Kosovo - Multiple Indicator Cluster Survey - 2013

Publication date: 2013

Monitoring the situation of children and women Multiple Indicator Cluster Survey 2013-2014 Kosovo (UNSCR 1244) Ministry of Foreign Affairs Directorate for Development Cooperation The Kosovo* Multiple Indicator Cluster Survey (MICS) was carried out in 2013-2014 by the Kosovo* Agency of Statistics, as part of the global MICS programme. The above mentioned MICS was conducted in parallel to the 2013-2014 Roma, Ashkali and Egyptian Communities in Kosovo* MICS which was based on a separate sample. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF, the Federal Ministry for European and International Affairs of Austria, the Grand Duchy of Luxembourg, the United Nations Population Fund (UNFPA), and the Ministry of Labour and Social Welfare (MLSW) provided financial support. UNICEF, UNFPA and MLSW as well as the World Health Organisation, the National Institute of Public Health, the Ministry of Health, the Ministry of Education, Science and Technology, the Office of Strategic Planning and the Kosovo* Agency of Statistics of the Office of the Prime Minister were represented on the Inter-Ministerial Technical and Steering Committees. Technical support was provided throughout the entire process through the secondment of UNICEF Staff and Consultants to work alongside the Kosovo* Agency of Statistics during all stages of the implementation of these surveys. Without the accompaniment and support of UNICEF Kosovo* these two surveys would not have been possible. The Kosovo* Agency of Statistics is grateful to the UNICEF Office in Kosovo* for its collaboration. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. The Kosovo* MICS presents up-to-date information for assessing the situation of children, women and men as well as to provide data for monitoring existing strategies and action plans. This MICS will also furnish data for designing future programme interventions and support evidence based planning of Kosovo* institutions. Importantly it will provide data to inform Kosovo*’s EU aspirations and planning in the EU enlargement process while contributing to improved quality in statistics, data collection, management and monitoring systems. Suggested citation: The Kosovo* Agency of Statistics. 2014. 2013-2014 Kosovo* Multiple Indicator Cluster Survey. Prishtinë/Priština, Kosovo*: The Kosovo* Agency of Statistics. * For UNICEF and UNFPA, all references to Kosovo* are made in the context of UN Security Council Resolution 1244 (1999). CREDITS Design: Julie Pudlowski Consulting Photography: © UNICEF Kosovo*/2013/Pirozzi Monitoring the situation of children and women Multiple Indicator Cluster Survey 2013-2014 © U N IC EF K os ov o* /2 01 3/ Pi ro zz i Kosovo* Ministry of Foreign Affairs Directorate for Development Cooperation iv M IC S K o so v o * © U N IC EF K os ov o* /2 01 3/ Pi ro zz i M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N i M IC S K o so v o * Summary Table of Survey Implementation and the Survey Population, Kosovo* MICS, 2013-2014 1 The questionnaire for men age 15-49 was administered in half of the selected households in each cluster. SURVEY POPULATION Average household size Percentage of population under - Age 5 - Age 18 Percentage of women age 15-49 years with at least one live birth in the last 2 years 5.4 7.9 31.8 12.1 Percentage of population living in - Urban areas - Rural areas 37.4 62.6 HOUSING CHARACTERISTICS HOUSEHOLD OR PERSONAL ASSETS Percentage of households with - Finished floor - Finished roofing - Finished walls Mean number of persons per room used for sleeping 96.7 98.2 97.4 2.21 Percentage of households that own - A Flat screen/LCD TV - A refrigerator - Agricultural land - Farm animals/livestock Percentage of households where at least a member has or owns a - Cell phone - Car - Bank account 41.1 96.9 61.5 35.2 97.7 66.9 83.8 SURVEY IMPLEMENTATION Sample frame - Updated 2011 Kosovo* Population and Housing Census August - September 2013 Questionnaires Household Women (age 15-49) Men (age 15-49) Children under five Questionnaire form for Vaccination Records at Health Facility Interviewer training October - November 2013 Fieldwork November 2013 - April 2014 Survey sample Households - Sampled - Occupied - Interviewed - Response rate (Percent) 4,870 4,406 4,127 93.7 Children under five - Eligible - Mothers (or caretakers) interviewed - Response rate (Percent) 1,786 1,648 92.3 Women - Eligible for interviews - Interviewed - Response rate (Percent) 5,915 5,251 88.8 Men1 - Eligible for interviews - Interviewed - Response rate (Percent) 2,921 2,165 74.1 ii M IC S K o so v o * CHILD MORTALITY Early childhood mortalitya MICS Indicator Indicator Description Value 1.1 Neonatal mortality rate Probability of dying within the first month of life 9 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 12 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 3 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 3 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 15 a Indicator values are per 1,000 live births and refer to the five-year period before the survey NUTRITION Nutritional status MICS Indicator Indicator Description Value 2.1a MDG 1.8 2.1b Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard 1.8 0.3 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height for age of the WHO standard 4.3 0.6 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard 1.4 0.3 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard 4.3 Breastfeeding and infant feeding 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 96.7 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 45.4 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 39.9 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishment during the previous day 53.2 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 56.5 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 31.8 2.11 Median duration of breastfeeding The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 14.1 S U M M A R Y T A B L E O F F I N D I N G S Summary Table of Findings2 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Kosovo*, 2013-2014 2 See Appendix E for a detailed description of MICS indicators. M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N iii M IC S K o so v o * MICS Indicator Indicator Description Value 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 46.3 2.13 Introduction of solid, semi-solid or soft foods Percentage of infants age 6-8 months who received solid, semi-solid or soft foods during the previous day 90.3 2.14 Milk feeding frequency for non- breastfed children Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day 81.1 2.15 Minimum meal frequency Percentage of children age 6-23 months who received solid, semi- solid and soft foods (plus milk feeds for non-breastfed children) the minimum number of times or more during the previous day 90.3 2.16 Minimum dietary diversity Percentage of children age 6–23 months who received foods from 4 or more food groups during the previous day 63.3 2.17a 2.17b Minimum acceptable diet (a) Percentage of breastfed children age 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children age 6–23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 47.1 51.8 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 61.6 Low-birthweight 2.20 Low-birthweight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 5.4 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 99.0 CHILD HEALTH Vaccinations MICS Indicator Indicator Description Value 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 98.7 3.2 Polio immunization coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 91.0 3.3 Diphtheria, pertussis and tetanus (DPT) immunization coverage Percentage of children age 12-23 months who received the third dose of DPT vaccine (DPT3) by their first birthday 94.7 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 24-35 months who received measles vaccine by their second birthday 92.1 3.5 Hepatitis B immunization coverage Percentage of children age 12-23 months who received the third dose of Hepatitis B vaccine (HepB3) by their first birthday 94.0 3.6 Haemophilus influenzae type B (Hib) immunization coverage Percentage of children age 12-23 months who received the third dose of Hib vaccine (Hib3) by their first birthday 89.1 3.8 Full immunization coverage Percentage of children age 24-35 months who received all vaccinations recommended in the immunization schedule in Kosovo* by their first birthday (measles by second birthday) 78.5 iv M IC S K o so v o * Diarrhoea MICS Indicator Indicator Description Value - Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 9.1 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 46.9 SS3 Diarrhoea treatment with oral rehydration salts (ORS)4 Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS 38.6 SS Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding5 Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, or increased fluids) and continued feeding during the episode of diarrhoea 35.2 Acute Respiratory Infection (ARI) symptoms - Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 7.8 3.13 Care-seeking for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 73.1 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 38.6 Solid fuel use 3.15 Use of solid fuels for cooking Percentage of household members in households that use solid fuels as the primary source of domestic energy to cook 71.0 Fever - Children with fever Percentage of children under age 5 with fever in the last 2 weeks 20.8 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 71.2 WATER AND SANITATION MICS Indicator Indicator Description Value 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 98.5 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 22.0 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 78.3 4.4 Safe disposal of child’s faeces Percentage of children age 0-2 years whose last stools were disposed of safely 12.7 4.5 Place for handwashing Percentage of households with a specific place for handwashing where water and soap or other cleansing agent are present 90.0 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent 94.2 S U M M A R Y T A B L E O F F I N D I N G S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N v M IC S K o so v o * REPRODUCTIVE HEALTH Contraception and unmet need MICS Indicator Indicator Description Value - Total fertility rate Total fertility rate for women age 15-49 years 2.3 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rate for women age 15-19 years 15 5.2 Early childbearing Percentage of women age 20-24 years who had at least one live birth before age 18 1.4 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method 65.8 5.4 MDG 5.6 Unmet need Percentage of women age 15-49 years who are currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception 8.9 Maternal and newborn health 5.5a MDG 5.5 5.5b MDG 5.5 Antenatal care coverage Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 97.8 91.8 5.6 Content of antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 81.1 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 99.0 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 99.0 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 27.0 Post-natal health checks 5.10 Post-partum stay in health facility Percentage of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years 97.4 5.11 Post-natal health check for the newborn Percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery 95.9 5.12 Post-natal health check for the mother Percentage of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live birth in the last 2 years 85.2 vi M IC S K o so v o * CHILD DEVELOPMENT MICS Indicator Indicator Description Value 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 13.9 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 66.3 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 6.0 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 42.8 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 31.1 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 66.6 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 5.9 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy- numeracy, physical, social-emotional, and learning 83.4 LITERACY AND EDUCATION MICS Indicator Indicator Description Value 7.1 MDG 2.3 Literacy rate among young people Percentage of young people age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education (a) women (b) men 98.0 97.6 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 75.5 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 91.6 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 98.0 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 90.9 SS Lower secondary school net attendance ratio (adjusted) Percentage of children of lower secondary school age currently attending lower secondary school or higher 95.9 SS Upper secondary school net attendance ratio (adjusted) Percentage of children of upper secondary school age currently attending upper secondary school or higher 82.0 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 99.6 S U M M A R Y T A B L E O F F I N D I N G S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N vii M IC S K o so v o * MICS Indicator Indicator Description Value 7.7 Primary completion rate Number of children attending the last grade of primary school (excluding repeaters) divided by number of children of primary school completion age (age appropriate to final grade of primary school) 97.3 7.8 Transition rate to lower secondary schoola Number of children attending the last grade of primary school during the previous school year who are in the first grade of lower secondary school during the current school year divided by number of children attending the last grade of primary school during the previous school year 99.8 SS Transition rate to upper secondary school Number of children attending the last grade of lower secondary school during the previous school year who are in the first grade of upper secondary school during the current school year divided by number of children attending the last grade of lower secondary school during the previous school year 91.5 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 1.00 7.10 MDG 3.1 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 0.97 SS Gender parity index (lower secondary school) Lower secondary school net attendance ratio (adjusted) for girls divided by lower secondary school net attendance ratio (adjusted) for boys 0.99 SS Gender parity index (upper secondary school) Upper secondary school net attendance ratio (adjusted) for girls divided by upper secondary school net attendance ratio (adjusted) for boys 0.96 a Transition rate to lower secondary school corresponds to transition rate to secondary school as defined in MICS global indicator 7.8 CHILD PROTECTION Birth registration MICS Indicator Indicator Description Value 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 88.1 Child labour 8.2 Child labour Percentage of children age 5-17 years who are involved in child labour 10.7 Child discipline 8.3 Violent discipline Percentage of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month 61.4 Early marriage and polygyny 8.4 Marriage before age 15 Percentage of people age 15-49 years who were first married or in union before age 15 (a) Women (b) Men 0.8 0.1 8.5 Marriage before age 18 Percentage of people age 20-49 years who were first married or in union before age 18 (a) Women (b) Men 10.0 1.0 viii M IC S K o so v o * MICS Indicator Indicator Description Value 8.6 Young people age 15-19 years currently married or in union Percentage of young people age 15-19 years who are married or in union (a) Women (b) Men 3.0 0.4 8.7 Polygyny Percentage of people age 15-49 years who are in a polygynous union (a) Women (b) Men 0.5 0.1 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older (a) among women age 15-19 years (b) among women age 20-24 years (4.4) 6.3 ( ) Figure that is based on 25-49 unweighted cases Attitudes towards domestic violence 8.12 Attitudes towards domestic violence Percentage of people age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food (a) Women (b) Men 32.9 14.9 SS Attitudes towards domestic violence (including additional circumstances) Percentage of people age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food, (6) neglects the household and hygiene work, (7) she neglects his parents, (8) she makes him jealous by her behaviour to other men, (9) she makes decisions for the family without consulting him (a) Women (b) Men 42.4 21.9 Children’s living arrangements 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 0.5 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 2.5 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 4.1 HIV/AIDS AND SEXUAL BEHAVIOUR HIV/AIDS knowledge and attitudes MICS Indicator Indicator Description Value - Have heard of AIDS Percentage of people age 15-49 years who have heard of AIDS (a) Women (b) Men 91.4 93.4 S U M M A R Y T A B L E O F F I N D I N G S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N ix M IC S K o so v o * MICS Indicator Indicator Description Value 9.1 MDG 6.3 Knowledge about HIV prevention among young people Percentage of young people age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission (a) Women (b) Men 16.8 17.4 9.2 Knowledge of mother-to-child transmission of HIV Percentage of people age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV (a) Women (b) Men 44.7 38.3 9.3 Accepting attitudes towards people living with HIV Percentage of people age 15-49 years expressing accepting attitudes on all four questions toward people living with HIV (a) Women (b) Men 6.2 8.2 HIV testing 9.4 People who know where to be tested for HIV Percentage of people age 15-49 years who state knowledge of a place to be tested for HIV (a) Women (b) Men 15.5 31.0 9.5 People who have been tested for HIV and know the results Percentage of people age 15-49 years who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 0.7 1.4 9.6 Sexually active young people who have been tested for HIV and know the results Percentage of young people age 15-24 years who have had sex in the last 12 months, who have been tested for HIV in the last 12 months and who know their results (a) Women (b) Men 1.3 1.1 9.7 HIV counselling during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 3.6 9.8 HIV testing during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 2.1 Sexual behaviour 9.9 Young people who have never had sex Percentage of never married young people age 15-24 years who have never had sex (a) Women (b) Men 91.1 54.5 9.10 Sex before age 