Kyrgyzstan: Monitoring the situation of children and women: Multiple Indicator Cluster Survey (2006)

Publication date: 2006

Kyrgyzstan Monitoring the situation of children and women Multiple Indicator Cluster Survey Kyrgyz Republic, 2006 National Statistical Commitee of the Kyrgyz Republic United Nations Children’s Fund Kyrgyzstan Multiple Indicator Cluster Survey 2006 Ky rg yz st an 2 00 6 M ul tip le In di ca to r C lu st er S ur ve y Monitoring the situation of children and women Kyrgyzstan National Statistical Commitee of the Kyrgyz Republic United Nations Children’s Fund Multiple Indicator Cluster Survey Kyrgyz Republic, 2006 The Kyrgyz Multiple Indicator Cluster Survey (MICS) was carried by the National Statistical Committee of the Kyrgyz Republic in collaboration with the Ministry of Health, the Ministry of Labour and Social Protection, the Ministry of Education, the representative office of the World Health Organization (WHO), the United States Agency for International Development (USAID), non-governmental organizations Project HOPE and Zdrav- PLUS. Financial and technical support was provided by the United Nations Children’s Fund (UNICEF). The survey has been conducted as part of the third round of MICS surveys (MICS3), carried out around the world in more than 50 countries, in 2005-2006, following the first two rounds of MICS surveys that were conducted in 1995 and 2000. Survey tools are based on the models and standards developed by the global MICS project, designed to collect information on the situation of children and women in countries around the world. Additional information on the global MICS project may be obtained from www.childinfo.org. Suggested citation: Multiple Indicator Cluster Survey 2006, Kyrgyz Republic. Final Report. National Statistical Committee of the Kyrgyz Republic. United Nations Children’s Fund. 2007. Kyrgyzstan, Bishkek. MONITORING THE SITUATION OF CHILDREN AND WOMEN 3 LIST OF CONTRIBUTORS Prof., Dr. Zarylbek Kudabaev – The Chairman of the National Statistics Committee of the Kyr- gyz Republic (1997-2005), Prof. of American University in Central Asia, 205, str., Bishkek, Kyr- gyz Republic, 720040. Orozmat Abdykalykov – The Chairman of the National Statistics Committee of the Kyrgyz Republic (since 2005), National Statistics Committee, 374, Frunze str. Bishkek, Kyrgyz Republic, 720033. Galina Samohleb – The head of the household survey division, National Statistics Committee, 374, Frunze str. Bishkek, Kyrgyz Republic, 720033. Kulyipa Koichumanova – The head of the social statistics division, National Statistics Commit- tee, 374, Frunze str. Bishkek, Kyrgyz Republic, 720033. Gulsara Sulaimanova – Statistician, National Statistics Committee, 374, Frunze str. Bishkek, Kyrgyz Republic, 720033. Ludmila Torgasheva – The head of the demographic statistics division, National Statistics Com- mittee, 374, Frunze str. Bishkek, Kyrgyz Republic, 720033. Larisa Praslova – Data entry/data analysis specialist, National Statistics Committee, 374, Frunze str. Bishkek, Kyrgyz Republic, 720033. Larisa Murzakarimova – The Head of Republican Medical Information Centre, Ministry of Health, 43, Razzakova str., Bishkek, Kyrgyz Republic, 720000. Larisa Miroshnichenko, Ph.D. – Counsellor of Rector of the Balasagyn Kyrgyz National Uni- versity, 547, Frunze str., Bishkek, Kyrgyz Republic, 720024. Prof. Ludmila Kibardina – Professor of Kyrgyz Academy of Education, 25 bul. Erkindyk, Bishkek. Tursun Mamyrbaeva, M.D. – Senior Specialist. National Centre of Pediatrics and Children’s Surgery. 192, Ahunbaev str., Bishkek, Kyrgyz Republic. Ainura Jekshenova, Ph.D. – Science Secretary. National Centre of Pediatrics and Children’s Surgery. 192, Ahunbaev str., Bishkek, Kyrgyz Republic. Dr. Fritz van der Haar – Rollins School of Public Health of Emory University. 1518 Clifton Rd, N.E., Suite 716, Atlanta, GA, 30322 USA, 404/727-2427 Mr. Beau Gordinier – Communications Editor, American University of Central Asia, 205 Abdy- momunov str., Bishkek, Kyrgyz Republic, 720040. 4 TABLE OF CONTENTS Summary Table of Findings .6 List of Tables .8 List of Figures .10 List of Abbreviations .11 Acknowledgements .12 Summary of Findings and Conclusions.13 I. Introduction .16 Background .17 Survey Objectives .18 II. Sample and Survey Methodology.20 Sample Design .21 Questionnaires .22 Training and Fieldwork .23 Data Processing .23 III. Sample Coverage and the Characteristics of Households and Respondents.24 Sample Coverage .25 Characteristics of Households .25 Characteristics of Respondents .26 IV. Infant, Child and Maternal Mortality .28 Infant, Child and Maternal Mortality .29 V. Nutrition .32 Nutritional Status .33 Breastfeeding and Complementary Feeding .35 Consumption of Iodised Salt .36 Vitamin A supplements .37 Low Birth Weight .38 VI. Child Health .40 Oral Rehydration Treatment of Children with Diarrhea .41 Antibiotic Treatment of Children with Suspected Pneumonia .42 Solid Fuel Use .42 VII. Water and Sanitation.44 Access to Pure Drinking Water.45 Use of Sanitary – Hygienic Facilities for Excreta Disposal .47 VIII. Reproductive Health.48 Contraception .49 Unmet Need .50 Antenatal Care .50 Assistance at Delivery .52 IX. Early Childhood Development and Education .54 Preschool Attendance and School Readiness .56 Primary and Secondary School Participation .57 Adult Literacy .59 MONITORING THE SITUATION OF CHILDREN AND WOMEN 5 X. Child Protection .60 Birth Registration .61 Child Labour .62 Child Discipline .63 Early Marriage and Polygyny .64 Domestic Violence .65 XI. HIV/AIDS, Sexual Behaviour, and Orphaned Children .68 Knowledge of HIV Transmission and Condom Use .69 Sexual Behaviour Related to HIV Transmission .71 List of References .72 Selected Tables .73 Appendix A. Sample Design .143 Appendix B. List of Personnel Involved in the Survey .146 Appendix C. Estimates of Sampling Errors .148 Appendix D. Data Quality Tables .161 Appendix E. MICS Indicators: Numerators and Denominators .169 Appendix F. Questionnaires .173 CHILD DISCIPLINE MODULE .184 CHILD DISCIPLINE MODULE .173 6 SUMMARY TABLE OF FINDINGS Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Kyrgyzstan, 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value Units CHILD MORTALITY Child mortality 1 13 Under-five mortality rate 44 per thousand 2 14 Infant mortality rate 38 per thousand NUTRITION Nutritional status 6 4 Underweight prevalence (below -2 SD) 3.4 percent 7 Stunting prevalence (below -2 SD) 13.7 percent 8 Wasting prevalence (below -2 SD) 3.5 percent Breastfeeding 45 Timely initiation of breastfeeding 64.9 percent 15 Exclusive breastfeeding rate 31.5 percent 16 Continued breastfeeding rate at 12-15 months at 20-23 months 67.8 26.2 percent 17 Timely complementary feeding rate 49.3 percent 18 Frequency of complementary feeding 44.5 percent 19 Adequately fed infants 37.5 percent Salt iodization 41 Iodized salt consumption 76.1 percent Vitamin A 42 Vitamin A supplementation (under-fives) 47.0 percent 43 Vitamin A supplementation (post-partum mothers) 50.6 percent Low birth weight 9 Low birth weight infants 5.3 percent 10 Infants weighed at birth 96.9 percent CHILD HEALTH Care of illness 33 Use of oral rehydration therapy (ORT) 20.4 percent 34 Home management of diarrhoea 15.4 percent 35 Received ORT or increased fluids, and continued feeding 22.3 percent 23 Care seeking for suspected pneumonia 62.1 percent 22 Antibiotic treatment of suspected pneumonia 44.5 percent Solid fuel use 24 29 Solid fuels 37.3 percent Source and cost of supplies 96 Source of supplies (from public sources) Antibiotics 16.8 percent 97 Cost of supplies (median costs) Antibiotics Public sources 244.1 Som Private sources 100 Som ENVIRONMENT Water and sani- tation 11 30 Use of improved drinking water sources 88.2 percent 13 Water treatment 34.6 percent 12 31 Use of improved sanitation facilities 96.3 percent 14 Disposal of child’s faeces 42.7 percent REPRODUCTIVE HEALTH Contraception and unmet need 21 19c Contraceptive prevalence 47.8 percent 98 Unmet need for family planning 1.1 percent 99 Demand satisfied for family planning 97.7 percent Maternal and newborn health 20 Antenatal care 96.9 percent 44 Content of antenatal care Blood test taken Blood pressure measured Urine specimen taken Weight measured 96.8 96.8 96.6 96.6 percent 4 17 Skilled attendant at delivery 97.6 percent 5 Institutional deliveries 96.9 percent Maternal mortal- ity 3 16 Maternal mortality ratio 104 per 100,000 MONITORING THE SITUATION OF CHILDREN AND WOMEN 7 Topic MICS Indicator Number MDG Indicator Number Indicator Value Units CHILD DEVELOPMENT Child develop- ment 46 Support for learning 71.0 percent 47 Father’s support for learning 52.8 percent 48 Support for learning: more than 3 children’s books 76.2 percent 49 Support for learning: more than 3 non-children’s books 38.2 percent 50 Support for learning: materials for play (3 or more toys) 24.9 percent 51 Non-adult care 10.6 percent EDUCATION Education 52 Pre-school attendance 19.0 percent 53 School readiness 20.2 percent 54 Net intake rate in primary education 70.4 percent 55 6 Net primary school attendance rate 92.1 percent 56 Net secondary school attendance rate 89.2 percent 57 7 Children reaching grade five 98.6 percent 58 Transition rate to secondary school 99.1 percent 59 7b Primary completion rate 79.2 percent 61 9 Gender parity index Primary school Secondary school 1.03 1.04 ratio ratio Literacy 60 8 Adult literacy rate 99.9 percent CHILD PROTECTION Birth registration 62 Birth registration 94.2 percent Child labour 71 Child labour 3.6 percent 72 Labourer students 75.9 percent 73 Student labourers 3.3 percent Child discipline 74 Any psychological/physical punishment 51.4 percent Early marriage and polygyny 67 Early marriage Marriage before age 15 Marriage before age 18 0.8 12.2 percent 68 Young women aged 15-19 currently married/in union 7.7 percent 70 Polygyny 1.7 percent 69 Spousal age difference (>10 years) Women of age 15-19 Women of age 20-24 10.2 6.0 percent Domestic vio- lence 100 Attitudes towards domestic violence 37.7 percent HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED AND VULNERABLE CHILDREN HIV/AIDS knowledge and attitudes 82 19b Comprehensive knowledge about HIV prevention among young people 20.3 percent 89 Knowledge of mother- to-child transmission of HIV 58.0 percent 86 Attitude towards people with HIV/AIDS 5.2 percent 87 Women who know where to be tested for HIV 59.0 percent 88 Women who have been tested for HIV 37.0 percent 90 Counselling coverage for the prevention of mother-to- child transmission of HIV 62.6 percent 91 Testing coverage for the prevention of mother-to-child transmission of HIV 54.6 percent 92 Age-mixing among sexual partners 6.6 percent Sexual behaviour 83 19a Condom use with non-regular partners 56.0 percent 85 Higher risk sex in the last year 7.4 percent Orphanhood 78 Children’s living arrangements 5.4 percent 75 Prevalence of orphans 5.5 percent 8 LIST OF TABLES Table HH.1: Results of household and individual interviews .73 Table HH.2: Household age distribution by sex .73 Table HH.3: Household composition .74 Table HH.4: Women’s background characteristics .75 Table HH.5: Children’s background characteristics .76 Table CM.1: Child mortality .76 Table NU.1: Child malnourishment .77 Table NU.2: Initial breastfeeding .78 Table NU.3: Breastfeeding .79 Table NU.4: Adequately fed infants .80 Table NU.5: Iodized salt consumption .81 Table NU.6: Children’s vitamin A supplementation .82 Table NU.7: Post-partum mothers’ vitamin A supplementation .83 Table NU.8: Low birth weight infants .84 Table CH.4: Oral rehydration treatment.85 Table CH.5: Home management of diarrhoea .86 Table CH.6: Care seeking for suspected pneumonia .87 Table CH.7: Antibiotic treatment of pneumonia .88 Table CH.7A: Knowledge of the two danger signs of pneumonia .89 Table CH.8: Solid fuel use .90 Table CH.9: Solid fuel use by type of stove or fire .91 Table CH.16: Source and cost of supplies for antibiotics .92 Table EN.1: Use of improved water sources .93 Table EN.2: Household water treatment .94 Table EN.3: Time to source of water .95 Table EN.4: Person collecting water .96 Table EN.5: Use of sanitary means of excreta disposal .97 Table EN.6: Disposal of child’s faeces .98 Table EN.7: Use of improved water sources and improved sanitation .99 Table RH.1: Use of contraception .100 Table RH.2: Unmet need for contraception .102 Table RH.3: Antenatal care provider.103 Table RH.4: Antenatal care .104 Table RH.5: Assistance during delivery .105 Table RH.6: Maternal mortality ratio .107 Table CD.1: Family support for learning .108 Table CD.2: Learning materials.109 Table CD.3: Children left alone or w.ith other children .111 Table ED.1: Early childhood education .112 Table ED.2: Primary school entry .113 Table ED.3: Primary school net attendance ratio .114 Table ED.4: Secondary school net attendance ratio .115 Table ED.5: Children reaching grade 5 .116 Table ED.6: Primary school completion and transition to secondary education .117 Table ED.7: Education gender parity .118 Table ED.8: Adult literacy .119 Table CP.1: Birth registration .120 Table CP.2: Child labour .122 Table CP.3: Labourer students and student labourers .123 Table CP.4: Child discipline .124 Table CP.5: Early marriage and polygyny .126 Table CP.6: Spousal age difference .128 Table CP.9: Attitudes toward domestic violence .129 Table HA.1: Knowledge of preventing HIV transmission .131 Table HA.2: Identifying misconceptions about HIV/AIDS .132 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission .133 Table HA.4: Knowledge of mother-to-child HIV transmission .134 Table HA.5: Attitudes toward people living with HIV/AIDS .135 MONITORING THE SITUATION OF CHILDREN AND WOMEN 9 Table HA.6: Knowledge of a facility for HIV testing .137 Table HA.7: HIV testing and counseling coverage during antenatal care .138 Table HA.8: Sexual behaviour that increases risk of HIV infection .139 Table HA.9: Condom use at last high-risk sex .140 Table HA.10: Children’s living arrangements and orphanhood .142 Table SD.1: Allocation of Sample Clusters (Primary Sampling Units) to Sampling Domains .144 Table SE.2: Sampling errors: Total sample .150 Table SE.3: Sampling errors: Urban areas .151 Table SE.4: Sampling errors: Rural areas .152 Table SE.5: Sampling errors: Batken .153 Table SE.6: Sampling errors: Jalalabad .154 Table SE.7: Sampling errors: Issykkul .155 Table SE.8: Sampling errors: Naryn .156 Table SE.9: Sampling errors: Osh .157 Table SE.10: Sampling errors: Talas .158 Table SE.11: Sampling errors: Chui .159 Table SE.12: Sampling errors: Bishkek t.160 Table DQ.1: Age distribution of household population .161 Table DQ.2: Age distribution of eligible and interviewed women.162 Table DQ.3: Age distribution of eligible and interviewed under-5s .162 Table DQ.4: Age distribution of under-5 children .163 Table DQ.5: Heaping on ages and periods .164 Table DQ.6: Completeness of reporting .165 Table DQ.7: Presence of mother in the household and the person interviewed for the under-5 questionnaire .165 Table DQ.8: School attendance by single age .166 Table DQ.9: Sex ratio at birth among children ever born and living .167 Table DQ.10: Distribution of women by time since last birth .168 10 LIST OF FIGURES Figure SD: Spatial distribution of MICS3 clusters .21 Figure HH.1: Population of households surveyed, by age and sex, Kyrgyz Republic, 2006 (%). .25 Figure HH.2: Distribution of childbearing age women by five-year age groups, Kyrgyz Republic, 2006. .26 Figure CM.1: Under-5 mortality rates by background characteristics, Kyrgyz Republic, 2006 .30 Figure CM.2: Trend in under-5 mortality rates, Kyrgyz Republic, 2006 .30 Figure NU.1: Percentage of children under-5 who are undernourished, Kyrgyz Republic, 2006 .34 Figure NU.2: Regional distribution of malnutrition in 0-59 month old children, Kyrgyz Republic, 2006 .34 Figure NU.3: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Kyrgyz Republic, 2006 .35 Figure NU.4: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group, Kyrgyz Republic, 2006 .36 Figure NU.5: Percentage of households consuming adequately iodized salt, Kyrgyz Republic, 2006 .37 Figure NU.6: Percentage of Infants Weighing Less Than 2500 Grams at Birth, Kyrgyz Republic, 2006 .38 Figure CH.1: Percentage of children with episodes of diarrhea by age, Kyrgyz Republic, 2006. .41 Figure CH.2: Percentage of households that use solid fuels for cooking by region. Кyrgyz Republic, 2006. .43 Figure EN.1: Access to improved source of drinking water. Percent of households. Kyrgyz Republic. 2006. .45 Figure EN.2: Percentage distribution of household members by source of drinking water. Kyrgyz Republic, 2006 .46 Figure EN.3: Distribution of time spent by household members retrieving drinking water from the source. Кyrgyz Republic, 2006. .46 Figure EN.4: Percentage of population with access to improved drinking water sources and improved sanitary-hygienic facilities. Кyrgyz Republic, 2006. .47 Figure RH.1: Preferred means of contraception for women and educational level attainment. Кyrgyz Republic, 2006. .49 Figure RH.2: Percentage of contraception methods chosen by female respondent’s household wealth index. Кyrgyz Republic, 2006. .50 Figure RH.3: Coverage by antenatal care, Kyrgyz Republic, 2006. .51 Figure RH.4: Percentage of deliveries assisted by skilled attendant. Kyrgyz Republic. 2006. .52 Figure RH.5: Percentage of deliveries assisted by doctor or nurse/midwife according to household wealth index. Kyrgyz Republic. 2006. .53 Figure ED.1: Percentage of children aged 36-59 months currently attending early childhood education by household wealth index. Kyrgyz Republic. 2006. .56 Figure ED.2: Percentage of children of 6 years age attending grade 1, Kyrgyz Republic, 2006 .58 Figure CP.1: Birth registration by age group. Kyrgyz republic, 2006 .61 Figure CP.2: Percentage of types of punishment used with regard to children 3-14 years of age, Kyrgyz Republic, 2006 .64 Figure CP.3: Percentage of women who married before 18 years of age by region. Kyrgyz Republic. 2006. .65 Figure CP.4: Percentage of women who supported domestic violence for selected reasons by residence, Kyrgyz Republic, 2006 .66 Figure CP.5: Percentage of women who supported domestic violence for selected reasons by ethnicity, Kyrgyz Republic, 2006 .66 Figure HA.1: Percentage of women aware of two methods of preventing the spread of HIV/AIDS, by region. Kyrgyz Republic. 2006. .69 Figure HA.2: Percent of women who have comprehensive knowledge of HIV/AIDS transmission, Kyrgyzstan, 2006 .70 Figure HA.3: Sexual behaviour that increases risk of HIV infection, Kyrgyz Republic, 2006 .71 MONITORING THE SITUATION OF CHILDREN AND WOMEN 11 LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome BCG Bacillis-Cereus-Geuerin (Tuberculosis) CDC Center for Disease Control and Prevention, USA CEA Census Enumeration Areas DPT Diphteria Pertussis Tetanus EPI Expanded Programme on Immunization GAVI Global Alliance of Vaccines and Immunization GPI Gender Parity Index HIV Human Immunodeficiency Virus ICPD International Conference on Population and Development ILBD International Live Birth Definition IDD Iodine Deficiency Disorders IMCI Integrated Management of Childhood Illnesses IQ Intelligence Quotient ITN Insecticide Treated Net IUD Intrauterine Device LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MoH Ministry of Health NAR Net Attendance Rate NCHS National Center for Health Statistics ORT Oral Rehydration Therapy ORS Oral Rehydration Situation PPM Parts Per Million PSU Primary Sampling Unit SPSS Statistical Package for Social Sciences STI Sexually Transmitted Infection UNAIDS United Nations Programme on HIV/AIDS UNDP United Nations Development Programme UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund VAS Vitamin A Supplement WFFC World Fit for Children WHO World Health Organization TABLE REFERENCES CD – Child Development HA – HIV/AIDS CH – Child Health HH – Household CM – Child Mortality EN – Environment CP – Child Protection NU – Nutrition ED – Education RH – Reproductive Health 12 ACKNOWLEDGEMENTS Based on international methodologies, the Multiple Indicator Cluster Survey (MICS3) provides an excellent chance to reveal a comprehensive picture of the lives of children and women in Kyrgyzstan, and to compare it with the situation in more than 70 countries also implement- ing MICS3. The survey supplements government statistical data on some issues, thus drawing the attention of the Government and the public to new aspects. The survey results will provide one of the most important sources of alternative information to help monitor the progress of achieving the Millennium Development Goals (MDGs). The survey could not have been carried out without the dedication and professionalism of hundreds of people. However, we would like to express special acknowledgement to the interviewers, field editors, and drivers who completed fieldwork assignments in a timely and effective manner despite difficult winter conditions. The professionalism of the data entry specialists and statistics analysts greatly contributed to the strong foundation of high quality survey data upon which this report was built. We wish to especially extend our gratitude to the management and staff of the National Statistical Committee of the Kyrgyz Republic: Prof. Zarylbek Kudabaev and team, who initiated the preparation and launch of the survey, as well as to Mr. Orozmat Abdykalykov and team, who sup- ported the execution of the survey. We also greatly appreciate the contributions of the specialists and experts from the Ministry of Health, the Ministry of Labour and Social Protection, the Minis- try of Education, the National Statistical Committee, the representative office of the World Health Organization (WHO), the United States Agency for International Development (USAID), non-gov- ernmental organizations such as ZDRAV-Plus and Project Hope. All participated in the adaptation of questionnaires, the monitoring of fieldwork and the analysis of survey data. Special thanks also goes to Mr. Fritz van der Haar from the Center for Disease Control and Prevention (CDC, Atlanta), who has generously written several sections of the report related to the nutrition and malnutrition of children, salt iodization and Vitamin A supplementation. Finally, we acknowledge the UNICEF staff all over the world, who diligently executed the overall management of this global survey, developed questionnaire, data entry and indications estimation software, conducted training seminars, and supplied vital equipment and materials. MONITORING THE SITUATION OF CHILDREN AND WOMEN 13 SUMMARY OF FINDINGS AND CONCLUSIONS Household Population The total sample volume of the survey consisted of 5,200 households where nearly 25,000 persons reside. Because the sample size by strata is approximately equal, sample weights were used for reporting national level results. Females accounted for 52.9% of this popula- tion, where a majority of females (more than 61%) was less than 30 years old. Out of the surveyed women, 55% fell into the reproductive age range of 15-49 years. The number of children under 15 years of age accounted for 32.7% of the population, while 12% of the population was 0-4 years. Moreover, 81.5% of the households surveyed have children less than 18 years of age. The percentage of households with 4-5 members accounted for 40.3% of the population, while the next largest segment of households (2-3 members) measured 23.6%. Households located in rural areas accounted for 56.8% of all households interviewed. Among women interviewed, 61.5% identified themselves ethnically as Kyrgyz, with 18.8% as Uzbek and 13.5% as Russian. In terms of the educational attainment of women in the reproductive age range (15-49), near- ly 62.8% of these women completed the compulsory level (8 years), while 23.9% attained a high (university) level and 13.3% failed to complete the compulsory level of education In terms of household wealth, near parity existed among the number of children in each quintile group, where the 22.7% of children who lived in households in the richest quintile represented was the largest percentage among all quintiles. And while 17.4% of women of childbearing age lived in households in the poorest quintile, 25% lived in households in the richest quintile. Infant, Child and Maternal Mortality Infant, child and maternal mortality rates remain relatively high in Kyrgyzstan. The mor- tality rate for children under five year of age was 44 per 1000 live births while the infant mortality rate was 38 per 1000 live births. It can be noticed that infant and child mortality rates are steadily decreasing with time. The maternal mortality rate was estimated to be 104 deaths per 100,000 live births, showing no sign of improvement over the previous 10-15 years. Nutrition The prevalence of stunting as a result of malnourishment stands at 13.7%, where 3.7% of children are severely stunted. Not surprisingly, children from the two poorest quintile groups are more stunted (first – 18.8%; second – 14.9%) than the richest (10.2%). Stunting is most prevalent in the Talas, Batken and Issyk-kul regions. While nearly 90% of mothers start breast-feeding their newborn within one day of birth, less than one third of children are exclusively breastfed at six months of age, which is considered far less than optimal. Only 37.5% of infants are being appropriately fed throughout the first year of life. Three out of four households consume adequately iodised salt, however salt was more like- ly to be adequately iodised in urban (84.5%) than rural households (69.8%). Twice yearly the Kyrgyz Ministry of Health carries out mass distribution of high-dose vita- min A capsules for children aged 6-59 months, in addition to vitamin A supplements (VAS) that are distributed to new mothers to boost their levels during breastfeeding. Two out of three eligible children under five years old benefited form the national VAS campaign.            