Kyrgyzstan - Multiple Indicator Cluster Survey - 2014

Publication date: 2014

2 01 5 United Nations Population Fund Monitoring the situation of children and women Multiple Indicator Cluster Survey, 2014 FINAL REPORT Kyrgyz Republic K yr gy z R ep ub lic National Statistical Committee of the Kyrgyz Republic United Nations Children’s Fund in the Kyrgyz Republic Kyrgyz Republic Multiple Indicator Cluster Survey December, 2015 M ul tip le In di ca to r C lu st er S ur ve y UNICEF Sticky Note The final report of the Kyrgyzstan 2014 MICS, published in December 2015, has undergone some changes in March 2016. To find out more about these changes send an email to mics@unicef.org. This version of the report on the website is final and integrates all the changes. Multiple Indicator Cluster Survey in the Kyrgyz Republic 2014 Final Report December, 2015 Revised in March, 2016 The Kyrgyzstan Multiple Indicator Cluster Survey (MICS) was carried out in 2014 by the National Statistics Committee of the Kyrgyz Republic, as part of the global MICS programme. Technical support was provided by the United Nations Children’s Fund (UNICEF). UNICEF and UNFPA provided financial support. The global MICS programme was developed by UNICEF in the 1990s as an international household survey programme to support countries in the collection of internationally comparable data on a wide range of indicators on the situation of children and women. MICS surveys measure key indicators that allow countries to generate data for use in policies and programmes, and to monitor progress towards the Millennium Development Goals (MDGs) and other internationally agreed upon commitments. The 2014 Kyrgyzstan MICS presents up-to-date information for assessing the situation of children and women as well as to provide data for monitoring existing strategies and action plans. This MICS will also furnish data for designing future programme interventions and support evidence based planning. Suggested citation: National Statistical Committee of the Kyrgyz Republic and UNICEF. Kyrgyzstan Multiple Indicator Cluster Survey 2014, Final Report. Bishkek, Kyrgyzstan: National Statistical Committee of the Kyrgyz Republic and UNICEF. This material may be reprinted, quoted or otherwise reproduced, providing that the source is properly acknowledged. National Statistical Committee of the Kyrgyz Republic 374, Frunze str., Bishkek, 720033 Tel.: (+996 312) 625747, 324635 Fax.: (+996 312) 660138 Internet: www.stat.kg United Nations Children’s Fund (UNICEF) in the Kyrgyz Republic 160, Chui prs., Bishkek, 720040 Tel.: (+996 312) 611224, 611227 Fax.: (+996 312) 611191 Internet: www.unicef.org iii Kyrgyzstan MICS, 2014. Final Report Summary Table of Survey Implementation and the Survey Population, Kyrgyzstan MICS, 2014 Survey implementation Sample frame Updated 2009 Population Census March-April, 2014 Questionnaires Household Women (age 15-49) Children under five Questionnaire for Vaccination Records at Health Facility Interviewer training April, 2014 Fieldwork April–June, 2014 Survey sample Households - Sampled - Occupied - Interviewed - Response rate (percent) 7,190 7,062 6,934 98.2 Children under five - Eligible - Mothers (or caretakers) interviewed - Response rate (percent) 4,611 4,577 99.3 Women - Eligible for interviews - Interviewed - Response rate (percent) 6,995 6,854 98.0 Survey population Average household size 4.3 Percentage of population living in - Urban areas - Rural areas - Batken - Djalal–Abad - Issyk–Kul - Naryn - Osh Oblast - Talas - Chui - Bishkek City - Osh City 31.5 68.5 8.2 19.8 7.5 4.7 19.8 5.1 17.8 12.8 4.3 Percentage of population under: - Age 5 - Age 18 14.2 39.1 Percentage of women age 15-49 years with at least one live birth in the last 2 years 24.4 Housing characteristics Household or personal assets Percentage of households with - Electricity - Finished floor - Finished roofing - Finished walls 99.8 97.4 97.8 61.8 Percentage of households that own - A television - A refrigerator - Agricultural land - Farm animals/livestock 98.9 84.8 61.8 48.5 Mean number of persons per room used for sleeping 2.16 Percentage of households where at least a member has or owns a - Mobile phone - Car 98.0 48.7 iv Kyrgyzstan MICS, 2014. Final Report Summary Table of Findings1 Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Kyrgyzstan, 2014 Child mortality Early childhood mortality MICS Indicator Indicator name Description Value A 1.1 Neonatal mortality rate Probability of dying within the first month of life 17 1.2 MDG 4.2 Infant mortality rate Probability of dying between birth and the first birthday 24 1.3 Post-neonatal mortality rate Difference between infant and neonatal mortality rates 7 1.4 Child mortality rate Probability of dying between the first and the fifth birthdays 6 1.5 MDG 4.1 Under-five mortality rate Probability of dying between birth and the fifth birthday 29 A Indicator values are per 1,000 live births and refer to the five-year period before the survey Nutrition Nutritional status MICS Indicator Indicator name Description Value 2.1a 2.1b MDG 1.8 Underweight prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for age of the WHO standard 2.8 0.6 2.2a 2.2b Stunting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median height for age of the WHO standard 12.9 3.4 2.3a 2.3b Wasting prevalence (a) Moderate and severe (b) Severe Percentage of children under age 5 who fall below (a) minus two standard deviations (moderate and severe) (b) minus three standard deviations (severe) of the median weight for height of the WHO standard 2.8 0.8 2.4 Overweight prevalence Percentage of children under age 5 who are above two standard deviations of the median weight for height of the WHO standard 7.0 Breastfeeding and infant feeding MICS Indicator Indicator name Description Value 2.5 Children ever breastfed Percentage of women with a live birth in the last 2 years who breastfed their last live-born child at any time 97.6 2.6 Early initiation of breastfeeding Percentage of women with a live birth in the last 2 years who put their last newborn to the breast within one hour of birth 82.5 2.7 Exclusive breastfeeding under 6 months Percentage of infants under 6 months of age who are exclusively breastfed 41.1 2.8 Predominant breastfeeding under 6 months Percentage of infants under 6 months of age who received breast milk as the predominant source of nourishment during the previous day 69.5 2.9 Continued breastfeeding at 1 year Percentage of children age 12-15 months who received breast milk during the previous day 60.7 1 See Appendix E for a detailed description of MICS indicators v Kyrgyzstan MICS, 2014. Final Report Breastfeeding and infant feeding MICS Indicator Indicator name Description Value 2.10 Continued breastfeeding at 2 years Percentage of children age 20-23 months who received breast milk during the previous day 22.5 2.11 Median duration of breastfeeding The age in months when 50 percent of children age 0-35 months did not receive breast milk during the previous day 15.4 2.12 Age-appropriate breastfeeding Percentage of children age 0-23 months appropriately fed during the previous day 50.9 2.13 Introduction of solid, semi- solid or soft foods Percentage of infants age 6-8 months who received solid, semi- solid or soft foods during the previous day 85.4 2.14 Milk feeding frequency for non-breastfed children Percentage of non-breastfed children age 6-23 months who received at least 2 milk feedings during the previous day 62.8 2.15 Minimum meal frequency Percentage of children age 6-23 months who received solid, semi- solid and soft foods (plus milk feeds for non-breastfed children) the minimum number of times or more during the previous day 80.7 2.16 Minimum dietary diversity Percentage of children age 6–23 months who received foods from 4 or more food groups during the previous day 50.9 2.17a Minimum acceptable diet (a) Percentage of breastfed children age 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day (b) Percentage of non-breastfed children age 6–23 months who received at least 2 milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day 36.7 33.8 2.18 Bottle feeding Percentage of children age 0-23 months who were fed with a bottle during the previous day 29.8 Salt iodization MICS Indicator Indicator name Description Value 2.19 Iodized salt consumption Percentage of households with salt testing 15 parts per million or more of iodate 92.8 Low-birthweight MICS Indicator Indicator name Description Value 2.20 Low-birthweight infants Percentage of most recent live births in the last 2 years weighing below 2,500 grams at birth 5.9 2.21 Infants weighed at birth Percentage of most recent live births in the last 2 years who were weighed at birth 97.5 Child health Vaccinations MICS Indicator Indicator name Description Value 3.1 Tuberculosis immunization coverage Percentage of children age 12-23 months who received BCG vaccine by their first birthday 99.6 3.2 Polio immunization coverage Percentage of children age 12-23 months who received the third dose of OPV vaccine (OPV3) by their first birthday 87.5 3.3 3.5 3.6 Pentavalent DPT+HepB+Hib immunization coverage Percentage of children age 12-23 months who received the third dose of Pentavalent DPT+HepB+Hib vaccine by their first birthday 93.9 3.4 MDG 4.3 Measles immunization coverage Percentage of children age 24-35 months who received a measles vaccine by their second birthday 95.8 3.8 Full immunization coverage Percentage of children age 24-35 months who received all vaccinations recommended in the national immunization schedule by their first birthday (measles by second birthday) 80.4 vi Kyrgyzstan MICS, 2014. Final Report Diarrhoea MICS Indicator Indicator name Description Value – Children with diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks 5.5 3.10 Care-seeking for diarrhoea Percentage of children under age 5 with diarrhoea in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 51.9 3.11 Diarrhoea treatment with oral rehydration salts (ORS) and zinc Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORS and zinc 8.6 3.12 Diarrhoea treatment with oral rehydration therapy (ORT) and continued feeding Percentage of children under age 5 with diarrhoea in the last 2 weeks who received ORT (ORS packet, pre-packaged ORS fluid, recommended homemade fluid or increased fluids) and continued feeding during the episode of diarrhoea 67.2 Acute Respiratory Infection (ARI) symptoms MICS Indicator Indicator name Description Value – Children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks 2.3 3.13 Care-seeking for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 59.7 3.14 Antibiotic treatment for children with ARI symptoms Percentage of children under age 5 with ARI symptoms in the last 2 weeks who received antibiotics 84.7 Solid fuel use MICS Indicator Indicator name Description Value 3.15 Use of solid fuels for cooking Percentage of household members in households that use solid fuels as the primary source of domestic energy to cook 29.3 Fever MICS Indicator Indicator name Description Value – Children with fever Percentage of children under age 5 with fever in the last 2 weeks 14.3 3.20 Care-seeking for fever Percentage of children under age 5 with fever in the last 2 weeks for whom advice or treatment was sought from a health facility or provider 55.8 Water and sanitation Water and sanitation MICS Indicator Indicator name Description Value 4.1 MDG 7.8 Use of improved drinking water sources Percentage of household members using improved sources of drinking water 87.0 4.2 Water treatment Percentage of household members in households using unimproved drinking water who use an appropriate treatment method 77.2 4.3 MDG 7.9 Use of improved sanitation Percentage of household members using improved sanitation facilities which are not shared 97.5 4.4 Safe disposal of child’s faeces Percentage of children age 0-2 years whose last stools were disposed of safely 75.8 4.5 Place for handwashing Percentage of households with a specific place for hand washing where water and soap or other cleansing agent are present 94.5 4.6 Availability of soap or other cleansing agent Percentage of households with soap or other cleansing agent 96.8 vii Kyrgyzstan MICS, 2014. Final Report REPRODUCTIVE HEALTH Contraception and unmet need MICS Indicator Indicator name Description Value – Total fertility rate Total fertility rateA for women age 15-49 years 4.0 5.1 MDG 5.4 Adolescent birth rate Age-specific fertility rateA for women age 15-19 years 65 5.2 Early childbearing Percentage of women age 20-24 years who had at least one live birth before age 18 3.5 5.3 MDG 5.3 Contraceptive prevalence rate Percentage of women age 15-49 years currently married or in union who are using (or whose partner is using) a (modern or traditional) contraceptive method 42.0 5.4 MDG 5.6 Unmet need Percentage of women age 15-49 years who are currently married or in union who are fecund and want to space their births or limit the number of children they have and who are not currently using contraception 19.1 Maternal and newborn health MICS Indicator Indicator name Description Value 5.5a 5.5b MDG 5.5 MDG 5.5 Antenatal care coverage Percentage of women age 15-49 years with a live birth in the last 2 years who were attended during their last pregnancy that led to a live birth (a) at least once by skilled health personnel (b) at least four times by any provider 98.4 94.6 5.6 Content of antenatal care Percentage of women age 15-49 years with a live birth in the last 2 years who had their blood pressure measured and gave urine and blood samples during the last pregnancy that led to a live birth 98.2 5.7 MDG 5.2 Skilled attendant at delivery Percentage of women age 15-49 years with a live birth in the last 2 years who were attended by skilled health personnel during their most recent live birth 98.4 5.8 Institutional deliveries Percentage of women age 15-49 years with a live birth in the last 2 years whose most recent live birth was delivered in a health facility 98.3 5.9 Caesarean section Percentage of women age 15-49 years whose most recent live birth in the last 2 years was delivered by caesarean section 7.4 Post-natal health checks MICS Indicator Indicator name Description Value 5.10 Post-partum stay in health facility Percentage of women age 15-49 years who stayed in the health facility for 12 hours or more after the delivery of their most recent live birth in the last 2 years 99.8 5.11 Post-natal health check for the newborn Percentage of last live births in the last 2 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery 98.5 5.12 Post-natal health check for the mother Percentage of women age 15-49 years who received a health check while in facility or at home following delivery, or a post-natal care visit within 2 days after delivery of their most recent live birth in the last 2 years 97.8 Child development Child development MICS Indicator Indicator name Description Value 6.1 Attendance to early childhood education Percentage of children age 36-59 months who are attending an early childhood education programme 22.7 6.2 Support for learning Percentage of children age 36-59 months with whom an adult has engaged in four or more activities to promote learning and school readiness in the last 3 days 72.1 6.3 Father’s support for learning Percentage of children age 36-59 months whose biological father has engaged in four or more activities to promote learning and school readiness in the last 3 days 2.8 6.4 Mother’s support for learning Percentage of children age 36-59 months whose biological mother has engaged in four or more activities to promote learning and school readiness in the last 3 days 29.7 viii Kyrgyzstan MICS, 2014. Final Report Child development MICS Indicator Indicator name Description Value 6.5 Availability of children’s books Percentage of children under age 5 who have three or more children’s books 27.3 6.6 Availability of playthings Percentage of children under age 5 who play with two or more types of playthings 59.3 6.7 Inadequate care Percentage of children under age 5 left alone or in the care of another child younger than 10 years of age for more than one hour at least once in the last week 4.5 6.8 Early child development index Percentage of children age 36-59 months who are developmentally on track in at least three of the following four domains: literacy-numeracy, physical, social- emotional, and learning 78.3 2 Literacy and education Literacy and education MICS Indicator Indicator name Description Value 7.1 MDG 2.3 Literacy rate among young women Percentage of young women age 15-24 years who are able to read a short simple statement about everyday life or who attended secondary or higher education 99.3 7.2 School readiness Percentage of children in first grade of primary school who attended pre-school during the previous school year 43.1 7.3 Net intake rate in primary education Percentage of children of school-entry age who enter the first grade of primary school 94.9 7.4 MDG 2.1 Primary school net attendance ratio (adjusted) Percentage of children of primary school age currently attending primary or secondary school 99.3 7.5 Secondary school net attendance ratio (adjusted) Percentage of children of secondary school age currently attending secondary school or higher 94.0 7.SS1 Lower secondary schoolA net attendance ratio (adjusted) Percentage of children of lower secondary school age currently attending lower secondary school (5-9 grades) or higher 97.9 7.SS2 Upper secondary schoolB net attendance ratio (adjusted) Percentage of children of upper secondary school age currently attending upper secondary school (10-11 grades) or higher 82.4 7.6 MDG 2.2 Children reaching last grade of primary Percentage of children entering the first grade of primary school who eventually reach last grade 99.7 7.7 Primary completion rate Number of children attending the last grade of primary school (exclud- ing repeaters) divided by number of children of primary school comple- tion age (age appropriate to final grade of primary school) 103.7 7.8 Transition rate to secondary school Number of children attending the last grade of primary school during the previous school year who are in the first grade of secondary school during the current school year divided by number of children attending the last grade of primary school during the previous school year 98.3 7.9 MDG 3.1 Gender parity index (primary school) Primary school net attendance ratio (adjusted) for girls divided by primary school net attendance ratio (adjusted) for boys 1.00 7.10 MDG 3.1 Gender parity index (secondary school) Secondary school net attendance ratio (adjusted) for girls divided by secondary school net attendance ratio (adjusted) for boys 1.03 7.SS3 Gender parity index (lower secondary school) Lower secondary school net attendance ratio (adjusted) for girls divided by lower secondary school net attendance ratio (adjusted) for boys 1.00 7.SS4 Gender parity index (upper secondary school) Upper secondary school net attendance ratio (adjusted) for girls divided by upper secondary school net attendance ratio (adjusted) for boys 1.10 A Lower secondary school consists of grades 5–9 of secondary school. B Upper secondary school consist of grades 10–11 of secondary school. 