and at least one eligible woman age 15-49. The weighted average household size estimated by the survey is also shown in the table. The Table (HH.3a) shows that there were more male-headed households, recording a little over a half (53.8%) of the total composition. Additionally, most of the respondents were found in urban areas (55.6%). Note that within the households, a substantial percentage (25.2%) stated that their households comprised only one (1) person. The figures for the number of household members declined at higher orders indicating that larger households are relatively rare. Another key finding was that approximately 60.2 per cent of household heads indicated having received secondary education and close to 16.9 per cent have tertiary education. As shown in Table HH.3b, the mean household size is 3.2; but households with at least one child age 0-4 years is 21.8 per cent; 52.3 per cent of households have at least one child age 0-17 years, and for households with at least one woman age 15-49 years it is 59.8 per cent. Jamaica Multiple Indicator Cluster Survey 2011 28 35 TABLE HH.3B: HOUSEHOLD COMPOSITION PER CENT DISTRIBUTION OF HOUSEHOLDS BY SELECTED CHARACTERISTICS, JAMAICA, 2011 Weighted per cent Number of households weighted Number of households unweighted At least one child age 0-4 years 21.8 5,960 5,960 At least one child age 0-17 years 52.3 5,960 5,960 At least one woman age 15-49 years 59.8 5,960 5,960 Mean household size 3.2 5,960 5,960 CHARACTERISTICS OF FEMALE RESPONDENTS 15-49 YEARS OF AGE AND CHILDREN UNDER-5 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 number of weighted and unweighted observations is 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 area, age, marital status, motherhood status, births in the last two years, education3 and wealth index quintiles4. The majority of women (58.2%) resided in the urban areas. There was a fairly even distribution across the age groups with the highest (17.8%) found in the 15-19 age group and the lowest (11.7%) in the 45-49 age group. The marital/union status shows that approximately 48.1 per cent of women have never been married or in a union. However, over a half (65.7%) of all the female respondents had ever given birth to a child, but 3 4 Unless otherwise stated, “education” refers to highest educational level attended by the respondent throughout this report when it is used as a background variable. Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteris- tics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calcula- tions were as follows: radio, TV, non-mobile telephone, fridge, chair, table, sofa, cabinet, bed, stove, microwave, Air Conditioner, fan, washing machine, clothes dryer, dishwasher, water heater, watch, bike, mobile telephone, car, motor cycle or scooter, cart, boat, and ownership of dwelling, agricultural land, livestock, and bank accounts. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expen- diture levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, Filmer and Pritchett, 2001, and Gwatkinet. Al., 2000. 35 TABLE HH.3B: HOUSEHOLD COMPOSITION PER CENT DISTRIBUTION OF HOUSEHOLDS BY SELECTED CHARACTERISTICS, JAMAICA, 2011 Weighted per cent Number of households weighted Number of households unweighted At least one child age 0-4 years 21.8 5,960 5,960 At least one child age 0-17 years 52.3 5,960 5,960 At least one woman age 15-49 years 59.8 5,960 5,960 Mean household size 3.2 5,960 5,960 CHARACTERISTICS OF FEMALE RESPONDENTS 15-49 YEARS OF AGE AND CHILDREN UNDER-5 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 number of weighted and unweighted observations is 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 area, age, marital status, motherhood status, births in the last two years, education3 and wealth index quintiles4. The majority of women (58.2%) resided in the urban areas. There was a fairly even distribution across the age groups with the highest (17.8%) found in the 15-19 age group and the lowest (11.7%) in the 45-49 age group. The marital/union status shows that approximately 48.1 per cent of women have never been married or in a union. However, over a half (65.7%) of all the female respondents had ever given birth to a child, but 3 4 Unless otherwise stated, “education” refers to highest educational level attended by the respondent throughout this report when it is used as a background variable. Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteris- tics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calcula- tions were as follows: radio, TV, non-mobile telephone, fridge, chair, table, sofa, cabinet, bed, stove, microwave, Air Conditioner, fan, washing machine, clothes dryer, dishwasher, water heater, watch, bike, mobile telephone, car, motor cycle or scooter, cart, boat, and ownership of dwelling, agricultural land, livestock, and bank accounts. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expen- diture levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, Filmer and Pritchett, 2001, and Gwatkinet. Al., 2000. 35 TABLE HH.3B: HOUSEHOLD COMPOSITION PER CENT DISTRIBUTION OF HOUSEHOLDS BY SELECTED CHARACTERISTICS, JAMAICA, 2011 Weighted per cent Number of households weighted Number of households unweighted At least one child age 0-4 years 21.8 5,960 5,960 At least one child age 0-17 years 52.3 5,960 5,960 At least one woman age 15-49 years 59.8 5,960 5,960 Mean household size 3.2 5,960 5,960 CHARACTERISTICS OF FEMALE RESPONDENTS 15-49 YEARS OF AGE AND CHILDREN UNDER-5 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 number of weighted and unweighted observations is 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 area, age, marital status, motherhood status, births in the last two years, education3 and wealth index quintiles4. The majority of women (58.2%) resided in the urban areas. There was a fairly even distribution across the age groups with the highest (17.8%) found in the 15-19 age group and the lowest (11.7%) in the 45-49 age group. The marital/union status shows that approximately 48.1 per cent of women have never been married or in a union. However, over a half (65.7%) of all the female respondents had ever given birth to a child, but 3 4 Unless otherwise stated, “education” refers to highest educational level attended by the respondent throughout this report when it is used as a background variable. Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteris- tics, water and sanitation, and other characteristics that are related to the household’s wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets used in these calcula- tions were as follows: radio, TV, non-mobile telephone, fridge, chair, table, sofa, cabinet, bed, stove, microwave, Air Conditioner, fan, washing machine, clothes dryer, dishwasher, water heater, watch, bike, mobile telephone, car, motor cycle or scooter, cart, boat, and ownership of dwelling, agricultural land, livestock, and bank accounts. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expen- diture levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, Filmer and Pritchett, 2001, and Gwatkinet. Al., 2000. Jamaica Multiple Indicator Cluster Survey 201129 36 within the last two (2) years, approximately 87.8 per cent have not given birth to a child. It is noteworthy that the majority of women, 72.6 per cent, received a secondary education and 25.6 per cent received a tertiary education. Wealth is fairly even across the groups with the fewest women (16.5%) in the households of the poorest wealth quintile. TABLE HH.4: WOMEN'S BACKGROUND CHARACTERISTICS PER CENT AND FREQUENCY DISTRIBUTION OF WOMEN AGE 15-49 YEARS BY BACKGROUND CHARACTERISTICS, JAMAICA, 2011 Weighted per cent Number of women weighted Number of women unweighted Area Urban KMA 37.7 1,899 1,782 Other towns 20.5 1,030 1,372 Urban total 58.2 2,928 3,154 Rural 41.8 2,104 1,878 Age 15-19 17.8 894 915 20-24 14.5 732 753 25-29 14.5 728 722 30-34 13.1 659 682 35-39 14.5 732 706 40-44 13.9 698 659 45-49 11.7 589 595 Marital/ Union Status Currently married/in union* 34.7 1,744 1,739 Widowed 0.5 26 34 Divorced 1.0 52 48 Separated 15.7 790 813 Never married/in union* 48.1 2,420 2,398 Motherhood Status Ever gave birth 65.7 3,306 3,337 Never gave birth 34.3 1,726 1,695 Birth in the last two years Had a birth in last two years 12.2 614 630 Had no birth in last two years 87.8 4,418 4,402 Education None/Primary 1.8 90 91 Secondary 72.6 3,652 3,718 Tertiary 25.6 1,290 1,223 Wealth Index Quintiles Poorest 16.5 832 858 Second 20.6 1,038 1,028 Middle 20.5 1,029 1,043 Fourth 21.1 1,064 1,102 Richest 21.2 1,069 1,001 Total 100.0 5,032 5,032 *Union refers to married or living with a partner as if married Some background characteristics of children under 5 are presented in Table HH.5. These include the distri- bution of children by several attributes: sex, area, age, mother’s or caretaker’s education and wealth of the household. Table HH.5 shows marginally more males (52.1%) than females (47.9%). The majority of children under-5 were located in urban areas (56.6%) of which, 37.0 per cent were from the KMA and 19.6 per cent from other towns. By age, the highest proportion of children under-5 years old were from the 48-59 months age group (22.8%) and the lowest (9.8%) in the 6-11 months age group. Jamaica Multiple Indicator Cluster Survey 2011 30 37 Weighted Percent Number of Children Weighted Unweighted Sex Male 52.1 854 861 Female 47.9 785 778 Area Urban KMA 37.0 606 517 Other towns 19.6 321 458 Urban total 56.6 927 975 Rural 43.4 712 664 Age 0-5 10.3 168 167 6-11 9.8 160 161 12-23 19.6 321 315 24-35 20.0 327 325 36-47 17.6 289 304 48-59 22.8 373 367 Mother's Education None/Primary 2.9 47 58 Secondary 75.3 1,235 1,243 Tertiary 21.7 356 337 Missing/DK 0.0 0 1 Wealth Index Quintiles Poorest 21.8 358 387 Second 24.2 396 379 Middle 21.5 352 351 Fourth 16.7 274 287 Richest 15.9 260 235 Total 100.0 1,639 1,639 Additionally, in terms of household wealth, the poorer quintiles had more children under-5 (poorest – 21.8% and second - 24.2%) than those in richer quintiles (fourth - 16.7% and richest - 15.9%). TABLE HH.5: UNDER-5'S BACKGROUND CHARACTERISTICS PER CENT AND FREQUENCY DISTRIBUTION OF CHILDREN UNDER FIVE YEARS OF AGE BY SELECTED CHARACTERISTICS, JAMAICA, 2011 Jamaica Multiple Indicator Cluster Survey 201131 Jamaica Multiple Indicator Cluster Survey 2011 32 Jamaica Multiple Indicator Cluster Survey 201133 Jamaica Multiple Indicator Cluster Survey 2011 34 38 IV. Nutrition NUTRITIONAL STATUS BREASTFEEDING AND INFANT AND YOUNG CHILD FEEDING 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. WHO/UNICEF have the following feeding recommendations: Exclusive breastfeeding for first six months Continued breastfeeding for two years or more Safe, age-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 related to recommended child feeding practices are as follows: Early initiation of breastfeeding (within 1 hour of birth) Exclusive breastfeeding rate (< 6 months) Predominant breastfeeding (< 6 months) Continued breastfeeding rate (at 1 year and at 2 years) Duration of breastfeeding Age-appropriate breastfeeding (0-23 months) Introduction of solid, semi-solid and soft foods (6-8 months) Minimum meal frequency (6-23 months) Milk feeding frequency for non-breastfeeding children (6-23 months) Bottle feeding (0-23 months) Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Devel- opment target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. Jamaica Multiple Indicator Cluster Survey 201135 39 TABLE NU.1: INITIAL BREASTFEEDING PERCENTAGE OF LAST-BORN CHILDREN IN THE 2 YEARS PRECEDING THE SURVEY WHO WERE EVER BREASTFED, PERCENTAGE WHO WERE BREASTFED WITHIN ONE HOUR OF BIRTH AND WITHIN ONE DAY OF BIRTH, AND PERCENTAGE WHO RECEIVED A PRELACTEAL FEED, JAMAICA, 2011 Percentage ever breastfed [1] Percentage who were first breastfed: Within one hour of birth [2] Percentage who were first breastfed: Within one day of birth Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Area Urban KMA 96.7 66.5 82.6 20.3 187 Other towns 96.0 58.7 84.2 24.6 151 Urban total 96.4 63.0 83.3 22.2 338 Rural 94.2 66.8 81.5 21.8 276 Months Since Last Birth 0-11 months 96.0 64.2 83.8 23.1 306 12-23 months 94.6 66.1 80.4 20.8 293 Assistance at Delivery Skilled attendant 95.4 65.0 82.5 22.0 608 Traditional birth attendant (*) (*) (*) (*) 1 Other (*) (*) (*) (*) 3 Missing (*) (*) (*) (*) 2 Place of Delivery Public sector health facility 95.1 64.9 82.3 21.1 554 Private sector health facility (98.8) (66.2) (85.4) (33.5) 51 Home (*) (*) (*) (*) 7 Other/Missing (*) (*) (*) (*) 2 Mother’s Education None/Primary (*) (*) (*) (*) 9 Secondary 94.8 67.1 82.2 19.9 474 Tertiary 98.1 55.2 83.3 30.1 131 Wealth Index Quintiles Poorest 96.1 67.2 88.3 18.1 145 Second 91.1 67.0 75.7 17.9 146 Middle 97.7 64.9 84.8 26.8 131 Fourth 96.0 55.1 78.3 22.0 98 Richest 97.1 67.2 85.4 27.8 94 Total 95.4 64.7 82.5 22.0 614 [1] MICS indicator 2.4 [2] MICS indicator 2.5 (*) Figures that are based on less than 25 unweighted cases Table NU.1 provides the proportion of children born in the last two years who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 64.7 per cent of babies were breastfed for the first time within one hour of birth, while 82.5 per cent of newborns in Jamaica start breastfeeding within one Jamaica Multiple Indicator Cluster Survey 2011 36 40 day of birth. The proportion of newborns who received a prelacteal feed during the first three days after delivery was 22.0 per cent at the national level. In the rural areas, 66.8 per cent of babies were breastfed within one hour of birth; this was followed by KMA (66.5%) and other towns (58.7%). Nationally, if breastfed within one day of birth, newborns were more likely to be breastfed within the first hour. The percentages of babies who were breastfed within one day were 81.5 per cent, 82.6 per cent and 84.2 per cent for rural, KMA and other towns, respectively. Babies who received a prelacteal feed within three days were highest in other towns with 24.6 per cent, followed by rural areas (21.8%) and KMA (20.3%). Prelacteal feeds were most common among the wealthiest women and least common among the poorest women. TABLE NU.2: BREASTFEEDING PERCENTAGE OF LIVING CHILDREN ACCORDING TO BREASTFEEDING STATUS AT SELECTED AGE GROUPS, JAMAICA, 2011 Children 0-5 months Children 12-15 months Children 20-23 months Per cent exclusively breastfed [1] Per cent predominantly breastfed [2] Number of children Per cent breastfed (Continued breastfeeding at 1 year) [3] Number of children Per cent breastfed (Continued breastfeeding at 2 years) [4] Number of children Sex Male 23.3 36.7 87 34.6 57 (31.5) 48 Female 24.3 48.8 81 52.9 65 (30.8) 41 Area Urban KMA (27.1) (38.8) 51 (43.7) 44 (27.8) 29 Other towns 21.4 46.8 49 (13.0) 27 (38.1) 22 Urban total 24.3 42.8 100 32.0 71 32.2 51 Rural 23.0 42.2 69 (61.6) 51 (30.0) 38 Mother's Education None/Primary (*) (*) 3 (*) 2 (*) 2 Secondary 26.2 47.7 116 39.8 97 35.1 71 Tertiary (17.5) (29.6) 48 (*) 23 (*) 15 Missing/DK - - 0 (*) 0 - 0 Wealth Index Quintiles Poorest (20.6) (45.5) 25 (44.8) 35 (*) 19 Second (32.8) (67.4) 41 (*) 28 (*) 15 Middle (15.8) (28.0) 48 (*) 19 (*) 24 Fourth (25.9) (35.8) 30 (*) 20 (*) 20 Richest (*) (*) 24 (*) 20 (*) 12 Total 23.8 42.5 168 44.4 122 31.2 89 [1] MICS indicator 2.6 [2] MICS indicator 2.9 [3] MICS indicator 2.7 [4] MICS indicator 2.8 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases In Table NU.2, breastfeeding status is based on the reports of mothers/caretakers of children’s consump- tion 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, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. The percentage of children aged less than six months who were exclusively breastfed was 23.8 per cent, a level considerably lower than recommended. By age 12-15 months, 44.4 per cent of children were still Jamaica Multiple Indicator Cluster Survey 201137 41 being breastfed and by age 20-23 months, the proportion still being breastfed fell to 31.2 per cent. Overall, differences appeared small and were based on small numbers of cases which limits the analysis on these specific indicators. In the four categories, ‘exclusively breastfed’, ‘predominantly breastfed’, ‘continued breastfeeding at one year’, and ‘breastfed at age two’, KMA had the highest percentage of children, who were ‘exclusively breastfed’ (27.1%); the highest percentage of those ‘predominantly breastfed’ in the 0-5 month age group (46.8%) were in other towns, 61.6 per cent who ‘continued breastfeeding at one year’ were in the rural areas, and 38.1 per cent who were ‘breastfed at age two’ were in other towns. Other differentials showed small differences and were based on small denominators. Figure NU.1 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 below seven per cent. Only about 28 per cent of children were receiving breast milk after 2 years. Table NU.3 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the mean duration was 15.5 months for any breastfeeding, 1.6 months for exclusive breastfeeding, and 3.2 months for predominant breastfeeding. There was no difference in median duration for those exclusively breastfed (0.7 month each) and little difference by sex for predominant breastfeeding. The median duration for any breastfeeding among females and males were 14.2 and 10.9 months, respectively. Jamaica Multiple Indicator Cluster Survey 2011 38 42 In the any breastfeeding category for children under age 3, the median duration was 14.5 months in rural areas, followed by 10.6 months in other towns, 10.5 months in urban areas and 10.4 months in KMA. Of those predominantly breastfed, rural areas and KMA had a median of 1.8 months, while it was 1.9 months in urban areas and 2.1 months in other towns. The median time for children whose mothers had at the minimum a secondary education was 14.8 months, but the median for exclusively and predominantly breastfed were 0.5 and 1.0 month, respectively. TABLE NU.3: DURATION OF BREASTFEEDING MEDIAN DURATION OF ANY BREASTFEEDING, EXCLUSIVE BREASTFEEDING, AND PREDOMINANT BREASTFEEDING AMONG CHILDREN AGE 0-35 MONTHS, JAMAICA, 2011 Median duration (in months) of Number of children age 0- 35 months Any breastfeeding [1] Exclusive breastfeeding Predominant breastfeeding Sex Male 10.9 0.7 1.6 495 Female 14.2 0.7 2.4 482 Area Urban KMA 10.4 1.3 1.8 345 Other towns 10.6 0.5 2.1 211 Urban total 10.5 0.7 1.9 556 Rural 14.5 0.7 1.8 421 Mother’s Education None/Primary 21.1 2.3 4.3 750 Secondary+ 14.8 0.5 1.0 227 Missing/DK (*) (*) (*) 0 Wealth Index Quintiles Poorest 13.0 1.3 2.3 203 Second 12.5 1.3 3.8 230 Middle 12.7 0.5 0.7 215 Fourth 16.3 0.7 0.7 161 Richest 11.8 1.4 2.0 167 Median 12.5 0.7 1.9 977 Mean for all children (0-35 months) 15.5 1.6 3.2 977 [1] MICS indicator 2.10 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases Overall, there was no systematic pattern of duration of breastfeeding by household wealth status. The adequacy of infant feeding in children under-24 months is provided in Table NU.4.Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding, while infants aged 6-23 months are considered to be adequately fed if they are receiving breast milk and solid, semi-solid or soft food. According to these feeding patterns, only 33.8 per cent of children aged 6-23 months are being adequately fed. Adequate feeding among all infants age 0-5 months drops to 23.8 per cent. Combining these two groups, some 31.2 per cent of children age 0-23 months were appropriately breastfed. For children aged 0-5 months, exclusive breastfeeding did not vary much by sex, but in the age group 6- 23 months more girls were currently breastfed and receiving solid, semi-solid, or soft foods (38.8%) than boys (28.8%). In the 0-23 month age group, more girls were appropriately breastfed (35.2%) than boys Jamaica Multiple Indicator Cluster Survey 201139 43 TABLE NU.4: AGE-APPROPRIATE BREASTFEEDING PERCENTAGE OF CHILDREN AGE 0-23 MONTHS WHO WERE APPROPRIATELY BREASTFED DURING THE PREVIOUS DAY, JAMAICA, 2011 Children age 0-5 months Children age 6-23 months Children age 0-23 months Per cent exclusively breastfed [1] Number of children Per cent currently breastfeeding and receiving solid, semi- solid or soft foods Number of children Per cent appropriately breastfed [2] Number of children Sex Male 23.3 87 28.8 240 27.3 328 Female 24.3 81 38.8 241 35.2 322 Area Urban KMA 27.1 51 34.2 176 32.6 226 Other towns (21.4) 49 24.8 98 23.7 148 Urban total 24.3 100 30.8 274 29.1 374 Rural 23.0 69 37.7 208 34.1 276 None/Primary (*) 3 (*) 7 (*) 10 Secondary 26.2 116 33.0 383 31.4 499 Tertiary (17.5) 48 38.3 92 31.1 141 Mother not in household (*) 0 (*) 0 (*) 0 Missing/DK - 0 (*) 0 (*) 0 Wealth Index Quintiles Poorest (20.6) 25 32.6 118 30.5 142 Second (32.8) 41 33.4 112 33.2 153 Middle (15.8) 48 37.5 93 30.1 142 Fourth (25.9) 30 38.2 81 34.9 110 Richest (24.9) 24 27.4 78 26.8 102 Total 23.8 168 33.8 482 31.2 650 [1] MICS indicator 2.6 [2] MICS indicator 2.14 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases Adequate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and the prevention of under nutrition. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. It is required that for breastfed children, two or more meals of solid, semi-solid or soft foods are needed if they are six to eight months old, and three or more meals if they are 9-23 months of age. For children 6-23 months and older who are not breastfed, four or more meals of solid, semi-solid or soft foods or milk feeds are needed. Nationally, 54.6 per cent of children age 6-8 month received solid, semi-solid, or soft foods (see Table NU.5). Mother’s Education (27.3%). By area, children 0-23 months in rural areas were most likely to be appropriately breastfed but among children in rural areas 0-5 months, they were least likely to be exclusively breastfed. A breakdown of children age 0-5 months, ‘exclusively breastfed’ shows no distinctive difference among wealth quintiles, across the three age groups. Jamaica Multiple Indicator Cluster Survey 2011 40 44 TABLE NU.5: INTRODUCTION OF SOLID, SEMI-SOLID OR SOFT FOOD PERCENTAGE OF INFANTS AGE 6-8 MONTHS WHO RECEIVED SOLID, SEMI-SOLID OR SOFT FOODS DURING THE PREVIOUS DAY, JAMAICA, 2011 Currently breastfeeding Currently not breastfeeding All Per cent receiving solid, semi- solid or soft foods Number of children age 6-8 months Per cent receiving solid, semi-solid or soft foods Number of children age 6-8 months Per cent receiving solid, semi- solid or soft foods [1] Number of children age 6-8 months Sex Male (60.3) 28 (*) 12 (54.8) 40 Female (50.5) 29 (*) 7 (54.4) 36 Area Urban KMA (*) 21 (*) 9 (*) 30 Other towns (*) 8 (*) 3 (*) 11 Urban total (59.1) 29 (*) 12 (53.1) 41 Rural (*) 28 (*) 7 (56.3) 35 Total 55.3 57 (*) 19 54.6 76 [1] MICS indicator 2.12 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases Table NU.6 presents the proportion of children age 6-23 months who received semi-solid or soft foods the minimum number of times or more during the previous day according to breastfeeding status (see note in Table NU.6 for a definition of minimum number of times for different age groups). Overall, about two-fifth of the children age 6-23 months (42.0%) received solid, semi-solid and soft foods the minimum number of times. Among breastfed children age 6-23 months, nearly one-sixth of them (16.4%) received solid, semi-solid and soft foods the minimum number of times and this proportion was higher among males (18.2%) compared to females (14.9%). In terms of the distribution of these children according to their location, 28.4 per cent were in other towns, 17.5 per cent in KMA and 11.6 per cent in rural areas. A breakdown of the age group shows some fluctuations in the figures. In the 6-8 month age sub-group, 32.0 per cent were breastfed and solid, semi-solid and soft foods the minimum number of times, but in the 9-11 month sub-group, the percentage fell to 3.2 per cent. It increased to 13.2 per cent in the 12-17 month sub-group and 18.1 per cent in the 18-23 month sub-group. By household wealth, there was no overall pattern. Among non-breastfeeding children, nearly seven in ten children were receiving solid, semi-solid and soft foods or milk feeds 4 times or more. In this category, there were more females (69.7%) than males (62.5%); while among the age sub-groups, the lowest percentage was in the 18-23 month (54.4%) and the highest in the 9-11 month (79.1%). KMA had the highest percentage of these children (69.6), followed by rural areas (67.5%) and 57.4 per cent in other towns. There was no overall pattern by household wealth. Jamaica Multiple Indicator Cluster Survey 201141 45 TABLE NU.6: MINIMUM MEAL FREQUENCY PERCENTAGE OF CHILDREN AGE 6-23 MONTHS WHO RECEIVED SOLID, SEMI-SOLID, OR SOFT FOODS (AND MILK FEEDS FOR NON-BREASTFEEDING CHILDREN) THE MINIMUM NUMBER OF TIMES OR MORE DURING THE PREVIOUS DAY, ACCORDING TO BREASTFEEDING STATUS, JAMAICA, 2011 Currently breastfeeding Currently not breastfeeding All Per cent receiving solid, semi- solid and soft foods the minimum number of times Number of children age 6-23 months Per cent receiving at least 2 milk feeds [1] Per cent receiving solid, semi-solid and soft foods or milk feeds 4 times or more Number of children age 6-23 months Per cent with minimum meal frequency [2] Number of children age 6-23 months Sex Male 18.2 107 75.3 62.5 133 42.7 240 Female 14.9 125 79.5 69.7 116 41.3 241 Age 6-8 months 32.0 57 (*) (*) 19 42.5 76 9-11 months 3.2 54 (86.6) (79.1) 30 30.2 84 12-17 months 13.2 77 83.3 70.7 107 46.7 184 18-23 months (18.1) 44 64.7 54.4 93 42.7 137 Area Urban KMA 17.5 79 80.8 69.6 96 46.1 176 Other towns (28.4) 38 73.1 57.4 60 46.1 98 Urban total 21.1 118 77.8 64.9 156 46.1 274 Rural 11.6 115 76.3 67.5 93 36.6 208 Mother’s Education None/Primary (*) 1 (*) (*) 6 (*) 7 Secondary 15.1 188 78.8 68.4 195 42.3 383 Tertiary (21.7) 43 (72.5) (54.6) 49 39.2 92 Missing/DK (*) 0 - - 0 (*) 0 Wealth Index Quintiles Poorest 10.2 61 71.5 61.0 56 34.5 118 Second 16.5 58 83.0 68.8 54 41.5 112 Middle (25.0) 45 80.3 71.5 48 48.8 93 Fourth (13.5) 39 (74.8) (56.2) 42 35.5 81 Richest (19.7) 28 (76.9) (71.0) 50 52.6 78 Total 16.4 232 77.3 65.9 249 42.0 482 [1] MICS indicator 2.15 [2] MICS indicator 2.13 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.7 shows that bottle-feeding is still prevalent in Jamaica. Some 63.5 per cent of children under-6 months were fed using a bottle with a nipple, while 68.6 per cent of children 12-23 months used this method for feeding, while among all children 0-23, 69.4 per cent use a bottle with a nipple. Among children 0-23 months, more females (72.1%) than males (66.7%) used a bottle with a nipple. With regards to areas, 72.0 per cent of children 0-23 months in the KMA used a bottle with a nipple, 70.6 per cent in other towns and 66.5 per cent in rural areas. In terms of household wealth, bottle feeding was highest in the middle group (78.3%), but in poorest and richest quintiles it was 63.7 and 63.9 per cent, respectively. Jamaica Multiple Indicator Cluster Survey 2011 42 46 TABLE NU.7: BOTTLE FEEDING PERCENTAGE OF CHILDREN AGE 0-23 MONTHS WHO WERE FED WITH A BOTTLE WITH A NIPPLE DURING THE PREVIOUS DAY, JAMAICA, 2011 Percentage of children age 0-23 months fed with a bottle with a nipple [1] Number of children age 0- 23 months: Sex Male 66.7 328 Female 72.1 322 Age 0-5 months 63.5 168 6-11 months 77.1 160 12-23 months 68.6 321 Area Urban KMA 72.0 226 Other towns 70.6 148 Urban total 71.4 374 Rural 66.5 276 None/Primary (*) 10 Secondary 69.2 499 Tertiary 70.6 141 Missing/DK (*) 0 Wealth Index Quintiles Poorest 63.7 142 Second 69.1 153 Middle 78.3 142 Fourth 70.6 110 Richest 63.9 102 Total 69.4 650 [1] MICS indicator 2.11 (*) Figures that are based on less than 25 unweighted cases LOW BIRTH WEIGHT Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, 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. Mother’s Education Jamaica Multiple Indicator Cluster Survey 201143 47 In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. TABLE NU.8: LOW BIRTH WEIGHT INFANTS PERCENTAGE OF LAST-BORN CHILDREN IN THE 2 YEARS PRECEDING THE SURVEY THAT ARE ESTIMATED TO HAVE WEIGHED BELOW 2500 GRAMS AT BIRTH AND PERCENTAGE OF LIVE BIRTHS WEIGHED AT BIRTH, JAMAICA, 2011 Per cent of live births: Number of live births in the last 2 years Below 2500 grams [1] Weighed at birth [2] Area Urban KMA 15.8 95.9 187 Other towns 18.3 98.8 151 Urban total 16.9 97.2 338 Rural 15.8 95.6 276 Education None/Primary (*) (*) 9 Secondary 17.2 97.0 474 Tertiary 13.9 95.7 131 Wealth Index Quintiles Poorest 19.3 93.3 145 Second 15.4 97.6 146 Middle 14.6 98.3 131 Fourth 14.5 98.0 98 Richest 17.9 95.4 94 Total 16.4 96.5 614 [2] MICS indicator 2.19 (*) Figures that are based on less than 25 unweighted cases 5 5 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. International data indicate that many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore for consistency across countries, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth . 47 In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. TABLE NU.8: LOW BIRTH WEIGHT INFANTS PERCENTAGE OF LAST-BORN CHILDREN IN THE 2 YEARS PRECEDING THE SURVEY THAT ARE ESTIMATED TO HAVE WEIGHED BELOW 2500 GRAMS AT BIRTH AND PERCENTAGE OF LIVE BIRTHS WEIGHED AT BIRTH, JAMAICA, 2011 Per cent of live births: Number of live births in the last 2 years Below 2500 grams [1] Weighed at birth [2] Area Urban KMA 15.8 95.9 187 Other towns 18.3 98.8 151 Urban total 16.9 97.2 338 Rural 15.8 95.6 276 Education None/Primary (*) (*) 9 Secondary 17.2 97.0 474 Tertiary 13.9 95.7 131 Wealth Index Quintiles Poorest 19.3 93.3 145 Second 15.4 97.6 146 Middle 14.6 98.3 131 Fourth 14.5 98.0 98 Richest 17.9 95.4 94 Total 16.4 96.5 614 [2] MICS indicator 2.19 (*) Figures that are based on less than 25 unweighted cases 5 5 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. International data indicate that many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore for consistency across countries, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth . 48 Overall, 96.5 per cent of births were weighed at birth and 16.4 per cent of infants were estimated to weigh less than 2500 grams at birth (Table NU.8).The percentage of low birth weight did not vary much by areas or by quintile groups. Jamaica Multiple Indicator Cluster Survey 2011 44 Jamaica Multiple Indicator Cluster Survey 201145 Jamaica Multiple Indicator Cluster Survey 2011 46 49 V. VACCINATIONS According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT/DT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. In Jamaica, the Ministry of Health Child Health 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. World- wide there are still 27 million children overlooked by routine immunization and as a result, vaccine-prevent- able diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children less than one year of age at 90 per cent nationally, with at least 80 per cent coverage in every district or equivalent administrative unit. TABLE CH.1: VACCINATIONS IN FIRST YEAR OF LIFE PERCENTAGE OF CHILDREN AGE 18-29 MONTHS IMMUNIZED AGAINST CHILDHOOD DISEASES AT ANY TIME BEFORE THE SURVEY AND BEFORE THE FIRST BIRTHDAY (AND BY 18 MONTHS FOR MEASLES), JAMAICA, 2011 Vaccinated at any time before the survey according to: Vaccination card Vaccinated at any time before the survey according to: Mother's report Vaccinated at any time before the survey according to: Either Vaccinated by 12 months of age BCG [1] 77.8 21.7 99.5 99.5 Polio 1 75.9 21.1 97.0 96.6 Polio 2 75.9 21.1 97.0 96.3 Polio 3 [2] 76.2 15.9 92.0 91.1 DPT 1 77.8 19.9 97.7 96.8 DPT 2 77.8 19.5 97.3 96.4 DPT 3 [3] 77.8 13.7 91.5 89.9 Measles [4] 76.3 17.8 94.1 91.7 HepB 1 78.7 15.2 93.9 93.0 HepB 2 78.5 12.6 91.1 90.3 HepB 3 [5] 78.5 9.9 88.4 84.5 Hib 1* 74.7 na 74.7 74.2 Hib 2* 74.2 na 74.2 73.9 Hib 3* 74.2 na 74.2 71.4 All vaccinations 73.0 0.0 73.0 67.6 All vaccinations excluding Hib 74.9 11.1 86.1 79.8 No vaccinations 0.0 0.5 0.5 0.5 Number of children age 18-29 months 320 320 320 320 * data on mother’s report not collected [1] MICS indicator 3.1 [2] MICS indicator 3.2 [3] MICS indicator 3.3 [4] MICS indicator 3.4; MDG indicator 4.3 [5] MICS indicator 3.5 Jamaica Multiple Indicator Cluster Survey 201147 50 (MOH) recommends that a child be given the BCG vaccine at birth, three doses of DPT/DT by the age of six (6) months, three doses of the polio vaccine by age six (6) months and the measles vaccination at twelve (12) months. Mothers were asked to provide vaccination cards for children under the age of five. Interview- ers copied vaccination information from the cards onto the MICS questionnaire. Overall, 77.8 per cent of children had health cards that were seen by interviewers (Table CH.2). If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vacci- nations and, for DPT and Polio, how many times. The HaemophilusInfluenzae B (HiB) vaccine was added for Jamaica but information was collected based on seeing health cards only; no mother’s report was collected due to a design flaw in the questionnaire. The percentage of children age 18 to 23 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children age 18-23 months so that only children who are old enough to be fully vaccinated are counted. In columns 1 – 3 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 fourth column, only those who were vaccinat- ed by 18 months 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. Generally, the coverage rates for the stated vaccines were high, with over 90 per cent of children 18-29 months having been vaccinated at some point, as indicated by either their vaccination cards or their mother’ recall. There was almost universal coverage (99.5%) among children 18-29 months who had received a BCG vaccination by the age of 18 months. The first dose of DPT was given to 96.8 per cent of children 18-29 months. The percentage declined for subsequent doses of DPT to 96.4 per cent for the Jamaica Multiple Indicator Cluster Survey 2011 48 51 second dose, and 89.9 per cent for the third dose (Figure CH.1). Similarly, the percentage of children who were vaccinated against polio was highest for the first dose and declined for subsequent doses. Fewer than 97 per cent (96.6%) of children received their first dose of Polio by 18 months. This declined to 96.3 per cent for the second dose and 91.1 per cent by the third dose. The coverage for measles vaccine by 18 months was 91.7 per cent, while for the first dose of the Hepatitis B (HepB) vaccine it was 93.0 per cent. Subsequent doses of this vaccine (HepB 2 and HepB 3) were administered to 90.3 per cent and 84.5 per cent of children 18-29 months by the age of 18 months. The Haemophilus Influenzae B (HiB) vaccine was administered to a marginally lower proportion of children, with the first dose of HiB being given to 74.2 per cent, the second dose to 73.9 per cent and the final dose to 71.4 per cent. This may have occurred as no data were collected from mother’s reports. The percentage of children who had all the recommended vaccinations by their first birthday was 67.6 per cent, and no child was found who had not received any vaccine. Table CH.2 shows vaccination coverage rates among children 18-29 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the vaccination cards and mothers’/caretakers’ reports. There were 164 male and 156 female children between the age group 18 – 29 months; 78.0 per cent of female and 77.6 per cent male children had a vaccination card. While Urban Areas had a greater proportion of children with vaccination cards that were seen (79.8%), the proportion of children in the urban areas who received all the stated vaccines was lower (83.8%) than the proportion recorded for rural areas (88.9%). Within urban areas, 88.9per cent of children aged 18-29 months from other towns received all the stated vaccines. This was however offset by the relatively low proportion of children from the KMA (80.2%) who received all the stated vaccines. Further examination of the percentage of children in the KMA who received the stated vaccines revealed that the third doses of the DPT, Polio, HepB and HiB had a lower coverage rate than the other stated vaccines. An analysis of the results by wealth quintile shows that the richest quintile had the lowest percentage of vaccination cards seen at 66.6 per cent. By wealth, the middle quintile had the lowest proportion of children receiving all vaccinations. Jamaica Multiple Indicator Cluster Survey 201149 52 TA B LE C H .2 : V AC C IN AT IO N S B Y B AC K G R O U N D C H AR AC TE R IS TI C S P ER C EN TA G E O F C H IL D R EN A G E 18 -2 9 M O N TH S C U R R EN TL Y VA C C IN AT ED A G AI N ST C H IL D H O O D D IS EA SE S, J AM AI C A , 2 01 1 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : Pe rc en ta ge w ith va cc in at io n ca rd s ee n N um be r of ch ild re n ag e 18 -2 9 m on th s B C G Po lio 1 Po lio 2 Po lio 3 D PT 1 D PT 2 D PT 3 M ea sl es H ep B 1 H ep B 2 H ep B 3 N on e A ll Se x M al e 99 .7 94 .8 94 .8 90 .3 96 .4 95 .8 90 .6 94 .1 91 .7 91 .1 87 .1 0. 3 86 .2 78 .0 16 4 Fe m al e 99 .4 99 .4 99 .4 93 .8 99 .1 98 .8 92 .4 94 .1 96 .1 91 .1 89 .8 0. 6 85 .9 77 .6 15 6 A re a U rb an K M A 10 0. 0 94 .3 94 .3 88 .1 94 .6 94 .6 89 .1 89 .3 90 .0 87 .1 87 .1 0. 0 80 .2 75 .5 10 4 O th er to w ns 10 0. 0 10 0. 0 10 0. 0 92 .4 10 0. 0 99 .4 93 .6 95 .5 96 .6 94 .3 91 .6 0. 0 88 .9 85 .9 73 U rb an to ta l 10 0. 0 96 .6 96 .6 89 .9 96 .8 96 .5 90 .9 91 .8 92 .8 90 .1 89 .0 0. 0 83 .8 79 .8 17 7 R ur al 98 .9 97 .6 97 .6 94 .7 98 .9 98 .2 92 .2 97 .0 95 .2 92 .3 87 .7 1. 1 88 .9 75 .4 14 3 M ot he r's E du ca tio n N on e/ P rim ar y (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 S ec on da ry 99 .3 96 .2 96 .2 91 .4 96 .7 96 .5 91 .3 93 .3 93 .8 92 .1 88 .8 0. 7 86 .2 81 .0 22 4 Te rti ar y 10 0. 0 98 .8 98 .8 92 .6 10 0. 0 98 .8 91 .0 95 .5 93 .2 87 .5 86 .6 0. 0 84 .0 70 .5 86 W ea lth In de x Q ui nt ile s P oo re st 98 .3 98 .3 98 .3 95 .4 98 .2 98 .2 95 .2 96 .5 96 .8 92 .5 87 .7 1. 7 90 .1 83 .1 58 S ec on d 10 0. 0 10 0. 0 10 0. 0 97 .5 99 .4 98 .7 96 .2 98 .7 97 .9 97 .9 95 .5 0. 0 95 .0 88 .9 70 M id dl e 99 .2 93 .4 93 .4 82 .6 93 .2 93 .2 82 .0 83 .4 85 .1 82 .7 77 .0 0. 8 76 .2 74 .6 72 Fo ur th 10 0. 0 98 .5 98 .5 94 .8 98 .4 98 .4 91 .4 10 0. 0 94 .8 90 .7 90 .7 0. 0 86 .7 74 .6 62 R ic he st 10 0. 0 95 .2 95 .2 90 .8 10 0. 0 98 .3 93 .9 93 .5 95 .6 91 .9 91 .9 0. 0 82 .7 66 .6 58 To ta l 99 .5 97 .0 97 .0 92 .0 97 .7 97 .3 91 .5 94 .1 93 .9 91 .1 88 .4 0. 5 86 .1 77 .8 32 0 (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s Jamaica Multiple Indicator Cluster Survey 2011 50 53 NEONATAL TETANUS PROTECTION 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; Received at least 4 doses, the last within 10 years; Received at least 5 doses during lifetime. TABLE CH.3: NEONATAL TETANUS PROTECTION PERCENTAGE OF WOMEN AGE 15-49 YEARS WITH A LIVE BIRTH IN THE LAST 2 YEARS PROTECTED AGAINST NEONATAL TETANUS, JAMAICA, 2011 Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus [1] Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Area Urban KMA 23.4 5.8 0.0 0.0 0.0 29.2 187 Other towns 30.4 13.4 1.1 0.6 0.0 45.4 151 Urban total 26.5 9.2 0.5 0.3 0.0 36.4 338 Rural 25.7 14.2 0.3 0.0 0.3 40.5 276 Education None/Primary (*) (*) (*) (*) (*) (*) 9 Secondary 28.7 12.6 0.2 0.2 0.0 41.7 474 Tertiary 16.8 7.7 0.9 0.0 0.6 25.9 131 Wealth Index Quintiles Poorest 28.9 18.8 0.5 0.0 0.0 48.1 145 Second 25.0 11.1 0.3 0.6 0.0 37.0 146 Middle 29.9 7.7 0.9 0.0 0.0 38.5 131 Fourth 23.8 9.0 0.0 0.0 0.8 33.6 98 Richest 21.1 8.4 0.0 0.0 0.0 29.5 94 Total 26.2 11.4 0.4 0.1 0.1 38.2 614 [1] MICS indicator 3.7 (*) Figures that are based on less than 25 unweighted cases To assess the status of tetanus vaccination coverage, women who gave birth during the two years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this pregnancy were then asked about tetanus toxoid vaccinations they may have received prior to 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 mater- nal 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, if a woman did not receive two doses of the vaccine during their pregnancy, she (and her newborn) is also considered to be protected if the following conditions are met: Jamaica Multiple Indicator Cluster Survey 201151 54 this pregnancy. Interviewers also asked women to present their vaccination card, on which dates of tetanus toxoid are recorded and referred to information from the cards when available. Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last 2 years. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. Approximately 38 per cent of women who had a live birth within the last two years were protected against tetanus. The majority of these women (26.2%) received at least two doses of the tetanus toxoid vaccine during their last pregnancy. An additional 11.4 per cent received two doses of this vaccine, the last within the last three years and the remaining 0.6 per cent received the tetanus vaccine at some other point in their lives. The KMA at 29.2 per cent was the area which recorded the lowest percentage of women who had given birth in the last two years that were adequately protected from tetanus. In other towns, protection against tetanus was highest at 45.4 per cent. Together, 36.4 per cent of recent mothers from urban areas were adequately protected against Tetanus. In the rural areas, 40.5 per cent of recent mothers who had given birth in the two years prior to the survey were adequately protected from tetanus. The data also revealed that the richest quintile recorded the lowest percentage of recent mothers who were protected from tetanus (29.5%) and the poorest quintile the highest at (48.1%). Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tetanus, Jamaica, 2011 0 10 20 30 40 50 60 K M A O th er T ow ns U rb an R ur al S ec on da ry Te rti ar y P oo re st S ec on d M id dl e Fo ur th R ic he st Area Education Wealth Index Quintiles Total Pe rc en ta ge Background Characteristics 53 NEONATAL TETANUS PROTECTION 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; Received at least 4 doses, the last within 10 years; Received at least 5 doses during lifetime. TABLE CH.3: NEONATAL TETANUS PROTECTION PERCENTAGE OF WOMEN AGE 15-49 YEARS WITH A LIVE BIRTH IN THE LAST 2 YEARS PROTECTED AGAINST NEONATAL TETANUS, JAMAICA, 2011 Percentage of women who received at least 2 doses during last pregnancy Percentage of women who did not receive two or more doses during last pregnancy but received: Protected against tetanus [1] Number of women with a live birth in the last 2 years 2 doses, the last within prior 3 years 3 doses, the last within prior 5 years 4 doses, the last within prior 10 years 5 or more doses during lifetime Area Urban KMA 23.4 5.8 0.0 0.0 0.0 29.2 187 Other towns 30.4 13.4 1.1 0.6 0.0 45.4 151 Urban total 26.5 9.2 0.5 0.3 0.0 36.4 338 Rural 25.7 14.2 0.3 0.0 0.3 40.5 276 Education None/Primary (*) (*) (*) (*) (*) (*) 9 Secondary 28.7 12.6 0.2 0.2 0.0 41.7 474 Tertiary 16.8 7.7 0.9 0.0 0.6 25.9 131 Wealth Index Quintiles Poorest 28.9 18.8 0.5 0.0 0.0 48.1 145 Second 25.0 11.1 0.3 0.6 0.0 37.0 146 Middle 29.9 7.7 0.9 0.0 0.0 38.5 131 Fourth 23.8 9.0 0.0 0.0 0.8 33.6 98 Richest 21.1 8.4 0.0 0.0 0.0 29.5 94 Total 26.2 11.4 0.4 0.1 0.1 38.2 614 [1] MICS indicator 3.7 (*) Figures that are based on less than 25 unweighted cases To assess the status of tetanus vaccination coverage, women who gave birth during the two years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth, and if so, how many. Women who did not receive two or more tetanus toxoid vaccinations during this pregnancy were then asked about tetanus toxoid vaccinations they may have received prior to 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 mater- nal 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, if a woman did not receive two doses of the vaccine during their pregnancy, she (and her newborn) is also considered to be protected if the following conditions are met: Jamaica Multiple Indicator Cluster Survey 2011 52 55 ORAL REHYDRATION TREATMENT Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea- related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended 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. 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 per cent. The indicators are: Prevalence of diarrhoea Oral rehydration therapy (ORT) Home management of diarrhoea ORT with continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report if their child had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 5.7 per cent of children under five had diarrhoea in the two weeks preceding the survey (Table CH.4).The prevalence of diarrhoea varied across geographical areas. In both rural and urban areas, the prevalence of diarrhoea was 5.7 per cent. Within urban areas, the KMA recorded a prevalence rate of 4.1 per cent, while in other towns the prevalence of diarrhoea was comparatively higher at 8.6 per cent. During the weaning period (12-23 months), children become more prone to diarrhoea. The peak of diarrhoea prevalence occurred among children within the age group 12-23 at 8.7%, followed by those in the 24-35 months age group (6.1%). Table CH.4 also shows the percentage of children who were treated by Oral Rehydration Therapy (ORT) during the episode of diarrhoea. Among children with diarrhoea in the two weeks before the survey, ORS was used in 64.1 per cent of the cases. There were no major differences by background characteristics. More than a half, 56.6 per cent of children under-five years old with diarrhoea drank more than usual while 14.9 per cent drank about the same and 27.9 per cent were given less (10.3%) or much less (17.6%) to drink (Table CH.5). Regarding eating practices during diarrhoea, 59.4 per cent ate somewhat less (24.7%) or much less (34.7%), 27.2 per cent ate about the same and 2.4 per cent were given more to eat. The remaining 11.0 per cent either stopped feeding/eating, or had never been given food. Jamaica Multiple Indicator Cluster Survey 201153 56 TABLE CH.4: ORAL REHYDRATION SOLUTIONS AND RECOMMENDED HOMEMADE FLUIDS PERCENTAGE OF CHILDREN AGE 0-59 MONTHS WITH DIARRHOEA IN THE LAST TWO WEEKS, AND TREATMENT WITH ORAL REHYDRATION SOLUTIONS AND RECOMMENDED HOMEMADE FLUIDS, JAMAICA, 2011 Had diarrhoea in last two weeks Number of children age 0-59 months Children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea ORS (Fluid from ORS packet or pre- packaged ORS fluid) Sex Male 6.2 854 64.5 53 Female 5.1 785 (63.6) 40 Area Urban KMA 4.1 606 (66.9) 25 Other towns 8.6 321 (61.3) 28 Urban total 5.7 927 64.0 53 Rural 5.7 712 (64.3) 40 Age 0-11 2.4 329 (*) 8 12-23 8.7 321 (71.3) 28 24-35 6.1 327 (*) 20 36-47 5.8 289 (*) 17 48-59 5.4 373 (*) 20 Mother's Education None/Primary (10.8) 47 (*) 5 Secondary 5.8 1,235 63.7 71 Tertiary 4.7 356 (*) 17 Missing/DK (*) 0 - 0 Total 5.7 1,639 64.1 93 (*) Figures that are based on less than 25 unweighted cases ( ) Figures that are based on 25-49 unweighted cases Jamaica Multiple Indicator Cluster Survey 2011 54 57 T A B LE C H .5 : F EE D IN G P R AC TI C ES D U R IN G D IA R R H O EA P E R C EN T D IS TR IB U TI O N O F C H IL D R EN A G E 0- 59 M O N TH S W IT H D IA R R H O E A IN T H E LA ST T W O W EE K S B Y AM O U N T O F LI Q U ID S AN D F O O D G IV EN D U R IN G E PI SO D E O F D IA R R H O E A, J AM AI C A, 2 01 1 H ad di ar rh oe a in la st tw o w ee ks N um be r of ch ild re n ag e 0- 59 m on th s D rin ki ng p ra ct ic es d ur in g di ar rh oe a: Ea tin g pr ac tic es d ur in g di ar rh oe a: N um be r of ch ild re n ag ed 0 - 59 m on th s w ith di ar rh oe a G iv en m uc h le ss to dr in k G iv en so m ew ha t le ss to dr in k G iv en ab ou t th e sa m e to dr in k G iv en m or e to dr in k M is si ng / D K To ta l G iv en m uc h le ss to e at G iv en so m ew ha t le ss to e at G iv en ab ou t th e sa m e to e at G iv en m or e to e at St op pe d fo od H ad ne ve r be en gi ve n fo od To ta l Se x M al e 6. 2 85 4 19 .4 11 .4 13 .0 55 .1 1. 2 10 0. 0 34 .7 23 .0 27 .5 1. 9 5. 6 7. 4 10 0. 0 53 Fe m al e 5. 1 78 5 (1 5. 1) (8 .8 ) (1 7. 4) (5 8. 6) (0 .0 ) 10 0. 0 (3 4. 6) (2 7. 0) (2 6. 7) (3 .0 ) (8 .0 ) (0 .6 ) 10 0. 0 40 Ar ea U rb an K M A 4. 1 60 6 (2 7. 8) (1 6. 9) (1 5. 0) (3 7. 8) (2 .5 ) 10 0. 0 (3 4. 5) (3 4. 5) (1 5. 5) (6 .6 ) (5 .8 ) (3 .2 ) 10 0. 0 25 O th er to w ns 8. 6 32 1 (2 1. 4) (1 4. 9) (1 9. 3) (4 4. 4) (0 .0 ) 10 0. 0 (4 0. 1) (1 3. 1) (3 3. 5) (2 .0 ) (1 0. 4) (0 .9 ) 10 0. 0 28 U rb an to ta l 5. 7 92 7 24 .4 15 .9 17 .3 41 .3 1. 2 10 0. 0 37 .4 23 .2 25 .0 4. 2 8. 2 2. 0 10 0. 0 53 R ur al 5. 7 71 2 (8 .6 ) (3 .0 ) (1 1. 7) (7 6. 7) (0 .0 ) 10 0. 0 (3 1. 0) (2 6. 6) (3 0. 0) (0 .0 ) (4 .5 ) (7 .8 ) 10 0. 0 40 Ag e 0- 11 2. 4 32 9 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 8 12 -2 3 8. 7 32 1 (2 3. 5) (2 .6 ) (0 .0 ) (7 3. 9) (0 .0 ) 10 0. 0 (4 2. 1) (1 8. 2) (2 9. 5) (2 .0 ) (8 .1 ) (0 .0 ) 10 0. 0 28 24 -3 5 6. 1 32 7 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 20 36 -4 7 5. 8 28 9 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 17 48 -5 9 5. 4 37 3 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 20 M ot he r's E du ca tio n N on e/ P rim ar y 10 .8 47 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 S ec on da ry 5. 8 1, 23 5 19 .9 13 .1 15 .5 50 .5 0. 9 10 0. 0 32 .3 27 .2 27 .8 .6 6. 6 5. 5 10 0. 0 71 Te rti ar y 4. 7 35 6 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 17 W ea lth In de x Q ui nt ile s P oo re st 5. 9 35 8 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 21 S ec on d 7. 5 39 6 (2 6. 2) (1 1. 2) (1 4. 6) (4 5. 9) (2 .1 ) 10 0. 0 (4 3. 0) (1 1. 0) (3 3. 8) (1 .5 ) (4 .6 ) (6 .1 ) 10 0. 0 30 M id dl e 3. 6 35 2 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 13 Fo ur th 6. 7 27 4 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 18 R ic he st 4. 3 26 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 11 To ta l 5. 7 1, 63 9 17 .6 10 .3 14 .9 56 .6 0. 7 10 0. 0 34 .7 24 .7 27 .2 2. 4 6. 6 4. 5 10 0. 0 93 (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s Jamaica Multiple Indicator Cluster Survey 201155 58 TABLE CH.6: ORAL REHYDRATION THERAPY WITH CONTINUED FEEDING AND OTHER TREATMENTS PERCENTAGE OF CHILDREN AGE 0-59 MONTHS WITH DIARRHOEA IN THE LAST TWO WEEKS WHO RECEIVED ORAL REHYDRATION THERAPY WITH CONTINUED FEEDING, AND PERCENTAGE OF CHILDREN WITH DIARRHOEA WHO RECEIVED OTHER TREATMENTS, JAMAICA, 2011 Total Children with diarrhoea who received: ORS or increased fluids 84.3 ORT with continued feeding [1] 43.3 Other treatment: Pill or syrup: Amoxil 5.7 Ampicilin 0.0 Bactrim 1.9 Evithrom 0.0 Other Antibiotic 0.0 Antimotility 0.0 Zinc 0.0 Other 3.8 Unknown 0.0 Injection Antibiotic 4.0 Non-antibiotic 0.0 Unknown 0.0 Intravenous 4.9 Home remedy/ Herbal medicine 15.9 Other 21.0 Not given any treatment or drug 0.0 Number of children aged 0-59 months with diarrhoea 93 [1] MICS indicator 3.8 (*) Figures that are based on less than 25 unweighted cases ( ) Figures that are based on 25-49 unweighted cases Table CH.6 provides the proportion of children age 0-59 months with diarrhoea in the last two weeks who received oral rehydration therapy with continued feeding, and the percentage of children with diarrhoea who received other treatments. Overall, 84.3 per cent of children with diarrhoea in the two weeks preceding the survey received ORS or increased fluids. Combining the information in Table CH.5 with those in Table CH.4 on oral rehydration therapy, it is observed that 43.3 per cent of children received ORT and, at the same time, feeding was continued, as is recommended. There are minor differences in the home management of diarrhoea by background characteristics. In rural areas, 53.2 per cent of children received ORT and continued feeding. In urban areas however, this was 35.7 per cent (data not shown). 59 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 blocked nostrils. 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.7 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. Some 5.2 per cent of children age 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 82.3 per cent were taken to an appropriate provider. Table CH.7 also shows the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, age, area of residence, age, and socioeconomic factors. In Jamaica, 58.5 per cent of under-5 year old children with suspected pneumonia were treated with antibiotics during the two weeks prior to the survey. Across geographical areas, the percentage of under-5 year olds with suspected pneumonia who were treated with antibiotics was 68.6 per cent for rural areas and 52.6 per cent for urban areas. 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 number of deaths due to acute respiratory infections. Jamaica Multiple Indicator Cluster Survey 2011 56 60 TA B LE C H .7 : C AR E SE EK IN G F O R S U SP EC TE D P N EU M O N IA A N D A N TI B IO TI C U SE D U R IN G S U SP EC TE D P N EU M O N IA P E R C EN TA G E O F C H IL D R EN A G E 0- 59 M O N TH S W IT H S U SP EC TE D P N EU M O N IA IN T H E LA ST T W O W EE K S W H O W ER E TA K EN T O A H E AL TH P R O VI D ER A N D P ER C EN TA G E O F C H IL D R EN W H O W ER E G IV EN A N TI B IO TI C S, J A M AI C A, 2 01 1 H ad su sp ec te d pn eu m on ia in th e la st tw o w ee ks N um be r of ch ild re n ag e 0- 59 m on th s C hi ld re n w ith s us pe ct ed p ne um on ia w ho w er e ta ke n to : A ny ap pr op ria te pr ov id er [1 ] Pe rc en ta ge of c hi ld re n w ith su sp ec te d pn eu m on ia w ho re ce iv ed an tib io tic s in th e la st tw o w ee ks [2 ] N um be r o f ch ild re n ag e 0- 59 m on th s w ith su sp ec te d pn eu m on ia in th e la st tw o w ee ks Pu bl ic S ec to r Pr iv at e Se ct or O th er Government hospital Government health center Government health post Community health worker Mobile / Outreach clinic Other public Private hospital / clinic Private physician Private pharmacy Mobile clinic Other private medical Relative / Friend Shop Traditional practitioner Other Se x M al e 5. 7 85 4 (4 8. 0) (1 7. 7) (0 .0 ) (3 .4 ) (0 .0 ) (0 .0 ) (0 .0 ) (2 2. 0) (1 .3 ) (0 .0 ) (0 .9 ) (0 .9 ) (0 .0 ) (0 .0 ) (0 .0 ) (8 5. 3) (5 7. 3) 49 Fe m al e 4. 6 78 5 (4 9. 3) (7 .6 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (5 .3 ) (1 9. 6) (0 .0 ) (0 .0 ) (0 .0 ) (2 .1 ) (0 .0 ) (1 .2 ) (0 .0 ) (7 8. 3) (6 0. 1) 36 Ar ea U rb an K M A 5. 6 60 6 (4 9. 3) (1 8. 1) (0 .0 ) (5 .0 ) (0 .0 ) (0 .0 ) (2 .2 ) (1 2. 2) (0 .0 ) (0 .0 ) (0 .0 ) (2 .2 ) (0 .0 ) (0 .0 ) (0 .0 ) (8 4. 