14 Child Health Diarrhea is one of the leading causes of illness for children under five. Children in rural areas had episodes of diarrhea 1.5 times more often than children in urban areas. The high- est frequency of cases occurred in children between 6-23 months of age. Oral Rehydration Therapy (ORT) was not given to 79.6% of children with diarrhea. Mothers who had children with pneumonia within two weeks prior to the survey brought their children to receive antibiotic treatment at relevant medical clinics in 44.5% of cases. Mothers of children aged 0-59 months living in urban areas (50.3%) were more informed about pneumonia than mothers in rural areas (35.4%). Nearly 29% of mothers in the poorest quintiles knew of at least two symptoms of pneumonia, while almost 56% of mothers in the richest quintile knew of these. Water and Sanitation Overall, 88.2% of the population has access to improved drinking water sources, where 98.7% have access in urban areas and 81.8% in rural areas. Most water is accessed by water pipelines (52.8%), which run into the dwelling or onto the property, while 27.1% use public water taps. The largest level of surface water consumption takes place in Batken (28.5%), where risk of exposure to infectious intestinal diseases is greatly increased. Nearly 96% of the population lives in households that use sanitary-hygienic facilities, where little difference exists between urban and rural populations. Only 73.2% of households in Batken have access to such facilities. In Bishkek, about 64% of households connected to the sewer system. Reproductive Health Of the 4,195 women interviewed for this survey, only 47.8% of married women used con- traception, where the IUD is the most popular with about half of the women and condom use, the second most popular method, was favored by just 5.8% of married women. The use of contraception in northern regions is significantly higher than in the south. Condoms and oral contraception use is most prevalent in the two richest quintile groups. Of those who gave birth within the last two years (1,209 women), 97.5% received antenatal care and 96.9% of overall births took place in hospitals. The percentage of women who were assisted during delivery by doctor is nearly 76.3%, while in the poorest and richest quintile groups, respectively, 60.1% and 96.3% of women had received such care. Early Childhood Development Parental participation in early childhood development is crucial. In terms of wealth and pa- rental participation, while 64% of preschool age children in the poorest quintile participated in four or more types of child development activities with their parents, about 84% of children in the richest quintile were exposed to the same. Along ethnic lines, Russian children partici- pated the most (84%), while Kyrgyz (73.5%) and Uzbek parents (53.6%) ranked below them. Approximately 81% urban households have three or more children’s books, while in rural areas just 72.9% of households have. Education In terms of preschool education, nearly 19% of children aged 36-59 months attend preschool. Significant urban/rural and regional differences persist in this regard. One third of urban children (41.9% in Bishkek) attend preschool, while about 10% of children in rural areas (6.6% in Batken) do so. Mothers with less than a compulsory education do not generally          MONITORING THE SITUATION OF CHILDREN AND WOMEN 15 send their children to preschool, while 42.5% of mothers with a high education level send their kids to preschool. Out of the total number of children of primary school entrance age (6-7 years), only 70.4% of such children are attending first grade. Just 66.4% of such males attended the first form, while 75.5% of females do. The primary school net attendance ratio throughout the country is 92.1%, comprising 92.9% in urban areas and 91.7% in rural areas. Adult literacy rates in Kyrgyzstan among groups divided by urban/rural, region and eth- nicity are all at or very close to 100%. Child Protection The vast majority of children (94.2%) under five years of age have been registered, yet only 89.8% of children are registered before their first birthday. Reasons for failed registration of these children include unregistered marriage of the birth parents (32.4%), as well as the distance to the registry office (7.8%) and the costs of registering (3.8%). Of all children aged 5-14 years, 3.6 % of children were in involved in either economic or domestic work, while 1.5% worked outside their households and just 0.1% was paid for the labor performed. While 51.4% of children aged 3-14 were subjected to one form of psychological or physi- cal punishment by mother/caretaker or other household members, 2.6% were subjected to severe physical punishment. However, just 7.7% of mothers/caretakers believed imposing physical punishment was a correct way to raise a child. The minimal age of marriage in the Republic is 18, yet 12.2% of women got married before they reached 18. Daughters are given away in early marriage more often in poorest house- holds (16.5%) than in the richest (9.1%). Though polygyny had been effectively eliminated from the Republic by the 1930s, today 1.7% of women of reproductive age claim to be in a polygamous marriage. The largest per- centage of polygamous marriages was registered among the richest quintile (nearly 2%). Roughly 38% of women of reproductive age surveyed said they supported violence towards women if they either left home without husband’s permission (20.5%), providing inade- quate care for the children (22.4%), and disagreeing with the husband (25.6%). HIV/AIDS, Sexual Behaviour Further focus is needed on HIV/AIDS awareness, especially among young women in the southern regions, where awareness about prevention methods is dangerously low. Among 7,043 women of reproductive age interviewed, awareness of the disease is highest among those from Bishkek (99%) and the northern regions (approximately 96%), and lowest among women in the south (Batken – 81.8%; Osh – 86.4%; Jalalabad – 88.5%). Awareness of HIV/ AIDS prevention is lowest also in the south, where 41.0% of women from Batken are not aware of any methods of prevention (Osh – 29.5%; Jalalabad – 19.1%). Awareness of at least two methods of prevention ranged regionally from 71.4% in Bishkek and 81.6% in Talas to just about 35% in Batken (and 38% in Osh). While 63.6% of women between 30-34 years of age know of these methods, just 50% of 15-19 year olds are aware. Just 59.0% of women knew where they could get tested for HIV infection. The overall percentage of interviewed women aged 20-24 who had sexual intercourse before age 18 was just 10.2% (7.2% – urban; 12.9% – rural). The percentage of women aged 15-24 who had sexual contacts with more than one partner in the previous 12 months, considered the highest risk group, was 0.7%. Nearly 30% of women aged 15-24 had sexual contact during the preceding 12 months. Of these, 7.4% had contact with an irregular partner, and condom use was reported in 56% of these cases.             I. INTRODUCTION MONITORING THE SITUATION OF CHILDREN AND WOMEN 17 Background The Multiple Indicator Cluster Survey (MICS) was conducted in the Kyrgyz Republic in 2006 by the National Statistical Committee of the Kyrgyz Republic with the financial and method-ological support of the United Nations Children’s Fund (UNICEF). The survey was undertak- en to monitor progress in reaching the goals and targets stipulated in the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action for a World Fit for Children, adopted by 189 Member States at the United Nations General Assembly Special Session on Children in May 2002. In signing these international documents, governments committed themselves to improving condi- tions for their children and to monitoring progress towards that end. UNICEF was assigned a sup- porting role in this task (see Table 1). Table 1. 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 contained therein: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60). “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” Since beginning its work in the Kyrgyz Republic in 1994, UNICEF has paid special attention to children’s health and nutrition, children living in poverty, children deprived from parental care and other related issues. UNICEF, in cooperation with other international donor organizations, provides technical assistance to the Government for development of the state program of public health reforms, known as “MA- NAS TAALIMI 2006-2010.” UNICEF also supports the program of Integrated Management of Child- hood Illnesses (IMCI), including Care for Development Programme. Half of all maternity hospitals, maternity departments of regional hospitals, and polyclinics in the republic were certified as “baby- friendly.” In contrast to previous practices a newborn is now kept with the mother from the first hours of its life so the mother can breastfeed and provide her tenderness and love. 18 With support from UNICEF, the Kyrgyz Parliament has developed and approved the Code for Chil- dren of the Kyrgyz Republic. As a result, there is a legal mandate for the establishment of minimum standards in protecting children’s rights. UNICEF supports removing children from institutions and returning them to family or foster environments suited to the best interests of the children. For this purpose, UNICEF supported the government in creating social services designed to provide assis- tance to families in danger of losing custody of their children. With the participation of UNICEF and other partners under the Global Alliance of Vaccines and Immunization (GAVI), poliomyelitis was eliminated in Kyrgyzstan, and the number of measles and rubella cases was reduced. UNICEF and GAVI, along with other donor agencies also helped to dis- tribute significant amounts of vaccines and syringes, establish the necessary technical conditions for vaccine storage, and conduct trainings for medical personnel. It’s also planned to reduce vitamin A and iron deficiencies among children by one third by 2015 from 2000 levels, and to completely elimi- nate iodine deficiencies by the end of 2007. Improvement of primary school education quality is carried out jointly with governmental and non-governmental organizations and donors. These efforts include upgrading school programs and projects designed to increase local community involvement in the educational process. MICS3 survey was designed to evaluate the current status of various development indicators and to define priorities for future action. This survey report reflects the final results on all considered topics and indicators. Survey Objectives The main objectives of the Multiple Indicator Cluster Survey consist of the following: to provide updated information for assessing the situation of children and women in the Kyrgyz Republic; to collect data necessary for monitoring progress towards the Millennium Development Goals and the goals of Plan of Action for a World Fit for Children (WFFC), as a basis for future actions; to contribute to the improvement of data and monitoring systems in the Kyrgyz Republic and to strengthen technical expertise in the design, implementation and analysis of such systems.    MONITORING THE SITUATION OF CHILDREN AND WOMEN 19 II. SAMPLE AND SURVEY METHODOLOGY MONITORING THE SITUATION OF CHILDREN AND WOMEN 21 Sample Design The sample for the Kyrgyz Multiple Indicator Cluster Survey was designed to provide representa-tive estimates of MICS indicators at the national level, in urban and rural areas, as well as for eight regions: Batken, Jalalabad, Issyk Kul, Naryn, Osh, Talas, Chui regions, and Bishkek. The urban and rural areas of each region were used as strata, where the sample design was made in two stages. Four hundred clusters, or Census-1999 Enumeration Areas (CEA), were selected with a probability proportional to the population size in the first stage. For rural areas, populated settlements were used as Primary Sampling Units (PSUs). For urban areas, internal territorial-administrative units were used as PSUs. For each enumeration area, a household listing was updated and used as a sample framework for the second selection stage. Later, households with an equal probability were selected, according to the up-dated lists of addresses. Figure SD: Spatial distribution of MICS3 clusters In defining the cluster size, a high rate of intra-cluster correlation of different indicators was taken into account. This required clusters of small size, as well as consideration of the effective use of in- terviewers’ time, requiring a minimization of movement from one settlement to another. As a com- promise between data accuracy and the efficient use of limited time and funding, a cluster size was determined to consist of 13 households. Thus, a total sample volume consisted of 5,200 households. Given that a sample is self-weighting, and that sample size by strata is approximately equal, sample weights were used for reporting na- tional level results. A more detailed description of the sample design can be found in Appendix A. 22 Questionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect information on all de jure household members, the household, and the dwelling; 2) a women’s questionnaire administered in each household to all women aged 15-49 years; and 3) an under-5 questionnaire, administered to mothers or caretakers of all children under 5 living in the household. The Household Questionnaire included the following modules: Household listing Education Water and sanitation Household characteristics Child labour Child discipline Maternal mortality Consumption of iodized salt The Questionnaire for Individual Women was administered to all women aged 15-49 years living in the households, and included the following modules: Child mortality Maternal and newborn health Marriage/union Contraception Attitude toward domestic violence Sexual behavior HIV/AIDS knowledge The Questionnaire for Children Under Five was administered to mothers or caretakers of children under 5 years of age1 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: Birth registration and early learning Child development Vitamin А Breastfeeding Treatment of illness and care Anthropometric data The questionnaires are based on the MICS3 model questionnaire. The English version of question- naires was translated into Kyrgyz and Russian languages and was pre-tested in August 2005. Based on the results of the pre-test, modifications were made to the wording and translation of the ques- tionnaires. A copy of the Kyrgyz MICS questionnaires is provided in Appendix F. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, and measured the weights and heights of children age under 5 years. Details and findings of these measurements are provided in the respective sections of the report. 1 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report.                      MONITORING THE SITUATION OF CHILDREN AND WOMEN 23 Training and Fieldwork The interviewers have been adequately trained to collect data and apply questions. Training includ- ed lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Training was conducted in two rounds: for northern regions from November 23-27, 2005; for southern regions from December 8-11, 2005. The data were collected by 25 teams, each comprised of three interviewers, one driver and one edi- tor. The editor was responsible for ensuring data quality and use of proper interview techniques, establishing initial contact with households and remaining in constant connection with a regional supervisor. The fieldwork started in the northern regions on November 30, 2005, and was completed on Decem- ber 30, 2005. The data collection in the southern regions was conducted from December 18, 2005 to February 3, 2006. Data Processing The data processing was centralized. The field editors checked, cleared and packed the question- naires by clusters, then questionnaires were delivered to the central office of the National Statistical Committee for further processing. Each incoming pack was registered and simultaneously the da- tabase was created. Data were entered on twenty computers using CSPro software. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS3 project and adapted to the Kyrgyz ques- tionnaire were used throughout. Data processing began simultaneously with data collection in De- cember 2005, and was finished in spring of 2006. Data were analysed using the Statistical Package for Social Sciences (SPSS) software program, version 14, and the model syntax and tabulation plans developed by UNICEF for this purpose. III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS MONITORING THE SITUATION OF CHILDREN AND WOMEN 25 Sample Coverage During the course of the survey, all 400 PSUs selected at the first sampling stage were visited. A list of household addresses was made for those PSUs. Out of 5,200 sample households, 5,199 were found to be occupied (Table НН.1). Out of these populated households, 5,179 were successfully interviewed, yielding a household response rate of 99.6%. In all regions except for Naryn, the interviewers managed to carry out interviews in all selected households. In the interviewed households 7,043 women (aged 15-49) were identified. Of these women, 6,973 were successfully interviewed, which corresponds to a response rate of 99.0%. Additionally, the household sample accounted for 3,000children under five years of age, and 2,987 questionnaires were completed on these, for a response rate of 99.6. Characteristics of Households There were approximately 25,000 persons residing in the households included in the sample. Of these, 52.9% were females. The number of respondents under 15 years old was 32.7%, those in the age group of 15-64 years was 62.3%, while 5% of respondents were 65 years and older. The age structure of the population who was interviewed is described in Table HH.2. Thus, almost 40% represent the age group 0-17, while 12% were children from 0-4 years of age. The Figure HH.1 shows the pyramid of the population of the country by age and sex. Figure HH.1: Population of households surveyed, by age and sex, Kyrgyz Republic, 2006 (%). 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Males Females Households in the Kyrgyz Republic differ by size and geographical location. The size of the house- holds surveyed ranged between 1 and 21 persons. The households with 4-5 members accounted for 40.3%, 2-3 and 6-7 person households accounted for 23.6% each, and 9.5% of households had 8 or more members. The households located in rural areas accounted for 56.8% of all those interviewed. Almost 75% households are headed by males. The state language Kyrgyz is the mother tongue for 58.7% of the households heads (Table HH.3). The population of the Kyrgyz Republic is young, and its considerable proportion is represented by people of working age, as well as children. This is confirmed by the survey results. Thus, 81.5% of interviewed households have children under 18, 43.9% have children under five, and women aged 15-49 reside in 89.4% of the households. 26 Characteristics of Respondents Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to region, urban-rural areas, age, mari- tal status, motherhood status, education1, wealth index quintiles2, and ethnicity. When the overall number of households included in the sample is taken into account, the women numbered 7,043. Of these, 6,973 were successfully interviewed; more than half of them (56.6%) live in rural areas. As for the distribution by ethnic groups, the majority of interviewed women were Kyrgyz (61.5%), followed by Uzbek (18.8%) and Russian (13.5%). Among interviewed women, 59.6% of respondents were married, with 64.3% of them being mothers. A majority of female respondents (more than 55%) fell into the under-30 age group (Figure HH.2). One of the important development indicators is the level of education. The survey results show that the educational level of women in the age group 15-49 years is considerably high. Thus, 62.8% of in- terviewed women had attained a compulsory level of education (eight years), while 23.9% attained a high (university) level of education and only 13.3% of female respondents had an educational level below the compulsory level. Figure HH.2: Distribution of childbearing age women by five-year age groups, Kyrgyz Republic, 2006. 