15 among young people Percentage of young people age 15-24 years who had sexual intercourse before age 15 (a) Women (b) Men 0.2 4.4 9.11 Age-mixing among sexual partners Percentage of women age 15-24 years who had sex in the last 12 months with a partner who was 10 or more years older 6.5 x M IC S K o so v o * MICS Indicator Indicator Description Value 9.12 Multiple sexual partnerships Percentage of people age 15-49 years who had sexual intercourse with more than one partner in the last 12 months (a) Women (b) Men 0.0 7.1 9.13 Condom use at last sex among people with multiple sexual partnerships Percentage of people age 15-49 years who report having had more than one sexual partner in the last 12 months who also reported that a condom was used the last time they had sex (a) Women (b) Men (*) 36.8 9.14 Sex with non-regular partners Percentage of sexually active young people age 15-24 years who had sex with a non-marital, non-cohabitating partner in the last 12 months (a) Women (b) Men 6.9 37.1 9.15 MDG 6.2 Condom use with non-regular partners Percentage of young people age 15-24 years reporting the use of a condom during the last sexual intercourse with a non-marital, non- cohabiting sex partner in the last 12 months (a) Women (b) Men 37.3 67.6 (*) Figure that is based on fewer than 25 unweighted cases Male circumcision 9.17 Male circumcision Percentage of men age 15-49 years who report having been circumcised 91.5 ACCESS TO MASS MEDIA AND ICT Access to mass media MICS Indicator Indicator Description Value 10.1 Exposure to mass media Percentage of people age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television (a) Women (b) Men 23.4 42.4 Use of information/communication technology 10.2 Use of computers Percentage of young people age 15-24 years who used a computer during the last 12 months (a) Women (b) Men 93.6 92.8 10.3 Use of internet Percentage of young people age 15-24 years who used the internet during the last 12 months (a) Women (b) Men 95.0 96.9 S U M M A R Y T A B L E O F F I N D I N G S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xi M IC S K o so v o * SUBJECTIVE WELL-BEING MICS Indicator Indicator Description Value 11.1 Life satisfaction Percentage of young people age 15-24 years who are very or somewhat satisfied with their life, overall (a) Women (b) Men 91.8 93.0 11.2 Happiness Percentage of young people age 15-24 years who are very or somewhat happy (a) Women (b) Men 90.0 83.4 11.3 Perception of a better life Percentage of young people age 15-24 years whose life improved during the last one year, and who expect that their life will be better after one year (a) Women (b) Men 51.9 56.7 TOBACCO AND ALCOHOL USE Tobacco use MICS Indicator Indicator Description Value 12.1 Tobacco use Percentage of people age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month (a) Women (b) Men 19.3 34.3 12.2 Smoking before age 15 Percentage of people age 15-49 years who smoked a whole cigarette before age 15 (a) Women (b) Men 4.9 29.1 Alcohol use 12.3 Use of alcohol Percentage of people age 15-49 years who had at least one alcoholic drink at any time during the last one month (a) Women (b) Men 9.6 34.8 12.4 Use of alcohol before age 15 Percentage of people age 15-49 years who had at least one alcoholic drink before age 15 (a) Women (b) Men 1.3 10.8 xii M IC S K o so v o * © U N IC EF K os ov o* /2 01 4/ Be qi ri M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xiii M IC S K o so v o * TABLE OF CONTENTS Summary Table of Survey Implementation and the Survey Population, Kosovo* MICS, 2013-2014 . . . . i List of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi List of Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxii Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xxiii Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxv I . INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Survey Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 II . Sample and Survey Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Sample Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Training and Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Data Processing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 How to Read Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 III . Sample Coverage and the Characteristics of Households and Respondents . . . . . . . . . . . . . . . . . . . 9 Sample Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Characteristics of Households . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Characteristics of Female and Male Respondents 15-49 Years of Age and Children Under-5 . . . . . . . . . . . . . . . . 13 Housing characteristics, asset ownership, and wealth quintiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 IV . Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 V . Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Low Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27 Breastfeeding and Infant and Young Child Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 VI . Child Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 Care of Illness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44 Acute Respiratory Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Solid Fuel Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 xiv M IC S K o so v o * VII . Water and Sanitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Use of Improved Water Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 Use of Improved Sanitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 Handwashing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 VIII . Reproductive Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Fertility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73 Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Unmet Need. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Antenatal Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .82 Assistance at Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 Place of Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88 Post-natal Health Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .90 Abortions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97 IX . Early Childhood Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Early Childhood Care and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99 Quality of Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .100 Developmental Status of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 X . Literacy and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Literacy among Young Women and Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107 School Readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .108 Primary and Secondary School Participation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109 XI . Child Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Birth Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121 Child Labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123 Child Discipline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 Early Marriage and Polygyny. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130 Attitudes toward Domestic Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .135 Children’s Living Arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 XII . HIV/AIDS and Sexual Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 HIV/AIDS and Sexual Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Accepting Attitudes toward People Living with HIV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care. . . . . . . . . . . . . . . . . . . . .149 Sexual Behaviour Related to HIV Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 HIV Indicators for Young Women and Young Men. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .155 Male circumcision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159 XIII . Access to Mass Media and Use of Information/ Communication Technology . . . . . . . . . . . . . . . . . 163 Access to Mass Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163 Use of Information/Communication Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165 T A B L E O F C O N T E N T S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xv M IC S K o so v o * XIV . Subjective well-being . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 XV . Tobacco and Alcohol Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177 Alcohol Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .182 Appendix A . Sample Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186 Appendix B . List of Personnel Involved in the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .189 Appendix C . Estimates of Sampling Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193 Appendix D . Data Quality Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .202 Appendix E . Kosovo* MICS5 Indicators:Numerators and Denominators. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213 Appendix F1 . Household Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221 Appendix F2 . Questionnaire for Individual Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237 Appendix F3 . Questionnaire for Individual Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .265 Appendix F4 . Questionnaire for Children Under Five . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .279 Appendix F5 . Questionnaire Form for Vaccination Records at Health Facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293 Appendix G . Education according to the International Standard Classification (ISCED) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 xvi M IC S K o so v o * LIST OF TABLES Table HH.1: Results of household, women’s, men’s and under-5 interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Table HH.2: Age distribution of household population by sex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Table HH.3: Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table HH.4: Women’s background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Table HH.4M: Men’s background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Table HH.5: Under-5s’ background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table HH.6: Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Table HH.7: Household and personal assets. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table HH.8: Wealth quintiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table CM.1: Early childhood mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Table CM.2: Early childhood mortality rates by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table NU.1: Low birth weight infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Table NU.2: Nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table NU.3: Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table NU.4: Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Table NU.5: Duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table NU.6: Age-appropriate breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table NU.7: Introduction of solid, semi-solid, or soft foods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table NU.8: Infant and young child feeding (IYCF) practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table NU.9: Bottle feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table CH.1: Vaccinations in the first years of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table CH.2: Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table CH.3: Reported disease episodes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table CH.4: Care-seeking during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table CH.5: Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table CH.6: Oral rehydration solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table CH.7: Oral rehydration therapy with continued feeding and other treatments . . . . . . . . . . . . . . . . . . . . . . 48 Table CH.8: Source of ORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Table CH.9: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) . . . 51 Table CH.10: Knowledge of the two danger signs of pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Table CH.11: Solid fuel use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table CH.12: Solid fuel use by place of cooking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Table CH.13: Care-seeking during fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table CH.14: Treatment of children with fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table WS.1: Use of improved water sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Table WS.2: Household water treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table WS.3: Time to source of drinking water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table WS.4: Person collecting water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 L I S T O F T A B L E S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xvii M IC S K o so v o * Table WS.5: Types of sanitation facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table WS.6: Use and sharing of sanitation facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table WS.7: Drinking water and sanitation ladders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table WS.8: Disposal of child’s faeces. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table WS.9: Water and soap at place for handwashing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table WS.10: Availability of soap or other cleansing agent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table RH.1: Fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Table RH.2: Adolescent birth rate and total fertility rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Table RH.3: Early childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Table RH.4: Trends in early childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table RH.5: Use of contraception. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table RH.5A: Source of modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table RH.5B: Specific sources of modern contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Table RH.6: Unmet need for contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table RH.7: Antenatal care coverage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table RH.8: Number of antenatal care visits and timing of first visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table RH.9: Content of antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Table RH.10: Assistance during delivery and caesarean section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table RH.10A: Influence to have a caesarean section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table RH.11: Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Table RH.12A: Post-partum stay in health facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Table RH.13A: Post-natal health checks for newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table RH.14A: Post-natal care visits for newborns within the first week following discharge from health facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Table RH.15A: Post-natal health checks for mothers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table RH.16A: Post-natal care visits for mothers within the first week following discharge from health facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table RH.17: Post-natal health checks for mothers and newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Table RH.18: Lifetime experience with wasted pregnancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Table CD.1: Early childhood education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table CD.2: Support for learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Table CD.3: Learning materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Table CD.4: Inadequate care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table CD.5: Early child development index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table ED.1: Literacy (young women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Table ED.1M: Literacy (young men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Table ED.2: School readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Table ED.3: Primary school entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 xviii M IC S K o so v o * Table ED.4: Primary school attendance and out of school children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table ED.5A: Lower secondary school attendance and out of school children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Table ED.5B: Upper secondary school attendance and out of school children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table ED.6: Children reaching last grade of primary school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Table ED.7: Primary school completion and transition to lower secondary school . . . . . . . . . . . . . . . . . . . . . . . . 115 Table ED.8A: Education gender parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table ED.9A: Out of school gender parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Table ED.10: Summary of education indicators (ISCED ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Table CP.1: Birth registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Table CP.2: Children’s involvement in economic activities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Table CP.3: Children’s involvement in household chores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Table CP.4: Child labour. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Table CP.5: Child discipline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Table CP.6: Attitudes toward physical punishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Table CP.7: Early marriage and polygyny (women). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Table CP.7M: Early marriage and polygyny (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Table CP.8: Trends in early marriage (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Table CP.8M: Trends in early marriage (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Table CP.9: Spousal age difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table CP.10: Attitudes toward domestic violence (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table CP.10M: Attitudes toward domestic violence (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table CP.11: Children’s living arrangements and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Table CP.12: Children with parents living abroad . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Table HA.2: Knowledge of mother-to-child HIV transmission (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Table HA.2M: Knowledge of mother-to-child HIV transmission (men). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Table HA.3: Accepting attitudes toward people living with HIV (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Table HA.3M: Accepting attitudes toward people living with HIV (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Table HA.4: Knowledge of a place for HIV testing (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Table HA.4M: Knowledge of a place for HIV testing (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Table HA.5: HIV counselling and testing during antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Table HA.6: Sex with multiple partners (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Table HA.6M: Sex with multiple partners (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Table HA.7: Key HIV and AIDS indicators (young women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Table HA.7M: Key HIV and AIDS indicators (young men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 L I S T O F T A B L E S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xix M IC S K o so v o * Table HA.8: Key sexual behaviour indicators (young women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Table HA.8M: Key sexual behaviour indicators (young men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Table HA.9: Male circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 Table HA.10: Provider and location of circumcision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Table MT.1: Exposure to mass media (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Table MT.1M: Exposure to mass media (men). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Table MT.2: Use of computers and internet (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Table MT.2M: Use of computers and internet (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Table SW.1: Domains of life satisfaction (women). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170 Table SW.1M: Domains of life satisfaction (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Table SW.2: Overall life satisfaction and happiness (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Table SW.2M: Overall life satisfaction and happiness (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Table SW.3: Perception of a better life (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Table SW.3M: Perception of a better life (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Table TA.1: Current and ever use of tobacco (women). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 Table TA.1M: Current and ever use of tobacco (men). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 Table TA.2: Age at first use of cigarettes and frequency of use (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Table TA.2M: Age at first use of cigarettes and frequency of use (men) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 Table TA.3: Use of alcohol (women) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Table TA.3M: Use of alcohol (men). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Table SD.1: Proposed Number of Sample EAs and Households by Region and Stratum . . . . . . . . . . . . . . . . . . . 186 Table SE.1: Indicators selected for sampling error calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Table SE.2: Sampling errors: Total sample. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Table SE.3: Sampling errors: Urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Table SE.4: Sampling errors: Rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Table DQ.1: Age distribution of household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Table DQ.2: Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Table DQ.3: Age distribution of eligible and interviewed men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Table DQ.4: Age distribution of children in household and under-5 questionnaires . . . . . . . . . . . . . . . . . . . . . . 204 Table DQ.5: Birth date reporting: Household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Table DQ.6: Birth date and age reporting: Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Table DQ.7: Birth date and age reporting: Men. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Table DQ.8: Birth date and age reporting: Under-5s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Table DQ.9: Birth date reporting: Children, adolescents and young people . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Table DQ.10: Birth date reporting: First and last births . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Table DQ.11: Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 Table DQ.12: Completeness of information for anthropometric indicators: Underweight . . . . . . . . . . . . . . . . . 206 Table DQ.13: Completeness of information for anthropometric indicators: Stunting . . . . . . . . . . . . . . . . . . . . . . 207 xx M IC S K o so v o * Table DQ.14: Completeness of information for anthropometric indicators: Wasting . . . . . . . . . . . . . . . . . . . . . . 207 Table DQ.15: Heaping in anthropometric measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Table DQ.16: Observation of birth certificates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Table DQ.17: Observation of vaccination cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208 Table DQ.18: Observation of places for handwashing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Table DQ.19: Respondent to the under-5 questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Table DQ.20: Selection of children age 1-17 years for the child labour and child discipline modules . . . . . . . 209 Table DQ.21: School attendance by single age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Table DQ.22: Sex ratio at birth among children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Table DQ.23: Births by periods preceding the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Table DQ.24: Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Table DQ.25: Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Table ED.G1: Secondary school attendance and out of school children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Table ED.G2: Education gender parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296 Table ED.G3: Out of school gender parity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 L I S T O F T A B L E S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xxi M IC S K o so v o * LIST OF FIGURES Figure HH.1: Age and sex distribution of household population. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Figure CM.1: Early childhood mortality rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Figure CM.2: Under-5 mortality rates by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Figure CM.3: Trend in infant mortality rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe) . . 29 Figure NU.2: Infant feeding patterns by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Figure CH.1: Vaccinations by age 12 months (measles by 24 months) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Figure CH.2: Children under-5 with diarrhoea who received ORS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Figure CH.3: Children under-5 with diarrhoea receiving oral rehydration therapy (ORT) and continued feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Figure WS.1: Percent distribution of household members by source of drinking water. . . . . . . . . . . . . . . . . . . . . 61 Figure WS.2: Percent distribution of household members by use and sharing of sanitation facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Figure WS.3: Use of improved drinking water sources and improved sanitation facilities by household members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Figure RH.1: Age-specific fertility rates by area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Figure RH.2: Differentials in contraceptive use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Figure RH.3: Person assisting at delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Figure ED.1: Education indicators by sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Figure CP.1: Children under-5 whose births are registered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Figure CP.2: Child disciplining methods, children age 1-14 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Figure CP.3: Early marriage among women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Figure HA.1: Women and men with comprehensive knowledge of HIV transmission. . . . . . . . . . . . . . . . . . . . . . 144 Figure HA.2: Accepting attitudes toward people living with HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Figure HA.3: Sexual behaviour that increases the risk of HIV infection, young people age 15-24. . . . . . . . . . . 159 Figure TA.1: Ever and current smokers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Figure DQ.1: Household population by single ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Figure DQ.2: Weight and height/length measurements by digits reported for the decimal points. . . . . . . . . 208 xxii M IC S K o so v o * LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome ARI Acute Respiratory Infection ASFR Age-Specific Fertility Rate BCG Bacillus Calmette-Guérin (Tuberculosis) CBR Crude Birth Rate CEE/CIS Central and Eastern Europe and the Commonwealth of Independent States CHERG Child Health Epidemiology Reference Group CRC Convention on the Rights of the Child CSPro Census and Survey Processing System deff Design Effect DHS Demographic and Health Survey DPR Disaster Preparedness and Response DPR Disability, Injury Prevention and Rehabilitation DPT Diphteria Pertussis Tetanus EA Enumeration Area ECD Early Childhood Development ECDI Early Child Development Index ECE Early Childhood Education EPI Expanded Programme on Immunization EU European Union GPI Gender Parity Index HepB Hepatitis B Hib Haemophilus influenzae type B HIV Human Immunodeficiency Virus IMR Infant Mortality Rate IUD Intrauterine Device JMP WHO / UNICEF Joint Monitoring Programme LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Clusters Surveys programme MLSW Ministry of Labour and Social Welfare MMR Measles, Mumps and Rubella MNCH Maternal, Newborn, and Child Health MoH Ministry of Health NAR Net Attendance Ratio NPO National Professional Officer OECD Organisation for Economic Co-operation and Development OPV Oral Polio Vaccine ORT Oral Rehydration Treatment PAHO Pan American Health Organization PNC Post-Natal Care PSU Primary Sampling Unit SPSS Statistical Package for Social Sciences STI Sexually Transmitted Infections TFR Total Fertility Rate UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WASH Water, Sanitation and Hygiene WFFC World Fit for Children WHO World Health Organization L I S T O F A B B R E V I A T I O N S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xxiii M IC S K o so v o * ACKNOWLEDGEMENTS The Kosovo* Agency for Statistics would like to take this opportunity to acknowledge all the participants in the Kosovo* MICS who gave their contribution towards the implementation of the survey and in the preparation of this report. The hard work and commitment of the staff in the Kosovo* Agency for Statistics greatly contributed to the successful implementation of the survey. Survey implementation was made possible through the financial support of the United Nations Children’s Fund (UNICEF), the Federal Ministry for European and International Affairs of Austria, the Grand Duchy of Luxembourg, the United Nations Population Fund (UNFPA), and the Ministry of Labour and Social Welfare (MLSW). UNICEF, UNFPA and MLSW as well as the World Health Organisation, the National Institute of Public Health, the Ministry of Health, the Ministry of Education, Science and Technology, and the Office of Strategic Planning and the Kosovo* Agency of Statistics of the Office of the Prime Minister were represented on the Inter-Ministerial Technical and Steering Committees. Special thanks are owed to the staff and consultants of the UNICEF Kosovo* Office, UNICEF CEE/CIS Regional Office in Geneva and the global MICS team in UNICEF New York for their professional contribution and assistance in the implementation of this survey. Technical support was provided throughout the entire process through the secondment of UNICEF staff and consultants to work alongside the Kosovo* Agency of Statistics during all stages of survey implementation. Without the accompaniment and support of UNICEF Kosovo* this survey would not have been possible. The Kosovo* Agency of Statistics is grateful to the UNICEF Office in Kosovo* for its collaboration. Special thanks go to Siraj Mahmudlu, UNICEF Regional MICS Coordinator, and the members of the UNICEF regional team, in particular to Ahmet Sinan Türkyılmaz, Ana Abdelbasit and Ikhtier Kholmatov, whose continuous technical and logistical support was of vital importance. We express our sincere gratitude to the global MICS Team, especially Attila Hancıoğlu, Bo Pedersen, David Megill, Ivana Bjelic, Turgay Ünalan, and Yadigar Coşkun, who supported data processing and analysis. Thank you to the members of the MICS Steering Committee and MICS Technical Committee which provided important advice and comments during the preparation of the survey and the development of the questionnaires. We express our genuine gratitude to all the individuals and households of Kosovo* who generously opened the doors of their homes and gave their time to the realisation of this survey. Without their collaboration and contribution, the implementation of this survey would not have been possible and hence our greatest appreciation goes to them. We hope that this report will help to improve the living conditions of all children and women in Kosovo*. xxiv M IC S K o so v o * © U N IC EF K os ov o* /2 01 3/ Pi ro zz i M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xxv M IC S K o so v o * EXECUTIVE SUMMARY The 2013-2014 Kosovo* MICS is a nationally representative sample survey in which 4,127 households, 5,251 women, 2,165 men and 1,648 mothers (or caretakers) on behalf of children under five were interviewed. This MICS was conducted in parallel to the 2013-2014 Roma, Ashkali and Egyptian Communities in Kosovo* MICS which was based on a separate sample. Both MICS surveys were carried out in 2013-2014 in Kosovo* on two independent samples — the Kosovo* MICS on the nationally representative sample and the Roma, Ashkali and Egyptian Communities in Kosovo* MICS on the sample of the population living in those particular communities. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes. The survey presents up-to-date information for assessing the situation of children, women and men as well as to provide data for monitoring existing strategies and action plans. The findings pertain, unless stated otherwise, to November 2013 – April 2014, when the fieldwork was conducted by the Kosovo* Agency of Statistics with financial and technical support from the United Nations Children’s Fund (UNICEF). CHILD MORTALITY During the 15 years preceding the survey mortality has followed a steadily decreasing trend with the infant mortality rate during the five years preceding the survey at 12 per thousand live births, while the under-five mortality rate is 15 per thousand live births. The largest proportion of the infant deaths occur during the neonatal period (9 per thousand live births) and 80 percent of under-five deaths are infant deaths. Although higher, the estimated infant mortality trend according to the survey follows that of administrative data over that last 15 years. LOW BIRTH WEIGHT Almost all infants (99 percent) are weighed at birth and approximately one in twenty (five percent) are estimated to weigh less than 2,500 grams at birth (i.e. to have low birth weight). NUTRITIONAL STATUS One in twenty five children (four percent) under age five are moderately or severely stunted or too short for their age reflecting chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. This low percentage indicates that there is no notable issue related to stunting or underweight in Kosovo* as a whole. Furthermore almost no children under five in Kosovo* were classified as severely underweight, approximately two percent are moderately or severely underweight with four percent overweight or too heavy for their height. BREASTFEEDING AND INFANT AND YOUNG CHILD FEEDING Less than half of newborns (45 percent) are breastfed within one hour of birth and while more than four fifths (86 percent) are breastfed within one day of birth, exclusive breastfeeding is prevalent for only 40 percent of children under six months of age contributing to the rate of age-appropriate breastfeeding of less than half among children 0-23 months (46 percent). The median duration of any breastfeeding is 14.1 months for children under age 3 years, and is 2.0 months for exclusive breastfeeding. While most (90 percent) children were fed at least the minimum number of times, only two thirds (63 percent) received the minimum number of food groups or dietary diversity, hence less than half (49 percent) of children age 6-23 months and only a third (35 percent) from the poorest households were receiving the minimum acceptable diet. VACCINATIONS Less than four fifths (79 percent) of children 24-35 months old are fully immunized in accordance with the Kosovo* immunization schedule. Fortunately there are only minor reductions with each dose of a vaccine e.g. first dose of Polio is received by 98 percent while the third does by 91 percent indicating that of the reduced number who actually start their immunizations, many complete the required series reducing their potential to contract those preventable childhood diseases. While BCG vaccination coverage is very high at 99 percent, barely half of the children received the HepB at birth dose within 24 hours. xxvi M IC S K o so v o * CARE OF ILLNESS Less than one in ten (nine percent) children under age five years reported an episode of diarrhoea and eight percent symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey, while one in five (21 percent) had a fever in the last two weeks. Advice was not sought for more than half (53 percent) of children with diarrhoea or treatment with 23 percent given much less or almost nothing to eat resulting in only one third (35 