2 SS (survey–specific) denotes an indicator calculated by introduction of a non–standard module or question(s) to this survey that is not part of the global MICS5 Questionnaires or by applying a non-standard calculation method that is not included in the global MICS5 Tabulation Plan ix Kyrgyzstan MICS, 2014. Final Report Child protection Birth registration MICS Indicator Indicator name Description Value 8.1 Birth registration Percentage of children under age 5 whose births are reported registered 97.7 Child labour MICS Indicator Indicator name Description Value 8.2 Child labour Percentage of children age 5-17 years who are involved in child labour 25.8 Child discipline MICS Indicator Indicator name Description Value 8.3 Violent discipline Percentage of children age 1-14 years who experienced psychological aggression or physical punishment during the last one month 57.1 Early marriage and polygyny MICS Indicator Indicator name Description Value 8.4 Marriage before age 15 Percentage of women age 15-49 years who were first married or in union before age 15 0.4 8.5 Marriage before age 18 Percentage of women age 20-49 years who were first married or in union before age 18 12.7 8.6 Young people age 15-19 years currently married or in union Percentage of young women age 15-19 years who are married or in union 13.9 8.7 Polygyny Percentage of women age 15-49 years who are in a polygynous union 0.9 8.8a 8.8b Spousal age difference Percentage of young women who are married or in union and whose spouse is 10 or more years older, (a) among women age 15-19 years, (b) among women age 20-24 years 6.9 5.9 Attitudes towards domestic violence MICS Indicator Indicator name Description Value 8.12 Attitudes towards domestic violence Percentage of women age 15-49 years who state that a husband is justified in hitting or beating his wife in at least one of the following circumstances: (1) she goes out without telling him, (2) she neglects the children, (3) she argues with him, (4) she refuses sex with him, (5) she burns the food 32.8 Children’s living arrangements MICS Indicator Indicator name Description Value 8.13 Children’s living arrangements Percentage of children age 0-17 years living with neither biological parent 9.9 8.14 Prevalence of children with one or both parents dead Percentage of children age 0-17 years with one or both biological parents dead 3.4 8.15 Children with at least one parent living abroad Percentage of children 0-17 years with at least one biological parent living abroad 11.2 x Kyrgyzstan MICS, 2014. Final Report HIV/AIDS HIV/AIDS knowledge and attitudes MICS Indicator Indicator name Description Value - Have heard of AIDS Percentage of women age 15-49 years who have heard of AIDS 95.1 9.1 MDG 6.3 Knowledge about HIV prevention among young women Percentage of young women age 15-24 years who correctly identify ways of preventing the sexual transmission of HIV, and who reject major misconceptions about HIV transmission 19.8 9.2 Knowledge of mother-to- child transmission of HIV Percentage of women age 15-49 years who correctly identify all three means of mother-to-child transmission of HIV 64.2 9.3 Accepting attitudes towards people living with HIV Percentage of women age 15-49 years expressing accepting attitudes on all four questions toward people living with HIV 2.4 HIV testing MICS Indicator Indicator name Description Value 9.4 Women who know where to be tested for HIV Percentage of women age 15-49 years who state knowledge of a place to be tested for HIV 79.0 9.5 Women who have been tested for HIV and know the results Percentage of women age 15-49 years who have been tested for HIV in the last 12 months and who know their results 19.9 9.7 HIV counselling during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they received counselling on HIV during antenatal care 73.4 9.8 HIV testing during antenatal care Percentage of women age 15-49 years who had a live birth in the last 2 years and received antenatal care during the pregnancy of their most recent birth, reporting that they were offered and accepted an HIV test during antenatal care and received their results 78.2 Access to mass media and ICT Access to mass media MICS Indicator Indicator name Description Value 10.1 Exposure to mass media Percentage of women age 15-49 years who, at least once a week, read a newspaper or magazine, listen to the radio, and watch television 21.3 Use of information/communication technology MICS Indicator Indicator name Description Value 10.2 Use of computers Percentage of young women age 15-24 years who used a computer during the last 12 months 64.1 10.3 Use of internet Percentage of young women age 15-24 years who used the internet during the last 12 months 73.0 Subjective well-being Subjective well-being MICS Indicator Indicator name Description Value 11.1 Life satisfaction Percentage of young women age 15-24 years who are very or somewhat satisfied with their life, overall 96.1 11.2 Happiness Percentage of young women age 15-24 years who are very or somewhat happy 96.0 11.3 Perception of a better life Percentage of young women age 15-24 years whose life improved during the last one year, and who expect that their life will be better after one year 70.0 xi Kyrgyzstan MICS, 2014. Final Report Tobacco and alcohol use Tobacco use MICS Indicator Indicator name Description Value 12.1 Tobacco use Percentage of women age 15-49 years who smoked cigarettes, or used smoked or smokeless tobacco products at any time during the last one month 2.9 12.2 Smoking before age 15 Percentage of women age 15-49 years who smoked a whole cigarette before age 15 0.5 Alcohol use MICS Indicator Indicator name Description Value 12.3 Use of alcohol Percentage of women age 15-49 years who had at least one alcoholic drink at any time during the last one month 10.0 12.4 Use of alcohol before age 15 Percentage of women age 15-49 years who had at least one alcoholic drink before age 15 0.4 xii Table of Contents Summary Table of Survey Implementation and the Survey Population ……………………… iii Summary Table of Findings ………………………………………………………………………… iv Table of Contents ……………………………………………………………………………………… xii List of Tables …………………………………………………………………………………………… xiv List of Figures …………………………………………………………………………………………… xix List of Abbreviations …………………………………………………………………………………… xx Acknowledgements …………………………………………………………………………………… xxi Executive Summary ……………………………………………………………………………………xxii I. Introduction ……………………………………………………………………………………………… 1 Background ……………………………………………………………………………………………… 2 Survey Objectives ……………………………………………………………………………………… 3 II. Sample and Survey Methodology …………………………………………………………………… 4 Sample Design ………………………………………………………………………………………… 5 Questionnaires ………………………………………………………………………………………… 5 Training and Fieldwork ………………………………………………………………………………… 6 Data Processing ………………………………………………………………………………………… 6 How to Read Tables …………………………………………………………………………………… 7 III. Sample Coverage and the Characteristics of Households and Respondents……………… 8 Sample Coverage ……………………………………………………………………………………… 9 Characteristics of Households ……………………………………………………………………… 10 Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 ………… 13 Housing characteristics, asset ownership, and wealth quintiles ………………………………… 16 IV. Child Mortality ……………………………………………………………………………………… 20 V. Nutrition ……………………………………………………………………………………………… 27 Low Birth Weight ……………………………………………………………………………………… 28 Nutritional Status ……………………………………………………………………………………… 30 Breastfeeding and Infant and Young Child Feeding ……………………………………………… 33 Salt Iodization ………………………………………………………………………………………… 46 VI. Child Health ………………………………………………………………………………………… 48 Vaccinations …………………………………………………………………………………………… 49 Care of Illness ………………………………………………………………………………………… 54 Diarrhoea ……………………………………………………………………………………………… 55 Acute Respiratory Infections ………………………………………………………………………… 67 Solid Fuel Use ………………………………………………………………………………………… 70 Fever …………………………………………………………………………………………………… 72 VII. Water and Sanitation ……………………………………………………………………………… 76 Use of Improved Water Sources …………………………………………………………………… 77 Use of Improved Sanitation ………………………………………………………………………… 83 Handwashing ………………………………………………………………………………………… 91 VIII. Reproductive Health ……………………………………………………………………………… 94 Fertility ………………………………………………………………………………………………… 95 Contraception ………………………………………………………………………………………… 99 Unmet Need ……………………………………………………………………………………………105 Antenatal Care …………………………………………………………………………………………107 Assistance at Delivery ……………………………………………………………………………… 111 Place of Delivery ………………………………………………………………………………………114 Post-natal Health Checks ……………………………………………………………………………115 IX. Early Childhood Development ……………………………………………………………………129 Early Childhood Care and Education ………………………………………………………………130 Quality of Care …………………………………………………………………………………………131 xiii Developmental Status of Children …………………………………………………………………139 X. Literacy and Education ……………………………………………………………………………141 Literacy among Young Women ………………………………………………………………………142 School Readiness ……………………………………………………………………………………143 Primary and Secondary School Participation ………………………………………………………144 XI. Child Protection ……………………………………………………………………………………158 Birth Registration ………………………………………………………………………………………159 Child Labour ……………………………………………………………………………………………160 Child Discipline ………………………………………………………………………………………166 Early Marriage and Polygyny ………………………………………………………………………169 Attitudes toward Domestic Violence ………………………………………………………………177 Children’s Living Arrangements ……………………………………………………………………177 XII. HIV/AIDS ……………………………………………………………………………………………181 Knowledge about HIV Transmission and Misconceptions about HIV ……………………………182 Knowledge of mother-to-child HIV transmission …………………………………………………185 Accepting Attitudes toward People Living with HIV ………………………………………………187 Knowledge of a Place for HIV Testing, Counselling and Testing during Antenatal Care ………189 HIV Indicators for Young Women ……………………………………………………………………193 XIII. Access to Mass Media and Use of Information/Communication Technology …………196 Access to Mass Media ………………………………………………………………………………197 Use of Information/Communication Technology……………………………………………………198 XIV. Subjective well-being ……………………………………………………………………………200 XV. Tobacco and Alcohol Use …………………………………………………………………………207 Tobacco Use …………………………………………………………………………………………208 Alcohol Use ……………………………………………………………………………………………211 Appendix А. Sample Design …………………………………………………………………………213 Appendix B. List of Personnel Involved in the Survey …………………………………………217 Appendix C. Estimates of Sampling Errors ………………………………………………………221 Appendix D. Data Quality Tables ……………………………………………………………………248 Appendix E. 2014 Kyrgyzstan MICS Indicators: Numerators and Denominators …………263 Appendix F. Questionnaires …………………………………………………………………………271 F1. Household questionnaire ………………………………………………………………………272 F2. Questionnaire for Individual Women (age 15-49) ……………………………………………289 F3. Questionnaire for Children Under Five …………………………………………………………321 F4. Questionnaire Form for Vaccination Records at Health Facility ……………………………339 Appendix G. Additional Tables ………………………………………………………………………341 xiv List of Tables Table HH.1: Results of household, women's and under-5 interviews ………………………………… 9 Table HH.2: Age distribution of household population by sex ……………………………………… 10 Table HH.3: Household composition …………………………………………………………………… 12 Table HH.4: Women's background characteristics …………………………………………………… 14 Table HH.5: Under-5s’ background characteristics …………………………………………………… 15 Table HH.6: Housing characteristics …………………………………………………………………… 17 Table HH.7: Household and personal assets ………………………………………………………… 18 Table HH.8: Wealth quintiles …………………………………………………………………………… 19 Table CM.1: Early childhood mortality rates…………………………………………………………… 21 Table CM.2: Early childhood mortality rates by socioeconomic characteristics …………………… 22 Table CM.3: Early childhood mortality rates by demographic characteristics …………………… 24 Table NU.1: Low birth weight infants …………………………………………………………………… 29 Table NU.2: Nutritional status of children ……………………………………………………………… 31 Table NU.3: Initial breastfeeding ……………………………………………………………………… 35 Table NU.4: Breastfeeding ……………………………………………………………………………… 37 Table NU.5: Duration of breastfeeding ………………………………………………………………… 40 Table NU.6: Age-appropriate breastfeeding …………………………………………………………… 41 Table NU.7: Introduction of solid, semi-solid, or soft foods ………………………………………… 42 Table NU.8: Infant and young child feeding (IYCF) practices ……………………………………… 43 Table NU.9: Bottle feeding ……………………………………………………………………………… 45 Table NU.10: Iodized salt consumption ……………………………………………………………… 46 Table CH.1: Vaccinations in the first years of life … ………………………………………………… 50 Table CH.2: Vaccinations by background characteristics …………………………………………… 52 Table CH.3: Reported disease episodes ……………………………………………………………… 54 Table CH.4: Care-seeking during diarrhoea ………………………………………………………… 57 Table CH.5: Feeding practices during diarrhoea ……………………………………………………… 59 Table CH.6: Oral rehydration solutions, recommended homemade fluids, and zinc …………… 62 Table CH.7: Oral rehydration therapy with continued feeding and other treatments …………… 64 Table CH.8: Source of ORS and zinc ………………………………………………………………… 67 Table CH.9: Care-seeking for and antibiotic treatment of symptoms of acute respiratory infection (ARI) ……………………………………………………………………………………………………… 68 Table CH.10: Knowledge of the two danger signs of pneumonia …………………………………… 69 Table CH.11: Solid fuel use …………………………………………………………………………… 70 xv Table CH.12: Solid fuel use by place of cooking ……………………………………………………… 72 Table CH.13: Care-seeking during fever ……………………………………………………………… 73 Table CH.14: Treatment of children with fever ……………………………………………………… 74 Table WS.1: Use of improved water sources ………………………………………………………… 78 Table WS.2: Household water treatment ……………………………………………………………… 80 Table WS.3: Time to source of drinking water ……………………………………………………… 81 Table WS.4: Person collecting water ………………………………………………………………… 82 Table WS.5: Types of sanitation facilities ……………………………………………………………… 84 Table WS.6: Use and sharing of sanitation facilities ………………………………………………… 86 Table WS.7: Drinking water and sanitation ladders ………………………………………………… 88 Table WS.8: Disposal of child's faeces ………………………………………………………………… 90 Table WS.9: Water and soap at place for handwashing …………………………………………… 91 Table WS.10: Availability of soap or other cleansing agent ………………………………………… 93 Table RH.1: Fertility rates ……………………………………………………………………………… 95 Table RH.2: Adolescent birth rate and total fertility rate ……………………………………………… 97 Table RH.3: Early childbearing ………………………………………………………………………… 98 Table RH.4: Trends in early childbearing ……………………………………………………………… 99 Table RH.4A: Knowledge of specific contraceptive methods ………………………………………100 Table RH.4B: Knowledge of contraceptive methods …………………………………………………101 Table RH.5: Use of contraception ………………………………………………………………………102 Table RH.6: Unmet need for contraception ……………………………………………………………106 Table RH.7: Antenatal care coverage …………………………………………………………………108 Table RH.8: Number of antenatal care visits …………………………………………………………109 Table RH.9: Content of antenatal care …………………………………………………………………110 Table RH.10: Assistance during delivery and caesarean section ……………………………………112 Table RH.11: Place of delivery …………………………………………………………………………114 Table RH.12: Post-partum stay in health facility ………………………………………………………116 Table RH.13: Post-natal health checks for newborns ………………………………………………118 Table RH.14: Post-natal care visits for newborns within the first week following discharge from health facility ………………………………………………………………………………………………121 Table RH.15: Post-natal health checks for mothers …………………………………………………124 Table RH.16: Post-natal care visits for mothers within the first week following discharge from health facility ………………………………………………………………………………………………………126 Table RH.17: Post-natal health checks for mothers and newborns …………………………………128 Table CD.1: Early childhood education …………………………………………………………………130 xvi Table CD.2: Support for learning ………………………………………………………………………133 Table CD.3: Learning materials …………………………………………………………………………135 Table CD.4: Inadequate care ……………………………………………………………………………137 Table CD.5: Early child development index ……………………………………………………………140 Table ED.1: Literacy Young Women ……………………………………………………………………142 Table ED.2: School readiness …………………………………………………………………………143 Table ED.3: Primary school entry ………………………………………………………………………145 Table ED.4: Primary school attendance and out of school children …………………………………146 Table ED.5: Secondary school attendance and out of school children ……………………………148 Table ED.6: Children reaching last grade of primary school …………………………………………150 Table ED.7: Primary school completion and transition to secondary school ………………………152 Table ED.8: Education gender parity …………………………………………………………………153 Table ED.9: Out of school gender parity ………………………………………………………………155 Table CP.1: Birth registration ……………………………………………………………………………159 Table CP.2: Children's involvement in economic activities …………………………………………162 Table CP.3: Children's involvement in household chores ……………………………………………163 Table CP.4: Child labour …………………………………………………………………………………165 Table CP.5: Child discipline ………………………………………………………………………………167 Table CP.6: Attitudes toward physical punishment …………………………………………………168 Table CP.7: Early marriage and polygyny ………………………………………………………………170 Table CP.8: Trends in early marriage …………………………………………………………………172 Table CP.9: Spousal age difference ……………………………………………………………………174 Table CP.10: Attitudes toward domestic violence ……………………………………………………176 Table CP.11: Children's living arrangements and orphanhood ……………………………………178 Table CP.12: Children with parents living abroad ….