6) (5 2. 3) 34 O th er to w ns 6. 3 32 1 (3 5. 3) (1 8. 2) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (2 .4 ) (2 8. 4) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (7 9. 3) (5 3. 0) 20 U rb an to ta l 5. 8 92 7 44 .1 18 .1 0. 0 3. 1 0. 0 0. 0 2. 3 18 .3 0. 0 0. 0 0. 0 1. 4 0. 0 0. 0 0. 0 82 .6 52 .6 54 R ur al 4. 4 71 2 (5 6. 2) (5 .3 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) 2. 2 25 .6 2. 0 0. 0 1. 4 1. 4 0. 0 1. 4 0. 0 81 .9 68 .6 31 Ag e 0- 11 5. 8 32 9 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 19 12 -2 3 4. 2 32 1 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 14 24 -3 5 4. 2 32 7 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 14 36 -4 7 8. 9 28 9 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 26 48 -5 9 3. 6 37 3 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 13 M ot he r's e du ca tio n N on e/ P rim ar y (1 .8 ) 47 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 1 S ec on da ry 5. 9 12 35 50 .2 15 .8 0 2. 3 0 0 1. 6 15 .4 0. 9 0 0. 6 1. 7 0 0. 6 0 80 .7 52 .2 72 Te rti ar y 3. 4 35 6 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 12 M is si ng /D K (* ) 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 0 W ea lth in de x qu in til es P oo re st 5. 6 35 8 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 20 S ec on d 7. 0 39 6 (3 8. 5) (2 9. 9) (0 .0 ) (6 .1 ) (0 .0 ) (0 .0 ) (1 .7 ) (9 .0 ) (0 .0 ) (0 .0 ) (1 .6 ) (1 .6 ) (0 .0 ) (0 .0 ) (0 .0 ) (8 3. 3) (5 1. 8) 28 M id dl e 5. 2 35 2 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 18 Fo ur th 3. 2 27 4 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 9 R ic he st 4. 1 26 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) ( * ) (* ) (* ) (* ) (* ) (* ) 11 To ta l 5. 2 16 39 48 .5 13 .4 0. 0 2. 0 0. 0 0. 0 2. 3 21 .0 0. 8 0. 0 0. 5 1. 4 0. 0 0. 5 0. 0 82 .3 58 .5 85 [1 ] M IC S in di ca to r 3 .9 , [2 ] M IC S in di ca to r 3 .1 0 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s Jamaica Multiple Indicator Cluster Survey 201157 61 SOLID FUEL USE More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Liquefied Petroleum Gas (LPG) was the primary fuel used for cooking, with 82.2 per cent of households mainly using this fuel. This was followed by wood which was used by 7.8 per cent of households, charcoal, used by 5.0 per cent of households and electricity used by 3.4 per cent of households. Other types of fuel were used by 1.6 per cent of households. Overall, 13.7 per cent of all households in Jamaica are using solid fuels for cooking. Use of solid fuels is higher in rural areas (23.0%) than in urban areas at 6.0%. Within urban areas, other towns have a higher percentage of households that use solid fuels for cooking (10.3%) than the KMA (3.4%). In urban areas, 88.3 per cent and 5.1 per cent of households used LPG and electricity respectively. In rural areas, however, the two primary fuels used for cooking were LPG (74.9%) and Wood (15.6%). The data revealed a difference in the choice of fuel for cooking when disaggregated by the educational attainment of the household head. Whereas 83.1 per cent of households whose head had attained education to the secondary level used LPG, this was 89.1 per cent for those educated at the tertiary level. Additionally, 7.1 per cent of households whose heads received secondary education used wood, 1.1 per cent of households with heads with tertiary level education used wood as their main fuel for cooking. Overall, 13.6 per cent of households whose heads had secondary level education used solid fuels for cooking relative to 1.9 per cent among households whose heads had a tertiary level education and 22.5 per cent whose heads received an education up to the primary level. Disaggregated by wealth quintiles, the data revealed an inverse relationship between the use of solid fuels and wealth. Within the poorest quintile, the use of solid fuels was highest at 55.3 per cent. This proportion declined to 10.7 per cent for the second quintile and 2.1 per cent in the middle quintile. No household in the richest quintile used solid fuels for cooking. Within the fourth and richest quintiles, the only fuel used was LPG (92.5% - Richest, 98.5% - Fourth) and Electricity (7.5% - Richest, 1.0% - Fourth). 59 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 blocked nostrils. 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.7 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. Some 5.2 per cent of children age 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. Of these children, 82.3 per cent were taken to an appropriate provider. Table CH.7 also shows the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, age, area of residence, age, and socioeconomic factors. In Jamaica, 58.5 per cent of under-5 year old children with suspected pneumonia were treated with antibiotics during the two weeks prior to the survey. Across geographical areas, the percentage of under-5 year olds with suspected pneumonia who were treated with antibiotics was 68.6 per cent for rural areas and 52.6 per cent for urban areas. 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 number of deaths due to acute respiratory infections. Jamaica Multiple Indicator Cluster Survey 2011 58 62 Ta bl e CH .9 : S ol id fu el u se Pe rc en t d is tr ib ut io n of h ou se ho ld m em be rs a cc or di ng to ty pe o f c oo ki ng fu el u se d by th e ho us eh ol d, a nd p er ce nt ag e of h ou se ho ld m em be rs li vi ng in ho us eh ol ds u si ng s ol id fu el s fo r c oo ki ng , J am ai ca , 2 01 1 Pe rc en ta ge o f h ou se ho ld m em be rs in h ou se ho ld s us in g: So lid fu el s fo r co ok in g [1 ] N um be r o f ho us eh ol d m em be rs Electricity Liquefied Petroleum Gas ((LPG) Natural gas Biogas Kerosene Charcoal Wood Straw / Shrubs / Grass Animal dung Agricultural crop residue No food cooked in household Other Missing Total U rb an K M A 7. 5 88 .6 0. 0 0. 1 0. 0 3. 2 0. 3 0. 0 0. 0 0. 0 0. 4 0. 0 0. 0 10 0. 0 3. 4 65 17 O th er to w ns 1. 2 87 .8 0. 2 0. 0 0. 0 7. 2 3. 1 0. 0 0. 0 0. 0 0. 5 0. 0 0. 0 10 0. 0 10 .3 38 62 U rb an T ot al 5. 1 88 .3 0. 1 0. 0 0. 0 4. 7 1. 3 0. 0 0. 0 0. 0 0. 5 0. 0 0. 0 10 0. 0 6. 0 10 37 9 R ur al 1. 3 74 .9 0. 5 0. 0 0. 0 7. 4 15 .6 0. 0 0. 0 0. 0 0. 2 0. 0 0. 1 10 0. 0 23 .0 85 68 Ed uc at io n of h ou se ho ld h ea d N on e/ P rim ar y 2. 4 74 .3 0. 3 0. 0 0. 0 8. 3 14 .2 0. 0 0. 0 0. 0 0. 4 0. 0 0. 0 10 0. 0 22 .5 39 52 S ec on da ry 2. 5 83 .1 0. 3 0. 0 0. 0 6. 5 7. 1 0. 0 0. 0 0. 0 0. 4 0. 0 0. 1 10 0. 0 13 .6 11 76 6 Te rti ar y 8. 9 89 .1 0. 0 0. 0 0. 0 0. 7 1. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 10 0. 0 1. 9 28 84 M is si ng /D K 0. 6 84 .0 0. 0 0. 0 0. 0 3. 4 10 .5 0. 0 0. 0 0. 0 0. 0 0. 0 1. 5 10 0. 0 13 .9 34 5 W ea lth in de x qu in til es P oo re st 1. 9 40 .3 0. 6 0. 0 0. 0 22 .8 32 .6 0. 0 0. 0 0. 0 1. 5 0. 0 0. 3 10 0. 0 55 .3 37 89 S ec on d 3. 5 85 .1 0. 4 0. 1 0. 0 5. 5 5. 2 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 10 0. 0 10 .7 37 88 M id dl e 3. 1 94 .6 0. 1 0. 0 0. 0 1. 1 1. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 10 0. 0 2. 1 37 90 Fo ur th 1. 0 98 .5 0. 2 0. 0 0. 0 0. 2 0. 1 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 10 0. 0 0. 3 38 01 R ic he st 7. 5 92 .5 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 0. 0 37 79 To ta l 3. 4 82 .2 0. 3 0. 0 0. 0 5. 9 7. 8 0. 0 0. 0 0. 0 0. 4 0. 0 0. 1 10 0. 0 13 .7 18 94 7 [1 ] M IC S in di ca to r 3 .1 1 Jamaica Multiple Indicator Cluster Survey 201159 63 Solid fuel use alone is a poor proxy for indoor air pollution, since the concentration of the pollutants is different when the same fuel is burnt in different stoves or fires. Use of closed stoves with chimneys minimizes indoor pollution, while open stove or fire with no chimney or hood means that there is no protection from the harmful effects of solid fuels. Solid fuel use by place of cooking is depicted in Table CH.10. Among households that used solid fuels, the primary place of cooking was outdoors at 43.9 per cent. This was followed by cooking in a separate building (33.0%) and in a separate room used as a kitchen (18.3%). Interestingly, cooking outdoors was more popular in urban households that used solid fuel for cooking (48.2%) than in rural households (42.6%). In rural households, however, cooking in a separate building was the next most popular option (38.0%) compared to urban areas where cooking in a separate room used as a kitchen was the next most popular option (24.6%). TABLE CH.10: SOLID FUEL USE BY PLACE OF COOKING PER CENT DISTRIBUTION OF HOUSEHOLD MEMBERS IN HOUSEHOLDS USING SOLID FUELS BY PLACE OF COOKING, JAMAICA, 2011 Place of cooking: Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the house In a separate building Outdoors Other Missing Total Area Urban KMA 27.0 9.9 8.2 44.0 0.5 10.3 100.0 224 Other Towns 23.2 1.9 22.6 50.5 0.1 1.7 100.0 396 Urban Total 24.6 4.8 17.4 48.2 0.2 4.8 100.0 620 Rural 16.4 1.4 38.0 42.6 0.0 1.7 100.0 1,972 Education of Household Head None/Primary 18.3 1.4 38.1 40.1 0.1 2.0 100.0 890 Secondary 18.8 2.8 28.4 47.2 0.0 2.8 100.0 1,600 Tertiary 10.8 1.2 47.5 40.4 0.0 0.0 100.0 55 Missing/DK (11.0) (0.0) (77.9) (10.2) (0.0) (0.9) 100.0 48 Wealth Index Quintiles Poorest 18.3 2.2 31.6 44.9 0.1 2.9 100.0 2,097 Second 15.1 2.2 41.0 41.3 0.0 0.3 100.0 404 Middle 38.4 4.4 34.6 22.6 0.0 0.0 100.0 81 Fourth (*) (*) (*) (*) (*) (*) 100.0 10 Richest - - - - - - - 0 Total 18.3 2.2 33.0 43.9 0.1 2.4 100.0 2,592 ( ) Figures that are based on 25-49 unweighted cases (*) Figures that are based on less than 25 unweighted cases Jamaica Multiple Indicator Cluster Survey 2011 60 Jamaica Multiple Indicator Cluster Survey 201161 Jamaica Multiple Indicator Cluster Survey 2011 62 64 VI. Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS is 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 children’s faeces For more details on water and sanitation and to access some reference documents, please visit the UNICEF child info website http://www.childinfo.org/wes.html. USE OF IMPROVED WATER SOURCES The distribution of the population by source of drinking water is shown in Table WS.1A and Table WS.1B.The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, public tap/standpipe), tube well/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes, such as hand washing and cooking. Overall, 94.6 per cent of the population used an improved source of drinking water – 99.7 per cent in KMA, 98.0 per cent in other towns, and 89.2 per cent in rural areas. There are strong variations in the source of drinking water between urban areas and KMA on one hand, and rural areas on the other hand (Table WS.1).In other towns and KMA, 88.1 per cent and 91.2 per cent respectively, of their populations used piped drinking water. In contrast, only about 63.4 per cent of those residing in rural areas used piped water. In rural areas, the second most important source of drinking water is rainwater collection, while for other towns and KMA it is bottled water. Ninety-three per cent of households with a head who has at most a primary level of education have an improved source of water compared to the higher figure (97.6 %) recorded for those that have a head who has a tertiary level education. In terms of wealth, the figures for households with an improved source of water range from 89.3 per cent for the poorest quintile to 98.1 per cent for the richest quintile, with a steady increase in the use of improved sources with increases in household wealth. Water And Sanitation Jamaica Multiple Indicator Cluster Survey 201163 65 T A B LE W S. 1A : U SE O F IM PR O VE D W AT ER S O U R C ES P E R C EN T D IS TR IB U TI O N O F H O U SE H O LD P O PU LA TI O N A C C O R D IN G T O M AI N S O U R C E O F D R IN K IN G W AT ER A N D P ER C EN TA G E O F H O U SE H O LD P O PU LA TI O N U SI N G IM PR O VE D D R IN K IN G W AT ER S O U R C ES , J AM AI C A, 2 01 1 M ai n so ur ce o f d rin ki ng w at er Pe rc en ta ge us in g im pr ov ed so ur ce s of dr in ki ng w at er [1 ] N um be r o f ho us eh ol d m em be rs Im pr ov ed s ou rc es Pi pe d in to dw el lin g Pi pe d in to co m po un d, ya rd o r p lo t Pi pe d to ne ig hb ou r Pu bl ic ta p / st an dp ip e Pr ot ec te d w el l Pr ot ec te d sp rin g R ai nw at er co lle ct io n B ot tle d w at er A re a U rb an K M A 70 .9 17 .7 1. 4 1. 2 0. 1 0. 0 0. 0 8. 4 99 .7 6, 51 7 O th er to w ns 58 .7 21 .8 3. 1 4. 5 0. 5 0. 0 4. 5 4. 9 98 .0 3, 86 2 U rb an to ta l 66 .3 19 .3 2. 0 2. 4 0. 2 0. 0 1. 7 7. 1 99 .1 10 ,3 79 R ur al 32 .8 15 .7 3. 9 11 .0 0. 4 2. 5 20 .9 1. 9 89 .2 8, 56 8 Ed uc at io n of h ou se ho ld h ea d N on e/ P rim ar y 44 .7 17 .1 3. 2 7. 8 0. 4 1. 9 15 .4 2. 5 93 .0 3, 95 2 S ec on da ry 48 .4 20 .9 3. 3 6. 7 0. 3 1. 1 10 .3 3. 4 94 .5 11 ,7 66 Te rti ar y 71 .2 5. 4 1. 1 2. 0 0. 3 0. 4 4. 5 12 .6 97 .6 2, 88 4 M is si ng /D K 54 .3 13 .1 0. 0 11 .6 0. 0 0. 0 5. 0 10 .9 94 .8 34 5 W ea lth in de x qu in til es P oo re st 8. 9 30 .1 9. 1 18 .2 0. 5 3. 1 19 .1 0. 3 89 .3 3, 78 9 S ec on d 27 .1 36 .9 4. 0 8. 1 0. 3 1. 6 13 .1 1. 3 92 .3 3, 78 8 M id dl e 60 .3 14 .5 1. 1 3. 3 0. 5 0. 8 12 .9 2. 0 95 .4 3, 79 0 Fo ur th 78 .1 5. 7 0. 1 1. 6 0. 3 0. 2 6. 1 6. 0 98 .1 3, 80 1 R ic he st 81 .6 1. 1 0. 1 0. 3 0. 0 0. 0 0. 8 14 .3 98 .1 3, 77 9 To ta l 51 .2 17 .6 2. 9 6. 3 0. 3 1. 1 10 .4 4. 