15-19 years 21,9% 25-29 years 15,3% 45-49 years 9,5% 40-44 years 11,2% 35-39 years 11,3% 30-34 years 12,6% 20-24 years 18,1% As analysis has shown, with the increase of household prosperity, the proportion of women resid- ing in them is increasing too. Thus, 17.4% of childbearing age women lived in the poorest quintile of households, while 25% of childbearing age women lived in the richest quintile. 1 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 2 Principal components analysis was performed by using information on the ownership of household goods and ame- nities (assets) to assign weights to each household asset, and obtain wealth scores for each household in the sample. Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels, and the wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construc- tion of the wealth index can be found in Rutstein and Johnson, 2004, and Filmer and Pritchett, 2001 MONITORING THE SITUATION OF CHILDREN AND WOMEN 27 Some background characteristics of children under 5 are presented in Table HH.5. These include distribution of children by several attributes: sex, region and area of residence, age in months, moth- er’s or caretaker’s education, wealth, and ethnicity. The three thousand children in the 0-4 years group living in the interviewed households were al- most equally represented by sex. The proportion of children living in rural areas was higher than those living in the urban areas by 19.2%. Among all children surveyed, the proportion of children in the age groups 12-23 months, 24-35 months, 36-47 months and 48-59 months ranged between 18% and 22%. Children younger than 6 months old accounted for 10.9%. The educational level of mothers (caretakers) as a whole correlates with the educational level of childbearing age women. A majority (69.1%) of mothers (caretakers) surveyed attained compulsory education, while 23.8% of mothers attained a high (university) level of education. Only 7.1% of mothers had an educational level below compulsory. An almost even distribution of children in the households (from 19% to 20%) was observed in each quintile group in accordance with the wealth index, except 22.7% of children resided in households in the richest quintile group. IV. INFANT, CHILD AND MATERNAL MORTALITY MONITORING THE SITUATION OF CHILDREN AND WOMEN 29 Infant, Child and Maternal Mortality The International Convention on the Rights of the Child states that member states must take adequate measures to reduce infant and child mortality levels. The reduction of infant, child and maternal mortality is one of the key goals of the Millennium Development Goals and the Plan of Action of the International Conference on Population and Development (ICPD, Cairo, 1994). Their levels are one of the basic indicators that characterize the health of a country’s population. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this house- hold died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods mini- mize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. Identification of the infant/child mortality level in the Kyrgyz Republic is complicated by the fact that until 2004, the live/stillbirth criteria established during the Soviet era was in use. This led to the minimization of real infant/child mortality rates. From 2004, the Kyrgyz Republic began to employ the live birth definition recommended by the World Health Organization (WHO). A comparison of classifications and pregnancy terminations in the Kyrgyz Republic prior to and after the introduc- tion of International Live Birth Definition (ILBD) is shown below: Infant, born before 28th week of pregnancy with body weight <1000 g and height <35 cm Infant, born after the 28th week of pregnancy with body weight >1000 g and height >35 cm No signs of life No breath- ing, but there are other signs of life (palpitation, traction, pulsation of umbilical cord) Died within the first 7 days of life Survived within the first 7 days of life No signs of life No breath- ing, but there are other signs of life (palpitation, traction, pulsation of umbilical cord) Died within first 7 days of life Survived within first 7 days of life Prior transition to WHO criteria Miscarriage Live birth Intra-uterine death Live birth After transition to WHO criteria Intra-uter- ine death Live birth Intra-uter- ine death Live birth Thus, according to the Soviet methods, newborns without breathing were qualified as “stillbirths.” Infants born before 28 weeks of intra-uterine gestation with a weight of less than 1,000 gr. and a height less than 35 cm, who died within the first seven days, were qualified as “miscarriages.” When women are interviewed during the household survey about a child’s death, they most likely use the new definition of child mortality. It is worth noting that women who have been interviewed were using an empirical definition of “live birth” which was similar to the ILBD. Infant mortality: the probability of dying before the first birthday. The infant mortality rate is the number of infants who die before their first birthday per 1,000 live births. Child mortality: the probability of dying during the period between the birth and the fifth birthday. The child mortality rate is the number of deaths among children under five per 1,000 live births. In MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). The data used in the 30 estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women. The technique converts these data into probabilities of dying by taking into account both the mortal- ity risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. According to the survey data (see Table СМ.1), infant mortality in the Kyrgyz Republic is 38, while child mortality is 44 (Figure CM.1). Male mortality both before the first birthday and under five years of age is 1.8 times higher than the female mortality, which is significantly determined by biological factors. In rural areas where the living standard is lower, the child mortality rate is 1.4 times more than in urban areas. Figure CM.1: Under-5 mortality rates by background characteristics, Kyrgyz Republic, 2006 56 31 35 50 44 Per 1000 0 10 20 30 40 50 60 Country Rural Urban Area Female Male Sex A comparison with estimates of the infant and child mortality, obtained in the course of the Demo- graphic and Health Survey of 1997 (Table CM.A; Figure CM.2), shows that there was a steady reduc- tion of these indicators since the 1980s. For example, infant mortality rate has appeared 1.9 times less than DHS-97 figure while under five mortality has decreased by 1.8 times. (Figure CM.2). Figure CM.2: Trend in under-5 mortality rates, Kyrgyz Republic, 2006 10 20 30 40 50 60 70 80 90 100 110 1982 1986 1990 1994 1998 2002 2006 Year Pe r 1 ,0 00 MICS 2006 Ministry of Health DHS-1997 Maternal mortality: According to the ILBD definition, maternal mortality is defined as a woman’s death caused by pregnancy complications (irrespective of its duration and site), which occurs dur- ing the pregnancy period or during the 42 days after its termination. Thus, the rate of maternal mortality is defined by the number of women who die due to complications during the pregnancy, delivery or postpartum period per 100,000 live births. MONITORING THE SITUATION OF CHILDREN AND WOMEN 31 The most common fatal complication is post-partum haemorrhage. Sepsis, complications of unsafe abor- tion, prolonged or obstructed labour and the hypertensive disorders of pregnancy, especially eclampsia, claim further lives. These complications, which can occur at any time during pregnancy and childbirth without forewarning, require prompt access to quality obstetric services equipped to provide lifesaving drugs, antibiotics and transfusions and to perform the caesarean sections and other surgical interven- tions that prevent deaths from obstructed labour, eclampsia and intractable haemorrhage. The measurement of maternal mortality rate is a difficult task. Even countries with a developed sta- tistical system often underestimate this rate because of incorrect use of the WHO/UNICEF/UNFPA classification of the causes of death. That is why indirect estimation techniques are often used for the indicator measurement. The “sisterhood method” was applied in the survey for the measurement of the maternal mortality, as recommended by the UN and WHO. The method lies in recording the deaths of respondents’ sisters during the pregnancy and deliveries. In contrast, using direct techniques in the application of the “sister- hood method” help estimate the probabilities of fertile age women deaths as a result of pregnancy and delivery. The method should be used with caution because of a high probability of estimation error. According to the survey results (Table RH.6), the maternal mortality rate in the Kyrgyz Republic was 104 female deaths per 100,000 live births, which approximately corresponds to the estimations of international organizations (UNICEF, UNFPA, WHO) throughout the last 10-15 years. In contrast with infant and child mortality rates, the maternal mortality remains constant. Thus, the infant, child and maternal mortality rates are relatively high in the Kyrgyz Republic. The infant and maternal mortalities are determined by a multitude of causes: economic, social, cultural, the situa- tion of the public health system, the demographic structure and behavior and so on. If with regard to infant and child mortality there is a tendency to decrease, the maternal mortality rate remains constant. It is well known that infant mortality is considered as one of the most sensitive indicators of the level of poverty in a given country or in a broader sense of the level of socio-economic and human development. Addressing the infant, child and maternal mortalities represent an urgent public af- fair matter and should be a priority on the agenda of public authorities. V. NUTRITION MONITORING THE SITUATION OF CHILDREN AND WOMEN 33 Nutritional Status The nutritional status of children is a reflection of their overall health. When children consume an adequate diet, are not exposed to repeated illnesses, and are well cared for, they reach their growth potential and are considered well-nourished. Malnourished children are at higher risk of morbidity and mortality. Malnutrition during early childhood impacts on the impairment of men- tal development and learning ability later in life. In a well-nourished population, there is a standard distribution of height and weight for children under the age of five. The heights and weights of malnourished children are lower than what the expected average of well-nourished children should be at the same age. Therefore, malnourishment in a population can be gauged by comparing the average heights and weights of these children to a reference distribution of children of the same age from a well-nourished, healthy population. The reference population used in this report is the WHO/CDC/NCHS growth reference, which is recommended for use by UNICEF and the WHO. Each of the three nutritional status indicators can be expressed in Z-scores, or standard deviation units (SD), which show how the children surveyed differ from the mean of this reference. In the chosen reference population, less than 2.3 percent of children have nutritional status indicator scoring one SD unit below the mean score. Only 0.14 per- cent of children have nutritional status indicators scoring two SD units below the mean. Weight for age is a measure of both acute and chronic hypotrophy. Children whose weight is more than 2SD units below the average weight of children of the same age in the reference population are considered moderately or severely underweight, while those whose weight for their age is more than 2SD units below the mean are classified as severely underweight. Measurement for the weight of infants and young children is a time-tested method in strategies to prevent child hypotrophy. Height for age is a measure of linear growth, or stature. Children whose height is more than 2SD units below the mean height are considered short and are classified as stunted, while those whose height for age is more than 3SD units below the mean are classified as severely stunted. Stunting in children usually reflects chronic hypotrophy as a result of inadequate food consumption over a long period or a result of chronic illness. Finally, children whose weight for height is more then 2SD units below the mean weight for height of children in the reference population are classified as wasted (hypotrophic), while those whose weight for height is more than 3SD units below the average are considered severely wasted. Wasting or thinness, is usually the result of a recent illness or acute nutritional deficiency. Overfeeding of children on the other hand mostly underlies over-nutrition or fatness, which can be measured also by their weight for height. Children whose weight for height is more than 2SD units above the mean weight of children of the same height in the reference population are considered obese. Especially at the low end of the weight for height distribution of 0-59 month old children, significant seasonal shifts may be observed in this indicator in association with fluctuations in food availability or disease prevalence. The distribution of children classified into each of these categories, based on the anthropometric measurements that were taken during the survey, is presented in Table NU.1. Children who were not weighed and measured (approximately 2%) and those whose measurements are outside a plau- sible range (another 1.4%) are excluded from the consideration. Overall, the information in Table NU.1 reports data from 96.5 percent of the surveyed children. Of the children aged 0-59 months, only 3.4% are underweight and 0.3 % are severely underweight. Almost one in seven children (13.7 %), however, is stunted and 3.7 % are severely stunted. Wasting occurs in 3.5 % of children and severe wasting in 0.4%. Obesity occurs in 5.8 % of children. There- fore, the most extensive nutritional problem in the Kyrgyz Republic among the under five year-old children is stunting, or retarded growth, which reflects chronic poor nutrition. The nutritional indicators do not differ significantly by sex. In rural areas, however, more children are stunted (15.7%) and wasted (4.1%), which exceeds similar indicators in urban areas where 10.8% are stunted and 2.7% are wasted. Moreover, stunting and wasting is lower for children whose moth- 34 ers had completed higher education. At the same time, obesity occurred nearly twice as often in these children (8.9%) than in children of mothers who only completed a secondary education (5.2%). These anthropometric indicators are correlated with the wealth index of the households, with chil- dren in the poorer households (first and second quintiles) being notably more stunted (18.8% and 14,9% respectively) than children in the remainder of households (10-12%). Also, more Kyrgyz chil- dren (15.6%) are stunted than children of Russian or Uzbek ethnicity. The age pattern of malnutrition (Figure NU.1) shows that childhood stunting increases to above 15 percent by 24 months of age. This is associated with a small but steady increase in wasting that extends into the third year of age. Although wasting is not of a critical level in the Kyrgyz Republic, it is higher for children below two years of age and significant in infants less than six months old (8.3%). As for children below six months, almost one percent is severely wasted, putting them at a sizably higher risk of suffering from malnutrition-related death. Figure NU.1: Percentage of children under-5 who are undernourished, Kyrgyz Republic, 2006 0 5 10 15 20 Wasted Stunted Underweight 6060 Age (in Months) Pe rc en t 5040302010 As shown in Figure NU.2, substantial differences in nutritional indicators exist between regions. Stunting in children under 5 is the highest in the Talas, Issyk-kul and Batken regions (approximately 22-27%), the lowest (approximately 8-10%) in the regions of Jalalabad, Chui and Bishkek City, with the Naryn and Osh regions showing stunting levels between (14-15%). Wasting was the highest (8- 9%) in Jalalabad and Issyk-kul regions. Interestingly, obesity in children is most notable in Issyk-kul and Talas regions – regions with the highest occurrence of stunting. Figure NU.2: Regional distribution of malnutrition in 0-59 month old children, Kyrgyz Republic, 2006 0 5 10 15 20 25 30 Obesity (Weight for Height) Wasted (Weight for Height) Stunted (Height for Age) Batken region Jalal-abad region Issyk-kul region Naryn region Osh region Talas region Chui region Bishkek Kyrgyzstan MONITORING THE SITUATION OF CHILDREN AND WOMEN 35 Breastfeeding and Complementary Feeding Breastfeeding for the first few years of a child’s life is an economical and safe way to protect children from infection and provide an ideal source of nutrients. Lack of breastfeeding denies the infant an opportunity for early bonding and socialization. Mothers may stop breastfeeding too soon and turn to the use of infant formula, which can contribute to growth stunting and micronutrient malnutri- tion. Bottle feeding is unsafe in households where clean water is not readily available. At the age of six months, the nutritional needs of infants can no longer be satisfied by breastfeeding alone, that is why complementary feeding needs to start from this age onward to make sure that young children continue to grow properly and stay healthy. The World Fit for Children goal states that children should be exclusively breastfed for the first six months and that breastfeeding should continue along with safe, appropriate and adequate complementary feeding up to the second year and beyond. In Table NU.3 breastfeeding status results are based on the reports from mothers/caretakers on chil- dren’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk and vitamins, mineral supplements, or medicine. The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. After giving birth, about 64.9% of mothers start breastfeeding their newborn within one hour and nearly 90% within one day (Table NU.2, Figure NU.3). However, only 31.5% of children up to six months of age are exclusively breastfed, a level much lower than considered optimal. Mothers/caretaker responses indicate that exclusive breastfeeding during the first three months of life among male infants is less prevalent than among female infants (32.9% vs. 50.8% respectively). Moreover, exclusive breastfeeding for 0-5 month children is about 16 % less prevalent in urban ar- eas than in rural areas, and about 11% among infants of higher educated mothers if compared with mothers having secondary education. More than two out of three young children are still breastfed by age 12-15 months, and 26 % continue breastfeeding until their second birthday. Figure NU.3: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Kyrgyz Republic, 2006 0 20 40 60 80 100 Within one day Within one hour C ou nt ry Ru ra l U rb an Bi sh ke k c. C hu i Ta la s O sh N ar yn Is sy k- K ul Ja la la ba d Ba tk en 81.3 82.3 92.5 91.5 91.6 93.9 87.3 94.0 91.2 88.2 89.4 48.5 74.9 65.5 83.6 70.4 55.0 48.1 66.7 65.2 64.7 64.9 Pe rc en t After six months of age, half of the infants have started receiving solid or semi-solid foods in ad- dition to continued breastfeeding, and after nine months, 38.8% of infants are breastfed along with complementary feeding at least three times daily (Table NU.4). The percentage of infants aged 6-11 months being breastfed and given complementary feeding in the recommended frequency is about 10% higher than infants aged 9-11 months. 