…………………………………………………179 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV, and comprehensive knowledge about HIV transmission ……………………………………………………………………183 Table HA.2: Knowledge of mother-to-child HIV transmission ………………………………………186 Table HA.3: Accepting attitudes toward people living with HIV ……………………………………187 Table HA.4: Knowledge of a place for HIV testing ……………………………………………………190 Table HA.5: HIV counselling and testing during antenatal care ……………………………………191 Table HA.6: Key HIV and AIDS indicators (young women) …………………………………………194 Table MT.1: Exposure to mass media …………………………………………………………………197 Table MT.2: Use of computers and internet …………………………………………………………199 Table SW.1: Domains of life satisfactio n.………………………………………………………………202 xvii Table SW.2: Overall life satisfaction and happiness …………………………………………………204 Table SW.3: Perception of a better life …………………………………………………………………206 Table TA.1: Current and ever use of tobacco …………………………………………………………209 Table TA.2: Age at first use of cigarettes and frequency of use … …………………………………210 Table TA.3: Use of alcohol ………………………………………………………………………………212 Table SD.1: Final sample allocation ……………………………………………………………………214 Table SE.1: Indicators selected for sampling error calculations ……………………………………222 Table SE.2: Sampling errors: Total sample ……………………………………………………………224 Table SE.3: Sampling errors: Urban ……………………………………………………………………226 Table SE.4: Sampling errors: Rural ……………………………………………………………………228 Table SE.5: Sampling errors: Batken …………………………………………………………………230 Table SE.6: Sampling errors: Djalal-Abad ……………………………………………………………232 Table SE.7: Sampling errors: Issyk-Kul ………………………………………………………………234 Table SE.8: Sampling errors: Naryn ……………………………………………………………………236 Table SE.9: Sampling errors: Osh Oblast………………………………………………………………238 Table SE.10: Sampling errors: Talas ……………………………………………………………………240 Table SE.11: Sampling errors: Chui ……………………………………………………………………242 Table SE.12: Sampling errors: Bishkek City …………………………………………………………244 Table SE.13: Sampling errors: Osh City ………………………………………………………………246 Table DQ.1: Age distribution of household population ………………………………………………248 Table DQ.2: Age distribution of eligible and interviewed women ……………………………………249 Table DQ.3: Age distribution of children in household and under-5 questionnaires ………………250 Table DQ.4: Birth date reporting: Household population ……………………………………………250 Table DQ.5: Birth date and age reporting: Women ……………………………………………………251 Table DQ.6: Birth date and age reporting: Under-5s …………………………………………………251 Table DQ.7: Birth date reporting: Children, adolescents and young people ………………………252 Table DQ.8: Birth date reporting: First and last births ………………………………………………252 Table DQ.9: Completeness of reporting ………………………………………………………………253 Table DQ.10: Completeness of information for anthropometric indicators: Underweight …………253 Table DQ.11: Completeness of information for anthropometric indicators: Stunting ……………254 Table DQ.12: Completeness of information for anthropometric indicators: Wasting ………………254 Table DQ.13: Heaping in anthropometric measurements ……………………………………………255 Table DQ:14: Observation of birth certificates …………………………………………………………256 Table DQ.15: Observation of vaccination cards ………………………………………………………256 Table DQ.16: Observation of places for hand washing ………………………………………………257 xviii Table DQ.17: Respondent to the under-5 questionnaire ……………………………………………257 Table DQ.18: Selection of children age 1-17 years for the child labour and child discipline modules … 258 Table DQ.19: School attendance by single age ………………………………………………………259 Table DQ.20: Sex ratio at birth among children ever born and living ………………………………260 Table DQ.21: Births by periods preceding the survey ………………………………………………260 Table DQ.22: Reporting of age at death in days ………………………………………………………261 Table DQ.23: Reporting of age at death in months …………………………………………………262 Table ED.5A: Lower secondary school attendance and out of school children ……………………341 Table ED.5B: Upper secondary school attendance and out of school children ……………………343 xix List of Figures Figure HH.1: Age and sex distribution of household population …………………………………… 11 Figure CM.1: Early childhood mortality rates ………………………………………………………… 22 Figure CM.2: Under-5 mortality rates by area and region …………………………………………… 25 Figure CM.3: Trend in under-5 mortality rates ……………………………………………………… 26 Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe) …………………………………………………………………………………………………… 33 Figure NU.2: Initiation of breastfeeding ……………………………………………………………… 36 Figure NU.3: Infant feeding patterns by age ………………………………………………………… 39 Figure NU.4: Consumption of iodized salt …………………………………………………………… 47 Figure CH.1: Vaccinations by age 12 months (measles by 24 months) …………………………… 51 Figure CH.2: Children under-5 with diarrhoea who received ORS ………………………………… 61 Figure CH.3: Children under-5 with diarrhoea receiving oral rehydration therapy (ORT) and continued feeding …………………………………………………………………………………………………… 66 Figure WS.1: Percent distribution of household members by source of drinking water ………………… 79 Figure WS.2: Percent distribution of household members by use and sharing of sanitation facilities … 85 Figure WS.3: Use of improved drinking water sources and improved sanitation facilities by house- hold members …………………………………………………………………………………………… 89 Figure RH.1: Age-specific fertility rates by area … …………………………………………………… 96 Figure RH.2: Differentials in contraceptive use ………………………………………………………104 Figure RH.3: Person assisting at delivery ……………………………………………………………113 Figure ED.1: Education indicators by sex ……………………………………………………………157 Figure CP.1: Child disciplining methods, children age 1-14 years …………………………………166 Figure CP.2: Early marriage among women …………………………………………………………173 Figure HA.1: Women with comprehensive knowledge of HIV transmission ………………………185 Figure HA.2: Accepting attitudes toward people living with HIV/AIDS ……………………………189 Figure TA.1: Ever and current smokers ………………………………………………………………210 Figure DQ.1: Household population by single ages …………………………………………………249 Figure DQ.2: Weight and height/length measurements by digits reported for the decimal points ……255 xx Kyrgyzstan MICS, 2014. Final Report List of Abbreviations AIDS Acquired Immune Deficiency Syndrome ARI Acute Respiratory Infection ASFR Age-Specific Fertility Rate BCG Bacillus Calmette-Guérin CBR Crude Birth Rate CRC Convention on the Rights of the Child CSPro Census and Survey Processing System DEFF Design Effect defft Square root of the Design Effect DHS Demographic and Health Survey DPT Diphteria Pertussis Tetanus EA Enumeration Area EPI Expanded Programme on Immunization ECD Early Child Development ECDI Early Child Development Index GAPPD Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea GFR General Fertility Rate GPI Gender Parity Index GVAP Global Vaccine Action Plan HepB Hepatitis B HIV Human Immunodeficiency Virus IMR Infant Mortality Rate IYCF Infant and Young Child Feeding JMP WHO / UNICEF Joint Monitoring Programme LAM Lactational Amenorrhea Method MDG Millennium Development Goals MICS Multiple Indicator Cluster Survey MICS5 Fifth global round of Multiple Indicator Clusters Surveys programme MoH Ministry of Health MMR Measles, Mumps and Rubella NAR Net Attendance Ratio NSC National Statistics Committee OPV Oral Polio Vaccine ORS Oral Rehydration Solution ORT Oral Rehydration Treatment ppm Parts per Million PNC Post-Natal Care PSU Primary Sampling Unit SPSS Statistical Package for Social Sciences TFR Total Fertility Rate U5MR Under 5 Mortality Rate UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund VR Vital Registration WFFC World Fit for Children WHO World Health Organization xxi Kyrgyzstan MICS, 2014. Final Report Acknowledgements The Kyrgyzstan Multiple Indicator Cluster Survey (MICS) is based on an internationally recognized methodology and provides a unique opportunity to draw a comprehensive picture of the lives of children and women in Kyrgyzstan. The survey data supplements the existing sources of official statistical information on the quality of the population living standards by drawing the attention of the government and the public to important new issues and 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 implementation of the 2014 Kyrgyzstan MICS survey and this report are the result of a joint effort by a number of individuals, institutions and organisations that have contributed, with their professional knowledge and commitment. The United Nation Children’s Fund (UNICEF) provided financial and technical support, which made the survey implementation possible. I wish to express my special thanks to Yukie Mokuo, UNICEF Representative in the Kyrgyz Republic, and Muktar Minbaev, UNICEF Research, Monitoring and Evaluation Specialist, for the extensive technical, methodological and financial support received towards this survey. The hard work and commitment of Tolgonai Berdikeeva, UNFPA Programme Specialist, and Larisa Praslova, National MICS Consultant, greatly contributed to the successful implementation of the survey. Special thanks go to Siraj Mahmudlu, UNICEF Regional MICS Coordinator, and the members of the UNICEF Regional team, in particular to Ana Abdelbasit, Ismet Koch, Hans Pettersson and Ikhtier Kholmatov, whose continuous technical and methodological support was of vital importance. We express our sincere gratitude to the global MICS Team, especially Attila Hancioglu, Bo Pedersen, Turgay Unalan, Ivana Bjelic and Yadigar Coskun, who guided survey implementation, data processing and analysis. Let me also thank the contributors from the national government bodies, and managers and experts from the national and regional statistical authorities for their valuable inputs to the successful implementation of this project. Chairman, National Statistical Committee of the Kyrgyz Republic Akylbek Osmonaliev xxii Kyrgyzstan MICS, 2014. Final Report Executive Summary The 2014 Kyrgyzstan MICS is a nationally representative sample survey. For selected indicators, the survey is also representative at the regional level. Sample Coverage • In the 6,934 households successfully interviewed in the survey, 29,786 household members were listed. Of these, 14,597 were males, and 15,189 were females. • Overall, 6,854 women age 15–49 years participated in the survey. Questionnaires for children under five were completed for 4,577 children including 2,342 boys and 2,235 girls. Child Mortality • In the five year period preceding the survey, Kyrgyzstan had neonatal, infant and under 5 mortality rates of 17, 24 and 29 per 1,000 live births, respectively, with males having somewhat higher rates than females. • For infant and under–5 mortality, rural areas recorded approximately 1.5 times more deaths per 1,000 live births compared to urban areas. The difference between the poorest and richest households in terms of childhood mortality rates was two–fold . • Comparison of the MICS findings with other sources showed reduction in under 5 mortality rates over the years. Low Birth Weight • Overall, 98 percent of births were weighed at birth and 6 percent of infants are estimated to weigh less than 2,500 grams at birth. The prevalence of low birth weight does not vary much by region, urban and rural areas or mother’s education. Nutritional status • The prevalence of child malnutrition (moderate and severe) of children under the age of five is relatively low: 3 percent of children are underweight, and 3 percent are wasted. However, 13 percent of children are stunted and more than 7 percent of children are overweight. Breastfeeding and Infant and Young Child Feeding • Although 83 percent of babies are breastfed for the first time within one hour of birth and 98 percent are ever breastfed in Kyrgyzstan, only 41 percent of children are exclusively breastfed until the sixth month of age while 70 percent of children 0–5 months old are predominantly breastfed. • The median duration of exclusive breastfeeding of children 0–35 months old in Kyrgyzstan is 1.5 months while for any breastfeeding it is 15.4 months. Salt Iodization • Salt used for cooking was tested for iodine content in 98.2 percent of all households. In bulk of households (92.8 percent) salt was found to be adequately iodised. xxiii Kyrgyzstan MICS, 2014. Final Report Vaccinations • Eighty–eight percent of children aged 24–35 months received all the recommended vaccinations by the time of the survey. This percentage is lower in urban areas (82 percent), in Bishkek city in particular (72 percent), than in rural areas (91 percent). The percentage of children who received a measles vaccine is 97 percent with the lowest coverage in Bishkek – 92 percent. • The percentage of children aged 24–35 months who received all the recommended vaccinations by their first birthday (by the second birthday for measles) is lower at 80 percent. Diarrhoea • Overall, 5.5 percent of under five children were reported to have had diarrhoea in the two weeks preceding the survey. During the episode of diarrhoea, 20 percent of these children were given much less to eat and 11 percent of children were given nothing to eat. Water and Sanitation • Overall, 87 percent of the population in Kyrgyzstan uses an improved source of drinking water – 98 percent in urban areas and 82 percent in rural areas. Only 64 percent of the household population have the drinking water source on the premises. • 98 percent of the population of Kyrgyzstan lives in households with improved sanitation. However, only 16.8 percent of the population use flush toilets; use of flush toilets is profoundly different between urban and rural areas (47.2 and 2.7 percent, respectively). Fertility • The total fertility rate for the three years preceding the 2014 Kyrgyzstan MICS is 4.0 births per woman. Fertility is considerably higher in rural areas (4.2 births per woman) than in urban areas (3.6 births per woman). • The adolescent birth rate in the country is 65 per 1000 women. Only 3 percent of women age 20–24 have had a live birth before the age of 18. Contraception and Unmet Need • The data show that almost all women have heard of any contraceptive method and the mean number of methods known by women is 8 (of 14 methods). • Current use of contraception was reported by 42 percent of women currently married or in union. The most popular modern methods are IUD, which is used by 22 percent of women and male condoms – 10 percent. • Overall, 19 percent of women age 15–49 years who are married or in union have unmet need for contraception, including 12 percent for spacing, and 7 percent for limiting. Ante– and Post–natal Care and Assistance at Delivery • In Kyrgyzstan, only 1.5 percent of women do not receive antenatal care while 95 percent of mothers received antenatal care at least four times. The majority of antenatal care is provided by medical doctors (92 percent). xxiv Kyrgyzstan MICS, 2014. Final Report • The delivery of 98 percent of births in the last two years was attended by skilled personnel and took place in a health facility. Eighty–two percent of those women giving birth in a health facility stay 3 days or more in the facility after delivery. Seven percent of all births are delivered via a C–section. • With regards to PNC visits, these predominantly occur either after the first week following birth (56 percent) or within 3–6 days after the delivery (36 percent). Early Childhood Care and Education • In Kyrgyzstan nearly 23 percent of children age 36–59 months are attending an organised early childhood education programme. Urban–rural differentials are notable – the figure is as high as 40 percent in urban areas, compared to 16 percent in rural areas. • For close to three–quarters (72 percent) of children age 36–59 months, an adult household member engaged in four or more activities that promote learning and school readiness. Only 27 percent of children age 0–59 months live in households where at least 3 children’s books are present for the child. School Readiness • Overall, 43 percent of children who are currently attending the first grade of primary school were attending pre–school the previous year. More than half of the children in first grade in urban areas (52 percent) had attended pre–school the previous year compared to 40 percent among children living in rural areas. Primary and Secondary School Participation • The vast majority of children of primary school age (99.3 percent) are attending school. Of all children starting grade one, the majority (99.7 percent) will eventually reach grade 5. • About 94 percent of children age 11–17 years are attending secondary school grades. For the children of upper secondary school age the attendance decrease sharply reaching the minimum among children age 17 (84 percent). At the secondary school level girls account for about 36 percent of the total out–of–school population. Birth Registration • The births of 97.7 percent of children under five years have been registered. Three in four mothers (76 percent) of unregistered children appear to be aware of the registration process. Child Labour • In Kyrgyzstan, one in four children (26 percent) age 5–17 were engaged in child labour, while 15 percent were working under hazardous conditions. Male children (30 percent) are more likely to be involved in child labour than female children (22 percent), with rural areas having 2.5 times higher child labour percentage than urban areas (1 vs. 12 percent). Early Marriage • Among women age 15–49 years, just 0.4 percent were married before age 15. Among women age 20–49 years, about one in eight (13 percent) women were married before age 18. About one in seven (14 percent) young women age 15–19 years is currently married or in union. xxv Kyrgyzstan MICS, 2014. Final Report Attitudes toward Domestic Violence • Overall, 33 percent of women in Kyrgyzstan feel that a husband/partner is justified in hitting or beating his wife (in at least one of the five situations). Children’s Living Arrangements • Overall, 77.1 percent of children age 0–17 years in Kyrgyzstan live with both their parents. One in ten children (9.9 percent) live with neither of their biological parents while, most often, both of them are alive (9 percent). • In Kyrgyzstan, one in nine children (11.2 percent) age 0–17 have one or both parents living abroad. Both the mother and father were abroad in almost half of these cases. HIV/AIDS • In Kyrgyzstan, 95 percent of the women age 15–49 years have heard of AIDS. However, the percentage of those who know two main ways of preventing