percent) of children receiving oral rehydration treatment (ORT) and, at the same time, continued feeding which is the recommended course of action. While care seeking for diarrhoea is low, 73 percent of children age 0-59 months with symptoms of ARI were taken to a qualified provider yet only 11 percent of women know at least one of the two danger signs of pneumonia (fast breathing and difficult breathing). SOLID FUEL USE Overall, almost three quarters (71 percent) of the household population use solid fuels for cooking, consisting mainly of wood (70 percent) and yet only eight percent used these fuels in a separate room that is used as a kitchen implying that there is a very high potential for exposure indoor air pollution. USE OF IMPROVED WATER SOURCES While access to an improved source of drinking water is very high on average (99 percent), only half of the population in the poorest wealth quintile have water piped into the dwelling (55 percent). For the seven percent of population which don’t have the source of drinking water on the premises it is most often an adult male (77 percent) or an adult women (19 percent) who collects it. USE OF IMPROVED SANITATION While the vast majority of the population in urban areas has access to improved sanitation (98 percent) only 68 percent of the population in rural areas have the same access with open defecation localised among the poorest population. While only one percent of the population in general use an improved toilet facility that is public or shared with other households, the value is five percent in the poorest population. Slightly more than half of the poorest population (57 percent) have access to improved drinking water sources and improved sanitation, while the highest proportion is found among the population in urban areas (96 percent). Of concern is the fact that only 13 percent of children’s faeces was disposed of safely with the vast majority (85 percent) disposed of in the garbage. HANDWASHING Less than two percent of households could not indicate a specific place where household members usually wash their hands and only nine in ten (88 percent) of the poorest households had soap or other cleansing agent anywhere in the dwelling compared to 93 percent and above for the other wealth quintiles. FERTILITY It is important to note that early childbearing has gradually declined over the last 10 years, most notably in urban areas. CONTRACEPTION Two thirds (66 percent) of women currently married or in union reported current use of contraception. The most popular method, and actually one that is not considered a modern method, is withdrawal which is used by half of married women (51 percent). Modern methods are used by only one in seven married women (14 percent) and less than two percent among those with no living children. The decision on use of contraception appears to typically be a joint decision of the wife and husband (94 percent of the cases). E X E C U T I V E S U M M A R Y M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xxvii M IC S K o so v o * UNMET NEED One in ten married women (nine percent) has expressed unmet need for contraception with the value being highest among those age 20-24 and 25-29 years (14 and 16 percent, respectively). Overall, seven in eight women (88 percent) have the demand for contraception satisfied with the value increasing with age from 78 percent (age 20-24 years) to 94 percent (40-44 years). ANTENATAL CARE The large majority of antenatal care is provided by medical doctors (98 percent) yet a relatively small percentage of women (two percent) do not receive any antenatal care. Almost all mothers (97 percent) received antenatal care more than once and 92 percent received antenatal care the recommended minimum of four times. About four fifths (82 percent) of the women living in poorest households received four or more antenatal care visits while it is almost universal (99 percent) among those living in the richest households. While access to antenatal care is largely sought in general and 95 percent of women had their first antenatal care visit within the first trimester, nine percent of women in the poorest households do not get their first antenatal care visit during the first trimester and five percent of the poorest women had no antenatal care. The most common content of antenatal care was an ultrasound (98 percent of women) while barely half (57 percent of women) had their health book updated indicating that although antenatal care is largely received, the full range of possible content provision is lacking. ASSISTANCE AT DELIVERY Almost all births (99 percent) occurring in the two years preceding the MICS survey were delivered by skilled personnel (90 percent doctors and nine percent delivered with assistance of a nurse/midwife). Overall, a quarter (27 percent) of women delivered in the last two years by C-section with the decision being taken before the onset of labour pains in 18 percent of cases. The percent of women who delivered in the last two years by C-section is higher (33 percent) in urban areas compared to rural areas (24 percent) as well as among women from the richest households (35 percent). The doctor was the main influence on decision for the birth to be delivered by C-section in 75 percent of the cases with 16 percent of cases it being the woman. PLACE OF DELIVERY Less than one percent of births take place at home while 96 percent are delivered in a public health facility and three percent in the private sector. POST-NATAL HEALTH CHECKS While 97 percent of women who gave birth in a health facility stay in the facility 12 hours or more after delivery, half stay two days or more and nine percent stayed seven days or more. Importantly almost one in ten (eight percent) of newborns did not receive any post-natal care visit following discharge from a health facility with this value as high as 15 percent for newborns from older mothers. All (100 percent) post-natal care visits for newborns within the first week following discharge from the health facility are provided by a doctor / nurse / midwife and 60 percent occur in the public sector. While the majority (92 percent) of newborns were visited following discharge from the health facility, less than half of the mothers were visited to check their health (43 percent). 38 percent of those women with a C-section were not visited following discharge from the health facility and 68 percent of those from the poorest households did not receive any post-natal care visit upon discharge. ABORTIONS Overall, eight percent of women age 15-49 years have had at least one induced abortion and this increases to 17 percent of women age 45-49 years. Among women who had an abortion 25 percent had two or three abortions while four percent had four or more abortions. xxviii M IC S K o so v o * EARLY CHILDHOOD CARE AND EDUCATION 14 percent of children age 36-59 months were attending an organised early childhood education programme with only nine percent in rural areas and seven percent among children from the poorest households. QUALITY OF CARE For only two thirds (66 percent) of children age 36-59 months, an adult household member engaged in four or more activities that promote learning and school readiness during the three days preceding the survey. The father’s involvement in such activities was extremely limited at only six percent while 43 percent of mothers engaged with their children in such activities. Furthermore, only a third (31 percent) of children under five live in households where at least three children’s books are present while the proportion of children with 10 or more books declines to only 10 percent. EARLY CHILD DEVELOPMENT INDEX (ECDI) Four fifths (83 percent) of children age 36-59 months are developmentally on track with slightly higher ECDI observed in children attending an early childhood education programme (90 percent). While 97 percent of children are on track in the physical domain and 96 in the learning domain, only 83 percent are on track in the social-emotional and less than one in five (18 percent) are on track in the literacy-numeracy domain. LITERACY AMONG YOUNG WOMEN AND MEN Almost all (98 percent) of young women age 15-24 years are literate and 93 percent of those who stated that lower secondary school was their highest level of education. The literacy rate among young men age 15-24 years was similar at 98 percent with only 82 percent of men who stated that lower secondary school was their highest level of education were actually able to read. SCHOOL READINESS Three quarters (76 percent) of children who are currently attending the first grade of primary school were attending pre-school the previous year and 64 percent among children in the poorest households. PRIMARY AND SECONDARY SCHOOL PARTICIPATION The majority of children of primary school age are attending school (98 percent) yet only 92 percent of primary school entry age children (age 6) attend the first grade of primary school. Two percent of primary school age children are out of school and one-tenth (10 percent) of male children age 6 are out of school. Similar to primary school, 96 percent of the children are attending lower secondary school or higher. A positive correlation with educational attainment of the mother is observed; among mothers with no education, the proportion of children attending lower secondary school is 86 percent, while it is 98 percent among children whose mother has lower secondary education herself. Only four fifths (82 percent) of the children are attending upper secondary school. Of the remaining one fifth, most (14 percent) are completely out of school. One fifth (21 percent) of girl children are out of school in rural areas compared to 13 percent of boys. While one in seven children (14 percent) attend early childhood education, all children starting grade one will eventually reach grade 5 and the primary school completion rate is 97 percent. Fortunately all children transition from primary to lower secondary with attendance rates at 98 percent. 92 percent transition to upper secondary and the attendance rates are about 90 percent. While the gender parity for primary school is close to 1.00, indicating no difference in the attendance of girls and boys to primary school, the indicator drops to 0.99 for lower secondary education and even lower to 0.96 for upper secondary education. The disadvantage of girls is particularly pronounced in rural areas at the upper secondary level (0.92) as well as among children living in the poorest households (0.90). E X E C U T I V E S U M M A R Y M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xxix M IC S K o so v o * BIRTH REGISTRATION While 74 percent of children possess a birth certificate, the births of 88 percent of children under five years have been reported as registered and registration becomes more likely as a child grows older. Sadly, a quarter (23 percent) of mothers of unregistered children do not knowing how to register a child’s birth. CHILD LABOUR Eight percent of children age 5-11 years, 14 percent age 12-14 years, and 26 percent age 15-17 years are engaged in economic activities. Male children far more likely to be involved in child labour based on economic activities. Child labour among those age 12-14 years based on economic activities is more commonplace in rural areas (eight percent) than urban areas (one percent). In general 16 percent of male children and five percent of female children are involved in child labour. Seven percent of children age 5-17 years are working under hazardous conditions and 12 percent of children age 5-17 years who are not attending school are involved in child labour. CHILD DISCIPLINE Three fifths (61 percent) of children age 1-14 years were subjected to at least one form of psychological or physical punishment by household members during the past month and 24 percent experienced physical punishment. While only a third (31 percent) of children were disciplined in an only non-violent manner, six percent were subjected to severe punishment (hitting the child on the head, ears or face or hitting the child hard and repeatedly). One tenth (10 percent) of respondents to the household questionnaire believe that physical punishment is a necessary part of child-rearing. EARLY MARRIAGE AND POLYGYNY The proportion of women married or in union by age 15 or 18 has gradually declined over time. One percent of women age 15-49 years were married before age 15, one tenth (10 percent) of women age 20-49 years were married before age 18. About three percent of young women age 15-19 years are currently married. ATTITUDES TOWARD DOMESTIC VIOLENCE Overall, a third (33 percent) of women feel that a husband is justified in hitting or beating his wife in at least one of five situations. Women in most cases agree and justify violence in instances when a wife neglects the children (28 percent) or if she demonstrates her autonomy exemplified by going out without telling her husband (17 percent) or arguing with him (14 percent). Around one-tenth of women believe that wife-beating is justified if the wife refuses to have sex with the husband and five percent if she burns the food. Justification in any of the five situations is less present among those living in richest households, more educated, and also never married women. With increasing education women are less likely to feel that a husband is justified in hitting or beating his wife with 68 percent agreeing with no education compared to nine percent agreeing with higher education. In general men are less likely to justify violence than women with 15 percent of men justifying wife-beating for any of the five reasons. CHILDREN’S LIVING ARRANGEMENTS A very small proportion of children have lost one or both parents with 92 percent of children age 0-17 years living with both parents and less than one percent living with neither of their biological parents while both of them are alive. xxx M IC S K o so v o * KNOWLEDGE ABOUT HIV TRANSMISSION AND MISCONCEPTIONS ABOUT HIV Most (91 percent) of the women age 15-49 years and men (93 percent) age 15-49 years have heard of AIDS. Yet, the percentage of those who know of both main ways of preventing HIV transmission – having only one faithful uninfected partner and using a condom every time – is only 60 percent for women and 81 percent for men. People who have comprehensive knowledge about HIV prevention include those who know of the two main ways of HIV prevention (having only one faithful uninfected partner and using a condom every time), who know that a healthy looking person can be HIV-positive, and who reject the two most common misconceptions. Comprehensive knowledge of HIV prevention methods and transmission is low with 15 percent of women and 20 percent of men. Overall, three quarters (73 percent of women and 72 percent of men) know that HIV can be transmitted from mother to child. The percentage of women and men who know all three ways of mother-to-child transmission is about half (45 percent) and a quarter (38 percent) respectively, while 18 percent of women and 21 percent of men did not know of any specific way. ACCEPTING ATTITUDES TOWARD PEOPLE LIVING WITH HIV While agreement with at least one accepting attitude is almost universal (due in large part to high levels of willingness to care for a family member with AIDS in their own home), expressions of accepting attitudes on all four indicators are almost non-existent at six percent for women and eight percent for men. KNOWLEDGE OF A PLACE FOR HIV TESTING, COUNSELLING AND TESTING DURING ANTENATAL CARE While only 16 percent of women and 31 percent of men know where to be tested, only three percent and seven percent respectively have actually been tested with similar percentages knowing the result of their most recent test. While antenatal care coverage from a health care professional for their last pregnancy is almost universal (98 percent), only four percent received HIV counselling during their antenatal care and then two percent were offered an HIV test and were tested for HIV. SEXUAL BEHAVIOUR RELATED TO HIV TRANSMISSION No women and seven percent of men 15-49 years of age report having sex with more than one partner in the last 12 months, with one third of the men reporting the use of a condom when they had sex the last time. HIV INDICATORS FOR YOUNG WOMEN AND YOUNG MEN Knowledge of mother to child transmission, and knowledge of a place to get tested are generally worse in the age 15-24 years age group than older age groups. Overall, a quarter (25 percent) of young women and half (48 percent) of young men reported ever having sex and less than one percent and four percent, respectively, before age 15. Furthermore, less than one percent of young women had sex with more than one partner in the last 12 months while the figure for young men was nine percent. Seven percent of the young women and 37 percent of the young men had sex in the last 12 months with a non-marital non-cohabiting partner, yet only a third (37 percent) of these women and two thirds (67 percent) of these men used a condom during the most recent encounter. MALE CIRCUMCISION Male circumcision is almost universal (92 percent) with the majority undergoing the procedure during age 5-9 years (49 percent), age 10-14 (37 percent) followed by 1-4 years (nine percent). The health worker/professional is the most common person performing circumcision (57 percent on average) for 17 percent of the oldest age group compared to 86 percent for the youngest age group indicating a shift in the choice of provider over time. A quarter (24 percent) of the circumcisions of those age 15-24 years occur at home while two thirds (64 percent) at a private health institution. E X E C U T I V E S U M M A R Y M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N xxxi M IC S K o so v o * ACCESS TO MASS MEDIA Men age 15-49 years report a higher level of exposure to all three types of media than women. Only 44 percent of women in Kosovo* read a newspaper or magazine, 48 percent listen to the radio, and 99 percent watch television at least once a week. Overall, one percent do not have regular exposure to any of the three media, while 99 percent are exposed to at least one and 23 percent to all the three types of media on a weekly basis. At least once a week, 66 percent of men read a newspaper or magazine, 63 percent listen to the radio, and 98 percent watch television. One percent do not have regular exposure to any of the three media. All men (100 percent) are exposed to at least one and 42 percent to all the three types of media on a weekly basis. USE OF INFORMATION/COMMUNICATION TECHNOLOGY Overall, almost all (97 percent) women age 15-24 years ever used the internet and about four fifths (82 percent) of women with lower secondary education report using a computer during the last year compared to almost all of the women (99 percent) with higher education. The use of the internet during the last year is greatest among young women in the richest households (100 percent), as opposed to those living in the poorest households (84 percent). 