8 94 .6 18 ,9 47 [1 ] M IC S in di ca to r 4 .1 ; M D G in di ca to r 7 .8 * H ou se ho ld s us in g bo ttl ed w at er a s th e m ai n so ur ce o f d rin ki ng w at er a re c la ss ifi ed in to im pr ov ed o r u ni m pr ov ed d rin ki ng w at er u se rs a cc or di ng to th e w at er s ou rc e us ed fo r o th er p ur po se s su ch a s co ok in g an d ha nd w as hi ng . Jamaica Multiple Indicator Cluster Survey 2011 64 66 T A B LE W S. 1B : U SE O F IM PR O VE D W AT ER S O U R C ES P E R C EN T D IS TR IB U TI O N O F H O U SE H O LD P O PU LA TI O N A C C O R D IN G T O M AI N S O U R C E O F D R IN K IN G W AT ER A N D P ER C EN TA G E O F H O U SE H O LD PO PU LA TI O N U SI N G IM PR O VE D D R IN K IN G W AT ER S O U R C ES , J AM AI C A, 2 01 1 M ai n so ur ce o f d rin ki ng w at er N um be r o f ho us eh ol d m em be rs U ni m pr ov ed s ou rc es U np ro te ct ed w el l U np ro te ct ed sp rin g Ta nk er - tr uc k C ar t w ith sm al l ta nk / dr um Su rf ac e w at er + B ot tle d w at er O th er M is si ng A re a U rb an K M A 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 1 0. 0 6, 51 7 O th er to w ns 0. 0 0. 2 0. 9 0. 1 0. 0 0. 5 0. 2 0. 0 3, 86 2 U rb an to ta l 0. 0 0. 1 0. 4 0. 0 0. 0 0. 3 0. 1 0. 0 10 ,3 79 R ur al 0. 1 2. 6 2. 7 1. 7 1. 4 0. 6 1. 7 0. 0 8, 56 8 Ed uc at io n of H ou se ho ld H ea d N on e/ P rim ar y 0. 0 2. 4 1. 1 0. 5 0. 9 0. 6 1. 6 0. 0 3, 95 2 S ec on da ry 0. 0 1. 2 1. 5 1. 1 0. 7 0. 4 0. 7 0. 0 11 ,7 66 Te rti ar y 0. 1 0. 0 1. 6 0. 0 0. 1 0. 5 0. 2 0. 0 2, 88 4 M is si ng /D K 0. 0 0. 5 3. 1 0. 0 1. 4 0. 0 0. 3 0. 0 34 5 W ea lth In de x Q ui nt ile s P oo re st 0. 2 3. 5 1. 3 1. 4 2. 4 0. 3 1. 6 0. 1 3, 78 9 S ec on d 0. 1 1. 8 1. 6 2. 1 0. 5 0. 0 1. 5 0. 0 3, 78 8 M id dl e 0. 0 0. 7 2. 7 0. 2 0. 2 0. 3 0. 6 0. 0 3, 79 0 Fo ur th 0. 0 0. 0 1. 2 0. 1 0. 0 0. 2 0. 4 0. 0 3, 80 1 R ic he st 0. 0 0. 0 0. 3 0. 0 0. 0 1. 5 0. 1 0. 0 3, 77 9 To ta l 0. 0 1. 2 1. 4 0. 8 0. 6 0. 4 0. 8 0. 0 18 ,9 47 Jamaica Multiple Indicator Cluster Survey 201165 67 Use of in-house water treatment is presented in Table WS.2. Households were asked about ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, and using solar disinfection were considered as proper treatment of drinking water. The table shows water treatment by all households and the percentage of household members living in households using unimproved water sources but using appropriate water treatment methods. One half of the population used some method to treat their drinking water. The two methods most frequently employed were boiling and adding bleach or chlorine. A half of those household members in household using an unimproved drinking water source used an appropriate water treatment method. 70 The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collected the water in Table WS.4. Note that these results refer to one round-trip from home to drinking water source. Information on the number of trips made in one day was not collected. Table WS.3 shows that for 86.5 per cent of households, the drinking water source was on the premises. There is little difference in the figures between households in rural areas and those in other towns and KMA, although 74.3 per cent of rural households have the source of drinking water on the premises, the figure for other towns was 93.3 per cent and 98.5 per cent for households in KMA. Education and wealth seem also to be associated with households that have the source of drinking water on the premises. Households headed by persons with a primary level of education have a figure of 82.9 per cent, slightly lower than the national average of 86.5 per cent, whereas those headed by persons with a tertiary level of education have a figure of 94.9 per cent. In terms of wealth, 65.9 per cent of households in the poorest quintile have the source of drinking water on the premises. This figure increases with each successive quintile to reach 97.8 per cent for the richest quintile. For 5.7 per cent of all households, it takes less than 30 minutes to get to the water source and bring water, while 2.0 per cent of households spend 30 minutes or more for this purpose. In rural areas 10.2 per cent of households spend less than 30 minutes to get water and return to the home and 3.8 % spend more than 30 minutes on this chore. Table WS.4 shows that for 59.6 per cent of households, an adult male is usually the person collecting the water, when the source of drinking water is not on the premises. Adult females collect water in 32.6 per cent of the cases, with the rest of the households - female or male children under age 15 - collecting in 3.7 per cent of the cases. Jamaica Multiple Indicator Cluster Survey 2011 66 68 T A B LE W S. 2: H O U SE H O LD W A TE R T R EA TM EN T P E R C EN TA G E O F H O US EH O LD P O PU LA TI O N B Y D R IN K IN G W AT ER T R EA TM EN T M ET H O D U SE D IN T H E H O U SE H O LD , A N D F O R H O U SE H O LD M EM B ER S LI VI N G IN H O U SE H O LD S W H ER E AN U N IM PR O VE D D R IN K IN G W AT ER S O U R C E IS U SE D , T H E PE R C EN TA G E W H O A R E U SI N G A N A PP R O PR IA TE T R EA TM EN T M ET H O D , J AM AI C A, 2 01 1 W at er tr ea tm en t m et ho d us ed in th e ho us eh ol d N um be r o f ho us eh ol d m em be rs Pe rc en ta ge o f ho us eh ol d m em be rs in ho us eh ol ds u si ng un im pr ov ed d rin ki ng w at er s ou rc es a nd us in g an a pp ro pr ia te w at er tr ea tm en t m et ho d [1 ] N um be r o f ho us eh ol d m em be rs in ho us eh ol ds u si ng un im pr ov ed dr in ki ng w at er so ur ce s N on e B oi l A dd bl ea ch / ch lo rin e St ra in th ro ug h a cl ot h U se w at er fil te r So la r di si nf ec tio n Le t i t st an d an d se ttl e O th er D on 't kn ow A re a U rb an K M A 54 .0 35 .7 12 .9 0. 1 5. 1 0. 0 0. 6 0. 1 0. 1 6, 51 7 (* ) 17 O th er to w ns 51 .6 33 .7 14 .1 0. 2 5. 7 0. 0 1. 2 0. 6 0. 0 3, 86 2 50 .5 76 U rb an to ta l 53 .1 34 .9 13 .4 0. 2 5. 3 0. 0 0. 9 0. 3 0. 1 10 ,3 79 43 .5 93 R ur al 47 .3 31 .9 25 .7 0. 3 1. 4 0. 0 0. 6 0. 7 0. 1 8, 56 8 50 .3 92 3 Ed uc at io n of H ou se ho ld H ea d N on e/ Pr im ar y 48 .3 33 .4 21 .1 0. 2 1. 7 0. 1 1. 2 0. 5 0. 2 3, 95 2 58 .4 27 7 Se co nd ar y 51 .6 33 .1 20 .4 0. 2 2. 3 0. 0 0. 6 0. 4 0. 0 11 ,7 66 47 .2 65 2 Te rti ar y 47 .8 36 .0 11 .0 0. 2 11 .0 0. 0 0. 7 0. 9 0. 0 2, 88 4 42 .0 69 M is si ng /D K 61 .1 29 .9 12 .3 0. 0 4. 8 0. 0 0. 2 0. 5 0. 0 34 5 (3 5. 5) 18 W ea lth In de x Q ui nt ile s Po or es t 52 .0 28 .4 24 .5 0. 4 0. 1 0. 0 1. 2 0. 6 0. 1 3, 78 9 50 .2 40 7 Se co nd 47 .9 36 .0 25 .6 0. 2 0. 2 0. 0 0. 6 0. 5 0. 0 3, 78 8 47 .0 29 2 M id dl e 46 .9 35 .5 24 .3 0. 3 1. 2 0. 0 1. 1 0. 3 0. 1 3, 79 0 61 .9 17 4 Fo ur th 52 .4 35 .6 15 .0 0. 1 3. 5 0. 0 0. 3 0. 5 0. 2 3, 80 1 63 .2 71 R ic he st 53 .1 32 .2 5. 3 0. 1 12 .8 0. 1 0. 6 0. 6 0. 0 3, 77 9 15 .0 72 To ta l 50 .5 33 .6 19 .0 0. 2 3. 6 0. 0 0. 7 0. 5 0. 1 18 ,9 47 49 .7 1, 01 5 [1 ] M IC S in di ca to r 4 .2 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s( *) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s Jamaica Multiple Indicator Cluster Survey 201167 69 TA B LE W S. 3: T IM E TO S O U R C E O F D R IN K IN G W AT ER P E R C EN T D IS TR IB U TI O N O F H O U SE H O LD P O PU LA TI O N A C C O R D IN G T O T IM E TO G O T O S O U R C E O F D R IN K IN G W AT ER , G ET W AT ER A N D R ET U R N , F O R U SE R S O F IM PR O VE D AN D U N IM PR O VE D D R IN K IN G W AT ER S O U R C ES , J AM AI C A, 2 01 1 Ti m e to s ou rc e of d rin ki ng w at er To ta l N um be r o f ho us eh ol d m em be rs U se rs o f i m pr ov ed d rin ki ng w at er s ou rc es U se rs o f u ni m pr ov ed d rin ki ng w at er s ou rc es W at er o n pr em is es Le ss th an 30 m in ut es 30 m in ut es or m or e M is si ng /D K W at er o n pr em is es Le ss th an 30 m in ut es 30 m in ut es or m or e M is si ng /D K A re a U rb an K M A 98 .5 0. 8 0. 4 0. 0 0. 0 0. 0 0. 0 0. 2 10 0. 0 6, 51 7 O th er to w ns 93 .3 4. 0 0. 7 0. 0 0. 6 0. 4 0. 6 0. 4 10 0. 0 3, 86 2 U rb an to ta l 96 .6 2. 0 0. 5 0. 0 0. 2 0. 2 0. 2 0. 2 10 0. 0 10 ,3 79 R ur al 74 .3 10 .2 3. 8 1. 0 3. 1 3. 6 3. 3 0. 7 10 0. 0 8, 56 8 Ed uc at io n of H ou se ho ld H ea d N on e/ P rim ar y 82 .9 7. 6 2. 3 0. 1 1. 9 2. 3 2. 3 0. 5 10 0. 0 3, 95 2 S ec on da ry 85 .8 6. 0 2. 1 0. 6 1. 6 1. 8 1. 7 0. 4 10 0. 0 11 ,7 66 Te rti ar y 94 .9 1. 9 0. 5 0. 4 1. 0 0. 6 0. 4 0. 4 10 0. 0 2, 88 4 M is si ng /D K 81 .1 5. 9 7. 8 0. 0 1. 4 2. 2 1. 4 0. 3 10 0. 0 34 5 W ea lth In de x Q ui nt ile s P oo re st 65 .9 18 .0 5. 1 0. 3 1. 9 4. 8 3. 7 0. 2 10 0. 0 3, 78 9 S ec on d 81 .8 6. 9 2. 3 1. 3 1. 9 2. 9 2. 4 0. 5 10 0. 0 3, 78 8 M id dl e 90 .8 2. 5 2. 0 0. 2 2. 4 0. 6 1. 2 0. 4 10 0. 0 3, 79 0 Fo ur th 96 .1 1. 1 0. 7 0. 3 0. 9 0. 1 0. 4 0. 5 10 0. 0 3, 80 1 R ic he st 97 .8 0. 1 0. 0 0. 2 0. 6 0. 4 0. 4 0. 6 10 0. 0 3, 77 9 To ta l 86 .5 5. 7 2. 0 0. 5 1. 5 1. 7 1. 6 0. 5 10 0. 0 18 ,9 47 Jamaica Multiple Indicator Cluster Survey 2011 68 71 T A B LE W S. 4: P ER SO N C O LL EC TI N G W AT ER P E R C EN TA G E O F H O U SE H O LD S W IT H O U T D R IN K IN G W AT ER O N P R EM IS ES , A N D P ER C EN T D IS TR IB U TI O N O F H O U SE H O LD S W IT H O U T D R IN K IN G W AT ER O N P R EM IS ES AC C O R D IN G T O T H E PE R SO N U SU AL LY C O LL EC TI N G D R IN K IN G W AT ER U SE D IN T H E H O U SE H O LD , J AM AI C A, 2 01 1 Pe rc en ta ge of ho us eh ol ds w ith ou t dr in ki ng w at er o n pr em is es N um be r o f ho us eh ol ds Pe rs on u su al ly c ol le ct in g dr in ki ng w at er N um be r o f ho us eh ol ds w ith ou t dr in ki ng w at er o n pr em is es A du lt w om an (a ge 1 5+ ye ar s) A du lt m an (a ge 1 5+ ye ar s) Fe m al e ch ild (u nd er 1 5) M al e ch ild (u nd er 1 5) M is si ng To ta l A re a U rb an K M A 1. 6 2, 08 4 (5 0. 3) (2 8. 2) (0 .0 ) (0 .0 ) (2 1. 5) 10 0 33 O th er to w ns 6. 0 1, 23 2 29 .1 60 .2 1. 8 6. 0 2. 9 10 0 74 U rb an to ta l 3. 2 3, 31 6 35 .6 50 .4 1. 2 4. 2 8. 6 10 0 10 6 R ur al 21 .8 2, 64 4 32 .0 61 .3 1. 6 1. 7 3. 3 10 0 57 7 Ed uc at io n of H ou se ho ld H ea d N on e/ P rim ar y 14 .9 1, 28 1 34 .1 60 .9 0. 5 0. 6 3. 8 10 0 19 1 S ec on da ry 12 .1 3, 58 9 31 .5 59 .1 1. 8 3. 0 4. 6 10 0 43 4 Te rti ar y 4. 5 1, 00 5 (2 9. 7) (6 3. 3) (4 .3 ) (0 .0 ) (2 .8 ) 10 0 45 M is si ng /D K 16 .0 85 (* ) (* ) (* ) (* ) (* ) 10 0. 0 14 W ea lth In de x Q ui nt ile s P oo re st 29 .3 1, 32 3 33 .4 61 .1 1. 4 3. 0 1. 1 10 0 38 8 S ec on d 14 .3 1, 13 6 36 .0 58 .8 2. 6 1. 6 1. 1 10 0 16 2 M id dl e 7. 4 1, 10 2 27 .2 60 .8 1. 1 0. 0 10 .9 10 0 82 Fo ur th 2. 6 1, 16 5 (1 5. 7) (6 6. 1) (0 .0 ) (0 .0 ) (1 8. 1) 10 0 31 R ic he st 1. 6 1, 23 3 (* ) (* ) (* ) (* ) (* ) 10 0. 0 20 To ta l 11 .5 5, 96 0 32 .6 59 .6 1. 6 2. 1 4. 2 10 0 68 3 ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s Jamaica Multiple Indicator Cluster Survey 201169 72 USE OF IMPROVED SANITATION FACILITIES Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. Improved sanitation can reduce diarrhoeal disease by more than a third, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. 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. There were sizeable variations in the type of sanitation system used by the different areas. In terms of a sanitation facility employing a flush mechanism to a sewer system, a septic tank or a pit, 97.9 per cent of households in KMA used such a system, 90.8 per cent in urban areas, 79.0 per cent in other towns and only 62.3 per cent in rural areas. About a third (33.9%) of households in rural areas used pit latrines with slab compared to a high 18.7 per cent in other towns, 7.7 per cent in urban areas and 1.1 per cent in KMA. There is a noticeable correlation between wealth and the type of sanitation facility used, while those in the richest quintile of the population used a flush system to a sewer, a septic tank or to a pit, the poorest quintile had 64.2 per cent of households using pit latrines with slab. In terms of education there is little variation with improved sanitation facilities. Access to safe drinking-water and to basic sanitation is measured by the proportion of population using an improved sanitation facility. MDGs and WHO / UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation classify households as using an unimproved sanitation facility if they are using otherwise acceptable sanitation facilities but sharing a facility between two or more households or using a public toilet facility. As shown in Table WS.6, 86.5 per cent of the household population used an improved sanitation facility that is not shared. Use of a shared facility is more common among households in KMA (15.2%) followed by other towns (13.8%), urban area (13.5%) and rural area (10.7%).Also, sharing of facilities was most prevalent among the poorest quintile of the population with 29.5 per cent. Jamaica Multiple Indicator Cluster Survey 2011 70 73 T A B LE W S. 5: T YP ES O F SA N IT AT IO N F AC IL IT IE S P E R C EN T D IS TR IB U TI O N O F H O U SE H O LD P O PU LA TI O N A C C O R D IN G T O T YP E O F TO IL ET F AC IL IT Y U SE D B Y TH E H O U SE H O LD , J AM AI C A, 2 01 1 Ty pe o f t oi le t f ac ili ty u se d by h ou se ho ld To ta l N um be r o f ho us eh ol d m em be rs Im pr ov ed s an ita tio n fa ci lit y U ni m pr ov ed s an ita tio n fa ci lit y N o fa ci lit y, B us h, Fi el d Fl us h to pi pe d se w er sy st em Fl us h to se pt ic ta nk Fl us h to p it (la tr in e) Fl us h to un kn ow n pl ac e / N ot s ur e / D K w he re Ve nt ila te d Im pr ov ed Pi t l at rin e (V IP ) Pi t la tr in e w ith sl ab Fl us h to so m e w he re el se Pi t la tr in e w ith ou t sl ab / O pe n pi t B uc ke t O th er M is si ng A re a U rb an K M A 46 .2 31 .8 19 .9 0. 2 0. 1 1. 1 0. 1 0. 0 0. 0 0. 0 0. 4 0. 1 10 0 6, 51 7 O th er to w ns 14 .5 31 .9 32 .6 0. 3 0. 9 18 .7 0. 1 0. 5 0. 0 0. 3 0. 0 0. 2 10 0 3, 86 2 U rb an to ta l 34 .4 31 .8 24 .6 0. 3 0. 4 7. 7 0. 1 0. 2 0. 0 0. 1 0. 3 0. 2 10 0 10 ,3 79 R ur al 7. 3 21 .7 33 .3 0. 