HIV transmission is only 62 percent. • The percentage of women who know all three ways of mother–to–child transmission is 64.2 percent, while 4.5 percent of women did not know of any specific way. Awareness is notably higher among ever married women (68 percent) as opposed to never married women (50 percent). • In Kyrgyzstan, 83 percent of women who have heard of AIDS agree with at least one accepting statement. The most common accepting attitude is willingness to care for a family member with AIDS in own home: 59 of respondents agree with this. • In Kyrgyzstan, 79 percent of all women knew where to be tested with a little difference between urban and rural areas. More than two thirds (67 percent) of women in the country have actually been tested and 59 percent know the result of their most recent test. • Only 37 percent of young women age 15–24 years have ever been tested and know the result of the most recent test, while only 20 percent have been tested for HIV in the last 12 months and know the result. Access to Mass Media and Use of Information/Communication Technology • In Kyrgyzstan 45 percent of women age 15–49 years read a newspaper or magazine, 37 percent listen to the radio, and 98 percent watch television at least once a week. Among 15–24 year old women, 45 percent used a computer and 64 percent used the internet, at least once a week during the last month. Subjective well–being • Young women age 15–24 years are the most satisfied with the way they look (97 percent), their health (96 percent), and their family life (93 percent). Among the domains, young women age 15-24 years who are very or somewhat satisfied with their income (78 percent), with 81 percent of young women not having an income at all. Tobacco and Alcohol Use • In Kyrgyzstan, use of tobacco products is not very common among women age 15–49 years: 12 percent of women reported to have ever used a tobacco product and only 0.5 percent of women 15–49 years old smoked a cigarette for the first time before age 15. xxvi Kyrgyzstan MICS, 2014. Final Report • One out of ten women age 15–49 years had at least one drink of alcohol on one or more days during the last one month. Only 0.4 percent of women of the same age group first drank alcohol before the age of 15, while 58 percent of women never had an alcoholic drink. I. Introduction 2 Kyrgyzstan MICS, 2014. Final Report Background This final report is based on the results of the Multiple Indicator Cluster Survey (MICS) conducted in 2014 by National Statistical Committee of the Kyrgyz Republic. The survey provides statistically sound and internationally comparable data essential for developing evidence–based policies and programmes, and for monitoring progress toward national goals and global commitments. Among these global commitments are those emanating from the World Fit for Children Declaration and Plan of Action, the goals of the United Nations General Assembly Special Session on HIV/AIDS, the Education for All Declaration and the Millennium Development Goals (MDGs). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child–focused research. We will enhance international cooperation to support statistical capacity–building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and subnational levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action of the World Fit for Children (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary–General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” As a follow–up to the World Summit on Children in 1990, the United Nations Children’s Fund developed a uniform list of indicators and a methodology for collecting statistically reliable and internationally comparable data with a view to building the capacity of the national governments to monitor the situation of children and to gauge progress in implementing the Convention on the Rights of the Child. Today, MICS has become a recognized tool for measuring progress in implementing the national targets and global commitments on improving the welfare of children. As a party to the international covenants on children and human development, the Kyrgyz Republic attributes great priority to meeting its international obligations; it is implementing concrete measures to monitor progress and build the capacity of its statistical systems, given their decisive role in informing the national strategic planning processes. 3 Kyrgyzstan MICS, 2014. Final Report The 2014 Kyrgyzstan MICS findings will be critically important for final MDG reporting in 2015, and are expected to form part of the baseline data for the post–2015 era. 2014 Kyrgyzstan MICS is expected to contribute to the evidence base of several other important initiatives, including Committing to Child Survival: A Promise Renewed, a global movement to end child deaths from preventable causes, and the accountability framework proposed by the Commission on Information and Accountability for the Global Strategy for Women's and Children's Health. Survey Objectives The 2014 Kyrgyzstan MICS has as its primary objectives: • To provide up–to–date information for assessing the situation of children and women in Kyrgyzstan; • To generate data for the critical assessment of the progress made in various areas, and to put additional efforts in those areas that require more attention; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action; • To collect disaggregated data for the identification of disparities, to allow for evidence based policy–making aimed at social inclusion of the most vulnerable; • To contribute to the generation of baselines for the indicators of Sustainable Development Goals; • To validate data from other sources and the results of focused interventions. II. Sample and Survey Methodology 5 Kyrgyzstan MICS, 2014. Final Report Sample Design The sample for the 2014 Kyrgyzstan Multiple Indicator Cluster Survey was designed to provide estimates for a large number of indicators on the situation of children and women at the national level, for urban and rural areas, and for seven oblasts: Batken, Djalal-Abad, Issyk-Kul, Naryn, Osh, Talas and Chui as well as Bishkek and Osh cities. The sampling frame was based on the data and cartographic materials from the 2009 Kyrgyzstan Population Census. The primary sampling units (PSUs) were the enumeration areas (EAs) defined for the census. The urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. Within each stratum, a specified number of census enumeration areas were selected systematically with probability proportional to size. After a household listing was carried out within the selected enumeration areas, a systematic sample of 18 households was drawn in each sample enumeration area. All selected enumeration areas were visited during the fieldwork period. The sample was stratified by region, urban and rural areas, and is not self-weighting. For reporting national level findings, sample weights are used. A more detailed description can be found in Appendix A on sample design. Questionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire which was used to collect basic demographic information on all de jure household members (usual residents), the household, and the dwelling; 2) a questionnaire for individual women administered in each household to all women age 15-49 years; 3) an under-5 questionnaire, administered to mothers (or caretakers) for all children under 5 living in the household, as well as a form for collecting vaccination records at Health Facilities for children under 3. The Household Questionnaire included the following modules: • List of Household Members • Education • Child Labour • Child Discipline • Household Characteristics • Water and Sanitation • Handwashing • Salt Iodization The Questionnaire for Individual Women was administered to all women age 15-49 years living in the households, and included the following modules: • Woman’s Background • Access to Mass Media and Use of Information/Communication Technology • Fertility/Birth History • Desire for Last Birth • Maternal and Newborn Health • Post-natal Health Checks • Illness Symptoms • Contraception • Unmet Need • Attitudes Toward Domestic Violence 6 Kyrgyzstan MICS, 2014. Final Report • Marriage/Union • HIV/AIDS • Tobacco and Alcohol Use • Life Satisfaction The Questionnaire for Children Under Five was administered to mothers (or caretakers) of children under 5 years of age3 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Age • Birth Registration • Early Childhood Development • Breastfeeding and Dietary Intake • Immunization • Care of Illness • Anthropometry For all children age 0-2 years with a completed Questionnaire for Children Under Five an additional form, the Questionnaire Form For Vaccination Records At Health Facility, was used to record vaccinations from the registers at health facilities. The questionnaires are based on the MICS5 model questionnaire4. From the MICS5 model English version, the questionnaires were customised and translated into Kyrgyz and Russian and were pre- tested in Bishkek city and the Chui oblast during February-March of 2014. Based on the findings of the pre-test, modifications were made to the wording and translation of the questionnaires. A copy of the 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, observed the place for handwashing, and measured the weights and heights of children age under 5 years. Details and findings of these observations and measurements are provided in the respective sections of the report. Training and Fieldwork Training for the fieldwork was conducted for 13 days on 7-19 April 2014. Training included lectures on interviewing techniques and the contents of the questionnaires, role games and mock interviews between trainees to gain practice in asking questions and regular oral and written quizzes. Towards the end of the training period, trainees spent three days in practice interviewing in the Issyk-Kul oblast. The data were collected by 9 teams; each was comprised of 4 interviewers, one driver, one editor, one measurer and a supervisor. Fieldwork began on 24 April 2014 and concluded in late June of 2014. Data Processing Data were entered using the CSPro software, version 5.0, under supervision of the data entry supervisor. The data were entered on 14 desktop computers and carried out by 14 data entry operators and 2 data entry editors. For quality assurance purposes, all questionnaires were double- entered and internal consistency checks were performed. Procedures and standard programs 3 The terms “children under 5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. 4 The model MICS5 questionnaires can be found at http://mics.unicef.org/tools 7 Kyrgyzstan MICS, 2014. Final Report developed under the global MICS programme and adapted to the Kyrgyzstan questionnaires were used throughout. Data processing began simultaneously with data collection on 6 May and concluded early in July 2014. Data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 20. Model syntax and tabulation plans developed by UNICEF were customized and used for this purpose. How to Read Tables The tables of this report present data collected through this survey in standard way, intuitively easy to understand. However, the reader should be aware of the following remarks. Values in parenthesis indicate that the percentage or proportion is based on only 25–49 unweighted cases and should be treated with caution. An asterisk in tables indicates that the percentage or proportion has been suppressed because it is based on fewer than 25 unweighted cases while dash denotes 0 unweighted cases. Age groups presented in this report also include those persons that had reached the full age indicated by the upper limit for an age group; for instance, respondents age 15–49 include persons who had fully reached 49 years of age. Similarly, the age group of children age 20–23 months includes those who had fully reached 23 months. The education categories “None” and “Primary” are based on fewer than 25 unweighted cases and therefore too small to be reported separately; these categories are combined into “None/Primary”. The categories “Professional primary” and “Professional middle” are combined “Professional primary/middle”. The categories “None” and “Primary” and “Professional primary” and “Professional middle” are shown as individual categories in tables that describe the background characteristics of households and respondents (Section III). Also, in the tables and throughout the report, mother's education refers to educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. III. Sample Coverage and the Characteristics of Households and Respon- dents 9 Kyrgyzstan MICS, 2014. Final Report Sample Coverage Of the 7,190 households selected for the sample, 7,035 were found to be occupied, of which 27 actually comprised two households, leading to a total of 7,062 occupied households. Of these, 6,934 were successfully interviewed yielding a household response rate of 98.2 percent. In the interviewed households, 6,995 women (age 15-49 years) were identified. Of these, 6,854 were successfully interviewed, yielding a response rate of 98.0 percent within the interviewed households. There were 4,611 children under age five listed in the household questionnaires. Questionnaires were completed for 4,577 of these children, which corresponds to a response rate of 99.3 percent within interviewed households. Overall response rates of 96.2 and 97.5 percent were achieved for the individual interviews of women and under-5s, respectively. Household response rates across urban and rural areas were quite similar. In terms of regions, household response rates were over 92 percent in all regions (Table HH.1). Table HH.1: Results of household, women's and under-5 interviews Number of households, women and children under 5 by interview results and response rates, Kyrgyzstan, 2014 To ta l Area Region U rb an R ur al B at ke n D ja la l-A ba d Is sy k- K ul N ar yn O sh O bl as t Ta la s C hu i B is hk ek C ity O sh C ity Households Sampled 7190 2974 4216 813 900 810 809 810 774 813 813 648 Occupied 7062 2879 4183 791 900 788 809 787 774 809 769 635 Interviewed 6934 2812 4122 730 900 780 809 787 774 792 738 624 Household response rate 98.2 97.7 98.5 92.3 100.0 99.0 100.0 100.0 100.0 97.9 96.0 98.3 Women Eligible 6995 2659 4336 791 965 595 702 991 954 699 655 643 Interviewed 6854 2626 4228 731 958 591 693 961 949 683 653 635 Women's response rate 98.0 98.8 97.5 92.4 99.3 99.3 98.7 97.0 99.5 97.7 99.7 98.8 Women's overall response rate 96.2 96.5 96.1 85.3 99.3 98.3 98.7 97.0 99.5 95.7 95.7 97.0 Children under 5 Eligible 4611 1512 3099 539 632 306 447 741 933 382 276 355 Mothers (or caretakers) interviewed 4577 1503 3074 533 631 306 447 726 932 374 276 352 Under-5s' response rate 99.3 99.4 99.2 98.9 99.8 100.0 100.0 98.0 99.9 97.9 100.0 99.2 Under-5s' overall response rate 97.5 97.1 97.7 91.3 99.8 99.0 100.0 98.0 99.9 95.8 96.0 97.4 10 Kyrgyzstan MICS, 2014. Final Report Characteristics of Households The weighted age and sex distribution of the survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In the 6934 households successfully interviewed in the survey, 29,786 household members were listed. Of these, 14,597 were males, and 15,189 were females. Table HH.2: Age distribution of household population by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more), by sex, Kyrgyzstan, 2014 Total Males Females Number Percent Number Percent Number Percent Total 29786 100.0 14597 100.0 15189 100.0 Age 0-4 4233 14.2 2167 14.8 2066 13.6 5-9 3288 11.0 1703 11.7 1585 10.4 10-14 2648 8.9 1335 9.1 1313 8.6 15-19 2407 8.1 1231 8.4 1176 7.7 20-24 2315 7.8 1090 7.5 1225 8.1 25-29 2319 7.8 1174 8.0 1145 7.5 30-34 1872 6.3 934 6.4 937 6.2 35-39 1729 5.8 875 6.0 854 5.6 40-44 1598 5.4 790 5.4 809 5.3 45-49 1452 4.9 709 4.9 742 4.9 50-54 1775 6.0 791 5.4 984 6.5 55-59 1419 4.8 648 4.4 772 5.1 60-64 998 3.4 425 2.9 574 3.8 65-69 580 1.9 242 1.7 338 2.2 70-74 412 1.4 178 1.2 234 1.5 75-79 392 1.3 169 1.2 224 1.5 80-84 203 0.7 83 0.6 120 0.8 85+ 142 0.5 53 0.4 89 0.6 Missing/DK 3 0.0 0 0.0 3 0.0 Dependency age groups 0-14 10169 34.1 5205 35.7 4964 32.7 15-64 17885 60.0 8667 59.4 9218 60.7 65+ 1729 5.8 725 5.0 1004 6.6 Missing/DK 3 0.0 0 0.0 3 0.0 Children and adult populations Children age 0-17 years 11659 39.1 5998 41.1 5660 37.3 Adults age 18+ years 18124 60.8 8598 58.9 9526 62.7 Missing/DK 3 0.0 0 0.0 3 0.0 According to the survey data, the proportion of males in the total population was 49.0 percent, the proportion of women was 51.0 percent. According to the National Statistics Committee( NSC) data, 11 Kyrgyzstan MICS, 2014. Final Report as of 1 January 2014, the shares of men and women in the total resident population was respectively 49.5 percent and 50.5 percent. According to the survey data the proportion of children age 0-14 years in the overall population is 34.1 percent; the proportion of the population age 65+ is 5.8 percent. Children up to 18 years of age constitute 39.1 percent of the population. The largest two 5-year groups are the 0-4 and 5-9 year age-groups (14.2 and 11.0 percent respectively). The male-female ratio shows some variations and after 60 years of life the number of women exceeds that of men (Table HH.2 and Figure HH.1). Figure HH.1: Age and sex distribution of household population, Kyrgyzstan, 2014 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Percent Age Males Females Note: 3 household members with missing age and/or sex are excluded Tables HH.3, HH.4 and HH.5 provide basic information on the households, female respondents age 15-49, and children under-5. Both unweighted and weighted numbers are presented. Such information is essential for the interpretation of findings presented later in the report and provide background information on the representativeness of the survey sample. The remaining tables in this report are presented only with weighted numbers5. Table HH.3 provides basic background information on the households, including the sex of the household head, region, area, number of household members, education of household head, and native language6 of the household head are shown in the table. These background characteristics are used in subsequent tables in this report; the figures in the table are also intended to show the numbers of observations by major categories of analysis in the report. 