87 percent of young men in the poorest households used the internet during the last year compared to universal use among the young men in the richest households (100 percent). 93 percent of 15-24 year old men used a computer during the last year and 98 percent used the internet at least once during their lifetime. SUBJECTIVE WELL-BEING 92 percent of 15-24 year old women are satisfied with their life overall with the figure ranging from 86 percent for young women living in the poorest households to 96 percent living in the richest households showing a strong relationship between wealth and life satisfaction. 90 percent of women and 83 of men age 15-24 years are very or somewhat happy with half (52 percent) of women and half (57 percent) of men thinking their lives improved during the last one year and expect their lives will get better after one year. TOBACCO USE While three quarters (78 percent) of men and half (47 percent) of women reported to have ever used a tobacco product, 34 percent of men and 19 percent of women smoked cigarettes, or used smoked or smokeless tobacco products during the last month. One fifth (18 percent) of women and more than a third of men (37 percent) age 15-49 years who currently smoke live in the same households with at least one under five year old. Almost a third (29 percent) of men 15-49 years old smoked a cigarette before age 15 compared to five percent of women. Two thirds (63 percent) of men and a quarter (23 percent) of women smoked more than 20 cigarettes in the last 24 hours while 87 percent of men and 51 percent of women smoked 10 or more cigarettes in the last 24 hours. ALCOHOL USE The proportion of men that consume alcohol is considerably higher than among women with 35 percent of men 15-49 years old had at least one drink of alcohol during the last month compared to 10 percent of women. Use of alcohol before the age of 15 is more common among men (11 percent) than among women (one percent). While 77 percent of women never had an alcoholic drink, the same is true for only a third (32 percent) of men. xxxii M IC S K o so v o * © U N IC EF K os ov o* /2 01 1/ Ka ra ho da M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 1 M IC S K o so v o * I. INTRODUCTION BACKGROUND This report is based on the Kosovo* Multiple Indicator Cluster Survey (MICS), conducted in 2013-2014 by the Kosovo* Agency for Statistics. The survey provides statistically sound and internationally comparable data essential for developing evidence-based policies and programmes, and for monitoring progress toward goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action of the World Fit for Children (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” UNICEF’s programmatic focus in the Balkan region is embedded in the context of European integration, responding to efforts in strengthening evidence-based planning and informed decision-making processes. Guided by functioning monitoring and evaluation systems, social accountability is an important parameter in this process yet uniquely positioned in the region, Kosovo* is today still facing major gaps in the information sector. The lack of data management systems and inaccuracy of existing data and combined with low technical capacities present major obstacles to the utilization of data for planning and monitoring. By enabling the understanding of causalities, the monitoring and evaluation of programme implementation and achievements of results will leverage and improve the collective knowledge on children and women in Kosovo*, support development partners to assist populations most likely to be excluded and respond to demands arising in that regard. Effective data and knowledge management serve the capacity for effective action and for achieving measurable results for children and women. 2 M IC S K o so v o * The Kosovo* MICS is destined to support the generation of high quality data on children, contributing to improved programme quality and accountability of duty bearers (i.e. key Kosovo* institutions) and right holders (i.e. children and women as well as other key beneficiaries). The findings of the survey are an important source of information for monitoring the implementation of the “Strategy and National Action Plan on Children’s Rights 2009-2013” as well as other commitments arising from the European integration processes and human rights principles contained within the Kosovo* Constitution. Furthermore the findings will serve to supplement available administrative data and official statistics. The Kosovo* MICS was conducted in parallel to the Roma, Ashkali and Egyptian Communities in Kosovo* MICS during 2013-2014 by the Kosovo* Agency for Statistics using the same methodology and survey tools but based on a separate sample. The results of that survey are available in a separate survey report. The Kosovo* MICS is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end child deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women’s and Children’s Health. SURVEY OBJECTIVES The 2013-2014 Kosovo* MICS has as its primary objectives: • To provide up-to-date information for assessing the situation of children and women in Kosovo*; • To generate data for the critical assessment of the progress made in various areas, and to put additional efforts in those areas that require more attention; • To collect disaggregated data for the identification of disparities, to allow for evidence based policy-making aimed at social inclusion of the most vulnerable; • To contribute to the generation of baseline data for the post-2015 agenda; • To validate data from other sources and the results of focused interventions. I N T R O D U C T I O N © U N IC EF K os ov o* /2 01 1/ Ka ra ho da 4 M IC S K o so v o * © U N IC EF K os ov o* /2 01 3/ Pi ro zz i M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 5 M IC S K o so v o * II. SAMPLE AND SURVEY METHODOLOGY SAMPLE DESIGN The sample for the Kosovo* Multiple Indicator Cluster Survey was designed to provide estimates for a large number of indicators on the situation of children and women at the Kosovo*, urban and rural levels. The urban and rural areas within each of the seven regions (Gjakovë/Đakovica, Gjilan/Gnjilane, Mitrovicë/Mitrovica, Pejë/ Pec, Prizren/Prizren, Prishtinë/Priština and Ferizaj/Uroševac) were identified as the sample strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 16 households was drawn in each sample enumeration area. The target sample size was 4,800 households with a total selected number of 300 enumeration areas. The questionnaire for men age 15-49 was administered in half of the selected households in each enumeration area. All of the selected enumeration areas were visited during the fieldwork period. The sample was stratified by region, urban and rural areas, and is not self-weighting. For reporting Kosovo* level results, sample weights are used. A more detailed description can be found in Appendix A on sample design. QUESTIONNAIRES Four sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect basic demographic information on all de jure household members (usual residents), the household, and the dwelling; 2) a questionnaire for individual women administered in each household to all women age 15-49 years; 3) a questionnaire for individual men administered in every second household to all men age 15-49 years; 4) an under-5 questionnaire, administered to mothers (or caretakers) for all children under 5 living in the household; and a questionnaire for vaccination records at Health Facilities for children under 3 was administered. The questionnaires included the following modules: The Household Questionnaire included the following modules: • List of Household Members • Education • Child Labour • Child Discipline • Household Characteristics • Water and Sanitation • Handwashing The Questionnaire for Individual Women was administered to all women age 15-49 years living in the households, and included the following modules: • Woman’s Background • Access to Mass Media and Use of Information/Communication Technology • Fertility/Birth History • Desire for Last Birth • Maternal and Newborn Health6 • Post-natal Health Checks • Illness Symptoms • Contraception7 • Unmet Need • Attitudes Toward Domestic Violence • Marriage/Union • Sexual Behaviour • HIV/AIDS • Tobacco and Alcohol Use • Life Satisfaction 6 This module included a survey-specific question about the main influence to have the caesarean section. 7 This module included survey-specific questions about the source of modern contraceptive methods and the main decision-maker on the use of contraception. 6 M IC S K o so v o * The Questionnaire for Individual Men was administered to all men age 15-49 years living in the selected sub- sample of households, and included the following modules: • Man’s Background • Access to Mass Media and Use of Information/Communication Technology • Fertility • Attitudes Toward Domestic Violence • Marriage/Union • Sexual Behaviour • HIV/AIDS • Circumcision • Tobacco and Alcohol Use • Life Satisfaction The Questionnaire for Children Under Five was administered to mothers (or caretakers) of children under 5 years of age8 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Age • Birth Registration • Early Childhood Development • Breastfeeding and Dietary Intake • Immunization • Care of Illness • Anthropometry For all children age 0-2 years with a completed Questionnaire for Children Under Five an additional form, the Questionnaire Form For Vaccination Records At Health Facility, was used to record vaccinations from the registers at health facilities. Although all vaccination records for children under 3 years of age were expected to be available with each parent, given the change in the immunization schedule in June 2010 it necessitated visits to health facilities to ensure accuracy in terms of data collection of immunization records given the possible complications. The MICS field staff copied the vaccination information from the immunization card of the child in the Health Facility. The questionnaires are based on the MICS5 model questionnaire9. From the MICS5 model English version, the questionnaires were customised and translated into Albanian and Serbian languages and were pre-tested in Lipjan/Lipljan, Mamushë/Mamushe, Prishtinë/Priština and Zveçan/Zvečan municipalities during August 2013. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the Kosovo* MICS questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams observed the place for handwashing as well as measured the weights and heights of children age under 5 years. Details and findings of these observations and measurements are provided in the respective sections of the report. TRAINING AND FIELDWORK Training for the fieldwork was conducted for 17 days in September but an insufficient number of field staff met the necessary criteria and hence a public vacancy process was launched leading to a second training for 20 days in October and November 2013. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Towards the end of the training period, trainees spent three days in practice interviewing in the Prishtina/Priština municipality. S A M P L E A N D S U R V E Y M E T H O D O L O G Y 8 The terms “children under 5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. 9 The model MICS5 questionnaires can be found at http://mics.unicef.org/tools#survey-design M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 7 M IC S K o so v o * The data were collected by seven teams; each was comprised of four interviewers, one driver, one editor, one measurer and a supervisor. The interview teams were comprised of both female and male interviewers, with female interviewers administering questionnaires for individual women, while male interviewers administering questionnaires for individual men. Fieldwork began in November 2013 and concluded in April 2014. DATA PROCESSING Data were entered using the CSPro software, Version 5.0. The data were entered on seven desktop computers and carried out by seven data entry operators and one data entry supervisor. For quality assurance purposes there were two questionnaire administrators and two secondary editors, all questionnaires were double-entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS programme and adapted to the Kosovo* questionnaire were used throughout. Data processing began simultaneously with data collection in November 2013 and was completed in April 2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 20. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. HOW TO READ TABLES It should be noted that when education is used in the tables as a background characteristic primary, lower secondary and upper secondary education levels are defined in line with the current Kosovo* education system classification (five grades of primary school, four grades of lower secondary school, and four grades of upper secondary school). Age groups presented in this report also include those persons who had reached the full age indicated by the upper limit for an age group, for instance, respondents aged 15-49 include persons who had reached a full 49 years of age, while the age group of children aged 20-23 months includes those who had reached a full 23 months. Apart from Albanian and Serbian, data for ethnicity of the head of household is in most cases based on fewer than 25 unweighted cases. Therefore only data for these ethnic groups is presented in the report. Tables also contain particular marking that is used consistently to indicate the following: (*) – an asterisk in tables indicate that the percentage or proportion is based on less than 25 unweighted cases and are therefore too small to be reported (number) – a figure in parenthesis indicates that the percentage or proportion is based on 25 to 49 unweighted cases and should be treated with caution (M) – the letter ‘M’ after a table/figure code indicates that it refers to the male population (-) – a dash ‘-‘ in tables indicates that there is no unweighted case in that cell or in the denominator. In most tables the latter is the case i.e. the total number of cases is zero for the specific category of the background variable. 8 M IC S K o so v o * © U N IC EF K os ov o* /2 01 3/ Pi ro zz i M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 9 M IC S K o so v o * III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS SAMPLE COVERAGE Of the 4,870 households selected for the sample, 4,406 were found to be occupied. Of these, 4,127 were successfully interviewed yielding a household response rate of 94 percent. In the interviewed households, 5,915 women (age 15-49 years) were identified. Of these, 5,251 were successfully interviewed, yielding a response rate of 89 percent within the interviewed households. The survey also sampled men (age 15-49), but required only a subsample. All men (age 15-49) were identified in every other household. A total of 2,921 men (age 15-49 years) were listed in the household questionnaires. Questionnaires were completed for 2,165 eligible men, which corresponds to a response rate of 74 percent within eligible interviewed households. There were 1,786 children under age five listed in the household questionnaires. Questionnaires were completed for 1,648 of these children, which corresponds to a response rate of 92 percent within interviewed households. Overall response rates of 83, 69, and 86 percent are calculated for the individual interviews of women, men, and under-5s, respectively (Table HH.1). Table HH.1: Results of household, women’s, men’s and under-5 interviews Number of households, women, men, and children under 5 by interview results, and household, women’s, men’s and under-5’s response rates, Kosovo*, 2013-2014 Total Area Urban Rural Households Sampled 4870 2124 2746 Occupied 4406 1936 2470 Interviewed 4127 1755 2372 Household response rate 93.7 90.7 96.0 Women Eligible 5915 2327 3588 Interviewed 5251 2004 3247 Women’s response rate 88.8 86.1 90.5 Women’s overall response rate 83.2 78.1 86.9 Men Eligible 2921 1059 1862 Interviewed 2165 740 1425 Men’s response rate 74.1 69.9 76.5 Men’s overall response rate 69.4 63.3 73.5 Children under 5 Eligible 1786 661 1125 Mothers (or caretakers) interviewed 1648 590 1058 Under-5s’ response rate 92.3 89.3 94.0 Under-5s’ overall response rate 86.4 80.9 90.3 10 M IC S K o so v o * Response rates were higher in rural than urban areas. In order to try to improve the response rate for the men questionnaires, the field staff made numerous efforts to arrange to meet with some of the eligible male members of the households; however it was still impossible to obtain an interview with some of the eligible male respondents. A notable percentage of the eligible male household members were abroad for temporary employment, some in institutions and others working in another municipality and hence unable to make/keep appointments. The response rates of women in urban areas, children under five years in urban areas as well as men throughout Kosovo* were below 85 percent and hence results for these areas should be interpreted with some caution. However, the relatively high non-response rate was already taken into consideration during the sample design stage. CHARACTERISTICS OF HOUSEHOLDS The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 4,127 households successfully interviewed in the survey, 22,416 household members were listed. Of these, 11,271 were males, and 11,145 were females. S A M P L E C O V E R A G E | C H A R A C T E R I S T I C S O F H O U S E H O L D S A N D R E S P O N D E N T S Table HH.2: Age distribution of household population by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Kosovo*, 2013-2014 Total Males Females Number Percent Number Percent Number Percent Total 22416 100.0 11271 100.0 11145 100.0 Age 0-4 1780 7.9 939 8.3 841 7.5 5-9 1799 8.0 891 7.9 908 8.1 10-14 2217 9.9 1185 10.5 1032 9.3 15-19 2227 9.9 1166 10.3 1061 9.5 20-24 2113 9.4 1085 9.6 1028 9.2 25-29 1768 7.9 922 8.2 846 7.6 30-34 1472 6.6 733 6.5 739 6.6 35-39 1510 6.7 719 6.4 791 7.1 40-44 1499 6.7 700 6.2 799 7.2 45-49 1278 5.7 641 5.7 637 5.7 50-54 1155 5.2 573 5.1 582 5.2 55-59 988 4.4 509 4.5 479 4.3 60-64 823 3.7 388 3.4 436 3.9 65-69 624 2.8 281 2.5 342 3.1 70-74 479 2.1 225 2.0 254 2.3 75-79 388 1.7 181 1.6 207 1.9 80-84 198 0.9 90 0.8 109 1.0 85+ 95 0.4 43 0.4 52 0.5 Missing/DK 1 0.0 0 0.0 1 0.0 Dependency age groups 0-14 5796 25.9 3015 26.8 2781 24.9 15-64 14834 66.2 7435 66.0 7399 66.4 65+ 1785 8.0 820 7.3 965 8.7 Missing/DK 1 0.0 0 0.0 1 0.0 Child and adult populations Children age 0-17 years 7137 31.8 3737 33.2 3399 30.5 Adults age 18+ years 15278 68.2 7533 66.8 7745 69.5 Missing/DK 1 0.0 0 0.0 1 0.0 M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 11 M IC S K o so v o * The percentage distribution of the household population in terms of age and sex distribution in Table HH.2 closely align to that of the 2011 Census. While positive population growth can be seen in the much greater share of children age 0–14 years in the total population (26 percent) compared to the share of the population age 65 and over (eight percent) it is important to highlight the slight reduction in births as noted in the minor decrease in percentage distribution of those under 10 years of age. The positive population growth has contributed to almost one third (32 percent) of the population being 0-17 years of age and more than half (53 percent) under 30 years of age. The overall dependency rate, namely the ratio of the inactive population (aged 0-14 and 65+) to the active population (aged 15-64), expressed as a percentage was 51 percent, meaning that there were 51 inactive persons for each 100 active ones. There is very little variation in the percent distribution based on gender and the age of one female household member was not known. Figure HH.1: Age and sex distribution of household population, Kosovo*, 2013-2014 Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents age 15-49, male respondents age 15-49, and children under-5. Both unweighted and weighted numbers are presented. Such information is essential for the interpretation of findings presented later in the report and provides background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers.10 Table HH.3 provides basic background information on the households, including the sex of the household head, area, number of household members, education of household head, and ethnicity11 of the household head. 