1 2. 3 33 .9 0. 3 0. 4 0. 0 0. 1 0. 2 0. 4 10 0 8, 56 8 Ed uc at io n of H ou se ho ld H ea d N on e/ P rim ar y 15 .4 23 .7 29 .4 0. 0 2. 1 27 .6 0. 1 0. 8 0. 0 0. 2 0. 2 0. 4 10 0 3, 95 2 S ec on da ry 20 .6 27 .3 29 .2 0. 1 1. 3 20 .6 0. 2 0. 1 0. 0 0. 1 0. 2 0. 3 10 0 11 ,7 66 Te rti ar y 36 .2 32 .8 25 .9 0. 5 0. 2 3. 8 0. 2 0. 0 0. 0 0. 0 0. 4 0. 1 10 0 2, 88 4 M is si ng /D K 34 .8 21 .4 19 .8 0. 0 0. 0 20 .3 0. 0 2. 1 0. 0 0. 0 1. 5 0. 1 10 0 34 5 W ea lth In de x Q ui nt ile s P oo re st 3. 9 11 .0 14 .2 0. 0 3. 8 64 .2 0. 1 0. 9 0. 0 0. 4 0. 2 1. 2 10 0 3, 78 9 S ec on d 10 .6 26 .5 29 .9 0. 0 2. 2 29 .5 0. 4 0. 6 0. 0 0. 1 0. 0 0. 2 10 0 3, 78 8 M id dl e 18 .2 34 .4 42 .9 0. 2 0. 1 3. 6 0. 2 0. 0 0. 0 0. 0 0. 4 0. 0 10 0 3, 79 0 Fo ur th 30 .1 31 .6 36 .9 0. 4 0. 3 0. 4 0. 1 0. 0 0. 0 0. 0 0. 3 0. 0 10 0 3, 80 1 R ic he st 48 .0 32 .9 18 .7 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 10 0 3, 77 9 To ta l 22 .1 27 .3 28 .5 0. 2 1. 3 19 .5 0. 2 0. 3 0. 0 0. 1 0. 2 0. 3 10 0 18 ,9 47 Jamaica Multiple Indicator Cluster Survey 201171 74 TA B LE W S. 6: U SE A N D S H AR IN G O F SA N IT AT IO N F AC IL IT IE S P E R C EN T D IS TR IB U TI O N O F H O U SE H O LD P O PU LA TI O N B Y U SE O F PR IV AT E AN D P U B LI C S AN IT AT IO N F AC IL IT IE S AN D U SE O F SH AR ED F AC IL IT IE S, B Y U SE R S O F IM PR O VE D AN D U N IM PR O VE D S AN IT AT IO N F AC IL IT IE S, J AM AI C A, 2 01 1 U se rs o f i m pr ov ed s an ita tio n fa ci lit ie s U se rs o f u ni m pr ov ed s an ita tio n fa ci lit ie s O pe n de fe ca tio n (n o fa ci lit y, bu sh fie ld ) To ta l N um be r o f ho us eh ol d m em be rs N ot sh ar ed [1 ] Pu bl ic fa ci lit y Sh ar ed b y: 5 ho us eh ol ds or le ss Sh ar ed b y: M or e th an 5 ho us eh ol ds M is si ng /D K N ot sh ar ed Sh ar ed b y: 5 ho us eh ol ds or le ss Sh ar ed b y: M or e th an 5 ho us eh ol ds A re a U rb an K M A 83 .9 0. 1 12 .3 2. 9 0. 1 0. 5 0. 0 0. 0 0. 1 10 0 6, 51 7 O th er to w ns 88 .1 0. 1 9. 8 0. 9 0. 1 0. 4 0. 6 0. 0 0. 2 10 0 3, 86 2 U rb an to ta l 85 .5 0. 1 11 .3 2. 2 0. 1 0. 4 0. 2 0. 0 0. 2 10 0 10 ,3 79 R ur al 87 .8 0. 1 10 .2 0. 5 0. 1 0. 8 0. 2 0. 0 0. 4 10 0 8, 56 8 Ed uc at io n of H ou se ho ld H ea d N on e/ P rim ar y 88 .0 0. 1 9. 3 0. 8 0. 0 0. 9 0. 4 0. 0 0. 4 10 0 3, 95 2 S ec on da ry 84 .0 0. 1 12 .9 2. 0 0. 1 0. 4 0. 2 0. 0 0. 3 10 0 11 ,7 66 Te rti ar y 94 .9 0. 0 4. 4 0. 1 0. 0 0. 6 0. 0 0. 0 0. 1 10 0 2, 88 4 M is si ng /D K 85 .0 0. 0 10 .2 1. 2 0. 0 3. 6 0. 0 0. 0 0. 1 10 0 34 5 W ea lth In de x Q ui nt ile s P oo re st 67 .2 0. 2 26 .1 3. 4 0. 3 0. 9 0. 7 0. 0 1. 2 10 0 3, 78 9 S ec on d 76 .9 0. 2 18 .8 2. 7 0. 0 0. 9 0. 2 0. 1 0. 2 10 0 3, 78 8 M id dl e 92 .6 0. 1 6. 5 0. 2 0. 1 0. 6 0. 0 0. 0 0. 0 10 0 3, 79 0 Fo ur th 96 .6 0. 0 2. 3 0. 8 0. 0 0. 4 0. 0 0. 0 0. 0 10 0 3, 80 1 R ic he st 99 .2 0. 1 0. 4 0. 0 0. 0 0. 3 0. 0 0. 0 0. 0 10 0 3, 77 9 To ta l 86 .5 0. 1 10 .8 1. 4 0. 1 0. 6 0. 2 0. 0 0. 3 10 0 18 ,9 47 [1 ] M IC S in di ca to r 4 .3 ; M D G in di ca to r 7 .9 Jamaica Multiple Indicator Cluster Survey 2011 72 75 6 6 WHO/UNICEF JMP (2008), MDG assessment report - h p://www.wssinfo.org/download?id_document=1279 Safe disposal of a child’s faeces is disposing of the stool, by the child using a toilet or by releasing the stool into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table WS.7.Twenty-eight per cent of all households with children of this age group disposed of the child’s stool safely. This low occurrence is likely due to the high use of disposable diapers by caretakers which are usually disposed of, in the garbage (66.5%). Rural areas have 34.8 per cent of its households carrying out safe disposal of stool, followed by other towns 23.6 per cent and KMA 23.1 per cent. Safe disposal seems to decrease along the wealth index as 28.1 per cent of the richest quintile of the population disposes of stool in this way, while 40.4 per cent of the poorest quintile disposes of stool safely. Interest- ingly, there seems to be an inverse relationship between the mother’s level of education and safe dispos- al of the child’s stool. Safe disposal of stool was highest (32.6%) where the mother has at most a primary level education, 28.5 per cent in the case of mothers with at least a secondary level of education and 27.0 per cent where the mother has a tertiary level education. In its 2008 report , the JMP developed a new way of presenting the access figures, by disaggregating and refining the data on drinking-water and sanitation and reflecting them in "ladder" format. This ladder allows a disaggregated analysis of trends in a three rung ladder for drinking-water and a four-rung ladder for sanitation. For sanitation, this gives an understanding of the proportion of population with no sanita- tion facilities at all, of those reliant on technologies defined by JMP as "unimproved," of those sharing sanitation facilities of otherwise acceptable technology, and those using "improved" sanitation facilities. Table WS.8 presents the percentages of household population by drinking water and sanitation ladders. The table also shows the percentage of household members using improved sources of drinking water and sanitary means of excreta disposal. Eighty-two per cent of the Jamaican population is using an improved drinking water source and improved sanitation. In other towns 86.3 per cent of the population are using such facilities, 84.7 per cent in urban areas, 83.7 per cent in KMA and 77.9 per cent in rural areas. As expected, wealth has a strong influence on whether a household has improved facilities or not. The poorest quintile had the lowest percentage of household with improved facilities (57.7%), while those in the richest quintile have the highest (97.3%). Jamaica Multiple Indicator Cluster Survey 201173 76 TA B LE W S. 7: D IS PO SA L O F C H IL D 'S F AE C ES P E R C EN T D IS TR IB U TI O N O F C H IL D R EN A G E 0- 2 YE AR S AC C O R D IN G T O P LA C E O F D IS PO SA L O F C H IL D 'S F AE C ES , A N D T H E PE R C EN TA G E O F C H IL D R EN A G E 0- 2 YE AR S W H O SE S TO O LS W ER E D IS PO SE D O F SA FE LY T H E LA ST T IM E TH E C H IL D P AS SE D S TO O LS , J AM AI C A, 2 01 1 Pl ac e of d is po sa l o f c hi ld 's fa ec es To ta l Pe rc en ta ge o f ch ild re n w ho se la st st oo ls w er e di sp os ed o f sa fe ly [1 ] N um be r o f ch ild re n ag e 0- 2 ye ar s C hi ld us ed to ile t / la tr in e Pu t / R in se d in to to ile t o r la tr in e Pu t / R in se d in to dr ai n or di tc h Th ro w n in to ga rb ag e (s ol id w as te ) B ur ie d O th er D K M is si ng Ty pe o f S an ita tio n Fa ci lit y in D w el lin g Im pr ov ed 13 .2 15 .1 0. 7 66 .5 1. 2 2. 0 0. 3 1. 1 10 0 28 .3 97 5 U ni m pr ov ed (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) 4 O pe n de fe ca tio n (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) 1 A re a U rb an K M A 18 .2 4. 9 1. 9 72 .8 0. 2 0. 5 0. 1 1. 3 10 0 23 .1 34 7 O th er to w ns 9. 5 14 .1 0. 0 73 .1 0. 5 1. 7 0. 7 0. 4 10 0 23 .6 21 1 U rb an to ta l 14 .9 8. 4 1. 2 72 .9 0. 3 1. 0 0. 3 0. 9 10 0 23 .3 55 9 R ur al 10 .8 23 .9 0. 1 58 .0 2. 3 3. 4 0. 2 1. 2 10 0 34 .8 42 1 M ot he r's E du ca tio n N on e/ P rim ar y (1 6. 7) (1 5. 9) (2 .2 ) (6 0. 2) (0 .0 ) (5 .0 ) (0 .0 ) (0 .0 ) 10 0. 0 (3 2. 6) 20 S ec on da ry 11 .8 16 .8 0. 9 65 .7 1. 6 1. 9 0. 2 1. 2 10 0 28 .5 73 2 Te rti ar y 17 .4 9. 6 0. 0 69 .7 0. 0 2. 0 0. 6 0. 7 10 0 27 .0 22 8 M is si ng /D K (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) 0 W ea lth In de x Q ui nt ile s P oo re st 8. 8 31 .6 0. 2 51 .1 1. 1 4. 7 0. 0 2. 5 10 0 40 .4 20 3 S ec on d 10 .2 19 .7 1. 9 64 .0 3. 0 0. 6 0. 3 0. 4 10 0 29 .9 23 1 M id dl e 12 .9 7. 6 1. 0 76 .6 1. 0 0. 8 0. 2 0. 0 10 0 20 .5 21 5 Fo ur th 13 .6 7. 6 0. 0 73 .1 0. 3 3. 5 0. 9 1. 0 10 0 21 .2 16 4 R ic he st 22 .6 5. 5 0. 0 69 .4 0. 0 0. 8 0. 0 1. 7 10 0 28 .1 16 7 To ta l 13 .2 15 .1 0. 7 66 .5 1. 2 2. 0 0. 3 1. 0 10 0 28 .2 98 0 [1 ] M IC S in di ca to r 4 .4 (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s Jamaica Multiple Indicator Cluster Survey 2011 74 77 HAND WASHING Hand washing with water and soap is the most cost effective health intervention to reduce both the incidence of diarrhoea and pneumonia in children under five. It is most effective when done using water and soap after visiting a toilet or cleaning a child, before eating or handling food and, before feeding a child. Monitoring correct hand washing behaviour at these critical times is challenging. A reliable alternative to observations or self-reported behaviour is assessing the likelihood that correct hand washing behaviour takes place by observing if a household has a specific place where people most often wash their hands and observing if water and soap (or other local cleansing materials) are present at a specific place for hand washing. In Jamaica, in 65.5 per cent of the households a specific place for hand washing was observed, while 19.5 per cent of the households did not give a permission to see the place used for hand washing (Table WS9). Of those households where a place for hand washing was observed, about 80 per cent had both water and soap present at the designated place. In 15 per cent of the households only water was available at the designated place, while in 2.3 per cent of the households the place only had soap but no water. The remaining 2.7 per cent of households had neither water nor soap available at the designated place for hand washing. In 89 per cent of households, there was soap available in some part of the dwelling (Table WS 10). Jamaica Multiple Indicator Cluster Survey 201175 78 T A BL E W S. 8: D RI NK IN G W AT ER A ND S AN IT AT IO N LA DD ER S P E RC EN TA GE O F HO US EH OL D PO PU LA TI ON B Y DR IN KI NG W AT ER A ND S AN IT AT IO N LA DD ER S, JA M AI CA , 2 01 1 Pe rc en ta ge o f h ou se ho ld p op ul at io n us in g: Nu m be r o f ho us eh ol d m em be rs Im pr ov ed Un im pr ov ed dr in ki ng wa te r To ta l Im pr ov ed sa ni ta tio n [2 ] Un im pr ov ed s an ita tio n To ta l Im pr ov ed dr in ki ng wa te r so ur ce s an d im pr ov ed sa ni ta tio n Im pr ov ed d rin kin g wa te r [ 1] Sh ar ed im pr ov ed fa ci lit ies Un im pr ov ed fa ci lit ies Op en de fe ca tio n Pi pe d in to dw el lin g, pl ot o r ya rd Ot he r im pr ov ed Ar ea Ur ba n K M A 97 .0 2. 7 0. 3 10 0 83 .9 15 .4 0. 5 0. 1 10 0 83 .7 6, 51 7 O th er to wn s 85 .1 12 .9 2. 0 10 0 88 .1 10 .8 1. 0 0. 2 10 0 86 .3 3, 86 2 Ur ba n to ta l 92 .6 6. 5 0. 9 10 0 85 .5 13 .7 0. 7 0. 2 10 0 84 .7 10 ,3 79 Ru ra l 49 .8 39 .5 10 .8 10 0 87 .8 10 .9 1. 0 0. 4 10 0 77 .9 8, 56 8 Ed uc at io n of H ou se ho ld H ea d No ne /P rim ar y 63 .8 29 .2 7. 0 10 0 88 .0 10 .3 1. 4 0. 4 10 0 81 .6 3, 95 2 Se co nd ar y 72 .4 22 .0 5. 5 10 0 84 .0 15 .1 0. 6 0. 3 10 0 78 .9 11 ,7 66 Te rti ar y 88 .8 8. 8 2. 4 10 0 94 .9 4. 5 0. 6 0. 1 10 0 92 .8 2, 88 4 M iss ing /D K 78 .2 16 .5 5. 2 10 0 85 .0 11 .3 3. 6 0. 1 10 0 80 .0 34 5 W ea lth In de x Q ui nt ile s Po or es t 39 .2 50 .1 10 .7 10 0 67 .2 30 .0 1. 6 1. 2 10 0 57 .7 3, 78 9 Se co nd 64 .5 27 .8 7. 7 10 0 76 .9 21 .7 1. 2 0. 2 10 0 70 .0 3, 78 8 M idd le 76 .5 18 .9 4. 6 10 0 92 .6 6. 9 0. 6 0. 0 10 0 88 .2 3, 79 0 Fo ur th 89 .1 9. 1 1. 9 10 0 96 .6 3. 0 0. 4 0. 0 10 0 94 .8 3, 80 1 Ri ch es t 96 .8 1. 3 1. 9 10 0 99 .2 0. 5 0. 3 0. 0 10 0 97 .3 3, 77 9 To ta l 73 .2 21 .4 5. 4 10 0. 0 86 .5 12 .4 0. 8 0. 3 10 0. 0 81 .6 18 94 7 [1 ] M IC S ind ica to r 4 .1 [2 ] M IC S ind ica to r 4 .3 Jamaica Multiple Indicator Cluster Survey 2011 76 79 T A BL E W S. 9: W AT ER A ND S OA P AT P LA CE F OR H AN D W AS HI NG P E RC EN TA GE O F HO US EH OL DS W HE RE P LA CE F OR H AN D W AS HI NG W AS O BS ER VE D AN D PE R CE NT D IS TR IB UT IO N OF H OU SE HO LD S BY A VA IL AB IL IT Y OF W AT ER A ND S OA P AT P LA CE FO R HA ND W AS HI NG , J AM AI CA , 2 01 1 Pe rc en ta ge of ho us eh ol ds wh er e pl ac e fo r ha nd wa sh in g wa s ob se rv ed Pe rc en ta ge o f h ou se ho ld s wh er e pl ac e fo r ha nd w as hi ng w as n ot o bs er ve d To ta l Nu m be r o f ho us eh ol ds Pe r c en t d is tri bu tio n of h ou se ho ld s w he re pl ac e fo r h an d wa sh in g wa s ob se rv ed , wh er e: To ta l Nu m be r o f ho us eh ol ds wh er e pl ac e fo r ha nd wa sh in g wa s ob se rv ed No t i n dw el lin g/ pl ot / ya rd No pe rm is si on to s ee Ot he r re as on s M is sin g W at er an d so ap a re av ai la bl e [1 ] W at er is av ai la bl e, so ap is no t av ai la bl e W at er is no t av ai la bl e, so ap is av ai la bl e W at er an d so ap a re no t av ai la bl e Ar ea Ur ba n K M A 66 .1 6. 4 20 .1 7. 4 0. 0 10 0 2, 08 4 80 .0 19 .4 0. 2 0. 4 10 0 1, 37 8 O th er to wn s 58 .5 4. 3 28 .8 8. 1 0. 3 10 0 1, 23 2 87 .9 8. 5 2. 2 1. 5 10 0 72 0 Ur ba n to ta l 63 .3 5. 6 23 .3 7. 7 0. 1 10 0 3, 31 6 82 .7 15 .6 0. 9 0. 8 10 0 2, 09 8 Ru ra l 68 .2 3. 6 14 .7 13 .4 0. 0 10 0 2, 64 4 77 .0 14 .3 3. 9 4. 9 10 0 1, 80 3 Ed uc at io n of H ou se ho ld H ea d No ne /P rim ar y 64 .5 5. 3 17 .8 12 .3 0. 1 10 0 1, 28 1 74 .4 19 .0 2. 8 3. 8 10 0 82 6 Se co nd ar y 66 .4 4. 9 18 .7 9. 9 0. 1 10 0 3, 58 9 78 .9 15 .9 2. 4 2. 8 10 0 2, 38 5 Te rti ar y 64 .2 3. 6 23 .1 8. 9 0. 2 10 0 1, 00 5 92 .2 6. 4 0. 9 0. 5 10 0 64 6 M iss ing /D K 52 .3 0. 5 36 .3 10 .9 0. 0 10 0 85 (7 4. 3) (1 5. 7) (1 .8 ) (8 .2 ) 10 0 44 W ea lth In de x Q ui nt ile s Po or es t 64 .7 7. 6 13 .2 14 .5 0. 1 10 0 1, 32 3 61 .7 26 .6 4. 1 7. 6 10 0 85 6 Se co nd 65 .9 6. 6 15 .9 11 .4 0. 1 10 0 1, 13 6 72 .4 21 .7 2. 4 3. 6 10 0 74 9 M idd le 66 .8 4. 2 19 .1 9. 8 0. 1 10 0 1, 10 2 85 .0 11 .3 2. 4 1. 4 10 0 73 6 Fo ur th 64 .2 2. 9 24 .5 8. 4 0. 