5 See Appendix A on sample design for more details on sample weights 6 This was determined by asking question HC1 on the mother tongue of the household head 12 Kyrgyzstan MICS, 2014. Final Report Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Kyrgyzstan, 2014 Weighted percent Number of households Weighted Unweighted Total 100.0 6934 6934 Sex of household head Male 72.1 5002 5086 Female 27.9 1932 1848 Region Batken 7.3 508 730 Djalal-Abad 17.8 1235 900 Issyk-Kul 9.1 628 780 Naryn 4.7 323 809 Osh Oblast 14.8 1028 787 Talas 3.9 270 774 Chui 20.1 1393 792 Bishkek City 17.8 1237 738 Osh City 4.5 312 624 Area Urban 39.5 2739 2812 Rural 60.5 4195 4122 Number of household members 1 8.5 586 497 2 15.4 1067 938 3 14.4 1002 983 4 17.3 1200 1220 5 16.9 1174 1231 6 13.0 901 990 7 7.7 536 590 8 3.5 242 261 9 1.3 91 94 10+ 1.9 134 130 Education of household head None 1.2 82 76 Primary 2.9 200 187 Basic secondary 10.6 737 701 Complete secondary 39.7 2751 2919 Professional primary 7.1 493 545 Professional middle 15.5 1078 995 Higher 22.9 1591 1509 Missing/DK 0.0 2 2 Mother tongue of household head Kyrgyz 69.1 4792 5141 Russian 14.5 1006 678 Uzbek 12.2 844 901 Other language 4.2 290 211 Missing/DK 0.0 2 3 Mean household size 4.30 6934 6934 13 Kyrgyzstan MICS, 2014. Final Report The weighted and unweighted total number of households are equal, since sample weights were normalized. The table also shows the weighted mean household size estimated by the survey. In terms of the gender structure for heads of households in Kyrgyzstan, 27.9 percent of heads of household are female. Men headed almost three out of four households (72.1 percent). Of the total number of households, nearly 39.5 percent lived in urban settlements and 60.5 percent in rural areas. At the time of survey, the average household size was 4.3 people. However, about a quarter of households (23.9 percent) consisted of one or two persons, 61.7 percent of households had 3-6 persons and households consisting of 7 or more persons amounted to 14.5 percent. The majority of households (69.1 percent) are headed by persons who indicated Kyrgyz as their mother tongue, Uzbek was indicated in 12.2 percent of cases, Russian 14.5 percent, languages of other nationalities - 4.2 percent. Characteristics of Female Respondents 15-49 Years of Age and Children Under-5 Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In these tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women and children under age five, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents, age 15-49 years. The table includes information on the distribution of women according to region, area, age, marital/union status, motherhood status, births in last two years, education7, wealth index quintiles8,9, and mother tongue of the household head. The proportion of older women is lower, with 11 percent in the 45-49 years age group. Of the total number of women age 15-49 years, 64.6 percent lived in urban areas and 35.4 percent in rural areas. At the time of survey, 69.3 percent of women in this age group were married or in union, 8.9 percent were widowed, divorced or separated, and 21.9 percent were never married or in union. Accordingly, a decrease in the share of women never married or in union is observed; from 32.5 percent in 2009 according to the 2009 Census to 27.0 percent (2012 DHS) and 21.9 percent in the 2014 MICS. 7 Throughout this report, unless otherwise stated, “education” refers to highest educational level ever attended by the respondent when it is used as a background variable. 8 The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth index values. Each household in the total sample is then assigned a wealth score based on the assets owned by that household and on the final factor scores obtained as described above. The survey household population is then ranked according to the wealth score of the household they are living in, and is finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). In Kyrgyzstan MICS, the following assets were used in these calculations: television, non-mobile phone, refrigerator, laptop/planchet, table, armchair, sofa, bed, cupboard, fan, water heater, washing machine, air conditioner, camera, microwave, watch, car, tractor or other machine for household. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Filmer, D and Pritchett, L. 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115-132; Rutstein, SO and Johnson, K. 2004. The DHS Wealth Index. DHS Comparative Reports No. 6; and Rutstein, SO. 2008. The DHS Wealth Index: Approaches for Rural and Urban Areas. DHS Working Papers No. 60. 9 When describing survey results by wealth quintiles, appropriate terminology is used when referring to individual household members, such as for instance “women in the richest population quintile”, which is used interchangeably with “women in the wealthiest survey population”, “women living in households in the richest population wealth quintile”, and similar. 14 Kyrgyzstan MICS, 2014. Final Report Table HH.4: Women's background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Kyrgyzstan, 2014 Weighted percent Number of women Weighted Unweighted Total 100.0 6854 6854 Region Batken 7.9 543 731 Djalal-Abad 19.5 1336 958 Issyk-Kul 6.8 469 591 Naryn 4.1 282 693 Osh 18.6 1277 961 Talas 4.9 333 949 Chui 17.7 1216 683 Bishkek City 15.6 1072 653 Osh City 4.8 326 635 Area Urban 35.4 2424 2626 Rural 64.6 4430 4228 Age 15-19 17.1 1169 1162 20-24 17.7 1214 1155 25-29 16.7 1145 1175 30-34 13.6 935 979 35-39 12.5 854 853 40-44 11.7 804 785 45-49 10.7 733 745 Marital/Union status Currently married/in union 69.3 4750 4889 Widowed 2.1 143 156 Divorced 6.3 428 387 Separated 0.5 35 23 Never married/in union 21.9 1498 1399 Motherhood and recent births Never gave birth 28.3 1936 1806 Ever gave birth 71.7 4918 5048 Gave birth in last two years 24.4 1675 1766 No birth in last two years 47.3 3242 3282 Education None/Primary 0.8 58 40 Basic secondary 13.7 941 901 Complete secondary 41.0 2813 2917 Professional primary/middle 18.4 1258 1289 Higher 26.0 1784 1707 Wealth index quintile Poorest 18.2 1245 1494 Second 18.8 1292 1309 Middle 19.3 1320 1335 Fourth 20.8 1424 1391 Richest 23.0 1574 1325 Mother tongue of household head Kyrgyz 71.4 4891 5159 Russian 8.5 582 374 Uzbek 15.7 1074 1096 Other language 4.4 305 222 Missing 0.0 2 3 15 Kyrgyzstan MICS, 2014. Final Report Table HH.5: Under-5s’ background characteristics Percent and frequency distribution of children under five years of age by selected characteristics, Kyrgyzstan, 2014 Weighted percent Number of under-5 children Weighted Unweighted Total 100.0 4577 4577 Sex Male 51.2 2342 2348 Female 48.8 2235 2229 Region Batken 8.9 408 533 Djalal-Abad 20.9 956 631 Issyk-Kul 5.8 264 306 Naryn 4.3 195 447 Osh 22.2 1015 726 Talas 7.7 352 932 Chui 15.6 715 374 Bishkek City 10.4 474 276 Osh City 4.3 198 352 Area Urban 29.7 1360 1503 Rural 70.3 3217 3074 Age 0-5 months 9.9 455 432 6-11 months 11.7 534 522 12-23 months 19.2 880 880 24-35 months 20.5 939 927 36-47 months 20.2 925 944 48-59 months 18.5 845 872 Respondent to the under-5 questionnaire Mother 90.8 4154 4172 Other primary caretaker 9.2 423 405 Mother’s educationa None/Primary 1.3 58 34 Basic secondary 11.6 529 459 Complete secondary 45.9 2102 2129 Professional primary/middle 16.0 732 783 Higher 25.2 1155 1172 Wealth index quintile Poorest 21.5 986 1115 Second 22.7 1039 1011 Middle 20.8 951 970 Fourth 18.0 823 832 Richest 17.0 778 649 Mother tongue of household head Kyrgyz 77.2 3534 3656 Russian 3.9 180 122 Uzbek 14.3 656 656 Other language 4.5 205 140 Missing 0.0 2 3 a In this table and throughout the report, mother's education refers to educational attainment of mothers as well as caretakers of children under 5, who are the respondents to the under-5 questionnaire if the mother is deceased or is living elsewhere. 16 Kyrgyzstan MICS, 2014. Final Report By motherhood status, 71.7 percent of women had ever given birth, and 24.4 percent of women gave birth in the two years preceding the survey. By educational attainment, nearly 99 percent of women have at least basic secondary education with the following distribution: nearly 13.7 percent have basic secondary education, 41.0 percent have completed secondary education, 18.4 percent have professional primary/middle education and 26.0 percent completed higher education. The educational level of women has increased significantly. The proportion of women with higher education has increased from 17.6 percent, according to the 2009 Census data, to 26 percent in 2014 Kyrgyzstan MICS. Similarly, there was an increase in the proportion of women with professional education (12.0 and 18.4 percent, respectively) and the proportion of women with basic secondary education (from 10.9 percent to 13.7 percent). As far as wealth index quintiles are concerned, fewer women live in households within the poorest quintile —18.2 percent — while 23.0 percent of women live in the households within the richest wealth quintile. Background characteristics of children under 5 are presented in Table HH.5. These include the distribution of children by several attributes: sex, region and area, age in months, respondent type, mother’s (or caretaker’s) education, wealth, and mother tongue. 4,577 children under 5 were surveyed of which 51.2 percent boys, and 48.8 percent girls. Nearly 29.6 percent of children live in urban and 70.3 percent live in rural areas. The percentage distribution of children under 5 by age group is as follows: under 12 months – 21.6 percent, 12-23 months – 19.2 percent, 24-35 months – 20.5 percent, 36-47 months – 20.2 percent and 48-59 months – 18.5 percent. The distribution corresponds closely to the vital registration statistics (as of January 2014) which gives the following figures: under 12 months – 21.1 percent, 12-23 months – 20.9 percent, 24-35 months – 20.2 percent, 36-47 months – 19.7 percent and 48-59 months – 18.1 percent. Among respondents to the questionnaire for children under 5 91 percent were mothers and the remaining 9 percent were the primary caretakers. About 41.2 percent of mothers (or caretakers had professional or higher education, 45.9 percent had completed secondary education and nearly 11.6 percent have basic secondary education. The smallest percentage of children (17.0 percent) live in the richest quintile and the largest (21.5 and 22.7 percent, respectively) in the two bottom wealth quintiles. More than 90 percent of children live in households where the mother tongue of the household head is Kyrgyz (77.2 percent) or Uzbek (14.3 percent). Housing characteristics, asset ownership, and wealth quintiles Tables HH.6, HH.7 and HH.8 provide further details on household level characteristics. HH.6 presents characteristics of housing, disaggregated by area and region, distributed by whether the dwelling has electricity, the main materials of the flooring, roof, and exterior walls, as well as the number of rooms used for sleeping. The vast majority (99.8 percent) of the population live in households with electricity; there are minor differences in access to electricity between urban (99.9 percent) and rural (99.7 percent) areas. The figure is somewhat lower in the Naryn oblast where 97.0 percent of the population have electricity at home. An increase in nationwide coverage by 1.4 percent is observed since 2009, if compared with 2009 Census data. The vast majority of households have a finished floor (97.4 percent), finished roofing (97.8 percent). Nearly 61.8 percent have finished exterior walls with notable variation between urban and rural areas (78.8 and 50.6 percent respectively) and across oblasts. The mean number of persons per room used for sleeping is 2.16 with a minor difference between urban and rural areas, and regions. 17 Kyrgyzstan MICS, 2014. Final Report Table HH.6: Housing characteristics Percent distribution of households by selected housing characteristics, according to area of residence and regions, Kyrgyzstan, 2014 Total Area Region U rb an R ur al B at ke n D ja la l- A ba d Is sy k- K ul N ar yn O sh Ta la s C hu i B is hk ek C ity O sh C ity Electricity Yes 99.8 99.9 99.7 99.7 100.0 100.0 97.0 99.8 100.0 99.9 100.0 99.9 No 0.2 0.0 0.3 0.3 0.0 0.0 3.0 0.2 0.0 0.0 0.0 0.1 Missing/DK 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 Flooring Natural floor 1.5 0.3 2.3 5.5 4.8 0.0 0.9 0.7 0.1 0.0 0.1 1.7 Rudimentary floor 0.6 0.6 0.5 0.3 1.1 0.5 0.2 0.0 2.7 0.3 0.2 1.7 Finished floor 97.4 98.9 96.4 91.0 93.6 99.5 98.8 99.3 96.8 98.7 99.6 96.2 Other 0.6 0.2 0.8 3.2 0.5 0.0 0.0 0.0 0.4 1.0 0.0 0.4 Missing/DK 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 Roof Natural roofing 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.7 0.0 0.0 Rudimentary roofing 1.5 1.8 1.1 7.4 4.6 0.7 6.8 0.0 1.0 0.0 0.0 0.0 Finished roofing 97.8 97.7 98.0 92.6 95.4 98.5 93.2 100.0 97.9 96.6 100.0 99.2 Other 0.5 0.4 0.7 0.0 0.0 0.0 0.0 0.0 0.0 2.7 0.0 0.8 Missing/DK 0.1 0.1 0.0 0.0 0.0 0.8 0.0 0.0 1.2 0.0 0.0 0.0 Exterior walls Natural walls 8.2 3.2 11.4 64.7 0.4 0.3 58.5 0.2 15.0 0.0 0.0 0.3 Rudimentary walls 29.2 17.5 36.9 6.9 44.6 66.9 9.3 37.4 50.2 15.2 17.8 12.6 Finished walls 61.8 78.8 50.6 28.4 53.3 32.7 32.1 62.3 34.7 82.6 82.2 86.9 Other 0.8 0.4 1.0 0.0 1.8 0.0 0.0 0.0 0.1 2.3 0.0 0.0 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0 0.2 Rooms used for sleeping 1 27.1 43.1 16.7 18.7 20.3 26.9 31.3 4.4 16.7 34.1 50.7 22.5 2 43.1 38.3 46.3 55.8 49.8 51.1 52.4 37.8 51.3 37.3 33.3 45.8 3 or more 28.5 17.2 35.8 25.1 28.9 16.8 16.0 56.7 30.6 27.9 14.7 30.8 Missing/DK 1.3 1.4 1.2 0.4 0.9 5.2 0.3 1.1 1.4 0.7 1.3 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 6934 2739 4195 508 1235 628 323 1028 270 1393 1237 312 Mean number of persons per room used for sleeping 2.16 2.07 2.22 2.40 2.34 1.95 2.57 2.14 2.80 1.96 2.00 2.01 In Table HH.7 households are distributed according to ownership of assets by households and by individual household members. This also includes ownership of dwelling. 18 Kyrgyzstan MICS, 2014. Final Report Table HH.7: Household and personal assets Percentage of households by ownership of selected household and personal assets, and percent distribution by ownership of dwelling, according to area of residence and regions, Kyrgyzstan, 2014 Total Area Region U rb an R ur al B at ke n D ja la l-A ba d Is sy k- K ul N ar yn O sh Ta la s C hu i B is hk ek C ity O sh C ity Percentage of households that own a Radio 30.0 28.9 30.8 28.1 22.4 31.4 37.8 35.7 28.4 29.0 35.4 18.6 Television 98.9 99.1 98.9 99.0 99.5 99.7 96.1 98.6 100.0 98.5 99.5 97.9 Non-mobile telephone 27.0 51.1 11.2 6.2 8.3 34.2 13.9 2.9 12.2 33.5 63.4 51.8 Refrigerator 84.8 91.5 80.4 72.1 74.4 85.4 69.0 88.2 74.2 91.7 94.0 91.8 Computer/Laptop/Tablet 28.7 44.2 18.6 20.7 14.2 16.2 11.5 15.8 18.8 38.8 55.9 41.1 Table 91.8 95.4 89.5 69.5 79.6 98.3 92.8 97.7 98.1 96.4 98.2 91.7 Armchair 60.1 65.4 56.7 37.6 55.3 66.8 39.6 57.7 66.2 70.9 65.6 56.0 Sofa 67.0 71.5 64.1 50.0 63.3 72.8 62.6 68.8 70.2 68.1 75.2 55.4 Bed 80.6 79.0 81.7 63.4 72.8 76.4 79.2 90.2 78.8 87.5 85.1 70.5 Cupboard 94.7 95.2 94.4 85.3 93.0 98.5 93.8 98.2 91.6 94.6 96.8 93.7 Fan 30.5 35.8 27.1 28.1 31.3 1.6 3.7 30.4 19.6 41.5 39.7 42.2 Water Heater 19.2 31.7 11.1 8.0 14.3 20.6 9.3 1.6 13.9 34.0 23.1 45.7 Three phase electricty 8.8 8.4 9.1 1.7 0.8 6.2 13.7 0.2 21.8 23.0 9.3 4.2 Washing machine 28.9 49.9 15.1 5.3 15.6 28.4 8.1 0.8 12.1 45.2 63.9 36.8 Air conditioning 4.7 7.0 3.1 1.3 2.5 0.4 0.4 4.1 1.5 7.8 8.9 5.4 Camera 18.2 23.9 14.5 15.6 13.8 9.8 6.8 15.6 12.3 24.9 25.4 24.4 Microwave 21.9 31.9 15.5 10.4 10.8 19.9 4.5 14.5 16.1 33.6 38.2 20.0 Bath in the house 26.0 56.6 6.0 11.6 18.8 11.0 8.6 0.6 7.3 31.3 65.8 44.6 Toilet in the house 24.8 54.9 5.0 11.4 18.4 12.2 8.7 0.3 5.3 28.2 62.4 45.8 Percentage of households that own Agricultural land 61.8 30.2 82.4 82.5 67.8 82.5 74.4 83.5 79.8 58.4 27.5 12.9 Farm animals/Livestock 48.5 14.2 70.9 66.5 61.9 56.1 72.0 74.1 64.5 44.9 5.0 17.7 Percentage of households where at least one member owns or has a Watch 38.3 45.2 33.8 27.4 26.7 29.0 33.7 50.1 30.3 33.2 61.6 24.0 Mobile telephone 98.0 97.6 98.2 98.7 97.7 99.1 97.7 99.3 99.3 97.1 96.8 98.7 Bicycle 24.1 13.8 30.8 31.7 24.5 17.4 13.3 44.8 33.9 26.9 7.5 11.9 Motorcycle or scooter 1.2 0.6 1.6 3.6 0.2 1.0 0.4 1.7 1.1 2.0 0.3 0.7 Animal-drawn cart 7.8 0.4 12.7 5.7 4.4 11.0 16.9 23.8 12.4 3.8 0.2 0.3 Car 48.7 44.3 51.6 53.6 47.2 46.8 40.9 62.4 52.1 45.3 42.6 50.7 Boat with a motor 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 Tractor or other machine for household 3.9 1.0 5.8 4.4 2.6 4.1 9.6 5.8 10.2 4.6 0.3 1.4 Bank account 1.9 2.6 1.5 1.4 0.8 1.0 3.3 0.7 0.8 3.0 3.0 3.4 Ownership of dwelling Owned by a household member 91.3 83.8 96.2 94.6 95.4 93.4 93.7 99.8 93.3 89.0 81.2 83.2 Not owned 8.7 16.2 3.8 5.4 4.6 6.4 6.3 0.2 6.7 11.0 18.8 16.8 Rented 8.5 15.8 3.8 5.4 4.5 6.4 6.2 0.2 6.7 11.0 18.3 15.4 Other 0.2 0.4 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0 0.5 1.4 Missing/DK 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 6934 2739 4195 508 1235 628 323 1028 270 1393 1237 312 19 Kyrgyzstan MICS, 2014. Final Report The majority of households, both in urban and in rural areas, have a TV (98.9 percent), refrigerator (84.8 percent), table (91.8 percent), bed (80.6 percent), cupboard (94.7 percent), sofa (67.0 percent) and armchairs (60.1 percent). Less than one third of households have a landline phone (27.0 percent), computer or laptop (28.7 percent), washing machine (28.9 percent), microwave (21.9 percent) - the ownership of these household assets is notably different between urban and rural areas. A much larger percentage of households own agricultural land (82.4 percent) and farm animals/ livestock (70.9 percent) in rural areas than in urban areas (30.2 percent and 14.2 percent respectively). Around half (48.7 percent) of households own a car with a minor difference between urban and rural areas. Cell phones are the most common item to be owned by at least one member of a household at 98.0 percent while just less than 2 percent of households have a bank account. Regarding ownership of dwelling, 91.3 percent of the dwellings were owned by one of the household members. Table HH.8 shows how the household populations in areas and regions are distributed according to household wealth quintiles. There are notable differences in the distribution of population by wealth index across regions and by urban and rural areas. Nearly 27.1 percent of the rural population belong to the poorest quintile compared to 4.5 percent from urban areas. The proportion of the population living in the poorest wealth