36 Although 90% of newborns are being breastfed within one day after birth, exclusive breastfeeding into the 6th month of life is not practiced in two-thirds of infants. The occurrence of initial exclusive breastfeeding is lowest in male infants and in urban areas. The practice of complementary feeding during the second six months of life is closer to international recommendations in male infants and by mothers of higher education. Nevertheless, only 37.5% of infants are being appropriately fed throughout their first year of life, which leaves substantial room for improvements in infant and young child feeding practices. Continued breastfeeding up to two years and beyond is established among a significant proportion of young children in the Kyrgyz Republic (Figure NU.4), however, an encouraging finding of good child feeding practices. Figure NU.4: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group, Kyrgyz Republic, 2006 0 20 40 60 80 100 34 -3 5 32 -3 3 30 -3 1 28 -2 9 26 -2 7 24 -2 5 22 -2 3 20 -2 1 18 -1 9 16 -1 7 14 -1 5 12 -1 3 10 -1 1 8- 9 6- 7 4- 5 2- 3 0- 1 Age (in Months) Pe rc en t Weaned (not breastfed) Breastfed and complementary foods Breastfed and other milk/ formula Breastfed and non-milk liquids Breastfed and plain water only Exclusively breastfed Consumption of Iodised Salt Illnesses, caused by iodine deficiency (iodine deficiency disorders or IDD) are a global concern. A diet low in iodine leads to diminished mental function and intellectual performance, thereby reduc- ing the education performance of the future generation. Iodine deficiency during pregnancy can lead to increased miscarriages and stillbirths, and in extreme cases it causes endemic cretinism. Iodine deficiency can be prevented by the low-cost strategy of iodising all the salt for human consumption, including the salt used by food industry, and for feeding animals. Table NU.5 shows the results of the household salt samples that were tested with a solution that detects iodine. The legislation of the Kyrgyz Republic mandates that all edible salt should be iodised with potassium iodate at 40±15mg iodine per kg, or parts per million (PPM) at the point of produc- tion and have at least 15ppm at the point of consumption. Household salt was tested for iodine during the interviews of 5,160 households. The results of on- the-spot tests showed that three out of four households consume adequately iodised salt (15+ PPM). The salt was more likely to be adequately iodised in urban than in rural areas (84.5 and 69.8%, re- spectively) and in the richest households (89.9% in the fifth quintile and approximately 68.5% in the first three quintiles). In 23.6% of households, the tests showed inadequate iodine levels (<15 PPM). It might be worthy to notice that in 2.7% of households the test result showed zero level of iodization. Thus, the survey results show that practically all the salt supplied in the Kyrgyz Republic is being iodised to some extent, although the salt is iodised at a minimum level according to the national standard. As Figure NU.5 shows, use of adequately iodized salt was lowest in the Osh (56.8%) and highest in the neighboring Batken region (96%). The notably higher occurrence of non-iodised and insuf- ficiently iodised salt in the households in Osh region was related to an ownership dispute about the salt iodization plant in Osh town. MONITORING THE SITUATION OF CHILDREN AND WOMEN 37 Figure NU.5: Percentage of households consuming adequately iodized salt, Kyrgyz Republic, 2006 0 20 40 60 80 100 Country Rural Urban Bishkek c. Chui Talas Osh Naryn Issyk-Kul Jalalabad Batken 96.072.0 69.8 72.4 56.8 80.3 85.3 88.0 84.5 69.8 76.1 R eg io ns Percent Vitamin A supplements Vitamin A shortage or deficiency impairs the immune system of infants and young children, increas- ing their chances of dying from common childhood illness. It can cause eye damage and blindness in children with severe or recurrent diarrhea, or in those with an inexpensive high fever from viral diseases such as measles. In a population with vitamin A deficiency, pregnant and lactating women are at a higher health risk. Yet, this deficiency can easily be prevented with an inexpensive high- dose supplements, food fortification, or otherwise improved dietary habits. Based on international guidelines endorsed by UNICEF and the WHO, twice yearly the Kyrgyz Ministry of Health carries out mass distribution of high-dose vitamin A capsules for children aged 6-59 months. In addition, vitamin A supplements (VAS) are supplied to mothers after giving birth to boost their vitamin A status during breastfeeding, which benefits the infants during their first six months of life. In Tables NU.6 and NU.7 the status of vitamin A supplementation of children and post-partum mothers is based on the recollection by mothers/caretakers of the six-month period prior to inter- view. Responses about VAS receipts were obtained for 95.6% of the 6-59 month old children. Of the 6,973 women aged 15-49 years interviewed in the survey, 1,209 women who gave birth in the two years before the interview provided information about whether they received a high-dose VAS within eight weeks after giving birth. Within the six months prior to the MICS, 47% of the 6-59 months children received VAS within 6 last months, and 18% of children never received it. In general, three out of four eligible children under five years old had benefited from the national vitamin A campaign. The proportion of children who received a confirmed VAS within last six months were higher in urban areas (52% vs. 44%) than in rural areas. Children whose mothers had higher education received a con- firmed VAS (58%) more often than those whose mothers had just a secondary education (43%). The age pattern of confirmed vitamin A supplement receipts shows a modest decline after the age of two years. For children aged 6-11 months at the time of the survey, nearly 40% of their mothers re- ported that the infant had not received a supplement, but the responses for this age group are likely influenced by the timing of the last round of the national supplementation scheme. Confirmed receipts of a VAS were highest for Russian children (58.7%), and lowest for Uzbek chil- dren (33.1%), while 49% of Kyrgyz children received a VAS. The differences in the number of non- response responses by ethnic group are insignificant. Half of all women who gave birth in the two years prior to the survey confirmed that they received a VAS within eight weeks after giving birth. The differences between urban and rural areas, and between the respondent’s educational levels are not significant. 38 Low Birth Weight Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job op- portunities as adults. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not deliv- ered in facilities, and those who are represent only a selected sample of all births. Because many infants are not weighed at birth and those who are weighed may 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 birth1. Overall, 96.9% of births were weighed at birth and approximately 5.3 percent of infants are esti- mated to weigh less than 2500 grams at birth (Table NU.8). There was significant variation by region with the highest rate in Naryn region (Figure NU.6). The percentage of low birth weight does not vary much by urban and rural areas or by mother’s education. Figure NU.6: Percentage of Infants Weighing Less Than 2500 Grams at Birth, Kyrgyz Republic, 2006 0 2 4 6 8 10 12 C ou nt ry Bi sh ke k c. C hu i Ta la s O sh N ar yn Is sy k- K ul Ja la la ba d Ba tk en 4,1 3,5 4,5 10,3 5,0 3,5 6,1 6,2 5,3 Regions Pe rc en t 1 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. MONITORING THE SITUATION OF CHILDREN AND WOMEN 39 VI. CHILD HEALTH MONITORING THE SITUATION OF CHILDREN AND WOMEN 41 Oral Rehydration Treatment of Children with Diarrhea Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) – can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and 2) reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: Prevalence of diarrhoea Oral rehydration therapy (ORT) Home management of diarrhoea (ORT or increased fluids) AND continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. During the course of the survey, 2,883 children aged 0-59 months had been covered. Of these, 103 chil- dren (3.6%) had episodes of diarrhea in the two weeks preceding the survey (Table CH.4). As analysis shows, male children suffer from diarrhea more frequently than females children by 1.4 times. Children from rural area had episodes of diarrhea 1.5 times more often than children in urban areas had. Children of 6-23 months have shown the highest frequency of diarrhea cases, occurring 1.6 times more frequently in comparison with children aged 0-6 months, and 3.5 times more than chil- dren aged 24-47 months (Figure CH.1). Figure CH.1: Percentage of children with episodes of diarrhea by age, Kyrgyz Republic, 2006 0 2 4 6 8 10 12 48-59 months36-47 months24 - 35 months12 -23 months6 - 11 monthsless than 6 months 3,9 6,6 7,2 2,2 2,6 0,9 Of those children who had diarrhea nearly 79.6% did not receive oral rehydration therapy (ORT). Home treatment was carried out only in 15.4% of cases. Home treatment was more likely for girls than for boys (29.3% vs. 17.4% respectively).     42 Children with diarrhea received increased volume of fluids in 25% of cases and, correspondingly, in 75% of cases they received just adequate or lower volume of fluids (Table CH.5). During the diarrhea episodes, 48.1% of children have received reduced quantities of food or did not eat at all. Antibiotic Treatment of Children with Suspected Pneumonia Globally pneumonia is the leading cause of death in children and the prescription of antibiotics for children under five with suspected pneumonia is one of the most effective ways of fight with it. Chil- dren with suspected pneumonia, besides having fever or cough, often suffer from rapid or difficult breathing and other symptoms linked to disorders of the respiratory system. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were NOT due to a problem in the chest and a blocked nose. The indicators are: Prevalence of suspected pneumonia Care seeking for suspected pneumonia Antibiotic treatment for suspected pneumonia Knowledge of the danger signs of pneumonia Survey respondents were asked if they had children who suffered from pneumonia within the past two weeks prior to the survey, and whether they received antibiotics during the same period or not. Table CH.6 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. Children whose mothers had higher education were at lower risk of pneumo- nia (4.9%) than those whose mothers had just a secondary education (5.6%) or lower level of educa- tion (8.9%). Nearly 5.6% of children aged 0-59 months were reported to have symptoms of pneumonia during the two weeks preceding the survey. Of these children, 62.1% were taken to an appropriate pro- vider. Children with suspected pneumonia were taken to public hospital or health centre in 43% of cases, and to village health worker in 19.7% of cases. Table CH.7 presents the use of antibiotics for the treatment of suspected pneumonia in under-5s during the two weeks prior to the survey. In the country, 44.5% of under-5 children with suspected pneumonia had received an antibiotic– 69.8% in urban areas and 26.8% in rural areas. The table also that antibiotic treatment of suspected pneumonia is likely to grow up with mother’s education, but does not vary significantly with respect to the age of child. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.7A. Obvious- ly, mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. Overall, 41.8% of women know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is a developing fever (88.3%). About 51.5% of mothers identified fast breathing and 66.5% of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. Mothers of children aged 0-59 months living in urban areas (50.3%) were more informed about two danger signs of pneumonia than mothers living in rural areas (35.4%). Furthermore, the higher the level of education mothers had, the higher the level of their awareness. The level of awareness about two dangerous pneumonia symptoms is also positively related to the household wealth index. Only 28.5% of mothers in the poorest household group were informed about pneumonia symptoms, while in the middle group 43.4% of mothers and in the richest group 55.9% of mothers were informed about it. Solid Fuel Use Cooking with solid fuels (biomass and coal) leads to high levels of indoor pollution and is a major cause of health problems that can take the form of acute respiratory illnesses, particularly among     MONITORING THE SITUATION OF CHILDREN AND WOMEN 43 children, as well as chronic obstructive illness of the lungs, cancer and other diseases. Use of a closed stove with a chimney decreases indoor pollution significantly. According to the survey data, more than a third (37.3%) of all households in the Kyrgyz Republic use solid fuels for cooking (Table СН.8). Large regional differences in solid fuel use exist, as well as differences between urban and rural areas. The highest rate is recorded in the southern regions of the country: from 64.1% in the Jalalabad region, to 67.1% in the Osh region, up to 78.3% in Batken region (Figure CH.2). Figure CH.2: Percentage of households that use solid fuels for cooking by region. Кyrgyz Republic, 2006 0 20 40 60 80 100 Kyrgyz Republic Rural Urban Batken Osh Jalalabad Naryn Issyk-kul Chui Talas Bishkek c. 1,0 10,5 21,3 36,1 67,1 78,3 12,4 56,2 13,8 64,1 37,3 Solid fuel use for cooking in urban areas is not significant (12.4% of households), but widely prevails in rural areas, where more than half (56.2%) of households use solid fuel. The most common form of solid fuel used for cooking is either coal or firewood. Depending on the level of household wealth, differences are rather significant, with 76.6% of the poor- est group using solid fuel for cooking, while just 0.3% of the richest group. The same trend is observed with regard to the education level of the head of household, where 62.5% of those with education lower than secondary use solid fuels and just 15.1% of those with a high education level do so. Differences in solid fuel use for cooking by ethnicity of the head of household are also significant. The largest use of solid fuel is made by Uzbek (67.2%) and Kyrgyz (39.8%) households, while just 4% of Russian households use solid fuels. These trends are largely due to the high number of Asian ethnic groups (Kyrgyz and Uzbek) living in rural areas, and also because of persisting cooking tradi- tions of Asian ethnic groups, who bake bread, as a rule, in ovens heated with firewood or coal. Solid fuel use alone is a poor proxy for indoor air pollution, since the concentration of the pollut- ants is different when the same fuel is burnt in different stoves or fires. Use of closed stoves with chimneys minimizes indoor pollution, while open stove or fire with no chimney or hood means that there is no protection from the harmful effects of solid fuels. The type of stove used with a solid fuel is depicted in Table CH.9. Most households have closed stove with chimney (78.4%), while open stove or fire with chimney or hood was observed in 14.6% households. The proportion of households with open stove or fire with no chimney or hood is about 2.9%. VII. WATER AND SANITATION MONITORING THE SITUATION OF CHILDREN AND WOMEN 45 Access to Pure Drinking Water Access to drinking water of high quality is a necessity for good health. Globally water from open sources is one of basic reasons for the spread of such diseases as trachoma, cholera, ty-phoid, hepatitis A and schistosomiasis. Organic, non-organic and radiological contaminants with harmful effects on human health may also be found in drinking water. Piped water, public tap water, borehole/tube well water, protected well water and protected spring water are considered improved drinking water sources. Overall, 88.2% of the population (98.7% in urban areas and 81.8% in rural areas) have an access to improved drinking water sources (Table EN.1). The situation in southern regions is considerably worse than in northern regions; access to the pure drinking water is available to 68.3% of the population in the Batken region, and to 84.2% of the population in the Jalalabad region (Figure EN.1). In households in the poorest group, only 73.8% have access to improved drinking water sources, while 100% of the richest households have access to them. Figure EN.1: Access to improved source of drinking water. Percent of households. Kyrgyz Republic. 2006 0 20 40 60 80 100 Bishkek c. Chui Issyk-Kul Talas Naryn Jalalabad Osh Batken Rural Urban Kyrgyz Republic 88.2 98.7 81.8 68.3 84.2 86.0 87.6 90.7 99.0 100.0 82.4 The source of drinking water for the population varies strongly by region (Table EN.1). The most common drinking water sources in the Kyrgyz Republic are water pipelines (used by 52.8% of the population), which run into the dwelling or onto the property, and public taps (used by 27.1% of the population). Drinking water delivered into dwellings or onto property via pipelines was quite common for Bishkek City (80.3%) and the Chui region (52.7%). In the Talas region 41.3% of the population use piped wells (boreholes), and 21.8% use public taps (Figure EN.2). The people of the remaining regions mostly use public taps and water pipeline running onto the property. According to the survey results, 11.8% of population do not have any access to clean drinking wa- ter, including just 9% who use surface water. The largest level of the surface water consumption is observed in the Batken (28.5%), Osh (14.0%) and Naryn (10.6%) regions. The people of these regions are therefore greatly exposed to the risk of infectious intestinal diseases. 46 Figure EN.2: Percentage distribution of household members by source of drinking water. Kyrgyz Republic, 2006 Piped into dwelling, yard or plot, 52.8 Other unimproved, 2.8 Public tap/standpipe, 27.1 Tubewell/borehole, 5.3 Surface water, 9.0 Other improved, 3.0 Use of in-house water treatment is presented in Table EN.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a water filter, and using solar disinfection were considered as proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. Only 46.7% of population using unimproved water sources conduct appropriate water treatment – 53% in urban areas and 46.4% in rural areas. This percentage is the least in Jalalabad (27.1%) and Batken (31.6%) regions. In general, 34.6% of population use appropriately treated water, including 34.2% who boil water, 14% who allow it to precipitate, the remaining either chlorinate water, subject it to solar disinfection and/or use various forms of filtration. The amount of time it takes to obtain water is presented in Table EN.3 and the person who usually collected the water in Table EN.4. Note that these results refer to one roundtrip from home to drink- ing water source. Information on the number of trips made in one day was not collected. More than half of households (58.0%) use water from sources piped into their dwelling. The remain- ing households retrieve water from sources located outside at varying distances from their dwell- ing. The time spent on water retrieval among these households can vary from five minutes to more than one hour per trip. For populations living in rural areas, one of main problems is water must be retrieved from sources located far from their dwellings. For 34.8% of households, retrieval takes on average up to 30 minutes (Figure EN.3). Figure EN.3: Distribution of time spent by household members retrieving drinking water from the source. Кyrgyz Republic, 2006 Water on premises, 58.0% 1 hour or more, 1.7%30 minutes to less than 1 hour, 4.8% 15 minutes to less than 30 minutes, 10.9% Less than 15 minutes, 23.9% DK/Missing, 0.6% MONITORING THE SITUATION OF CHILDREN AND WOMEN 47 In rural areas such time is spent for water retrieval by 52.1% of households, while for 12.1% of house- holds in urban areas it takes up to 30 minutes to retrieve water. Regional differences are also signifi- cant. More than 70% of households in Naryn and Talas spend up to 30 minutes for retrieving water from the source. Water retrieval trips of more than 30 minutes are experienced by 6.5% of households in the Kyrgyz Republic, including 1.2% of urban households and 10.6% of rural. In addition, 49.3% of women retrieve water for their household, and 10.2% of girls under 15 undertake this task. Use of Sanitary – Hygienic Facilities for Excreta Disposal In many countries, outbreaks of several diseases, including diarrhea and poliomyelitis, are often connected with improper removal of human excreta and lack of maintenance of proper personal hygiene. Improved sanitary-hygienic facilities include toilets with water flushing, toilets connected with a sewer system or a septic tank, other types of toilets with water flushing, and improved pit- latrines with cesspools or common cesspools. Nearly 96.3% of the population lives in households that use sanitary-hygienic facilities, including 99.1% of the urban population and 94.6% of the rural population (Table EN.5). Only 73.2% of the population of the Batken region has access to improved sanitary-hygienic facilities, and 26.3% of the population use an open pit without a slab. Some 64% of the inhabitants of Bishkek live in households with access to the sewer system (Figure EN.4). The population of the country usually use pit latrines with slabs (68.5%), whereas proportion of water-flashing toilets is equal to 27.2%. About 3.7% of population have no access to improved facilities. The Table EN.5 indicates that use toilets with water flushing is strongly correlated with wealth and is profoundly different between urban and rural areas. Figure EN.4: Percentage of population with access to improved drinking water sources and improved sanitary-hygienic facilities. Кyrgyz Republic, 2006 20 40 60 80 100 Ba tk en re gi on Ja la la ba d re gi on Is sy k- ku l re gi on N ar yn re gi on O sh re gi on Ta la s re gi on C hu i r eg io n Bi sh ke k C ity Improved drinking water sources Sanitary-hygienic facilities for excreta removal Improved drinking water sources and sanitary-hygienic facilities for excreta removal Safe disposal of a child’s faeces means that the last stool by the child was disposed of by use of a toi- let or rinsed into toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table EN.6. In general, proportion of children whose stools are disposed of safely is equal to 42.7% – 56.7% in urban areas and 32.7% in rural areas. An overview of the percentage of households with improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.7. According to the survey data, percentage of household population using improved sources of drinking water is equal to 88.2%. Nearly 96.3% of population use sanitary means of excreta disposal. In general, 84.9% of population has access to improved sources of drinking water and sanitary means of excreta disposal. Again, the situation in the Batken region is considerably worse than in other regions; only 45.8% percent of the population in this region gets its drinking water from an improved source and uses sanitary means. VIII. REPRODUCTIVE HEALTH MONITORING THE SITUATION OF CHILDREN AND WOMEN 49 Contraception Family planning is one of the most important aspects of reproductive behaviour. The fertility control in contemporary society depends on the social position of a woman, her age, place of resi-dence and dwelling conditions, as well as on the social and cultural climate in which she lives. For this survey, 4,195 women currently married or in union were interviewed with regard to reproductive health. The women were asked whether they use contraception, and which methods they preferred. The analysis showed that only 47.8% of married women use contraception (Table RH.1). Use of an Intra Uterine Device (IUD) is the most popular method chosen by the women who admitted using contraception (32%). The second most popular method is the use of condoms (5.8%). The use of oral contraceptives is preferred by 5.1 % of women. The survey revealed a significant regional differentiation among women who admitted using con- traception. The level of contraception use in northern areas is significantly higher in comparison with the national average (52.6% in the Issyk-kul region; 55.6% in the Talas region), while it is sig- nificantly lower in the Jalalabad (36.2%) and Batken (45.3%) regions. A woman’s decision to use contraceptives can be connected to a great extent with a her educational level. Female respondents who have obtained secondary and higher education use contraceptives more frequently than respondents with just a primary level education. The education level also im- pacts a woman’s choice of contraception methods (Figure RH.1). The data show that women with higher education use oral contraception and condoms more often (by a factor of 1.5-2.0). Figure RH.1: Preferred means of contraception for women and educational level attainment. Кyrgyz Republic, 2006 0 5 10 15 20 25 30 35 Higher Secondary Primary Surgical sterilization Injective contraception IUD Condoms Oral contraception The survey also revealed that a woman’s wealth influenced her choice of contraception method. The poorer the woman’s household, the less she will spend on contraception. The highest level of IUD use is recorded in the poorest quintile group. Condoms and oral contraception use is most prevalent in the fourth and the richest quintile groups (Figure RH.2). The preferred choice of contraception methods is slightly different in urban and rural areas. Women of reproductive age in rural areas use IUD 1.2 times more often than their urban counterparts. Corre- spondingly, in rural areas oral contraception is used rarely by almost 1.5 times and condoms – more rarely by 3 times. In terms of ethnic groups, IUDs are more frequently used by Kyrgyz (33.4%) and Uzbek women (31.9%), Russian women were three times more likely to use condoms and twice as likely to use oral contraceptives than Kyrgyz or Uzbek women did. 50 Figure RH.2: Percentage of contraception methods chosen by female respondent’s household wealth index. Кyrgyz Republic, 2006 0 5 10 15 20 25 30 35 40 Surgical sterilization Injective contraception IUD Condoms Oral contraception RichestFourthMiddleSecondPoorest Unmet Need Unmet need1 for contraception refers to fecund women who are not using any method of contracep- tion, but who wish to postpone the next birth or who wish to stop childbearing altogether. Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Women in unmet need for spacing includes women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not us- ing contraception, and want to space their births. Pregnant women are considered to want to space their births when they did not want the child at the time they got pregnant. Women who are not pregnant are classified in this category if they want to have a(nother) child, but want to have the child at least two years later, or after marriage. Women in unmet need for limiting are those women who are currently married (or in union), fecund ((are currently pregnant or think that they are physically able to become pregnant), currently not us- ing contraception, and want to limit their births. The latter group includes women who are currently pregnant but had not wanted the pregnancy at all, and women who are not currently pregnant but do not want to have a(nother) child. Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for limiting. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. Percentage of demand for contraception satisfied is defined as the proportion of women currently married or in union who are currently using contra- ception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Table RH.2 shows the results of the survey on unmet need and the demand for contraception satis- fied. Answers of nearly 4,200 surveyed women showed that unmet need for contraception is about 1.1%. Very slight fluctuations (in terms of region, age group, education, etc.) are actually observed. Antenatal Care The antenatal period is a time of intrauterine development of the fetus from the time the zygote is formed until the labour process takes place. The antenatal period presents important opportunities 1 Unmet need measurement in MICS is somewhat different than that used in other household surveys, such as the De- mographic and Health Surveys (DHS). In DHS, more detailed information is collected on additional variables, such as postpartum amenorrhea, and sexual activity. Results from the two types of surveys are strictly not comparable. MONITORING THE SITUATION OF CHILDREN AND WOMEN 51 for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. It is very important to adequately organize a system of antenatal care (antenatal monitoring) which includes care provided to pregnant woman to protect her health as well as the health of her unborn child, and to ensure necessary assistance for her partner or her family to ease the transition to motherhood and fatherhood. Antenatal care envisages prophylaxis, early screening and treatment of diseases, for a mother and a fetus. Training that helps woman correctly prepare for labour and enhances her trust towards health personnel (birth attendants) plays an important role. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women’s nutritional status and prevent infections (e.g., malaria and STIs) during pregnancy. Quality health care and testing during the antenatal period allows early stage prevention and detection of the signs and symptoms of dis- eases or deviations and allow the mother to seek appropriate treatment. This, in its own turn, assists in reducing newborn morbidity and infant mortality. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of dif- ferent models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: Blood pressure measurement Urine testing for bateriuria and proteinuria Blood testing to detect syphilis and severe anemia Weight/height measurement (optional) In order to determine the quality of antenatal care, 1,209 women who had given birth to children during the two preceding years were interviewed. The proportion of pregnant women who received skilled antenatal care/monitoring once or several times during the pregnancy is 96.9%. The analysis shows, there was no significant difference observed by regions. The lowest percent of those who received antenatal care services once or several times during pregnancy was in Jalalabad region (92.7%). However, there was some difference between urban and rural areas (95.4% and 99.0% re- spectively). In the poorest quintile group, these women accounted for 93.6%, and in the richest quin- tile they accounted for 99.0%. According to the survey results, in 85.3% of these cases, doctors provided antenatal care services and in 11.3% of cases, a nurse or midwife provided these services. Of the surveyed women, 2.5% did not obtain any antenatal care services during pregnancy. It is noted that there is a difference between rural and ur- ban areas in terms of antenatal care services provided by a physician (79.0% vs. 94.6% respectively). The highest proportion of women who received antenatal care from medical doctor are in Bishkek (98.2%) and the Naryn region (94.6%), while in the Issyk-kul and Batken regions the percent women who received antenatal care was 78% and 75.5% respectively (Figure RH.3). Correspondingly, the highest proportion of pregnant women who received antenatal care from a nurse or midwife was observed in these regions (18.5% in the Issyk-kul region and 21.8% in the Batken region). Figure RH.3: Coverage by antenatal care, Kyrgyz Republic, 2006 0 20 40 60 80 100 Batken Jalalabad Issyk-kul Naryn Osh Talas Chui Bishkek City Doctor Nurse/midwife     52 Also, there was a correlation between the household wealth index and antenatal care coverage by doctors. The lowest coverage rate is observed in the poorest and the second quintile groups (71.7% and 82.4% respectively), and the highest coverage rate is observed in the richest and the fourth quin- tiles (93.3% and 88.6% respectively). Additionally, blood testing and blood pressure measurements were carried out in 96.8% of cases, while in 96.6% of cases urine testing and weight measurements were performed. Assistance at Delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for ob- stetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The basic goals of assistance to women during the birthing process include safe (non-traumatic) deliveries, early diagnosis and treatment of delivery complications (such as excessive bleeding, ec- lampsy, obstructed labor, etc.), early diagnosis and treatment of post-partum complications and effective post-partum care. No less important is the attention given to the newborn in the early neo- natal period. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. At present, delivery at the hospital is free of charge in the Kyrgyz Republic. However, in spite of this, delivery assistance in hospitals is not accessible for all women, especially those who live in remote, mountainous areas, for example, in the Naryn, Osh and Jalalabad regions. Over the course of this survey, 1,209 women between the ages of 15-49 who gave birth within the past two years were asked where their deliveries took place (at medical institutions or otherwise), and who provided assistance at delivery. The analysis revealed that deliveries in the overwhelming majority of cases (96.9% throughout the entire Republic) took place in medical institutions (Table RH.5). For the most part, large regional differences were not observed, except for the Batken and Jalalabad regions. In these regions, the per- centage of deliveries that took place in medical institutions was 88.3%, and 92.6%, respectively. Figure RH.4: Percentage of deliveries assisted by skilled attendant. Kyrgyz Republic. 2006 0 20 40 60 80 100 Batken Jalalabad Issyk-kul Naryn Osh Talas Chui Bishkek Doctor Nurse/midwife All the deliveries in the Chui and Issyk-kul regions and Bishkek city were assisted by skilled health personnel. In a majority of cases (76.3%), doctors provided delivery assistance, while in 20.9% of MONITORING THE SITUATION OF CHILDREN AND WOMEN 53 cases a nurse or midwife handled the task. In just 1.8% of cases, skilled birth attendants did not at- tend in the delivery (Figure RH.4). It was revealed that the percentage of deliveries assisted by doctors or nurse/midwife depended on the woman’s place of residence. In urban areas, 94.2% of deliveries were assisted by doctors and only 5.7% were assisted by a nurse or midwife. In rural areas doctors administered 64.0% of births with 31.2% of births assisted by nurse/midwife. Figure RH.5: Percentage of deliveries assisted by doctor or nurse/midwife according to household wealth index. Kyrgyz Republic. 2006 0 20 40 60 80 100 Nurse or midwife Doctor RichestFourthMiddleSecondPoorest 60,1 57,8 77,8 83,2 96,3 33,2 41,1 17,1 14,9 3,7 The survey results by ethnic group showed that the percentage of deliveries assisted by doctors is a little higher for Russian respondents (86.4%) compared to other groups, and they have 100% of their deliveries in medical institutions. The percentage of deliveries assisted by doctors for Kyrgyz women reached 74.0%, while 22.7% of births were assisted by nurse or midwife. For Uzbek women the percentages were 72.6 % and 23.6%, respectively. According to the survey results, the higher the educational level of woman, the higher is the likeli- hood her delivery was assisted by doctors, while a higher percentage of women with just a primary education received delivery assistance from a nurse or midwife. The wealth index level of a household also has an impact on the type of medical assistance at de- livery. As Figure RH.5 shows, nearly 60% of women from the poorest quintile group of households had their deliveries assisted by doctors, while 33.2% of women from these households received as- sistance from a nurse or midwife. For the richest quintile groups these indicators are equal to 96.3% and 3.7%, respectively. IX. EARLY CHILDHOOD DEVELOPMENT AND EDUCATION MONITORING THE SITUATION OF CHILDREN AND WOMEN 55 One of the most important periods of a child’s development is the first five years of life. Care provided by adults in this critical period establishes the basis and conditions for more suc-cessful child development in the future. Parents and adults involve the child in the various activities such as reading books with text or pictures available at home, and playing games that help develop mental and physical capacities. Especially within the preschool period a child’s physical health, character, attitude towards other people, and drive to learn and study are formed. Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. During the three days preceding the survey, around 70% of children under the age of five, participated in four or more types of activities that promoted training and preparation for school (Table CD.1). It was discovered that the level of the parents’ education influences their children’s development and predicts a high level of interaction with their children. For example, the higher the educational level of the mother and father, the more frequently and more qualitatively they interact with their child. The survey revealed gender parity, where parents paid equal attention to females and males in ac- tivities such as reading books, going for walks, developing games, etc. At the same time, the social status of a family and its wealth index score makes a noticeable influence on the level of parental participation in their child’s development. While 64% of children under five in the poorest quintile participated in four or more types of child development activities, more than 83.6% of children in the richest quintile were involved in such activities. Also, a number of child development activities positively correlate with well-being index. Differences were also observed among surveyed ethnic groups. The highest degree of parental par- ticipation in the early childhood development was observed among Russians, where 84% of chil- dren were involved in such activities. In Kyrgyz families, the rate is equal to 73.5% and it is equal to 53.6% in Uzbek families. Difference of the percentage of families where the father participated in early childhood education was insignificant among each ethnic group (5.1% of Russian families, 4.5% of Kyrgyz families, and 3.8% of Uzbek families). Differences in the attitudes of parents toward early childhood development among urban and rural families were recorded, where parents in rural areas participated slightly less than urban parents (65.0% vs. 79.7%). This is connected partially with the lower level of education of rural populations, where according to the results of the 1999 Census, the proportion of young people who attain higher education has steadily decreased. Exposure to books in early years not only provides the child with greater understanding of the na- ture of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance and IQ scores. In general, throughout the Republic more than 76% of children live in households that have three or more children’s books (Table CD.2). In addition, the number of available books for children exceeds the number for adults. Both boys and girls are equally provided with books. As the survey testifies, children in urban areas have greater access to books than in rural areas. Nearly 81% of urban children under five years of age have three or more books, while 72.9% of chil- dren under five in rural areas have three or more books. Apparently, the resulting difference was influenced by the lower level of rural household incomes, as well as by the difficulties of purchasing of books in rural areas. At the regional level, the difference in the availability of books for children is insignificant (from 73% to 86%), except for the Jalalabad region (58%). Also, the availability of three or more books for children and adults with regard to the household wealth index reveals little difference between the richest and poorest households. Along with books, toys provide a defining influence on early childhood development. The survey showed that approximately 25% of children between the ages of 0-59 months had three or more types of objects designed for games at home. These include objects found around the house, self-made toys, toys 56 bought at a shop, and objects and toys found outside the house. It was noted that 95.1% of children in urban households and 86.4% of children in rural households use toys purchased from a shop. As for self- made toys, they are more frequently used in the Talas region (46.7%) and the Issyk-kul region (40.5%). Rural children play more often with self-made toys than urban children (33.1% vs. 15.5%, respectively). Leaving children alone or in the presence of other young children is known to increase the risk of ac- cidents. In MICS, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.3 shows that 10% of children aged 0-59 months were left in the care of other children, while 1.6% were left alone during the week preceding the interview. Generally, it was estimated that 10.6% of children were left with inadequate care during the week preceding the survey. This hap- pened more often for rural inhabitants than for urban ones (12.5 % vs. 7.8%, respectively), and more common for children at age 24-59 months (13.9%) than for children under 2 years old (5.7%). Also, the higher income parents have, the lower is the risk for their children to be left alone. Preschool Attendance and School Readiness Attendance to preschool education in an organized learning or child education program is important for the readiness of children to school. One of the World Fit for Children goals is the promotion of early childhood education. Participation in preschool and primary school plays a vital role both in a child’s subsequent de- velopment and the identification of his/her role in society. It is generally known that participation in preschool and similar school preparation programs at an early age greatly enhance to a child’s success in school. The development of the child at this stage also directly depends on the parents’ influence and on the amount of attention they pay to the child’s education. Preschool institutions were always significant within the framework of children preparation for school, taking into account professional skills of the staff and appropriateness of educational meth- ods. But as the survey results show, preschool institutions are attended by 19% of children aged 36-59 months (Table ED.1). Rather significant differences are available in respect of this indicator between urban and rural areas, as well as between regions. One third of children attend preschool institutions in towns, while this indicator is around 10% for rural areas. The highest attendance per- centage (41.9%) falls in Bishkek city, the lowest – in Batken region at 6.6%. The analysis of the ethnic composition of children shows that Russian children have the highest rate of preschool education during preschool age (42.6%.) For Kyrgyz children this indicator is 17.3%, for Uzbek children the percentage is 14.9%. Wealthy people (47.4% in the richest quintile) more often than others (7.1% in the poorest quintile) expose their children to preschool education (Figure ED.1). Figure ED.1: Percentage of children aged 36-59 months currently attending early childhood education by household wealth index. Kyrgyz Republic. 2006 0 10 20 30 40 50 RichestFourthMiddleSecondPoorest 7.1 8.8 13.7 17.8 47.4 quintiles % MONITORING THE SITUATION OF CHILDREN AND WOMEN 57 Within the coverage of children with educational programs again mothers’ educational level is a de- cisive factor. Thus, 13.5% of children aged 36-59 months, whose mothers have secondary education, attend educational programs at the early age, while 42.5% of children whose mothers have higher education received preschool education. Most of children (91.1%) whose mothers have gained only primary education don’t attend preschool educational programs. The Table ED.1 also shows the proportion of children in the first grade of primary school who at- tended pre-school the previous year, an important indicator of school readiness. Overall, 20.2% of children who are currently age 7 and attending the first grade of primary school were attending pre-school the previous year. The proportion among males is slightly higher (20.7%) than females (19.6%), while almost two out of five urban children (39.5%) had attended pre-school the previous year compared to 8.8% among children living in rural areas. Primary and Secondary School Participation Universal access to basic education and the achievement of primary education by the world’s chil- dren is one of the most important goals of the Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. The indicators for primary and secondary school attendance include: Net intake rate in primary education Net primary school attendance rate Net secondary school attendance rate Net primary school attendance rate of children of secondary school age Female to male education ratio (GPI) The indicators of school progression include: Survival rate to grade five Transition rate to secondary school Net primary completion rate As the survey results showed, throughout the Kyrgyz Republic only 72.6% of children at- tend primary school out of the total number of children at the primary school entrance age of 7 years (Table ED.2). Moreover, the per- centage of males who entered primary school made up 68.5%, while the percentage of fe- males entering totalled 77.9%. At the regional level, the highest percentage of children en- tering the first form came from the Osh region (94.5%). The influence of the parents’ educational lev- el on their children’s attendance at primary school was notable. Nearly 71% of seven year olds, whose mothers have a secondary edu- cation, attended primary school, and nearly 76.1% of children whose mothers had higher education attended primary school.         