1 10 0 1, 16 5 90 .7 7. 5 1. 6 0. 2 10 0 74 7 Ri ch es t 65 .9 2. 1 25 .2 6. 7 0. 1 10 0 1, 23 3 92 .3 6. 9 0. 8 0. 1 10 0 81 3 To ta l 65 .5 4. 7 19 .5 10 .2 0. 1 10 0 5, 96 0 80 .1 15 .0 2. 3 2. 7 10 0 3, 90 1 [1 ] M IC S ind ica to r 4 .5 ( ) Fi gu re s t ha t a re b as ed o n 25 -4 9 un we igh te d ca se s Jamaica Multiple Indicator Cluster Survey 201177 80 TA B LE W S. 10 : A V AI LA B IL IT Y O F SO AP P E R C EN T D IS TR IB U TI O N O F H O U SE H O LD S B Y AV AI LA B IL IT Y O F SO AP IN T H E D W EL LI N G , J AM AI C A, 2 01 1 Pl ac e fo r h an d w as hi ng o bs er ve d Pl ac e fo r h an d w as hi ng n ot o bs er ve d To ta l Pe rc en ta ge of ho us eh ol ds w ith s oa p an yw he re in th e dw el lin g [1 ] N um be r o f ho us eh ol ds So ap ob se rv ed So ap sh ow n N o so ap in ho us eh ol d N ot ab le /D oe s no t w an t to s ho w so ap So ap ob se rv ed So ap sh ow n N o so ap in ho us eh ol d N ot ab le /D oe s no t w an t to s ho w so ap A re a U rb an K M A 53 .0 11 .5 0. 4 1. 2 0. 0 29 .0 0. 5 4. 4 10 0 93 .5 2, 08 4 O th er to w ns 52 .6 4. 3 0. 5 1. 0 0. 0 21 .1 1. 5 18 .9 10 0 78 .0 1, 23 2 U rb an to ta l 52 .9 8. 8 0. 4 1. 1 0. 0 26 .1 0. 9 9. 8 10 0 87 .7 3, 31 6 R ur al 55 .2 11 .7 0. 7 0. 6 0. 0 22 .7 0. 8 8. 3 10 0 89 .5 2, 64 4 Ed uc at io n of H ou se ho ld H ea d N on e/ P rim ar y 49 .8 12 .2 0. 9 1. 6 0. 0 24 .6 1. 2 9. 7 10 0 86 .5 1, 28 1 S ec on da ry 54 .0 11 .1 0. 6 0. 7 0. 0 24 .5 0. 9 8. 2 10 0 89 .6 3, 58 9 Te rti ar y 59 .8 3. 9 0. 0 0. 5 0. 0 24 .5 0. 2 11 .0 10 0 88 .3 1, 00 5 M is si ng /D K 39 .8 10 .4 0. 0 2. 1 0. 0 27 .7 1. 5 18 .5 10 0 77 .9 85 W ea lth In de x Q ui nt ile s P oo re st 42 .5 19 .3 1. 3 1. 6 0. 0 23 .8 2. 5 8. 9 10 0 85 .6 1, 32 3 S ec on d 49 .3 14 .4 0. 9 1. 3 0. 0 24 .5 0. 8 8. 8 10 0 88 .3 1, 13 6 M id dl e 58 .3 7. 5 0. 3 0. 6 0. 0 24 .1 0. 2 8. 9 10 0 90 .0 1, 10 2 Fo ur th 59 .2 4. 2 0. 2 0. 6 0. 0 27 .0 0. 2 8. 6 10 0 90 .4 1, 16 5 R ic he st 61 .3 4. 2 0. 1 0. 3 0. 0 23 .4 0. 3 10 .4 10 0 88 .9 1, 23 3 To ta l 53 .9 10 .1 0. 6 0. 9 0. 0 24 .6 0. 8 9. 1 10 0 88 .5 5, 96 0 [1 ] M IC S in di ca to r 4 .6 Jamaica Multiple Indicator Cluster Survey 2011 78 Jamaica Multiple Indicator Cluster Survey 201179 Jamaica Multiple Indicator Cluster Survey 2011 80 81 VII. Reproductive Health addresses the reproductive processes, functions and system. Implicit within the framework of WHO's definition, is the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide the best chance of having a healthy infant. FERTILITY In MICS4, adolescent birth rates and total fertility rates are calculated by using information on the date of last birth of each woman and are based on the one-year period (1-12 months) preceding the survey. Rates are underestimated by a very small margin due to absence of information on multiple births (twins, triplets etc.) and on women having multiple deliveries during the one year period preceding the survey. Tables RH.1A and RH.1B show adolescent birth rates and total fertility rate. The adolescent birth rate (age-specific fertility rate for women age 15-19) is defined as the number of births to women age 15-19 years during the one year period preceding the survey, divided by the average number of women age 15- 19 (number of women-years lived between ages 15 through 19, inclusive) during the same period, expressed per 1000 women. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. The data show a higher GFR and TFR among rural women. The highest age specific fertility rate of 129 births per 1000 women occurs among rural women age 25-29. TABLE RH.1A: FERTILITY RATES ADOLESCENT BIRTH RATE, AGE-SPECIFIC AND TOTAL FERTILITY RATES, THE GENERAL FERTILITY RATE, AND THE CRUDE BIRTH RATE FOR THE ONE YEAR PRECEDING THE SURVEY, BY AREA, JAMAICA 2011 Urban Total Age 15-191 72 70 20-24 112 106 25-29 110 118 30-34 61 72 35-39 53 59 40-44 7 16 45-49 2 5 3 Total Fertility Rate (TFR) 2.1 2.2 General Fertility Rate (GFR) 70 74 Crude Birth Rate (CBR) 17 18 [1] MICS indicator 5.1; MDG indicator 5.4 Reproductive Health Rural 67 98 129 91 68 27 2.4 80 19 Note7: TFR: Total fertility rate expressed per woman age 15-49 GFR: General fertility rate expressed per 1,000 women age 15-49 CBR: Crude birth rate expressed per 1,000 population However, the adolescent birth rate is lower among women age 15-19 in rural areas. Adolescents with no or primary education exhibit a high birth rate of 177 per 1000 women of that age, more than twice the rate among adolescents with tertiary education (87 per 1000 women). The number of births per 1000 women is highest among adolescents in the poorest and second poorest quintiles. TABLE RH.1B ADOLESCENT BIRTH RATES AND TOTAL FERTILITY RATES, JAMAICA, 2011 Adolescent birth rate [1] (Age-specific fertility rate for women age 15-19) Total Fertility Rate Area Urban KMA 73 1.8 Other towns 70 2.6 Urban total 72 2.1 Rural 67 2.4 Mother's Education None/Primary 177 1.7 Secondary 66 2.4 Tertiary 87 1.9 Wealth Index Quintiles Poorest 100 3.2 Second 107 2.6 Middle 77 2.5 Fourth 48 1.6 Richest 7 1.4 Total 70 2.2 [1] MICS indicator 5.1; [1] MICS indicator 5.4 7 Age-specific fertility rate is defined as the number of live births to women of a specific age group during the one year period preceding the survey divided by the average number of women in that age group during the same period, expressed per 1000 women. The age-specific fertility rate for women age 15-19 is also referred as the adolescent birth rate. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. The general fertility rate (GFR) is number of live births to women age 15-49 years during the one year period preceding the survey divided by the average number of women in the same age group during the same period, expressed per 1000 women. The crude birth rate (CBR) is the number of births during the one year period preceding the survey, divided by the total population during the same period, expressed per 1,000 population. Age specific and total fertility rates are calculated by using information on the date of last birth of each woman (CM12) and are based on the one-year period (1-12 months) preceding the survey. Jamaica Multiple Indicator Cluster Survey 201181 Note7: TFR: Total fertility rate expressed per woman age 15-49 GFR: General fertility rate expressed per 1,000 women age 15-49 CBR: Crude birth rate expressed per 1,000 population However, the adolescent birth rate is lower among women age 15-19 in rural areas. Adolescents with no or primary education exhibit a high birth rate of 177 per 1000 women of that age, more than twice the rate among adolescents with tertiary education (87 per 1000 women). The number of births per 1000 women is highest among adolescents in the poorest and second poorest quintiles. TABLE RH.1B ADOLESCENT BIRTH RATES AND TOTAL FERTILITY RATES, JAMAICA, 2011 Adolescent birth rate [1] (Age-specific fertility rate for women age 15-19) Total Fertility Rate Area Urban KMA 73 1.8 Other towns 70 2.6 Urban total 72 2.1 Rural 67 2.4 Mother's Education None/Primary 177 1.7 Secondary 66 2.4 Tertiary 87 1.9 Wealth Index Quintiles Poorest 100 3.2 Second 107 2.6 Middle 77 2.5 Fourth 48 1.6 Richest 7 1.4 Total 70 2.2 [1] MICS indicator 5.1; [1] MICS indicator 5.4 7 Age-specific fertility rate is defined as the number of live births to women of a specific age group during the one year period preceding the survey divided by the average number of women in that age group during the same period, expressed per 1000 women. The age-specific fertility rate for women age 15-19 is also referred as the adolescent birth rate. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. The general fertility rate (GFR) is number of live births to women age 15-49 years during the one year period preceding the survey divided by the average number of women in the same age group during the same period, expressed per 1000 women. The crude birth rate (CBR) is the number of births during the one year period preceding the survey, divided by the total population during the same period, expressed per 1,000 population. Age specific and total fertility rates are calculated by using information on the date of last birth of each woman (CM12) and are based on the one-year period (1-12 months) preceding the survey. Note7: TFR: Total fertility rate expressed per woman age 15-49 GFR: General fertility rate expressed per 1,000 women age 15-49 CBR: Crude birth rate expressed per 1,000 population However, the adolescent birth rate is lower among women age 15-19 in rural areas. Adolescents with no or primary education exhibit a high birth rate of 177 per 1000 women of that age, more than twice the rate among adolescents with tertiary education (87 per 1000 women). The number of births per 1000 women is highest among adolescents in the poorest and second poorest quintiles. TABLE RH.1B ADOLESCENT BIRTH RATES AND TOTAL FERTILITY RATES, JAMAICA, 2011 Adolescent birth rate [1] (Age-specific fertility rate for women age 15-19) Total Fertility Rate Area Urban KMA 73 1.8 Other towns 70 2.6 Urban total 72 2.1 Rural 67 2.4 Mother's Education None/Primary 177 1.7 Secondary 66 2.4 Tertiary 87 1.9 Wealth Index Quintiles Poorest 100 3.2 Second 107 2.6 Middle 77 2.5 Fourth 48 1.6 Richest 7 1.4 Total 70 2.2 [1] MICS indicator 5.1; [1] MICS indicator 5.4 7 Age-specific fertility rate is defined as the number of live births to women of a specific age group during the one year period preceding the survey divided by the average number of women in that age group during the same period, expressed per 1000 women. The age-specific fertility rate for women age 15-19 is also referred as the adolescent birth rate. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. The general fertility rate (GFR) is number of live births to women age 15-49 years during the one year period preceding the survey divided by the average number of women in the same age group during the same period, expressed per 1000 women. The crude birth rate (CBR) is the number of births during the one year period preceding the survey, divided by the total population during the same period, expressed per 1,000 population. Age specific and total fertility rates are calculated by using information on the date of last birth of each woman (CM12) and are based on the one-year period (1-12 months) preceding the survey. Note7: TFR: Total fertility rate expressed per woman age 15-49 GFR: General fertility rate expressed per 1,000 women age 15-49 CBR: Crude birth rate expressed per 1,000 population However, the adolescent birth rate is lower among women age 15-19 in rural areas. Adolescents with no or primary education exhibit a high birth rate of 177 per 1000 women of that age, more than twice the rate among adolescents with tertiary education (87 per 1000 women). The number of births per 1000 women is highest among adolescents in the poorest and second poorest quintiles. TABLE RH.1B ADOLESCENT BIRTH RATES AND TOTAL FERTILITY RATES, JAMAICA, 2011 Adolescent birth rate [1] (Age-specific fertility rate for women age 15-19) Total Fertility Rate Area Urban KMA 73 1.8 Other towns 70 2.6 Urban total 72 2.1 Rural 67 2.4 Mother's Education None/Primary 177 1.7 Secondary 66 2.4 Tertiary 87 1.9 Wealth Index Quintiles Poorest 100 3.2 Second 107 2.6 Middle 77 2.5 Fourth 48 1.6 Richest 7 1.4 Total 70 2.2 [1] MICS indicator 5.1; [1] MICS indicator 5.4 7 Age-specific fertility rate is defined as the number of live births to women of a specific age group during the one year period preceding the survey divided by the average number of women in that age group during the same period, expressed per 1000 women. The age-specific fertility rate for women age 15-19 is also referred as the adolescent birth rate. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates calculated for each of the 5-year age groups of women, from age 15 through to age 49. The TFR denotes the average number of children to which a woman will have given birth by the end of her reproductive years if current fertility rates prevailed. The general fertility rate (GFR) is number of live births to women age 15-49 years during the one year period preceding the survey divided by the average number of women in the same age group during the same period, expressed per 1000 women. The crude birth rate (CBR) is the number of births during the one year period preceding the survey, divided by the total population during the same period, expressed per 1,000 population. Age specific and total fertility rates are calculated by using information on the date of last birth of each woman (CM12) and are based on the one-year period (1-12 months) preceding the survey. Jamaica Multiple Indicator Cluster Survey 2011 82 83 EARLY CHILDBEARING Childbearing early in life carries significant risks for young people all around the world. Table RH.2 presents some early childbearing indicators for women age 15-19 and 20-24. In Jamaica, as shown in Table RH.3, 8.9 per cent of women ages 15-19 years who have already had a birth, or are pregnant with their first child, less than 1 per cent have had a live birth before age 15. Of the women who had a live birth in the age group 15-19, 8 per cent were located in rural areas, 9.3 per cent in KMA, and 9.9 per cent in other towns. TABLE RH.2: EARLY CHILDBEARING PERCENTAGE OF WOMEN AGE 15-19 WHO HAVE HAD A LIVE BIRTH; PERCENTAGE OF WOMEN AGE 15-19 WHO HAVE BEGUN CHILDBEARING BEFORE AGE 15, AND THE PERCENTAGE OF WOMEN AGE 20-24 WHO HAVE HAD A LIVE BIRTH BEFORE AGE 18, JAMAICA, 2011 Number of women age 15- 19 Number of women age 15-19 Percentage of women age 20-24 who have ha

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