quintile is highest in Batken (51.5 percent) oblast and lowest in Bishkek city (less than one percent). These findings appear to be in line with NSC data on poverty in the country. Table HH.8: Wealth quintiles Percent distribution of the household population by wealth index quintile, according to area of residence and regions, Kyrgyzstan, 2014 Wealth index quintile Total Number of household membersPoorest Second Middle Fourth Richest Total 20.0 20.0 20.0 20.0 20.0 100.0 29786 Area Urban 4.5 3.8 10.5 27.6 53.5 100.0 9393 Rural 27.1 27.5 24.4 16.5 4.5 100.0 20393 Region Batken 51.5 20.5 14.0 6.3 7.7 100.0 2432 Djalal-Abad 26.9 27.4 23.3 9.3 13.0 100.0 5883 Issyk-Kul 19.6 23.9 22.1 23.4 11.0 100.0 2245 Naryn 49.8 22.5 11.2 9.9 6.7 100.0 1411 Osh Oblast 23.7 34.8 25.6 15.6 0.3 100.0 5900 Talas 18.5 25.0 29.6 22.1 4.8 100.0 1519 Chui 3.3 8.1 23.1 38.5 27.0 100.0 5312 Bishkek City 0.2 1.5 5.1 23.8 69.5 100.0 3812 Osh City 9.0 5.3 17.0 30.5 38.2 100.0 1273 IV. Child Mortality 21 Kyrgyzstan MICS, 2014. Final Report One of the overarching goals of the Millennium Development Goals (MDGs) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction of under-five mortality by two- thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Mortality rates presented in this chapter are calculated from information collected in the birth histories of the Women’s Questionnaires. All interviewed women were asked whether they had ever given birth, and if yes, they were asked to report the number of sons and daughters who live with them, the number who live elsewhere, and the number who have died. In addition, they were asked to provide a detailed birth history of live births of children in chronological order starting with the firstborn. Women were asked whether births were single or multiple, the sex of the children, the date of birth (month and year), and survival status. Further, for children still alive, they were asked the current age of the child and, if not alive, the age at death. Childhood mortality rates are expressed by conventional age categories and are defined as follows: • Neonatal mortality (NN): probability of dying within the first month of life • Post-neonatal mortality (PNN): difference between infant and neonatal mortality rates • Infant mortality (1q0): probability of dying between birth and the first birthday • Child mortality (4q1): probability of dying between the first and the fifth birthdays • Under-five mortality (5q0): the probability of dying between birth and the fifth birthday Rates are expressed as deaths per 1,000 live births, except in the case of child mortality, which is expressed as deaths per 1,000 children surviving to age one, and post-neonatal mortality, which is the difference between infant and neonatal mortality rates. Table CM.1: Early childhood mortality rates Neonatal, post-neonatal, Infant, child and under-five mortality rates for five year periods preceding the survey, Kyrgyzstan, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Years preceding the survey 0-4 17 7 24 6 29 5-9 16 9 25 6 31 10-14 18 17 35 6 40 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates Table CM.1 and Figure CM.1 present neonatal, post-neonatal, infant, child, and under-five mortality rates for the three most recent five-year periods before the survey. Neonatal mortality in the most recent 5-year period is estimated at 17 per 1,000 live births, while the post-neonatal mortality rate is estimated at 7 per 1,000 live births. 22 Kyrgyzstan MICS, 2014. Final Report Figure CM.1: Early childhood mortality rates, Kyrgyzstan, 2014 18 17 35 6 40 16 9 25 6 31 17 7 24 6 29 0 5 10 15 20 25 30 35 40 45 Neonatal mortality rate Post-neonatal mortality rate Infant mortality rate Child mortality rate Under-five mortality rate Years preceding the survey Note: Indicator values are per 1,000 live births: 10-14 5-9 0-4 The infant mortality rate in the five years preceding the survey is 24 per 1,000 live births and under-five mortality is 29 deaths per 1,000 live births for the same period, indicating that majority (83 percent) of under-five deaths are infant deaths. Table CM.2: Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by socioeconomic characteristics, Kyrgyzstan, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 17 7 24 6 29 Region Batken (21) (9) (30) (2) (32) Djalal-Abad 16 3 20 5 24 Issyk-Kul (26) (14) (40) (4) (43) Naryn (10) (17) (27) (7) (34) Osh Oblast 25 9 34 (16) (49) Talas 14 3 17 1 18 Chui (8) (8) (16) (2) (18) Bishkek City (14) (0) (14) (*) (*) Osh City (9) (9) (17) (*) (*) 23 Kyrgyzstan MICS, 2014. Final Report Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Area Urban 13 3 17 4 20 Rural 18 9 27 7 33 Mother's education Primary/None (11) (6) (17) (5) (21) Complete secondary 19 9 28 8 36 Professional primary/ middle 21 6 27 3 30 Higher 12 3 15 4 19 Wealth index quintile Poorest 27 8 35 2 37 Second 15 8 23 13 36 Middle 13 9 22 6 28 Fourth 20 2 22 4 26 Richest 8 7 15 3 18 Mother tongue of household head Kyrgyz 16 7 22 6 28 Russian (*) (*) (*) (*) (*) Uzbek 19 9 28 (3) (31) Other language (*) (*) (*) (*) (*) 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates (*) – Figures that are based on fewer than 250 unweighted person-years of exposure ( ) – Figures that are based on 250 – 499 unweighted person-years of exposure 24 Kyrgyzstan MICS, 2014. Final Report Table CM.3: Early childhood mortality rates by demographic characteristics Neonatal, post-neonatal, Infant, child and under-five mortality rates for the five year period preceding the survey, by demographic characteristics, Kyrgyzstan, 2014 Neonatal mortality rate1 Post-neonatal mortality rate2, a Infant mortality rate3 Child mortality rate4 Under-five mortality rate5 Total 17 7 24 6 29 Sex of child Male 17 8 25 5 30 Female 16 6 22 7 28 Mother's age at birth Less than 20 (14) (20) (33) (4) (37) 20-34 17 6 23 6 28 35-49 (16) (5) (21) (8) (29) Birth order 1 28 6 34 4 38 2-3 10 7 17 6 23 4-6 13 7 21 10 30 7+ (*) (*) (*) (*) (*) Previous birth intervalb < 2 years 23 8 31 3 34 2 years 10 9 19 (9) (28) 3 years (13) (2) (15) (5) (20) 4+ years 10 4 14 10 24 1 MICS indicator 1.1 - Neonatal mortality rate 2 MICS indicator 1.3 - Post-neonatal mortality rate 3 MICS indicator 1.2; MDG indicator 4.2 - Infant mortality rate 4 MICS indicator 1.4 - Child mortality rate 5 MICS indicator 1.5; MDG indicator 4.1 - Under-five mortality rate a Post-neonatal mortality rates are computed as the difference between the infant and neonatal mortality rates b Excludes first order births (*) – Figures that are based on fewer than 250 unweighted person-years of exposure ( ) – Figures that are based on 250 – 499 unweighted person-years of exposure Tables CM.2 and CM.3 provide estimates of child mortality by socioeconomic and demographic characteristics. There is some difference between the probabilities of dying among males and females; infant mortality in boys is higher than in girls standing at 25 and 22 per 1,000 live births, while the under-five mortality rate is 30 and 28, respectively. Difference between urban and rural areas is more evident: infant and under-5 mortality rates are much lower in urban areas (17 and 20, respectively) while the rates for rural children are about 1.6 times higher (27 and 33, respectively). Figure CM.2 provides a graphical presentation of these differences. There are also differences in mortality in terms of educational levels, wealth, and mother tongue of household head. 25 Kyrgyzstan MICS, 2014. Final Report Figure CM.2: Under-5 mortality rates by area and region, Kyrgyzstan, 2014 29 (21) 36 30 19 37 18 36 28 26 20 33 0 10 20 30 40 Kyrgyzstan Primary Secondary Professional primary/middle Higher Poorest Second Middle Fourth Richest Urban Rural Under 5 years Mortality Rates per 1,000 Births ( ) – Figures that are based on 250-499 unweighted person-years of exposure Figure CM.3 compares the findings of 2014 Kyrgyzstan MICS on under-5 mortality rates with those from other data sources; three surveys, 2012 DHS, 2006 MICS and 2014 MICS as well as the vital registration (VR) system statistics. 2014 Kyrgyzstan MICS findings are obtained from Table CM.1. A decline in mortality estimates in the last 15 years is observed. The most recent U5MR estimate (29 per thousand live births for 0-4 years preceeding the survey) from the 2014 MICS is very close to the average derived from the vital registration system for the same period, while the trend indicated by the survey results are in broad agreement with vital registration data and those in the previous 2006 MICS survey. The mortality data and trend depicted by the 2012 DHS is also a declining one coinciding very well with those indicated by 2014 MICS. Further qualification of these apparent declines and differences as well as its determinants should be taken up in a more detailed and separate analysis. 26 Kyrgyzstan MICS, 2014. Final Report Figure CM.3: Trend in under-5 mortality rates, Kyrgyzstan, 2014 0 10 20 30 40 50 60 70 80 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 DHS 2012 MICS 2006 VR MICS 2014 pe r 1 ,0 00 li ve b irt hs V. Nutrition 28 Kyrgyzstan MICS, 2014. Final Report Low Birth Weight Weight at birth is a good indicator not only of a mother's health and nutritional status but also the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run a higher risk of bearing low birth weight babies. One of the major challenges in measuring the incidence of low birth weight is that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. 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 birth10. 10 For a detailed description of the methodology, see Boerma, JT et al. 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization 74(2): 209-16 29 Kyrgyzstan MICS, 2014. Final Report Table NU.1: Low birth weight infants Percentage of last live-born children in the last two years that are estimated to have weighed below 2,500 grams at birth and percentage of live births weighed at birth, Kyrgyzstan, 2014 Percent distribution of births by mother's assessment of size at birth Total Percentage of live births: Number of last live-born children in the last two years Very small Smaller than average Average Larger than average or very large DK Below 2,500 grams1 Weighed at birth2 Total 1.7 10.2 71.8 14.8 1.5 100.0 5.9 97.5 1675 Mother's age at birth Less than 20 years 2.3 16.0 72.1 8.6 1.1 100.0 7.8 97.5 138 20-34 years 1.9 9.6 72.0 15.2 1.4 100.0 5.8 97.7 1340 35-49 years 0.7 10.1 70.1 16.6 2.6 100.0 5.5 96.3 197 Birth order 1 1.7 14.8 73.0 9.4 1.2 100.0 6.6 97.8 473 2-3 1.7 8.5 72.8 15.5 1.5 100.0 5.5 97.6 867 4-5 1.9 7.4 67.7 21.8 1.3 100.0 5.3 97.7 281 6+ 3.0 10.2 64.5 15.4 6.9 100.0 9.5 92.1 54 Region Batken 3.0 9.1 56.3 30.0 1.6 100.0 6.4 98.0 148 Djalal-Abad 0.8 8.6 75.3 14.1 1.1 100.0 4.5 98.1 351 Issyk-Kul 0.6 12.1 78.7 5.1 3.5 100.0 6.4 95.7 97 Naryn 2.6 11.9 72.9 10.2 2.4 100.0 7.3 93.7 56 Osh Oblast 1.3 15.0 70.5 12.3 0.9 100.0 6.6 97.3 366 Talas 0.0 9.1 74.5 14.5 1.9 100.0 4.4 97.7 124 Chui 4.4 6.6 76.8 9.3 2.9 100.0 8.2 97.3 260 Bishkek City 1.6 7.8 68.2 22.3 0.0 100.0 4.6 97.8 197 Osh City 0.7 11.9 69.0 16.3 2.1 100.0 5.4 99.5 76 Area Urban 1.6 7.8 70.8 18.8 1.0 100.0 4.9 97.9 539 Rural 1.8 11.3 72.2 12.9 1.8 100.0 6.4 97.3 1137 Mother’s education None/primary (*) (*) (*) (*) (*) 100.0 (*) (*) 15 Basic secondary 2.3 10.4 73.7 11.5 2.1 100.0 6.8 97.7 200 Complete secondary 1.8 9.8 69.7 17.3 1.5 100.0 5.8 97.6 757 Professional primary/ middle 2.4 13.8 70.2 12.1 1.5 100.0 7.5 99.6 234 Higher 1.1 7.2 76.4 14.0 1.3 100.0 4.6 97.6 469 Cannot be determined - - - - - 100.0 - - 0 Missing/DK - - - - - 100.0 - - 0 Wealth index quintile Poorest 2.1 11.5 69.3 15.1 1.9 100.0 6.6 95.7 336 Second 0.9 11.1 70.9 15.8 1.4 100.0 5.2 97.9 372 Middle 2.3 10.0 76.6 10.3 0.7 100.0 6.2 98.0 349 Fourth 2.0 10.8 69.1 15.7 2.3 100.0 6.8 97.9 312 Richest 1.5 7.0 72.6 17.5 1.5 100.0 5.0 98.2 306 Mother tongue of household head Kyrgyz 1.8 9.7 71.4 15.7 1.4 100.0 5.9 97.7 1283 Russian (3.3) (3.4) (81.2) (12.2) (0.0) 100.0 (5.1) (100.0) 63 Uzbek 0.3 11.6 72.4 13.9 1.8 100.0 4.9 97.6 256 Other language 4.3 18.8 68.2 5.1 3.5 100.0 11.3 91.4 73 1 MICS indicator 2.20 - Low-birthweight infants 2 MICS indicator 2.21 - Infants weighed at birth "-" denotes 0 unweighted case in that cell or in the denominator (*) – Figures that are based on fewer than 25 unweighted cases ( ) – Figures that are based on 25-49 unweighted cases 30 Kyrgyzstan MICS, 2014. Final Report Overall, 97.5 percent of births were weighed at birth and 5.9 percent of infants are estimated to weigh less than 2,500 grams at birth (Table NU.1). There is no notable variation by region. The prevalence of low birth weight also does not vary much by urban and rural areas or by mother’s education. Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Undernutrition is associated with more than half of all child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth. Three-quarters of children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development Goal target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on the WHO growth standards11. Each of the three nutritional status indicators – weight-for-age, height-for-age, and weight-for-height - can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight- for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Weight-for-height can be used to assess wasting and overweight status. Children whose weight- for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Children whose weight-for-height is more than two standard deviations above the median reference population are classified as moderately or severely overweight. In MICS, weights and heights of all children under 5 years of age were measured using the anthropometric equipment recommended12. by UNICEF. Findings in this section are based on the results of these measurements. 11 http://www.who.int/childgrowth/standards/technical_report 12 See MICS Supply Procurement Instructions: http://mics.unicef.org/tools 31 Kyrgyzstan MICS, 2014. Final Report Table NU.2: Nutritional status of children Percentage of children under age 5 by nutritional status according to three anthropometric indices: weight for age, height for age, and weight for height, Kyrgyzstan, 2014 Weight for age N um be r o f c hi ld re n un de r a ge 5 Height for age N um be r o f c hi ld re n un de r a ge 5 Weight for height N um be r o f c hi ld re n un de r a ge 5 Under- weight M ea n Z- S co re (S D ) Stunted M ea n Z- S co re (S D ) Wasted Over- weight M ea n Z- S co re (S D ) Percent below Percent below Percent below P er ce nt ab ov e – 2 S D 1 – 3 S D 2 – 2 S D 3 – 3 S D 4 – 2 S D 5 – 3 S D 6 + 2 S D 7 Total 2.8 0.6 -0.1 4441 12.9 3.4 -0.7 4412 2.8 0.8 7.0 0.4 4414 Sex Male 2.9 0.6 -0.1 2269 13.8 3.4 -0.7 2248 2.8 0.8 7.8 0.5 2255 Female 2.6 0.6 -0.1 2172 12.0 3.4 -0.7 2164 2.9 0.9 6.1 0.4 2160 Region Batken 2.3 0.4 -0.2 402 13.6 1.3 -0.8 402 2.2 0.8 3.4 0.3 401 Djalal-Abad 6.9 1.4 -0.4 945 21.3 7.7 -0.9 931 7.9 2.5 8.7 0.2 934 Issyk-Kul 1.7 1.1 -0.1 262 14.1 2.8 -0.9 258 1.7 0.3 7.8 0.6 261 Naryn 2.9 0.7 -0.1 189 16.4 5.3 -0.9 188 0.5 0.2 6.2 0.5 189 Osh Oblast 1.0 0.2 0.0 1001 10.6 1.8 -0.8 1000 1.1 0.3 4.7 0.5 1001 Talas 2.0 0.3 0.0 352 11.0 2.2 -0.8 352 1.0 0.4 7.3 0.6 352 Chui 1.6 0.0 0.1 637 7.6 1.9 -0.4 631 1.5 0.3 9.0 0.5 628 Bishkek City 1.1 0.5 0.2 467 7.6 2.5 -0.3 467 2.1 0.6 9.5 0.6 467 Osh City 3.9 0.5 -0.2 187 12.1 3.3 -0.7 183 2.4 0.0 4.3 0.3 182 Area Urban 1.9 0.5 0.0 1310 11.8 3.1 -0.6 1303 2.6 0.6 8.2 0.5 1300 Rural 3.1 0.6 -0.1 3131 13.4 3.5 -0.8 3110 2.9 0.9 6.5 0.4 3114 Age 0-5 months 2.5 0.2 0.2 441 5.3 2.5 0.1 438 6.5 2.7 9.0 0.2 429 6-11 months 2.2 0.7 0.4 528 7.2 2.0 0.0 525 3.1 0.3 11.5 0.6 527 12-17 months 1.4 0.0 0.2 408 11.2 2.4 -0.6 407 2.3 0.4 11.1 0.7 407 18-23 months 2.9 1.1 0.0 456 18.2 6.3 -0.9 453 2.2 0.9 6.8 0.6 453 24-35 months 3.5 1.0 -0.2 907 18.6 5.6 -1.0 897 1.6 0.3 6.8 0.5 900 36-47 months 3.2 0.4 -0.3 878 14.6 3.0 -1.0 874 2.9 0.6 5.0 0.4 877 48-59 months 2.8 0.4 -0.4 823 10.5 1.7 -0.9 818 2.7 1.2 3.3 0.2 821 Mother’s education None/primary (0.0) (0.0) (-0.2) 56 (26.5) (8.3) (-1.4) 56 (1.3) (0.0) (8.3) (0.8) 56 Basic secondary 4.6 0.9 -0.3 519 17.1 4.4 -0.8 514 3.2 0.4 4.9 0.3 512 Complete secondary 2.6 0.6 -0.1 2062 13.5 2.7 -0.8 2052 3.2 0.9 6.7 0.4 2058 Professional primary/middle 3.6 0.8 -0.1 700 11.8 3.6 -0.7 694 2.1 0.7 7.2 0.5 689 Higher 1.8 0.4 0.1 1104 9.8 3.8 -0.5 1096 2.5 1.1 8.3 0.5 1099 32 Kyrgyzstan MICS, 2014. Final Report Weight for age N um be r o f c hi ld re n un de r a ge 5 Height for age N um be r o f c hi ld re n un de r a ge 5 Weight for height N um be r o f c hi ld re n un de r a ge 5 Under- weight M ea n Z- S co re (S D ) Stunted M ea n Z- S co re (S D ) Wasted Over- weight M ea n Z- S co re (S D ) Percent below Percent below Percent below P er ce nt ab ov e – 2 S D 1 – 3 S D 2 – 2 S D 3 – 3 S D 4 – 2 S D 5 – 3 S D 6 + 2 S D 7 Wealth index quintile Poorest 3.5 0.8 -0.2 971 17.7 4.4 -0.9 970 3.1 1.0 6.2 0.4 970 Second 4.0 0.8 -0.2 1020 14.2 3.8 -0.8 1010 3.6 1.6 4.4 0.4 1015 Middle 2.1 0.5 -0.1 919 10.1 2.6 -0.7 911 2.4 0.3 7.0 0.5 910 Fourth 2.4 0.3 0.1 795 10.7 2.7 -0.6 789 1.6 0.2 9.2 0.6 788 Richest 1.6 0.4 0.1 736 10.7 3.2 -0.4 732 3.3 1.0 9.2 0.5 731 Mother tongue of household head Kyrgyz 2.4 0.6 0.0 3421 12.0 2.9 -0.7 3405 2.4 0.9 7.0 0.5 3404 Russian 3.4 0.0 0.1 172 11.7 2.4 -0.5 167 2.8 0.0 13.4 0.6 171 Uzbek 4.7 0.6 -0.3 648 17.1 5.9 -0.8 645 5.3 1.2 6.5 0.3 645 Other language 3.1 0.0 -0.3 197 15.8 5.5 -0.8 193 2.4 0.0 2.8 0.3 192 1 MICS indicator 2.1a and MDG indicator 1.8 - Underweight prevalence (moderate and severe) 2 MICS indicator 2.1b - Underweight prevalence (severe) 3 MICS indicator 2.2a - Stunting prevalence (moderate and severe) 4 MICS indicator 2.2b - Stunting prevalence (severe) 5 MICS indicator 2.3a - Wasting prevalence (moderate and severe) 6 MICS indicator 2.3b - Wasting prevalence (severe) 7 MICS indicator 2.4 - Overweight prevalence ( ) – Figures that are based on 25-49 unweighted cases Table NU.2 shows percentages of children classified into each of the above described categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes mean z-scores for all three anthropometric indicators. Children whose full birth date (month and year) were not obtained and children whose measurements are outside a plausible range are excluded from Table NU.2. Additionally, children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/ her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. Percentages of children by age and reasons for exclusion are shown in the data quality Tables DQ.10, DQ.11, and DQ.12 in Appendix D. The tables show that due to incomplete dates of birth, implausible measurements, and/or missing weight and/or height, 3.0 percent of children have been excluded from calculations of the weight-for-age indicator, 3.6 percent from the height-for-age indicator, and 3.6 percent for the weight-for-height indicator. In Kyrgyzstan, 2.8 percent of children under age five are moderately or severely underweight and 0.6 percent are classified as severely underweight (Table NU.2). At the same time, 12.9 percent of children are moderately or severely underweight stunted or too short for their age and 2.8 percent are moderately or severely underweight wasted or too thin for their height. More than 7 percent of children are overweight, or too heavy for their height. 