58 The primary school net attendance ratio1 throughout the country is 92.1%, comprising 92.9% in ur- ban areas and 91.7% in rural areas (Table ED.3). Differences according to gender are insignificant, except for the Chui region, where a gap between males and females exceeds 10%, with females’ rate being higher. The first grade net attendance ratio is the highest among Uzbeks (95.4%) and Kyrgyz (91.9%) who timely send their children to primary school. Interestingly, one third of children of age six already attend the 1-st grade (Figure ED.2). As for children at the primary school entrance age of 7 years, about 50.5% of them attend primary first grade, while 20.0% of them attend second grade already and nearly 2.2% of children of age seven attend primary third grade. Figure ED.2: Percentage of children of 6 years age attending grade 1, Kyrgyz Republic, 2006 0 5 10 15 20 25 30 35 40 Kyrgyzstan Mother's Education Higher Secondary Not secondary Residence Rural Urban Sex Female Male 30.8 35.2 26.3 35.9 25.9 36.1 15.5 33.0 The primary school net attendance ratio of children of secondary school age is presented in Table ED.4W. Nearly 17.1% of the 11 years old children are attending primary school when they should be attending secondary school. The percentage doesn’t vary much with regard to region, residence or mother’s education. Throughout the Republic 98.6% of schoolchildren complete their primary school education and pass to the fifth form (Table ЕD 5). The primary school completion net ratio on average throughout the country is 79.2%, and the ratio of transfer to the secondary school level is 99.1% (Table ЕD 6). The primary school completion net ratio for males is 78.1%, and for females – 80.3%. The primary school completion net ratio in urban areas is nearly 81%, and 78.4% in rural areas. As for the wealth index, transition rate to secondary education is the highest in the richest quintile, which measure 100%. Meanwhile, if the ratio of transfer to the secondary school level for all nation- alities is rather high, then the primary school completion net ratio is, on the contrary, rather low (for Kyrgyz - 78.8%, for Russians - 64.2%, for Uzbeks - 85.3%). Such indicators are often explained by internal and external migration processes. Some 89.2% of children at the relevant age attend the middle or senior stages of secondary school in the country (Table ЕD.4). In urban areas this includes 90.9% of children of relevant age, at 88.4% in rural areas. As the survey results showed, the ratio of school completion decreases with the increase of age. And, it is observed both among males and among females. It is explained, first, by the increasing burden of education related expenses on the family, when the poorest strata are not able to cover education expenses at the middle and especially at the senior stage. Expenses include: textbooks and writ- ing materials, books, clothes, footwear and food. Not having sufficient income, poorer families are forced to decrease their demand for their children’s education. In addition, same families do not see 1 The primary school net attendance ratio – Percentage of children at the age of the primary school (7-11 years), who at present attend primary school in the total number of surveyed children at the age of primary school. MONITORING THE SITUATION OF CHILDREN AND WOMEN 59 the importance for their children to continue education at the senior stage because of the impossibil- ity of their children continuing their education at the institutions of higher learning. As the analysis reveals, according to the secondary school net attendance ratio, the Kyrgyz Republic has nearly closed the gender gap in basic education (Table ЕD.7). Females are not only unimpeded in obtaining educational services, but according to several indicators, they surpass indicators related to males (Table ЕD.3, Table ЕD.4). Adult Literacy One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s questionnaire was ad- ministered, the results are based only on females age 15-24. . Literacy was assessed on the ability of women to read a short simple statement or on school attendance. It is generally known that the literacy rate in Kyrgyzstan is sufficiently high, and approaching to the total literacy coverage. Results of the survey show that the percentage of female literacy in the age group 15-24 years is practically equal to 100% (Table ED.8) with a few very low regional and ethni- cal variations. X. CHILD PROTECTION MONITORING THE SITUATION OF CHILDREN AND WOMEN 61 Birth Registration The International Convention on the Rights of the Child states that every child has the right from birth to have a name, a nationality and to have the right to protection of his or her iden-tity. Birth registration is a fundamental means of securing these rights for children. According to the survey data, the births of the vast majority of children under five years of age in the Kyrgyz Republic (94.2%) have been registered (Table СР.1). Birth registration in urban areas (95.9%) is a little higher than in rural areas (93.1%). The highest registration rate exists among the children of the Batken region, where 97.9% of newborns have a birth certificate. Gender disparities are rather insignif- icant; the percentage of registered males (94.8%) is only slightly higher than that of females (93.6%). According to Kyrgyz Republic legislation, an application for the birth registration of a child should be submitted to the registry office not later than one month after the birth. However, as the survey results showed, the number of registered newborns during the first year of their lives made up only 89.8% (Figure CP.1). Figure CP.1: Birth registration by age group. Kyrgyz republic, 2006 80 85 90 95 100 48-59 months36-47 months24-35 months12-23 months0-11 months An unregistered marriage (32.4% of respondents) is one of main reasons for the missing registra- tions of newborns. The second reason for no-registration of their child is the distance to the registry office. Kyrgyzstan is a mountainous country, and it is often necessary for parents of a newborn to cross high, mountainous passes during their travels to the local registry office. It was revealed that for 3.8% of parents, the cost of the child birth registration is too high. A small portion of respondents (1.3%) did not know where they can obtain the child birth certificate. Half of one percent of respondents did not wish to pay a fine because of their delay in registering, though according to the legislation of the country, there is no system of fines in this case. It is most likely that parents did not know about this fact. It should be pointed out that nevertheless, the majority of respondents (53.1%) did not register their children’s birth due to so-called “other reasons” (an open question of the Questionnaire, where a reply was written by the interviewer) which included the parents lacking passports. As is well known, passport issuance was practically stopped in the country for a while, and the situation has only improved somewhat beginning in 2006. A mother’s educational level does not play a significant role in the receipt of the child’s birth cer- tificate. While 96. 3% of newborns were registered with mother’s who attained higher education, some 93.4% of newborns were registered with mothers with education less than secondary. Thus, it is possible to state that the improvement of a newborn registration system at registry offices directly depends on population awareness. 62 The frequency of children living with neither parent, mother only, and father only is presented in Table HA.10. Nearly 82% out of 9,923 surveyed children live in both parents. This percentage doesn’t much vary by ethnicity except Russian population where this figure is equal to 66% only. Children living with neither biological parent comprised 5.4% of cases while there were only 0.5% of children having both parents dead. Nearly 12% of children are living with one parent; mostly with mothers (10.8%). Child Labour Article 32 of the Convention on the Rights of the Child states: “States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development…” The World Fit for Children mentions nine strate- gies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions addressed the issue of child labour, that is, chil- dren 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: Ages 5-11: at least one hour of economic work or 28 hours of domestic work per week. Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiating child labour from child work to identify the type of work that should be eliminated. In the Kyrgyz Republic, child labour is determined by social and cultural structure of the Kyrgyz society. Some parents raise their children from an early age without taking into account wishes of the child as well as perspectives of child development in order to serve family interests. Over time these children fail to learn how to make decisions on their own, let alone know what kind of rights they have as a child. The process of suppressing a child’s personality when its own identity is being formed occurs painlessly and, perhaps, unnoticed by the children themselves. The fact that often heavy child labour is contraindicated to children from the viewpoint of its safety and health protec- tion is not taken seriously. In accordance with the survey data, out of all children of 5-14 years of age 3.6% were child laborers. The gender breakdown shows that 4.3% of male children and 2.9% of female children are working children. Among them 1.5% were children working outside their households and only 0.1% of them were paid for the work they performed. Domestic work (28 hours per week) was done by 1.2% of children (1.4% of male children and 0.9% of female children). About 1.3% of children were engaged in the family business. It was revealed that the majority of working children reside in rural households (4.5%) as they per- form the role of bread-winners with consent from their parents, relatives or participants in the fam- ily business. Only 1.9% of children in urban areas are working. At the time of the survey, 84% of children aged 5-14 years attended school. More specifically, 75.9% of them were also involved in child labour activities (Table CP.3). Parents influence their children in terms of their life values and beliefs, character formation, espe- cially at an early age. Children prefer to be engaged in the similar types of activities and life style as their parents. This fact confirms that early engagement in the labour activities is perceived as normal way of living. Even when families stop experiencing a shortage of resources, these children may continue working.   MONITORING THE SITUATION OF CHILDREN AND WOMEN 63 Child Discipline As stated in A World Fit for Children, “children must be protected against any acts of violence…” and The Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In the MICS survey, mother/caretakers of children 3-14 years were asked a series of questions on the ways parents tend to discipline their children when they misbehave. Note that for the child dis- cipline module, one child aged 3-14 years per household was selected randomly during fieldwork. Out of these questions, three indicators used to describe aspects of child discipline are: Psychological aggression as punishment. Minor physical punishment. Severe physical punishment. One of the important facts was to know the number of parents/caretakers of children 3-14 years of age that believe that in order to raise their children properly, they need to physically punish them. In the Kyrgyz Republic, about half of children (51.4%) in the age group 3-14 years were subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. More importantly, 2.6% of children were subjected to severe physical punish- ment. The survey found that 7.7% of mothers and caretakers think that imposing physical punish- ment on a child is a correct way of raising a child. It was revealed that male children were subjected to both minor and severe physical discipline (37.4% and 2.9% respectively) more than female children (33.7% and 2.3% respectively) (Figure CP.2). It is interesting that differences with respect to many of the background variables (rural/urban, child age, mother’s education, etc.) were not observed. Only a small percentage of parents/caretakers stated they believe that in order to raise their children properly, they need to physically punish them (7.7%), when 38.3% of parents indicated the opposite.    64 Figure CP.2: Percentage of types of punishment used with regard to children 3-14 years of age, Kyrgyz Republic, 2006 0 10 20 30 40 50 Severe physicial punishment Minor physical punishment Psychological punishment 10-14 years 5-9 years 3-4 years RuralUrbanGirlsBoysTotal Early Marriage and Polygyny In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also reliev- ing financial burdens on the family. The right to ‘free and full’ consent to a marriage is recognized in the Universal Declaration of Human Rights – with the recognition that consent cannot be ‘free and full’ when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women mentions the right to protection from child marriage in article 16, which states: “The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage.” Child and juvenile marriage is a violation of human rights, as it impedes the development of girls, and often results in early pregnancy and social isolation reduces the changes of the girl receiving a proper education or vocational training. They reinforce the gendered nature of poverty. Women married at younger ages are more likely to dropout of school, experience higher levels of fertility, have larger probability of mortality related to maternity, and are more likely to become victims of domestic violence. Young married girls are a unique, though often invisible, group. Required to perform heavy amounts of domestic work, under pressure to demonstrate fertility, and responsible for raising children while still children themselves, married girls and child mothers face constrained decision-making and reduced life choices. The minimal age for marriage in the Kyrgyz Republic for both men and women is 18, as established by the Family Code. In certain circumstances, (more often, it is the bride’s pregnancy), local state bodies are authorized to give permits to persons upon reaching 16 years, who wish to get married. Approximately 12.2% of women in the Kyrgyz Republic get married before their 18th birthday (Ta- ble CP.5 and Figure CP.3). Marriages before age 18 are more often in rural areas than in urban areas (14.2% vs. 9.7% for women aged 20-49 years). In addition, percentage of married (or in union) wom- en aged 15-19 years is also higher in rural areas than in urban areas (10.1% vs. 4.1% respectively). Among women having less than secondary education a proportion of those who married prior reaching their 18th birthday is equal to 28.4%. The rate is more than 2 times less for women with secondary education (13.1%) and more than 4.5 lower for women with higher education. According to the survey results, daughters are given away in marriage at an early nuptial age more often in the poorest (16.5%), than in the richest (9.1%) households. Thus, it is possible to mention poverty as on of the main reasons of early marriages. MONITORING THE SITUATION OF CHILDREN AND WOMEN 65 Figure CP.3: Percentage of women who married before 18 years of age by region. Kyrgyz Republic. 2006 0 5 10 15 20 Kyrgyz Republic Chui region Talas region Issyk-kul region Osh region Batken region Naryn region Jalalabad region Bishkek City 7.7 9.5 9.7 11.5 13.4 14.7 17.7 18.2 12.2 The largest percentage of women, who indicated their early marriage, falls into the 30-34 age group (17.5%), followed by the 25-29 age group (13.8%), and the 45-49 age group (12.0%). Thus, a tendency for women to marry early was more likely to happen in the last decade and than 30 years ago. Here it is appropriate to remind that a distinctive feature of the Kyrgyz population at the end of the 19th century was an early marriage age for women. According to the census data of 1897, 35% of 15-16 year old women were married, and in the 20-24 age group, practically all women were married. The struggle against early marriages gained momentum after the establishment of the Soviet Union, when most young girls entered the public educational system. In the 1920s and 1930s, a movement against polygyny also gained acceptance. By the 1930s a polyg- yny among the Kyrgyz population had virtually been eliminated. However, according to the survey data, around 1.7% of respondents of fertile age (15-49) stated that they were in a polygamous mar- riage or union. Such a social position depends on the location and on the wealth level. Polygamous marriages were registered more often in the Batken (3. 6%) and Chui (3.1%) regions. The reason for this could be attributed to a high level of young unmarried male labourers in Batken region who mi- grated, to a relatively low level of poverty in the Chui region. The largest percentage of polygamous marriages was observed among representatives of the richer strata of population (1.9% and 2.0) and the least number recorded among the poorest population strata (1.2%). With regard to the average age difference of the married couple, it is quite common for 20-24 year old women to have husbands (partners) who are 0-4 years older (57.0%) or 5-9 years older (35.6%). Rarely these women have husbands who are younger (1.4%) or considerably older (more than 10 years – 6.0%) (Table CP.6). In conclusion, the early marriage of women is characteristic for the Kyrgyz Republic, just as it had been previously. The occurrence of polygamous marriages (unions) has also failed to disappear. On the one hand, it is caused by a significant poverty level of population, and on the other hand, it is due to a preservation of folk traditions. Domestic Violence The UN Declaration on the Elimination of Violence against Women of 1993 defined a violence against women as “… any act of gender-based violence that result in, or is likely to result in, physical, sexual of psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life” and called for eradication of violence with regard to women. Violence towards women includes the following forms: violence committed by a partner and rape, in- cluding spousal rape. Domestic violence, or violence committed by a close partner, is a type of aggres- 66 sive behaviour including the use of forceful actions both physical and sexual. The forms of physical vio- lence include slapping, shaking, beating by the hand or by an object, suffocating, hitting with the legs, etc. Forms of sexual violence include forced sexual relations through threats or use of physical force. A number of questions were asked of women aged 15-49 years to assess their attitudes towards wheth- er husbands or partners are justified when hitting or beating their wives in a variety of scenarios. On average, nearly one of the five women who participated in the interview expressed support for the possibility of violence towards women for such reasons as leaving the house without husband’s per- mission (20.5%), inappropriate or inadequate care provided to the children (22.4%), disagreeing with and/or objecting to the husband (25,6%) (Figure CP.4). However, the percentage of such support de- creases if the cause of violence is refusal to have unwanted sexual intercourse (9.5%) or burned food (11.3%). In general, about 38% of women accepted domestic violence due to any of above reasons, at that rural women accepted domestic violence as justified twice as often as urban women. Figure CP.4: Percentage of women who supported domestic violence for selected reasons by residence, Kyrgyz Republic, 2006 0 5 10 15 20 25 30 35 UrbanRuralTotal Burned foodRefusal to have sexual intercourse Disagreement and objecting to husband Inappro- priate child care Leaving the house without husband's permission The respondents’ answers vary by ethnic group and this variation may be connected with the degree of domestic violence episodes committed by the husbands or partners against the women. The main assumption here is that women that agree with the statements indicating that husbands/partners are justified to beat their wives/partners in reality tend to be abused by their own husbands/part- ners. Uzbek women tended to agree with the justification for punishment in the situations described above considerably more than Kyrgyz and Russian women (Figure CP.5). Figure CP.5: Percentage of women who supported domestic violence for selected reasons by ethnicity, Kyrgyz Republic, 2006 0 10 20 30 40 50 60 Burned food Refusal to have sexual intercourse Disagreement and objecting to husband Inappropriate child care Leaving the house without husband's permission OtherUzbekRussianKyrgyz MONITORING THE SITUATION OF CHILDREN AND WOMEN 67 XI. HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED CHILDREN MONITORING THE SITUATION OF CHILDREN AND WOMEN 69 Knowledge of HIV Transmission and Condom Use The availability of correct information about HIV/AIDS transmission and prevention, especially among young people, is a major factor in controlling infection rates. Incorrect information, on the contrary, reduces the effectiveness of preventive activities and leads to higher infection rates. In order to identify their level of awareness of HIV/AIDS and its prevention, the subjects interviewed were asked whether they knew how HIV is transmitted and how it is possible to protect themselves. There were 7,043 women interviewed on the subject. The survey results showed that the level of HIV/AIDS awareness among women aged 15-49 varied regionally (Table НА.1). While 99% of fe- male respondents in Bishkek had heard about HIV/AIDS, around 96% of women in the northern regions knew of the disease, just 81.8% in Batken, 86.4% in Osh, and 88.5% in Jalalabad had knowl- edge of HIV/AIDS. The lowest levels of awareness among the respondents regarding preventing HIV/AIDS trans- mission was recorded in the Batken (41.0%), Osh (29.5%) and Jalalabad (19.1%) regions; where the respondents did not know even one method of HIV/AIDS prevention. Table HA.2 presents the percent of women who can correctly identify misconceptions concerning HIV. The indicator is based on the two most common and relevant misconceptions in Kyrgyzstan, that HIV can be transmitted by sharing food and by mosquito bites. The table also provides infor- mation on whether women know that HIV cannot be transmitted by supernatural means, and that HIV can be transmitted by sharing needles. Of the interviewed women, only 27.3% reject the two most common misconceptions and know that a healthy-looking person can be infected. Nearly 56% of women know that HIV cannot be transmitted by sharing food, and 47.8% of women know that HIV cannot be transmitted by mosquito bites, while 64.8% of women know that a healthy-looking person can be infected. Again, the lowest levels of awareness regarding HIV/AIDS transmission was recorded in the Bat- ken and Osh regions (respectively, 10.8% and 7.8% as for rejecting two most common misconcep- tions and knowing that healthy-looking people can be infected). As expected, the percent of women with comprehensive knowledge increases with the woman’s education level. Awareness level is positively correlated with household well-being index. The survey showed that percentage of women informed about at least two methods of preventing HIV/AIDS transmission differed by regions (Table HA.3). In Bishkek, 71.4% of respondents knew two methods while in the Naryn and Chui regions was 69.5% and 67.8% respectively. The percent- age of respondents knowing two methods of prevention in Talas is 81, 6 %, in Jalalabad is 51,5 % and in Batken and Osh is less than 40% (Figure HA.1). Figure HA.1: Percentage of women aware of two methods of preventing the spread of HIV/AIDS, by region. Kyrgyz Republic. 2006 0 20 40 60 80 100 Bishkek City Chui region Talas region Osh region Naryn region Issyk-kul region Jalalabad region Batken region 51.5 62.0 69.5 38.3 81.6 67.8 71.4 35.1 70 Significant differences are revealed in the level of respondents’ knowledge about two ways of HIV/ AIDS transmission prevention between urban (61.9%) and rural areas (53.6%). The largest awareness was manifested with respondents 30-34 years old respondents (63.6%) and 40-44 year old respon- dents (61.7%), while just 50% of 15-19 aged respondents were aware of two methods of prevention. The survey revealed a correlation between education level and awareness among 15-49 year old women (Figure HA.2). Among women with primary education, just 50.9% were aware of two pre- vention methods, while almost 55.6% who were aware had a secondary education level, and some 65% of those with higher education backgrounds were aware. Figure HA.2: Percent of women who have comprehensive knowledge of HIV/AIDS transmission, Kyrgyzstan, 2006 50.9 55.6 64.9 57.2 21.2 24.3 38.5 27.3 16.9 17.9 28.9 20.4 Pe rc en t 0 10 20 30 40 50 60 70 80 Comprehensive knowledge Identify 3 misconceptions Knows 2 ways to prevent HIV CountryHigherSecondaryNot secondary The higher is the quintile by the household wealth index the higher is a level of women’s awareness. Kyrgyz (21.7%) and Russian (32.9%) women more likely have comprehensive knowledge then Uz- bek women (6.4%) (Table НА.3). Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeeding. The level of knowledge among women age 15-49 years concerning mother-to-child transmission is presented in Table HA.4. Overall, 86% of women know that HIV can be transmitted from mother to child. The percentage of women who know all three ways of mother-to-child transmission is 58%, while 6.1% of women did not know of any specific way. The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) would care for family member sick with AIDS; 2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status of a family member a secret. Table HA.5 presents the attitudes of women towards people living with HIV/AIDS. Ac- cording to the survey 94.8% of respondents agree with at least one discriminatory statement. This percentage does not vary much with regard to age group and education of respondents. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. Only 59% of women know where to be tested, while 37% have actually been tested. Of these, a large proportion has been told the result (79.2%). Women in Bishkek and Chui region are most informed on where to be tested for HIV (80.6% and 79.1% re- spectively). Among 1,209 women who had given birth within the two years preceding the survey, the percent who received counselling and HIV testing during antenatal care is presented in Table HA.7. About 97% of the above women were covered by antenatal care, but only 62.6% of them were informed of HIV/AIDS prevention methods by any medical staff. MONITORING THE SITUATION OF CHILDREN AND WOMEN 71 Less than 50% of pregnant women received information on HIV/AIDS prevention methods from any medical staff in Jalalabad region, Naryn region and Chui region. In rural areas, health staff showed information on HIV/AIDS with 53.9% of women, while in urban area the percentage was as high as 75.4%. Sexual Behaviour Related to HIV Transmission Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms dur- ing sex, especially with non-regular partners, is especially important for reducing the spread of HIV. In most countries over half of new HIV infections are among young people 15-24 years thus a change in behaviour among this age group will be especially important to reduce new infections. The survey assessed the use of condoms as one of the main methods to prevent HIV-infection. A module of questions was administered to women 15-24 years of age to assess their risk of HIV infec- tion (Table HA.8). Risk factors for HIV include sex at an early age, sex with older men, sex with a non-marital non-cohabitating partner, and failure to use a condom. In accordance with the survey results, almost no sex at early age (before 15 years of age) was re- ported among interviewed rural and urban women aged 15-19 years. The percentage of the women who had sex before age 15 was about 0.2%. The proportion of women aged 20-24 years, who had sexual intercourse before 18 years of age, was 10.2%. It was equal to 12.9% in rural areas and 7.2% in urban areas. This corresponds roughly to the percentage of women aged 20-24 who were married before the age of 18 (10.4%). Figure HA.3: Sexual behaviour that increases risk of HIV infection, Kyrgyz Republic, 2006 0 3 6 9 12 15 Women 20-24 who had sex in last 12 months with a man 10 years or more older Women 20-24 who had sex before age 18 Women 15-19 who had sex before age 15 CountryRuralUrban 0.2 0.1 0.2 7.2 12.9 10.2 6.3 6.8 6.6 Pe rc en t The frequency of sexual behaviour that increase the risk of HIV infection among women who had a sexual intercourse within the last 12 months with older men (10 years), does not considerably differ both in urban and in rural areas (6.3% and 6.8% respectively) (Figure HA.3). The proportion of young women 15-24 years of age who had sexual contacts with more than one partner within the previous 12 months was 0.7% (Table HA.9). These women are considered to be high risk group population. It is noted that out of 29.6% of 15-24 year old women who had sexual contact with non-cohabiting partners during the 12 months preceding the survey, only 7.4% had contacts with an irregular partner, therefore, exposing themselves to higher risk of HIV infection. Only 56% of them used condoms. 72 LIST OF REFERENCES Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. Demographic and Health Survey – 1997. Ministry of Health of the Kyrgyz Republic. Research Institute of Obstetrics and Pediatrics. Macro International Inc., Calverton, Maryland, USA. Au- gust 1998, pp.94-98. Maternal Mortality in 1995: Estimates developed by WHO, UNICEF, UNFPA. WHO, UNICEF and UNFPA, Geneva, 2001, p.4. The sisterhood Method for Estimating Maternal Mortality. Guidance notes for potential users. World Health Organization. Division of Reproductive Health. United Nations Children’s Fund. Geneva. 1997. Filmer, D. and Pritchett, L., 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN M.Denisenko, 2004. Population of Kyrgyzstan. Bishkek, Kyrgyzstan, p.164 www.childinfo.org MONITORING THE SITUATION OF CHILDREN AND WOMEN 73 SELECTED TABLES Table HH.1: Results of household and individual interviews Numbers of households, women and children under 5 by results of the household, women’s and under-five’s interviews, and household, women’s and under-five’s response rates, Kyrgyzstan, 2006 Residence Region TotalUrban Rural Bat- ken Jalala- bad Issyk- Kul Naryn Osh Talas Chui Bish- kek c. Number of households Sampled households 2 990 2 210 624 624 624 624 832 624 624 624 5 200 Occupied households 2 990 2 209 624 624 624 623 832 624 624 624 5 199 Interviewed households 2 985 2 194 624 624 624 603 832 624 624 624 5 179 Household response rate 99.8 99.3 100.0 100.0 100.0 96.8 100.0 100.0 100.0 100.0 99.6 Number of women Eligible women 4 062 2 981 802 925 773 690 1 148 898 848 959 7 043 Interviewed women 4 040 2 933 797 908 769 671 1 139 893 838 958 6 973 Women response rate 99.5 98.4 99.4 98.2 99.5 97.2 99.2 99.4 98.8 99.9 99.0 Women’s overall response rate 99.3 97.7 99.4 98.2 99.5 94.1 99.2 99.4 98.8 99.9 98.6 Number of children under 5 Eligible children under 5 1 568 1 432 342 325 348 320 539 465 276 385 3 000 Mother/Caretaker Interviewed 1 565 1 422 340 324 348 316 539 463 272 385 2 987 Child response rate 99.8 99.3 99.4 99.7 100.0 98.8 100.0 99.6 98.6 100.0 99.6 Children’s overall response rate 99.6 98.6 99.4 99.7 100.0 95.6 100.0 99.6 98.6 100.0 99.2 Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups and number of children aged 0-17 years, by sex, Kyrgyzstan, 2006 Males Females Total Number Percent Number Percent Number Percent Age 0-4 1 511 12.8 1 494 11.3 3 005 12.0 5-9 1 228 10.4 1 210 9.1 2 438 9.7 10-14 1 391 11.8 1 359 10.3 2 750 11.0 15-19 1 255 10.6 1 593 12.0 2 848 11.4 20-24 990 8.4 1 322 10.0 2 312 9.2 25-29 940 8.0 1 106 8.3 2 046 8.2 30-34 855 7.3 925 7.0 1 781 7.1 35-39 778 6.6 813 6.1 1 591 6.4 40-44 692 5.9 811 6.1 1 503 6.0 45-49 641 5.4 689 5.2 1 330 5.3 50-54 515 4.4 614 4.6 1 129 4.5 55-59 323 2.7 355 2.7 677 2.7 60-64 164 1.4 210 1.6 374 1.5 65-69 240 2.0 263 2.0 503 2.0 70+ 272 2.3 481 3.6 753 3.0 Dependency age groups < 15 4 129 35.0 4 063 30.7 8 192 32.7 15-64 7 153 60.6 8 438 63.7 15 591 62.3 65 + 512 4.3 744 5.6 1 256 5.0 Children aged 0-17 4 962 42.1 4 960 37.4 9 923 39.6 Adults 18+ 6 832 57.9 8 285 62.6 15 117 60.4 Total 11 794 100.0 13 246 100.0 25 040 100.0 74 Table HH.3: Household composition Percent distribution of households by selected characteristics, Kyrgyzstan, 2006 Weighted percent Number of households Weighted Unweighted Sex of household head Male 74.7 3 884 3 931 Female 25.3 1 316 1 248 Region Batken 7.5 388 624 Jalalabad 16.0 832 624 Issyk-Kul 8.6 447 624 Naryn 4.9 254 603 Osh 21.7 1 131 832 Talas 3.7 191 624 Chui 17.4 902 624 Bishkek c. 20.3 1 055 624 Residence Urban 43.2 2 247 2 985 Rural 56.8 2 953 2 194 Number of household members 1 3.0 158 164 2-3 23.6 1 228 1 185 4-5 40.3 2 093 2 162 6-7 23.6 1 228 1 254 8-9 6.4 333 307 10+ 3.1 159 107 Ethnicity/Language Kyrgyz 58.7 3 052 3 507 Russian 18.3 953 712 Uzbek 16.9 879 675 Other 6.1 316 285 Total 100.0 5 200 5 179 At least one child aged < 18 years 81.5 5 200 5 179 At least one child aged < 5 years 43.9 5 200 5 179 At least one woman aged 15-49 years 89.4 5 200 5 179 MONITORING THE SITUATION OF CHILDREN AND WOMEN 75 Table HH.4: Women’s background characteristics Percent distribution of women aged 15-49 years by background characteristics, Kyrgyzstan, 2006 Weighted percent Number of women Weighted Unweighted Region Batken 6.9 489 797 Jalalabad 17.7 1 245 908 Issyk-Kul 7.4 523 769 Naryn 4.0 281 671 Osh 21.8 1 536 1 139 Talas 4.0 282 893 Chui 16.0 1 130 838 Bishkek c. 22.1 1 556 958 Residence Urban 43.4 3 055 4 040 Rural 56.6 3 988 2 933 Age 15-19 21.9 1 542 1 554 20-24 18.1 1 276 1 218 25-29 15.3 1 077 1 014 30-34 12.6 887 873 35-39 11.3 799 799 40-44 11.2 791 812 45-49 9.5 671 703 Marital/Union status Currently married/in union 59.6 4 195 4 156 Formerly married/in union 9.6 674 698 Never married/in union 30.9 2 174 2 119 Motherhood status Ever gave birth 64.3 4 529 4 478 Never gave birth 35.7 2 514 2 495 Education Not secondary 13.3 939 960 Secondary 62.8 4 422 4 449 Higher 23.9 1 682 1 564 Wealth index quintiles Poorest 17.4 1 228 1 464 Second 19.0 1 337 1 405 Middle 18.2 1 279 1 316 Fourth 20.4 1 436 1 367 Richest 25.0 1 763 1 421 Ethnicity/Language Kyrgyz 61.5 4 333 4 865 Russian 13.5 950 716 Uzbek 18.8 1 324 999 Other 5.9 417 377 Total 100.0 7 043 6 973 76 Table HH.5: Children’s background characteristics Percent distribution of children under five years of age by background characteristics, Kyrgyzstan, 2006 Weighted percent Number of under-5 children Weighted Unweighted Sex Male 50.3 1 509 1 540 Female 49.7 1 491 1 447 Region Batken 8.0 239 340 Jalalabad 14.7 440 324 Isyk-Kul 8.0 239 348 Naryn 4.2 127 316 Osh 24.3 728 539 Talas 5.1 154 463 Chui 14.2 425 272 Bishkek c. 21.6 648 385 Residence Urban 40.4 1 211 1 556 Rural 59.6 1 789 1 431 Age < 6 months 10.9 327 286 6-11 months 8.9 266 285 12-23 months 21.1 633 589 24-35 months 19.6 587 598 36-47 months 17.9 537 551 48-59 months 21.7 650 678 Mother’s education Not secondary 7.1 214 177 Secondary 69.1 2 074 2 132 High 23.8 713 678 Wealth index quintiles Poorest 20.4 613 742 Second 19.1 573 631 Middle 18.9 567 572 Fourth 18.8 566 516 Richest 22.7 682 526 Ethnicity/Language* Kyrgyz 66.6 1 998 2 269 Russian 9.8 295 204 Uzbek 17.8 533 375 Other 5.7 171 133 Total 100.0 3 000 2 987 Note: * – 6 unweighted cases with missing ethnicity not shown. Table CM.1: Child mortality Infant and under-five mortality rates, Kyrgyzstan, 2006 Infant mortality rate* Under-five mortality rate** Sex Male 48 56 Female 27 31 Residence Urban 31 35 Rural 43 50 Total 38 44 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 MONITORING THE SITUATION OF CHILDREN AND WOMEN 77 Table NU.1: Child malnourishment Percentage of children aged 0-59 months who are severely or moderately malnourished, Kyrgyzstan, 2006 Weight for age Height for age Weight for height Number of children aged 0-59 months % below % below % below % below % below % below % above - 2 SD* - 3 SD - 2 SD** - 3 SD – 2 SD*** - 3 SD + 2 SD Sex Male 3.9 0.2 14.0 3.5 2.8 0.4 5.8 1 450 Female 2.9 0.3 13.3 3.8 4.3 0.3 5.8 1 434 Region Batken 5.5 0.2 21.5 6.9 3.3 … 5.3 233 Jalalabad 2.5 0.2 8.3 3.3 9.2 0.1 3.6 422 Isyk-Kul 6.9 0.9 22.6 8.6 7.8 3.4 9.2 229 Naryn 9.0 0.5 13.7 2.2 1.9 0.1 6.3 110 Osh 2.7 0.4 15.2 1.6 1.0 0.1 6.2 699 Talas 4.8 0.6 27.3 10.8 2.0 1.2 12.4 144 Chui 2.3 … 10.5 3.3 2.9 … 3.1 415 Bishkek c. 2.1 … 8.5 2.1 2.1 … 6.1 632 Residence Urban 3.4 0.4 10.8 2.7 2.7 0.2 5.9 1 172 Rural 3.4 0.1 15.7 4.3 4.1 0.5 5.8 1 711 Age < 6 months 0.3 0.1 4.9 2.1 8.3 0.9 6.5 302 6-11 months 1.8 0.3 6.9 2.1 2.3 0.2 8.4 261 12-23 months 3.3 0.2 15.7 4.9 6.2 0.2 8.8 597 24-35 months 5.3 … 14.7 4.0 1.6 0.6 3.6 562 36-47 months 3.3 0.5 14.9 3.5 3.3 0.3 2.9 527 48-59 months 4.0 0.4 16.9 3.9 1.2 0.3 6.1 633 Mother’s education Not secondary 6.4 0.1 21.7 6.7 11.8 1.5 2.0 210 Secondary 3.6 0.3 14.2 3.6 3.0 0.3 5.2 1990 High 1.9 0.2 9.7 3.0 2.4 0.2 8.9 684 Wealth index quintiles Poorest 3.0 0.2 18.8 3.5 3.0 0.2 6.1 584 Second 3.4 0.1 14.9 3.9 3.2 0.3 4.9 556 Middle 4.2 0.5 12.5 4.8 6.1 0.6 4.3 535 Fourth 4.1 0.4 12.4 4.5 2.8 0.7 6.9 544 Richest 2.6 0.2 10.2 2.1 2.9 0.2 6.8 664 Ethnicity/Language Kyrgyz 3.5 0.3 15.6 3.9 2.5 0.5 6.9 1 906 Russian 0.6 0.2 4.6 3.5 1.3 … 5.1 288 Uzbek 3.7 0.3 9.3 1.4 7.7 0.1 3.4 518 Other 6.3 0.5 20.7 8.6 6.9 0.3 2.9 169 Missing (*) (*) (*) (*) (*) (*) (*) 4 Total 3.4 0.3 13.7 3.7 3.5 0.4 5.8 2 883 * MICS indicator 6; MDG indicator 4 ** MICS indicator 7 *** MICS indicator 8 (*) – Figures that are based on less then 25 unweighted cases … – No reported cases 78 Table NU.2: Initial breastfeeding Percentage of women aged 15-49 years with a birth in the two years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, Kyrgyzstan, 2006 Percentage who started breastfeeding within one hour of birth* Percentage who started breastfeeding within one day of birth Number of women with a live birth in the two years preceding the survey Region Batken 48.5 81.3 91 Jalalabad 74.9 82.3 189 Isyk-Kul 65.5 92.5 81 Naryn 83.6 91.5 51 Osh 70.4 91.6 298 Talas 55.0 93.9 45 Chui 48.1 87.3 182 Bishkek c. 66.7 94.0 273 Residence Urban 65.2 91.2 490 Rural 64.7 88.2 719 Months since birth < 6 months 63.9 89.2 322 6-11 months 67.6 84.4 261 12-23 months 64.3 91.6 626 Mother’s education Not secondary 57.7 81.4 115 Secondary 67.3 90.5 777 High 61.7 89.5 318 Wealth index quintiles Poorest 63.3 89.1 228 Second 67.4 89.4 219 Middle 66.8 88.0 252 Fourth 63.1 87.7 220 Richest 64.0 92.3 290 Ethnicity/Language Kyrgyz 69.4 90.1 793 Russian 45.4 86.5 121 Uzbek 66.4 88.5 226 Other 41.6 89.5 68 Total 64.9 89.4 1 209 * MICS indicator 45 MONITORING THE SITUATION OF CHILDREN AND WOMEN 79 Ta bl e N U .3 : B re as tfe ed in g P er ce nt ag e of li vi ng c hi ld re n ac co rd in g to b re as tfe ed in g st at us a t e ac h ag e gr ou p. K yr gy zs ta n, 2 00 6 C hi ld re n 0- 3 m on th s C hi ld re n 0- 5 m on th s C hi ld re n 6- 9 m on th s C hi ld re n 12 -1 5 m on th s C hi ld re n 20 -2 3 m on th s Pe rc en t ex cl us iv el y br ea st fe d N um be r o f ch ild re n Pe rc en t ex cl us iv el y br ea st fe d* N um be r o f ch ild re n % re ce iv in g br ea st m ilk & so lid / m us hy fo od ** N um be r o f ch ild re n Pe rc en t br ea st fe d* ** N um be r o f ch ild re n Pe rc en t br ea st fe d* ** N um be r o f ch ild re n Se x M al e 32 .9 96 30 .1 14 5 58 .3 90 63 .4 9 7 46 .3 85 Fe m al e 50 .8 73 32 .8 15 7 39 .0 79 70 .7 14 3 8. 1 94 R es id en ce U rb an 34 .5 67 22 .3 12 4 47 .9 87 60 .9 82 19 .6 65 Ru ra l 44 .7 10 2 38 .0 17 8 50 .8 82 71 .4 15 8 30 .1 11 4 M ot he r’s e du ca tio n N ot s ec on da ry (* ) 7 (2 1. 4) 30 (* ) 9 (* ) 17 (* ) 14 Se co nd ar y 42 .3 12 7 35 .9 19 5 43 .5 96 69 .0 16 3 29 .3 10 7 H ig h (3 4. 3) 35 24 .5 77 56 .9 65 59 .4 61 9. 9 59 W ea lth in de x qu in til es Po or es t (3 0. 5) 27 (3 0. 3) 49 43 .1 36 (6 8. 7) 47 (4 1. 2) 34 Se co nd (7 0. 0) 37 47 .9 59 (* ) 15 85 .3 53 (6 1. 5) 28 M id dl e (4 3. 5) 28 38 .2 64 48 .1 40 64 .9 60 (2 0. 1) 40 Fo ur th (3 5. 8) 34 29 .1 57 (6 0. 2) 26 (5 2. 2) 37 (1 2. 4) 29 Ri ch es t (2 3. 4) 43 15 .4 74 51 .2 52 (6 2. 7) 43 (8 .4 ) 49 Et hn ic ity /L an gu ag e K yr gy z 40 .6 11 6 32 .0 19 3 50 .5 12 9 63 .8 16 1 18 .5 95 Ru ss ia n (* ) 16 (8 .2 ) 26 (* ) 16 (* ) 16 (* ) 15 U zb ek (6 9. 9) 27 47 .4 63 (* ) 17 (9 3. 4) 50 (5 7. 9) 43 O th er (* ) 10 (* ) 20 (* ) 7 (* ) 13 4. 1 26 To ta l 40 .7 16 9 31 .5 30 2 49 .3 16 9 67 .8 24 1 26 .2 18 0 * M IC S in di ca to r 1 5 ** M IC S in di ca to r 1 7 ** * M IC S in di ca to r 1 6 (… ) – F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) – F ig ur es th at a re b as ed o n le ss th en 2 5 un w ei gh te d ca se s 80 Table NU.4: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times yesterday and percentage of infants adequately fed, Kyrgyzstan, 2006 Percent of infants Number of infants aged 0-11 months 0-5 months exclusively breastfed 6-8 months who received breastmilk and complementary food at least 2 times in prior 24 hours 9-11 months who received breastmilk and complementary food at least 3 times in prior 24 hours 6-11 months who received breastmilk and complementary food at least the minimum recommended number of times per day* 0-11 months who were appropriately fed** Sex Male 30.1 54.7 53.5 54.2 41.7 278 Female 32.8 41.9 26.2 34.3 33.5 285 Region Batken 46.0 67.5 72.3 69.9 54.9 51 Jalalabad 41.5 … 33.0 11.1 34.2 73 Isyk-Kul (31.1) (18.6) (18.7) (18.6) (24.4) 40 Naryn (27.9) (28.9) (33.3) (32.2) (30.0) 27 Osh 51.6 50.4 18.5 37.3 44.8 128 Talas (*) (*) (*) (*) (*) 22 Chui 2.5 70.3 49.8 57.6 34.1 75 Bishkek c. 15.9 58.1 38.5 52.3 34.1 148 Residence Urban 22.3 49.9 37.3 45.2 33.5 244 Rural 38.0 48.0 39.7 43.9 40.6 320 Mother’s education Not secondary (21.4) (48.3) (58.6) (51.7) (29.4) 41 Secondary 35.9 42.6 41.5 42.1 38.7 360 High 24.5 58.5 29.1 48.1 36.9 163 Wealth index quintiles Poorest 30.3 42.4 26.2 35.4 33.1 108 Second 47.9 19.4 44.1 29.9 42.6 84 Middle 38.2 52.7 54.1 53.4 45.6 125 Fourth 29.1 64.2 42.8 53.7 40.1 102 Richest 15.4 52.5 29.0 43.4 29.2 145 Ethnicity/Language Kyrgyz 32.0 47.9 44.7 46.5 39.4 393 Russian 8.2 35.5 16.0 23.5 16.3 56 Uzbek 47.4 50.5 29.4 42.9 46.2 86 Other (9.2) (82.7) (15.2) (74.6) (28.4) 28 Total 31.5 48.9 38.8 44.5 37.5 564 * MICS indicator 18 ** MICS indicator 19 (…) – Figures that are based on 25-49 unweighted cases (*) – Figures that are based on less then 25 unweighted cases … – No reported cases MONITORING THE SITUATION OF CHILDREN AND WOMEN 81 Table NU.5: Iodized salt consumption Percentage of households consuming adeuqately iodized salt, Kyrgyzstan, 2006 Percent of households in which salt was tested Number of households interviewed Percent of households with salt test result Number of households in which salt was tested or with no salt Percent of households with no salt <15 PPM 15+ PPM* Total Region Batken 99.3 388 0.3 3.7 96.0 100.0 387 Jalalabad 99.2 832 0.2 27.8 72.0 100.0 827 Issyk-Kul 99.7 447 0.2 30.0 69.8 100.0 446 Naryn 98.7 254 … 27.6 72.4 100.0 251 Osh 99.6 1 131 0.4 42.8 56.8 100.0 1 130 Talas 99.9 191 … 19.7 80.3 100.0 190 Chui 99.8 902 0.2 14.5 85.3 100.0 902 Bishkek c. 97.0 1 055 0.3 11.7 88.0 100.0 1 026 Residence Urban 98.1 2 247 0.5 15.0 84.5 100.0 2 216 Rural 99.6 2 953 0.1 30.1 69.8 100.0 2 944 Wealth index quintiles Poorest 99.1 917 0.2 31.4 68.5 100.0 911 Second 99.4 918 0.3 30.9 68.8 100.0 915 Middle 99.7 960 0.3 32.1 67.6 100.0 960 Fourth 99.5 1 106 0.1 20.0 79.9 100.0 1 102 Richest 97.6 1 299 0.4 9.7 89.9 100.0 1 272 Total 99.0 5 200 0.3 23.6 76.1 100.0 5 160 *MICS indicator 41 … – No reported cases 82 Table NU.6: Children’s vitamin A supplementation Percent distribution of children aged 6-59 months by whether they have received a high dose vitamin A supplement in the last 6 months, Kyrgyzstan, 2006 Percent of children who received vitamin A: Not sure if received vitamin A Never received vitamin A Total Number of children aged 6-59 months Within last 6 months* Prior to last 6 months Not sure when Sex Male 45.2 20.0 9.4 5.8 19.6 100.0 1 305 Female 48.7 17.8 12.1 4.9 16.4 100.0 1 276 Region Batken 38.4 34.6 14.9 3.9 8.3 100.0 201 Jalalabad 26.8 11.2 35.7 20.0 6.3 100.0 367 Isyk-Kul 54.1 22.6 7.8 0.3 15.2 100.0 211 Naryn 70.4 16.4 1.6 0.5 11.1 100.0 96 Osh 43.8 12.9 6.3 6.2 30.7 100.0 632 Talas 46.8 35.4 5.7 1.1 10.9 100.0 135 Chui 54.5 25.6 8.1 3.0 8.8 100.0 383 Bishkek c. 55.0 15.7 3.6 0.6 25.1 100.0 558 Residence Urban 51.7 16.6 7.8 4.3 19.5 100.0 1 084 Rural 43.7 20.5 12.7 6.0 17.0 100.0 1 589 Age 6-11 months 51.2 1.1 5.6 2.6 39.4 100.0 261 12-23 months 52.4 17.3 10.4 3.8 16.1 100.0 597 24-35 months 49.5 27.2 7.6 2.6 13.2 100.0 562 36-47 months 43.4 21.3 14.9 7.7 12.6 100.0 527 48-59 months 40.8 18.5 12.6 8.4 19.7 100.0 633 Mother’s education Not secondary 49.3 23.8 12.4 7.6 6.8 100.0 180 Secondary 42.9 19.6 11.1 6.3 20.1 100.0 1 795 High 58.4 15.4 9.1 1.8 15.3 100.0 607 Wealth index quintiles Poorest 35.9 21.2 12.6 8.3 22.0 100.0 535 Second 42.1 18.8 17.5 2.8 18.8 100.0 497 Middle 49.7 17.4 10.0 9.0 14.0 100.0 471 Fourth 46.5 23.0 10.0 5.1 15.4 100.0 488 Richest 59.2 14.9 4.6 2.1 19.1 100.0 590 Ethnicity/Language Kyrgyz 48.9 19.6 8.9 3.8 18.8 100.0 1 712 Russian 58.7 16.9 5.7 4.1 14.6 100.0 262 Uzbek 33.1 14.3 19.5 13.4 19.7 100.0 455 Other 46.6 30.0 13.4 0.9 9.1 100.0 149 Missing (*) (*) (*) (*) (*) 100.0 3 Total 47.0 18.9 10.7 5.3 18.0 100.0 2 581 * MICS indicator 42 (*) – Figures that are based on less then 25 unweighted cases MONITORING THE SITUATION OF CHILDREN AND WOMEN 83 Table NU.7: Post-partum mothers’ vitamin A supplementation Percentage of women aged 15-49 years with a live birth in the 2 years preceding the survey by whether they received a high dose vitamin A supplement before the infant was 8 weeks old, Kyrgyzstan, 2006 Received vitamin A supplement* Not sure if received vitamin A Number of women aged 15-49 years Region Batken 70.9 4.4 91 Jalalabad 42.4 10.7 189 Isyk-Kul 58.6 0.6 81 Naryn 19.6 … 51 Osh 57.4 2.8 298 Talas 64.4 5.1 45 Chui 48.4 0.6 182 Bishkek c. 44.6 … 273 Residence Urban 50.4 0.8 490 Rural 50.7 4.5 719 Education Not secondary 38.6 1.5 115 Secondary 52.6 2.6 777 High 49.9 4.6 318 Wealth index quintiles Poorest 61.9 5.2 228 Second 49.7 3.8 219 Middle 45.1 3.8 252 Fourth 48.8 2.4 220 Richest 48.5 0.6 290 Ethnicity/Language Kyrgyz 53.5 3.3 793 Russian 52.3 … 121 Uzbek 36.3 4.7 226 Other 61.8 … 68 Total 50.6 3.0 1 209 *MICS indicator 43 … – No reported cases 84 Table NU.8: Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Kyrgyzstan, 2006 Percent of live births: Number of live birthsBelow 2500 grams* Weighed at birth** Region Batken 4.1 97.2 91 Jalalabad 3.5 89.9 189 Isyk-Kul 4.5 99.5 81 Naryn 10.3 98.3 51 Osh 5.0 96.8 298 Talas 3.5 95.0 45 Chui 6.1 99.5 182 Bishkek c. 6.2 99.4 273 Residence Urban 5.8 98.9 490 Rural 4.9 95.5 719 Mother’s education Not secondary 5.5 95.4 115 Secondary 5.0 97.5 777 High 5.8 96.1 318 Wealth index quintiles Poorest 4.7 94.9 228 Second 4.2 95.7 219 Middle 4.8 96.6 252 Fourth 5.3 97.0 220 Richest 6.8 99.6 290 Ethnicity/Language Kyrgyz 5.4 97.1 793 Russian 7.5 99.4 121 Uzbek 2.9 94.1 226 Other 7.6 100.0 68 Total 5.3 96.9 1 209 * MICS indicator 9 ** MICS indicator 10 MONITORING THE SITUATION OF CHILDREN AND WOMEN 85 Table CH.4: Oral rehydration treatment Percentage of children aged 0-59 months with diarrhoea in the last two weeks and treatment with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Kyrgyzstan, 2006 Had diarrhoea in last two weeks Number of children aged 0-59 months Children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea Fluid from ORS packet Recom- mended homemade fluid Pre- packaged ORS fluid No treatment ORT Use Rate * Sex Male 4.2 1 450 19.4 1.5 2.1 79.9 20.1 60 Female 3.1 1 434 (20.3) (10.4) (9.8) (79.1) (20.9) 43 Region Batken 4.2 233 (*) … … (*) (*) 10 Jalalabad 2.3 422 (*) (*) (*) (*) (*) 10 Isyk-Kul 3.5 229 (*) … … (*) (*) 8 Naryn 1.7 110 … … … (*) … 2 Osh 2.1 699 (*) … … (*) (*) 14 Talas 6.7 144 … … … (*) … 10 Chui 6.8 415 (15.8) … (1.4) (82.8) (17.2) 28 Bishkek c. 3.5 632 (*) … … (*) (*) 22 Residence Urban 2.8 1 172 (16.8) (2.7) (2.7) (83.2) (16.8) 32 Rural 4.2 1 711 21.1 6.3 6.4 78.0 22.0 71 Age < 6 months 3.9 302 (*) … … (*) (*) 12 6-11 months 6.6 261 (*) (*) … (*) (*) 17 12-23 months 7.2 597 (16.4) … … (83.6) (16.4) 43 24-35 months 2.2 562 (*) … (*) (*) (*) 12 36-47 months 2.6 527 (*) (*) (*) (*) (*) 14 48-59 months 0.9 633 (*) … … (*) (*) 6 Mother’s education Not secondary 4.1 210 … … … (*) … 9 Secondary 2.9 1 990 21.8 9.3 9.5 77.1 22.9 57 High 5.5 684 (21.2) … … (78.8) (21.2) 38 Wealth index quintiles Poorest 2.7 584 (*) (*) (*) (*) (*) 16 Second 3.2 556 (*) (*) (*) (*) (*) 18 Middle 3.9 535 (*) (*) (*) (*) (*) 21 Fourth 4.0 544 (*) … … (*) (*) 22 Richest 4.0 664 (12.5) … … (87.5) 12.5 27 Ethnicity/Language Kyrgyz 3.4 1 906 24.7 1.7 1.9 74.3 25.7 66 Russian 4.0 288 … … … (*) … 11 Uzbek 2.0 518 (*) (*) (*) (*) (*) 10 Other 9.3 169 (*) … … (*) … 16 Total 3.6 2 883 19.8 5.2 5.3 79.6 20.4 103 * MICS indicator33 (…) – Figures that are based on 25-49 unweighted cases (*) – Figures that are based on less then 25 unweighted cases 86 Table CH.5: Home management of diarrhoea Percentage of children aged 0-59 months with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode,Kyrgyzstan, 2006 Had diarrhoea in last two weeks Number of children aged 0-59 months Children with diarrhoea who: Home manage- ment of diar- rhoea* Received ORT or increased fluids AND continued feeding** Num- ber of children aged 0-59 months with diar- rhoea Drank more Drank the same or less Ate somewhat less. same or more Ate much less or none Sex Male 4.2 1 450 23.9 76.1 49.5 50.5 13.4 17.2 60 Female 3.0 1 434 26.5 73.5 55.3 44.7 19.2 29.3 43 Residence Urban 2.8 1 172 25.2 (74.8) (66.1) (33.9) (24.8) (26.4) 32 Rural 4.2 1 711 24.9 75.1 45.5 54.5 11.2 20.5 71 Ethnicity/Language Kyrgyz 3.4 1 906 33.8 66.2 51.6 48.4 19.1 23.5 66 Russian 4.0 288 (*) (*) (*) (*) (*) (*) 11 Uzbek 2.0 518 (*) (*) (*) (*) (*) (*) 10 Other 9.3 169 (*) (*) (*) (*) (*) (*) 16 Total 3.6 2 883 25.0 75.0 51.9 48.1 15.4 22.3 103 * MICS indicator34 ** MICS Indicator 35 (…) – Figures that are based on 25-49 unweighted cases (*) – Figures that are based on less then 25 unweighted cases MONITORING THE SITUATION OF CHILDREN AND WOMEN 87 Ta bl e C H .6 : C ar e se ek in g fo r s us pe ct ed p ne um on ia P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ith s us pe ct ed p ne um on ia in th e la st tw o w ee ks ta ke n to a h ea lth p ro vi de r, K yr gy zs ta n, 2 00 6 H ad a cu te re sp ir at or y in fe ct io n N o. o f ch ild re n ag ed 0 -5 9 m on th s C hi ld re n w ith s us pe ct ed p ne um on ia w ho w er e ta ke n to : A ny ap pr o- pr ia te pr ov id er * N o. o f ch ild re n 0- 59 m os w ith su sp ec te d pn eu m o- ni a Pu bl ic s ou rc es Pr iv at e so ur ce s G ov t. H os pi ta l G ov t. he al th ce nt re G ov t. he al th po st V ill ag e he al th w or ke r M ob ile / ou tr ea ch cl in ic O th er pu bl ic Pr iv at e ph ys ic n. Ph ar m ac y Se x M al e 5. 