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. 10 See Appendix A on sample design for more details on sample weights. 11 This was determined by asking “To what ethnic group does the head of this household belong?” Males Females Age 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 6 4 2 0 2 4 6 Percent Note: 1 female household member with missing age is excluded 12 M IC S K o so v o * The weighted and unweighted total number of households are equal, since sample weights were normalized. The table also shows the weighted mean household size estimated by the survey. In 87 percent of the households the head of the household is a male and more than two fifths (42 percent) of households are located in urban areas. About one-sixth (16 percent) of households have a household head with either no education or with only primary education. Almost two thirds of households (62 percent) have 5 or more members and the estimated average household size was 5.4 members. The majority (87 percent) of household heads are from the Albanian ethnicity. Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Kosovo*, 2013-2014 Weighted percent Number of households Weighted Unweighted Total 100.0 4127 4127 Sex of household head Male 86.3 3562 3560 Female 13.7 565 567 Area Urban 41.5 1711 1755 Rural 58.5 2416 2372 Number of household members 1 3.6 150 139 2 7.7 319 322 3 9.0 370 364 4 17.3 716 716 5 19.7 814 813 6 16.4 677 682 7 10.7 443 444 8 5.7 234 235 9 3.5 146 151 10+ 6.3 258 261 Education of household head None 4.8 197 203 Primary 11.4 471 476 Lower secondary 23.4 964 979 Upper secondary 38.6 1594 1558 Higher 21.8 898 908 Missing/DK 0.1 3 3 Ethnicity of household head Albanian 86.9 3587 3657 Serbian 7.9 324 230 Other ethnic groups 5.2 216 240 Mean household size 5.4 4127 4127 S A M P L E C O V E R A G E | C H A R A C T E R I S T I C S O F H O U S E H O L D S A N D R E S P O N D E N T S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 13 M IC S K o so v o * Table HH.4: Women’s background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Kosovo*, 2013-2014 Weighted percent Number of women Weighted Unweighted Total 100.0 5251 5251 Area Urban 38.6 2029 2004 Rural 61.4 3222 3247 Age 15-19 18.0 945 949 20-24 16.8 884 886 25-29 13.4 701 691 30-34 12.9 679 676 35-39 13.8 726 728 40-44 13.8 724 728 45-49 11.3 591 593 Marital/Union status Currently married/in union 61.3 3221 3220 Widowed 1.3 67 70 Divorced 0.9 45 43 Separated 0.8 41 41 Never married/in union 35.7 1876 1877 Motherhood and recent births Never gave birth 41.7 2188 2182 Ever gave birth 58.3 3063 3069 Gave birth in last two years 12.1 636 637 No birth in last two years 46.2 2427 2432 Education None 1.6 86 88 Primary 3.9 204 203 Lower secondary 38.0 1997 2047 Upper secondary 34.3 1801 1768 Higher 22.2 1163 1145 Wealth index quintile Poorest 18.8 989 1004 Second 20.1 1056 1062 Middle 19.6 1031 1028 Fourth 20.8 1090 1096 Richest 20.7 1086 1061 Ethnicity of household head Albanian 90.9 4772 4829 Serbian 5.1 270 191 Other ethnic groups 4.0 209 231 CHARACTERISTICS OF FEMALE AND MALE RESPONDENTS 15-49 YEARS OF AGE AND CHILDREN UNDER-5 Tables HH.4, HH.4M and HH.5 provide information on the background characteristics of female and male respondents 15-49 years of age and of children under age 5. In all three tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women, men, and children under age five, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. 14 M IC S K o so v o * 12 Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when it is used as a background variable. 13 The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth index values. Each household in the total sample is then assigned a wealth score based on the assets owned by that household and on the final factor scores obtained as described above. The survey household population is then ranked according to the wealth score of the household they are living in, and is finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). In the Kosovo* MICS, the following assets were used in these calculations: Number of persons per sleeping room; main material of dwelling floor, roof and external walls; the type of fuel used for cooking; the place for cooking; possession by the household of a refrigerator, a bed, a table and chairs, internet, a clothes dryer, a vacuum cleaner, an air conditioner, a jacuzzi tub, a water heater, a laptop, a PC computer, a dish washer, a clothes washing machine, a flat screen/LCD television; possession by any household member of a motorcycle/ scooter, a car, a truck, a cell phone, a smart phone; ownership of dwelling and bank account by any household member; source of drinking water; location of water source; sharing of sanitation facilities; type of sanitation facility and availability of soap. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D and Pritchett, L. 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132; Rutstein, SO and Johnson, K. 2004. The DHS Wealth Index. DHS Comparative Reports No. 6; and Rutstein, SO. 2008. The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Papers No. 60. 14 When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as for instance “women in the richest population quintile”, which is used interchangeably with “women living in households in the richest population wealth quintile”, and similar. Table HH.4M: Men’s background characteristics Percent and frequency distribution of men age 15-49 years by selected background characteristics, Kosovo*, 2013-2014 Weighted percent Number of men Weighted Unweighted Total 100.0 2165 2165 Area Urban 36.2 783 740 Rural 63.8 1382 1425 Age 15-19 21.6 468 463 20-24 17.3 375 377 25-29 14.2 308 310 30-34 12.1 261 269 35-39 11.2 243 241 40-44 11.9 258 256 45-49 11.7 253 249 Marital/Union status Currently married/in union 49.3 1067 1061 Widowed 0.0 1 1 Divorced 0.4 10 10 Separated 0.5 10 9 Never married/in union 49.7 1077 1083 Missing 0.0 0 1 Table HH.4 provides background characteristics of female respondents, age 15-49 years. The table includes information on the distribution of women according to area, age, marital/union status, motherhood status, births in last two years, education12, wealth index quintiles13, 14, and ethnicity of the household head. Almost half (48 percent) of women are 15-29 years of age and almost two thirds (61 percent) of women age 15-49 years are currently married or in union while 36 percent have never been married or in union. The distribution by motherhood status is similar with 58 percent of women having ever given birth and 12 percent of women giving birth in the last two years. More than half (56 percent) of women have upper secondary education or higher and 19 percent of women live in households within the poorest wealth quintile. S A M P L E C O V E R A G E | C H A R A C T E R I S T I C S O F H O U S E H O L D S A N D R E S P O N D E N T S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 15 M IC S K o so v o * Similarly, Table HH.4M provides background characteristics of male respondents 15-49 years of age. The questionnaire for men age 15-49 was administered in a subset of the sampled households. The table shows information on the distribution of men according to area, age, marital status, fatherhood status, education, wealth index quintiles, and ethnicity of the household head. More than half (53 percent) of men are 15-29 years of age and half (49 percent) of men age 15-49 years are currently married or in union while the other half (50 percent) have never been married or in union. The distribution by fatherhood status indicates that 45 percent of men have at least one living child. Five-sixths (84 percent) of men have upper secondary education or higher and less than one percent have no education or primary education only. Background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, area, age in months, respondent type, mother’s (or caretaker’s) education, wealth, and ethnicity. The proportion of male and female children within the population under five years of age are 53 and 47 percent respectively with a larger proportion (64 percent) living in rural areas. Less than one-tenth (eight percent) of children under five years of age have a mother with no education or with primary education only. Less than one percentage point of children under five years of age do not live with their mother. As far as wealth index quintiles are concerned, 24 percent of children under five years live in households within the poorest population quintile, while 18 percent of children under five years live in households within the richest population quintile. Table HH.4M: Men’s background characteristics (cont.) Fatherhood status Has at least one living child 45.2 978 977 Has no living children 54.8 1186 1186 Missing/DK 0.1 1 2 Education None 0.1 3 4 Primary 0.7 15 17 Lower secondary 15.3 332 343 Upper secondary 57.6 1247 1236 Higher 26.2 567 565 Wealth index quintile Poorest 20.1 436 452 Second 21.0 454 461 Middle 20.0 432 425 Fourth 18.7 405 408 Richest 20.2 438 419 Ethnicity of household head Albanian 90.7 1963 1980 Serbian 5.2 112 80 Other ethnic groups 4.1 90 105 16 M IC S K o so v o * Table HH.5: Under-5s’ background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Kosovo*, 2013-2014 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 1648 1648 Sex Male 53.2 876 874 Female 46.8 772 774 Area Urban 36.4 599 590 Rural 63.6 1049 1058 Age 0-5 months 8.6 142 145 6-11 months 11.0 181 185 12-23 months 18.9 311 305 24-35 months 20.6 339 341 36-47 months 19.7 324 321 48-59 months 21.3 350 351 Respondent to the under-5 questionnaire Mother 99.4 1638 1638 Other primary caretaker 0.6 10 10 Mother’s educationa None 1.7 27 29 Primary 6.0 99 101 Lower secondary 45.0 741 755 Upper secondary 31.2 514 505 Higher 16.1 265 257 Missing/DK 0.1 1 1 Wealth index quintile Poorest 23.8 392 399 Second 19.6 322 321 Middle 19.4 320 320 Fourth 19.3 318 315 Richest 18.0 296 293 Ethnicity of household head Albanian 91.9 1515 1516 Serbian 2.7 44 31 Other ethnic groups 5.4 89 101 a In this table and throughout the report, mother’s education refers to the highest educational level ever attended by mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere S A M P L E C O V E R A G E | C H A R A C T E R I S T I C S O F H O U S E H O L D S A N D R E S P O N D E N T S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 17 M IC S K o so v o * HOUSING CHARACTERISTICS, ASSET OWNERSHIP, AND WEALTH QUINTILES Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. HH.6 presents characteristics of housing, disaggregated by area, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. The vast majority of households have a finished floor (97 percent), finished roofing (98 percent) and finished exterior walls (97 percent) with very slight variation only observed for finished roofing and exterior walls between urban and rural areas which is similar to the results from the 2011 Census. The mean number of persons per room used for sleeping is 2.21 with a larger average in rural areas (2.25) compared to urban areas (2.15). Households in rural areas are more likely to have 3 or more rooms used for sleeping (54 percent) than those urban areas (41 percent). Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence, Kosovo*, 2013-2014 Total Area Urban Rural Flooring Natural floor 0.1 0.0 0.2 Rudimentary floor 2.8 2.0 3.3 Finished floor 96.7 97.9 96.0 Other 0.1 0.0 0.2 Missing/DK 0.2 0.1 0.2 Roof Natural roofing 0.0 0.0 0.0 Rudimentary roofing 0.8 0.0 3.3 Finished roofing 98.2 99.7 93.4 Other 0.2 0.0 1.1 Missing/DK 0.8 0.3 2.3 Exterior walls Natural walls 0.1 0.0 0.2 Rudimentary walls 2.0 0.2 3.0 Finished walls 97.4 99.5 96.2 Other 0.2 0.0 0.4 Missing/DK 0.3 0.3 0.2 Rooms used for sleeping 1 14.7 16.7 13.4 2 36.5 41.8 32.7 3 or more 48.6 41.4 53.7 Missing/DK 0.2 0.1 0.2 Total 100.0 100.0 100.0 Number of households 4127 1711 2416 Mean number of persons per room used for sleeping 2.21 2.15 2.25 In Table HH.7 households are distributed according to ownership of assets by households and by individual household members. The ownership of household assets is largely variable between urban and rural areas. A large percentage of households owns a refrigerator (97 percent), a bed (99 percent), water heater (93 percent), vacuum cleaner and a clothes washing machine (94 percent respectively). Less than three fourths (72 percent) of 18 M IC S K o so v o * Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence, Kosovo*, 2013-2014 Total Area Urban Rural Percentage of households that own a Refrigerator 96.9 98.4 95.9 Bed 99.1 99.3 99.0 Table and chairs 84.4 88.1 81.8 Internet 72.2 80.1 66.5 Clothes dryer 7.3 10.6 5.0 Vacuum cleaner 94.4 97.2 92.4 Air conditioner 7.3 12.9 3.3 Jacuzzi tub 1.6 2.2 1.2 Water heater 93.4 97.1 90.7 Laptop computer 33.5 43.3 26.5 PC computer 62.4 67.4 58.9 Dish washer 25.4 39.0 15.7 Clothes washing machine 93.9 96.6 92.0 Flat screen/ LCD TV 41.1 51.1 34.0 Percentage of households that own Agricultural land 61.5 37.9 78.2 Farm animals/Livestock 35.2 7.0 55.2 Percentage of households where at least one member owns or has a Motorcycle or scooter 4.8 4.6 5.0 Animal-drawn cart 1.4 0.3 2.2 Car 66.9 64.6 68.5 Truck 5.3 3.7 6.4 Tractor 20.3 4.2 31.7 Cell phone 97.7 98.3 97.3 Phone with a touch screen or keyboard 52.7 60.3 47.4 Bank account 83.8 88.0 80.8 Ownership of dwelling Owned by a household member 92.2 88.4 94.9 Not owned 7.8 11.6 5.1 Rented 2.7 5.8 0.4 Temporary housing 1.7 2.0 1.4 Other 3.4 3.7 3.2 Total 100.0 100.0 100.0 Number of households 4127 1711 2416 households have internet access, 62 percent own a computer and 34 percent own a laptop. A much larger percent of households own agricultural land (78 percent) and farm animals/livestock (55 percent) in rural areas than in urban areas (38 percent and seven percent respectively). Cell phones are the most common item to be owned by at least one member of a household at 98 percent while there are just over half (53 percent) of households where at least one member owns a phone with a touch screen or keyboard. One-sixth (16 percent) of households do not have a bank account and 16 percent of households do not own their dwelling. S A M P L E C O V E R A G E | C H A R A C T E R I S T I C S O F H O U S E H O L D S A N D R E S P O N D E N T S M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 19 M IC S K o so v o * Table HH.8 shows the distribution of the household population by wealth index quintiles, according to area of residence, as well as sex, education and ethnicity of the household head. While there is little difference in wealth index by sex of the household head there is much more variability by urban and rural areas. The proportion of the household population living in the poorest wealth quintile is greater in rural areas (27 percent) than in urban (nine percent). Concentrations of the household population living in the poorest wealth index quintile occur in the households where the head of household has no education or only primary education. In the poorest wealth index quintile the percentage of the household population whose household head has lower secondary education is higher (32%) than for primary (24%). Forty percent of the household population where the head of household has higher education resides in the richest wealth quintile. It is important to note that the information presented here in terms of wealth quintiles is not equivalent to expenditures. Table HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintile, according to area of residence, sex, education and ethnicity of household head, Kosovo*, 2013-2014 Wealth index quintile Total Number of household membersPoorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 22416 Sex of household head Male 20.2 19.8 19.9 19.7 20.4 100.0 19796 Female 18.4 21.9 20.7 22.4 16.7 100.0 2620 Area Urban 8.5 12.3 14.7 24.0 40.5 100.0 8390 Rural 26.8 24.6 23.2 17.6 7.8 100.0 14026 Education of household head None 32.2 24.8 19.1 13.8 10.1 100.0 1255 Primary 23.6 23.3 20.0 19.9 13.1 100.0 2876 Lower secondary 32.3 24.5 18.7 15.1 9.3 100.0 5470 Upper secondary 17.0 20.1 22.1 21.0 19.8 100.0 8307 Higher 5.0 10.9 17.6 26.1 40.4 100.0 4480 Missing/DK (0.0) (0.0) (63.0) (0.0) (37.0) 100.0 28 Ethnicity of household head Albanian 19.5 20.2 20.4 20.1 19.8 100.0 20261 Serbian 21.0 14.9 17.2 18.8 28.0 100.0 1126 Other ethnic groups 28.4 21.5 14.2 19.8 16.1 100.0 1029 20 M IC S K o so v o * © U N IC EF K os ov o* /2 01 3/ A lij aj M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 21 M IC S K o so v o * IV. CHILD MORTALITY One of the overarching goals of the Millennium Development Goals (MDGs) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction of under-five mortality by two thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Mortality rates presented in this chapter are calculated from information collected in the birth histories of the Women’s Questionnaires. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died. In addition, they were asked to provide a detailed birth history of live births of children in chronological order starting with the firstborn. Women were asked whether births were single or multiple, the sex of the children, the date of birth (month and year), and survival status. Further, for children still alive, they were asked the current age of the child and, if not alive, the age at death. Childhood mortality rates are expressed by conventional age categories and are defined as follows: • Neonatal mortality (NN): probability of dying within the first month of life • Post-neonatal mortality (PNN): difference between infant and neonatal mortality rates • Infant mortality (1q0): probability of dying between birth and the first birthday • Child mortality (4q1): probability of dying between the first and the fifth birthdays • Under-five mortality (5q0): the probability of dying between birth and the fifth birthday Rates are expressed as deaths per 1,000 live births, except in the case of child mortality, which is expressed as deaths per 1,000 children surviving to age one, and post-neonatal mortality, which is the difference between infant and neonatal mortality rates. Table CM.1: Early childhood mortality rates Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, Kosovo*, 2013-2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Years preceding the survey 0-4 9 3 12 3 15 5-9 18 5 24 1 25 10-14 28 14 42 5 47 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Table CM.1 presents neonatal, post-neonatal, infant, child, and under-five mortality rates for the three most recent five-year periods before the survey. Figure CM.1 shows these mortality rates with a 95 percent confidence interval. Neonatal mortality in the most recent 5-year period (corresponding roughly to the period of 2008- 2014) is estimated at 9 per 1,000 live births, while the post-neonatal mortality rate is estimated at 3 per 1,000 live births. 22 M IC S K o so v o * C H I L D M O R T A L I T Y Figure CM.1: Early childhood mortality rates, Kosovo*, 2013-2014 The infant mortality rate in the five years preceding the survey is 12 per 1,000 live births and under-five mortality is 15 deaths per 1,000 live births for the same period, indicating that 80 percent of under-five deaths are infant deaths. The table and figure also show a declining trend at the Kosovo* level, during the last 15 years, with under-five mortality at 47 per 1,000 during the 10-14 year period preceding the survey, and 15 per 1,000 live births during the most recent 5-year period. A similar pattern is observed in all other indicators. Table CM.2: Early childhood mortality rates by background characteristics Neonatal, post-neonatal, infant, child and under-five mortality rates for the five year period preceding the survey, by background characteristics, Kosovo*, 2013-2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 9 3 12 3 15 Area Urban 7 3 9 1 11 Rural 11 3 13 4 18 Sex of child Male 11 3 13 4 17 Female 8 3 10 2 12 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Table CM.2 provides estimates of child mortality by background characteristics. There is some difference between the probabilities of dying among males and females with males having higher probabilities of the neonatal, infant and under-five mortality rates. Figure CM.2 provides a graphical presentation of these differences by area and shows the difference between the probabilities of dying before the age of five in urban and rural areas. Years preceding the survey 10-14 5-9 0-4 Note: Indicator values are per 1,000 live births Whiskers indicate the 95 percent confidence interval Neonatal mortality rate Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-five mortality rate 28 14 42 47 5 13 12 35 24 18 9 15 25 M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 23 M IC S K o so v o * Figure CM.3 compares the findings of the Kosovo* MICS on under-5 mortality rates with those from administrative data from the Kosovo* Agency for Statistics. The Kosovo* MICS findings are obtained from Table CM.1. The MICS estimates indicate a continued decline in mortality during the last 15 years. The most recent infant mortality estimate (12 per thousand live births) from MICS is similar to the estimate from the Kosovo* Agency of Statistics administrative data for the same year (2011.6) and 182 percent higher than the estimate from the 2011 Census for the same year (2008). Further qualification of these apparent declines and differences as well as its determinants should be taken up in a more detailed and separate analysis. Figure CM.3: Trend in infant mortality rates, Kosovo*, 2013-2014 Kosovo* Urban Rural 15 11 18 0 5 10 15 20 25 30 Note: Indicator values are per 1,000 live births Whiskers indicate the 95 percent confidence interval Note: There is no mortality data from the Kosovo* Agency of Statistics for 1998-2001 80 70 60 50 40 30 20 10 0 1978 1982 1986 1990 1994 1998 2002 2006 2010 2014 Per 1,000 live births Kosovo* Agency of Statistics administrative data MICS 2013-2014 Census 2011 Figure CM.2: Under-5 mortality rates by area, Kosovo*, 2013-2014 24 M IC S K o so v o * © U N IC EF K os ov o* M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 25 M IC S K o so v o * V. NUTRITION LOW BIRTH WEIGHT Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing low birth weight babies. One of the major challenges in measuring the incidence of low birth weight is that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. Fortunately in the case of Kosovo* the vast majority of births are in health facilities. Because many infants are not weighed at birth and those who are weighed may be a biased sample of all births, the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth.15 Again, fortunately this does not affect this survey to the same extent since the vast majority of births are in health facilities and weighed at birth. 15 For a detailed description of the methodology, see Boerma, JT et al. 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization 74(2): 209-16. 26 M IC S K o so v o * N U T R I T I O N Table NU.1: Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Kosovo*, 2013-2014 Percent distribution of births by mother’s assessment of size at birth Total Percentage of live births: Number of last live-born children in the last two years Very small Smaller than average Average Larger than average or very large DK Below 2,500 grams1 Weighed at birth2 Total 8.1 7.0 66.5 17.5 0.9 100.0 5.4 99.0 636 Mother’s age at birth Less than 20 years (*) (*) (*) (*) (*) 100.0 (*) (*) 24 20-34 years 8.3 7.4 66.2 17.6 0.5 100.0 5.5 99.5 532 35-49 years 8.2 5.0 64.5 19.6 2.7 100.0 5.2 97.3 80 Birth order 1 9.9 8.9 68.8 12.5 0.0 100.0 6.2 99.6 208 2-3 8.0 5.5 65.1 20.1 1.3 100.0 5.2 98.8 337 4+ 4.7 8.7 66.1 19.2 1.3 100.0 4.5 98.2 92 Area Urban 8.3 6.0 67.8 17.3 0.6 100.0 5.4 98.9 242 Rural 8.0 7.7 65.6 17.6 1.1 100.0 5.4 99.0 394 Mother’s education None (*) (*) (*) (*) (*) 100.0 (*) (*) 10 Primary (11.3) (0.0) (62.5) (26.2) (0.0) 100.0 (5.6) (100.0) 34 Lower secondary 7.0 9.2 64.8 17.9 1.1 100.0 5.2 98.3 279 Upper secondary 7.0 4.9 70.0 16.8 1.3 100.0 4.9 99.3 197 Higher 10.8 8.0 65.3 15.9 0.0 100.0 6.3 100.0 116 Wealth index quintile Poorest 5.8 7.4 63.3 21.1 2.4 100.0 4.6 97.6 140 Second 9.6 10.9 60.5 18.2 0.8 100.0 6.0 98.5 128 Middle 6.9 4.1 75.2 13.8 0.0 100.0 5.0 100.0 129 Fourth 12.5 7.3 64.1 14.9 1.1 100.0 6.7 98.9 124 Richest 6.0 5.3 69.6 19.1 0.0 100.0 4.6 100.0 116 Ethnicity of household head Albanian 7.6 7.3 67.5 16.8 0.8 100.0 5.3 98.9 579 Serbian (*) (*) (*) (*) (*) 100.0 (*) (*) 19 Other ethnic groups (17.8) (6.0) (45.8) (30.4) (0.0) 100.0 (7.7) (98.6) 38 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth ( ) Figures that are based on 25 – 49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, 99 percent of births were weighed at birth and approximately five percent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.1). The prevalence of low birth weight does not vary by background characteristics. M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 27 M IC S K o so v o * NUTRITIONAL STATUS Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Undernutrition 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 children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards16. Each of the three nutritional status indicators – weight-for-age, height-for-age, and weight-for-height – can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Weight-for-height can be used to assess wasting and overweight status. Children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. In MICS, weights and heights of all children under 5 years of age were measured using the anthropometric equipment recommended17 by UNICEF. Findings in this section are based on the results of these measurements. Table NU.2 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators. 16 http://www.who.int/childgrowth/standards/technical_report 17 See MICS Supply Procurement Instructions: http://mics.unicef.org/tools#survey-design 28 M IC S K o so v o * N U T R I T I O N Table NU.2: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Kosovo*, 2013-2014 Weight for age Number of children under age 5 Height for age Number of children under age 5 Weight for height Number of children under age 5 Underweight Mean Z-Score (SD) Stunted Mean Z-Score (SD) Wasted Overweight Mean Z-Score (SD) Percent below Percent below Percent below Percent above - 2 SD1 - 3 SD2 - 2 SD3 - 3 SD4 - 2 SD5 - 3 SD6 + 2 SD7 Total 1.8 0.3 0.0 1561 4.3 0.6 -0.1 1513 1.4 0.3 4.3 0.2 1508 Sex Male 1.8 0.2 0.1 820 4.3 0.8 -0.1 796 1.6 0.1 4.2 0.1 793 Female 1.7 0.3 0.0 741 4.2 0.3 -0.2 716 1.2 0.4 4.4 0.2 715 Area Urban 1.5 0.2 0.2 554 2.4 0.6 0.1 535 1.6 0.6 6.2 0.2 531 Rural 1.9 0.3 0.0 1007 5.3 0.6 -0.2 977 1.3 0.1 3.3 0.1 977 Age 0-5 months 4.6 0.6 -0.1 132 4.4 0.0 0.2 129 5.8 1.6 2.2 -0.4 129 6-11 months 2.6 0.6 -0.1 177 2.8 1.8 0.2 177 1.0 0.5 3.4 -0.1 177 12-17 months 0.7 0.7 0.2 142 3.5 0.0 0.1 139 2.0 0.0 5.6 0.2 138 18-23 months 0.6 0.0 0.1 157 2.6 0.6 -0.1 149 0.9 0.0 5.0 0.2 149 24-35 months 1.6 0.0 0.2 324 4.0 0.4 -0.2 310 1.1 0.0 4.7 0.3 308 36-47 months 1.8 0.4 0.0 298 7.6 0.4 -0.4 288 0.7 0.4 4.4 0.3 287 48-59 months 1.3 0.0 0.0 332 3.3 0.8 -0.3 321 0.7 0.0 4.3 0.2 320 Mother’s educationa None (4.3) (0.0) (-0.7) 27 (27.8) (8.6) (-1.1) 25 (0.0) (0.0) (0.0) (0.0) 26 Primary 6.2 1.2 -0.3 95 13.5 3.0 -0.7 94 2.1 0.0 3.8 0.2 93 Lower secondary 1.4 0.0 -0.1 717 3.7 0.0 -0.2 709 1.6 0.1 2.7 0.1 708 Upper secondary 1.6 0.6 0.2 487 2.4 0.9 0.1 459 1.5 0.7 7.5 0.2 457 Higher 1.2 0.0 0.2 235 3.1 0.0 0.2 225 0.3 0.0 3.5 0.2 224 Wealth index quintile Poorest 2.2 0.0 -0.2 384 8.9 1.0 -0.5 374 1.2 0.3 3.6 0.1 374 Second 2.8 0.7 -0.1 310 4.3 1.4 -0.3 300 1.9 0.8 2.8 0.0 300 Middle 0.9 0.0 0.1 302 2.6 0.4 0.0 295 1.6 0.0 3.8 0.2 295 Fourth 1.5 0.2 0.1 294 3.0 0.0 0.0 283 0.8 0.0 4.0 0.2 282 Richest 1.3 0.4 0.4 271 0.7 0.0 0.4 261 1.4 0.3 7.9 0.3 257 Ethnicity of household head Albanian 1.8 0.3 0.0 1440 3.7 0.5 -0.1 1396 1.4 0.3 4.3 0.1 1392 Serbian (*) (*) (*) 34 (*) (*) (*) 33 (*) (*) (*) (*) 33 Other ethnic groups 2.3 0.0 -0.2 87 10.1 2.2 -0.5 83 2.6 0.0 5.2 0.1 83 1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe) 2 MICS indicator 2.1b - Underweight prevalence (severe) 3 MICS indicator 2.2a - Stunting prevalence (moderate and severe) 4 MICS indicator 2.2b - Stunting prevalence (severe) 5 MICS indicator 2.3a - Wasting prevalence (moderate and severe) 6 MICS indicator 2.3b - Wasting prevalence (severe) 7 MICS indicator 2.4 - Overweight prevalence a Due to the low number of unweighted cases, the category “Missing/DK” for the background characteristic “Mother’s education” is not shown ( ) Figures that are based on 25 – 49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Children whose full birth date (month and year) were not obtained, and children whose measurements are outside a plausible range are excluded from Table NU.2. Additionally, children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/her height has not been measured, the child is included in M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 29 M IC S K o so v o * 18 The results for the category “No education” are based on 25-49 unweighted cases and should be interpreted with caution. 19 Bhuta, Z. et al. 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet June 6, 2013. BREASTFEEDING AND INFANT AND YOUNG CHILD FEEDING Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. 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 don’t start to breastfeed early enough, do not breastfeed exclusively for the recommended 6 months or stop breastfeeding too soon. There are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and can be unsafe if hygienic conditions, including safe drinking water are not readily available. Studies have shown that, in addition to continued breastfeeding, consumption of appropriate, adequate and safe solid, semi-solid and soft foods from the age of 6 months onwards leads to better health and growth outcomes, with potential to reduce stunting during the first two years of life.19 underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.12, DQ.13, and DQ.14 in Appendix D. The tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, five percent of children have been excluded from calculations of the weight-for-age indicator, eight percent from the height-for-age indicator, and nine percent for the weight-for-height indicator. One-quarter (26 percent) of height/length measurements by digit reported for the decimal points are either 0 or 5 (Table DQ.15) while weight measurements display a more even distribution. Approximately two percent of children under age five in Kosovo* are moderately or severely underweight and almost none are classified as severely underweight (Table NU.2). One in twenty children (four percent) is moderately or severely stunted or too short for their age and one percent are moderately or severely wasted or too thin for their height. This low percentage indicates that there is no notable issue related to stunting or underweight in Kosovo* as a whole. Stunting is concentrated on the poorest wealth quintiles compared to richest wealth quintile. Four percent of children are overweight or too heavy for their height. Those children whose mothers have upper secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with no education18 or with primary education. The differences in underweight, stunting, and wasting by gender are minimal. The age pattern shows that a there is some fluctuation in the percentage of children age 15 months and older who are wasted, underweight, overweight, and stunted (Figure NU.1). Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe), Kosovo*, 2013-2014 25 20 15 10 5 0 120 3624 6048 Age in months Pe rc en t Overweight Stunted Underweight Wasted 30 M IC S K o so v o * N U T R I T I O N UNICEF and WHO recommend that infants be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond.20 Information on breast feeding of children under 6 months is provided in Table NU.3. Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods.21 A summary of key guiding principles22, 23 for feeding 6-23 month olds is provided in the table below along with proximate measures for these guidelines collected in this survey. The guiding principles for which proximate measures and indicators exist are: (i) continued breastfeeding; (ii) appropriate frequency of meals (but not energy density); and (iii) appropriate nutrient content of food. Feeding frequency is used as proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Dietary diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For dietary diversity, seven food groups were created for which a child consuming at least four of these is considered to have a better quality diet. In most populations, consumption of at least four food groups means that the child has a high likelihood of consuming at least one animal-source food and at least one fruit or vegetable, in addition to a staple food (grain, root or tuber).24 These three dimensions of child feeding are combined into an assessment of the children who received appropriate feeding, using the indicator of “minimum acceptable diet”. To have a minimum acceptable diet in the previous day, a child must have received: (i) the appropriate number of meals/snacks/milk feeds; (ii) food items form at least 4 food groups; and (iii) breastmilk or at least 2 milk feeds (for non-breastfed children). 20 WHO. 2003. Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3-5 February 2003. 21 WHO. 2003. Global Strategy for Infant and Young Child Feeding. 22 PAHO. 2003. Guiding principles for complementary feeding of the breastfed child. 23 WHO. 2005. Guiding principles for feeding non-breastfed children 6-24 months of age. 24 WHO. 2008. Indicators for assessing infant and young child feeding practices. Part 1: Definitions. 25 Food groups used for assessment of this indicator are 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. Guiding Principle (age 6-23 months) Proximate measures Table Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.4 Appropriate frequency and energy density of meals Breastfed children Depending on age, two or three meals/snacks provided in the last 24 hours NU.6 Non-breastfed children Four meals/snacks and/or milk feeds provided in the last 24 hours Appropriate nutrient content of food Four food groups25 eaten in the last 24 hours NU.6 Appropriate amount of food No standard indicator exists na Appropriate consistency of food No standard indicator exists na Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists na M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 31 M IC S K o so v o * Table NU.