33 Kyrgyzstan MICS, 2014. Final Report Children in Djalal-Abad oblast are more likely to be underweight and stunted than other children. The percentage of overweight children ranges from 3.4 percent in the Batken oblast to 9.5 percent in Bishkek City. Those children whose mothers have complete secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with no or lower education. Boys appear to be slightly more likely to be underweight and stunted than girls are. The age pattern (Figure NU.1) shows an increase in stunting and underweight rates approximately at age 18 months at which many children cease to be breastfed and are exposed to risk on unbalanced complimantary feeding, contamination in water, food, and environment. Figure NU.1: Underweight, stunted, wasted and overweight children under age 5 (moderate and severe), Kyrgyzstan, 2014 UnderweightStunted WastedOverweight 0 2 4 6 8 10 12 14 16 18 20 0 12 24 36 48 60 Pe rc en t Age in months Breastfeeding and Infant and Young Child Feeding Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to 2 years of age. Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers do not start to breastfeed early enough, do not breastfeed exclusively for the recommended 6 months or stop breastfeeding too soon. There are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and can be unsafe if hygienic conditions, including safe drinking water are not readily available. Studies have shown that, in addition to continued breastfeeding, consumption of appropriate, adequate and safe solid, semi-solid and soft foods from the age of 6 months onwards leads to better health and growth outcomes, with potential to reduce stunting during the first two years of life13. 13 Bhuta Z. et al. 2013. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet June 6, 2013. 34 Kyrgyzstan MICS, 2014. Final Report UNICEF and WHO recommend that infants be breastfed within one hour of birth, breastfed exclusively for the first six months of life and continue to be breastfed up to 2 years of age and beyond14. Information on breastfeeding of children under 6 months is provided in Table NU.3. Starting at 6 months, breastfeeding should be combined with safe, age-appropriate feeding of solid, semi-solid and soft foods15. A summary of key guiding principles16,17 for feeding 6-23 month olds is provided in the table below (see Box NU.1) along with proximate measures for these guidelines collected in this survey. The guiding principles for which proximate measures and indicators exist are: (i) continued breastfeeding; (ii) appropriate frequency of meals (but not energy density); and (iii) appropriate nutrient content of food. 1 8 Box NU.1 Guiding Principle (age 6-23 months) Proximate measures Table Continue frequent, on-demand breastfeeding for two years and beyond Breastfed in the last 24 hours NU.4 Appropriate frequency and energy density of meals Breastfed children Depending on age, two or three meals/snacks provided in the last 24 hours Non-breastfed children Four meals/snacks and/or milk feeds provided in the last 24 hours NU.6 Appropriate nutrient content of food Four food groups18 eaten in the last 24 hours NU.6 Appropriate amount of food No standard indicator exists na Appropriate consistency of food No standard indicator exists na Use of vitamin-mineral supplements or fortified products for infant and mother No standard indicator exists na Practice good hygiene and proper food handling While it was not possible to develop indicators to fully capture programme guidance, one standard indicator does cover part of the principle: Not feeding with a bottle with a nipple NU.9 Practice responsive feeding, applying the principles of psycho-social care No standard indicator exists na Feeding frequency is used as proxy for energy intake, requiring children to receive a minimum number of meals/snacks (and milk feeds for non-breastfed children) for their age. Dietary diversity is used to ascertain the adequacy of the nutrient content of the food (not including iron) consumed. For dietary diversity, seven food groups were created for which a child consuming at least four of these is considered to have a better quality diet. In most populations, consumption of at least four food groups means that the child has a high likelihood of consuming at least one animal-source food and at least one fruit or vegetable, in addition to a staple food (grain, root or tuber)19. These three dimensions of child feeding are combined into an assessment of the children who received appropriate feeding, using the indicator of “minimum acceptable diet”. To have a minimum acceptable diet in the previous day, a child must have received: (i) the appropriate number of meals/snacks/milk feeds; (ii) food items form at least 4 food groups; and (iii) breastmilk or at least 2 milk feeds (for non-breastfed children). 14 WHO. 2003. Implementing the Global Strategy for Infant and Young Child Feeding. Meeting Report Geneva, 3-5 February 2003. 15 WHO. 2003. Global Strategy for Infant and Young Child Feeding. 16 PAHO. 2003. Guiding principles for complementary feeding of the breastfed child. 17 WHO. 2005. Guiding principles for feeding non-breastfed children 6-24 months of age. 18 Food groups used for assessment of this indicator are 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. 19 WHO. 2008. Indicators for assessing infant and young child feeding practices. Part 1: Definitions. 35 Kyrgyzstan MICS, 2014. Final Report Table NU.3: Initial breastfeeding Percentage of last live-born children in the last two years who were ever breastfed, breastfed within one hour of birth, and within one day of birth, and percentage who received a prelacteal feed, Kyrgyzstan, 2014 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last live- born children in the last two years Within one hour of birth2 Within one day of birth Region Batken 98.4 83.3 93.1 9.3 148 Djalal-Abad 98.9 80.4 92.1 10.3 351 Issyk-Kul 95.6 82.8 90.2 4.6 97 Naryn 98.4 84.4 95.1 6.2 56 Osh Oblast 97.6 92.3 95.6 5.0 366 Talas 97.7 92.0 93.4 7.6 124 Chui 96.1 67.3 87.9 7.8 260 Bishkek City 96.6 78.8 90.9 20.0 197 Osh City 98.8 87.2 96.7 7.5 76 Area Urban 97.9 82.4 93.6 13.0 539 Rural 97.4 82.5 91.9 7.1 1137 Months since last birth 0-11 months 98.7 83.8 93.1 9.8 915 12-23 months 96.2 80.9 91.6 8.0 760 Assistance at delivery Skilled attendant 98.6 83.4 93.4 9.2 1648 Other (*) (*) (*) (*) 8 No one/Missing (*) (*) (*) (*) 19 Place of delivery Public sector health facility 98.5 83.5 93.5 9.0 1627 Private sector health facility (*) (*) (*) (*) 21 Home (*) (*) (*) (*) 11 Other/Missing (*) (*) (*) (*) 17 Mother’s education None/primary (*) (*) (*) (*) 15 Basic secondary 97.2 85.1 93.8 8.5 200 Complete secondary 97.0 81.9 91.2 8.5 757 Professional primary/middle 99.0 82.4 94.1 6.0 234 Higher 98.0 82.2 93.1 11.8 469 Wealth index quintile Poorest 96.5 83.4 92.3 6.0 336 Second 98.2 86.2 94.1 8.6 372 Middle 98.8 83.7 91.1 10.1 349 Fourth 95.0 79.8 92.9 5.3 312 Richest 99.2 78.3 91.7 15.6 306 Mother tongue of household head Kyrgyz 97.5 82.4 92.3 10.0 1283 Russian (95.2) (70.9) (85.7) (9.6) 63 Uzbek 98.9 87.4 94.9 5.5 256 Other language 96.8 76.2 92.9 3.5 73 1 MICS indicator 2.5 - Children ever breastfed 2 MICS indicator 2.6 - Early initiation of breastfeeding (*) – Figures that are based on fewer than 25 unweighted cases ( ) – Figures that are based on 25-49 unweighted cases 36 Kyrgyzstan MICS, 2014. Final Report Table NU.3 is based on mothers’ reports of what their last-born child, born in the last two years, was fed in the first few days of life. It indicates the proportion who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed20. Although a very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother, only 82.5 percent of babies are breastfed for the first time within one hour of birth; while 92.5 percent of newborns in Kyrgyzstan start breastfeeding within one day of birth. The findings are presented in Figure NU.2 by region and area. The difference between urban and rural children who were first breastfed within one hour of birth was very low. Similar percentages are also observed across the wealth index quintiles: 82.2 percent in the richest quintile vs 83.4 percent in the poorest one. The difference between oblasts was much higher: the highest prevalence was in Osh and Talas oblasts (about 92 percent) while in Chui it was the lowest (67.3 percent). The percentage of mothers who started breastfeeding within one day of birth is 92.5 percent. There is no difference in the percentage of children breastfed within one day by area. The highest percentage of mothers who started breastfeeding within one day of birth was in Osh city (96.7 percent) and the lowest percentage is found in the Chui oblast (87.9 percent). Figure NU.2: Initiation of breastfeeding, Kyrgyzstan, 2014 93 92 90 95 96 93 88 91 97 94 92 93 83 80 83 84 92 92 67 79 87 82 83 83 0 20 40 60 80 100 Within one day Within one hour Ba tke n Dj ala l-A ba d Iss yk -K ul Na ry n Os h O bla st Ta las Ch ui Bis hk ek Ci ty Os h C ity Ur ba n Ru ral Ky rg yz sta n Pe rc en t 20 Prelacteal feed refers to the provision any liquid or food, other than breastmilk, to a newborn during the period when breastmilk flow is generally being established (estimated here as the first 3 days of life). 37 Kyrgyzstan MICS, 2014. Final Report The set of Infant and Young Child Feeding indicators reported in tables NU.4 through NU.8 are based on the mother’s report of consumption of food and fluids during the day or night prior to being interviewed. Data are subject to a number of limitations, some related to the respondent’s ability to provide a full report on the child’s liquid and food intake due to recall errors as well as lack of knowledge in cases where the child was fed by other individuals. In Table NU.4, breastfeeding status is presented for both Exclusively breastfed and Predominantly breastfed; referring to infants age less than 6 months who are breastfed, distinguished by the former only allowing vitamins, mineral supplements, and medicine and the latter allowing also plain water and non-milk liquids. The table also shows continued breastfeeding of children at 12-15 and 20-23 months of age. Table NU.4: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Kyrgyzstan, 2014 Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Total 41.1 69.5 455 60.7 284 22.5 311 Sex Male 40.5 67.2 245 58.7 163 25.3 150 Female 41.8 72.2 210 63.4 121 19.9 161 Region Batken 48.0 75.1 40 (93.6) 23 (28.0) 22 Djalal-Abad 17.7 58.6 84 (59.1) 59 30.8 77 Issyk-Kul (34.6) (81.2) 24 (*) 15 (*) 14 Naryn (*) (*) 9 (*) 10 (20.8) 14 Osh Oblast 47.6 68.9 94 48.5 75 19.9 82 Talas 56.5 69.5 34 55.2 25 4.7 20 Chui (47.5) (77.4) 80 (*) 32 (*) 45 Bishkek City (39.2) (60.3) 66 (*) 31 (*) 24 Osh City (45.6) (85.0) 23 (*) 13 (*) 13 Area Urban 39.5 66.7 152 68.3 89 24.4 79 Rural 41.9 70.9 303 57.2 195 21.8 232 Mother’s education None/primary (*) (*) 5 (*) 4 (*) 4 Basic secondary 31.1 64.9 55 (45.3) 36 (18.8) 38 Complete secondary 40.7 67.9 201 67.3 128 25.7 159 Professional primary/ middle 41.5 79.6 62 (56.7) 39 (23.2) 46 Higher 46.7 71.2 132 62.1 76 17.6 64 38 Kyrgyzstan MICS, 2014. Final Report Children age 0-5 months Children age 12-15 months Children age 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (Continued breastfeeding at 1 year)3 Number of children Percent breastfed (Continued breastfeeding at 2 years)4 Number of children Wealth index quintile Poorest 39.5 66.4 79 63.2 58 17.0 72 Second 39.5 65.5 107 62.0 65 29.0 72 Middle 46.4 69.8 93 53.9 59 24.3 61 Fourth 44.7 72.3 79 60.0 55 22.4 68 Richest 36.0 73.9 97 (65.0) 46 (18.0) 39 Mother tongue of household head Kyrgyz 43.4 70.0 362 65.1 219 20.4 234 Russian (*) (*) 15 (*) 8 (*) 8 Uzbek 31.5 65.3 59 (50.6) 49 (31.1) 52 Other language (*) (*) 17 (*) 8 (*) 18 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.8 - Predominant breastfeeding under 6 months 3 MICS indicator 2.9 - Continued breastfeeding at 1 year 4 MICS indicator 2.10 - Continued breastfeeding at 2 years (*) – Figures that are based on fewer than 25 unweighted cases ( ) – Figures that are based on 25-49 unweighted cases Approximately 41.1 percent of children age less than six months are exclusively breastfed. With 69.5 percent predominantly breastfed, it is evident that water-based liquids are displacing feeding of breastmilk to the greatest degree. By age 12-15 months, 60.7 percent of children are breastfed and by age 20-23 months, 22.5 percent are breastfed. There are no significant urban-rural differences for exclusive breastfeeding (39.5 percent and 41.9 percent, respectively), while by age 12-15 months a higher percentage of urban children are breastfed (68.3 vs 57.2). Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months. Even at the earliest ages, many of children are receiving liquids or foods other than breast milk, with plain water being of highest prevalence, even at the early age of 0-1 months. At age 4-5 months old, the percentage of children exclusively breastfed is 25.4 percent. At age 12-13 months old, only 0.8 percent of children are exclusively breastfed. 12.9 percent of children are receiving breast milk at age 2 years. 39 Kyrgyzstan MICS, 2014. Final Report Figure NU.3: Infant feeding patterns by age, Kyrgyzstan, 2014 Exclusively breastfed Breastfed and complementary foods Weaned (not breastfed) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age in months Weaned (not breastfed) Breastfed and complementary foods Breastfed and other milk / formula Breastfed and non-milk liquids Breastfed and plain water only Exclusively breastfed Table NU.5 shows the median duration of breastfeeding by selected background characteristics. Among children under age 3, the median duration is 15.4 months for any breastfeeding, 1.5 months for exclusive breastfeeding, and 4.5 months for predominant breastfeeding. Rural children are exclusively breastfed nearly 2 times longer than urban children are (1.8 vs 0.7 months). The longest median duration of exclusive breastfeeding was observed in the Naryn oblast (3.5 months), the shortest in the Batken oblast (0.4 month) and Chui oblast (0.7 month). The age-appropriateness of breastfeeding of children under age 24 months is provided in Table NU.6. Different criteria of feeding are used depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding, while children age 6-23 months are considered to be appropriately fed if they are receiving breastmilk and solid, semi-solid or soft food. As a result of feeding patterns, only 54.1 percent of children age 6-23 months are being appropriately breastfed and age-appropriate breastfeeding among all children age 0-23 months drops to 50.9 percent. There is no clear association between feeding patterns and the household wealth or mother’s education level. However, among children age 0-5 months, there looks to be a positive association between exclusive breastfeeding and mother’s education level. 40 Kyrgyzstan MICS, 2014. Final Report Table NU.5: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Kyrgyzstan, 2014 Median duration (in months) of: Number of children age 0-35 monthsAny breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Median 15.4 1.5 4.5 2807 Sex Male 15.5 1.4 4.7 1441 Female 15.3 1.7 4.3 1365 Region Batken 9.1 0.4 3.0 238 Djalal-Abad 16.4 1.3 3.5 594 Issyk-Kul 13.7 1.6 4.1 152 Naryn 16.4 3.5 4.1 103 Osh Oblast 14.4 1.9 4.5 616 Talas 14.3 3.1 4.6 208 Chui 14.4 0.7 5.3 441 Bishkek City 15.7 1.1 3.6 325 Osh City 16.1 1.8 5.7 130 Area Urban 15.6 0.7 4.1 878 Rural 15.2 1.8 4.7 1929 Mother’s education None/primary (*) (*) (*) 29 Basic secondary 14.8 1.7 3.7 328 Complete secondary 15.6 1.6 4.5 1301 Professional primary/middle 14.6 0.5 5.3 419 Higher 15.5 2.2 4.5 729 Wealth index quintile Poorest 15.7 1.8 4.0 567 Second 15.6 1.7 4.6 634 Middle 15.7 2.0 4.6 584 Fourth 15.3 2.2 4.7 512 Richest 14.8 0.6 4.6 509 Mother tongue of household head 2150 Kyrgyz 15.7 1.8 4.6 2150 Russian 13.2 0.6 3.7 112 Uzbek 14.8 1.9 4.0 426 Other language 13.0 2.6 5.3 119 Missing (*) (*) (*) 1 Mean 16.3 2.6 4.4 2807 1 MICS indicator 2.11 - Duration of breastfeeding (*) – Figures that are based on fewer than 25 unweighted cases 41 Kyrgyzstan MICS, 2014. Final Report Table NU.6: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the previous day, Kyrgyzstan, 2014 Children age 0-5 months Children age 6-23 months Children age 0-23 months Percent exclusively breastfed1 N um be r o f ch ild re n Percent currently breastfeeding and receiving solid, semi-solid or soft foods N um be r o f ch ild re n Percent appropriately breastfed2 N um be r o f ch ild re n Total 41.1 455 54.1 1414 50.9 1868 Sex Male 40.5 245 54.5 745 51.1 990 Female 41.8 210 53.6 668 50.8 878 Region Batken 48.0 40 66.6 109 61.6 150 Djalal-Abad 17.7 84 60.3 313 51.3 397 Issyk-Kul (34.6) 24 46.2 80 43.6 104 Naryn (*) 9 52.0 56 53.9 65 Osh Oblast 47.6 94 50.9 334 50.2 428 Talas 56.5 34 44.0 108 47.0 142 Chui (47.5) 80 51.9 203 50.6 283 Bishkek City (39.2) 66 55.6 150 50.6 216 Osh City (45.6) 23 50.4 61 49.1 84 Area Urban 39.5 152 56.7 431 52.2 583 Rural 41.9 303 52.9 983 50.3 1285 Mother’s education None/primary (*) 5 (*) 15 (*) 20 Basic secondary 31.1 55 54.1 162 48.3 217 Complete secondary 40.7 201 56.5 659 52.8 860 Professional primary/middle 41.5 62 48.5 205 46.9 268 Higher 46.7 132 53.7 371 51.9 503 Wealth index quintile Poorest 39.5 79 51.1 295 48.7 374 Second 39.5 107 54.8 321 51.0 428 Middle 46.4 93 56.0 293 53.7 386 Fourth 44.7 79 53.5 276 51.6 355 Richest 36.0 97 55.1 229 49.4 326 Mother tongue of household head Kyrgyz 43.4 362 53.4 1075 50.9 1437 Russian (*) 15 (52.3) 54 (43.3) 69 Uzbek 31.5 59 59.8 220 53.8 279 Other language (*) 17 (46.6) 64 47.6 82 1 MICS indicator 2.7 - Exclusive breastfeeding under 6 months 2 MICS indicator 2.12 - Age-appropriate breastfeeding (*) – Figures that are based on fewer than 25 unweighted cases ( ) – Figures that are based on 25-49 unweighted cases Overall, 85.4 percent of infants age 6-8 months received solid, semi-solid, or soft foods at least once during the previous day (Table NU.7). Among currently breastfeeding infants, this percentage is 83.6. There are no clear differences by sex or area. 42 Kyrgyzstan MICS, 2014. Final Report Table NU.7: Introduction of solid, semi-solid, or soft foods Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day, Kyrgyzstan, 2014 Currently breastfeeding Currently not breastfeeding All Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods Number of children age 6-8 months Percent receiving solid, semi-solid or soft foods1 Number of children age 6-8 months Total 83.6 216 (*) 29 85.4 245 Sex Male 81.5 103 (*) 15 83.9 119 Female 85.5 112 (*) 14 86.7 126 Area Urban 84.8 72 (*) 9 86.4 81 Rural 83.0 144 (*) 21 84.8 164 1 MICS indicator 2.13 - Introduction of solid, semi-solid or soft foods (*) – Figures that are based on fewer than 25 unweighted cases Overall, 80.7 percent of the children age 6-23 months were receiving solid, semi-solid and soft foods the minimum number as shown in Table NU.8. The proportions of males and females achieving the minimum meal frequency is similar (79.6 percent vs. 81.9 percent). The proportion of children receiving the minimum dietary diversity (50.9 percent), or foods from at least 4 food groups (35.5 percent), was much lower than that for minimum meal frequency (80.7 percent), indicating the need to focus on improving dietary quality and nutrient intake among this vulnerable group. A slightly higher proportion of children age 18-23 months (65.8 percent) were achieving the minimum dietary diversity compared to children age 12-17 months (58.6 percent) and to those who are 6-8 months old (22.9 percent). The overall assessment using the indicator of minimum acceptable diet revealed that only 35.5 percent of children age 6-23 months were benefitting from a diet sufficient in both diversity and frequency (Table NU.8). 