9 1 45 0 25 .6 10 .8 0. 5 20 .5 1. 5 4. 7 … 2. 5 63 .4 86 Fe m al e 5. 4 1 43 4 26 .0 24 .3 1. 3 18 .7 … 9. 1 9. 4 3. 7 60 .7 77 R es id en ce U rb an 5. 7 1 17 2 38 .9 13 .5 2. 2 … 0. 7 13 .1 … 6. 8 68 .1 67 Ru ra l 5. 6 1 71 1 16 .6 19 .8 … 33 .4 0. 9 2. 4 7. 6 0. 5 57 .9 96 M ot he r’s e du ca tio n N ot s ec on da ry 8. 9 21 0 (* ) (* ) … (* ) … (* ) (* ) … (* ) 19 Se co nd ar y 5. 6 1 99 0 16 .3 13 .3 1. 4 21 .6 0. 7 3. 1 … 3. 0 56 .2 11 0 H ig h 4. 9 68 4 (3 6. 2) (1 7. 4) … (2 .8 ) (1 .5 ) (1 7. 3) … (5 .0 ) (7 5. 1) 34 Et hn ic ity /L an gu ag e K yr gy z 5. 5 1 90 6 18 .9 14 .5 0. 1 9. 9 1. 3 7. 2 … 2. 2 51 .6 10 4 Ru ss ia n 4. 0 28 8 (* ) (* ) (* ) … … (* ) … (* ) (* ) 11 U zb ek 6. 7 51 8 (3 8. 4) (3 1. 8) (0 .9 ) (6 3. 1) … … (2 1. 0) … (9 2. 1) 34 O th er 7. 4 16 9 (* ) (* ) … … … (* ) … … (* ) 12 To ta l 5. 6 28 83 25 .8 17 .2 0. 9 19 .7 0. 8 6. 8 4. 4 3. 1 62 .1 16 3 * M IC S in di ca to r 2 3 (… ) – F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) – F ig ur es th at a re b as ed o n le ss th en 2 5 un w ei gh te d ca se s … – N o re po rt ed c as es 88 Table CH.7: Antibiotic treatment of pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, Kyrgyzstan, 2006 Percentage of under fives with suspected pneumonia who received antibiotics in the last two weeks* Number of children with suspected pneumonia in the two weeks prior to the survey Sex Male 40.4 86 Female 49.0 77 Residence Urban 69.8 67 Rural 26.8 96 Age 0-11 months (45.1) 30 12-23 months (52.7) 33 24-35 months (41.7) 34 36-47 months (41.7) 40 48-59 months (41.0) 26 Mother’s education Not secobdary (*) 19 Secondary 39.0 110 High (74.5) 34 Ethnicity/Language Kyrgyz 49.7 104 Russian (*) 11 Uzbek (16.7) 34 Other (*) 12 Total 44.5 163 * MICS indicator 22 (…) – Figures that are based on 25-49 unweighted cases (*) – Figures that are based on less then 25 unweighted cases MONITORING THE SITUATION OF CHILDREN AND WOMEN 89 Ta bl e C H .7 A : K no w le dg e of th e tw o da ng er s ig ns o f p ne um on ia P er ce nt ag e of m ot he rs /c ar et ak er s of c hi ld re n ag ed 0 -5 9 m on th s by k no w le dg e of ty pe s of s ym pt om s fo r t ak in g a ch ild im m ed ia te ly to a h ea lth fa ci lit y. a nd p er ce nt ag e of m ot he rs /c ar et ak er s w ho re co gn iz e fa st a nd d iffi cu lt br ea th in g as s ig ns fo r s ee ki ng c ar e im m ed ia te ly , K yr gy zs ta n, 2 00 6 Pe rc en ta ge o f m ot he rs /c ar et ak er s of c hi ld re n ag ed 0 -5 9 m on th s w ho th in k th at a c hi ld s ho ul d be ta ke n im m ed ia te ly to a h ea lth fa ci lit y if th e ch ild : M ot he rs /c ar et ak er s w ho re co gn iz e th e tw o da ng er s ig ns of p ne um on ia N um be r o f m ot he rs /c ar et ak er s of c hi ld re n ag ed 0- 59 m on th s Is n ot a bl e to d ri nk o r br ea st fe ed Be co m es si ck er D ev el op s a fe ve r H as fa st br ea th in g H as d if fic ul t br ea th in g H as b lo od in s to ol Is d ri nk in g po or ly H as o th er sy m pt om s R eg io n Ba tk en 49 .7 55 .4 90 .4 61 .5 63 .8 77 .4 23 .7 23 .6 46 .8 23 3 Ja la la ba d 29 .5 54 .3 81 .1 44 .9 46 .2 38 .4 28 .2 1. 5 36 .6 42 2 Is yk -K ul 41 .3 65 .7 91 .0 63 .5 69 .5 40 .7 38 .8 1. 0 46 .5 22 9 N ar yn 65 .6 91 .5 78 .6 62 .9 89 .6 92 .4 13 .0 3. 8 60 .1 11 0 O sh 47 .9 22 .5 96 .3 21 .3 53 .3 56 .9 8. 2 7. 0 9. 8 69 9 Ta la s 22 .8 62 .7 76 .2 43 .2 75 .1 63 .8 6. 5 1. 6 31 .2 14 4 C hu i 29 .6 62 .7 82 .0 63 .9 81 .2 78 .4 21 .1 17 .5 58 .8 41 5 Bi sh ke k c. 42 .9 65 .3 91 .7 71 .2 78 .9 53 .1 19 .7 1. 9 63 .7 63 2 R es id en ce U rb an 41 .9 58 .8 90 .0 58 .8 69 .1 55 .8 22 .2 6. 9 50 .3 1 17 2 Ru ra l 39 .6 49 .1 87 .3 45 .9 64 .7 60 .4 17 .3 7. 1 35 .4 1 71 1 M ot he r’s e du ca tio n N ot s ec on da ry 35 .0 49 .2 89 .6 43 .4 66 .8 63 .8 13 .8 7. 0 34 .7 21 0 Se co nd ar y 40 .8 51 .2 89 .2 50 .2 65 .9 57 .2 19 .5 6. 9 40 .4 1 99 0 H ig h 41 .3 59 .7 85 .9 56 .2 68 .0 60 .6 20 .5 7. 4 46 .6 68 4 W ea lth in de x qu in til es Po or es t 35 .7 40 .1 85 .3 45 .3 60 .8 56 .9 18 .1 3. 9 28 .5 58 4 Se co nd 42 .1 41 .6 88 .4 37 .8 61 .9 58 .8 15 .8 8. 5 27 .0 55 6 M id dl e 46 .8 58 .9 91 .1 50 .2 65 .6 59 .6 17 .7 5. 4 43 .4 53 5 Fo ur th 39 .7 63 .5 87 .6 56 .2 68 .1 61 .9 25 .4 9. 5 50 .6 54 4 Ri ch es t 39 .1 60 .6 89 .7 64 .0 74 .7 56 .0 19 .5 7. 9 55 .9 66 4 Et hn ic ity /L an gu ag e K yr gy z 42 .0 54 .2 87 .5 52 .5 65 .4 57 .5 18 .8 5. 4 41 .4 1 90 6 Ru ss ia n 41 .4 68 .8 86 .3 66 .0 81 .2 64 .2 18 .7 7. 4 61 .6 28 8 U zb ek 42 .7 42 .0 93 .2 36 .9 62 .9 56 .1 23 .6 5. 1 29 .1 51 8 O th er 15 .4 47 .4 89 .5 54 .3 64 .4 67 .4 11 .5 30 .7 46 .2 16 9 To ta l 40 .9 53 .1 88 .3 51 .5 66 .5 58 .9 19 .2 6. 9 41 .8 2 88 3 90 Ta bl e C H .8 : S ol id fu el u se P er ce nt d is tri bu tio n of h ou se ho ld s ac co rd in g to ty pe o f c oo ki ng fu el . a nd p er ce nt ag e of h ou se ho ld s us in g so lid fu el s fo r c oo ki ng , K yr gy zs ta n, 2 00 6 Pe rc en ta ge o f h ou se ho ld s us in g: El ec tr ic ity Li qu ifi ed Pe tr ol eu m G as (L PG ) N at ur al G as C oa l. lig ni te C ha rc oa l W oo d St ra w . sh ru bs . gr as s A ni m al du ng A gr i-c ul - tu ra l c ro p re si du e O th er so ur ce To ta l So lid fu el s fo r co ok in g* N um be r of h ou se - ho ld s R eg io n Ba tk en 10 .2 9. 0 1. 4 1. 8 13 .9 31 .7 … 12 .1 18 .8 1. 2 10 0. 0 78 .3 38 8 Ja la la ba d 26 .2 0. 9 8. 2 22 .8 12 .7 26 .3 … 2. 0 0. 2 0. 1 10 0. 0 64 .1 83 2 Is sy k- K ul 71 .5 7. 2 … 9. 7 1. 0 7. 3 … 3. 3 … … 10 0. 0 21 .3 44 7 N ar yn 62 .2 1. 6 0. 1 0. 6 0. 9 7. 0 0. 8 26 .9 … … 10 0. 0 36 .1 25 4 O sh 9. 8 4. 8 17 .7 40 .3 2. 6 18 .3 0. 0 5. 3 0. 6 0. 2 10 0. 0 67 .1 1 13 1 Ta la s 85 .9 3. 5 … 0. 2 1. 5 8. 6 … 0. 1 … … 10 0. 0 10 .5 19 1 C hu i 42 .4 26 .4 17 .4 4. 1 0. 4 8. 5 … 0. 8 … … 10 0. 0 13 .8 90 2 Bi sh ke k c. 18 .4 8. 3 72 .1 … … 1. 0 … … … 0. 2 10 0. 0 1. 0 1 05 5 R es id en ce U rb an 28 .7 9. 3 49 .2 6. 2 2. 4 2. 7 0. 0 0. 4 0. 6 0. 2 10 0. 0 12 .4 2 24 7 Ru ra l 32 .0 8. 7 2. 9 20 .2 5. 0 21 .7 0. 1 6. 9 2. 3 0. 2 10 0. 0 56 .2 2 95 3 Ed uc at io n N ot s ec on da ry 15 .9 11 .4 9. 2 19 .3 10 .4 20 .3 … 7. 5 4. 9 0. 9 10 0. 0 62 .5 23 8 Se co nd ar y 32 .2 8. 5 16 .5 16 .0 4. 2 15 .6 0. 0 5. 0 1. 7 0. 2 10 0. 0 42 .4 3 80 4 H ig h 27 .9 9. 8 46 .9 6. 9 1. 7 5. 3 0. 1 0. 6 0. 4 0. 1 10 0. 0 15 .1 1 15 7 W ea lth in de x qu in til es Po or es t 22 .7 0. 3 … 21 .7 4. 1 33 .8 0. 1 16 .6 0. 3 0. 4 10 0. 0 76 .6 91 7 Se co nd 35 .4 4. 6 … 19 .3 8. 4 25 .5 0. 1 5. 4 1. 1 0. 0 10 0. 0 59 .8 91 8 M id dl e 38 .8 8. 2 0. 8 25 .7 7. 0 12 .5 0. 1 0. 9 5. 3 0. 4 10 0. 0 51 .5 96 0 Fo ur th 40 .5 21 .9 20 .4 9. 9 1. 8 3. 5 … 0. 2 1. 5 0. 2 10 0. 0 17 .0 1 10 6 Ri ch es t 18 .1 7. 7 73 .8 0. 2 … 0. 0 … 0. 1 … … 10 0. 0 0. 3 1 29 9 Et hn ic ity /L an gu ag e K yr gy z 35 .4 5. 4 19 .1 14 .0 3. 5 13 .8 0. 1 6. 1 2. 4 0. 1 10 0. 0 39 .8 3 05 2 Ru ss ia n 34 .6 19 .5 41 .3 2. 2 0. 2 1. 7 … 0. 0 … 0. 4 10 0. 0 4. 0 95 3 U zb ek 14 .3 5. 5 12 .8 29 .9 9. 6 24 .6 0. 0 2. 3 0. 8 … 10 0. 0 67 .2 87 9 O th er 16 .1 21 .3 31 .8 7. 2 3. 5 16 .4 … 2. 3 0. 3 1. 0 10 0. 0 29 .7 31 6 To ta l 30 .5 9. 0 22 .9 14 .1 3. 9 13 .5 0. 0 4. 1 1. 6 0. 2 10 0. 0 37 .3 5 20 0 * M IC S in di ca to r 2 4; M D G In di ca to r 2 9 … – N o re po rt ed c as es MONITORING THE SITUATION OF CHILDREN AND WOMEN 91 Table CH.9: Solid fuel use by type of stove or fire Percentage of households using solid fuels for cooking by type of stove or fire, Kyrgyzstan, 2006 Percentage of households using solid fuels for cooking: Number of households using solid fuels for cooking Closed stove with chimney Open stove or fire with chimney or hood Open stove or fire with no chimney or hood Other stove Total Region Batken 31.9 40.2 8.1 18.8 100.0 304 Jalalabad 83.5 10.1 3.2 … 100.0 533 Issyk-Kul 81.6 13.3 4.3 … 100.0 95 Naryn 68.1 27.4 4.3 0.2 100.0 92 Osh 93.2 6.3 0.5 … 100.0 759 Talas (*) (*) (*) … 100.0 20 Chui 83.4 14.9 1.6 … 100.0 124 Bishkek c. (*) (*) … … 100.0 10 Residence Urban 78.6 15.6 4.3 0.6 100.0 278 Rural 78.4 14.5 2.7 3.4 100.0 1 660 Education Not secondary 78.8 14.1 4.8 2.4 100.0 148 Secondary 77.6 15.1 2.9 3.2 100.0 1 614 High 85.8 10.5 1.7 1.1 100.0 174 Wealth index quintiles Poorest 77.6 14.2 2.0 4.1 100.0 702 Second 73.7 17.6 3.5 4.9 100.0 549 Middle 83.3 12.8 3.0 0.2 100.0 495 Fourth 81.8 12.5 4.7 0.2 100.0 188 Richest (*) … … … 100.0 3 Ethnicity/Language Kyrgyz 75.3 16.1 4.2 2.6 100.0 1 215 Russian (97.2) … (2.8) … 100.0 38 Uzbek 87.8 10.0 0.6 1.5 100.0 591 Other 51.4 30.4 0.5 17.7 100.0 94 Total 78.4 14.6 2.9 3.0 100.0 1938 (…) – Figures that are based on 25-49 unweighted cases (*) – Figures that are based on less then 25 unweighted cases … – No reported cases 92 Table CH.16: Source and cost of supplies for antibiotics Percent distribution of children aged 0-59 months with suspected pneumonia during the two weeks preceding the survey by source of antibiotics for treatment of pneumonia percentage of children aged 0-59 months with suspected pneumonia during the two weeks preceding the survey for whom antibiotics were obtained for free and median cost of antibiotics for those paying for the antibiotics by type of source of antibiotics, Kyrgyzstan, 2006 Source of antibiotics Number of children with suspected pneumonia in prior 2 weeks who received antibiotics Percentage free Median cost for those not free Public* Private Other Total Public Private Public** Private** Sex Male (19.6) (75.6) (4.8) 100.0 35 (15.2) … (123.0) (100.0) Female (14.2) (85.0) (0.8) 100.0 38 (43.5) … (290.9) (100.0) Residence … Urban (23.3) (72.4) (4.3) 100.0 47 (27.9) … (246.1) (108.2) Rural (5.0) (95.0) … 100.0 26 (25.6) … … (100.0) Mother’s education Not secondary (*) (*) … 100.0 4 … … (*) (*) Secondary (16.6) (78.8) (4.6) 100.0 44 (23.4) … (250.0) (250.0) High (18.2) (81.8) … 100.0 25 (37.2) … (137.4) (137.4) Total 16.8 80.5 2.7 100.0 73 27.7 … 244.1 100.0 * MICS indicator 96 ** MICS indicator 97 (…) – Figures that are based on 25-49 unweighted cases (*) – Figures that are based on less then 25 unweighted cases … – No reported cases MONITORING THE SITUATION OF CHILDREN AND WOMEN 93 Ta bl e EN .1 : U se o f i m pr ov ed w at er s ou rc es P er ce nt d is tri bu tio n of h ou se ho ld p op ul at io n ac co rd in g to m ai n so ur ce o f d rin ki ng w at er a nd p er ce nt ag e of h ou se ho ld m em be rs u si ng im pr ov ed d rin ki ng w at er s ou rc es , K yr gy zs ta n, 2 00 6 M ai n so ur ce o f d ri nk in g w at er Im pr ov ed so ur ce o f dr in ki ng w at er * N um be r of h ou se - ho ld m em be rs Im pr ov ed s ou rc es U ni m pr ov ed s ou rc es To ta l Pi pe d in to dw el l- in g Pi pe d in to ya rd o r pl ot Pu bl ic ta p / st an d- pi pe Tu be w el l / bo re - ho le D ug pr ot ec t- ed w el l Pr o- te ct ed sp ri ng Bo ttl ed w at er D ug un pr o- te ct ed w el l U np ro - te ct ed sp ri ng Ta nk er - tr uc k Su rf ac e w a- te r ( ri ve r. st re am . la ke . e tc .) O th er R eg io n Ba tk en 1. 0 18 .2 45 .8 1. 9 0. 9 0. 4 … 0. 4 2. 8 0. 0 28 .5 … 10 0. 0 68 .3 2 02 1 Ja la la ba d 6. 0 33 .3 34 .2 1. 5 9. 1 … … 0. 2 3. 8 0. 3 9. 9 1. 7 10 0. 0 84 .2 4 64 9 Is sy k- K ul 17 .2 39 .1 32 .3 1. 5 0. 3 0. 3 … 0. 3 0. 8 … 8. 1 0. 1 10 0. 0 90 .7 1 95 4 N ar yn 6. 4 7. 4 59 .3 6. 8 4. 4 1. 5 … 0. 2 3. 1 … 10 .6 0. 1 10 0. 0 86 .0 1 17 0 O sh 14 .4 30 .0 36 .2 0. 2 1. 2 0. 4 … 0. 5 0. 4 … 14 .0 2. 6 10 0. 0 82 .4 6 09 5 Ta la s 6. 9 10 .2 21 .8 41 .3 6. 0 1. 4 … 3. 0 4. 8 … 4. 6 … 10 0. 0 87 .6 1 01 8 C hu i 52 .7 19 .4 8. 8 17 .3 0. 5 0. 3 … 0. 1 0. 1 0. 1 0. 7 … 10 0. 0 99 .0 3 84 0 Bi sh ke k c. 80 .3 15 .0 4. 2 … … 0. 1 0. 4 … … … … … 10 0. 0 10 0 4 29 5 R es id en ce U rb an 56 .5 28 .3 11 .0 2. 4 0. 2 0. 1 0. 2 0. 3 0. 5 … 0. 6 0. 0 10 0. 0 98 .7 9 46 9 Ru ra l 11 .5 21 .9 36 .9 7. 0 4. 1 0. 5 … 0. 4 2. 1 0. 1 14 .1 1. 5 10 0. 0 81 .8 15 5 71 M ot he r’s e du ca tio n N ot s ec on da ry 9. 8 23 .0 31 .2 3. 4 13 .0 … … … 1. 2 0. 9 16 .2 1. 4 10 0. 0 80 .4 1 26 8 Se co nd ar y 22 .7 25 .4 30 .8 5. 6 1. 9 0. 4 0. 0 0. 5 1. 7 0. 0 9. 2 1. 0 10 0. 0 86 .9 18 8 28 H ig h 55 .3 20 .4 11 .7 4. 3 2. 8 0. 4 0. 2 … 0. 7 … 4. 1 0. 2 10 0. 0 95 .0 4 93 6 W ea lth in de x qu in til es Po or es t … 10 .4 56 .8 4. 7 1. 4 0. 4 … 0. 4 2. 0 … 22 .5 1. 3 10 0. 0 73 .8 5 01 0 Se co nd … 32 .2 37 .5 5. 8 1. 6 0. 5 … 0. 8 4. 1 … 16 .0 1. 5 10 0. 0 77 .6 5 02 6 M id dl e 5. 8 36 .9 30 .6 10 .5 7. 6 0. 6 … 0. 5 1. 1 0. 1 4. 4 1. 9 10 0. 0 92 .1 4 98 9 Fo ur th 40 .9 39 .3 9. 5 5. 2 2. 5 0. 1 … … 0. 2 0. 2 2. 0 0. 0 10 0. 0 97 .5 5 00 8 Ri ch es t 95 .7 2. 8 1. 0 0. 0 … 0. 1 0. 3 … … … … … 10 0. 0 10 0. 0 5 00 7 Et hn ic ity /L an gu ag e K yr gy z 27 .5 19 .7 31 .1 5. 1 1. 8 0. 4 … 0. 4 2. 1 0. 1 10 .8 1. 1 10 0. 0 85 .6 15 3 59 Ru ss ia n 66 .5 16 .0 4. 6 10 .2 1. 2 0. 5 0. 3 0. 3 0. 2 … 0. 1 … 10 0. 0 99 .4 3 14 6 U zb ek 5. 3 44 .2 31 .8 1. 5 7. 5 0. 0 … 0. 3 0. 8 … 8. 0 1. 5 10 0. 0 89 .3 5 08 5 O th er 38 .2 21 .0 17 .0 9. 7 0. 1 0. 9 0. 5 … … … 12 .6 … 10 0. 0 87 .4 1 45 0 To ta l 28 .5 24 .3 27 .1 5. 3 2. 6 0. 4 0. 1 0. 3 1. 5 0. 1 9. 0 1. 0 10 0. 0 88 .2 25 0 40 * M IC S in di ca to r 1 1; M D G in di ca to r 3 0 … – N o re po rt ed c as es 94 Ta bl e EN .2 : H ou se ho ld w at er tr ea tm en t P er ce nt ag e di st rib ut io n of h ou se ho ld p op ul at io n ac co rd in g to d rin ki ng w at er tr ea tm en t m et ho d us ed in th e ho us eh ol d an d pe rc en ta ge o f h ou se ho ld m em be rs th at a pp lie d an a pp ro pr ia te w at er tr ea tm en t m et ho d, K yr gy zs ta n, 2 00 6 W at er tr ea tm en t m et ho d us ed in th e ho us eh ol d A ll dr in ki ng w at er so ur ce s Im pr ov ed d ri nk in g w at er s ou rc es : U ni m pr ov ed d ri nk in g w at er so ur ce s: N on e Bo il A dd bl ea ch / ch lo - ri ne St ra in th ro ug h a cl ot h U se w at er fil te r So la r di si n- fe ct - tio n Le t i t st an d an d se ttl e O th er A pp ro pr i- at e w at er tr ea tm en t m et ho d * N um be r o f ho us eh ol d m em be rs A pp ro pr i- at e w at er tr ea tm en t m et ho d N um be r o f ho us eh ol d m em be rs A pp ro pr i- at e w at er tr ea tm en t m et ho d N um be r o f ho us eh ol d m em be rs R eg io n Ba tk en 50 .2 27 .4 … … … … 30 .7 0. 2 27 .4 2. 02 1 25 .4 1 38 0 31 .6 64 1 Ja la la ba d 78 .5 16 .6 … … … … 20 .0 … 16 .6 4 64 9 14 .6 3 91 3 27 .1 73 6 Is sy k- K ul 46 .8 47 .3 … 0. 4 0. 3 0. 7 23 .5 … 47 .4 1 95 4 44 .7 1 77 2 74 .4 18 1 N ar yn 44 .9 51 .4 0. 0 1. 3 0. 1 … 25 .6 … 51 .4 1 18 6 48 .5 1 00 6 69 .8 16 4 O sh 48 .9 49 .6 0. 8 … … … 9. 1 … 49 .6 6 09 5 47 .9 5 02 3 57 .5 1 07 2 Ta la s 70 .2 26 .1 3. 0 2. 5 … … 10 .8 … 28 .1 1 01 8 22 .3 89 2 68 .6 12 6 C hu i 73 .8 25 .3 … 0. 1 0. 5 0. 0 2. 4 … 25 .5 3 84 0 25 .1 3 80 3 (7 0. 0) 37 Bi sh ke k c. 62 .8 33 .8 0. 2 … 1. 2 2. 2 10 .4 0. 1 35 .2 4 29 5 35 .2 4 29 5 … 0 R es id en ce U rb an 58 .9 37 .0 0. 1 0. 0 0. 6 1. 1 13 .3 0. 1 37 .7 9 46 9 37 .4 9 34 1 53 .0 12 8 Ru ra l 62 .6 32 .5 0. 5 0. 3 0. 1 0. 1 14 .5 … 32 .7 15 5 71 29 .6 12 7 42 46 .4 2 82 9 M ot he r’s e du ca tio n N ot s ec on da ry 58 .8 31 .2 … 0. 2 … … 21 .3 … 31 .2 1 26 8 31 .4 1 01 9 (3 0. 3) 24 9 Se co nd ar y 61 .7 33 .7 0. 2 0. 2 0. 1 0. 3 14 .1 0. 0 33 .9 18 8 28 32 .0 16 3 67 46 .5 2 46 1 H ig h 59 .9 36 .8 1. 1 0. 1 1. 1 1. 3 12 .1 … 37 .9 4 93 6 36 .5 4 68 9 64 .9 24 7 W ea lth in de x qu in til es Po or es t 54 .1 38 .8 0. 1 0. 5 … 0. 0 22 .5 … 38 .8 5 01 0 34 .9 3 69 6 49 .9 1 31 4 Se co nd 56 .6 34 .9 1. 2 0. 3 … … 18 .3 0. 1 35 .0 5 02 6 31 .8 3 90 2 46 .2 1 12 4 M id dl e 67 .6 30 .9 0. 3 0. 1 … … 7. 6 … 31 .2 4 98 9 30 .3 4 59 3 41 .4 39 6 Fo ur th 67 .3 30 .7 … 0. 1 0. 5 0. 4 9. 6 0. 1 31 .0 5 00 8 31 .0 4 88 5 (3 3. 6) 12 4 Ri ch es t 60 .6 35 .6 0. 2 0. 0 1. 0 1. 8 12 .2 … 36 .7 5 00 7 36 .7 5 00 7 … 0 Et hn ic ity /L an gu ag e K yr gy z 58 .7 37 .0 0. 2 0. 3 0. 1 0. 5 14 .0 0. 0 37 .2 15 3 59 35 .4 13 1 45 47 .9 2 21 3 Ru ss ia n 70 .3 26 .5 0. 2 0. 1 1. 5 1. 3 9. 2 … 27 .9 3 14 6 27 .7 3 12 8 (* ) 19 U zb ek 63 .1 31 .4 … … … … 17 .2 … 31 .4 5 08 5 30 .4 4 54 3 40 .2 54 2 O th er 61 .9 31 .2 3. 1 … 0. 5 … 14 .0 0. 2 31 .6 1 45 0 29 .0 1 26 7 (* ) 18 3 To ta l 61 .2 34 .2 0. 3 0. 2 0. 3 0. 4 14 .0 0. 0 34 .6 25 0 40 32 .9 22 0 84 46 .7 2 95 7 * M IC S in di ca to r 1 3 (… ) – F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s (* ) – F ig ur es th at a re b as ed o n le ss th en 2 5 un w ei gh te d ca se s … – N o re po rt ed c as es MONITORING THE SITUATION OF CHILDREN AND WOMEN 95 Table EN.3: Time to source of water Percent distribution of households according to time to go to source of drinking water get water and return and mean time to source of drinking water, Kyrgyzstan, 2006 Time to source of drinking water Mean time to source of drinking water* Num- ber of house- holds Water on premises Less than 15 minutes 15 minutes to less than 30 minutes 30 minutes to less than 1 hour 1 hour or more Don’t know or missing Total Region Batken 22.0 40.9 21.2 11.1 4.3 0.5 100.0 17.2 388 Jalalabad 44.5 35.0 13.7 3.0 0.9 2.9 100.0 12.4 832 Issyk-Kul 60.2 18.9 14.9 4.2 1.2 0.6 100.0 16.0 447 Naryn 14.6 52.6 18.4 11.8 2.5 0.1 100.0 14.5 254 Osh 47.5 20.2 18.8 9.7 3.5 0.3 100.0 22.1 1.131 Talas 16.8 62.9 9.7 7.7 2.4 0.6 100.0 12.0 191 Chui 74.1 21.0 2.8 1.0 1.0 0.1 100.0 10.7 902 Bishkek c. 96.5 3.2 0.2 … 0.2 … 100.0 10.5 1.055 Residence Urban 86.3 8.7 3.4 1.0 0.2 0.4 100.0 12.9 2.247 Rural 36.5 35.4 16.7 7.7 2.9 0.9 100.0 16.5 2.953 Education Not secondary 38.5 35.1 12.9 11.8 1.0 0.7 100.0 16.6 238 Secondary 52.7 26.8 12.5 5.2 2.0 0.8 100.0 15.9 3.804 High 79.4 12.0 5.2 2.2 1.1 0.0 100.0 16.2 1.157 Wealth index quintiles Poorest 10.3 48.6 23.7 13.0 3.9 0.7 100.0 17.5 917 Second 32.5 36.2 19.7 7.9 2.8 0.9 100.0 16.6 918 Middle 47.0 31.3 12.9 5.6 1.5 1.7 100.0 14.1 960 Fourth 80.2 13.8 4.2 0.4 1.1 0.3 100.0 12.7 1.106 Richest 99.1 0.7 0.1 0.1 0.1 … 100.0 16.7 1.299 Ethnicity/Language Kyrgyz 50.9 26.9 12.5 6.7 2.6 0.4 100.0 17.5 3.052 Russian 85.0 12.4 1.6 0.2 0.6 0.3 100.0 10.1 953 Uzbek 51.0 24.7 17.5 4.4 0.4 2.0 100.0 13.8 879 Other 65.0 26.4 5.8 1.9 0.8 0.2 100.0 11.2 316 Total 58.0 23.9 10.9 4.8 1.7 0.7 100.0 16.0 5.200 * The mean time to source of drinking water is calculated based on those households that do not have water on the premises. … – No reported cases 96 Table EN.4: Person collecting water Percent distribution of households according to the person collecting water used in the household, Kyrgyzstan, 2006 Person collecting drinking water Total Number of households Adult woman Adult man Girls under age 15 Boys under age 15 Don’t know Missing Region Batken 61.7 17.1 11.1 7.2 0.2 2.7 100.0 303 Jalalabad 61.5 10.6 16.7 6.0 … 5.2 100.0 462 Issyk-Kul 28.2 47.4 6.8 13.4 2.1 2.1 100.0 178 Naryn 27.5 46.2 8.5 13.2 … 4.7 100.0 217 Osh 49.1 29.3 11.5 9.5 … 0.7 100.0 593 Talas 37.9 47.0 5.3 8.2 0.6 1.0 100.0 159 Chui 52.4 35.7 1.5 9.5 … 0.9 100.0 234 Bishkek c. (59.1) (27.3) (4.5) (9.1) … … 100.0 37 Residence Urban 52.7 25.7 7.3 7.8 0.4 6.0 100.0 307 Rural 48.8 29.2 10.7 9.2 0.2 1.9 100.0 1 875 Education Not secondary 66.2 16.2 7.0 8.0 … 2.6 100.0 146 Secondary 47.9 29.4 10.7 9.2 0.3 2.4 100.0 1 798 High 49.5 31.2 8.6 7.9 … 2.8 100.0 237 Wealth index quintiles Poorest 50.5 28.3 9.6 8.5 0.5 2.5 100.0 823 Second 46.3 27.7 13.1 10.4 0.2 2.4 100.0 620 Middle 47.3 33.2 7.3 9.4 0.0 2.7 100.0 509 Fourth 59.9 21.2 11.1 5.7 … 2.2 100.0 219 Richest (*) (*) (*) (*) … … 100.0 12 Ethnicity/Language Kyrgyz 43.0 31.7 11.9 10.6 0.2 2.7 100.0 1 499 Russian 62.4 28.0 0.2 6.9 1.6 1.0 100.0 142 Uzbek 64.4 18.2 9.0 5.9 … 2.6 100.0 431 Other 59.2 30.6 5.6 3.0 0.5 1.2 100.0 110 Total 49.3 28.7 10.2 9.0 0.2 2.5 100.0 2 182 (…) – Figures that are based on 25-49 unweighted cases (*) – Figures that are based on less then 25 unweighted cases … – No reported cases MONITORING THE SITUATION OF CHILDREN AND WOMEN 97 Ta bl e EN .5 : U se o f s an ita ry m ea ns o f e xc re ta d is po sa l P er ce nt d is tri bu tio n of h ou se ho ld p op ul at io n ac co rd in g to ty pe o f t oi le t u se d by th e ho us eh ol d an d th e pe rc en ta ge o f h ou se ho ld m em be rs u si ng s an ita ry m ea ns o f e xc re ta di sp os al , K yr gy zs ta n, 2 00 6 Ty pe o f t oi le t f ac ili ty u se d by h ou se ho ld To ta l Pe rc en ta ge of p op ul a- tio n us in g sa ni ta ry m ea ns o f ex cr et a di sp os al * N um be r of h ou se - ho ld s m em be

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