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Kosovo*, 2013-2014 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live-born children in the last two years Within one hour of birth2 Within one day of birth Total 96.7 45.4 85.5 25.2 636 Area Urban 97.4 45.6 84.9 31.3 242 Rural 96.3 45.3 85.8 21.4 394 Months since last birth 0-11 months 97.5 46.1 85.0 28.4 323 12-23 months 95.9 44.7 86.0 21.9 314 Assistance at delivery Skilled attendant 97.4 45.6 86.0 25.4 630 Other (*) (*) (*) (*) 1 No one/Missing (*) (*) (*) (*) 4 Place of delivery Home (*) (*) (*) (*) 1 Health facility 97.4 45.6 86.0 25.3 630 Public 97.3 44.7 86.0 24.1 608 Private (*) (*) (*) (*) 22 Other/DK/Missing (*) (*) (*) (*) 6 Mother’s education None (*) (*) (*) (*) 10 Primary (92.3) (41.0) (83.4) (17.6) 34 Lower secondary 96.6 48.1 87.1 18.6 279 Upper secondary 98.3 43.1 85.7 27.6 197 Higher 96.6 43.4 82.8 41.2 116 Wealth index quintile Poorest 94.9 51.8 86.8 14.0 140 Second 98.2 42.1 92.1 21.3 128 Middle 97.2 43.1 83.2 27.0 129 Fourth 96.0 37.8 82.2 27.0 124 Richest 97.6 52.2 82.5 39.0 116 Ethnicity of household head Albanian 96.6 46.3 87.4 24.3 579 Serbian (*) (*) (*) (*) 19 Other ethnic groups (96.5) (50.5) (77.6) (20.6) 38 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding ( ) Figures that are based on 25 – 49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed.26 26 Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life). 32 M IC S K o so v o * N U T R I T I O N Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 45 percent of babies are breastfed for the first time within one hour of birth, while 86 percent of newborns start breastfeeding within one day of birth and 97 percentage were ever breastfed. There are no notable differentials by background characteristics. The set of Infant and Young Child Feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as lack of knowledge in cases where the child was fed by other individuals. In Table NU.4, breastfeeding status is presented for both Exclusively breastfed and Predominantly breastfed; referring to infants age less than 6 months who are breastfed, distinguished by the former only allowing vitamins, mineral supplements, and medicine and the latter allowing also plain water and non-milk liquids. The table also shows continued breastfeeding of children at 12-15 and 20-23 months of age. Table NU.4: Breastfeedinga Percentage of living children according to breastfeeding status at selected age groups, Kosovo*, 2013-2014 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Total 39.9 53.2 142 56.5 97 31.8 109 Sex Male 42.5 53.3 81 56.9 53 36.5 65 Female 36.5 53.0 61 (56.1) 43 (25.0) 44 Area Urban 50.3 59.0 52 (61.7) 35 (34.3) 42 Rural 33.9 49.8 90 53.6 61 30.3 67 Mother’s educationb Lower secondary/ Primary/None 39.0 53.7 71 60.1 54 38.0 53 Upper secondary/ Higher 40.9 52.7 72 52.1 43 25.9 56 Wealth index quintile Poorest (34.0) (51.2) 38 (*) 23 (*) 22 Second (*) (*) 22 (69.9) 24 (*) 26 Middle (43.4) (59.1) 29 (*) 20 (*) 23 Fourth (37.2) (37.2) 24 (*) 14 (*) 21 Richest (48.8) (64.5) 31 (*) 16 (*) 17 Wealth indexc Poorest 60 percent 37.5 53.6 88 57.8 67 31.8 71 Richest 40 percent 43.7 52.5 55 (53.6) 30 (31.9) 38 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years a The background characteristic “Ethnicity of the household head” is not shown in the table due to small number of unweighted cases per disaggregation category b Due to low numbers of denominators for the background characteristic “Mother’s education” the data are merged into two groups c Due to low numbers of denominators for the background characteristic “Wealth index quintiles” the data are merged into two: the poorest 60 percent (bottom three wealth quintiles) and the richest 40 percent (top two wealth quintiles) ( ) Figures that are based on 25 – 49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 33 M IC S K o so v o * Approximately 40 percent of children age less than six months are exclusively breastfed. With 53 percent predominantly breastfed, it is evident that water-based liquids are displacing feeding of breastmilk to a great degree. By age 12-15 months, 57 percent of children are breastfed and by age 20-23 months, 32 percent are breastfed. Children age less than six months are more likely to be exclusively breastfed in urban (50 percent) compared to rural areas (34 percent). Figure NU.2 shows the detailed pattern of breastfeeding by the child’s age in months. More than half of infants 2-3 months old (55 percent) are receiving liquids or foods other than breast milk, with other milk / formula being of highest prevalence. At age 4-5 months old, the percentage of children exclusively breastfed is below 21 percent. Only about one third (31 percent) of children are receiving breast milk at age 2 years. Figure NU.2: Infant feeding patterns by age, Kosovo*, 2013-2014 Note: Figures for age in months 0-1, 4-5, 12-13 and 20-21 are based on 25-49 unweighted cases Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 14.1 months for any breastfeeding, 2.0 months for exclusive breastfeeding, and 2.8 months for predominant breastfeeding. Male and female children appear to be breastfeed for similar durations and there is limited variability between urban and rural areas. The median duration of any breastfeeding is highest among mothers with primary education, while the exclusive breastfeeding median duration increases with increasing education level of the mother. 34 M IC S K o so v o * N U T R I T I O N Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Kosovo*, 2013-2014 Median duration (in months) of: Number of children age 0-35 monthsAny breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median 14.1 2.0 2.8 974 Sex Male 14.5 2.2 2.8 522 Female 13.7 1.8 2.8 452 Area Urban 15.0 2.5 3.3 353 Rural 13.0 1.9 2.5 621 Mother’s educationa None (*) (*) (*) 14 Primary 17.4 1.9 2.2 55 Lower secondary 15.8 2.0 2.9 437 Upper secondary 12.3 2.0 2.4 305 Higher 12.7 2.5 3.3 162 Wealth index quintile Poorest 15.5 1.8 2.7 230 Second 16.8 2.0 2.5 185 Middle 12.6 2.3 3.2 202 Fourth 11.6 0.7 0.7 181 Richest 15.0 2.4 3.6 176 Ethnicity of household headb Albanian 14.5 2.1 2.9 894 Serbian (*) - - 28 Other ethnic groups 13.1 1.7 2.5 52 Mean 15.2 2.5 3.4 974 1 MICS indicator 2.11 - Duration of breastfeeding a Due to the low number of unweighted cases, the category “Missing/DK” for the background characteristic “Mother’s education” is not shown b Due to the low number of unweighted cases, the category “Missing/DK” for the background characteristic “Ethnicity of household head” is not shown (*) Figures that are based on fewer than 25 unweighted cases “-” denotes 0 unweighted case in that cell or in the denominator The age-appropriateness of breastfeeding of children under age 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while children age 6-23 months are considered to be appropriately fed if they are receiving breastmilk and solid, semi-solid or soft food. As a result of feeding patterns, only 48 percent of children age 6-23 months are being appropriately breastfed and age-appropriate breastfeeding among all children age 0-23 months is 46 percent. M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 35 M IC S K o so v o * Table NU.6: Age-appropriate breastfeedinga Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Kosovo*, 2013-2014 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid, semi-solid or soft foods Number of children Percent appropriately breastfed2 Number of children Total 39.9 142 48.1 492 46.3 635 Sex Male 42.5 81 51.1 274 49.1 355 Female 36.5 61 44.4 218 42.7 280 Area Urban 50.3 52 49.2 185 49.5 238 Rural 33.9 90 47.4 307 44.4 397 Mother’s education None (*) 4 (*) 5 (*) 9 Primary (*) 9 (50.0) 31 (44.8) 40 Lower secondary 38.1 58 53.0 217 49.8 275 Upper secondary (34.8) 43 42.9 156 41.2 198 Higher (49.7) 29 43.7 83 45.2 112 Wealth index quintile Poorest (34.0) 38 53.9 104 48.6 141 Second (*) 22 48.5 100 46.3 122 Middle (43.4) 29 44.4 104 44.2 133 Fourth (37.2) 24 46.2 101 44.5 125 Richest (48.8) 31 47.4 83 47.8 114 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding a The background characteristic “Ethnicity of household head” is not shown in the table due to the small number of unweighted cases per disaggregation category ( ) Figures that are based on 25 – 49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, 90 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once during the previous day (Table NU.7); being similar among currently breastfeeding infants (87 percent). Table NU.7: Introduction of solid, semi-solid, or soft foods Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day, Kosovo*, 2013-2014 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods1 Number of children age 6-8 months Total 86.8 67 (100.0) 25 90.3 92 Sex Male (95.4) 39 (*) 11 96.4 50 Female (74.7) 28 (*) 13 (82.9) 41 Area Urban (*) 19 (*) 9 (96.8) 28 Rural (83.4) 48 (*) 16 87.5 64 1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods ( ) Figures that are based on 25 – 49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 36 M IC S K o so v o * N U T R I T I O N Table NU.8: Infant and young child feeding (IYCF) practicesa Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Kosovo*, 2013-2014 Currently breastfeeding Currently not breastfeeding All Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Percent of children who received: Number of children age 6-23 months Minimum dietary diversityb Minimum meal frequencyc Minimum acceptable diet1, d Minimum dietary diversityb Minimum meal frequencyc Minimum acceptable diet2, d At least 2 milk feeds3 Minimum dietary diversity4, b Minimum meal frequency5, c Minimum acceptable dietd Total 50.6 85.5 47.1 246 75.5 95.5 51.8 81.1 229 63.3 90.3 49.4 492 Sex Male 52.7 88.4 49.7 142 82.2 94.7 55.9 83.4 123 67.1 91.3 52.6 274 Female 47.7 81.5 43.6 105 67.7 96.6 47.1 78.4 106 58.5 89.1 45.3 218 Age 6-8 months 23.9 81.0 22.6 67 (*) (*) (*) (*) 22 28.7 84.6 23.4 92 9-11 months 56.0 88.1 54.4 51 (56.4) (95.5) (41.7) (90.2) 36 57.3 91.2 49.1 90 12-17 months 53.9 86.1 49.0 72 78.1 94.3 56.4 82.6 69 67.2 90.1 52.6 147 18-23 months 73.3 87.6 67.1 56 88.2 96.4 57.8 74.7 102 82.4 93.3 61.1 163 Area Urban 68.8 91.1 65.6 92 80.9 96.5 57.5 89.6 87 74.8 93.7 61.6 185 Rural 39.7 82.2 36.0 154 72.1 95.0 48.3 75.8 141 56.3 88.3 41.9 307 Mother’s educatione Lower secondary/ Primary/None 41.3 80.8 37.9 142 68.3 93.5 41.9 76.5 101 53.3 86.1 39.6 253 Upper secondary/ Higher 63.4 91.8 59.6 104 81.0 97.1 59.6 84.6 128 73.8 94.8 59.6 239 Wealth index quintile Poorest 39.9 78.8 36.9 60 (52.0) (86.4) (32.8) (71.6) 41 45.6 81.9 35.2 104 Second 40.4 84.7 38.7 52 (78.0) (98.2) (49.7) (84.7) 46 57.7 91.0 43.9 100 Middle (60.9) (89.0) (60.9) 48 (81.9) (94.5) (58.3) (79.0) 52 72.9 91.9 59.6 104 Fourth (52.6) (86.5) (43.4) 47 (82.6) (98.2) (52.5) (78.5) 51 68.4 92.5 48.2 101 Richest (65.2) (91.1) (60.9) 39 (79.1) (100.0) (64.6) (92.8) 39 73.6 95.5 62.7 83 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency a The background characteristic “Ethnicity of household head” is not shown in the table due to the small number of unweighted cases per disaggregation category b Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables c Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times d The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while for non-breastfed children it further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds e Due to low numbers of denominators for the background characteristic “Mother’s education” the data are merged into two groups ( ) Figures that are based on 25 – 49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases Overall, the majority of children age 6-23 months (90 percent) were receiving solid, semi-solid and soft foods the minimum number of times as shown in Table NU.8. The proportion of children receiving the minimum dietary diversity, or foods from at least 4 food groups, was much lower than that for minimum meal frequency, indicating the need to focus on improving diet quality and nutrient intake among this vulnerable group. A higher proportion of older (12-17 month old) children (67 percent) were achieving the minimum dietary diversity compared to younger (6-8 month old) children (29 percent). The overall assessment using the indicator of minimum acceptable diet revealed that less than half of the children age 6-23 months (49 percent) were benefitting from a diet sufficient in both diversity and frequency. The minimum acceptable diet of children increases with increasing education levels of the mother. Children living in rural areas are less likely to meet the minimum dietary diversity and hence the minimum acceptable diet compared to those in urban areas. The minimum dietary diversity of children not currently breastfeeding is higher than those currently breastfeeding. M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 37 M IC S K o so v o * 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.9 shows that bottle-feeding is prevalent in Kosovo*. Almost two thirds (62 percent) of children age 0-23 months are fed using a bottle with a nipple. There is little variability by location of the household or education level of the mother. Table NU.9: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Kosovo*, 2013-2014 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Total 61.6 635 Sex Male 64.5 355 Female 58.0 280 Age 0-5 months 38.9 142 6-11 months 70.0 181 12-23 months 67.2 311 Area Urban 61.3 238 Rural 61.8 397 Mother’s education None (*) 9 Primary (60.5) 40 Lower secondary 59.7 275 Upper secondary 64.3 198 Higher 67.0 112 Wealth index quintile Poorest 55.2 141 Second 59.4 122 Middle 63.2 133 Fourth 71.8 125 Richest 58.9 114 Ethnicity of household head Albanian 59.7 576 Serbian (*) 20 Other ethnic groups (70.1) 39 1 MICS indicator 2.18 - Bottle feeding ( ) Figures that are based on 25 – 49 unweighted cases (*) Figures that are based on fewer than 25 unweighted cases 38 M IC S K o so v o * © U N IC EF K os ov o* M O N I T O R I N G T H E S I T U A T I O N O F C H I L D R E N A N D W O M E N 39 M IC S K o so v o * VI. CHILD HEALTH VACCINATIONS 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. In addition, the Global Vaccine Action Plan (GVAP) was endorsed by the 194 Member States of the World Health Assembly in May 2012 to achieve the Decade of Vaccines vision by delivering universal access to immunization. Immunization has saved the lives of millions of children in the four decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still millions of children not reached by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. The WHO Recommended Routine Immunizations for Children27 recommends all children to be vaccinated against tuberculosis, diphtheria, pertussis, tetanus, polio, measles, hepatitis B, haemophilus influenzae type b, pneumonia/meningitis, rotavirus, and rubella. All doses in the primary series are recommended to be completed before the child’s first birthday, although depending on the epidemiology of disease in a country, the first doses of measles and rubella containing vaccines may be recommended at 12 months or later. The recommended number and timing of most other doses also vary slightly with local epidemiology and may include booster doses later in childhood. The vaccination schedule followed by the Kosovo* National Immunization Programme provides all the above mentioned vaccinations (except pneumonia/meningitis and rotavirus) with a birth dose of BCG and Hepatitis B vaccines (within 24 hours of birth), three doses of the pentavalent vaccine containing DPT, Hepatitis B and Haemophilus influenzae type b (Hib) antigens, three doses of the Polio vaccine, and one dose of the MMR vaccine containing measles, mumps, and rubella antigens. All vaccinations should be received during the first year of life except measles, which is administered at 12 months. The pentavalent DPT-HepB-Hib vaccine was first introduced in the Kosovo* immunization schedule in June 2011 and was implemented throughout Kosovo* by January 2012. The pentavalent vaccine fully replaced the individual monovalent vaccines and as such introduced Haemophilus influenzae type b as a new vaccine which was not administered before. Note in the tables the antigens included in the pentavalent vaccines are presented as individual antigens. Taking into consideration this vaccination schedule, the estimates for full immunization coverage from the Kosovo* MICS are based on children age 24-35 months. Information on vaccination coverage was collected for all children under three years of age. All mothers (or caretakers) were asked to provide vaccination cards. If the vaccination card for a child was available, interviewers copied vaccination information from the cards onto the MICS questionnaire. If no vaccination card was available for the child, the interviewer proceeded to ask the mother to recall whether or not the child had received each of the vaccinations, and for Polio, DPT, Hepatitis B, and Haemophilus influenzae type b how many doses were received. Information was also obtained from vaccination records at health facilities for all children. The final vaccination coverage estimates are based on information obtained from the vaccination records at health facilities, vaccination card and the mother’s report of vaccinations received by the child. The order of selection of data is first the data on an individual vaccine from the health facility form, then vaccination card, and finally based on the mother’s recall. 27 http://www.who.int/immunization/diseases/en. Table 2 includes recommendations for all children and additional antigens recommended only for children residing in certain regions of the world or living in certain high-risk population groups. 40 M IC S K o so v o * C H I L D H E A L T H Table CH.1: Vaccinations in the first years of life Percentage of children age 12-23 months and 24-35 months vaccinated against vaccine preventable childhood diseases at any time before the survey and by their first birthday, Kosovo*, 2013-2014 Children age 12-23 months: Children age 24-35 months: Vaccinated at any time before the survey according to: Vaccinated by 12 months of agea Vaccinated at any time before the survey according to: Vaccinated by 12 months of age (measles by 24 months)a Health facility records or vaccination card Mother’s report Either Health facility records or vaccination card Mother’s report Either Antigen BCG1 95.5 3.1 98.7 98.7 95.2 3.1 98.3 98.3 Polio 1 96.0 1.5 97.5 97.5 96.0 1.9 97.9 97.6 2 95.3 1.8 97.1 96.7 94.3 2.4 96.7 95.4 32 92.8 0.8 93.6 91.0 93.6 2.0 95.6 91.4 DPT 1 94.6 3.0 97.7 97.7 92.3 5.4 97.7 97.7 2 94.6 1.8 96.4 96.4 91.3 4.4 95.7 95.7 33 94.0 0.8 94.7 94.7 91.1 3.4 94.5 94.5 HepB At birth 51.7 0.6 52.3 52.3 53.1 2.4 55.5 55.5 1b 93.1 2.5 95.7 95.7 91.7 3.8 95.5 95.5 2 93.3 2.1 95.3 95.3 91.8 5.2 97.0 97.0 34 92.9 1.1 94.0 94.0 90.6 4.2 94.7 94.7 Hib 1 90.5 3.5 94.1 94.1 90.7 6.0 96.7 96.7 2 89.4 2.9 92.3 92.3 88.8 5.2 94.0 94.0 35 88.0 1.1 89.1 89.1 88.2 3.3 91.6 91.6 Measles (MM

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