43 Kyrgyzstan MICS, 2014. Final Report Table NU.8: Infant and young child feeding (IYCF) practices Percentage of children age 6-23 months who received appropriate liquids and solid, semi-solid, or soft foods the minimum number of times or more during the previous day, by breastfeeding status, Kyrgyzstan, 2014 Currently breastfeeding Currently not breastfeeding All Percent of children who received: N um be r o f c hi ld re n ag e 6- 23 m on th s Percent of children who received: N um be r o f c hi ld re n ag e 6- 23 m on th s Percent of children who received: N um be r o f c hi ld re n ag e 6- 23 m on th s M in im um d ie ta ry di ve rs ity a M in im um m ea l fre qu en cy b M in im um a cc ep ta bl e di et 1, c M in im um d ie ta ry di ve rs ity a M in im um m ea l fre qu en cy b M in im um a cc ep ta bl e di et 2, c A t l ea st 2 m ilk fe ed s3 M in im um d ie ta ry di ve rs ity 4, a M in im um m ea l fre qu en cy 5, b M in im um a cc ep ta bl e di et c Total 39.9 74.8 36.7 812 66.6 89.0 33.8 62.8 573 50.9 80.7 35.5 1414 Sex Male 41.5 72.1 37.3 429 66.5 90.2 35.6 64.1 303 51.7 79.6 36.6 745 Female 38.0 77.8 36.1 383 66.6 87.7 31.9 61.5 271 50.1 81.9 34.3 668 Age 6-8 months 21.8 68.8 21.0 216 (*) (*) (*) (*) 28 22.9 71.0 19.9 245 9-11 months 34.9 72.2 30.0 249 (69.9) (95.4) (43.0) (94.6) 38 39.8 75.3 31.7 289 12-17 months 52.0 77.5 47.3 233 68.3 88.9 38.8 68.3 171 58.6 82.3 43.7 413 18-23 months 59.9 86.3 59.9 114 68.0 88.4 32.1 55.8 336 65.8 87.9 39.1 467 Region Batken 39.7 74.6 35.7 76 (79.3) (95.6) (23.0) (41.5) 33 51.6 80.9 31.9 109 Djalal-Abad 40.6 49.3 31.8 193 60.7 61.7 31.3 54.4 113 48.1 53.9 31.6 313 Issyk-Kul (25.0) (75.9) (25.0) 40 (49.6) (91.6) (28.1) (83.5) 38 38.1 83.5 26.5 80 Naryn 46.6 79.8 46.6 32 81.7 100.0 51.5 96.6 24 61.0 88.3 48.7 56 Osh Oblast 32.0 87.3 32.0 181 58.6 94.7 22.0 45.8 149 44.1 90.6 27.5 334 Talas 46.7 89.4 46.7 52 62.1 98.8 40.8 82.2 55 54.5 94.2 43.7 108 Chui 56.7 86.2 53.7 114 (75.5) (95.0) (45.8) (69.8) 81 63.7 89.9 50.4 203 Bishkek City 37.3 86.3 37.3 87 (78.1) (98.5) (49.3) (85.8) 59 53.6 91.2 42.1 150 Osh City 29.7 58.7 24.3 36 (90.6) (93.3) (31.7) (47.9) 23 54.3 72.2 27.2 61 Area Urban 40.7 74.2 35.7 259 74.9 92.2 44.7 74.1 165 54.1 81.2 39.2 431 Rural 39.5 75.1 37.2 553 63.2 87.8 29.4 58.3 409 49.6 80.5 33.9 983 Mother’s education None/primary (*) (*) (*) 5 (*) (*) (*) (*) 8 (*) (*) (*) 15 Basic secondary 25.5 73.2 22.9 91 66.7 86.8 36.9 64.6 71 43.8 79.2 29.1 162 Complete secondary 38.5 74.6 35.0 393 64.8 85.9 29.6 59.6 248 48.8 79.0 32.9 659 Professional primary/ middle 48.8 74.9 45.5 108 70.1 92.5 30.3 54.8 95 58.3 83.1 38.4 205 Higher 43.7 75.2 41.1 214 69.4 92.4 42.0 74.5 150 54.2 82.3 41.5 371 44 Kyrgyzstan MICS, 2014. Final Report Currently breastfeeding Currently not breastfeeding All Percent of children who received: N um be r o f c hi ld re n ag e 6- 23 m on th s Percent of children who received: N um be r o f c hi ld re n ag e 6- 23 m on th s Percent of children who received: N um be r o f c hi ld re n ag e 6- 23 m on th s M in im um d ie ta ry di ve rs ity a M in im um m ea l fre qu en cy b M in im um ac ce pt ab le d ie t1, c M in im um d ie ta ry di ve rs ity a M in im um m ea l fre qu en cy b M in im um ac ce pt ab le d ie t2, c A t l ea st 2 m ilk fe ed s3 M in im um d ie ta ry di ve rs ity 4, a M in im um m ea l fre qu en cy 5, b M in im um ac ce pt ab le d ie tc Wealth index quintile Poorest 31.4 72.2 30.3 158 54.5 74.7 23.3 47.8 129 42.6 73.3 27.1 295 Second 36.3 77.4 34.1 190 68.3 95.0 28.7 58.7 128 49.0 84.5 31.9 321 Middle 37.9 68.8 32.6 175 59.8 90.1 25.4 60.4 113 45.7 77.1 29.8 293 Fourth 50.9 83.7 48.9 157 74.4 95.8 49.6 78.8 106 60.7 88.6 49.2 276 Richest 44.5 71.5 39.2 131 79.5 91.6 47.2 73.5 98 59.4 80.1 42.6 229 Mother tongue of household head Kyrgyz 39.8 75.8 37.3 613 68.9 91.0 34.1 65.9 443 51.9 82.2 35.9 1075 Russian (*) (*) (*) 30 (*) (*) (*) (*) 21 (67.2) (86.9) (52.7) 54 Uzbek 34.1 64.8 27.8 138 57.0 78.1 30.8 48.2 82 42.8 69.8 28.9 220 Other language (*) (*) (*) 31 (*) (*) (*) (*) 27 (49.6) (89.1) (38.2) 64 1 MICS indicator 2.17a - Minimum acceptable diet (breastfed) 2 MICS indicator 2.17b - Minimum acceptable diet (non-breastfed) 3 MICS indicator 2.14 - Milk feeding frequency for non-breastfed children 4 MICS indicator 2.16 - Minimum dietary diversity 5 MICS indicator 2.15 - Minimum meal frequency a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non- breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while for non-breastfed children it further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds. (*) – Figures that are based on fewer than 25 unweighted cases ( ) – Figures that are based on 25-49 unweighted cases The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Table NU.9 shows that bottle-feeding is prevalent in Kyrgyzstan. 29.8 percent of children age 0-23 months are fed using a bottle with a nipple, even for the younger children (under 6 months) the percentage is 18.3. The prevalence of bottle feeding among children age 0-23 months ranges from 20.7 percent in Djalal-Abad region, to 43.5 percent in Bishkek city. 45 Kyrgyzstan MICS, 2014. Final Report Table NU.9: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Kyrgyzstan, 2014 Percentage of children age 0-23 months fed with a bottle with a nipple1 Number of children age 0-23 months Total 29.8 1868 Sex Male 29.1 990 Female 30.6 878 Age 0-5 months 18.3 455 6-11 months 39.5 534 12-23 months 29.8 880 Region Batken 22.5 150 Djalal-Abad 20.7 397 Issyk-Kul 23.2 104 Naryn 31.8 65 Osh Oblast 26.7 428 Talas 39.2 142 Chui 35.6 283 Bishkek City 43.5 216 Osh City 37.1 84 Area Urban 36.4 583 Rural 26.8 1285 Mother’s education None/primary (*) 20 Basic secondary 30.2 217 Complete secondary 22.8 860 Professional primary/middle 36.7 268 Higher 38.4 503 Wealth index quintile Poorest 19.6 374 Second 23.7 428 Middle 32.0 386 Fourth 39.4 355 Richest 36.3 326 Mother tongue of household head Kyrgyz 30.4 1437 Russian (41.2) 69 Uzbek 25.3 279 Other language 23.9 82 1 MICS indicator 2.18 - Bottle feeding (*) – Figures that are based on fewer than 25 unweighted cases ( ) – Figures that are based on 25-49 unweighted cases 46 Kyrgyzstan MICS, 2014. Final Report Salt Iodization Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The indicator is the percentage of households consuming adequately iodized salt (≥15 parts per million). The Government of the Kyrgyz Republic took measures aimed at the prevention of iodine deficiency disorders through the adoption of the Law of the Kyrgyz Republic "On prevention of iodine deficiency disorders” (Governmental Decree N 40, February 18, 2000) and secondary legislation for its implementation. Production of iodized salt has begun in Kyrgyzstan after these legislations. The state Program on reduction of iodine deficiency diseases in the Kyrgyz Republic for 2010-2014 had been developed and implemented to secure progress achieved. Table NU.10: Iodized salt consumption Percent distribution of households by consumption of iodized salt, Kyrgyzstan, 2014 Percentage of households in which salt was tested Number of households No salt Percent of households with: Total Number of households in which salt was tested or with no salt Salt test result Not iodized 0 PPM >0 и <15 PPM 15+ PPM1 Total 98.2 6934 0.4 0.4 6.3 92.8 100.0 6835 Region Batken 99.6 508 0.1 0.7 6.7 92.6 100.0 506 Djalal-Abad 100.0 1235 0.0 0.1 3.1 96.8 100.0 1235 Issyk-Kul 99.7 628 0.3 0.3 4.7 94.8 100.0 628 Naryn 99.1 323 0.5 1.3 16.9 81.3 100.0 322 Osh Oblast 99.7 1028 0.0 0.5 12.2 87.2 100.0 1024 Talas 99.8 270 0.0 1.3 2.5 96.3 100.0 270 Chui 94.3 1393 1.2 0.8 10.0 88.1 100.0 1329 Bishkek City 97.9 1237 0.1 0.0 0.7 99.2 100.0 1212 Osh City 97.4 312 1.5 0.1 1.4 96.9 100.0 309 Area Urban 97.9 2739 0.2 0.1 3.9 95.7 100.0 2688 Rural 98.4 4195 0.4 0.6 7.9 91.0 100.0 4147 Wealth index quintile Poorest 99.7 1198 0.2 0.5 8.8 90.4 100.0 1197 Second 99.1 1193 0.6 0.5 7.0 91.9 100.0 1190 Middle 99.3 1239 0.2 0.5 8.4 90.9 100.0 1232 Fourth 96.9 1401 0.4 0.8 5.2 93.6 100.0 1363 Richest 97.0 1904 0.4 0.1 3.7 95.8 100.0 1853 1 MICS indicator 2.19 - Iodized salt consumption In 98.2 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodate. Table NU.10 shows that in 0.4 percent of households, there was no salt available. These households are included in the denominator of the indicator. In 92.8 percent of households, salt was found to contain 15 parts per million (ppm) or more 47 Kyrgyzstan MICS, 2014. Final Report of iodine. Use of iodized salt was lowest in the Naryn oblast (81.3 percent) and highest in Bishkek city (99.2 percent). 95.7 percent of urban households were found to be using adequately iodized salt as compared to 91 percent in rural areas. Interestingly, the difference between the richest (95.8 percent) and poorest households (90.4 percent) in terms of iodized salt consumption is much less than expected. The consumption of adequately iodized salt is graphically presented in Figure NU.4 together with the percentage of salt containing less than 15 ppm. Figure NU.4: Consumption of iodized salt, Kyrgyzstan, 2014 99 100 99 98 99 99 98 100 98 100 99 99 99 99 99 100 99 93 97 95 81 87 96 88 99 97 96 91 90 92 91 94 96 93 0 20 40 60 80 100 Pe rc en t Any iodine 15+ PPM of iodine VI. Child Health 49 Kyrgyzstan MICS, 2014. Final Report Vaccinations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. In addition, the Global Vaccine Action Plan (GVAP) was endorsed by the 194 Member States of the World Health Assembly in May 2012 to achieve the Decade of Vaccines vision by delivering universal access to immunization. Immunization has saved the lives of millions of children in the four decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still millions of children not reached by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. The WHO Recommended Routine Immunizations for Children21 recommends all children to be vaccinated against tuberculosis, diphtheria, pertussis, tetanus, polio, measles, hepatitis B, haemophilus influenzae type b, rotavirus, and rubella. All doses in the primary series are recommended to be completed before the child’s first birthday, although depending on the epidemiology of disease in a country, the first doses of measles and rubella containing vaccines may be recommended at 12 months or later. The recommended number and timing of most other doses also vary slightly with local epidemiology and may include booster doses later in childhood. The Ministry of Health of the Kyrgyz Republic accepted the above recommendations. Since 2001, the vaccination schedule followed by the National Immunization Programme provides all the above mentioned vaccinationsSince 2009, pentavalent vaccine (Penta) had been introduced to replace DPT and Hepatitis B vaccines (but first dose at birth). Besides DPT and Hepatitis B vaccines, Penta vaccine also contains three doses of Haemophilus influenzae type b (Hib) vaccine. Since 2002, measles vaccination protecting from measles, parotitis and rubella is carried out at 12 months. Taking into consideration this vaccination schedule, the estimates for full immunization from the 2014 Kyrgyzstan MICS are based on children age 24-35 months. Information on vaccination coverage was collected for all children under three years of age. All mothers (or caretakers) were asked to provide vaccination cards. However, the vaccination form (MoH Form #063) and child’s medical card (MoH Form#112) are normally kept in health clinics and very seldom at home. So vaccination information was copied from the cards onto the MICS questionnaire at health facilities and, less often, mothers recalled whether or not the child had received each of the vaccinations. The final vaccination coverage estimates are based on information obtained from both the vaccination card and the mother’s report of vaccinations received by the child. The percentage of children age 12-23 months and 24-35 months who have received each of the specific vaccinations by source of information (vaccination records at health facilities and mother’s recall) is shown in Table CH.1 and Figure CH.1. The denominators for the table are comprised of children age 12-23 months and 24-35 months so that only children who are old enough to be fully vaccinated are counted. In the first three columns in each panel of the table, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination records at health facilities or the mother’s report. In the last column in each panel, only those children who were vaccinated before their first birthday, as recommended, are included. For children without vaccination records, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination records. 21 http://www.who.int/immunization/diseases/en. Table 2 includes recommendations for all children and additional antigens recommended only for children residing in certain regions of the world or living in certain high-risk population groups. 50 Kyrgyzstan MICS, 2014. Final Report Table CH.1: Vaccinations in the first years of life Percentage of children age 12-23 months and 24-35 months vaccinated against vaccine preventable childhood diseases at any time before the survey and by their first birthday, Kyrgyzstan, 2014 Children age 12-23 months: Children age 24-35 months: Vaccinated at any time before the survey according to: Vaccinated by 12 months of agea Vaccinated at any time before the survey according to: Vaccinated by 12 months of age (measles by 24 months)a Health facility records or vaccination card Mother's report Either Health facility records or vaccination card Mother's report Either Antigen BCG1 89.7 9.9 99.6 99.6 87.1 11.6 98.7 98.7 Polio At birth 86.8 11.6 98.4 98.4 86.4 11.7 98.1 98.1 1 89.2 8.5 97.8 97.7 88.4 9.6 98.0 97.1 2 89.4 7.3 96.7 96.2 87.6 8.9 96.5 94.8 32 85.1 4.7 89.8 87.5 84.5 5.6 90.1 85.4 HepB At birth 87.0 11.9 98.9 98.9 78.7 19.4 98.1 98.1 Pentavalent (DPT+HebB+Hib) 1 89.9 8.1 98.0 97.9 88.9 8.7 97.6 96.8 2 89.8 7.5 97.4 97.2 88.2 9.1 97.3 95.6 33 88.2 7.2 95.5 93.9 87.0 8.3 95.3 91.0 Measles (MMR)4c 81.6 10.4 92.0 na 87.1 9.6 96.7 95.8 Fully vaccinated5, b na na na na 84.9 3.1 88.0 80.4 No vaccinations 0.0 0.4 0.4 0.4 0.0 1.2 1.2 1.2 Number of children 880 880 880 880 939 939 939 939 1 MICS indicator 3.1 - Tuberculosis immunization coverage 2 MICS indicator 3.2 - Polio immunization coverage 3 MICS indicators 3.3, 3.5,3.6 - Pentavalent DPT+HepB+Hib vaccine coverage 4 MICS indicator 3.4; MDG indicator 4.3 - Measles immunization coverage 5 MICS indicator 3.8 - Full immunization coverage na: not applicable a MICS indicators 3.1, 3.2, 3.3, 3.5, 3.6 refer to results of this column in the left panel; MICS indicators 3.4 and 3.8 refer to this column in the right panel b Includes: HepB at birth, BCG, Polio3 and Pentavalent3 (DPT+HepB+Hib-3) by 12 months of age and Measles (MMR) by 24 months of age as per the vaccination schedule in Kyrgyzstan c Measles is administered through the combined measles, mumps and rubella (MMR) vaccine in Kyrgyzstan Approximately 99.6 percent of children age 12-23 months received a BCG vaccination by the age of 12 months, and the first dose of Polio, Pentavalent DPT-HepB-Hib vaccine and HepB at birth vaccines was given to 98.4, 97.9 and 98.9 percent respectively. The percentages decline slightly to 96.2 and 97.2 percent respectively for the second dose of Polio and Pentavalent DPT-HepB-Hib vaccines, and to 87.5 and 93.9 percent respectively for the third dose. The individual coverage figures for children age 24-35 months are generally similar to those age 12-23 months suggesting that immunization coverage has been on average stable in the country in the last few years. It also shows that immunization is provided ‘timely’ which means in accordance with the timeline of the vaccination schedule without delays. Similarly to the younger age cohort, the percentage of children age 24-35 months receiving vaccines declines slightly by the third dose. The coverage for the measles vaccine by by their second birthday among children age 24-35 months is 51 Kyrgyzstan MICS, 2014. Final Report 95.8 percent. As a result, the percentage of children who had all the recommended vaccinations by their second birthday is 80.4 percent. Figure CH.1: Vaccinations by age 12 months (measles by 24 months), Kyrgyzstan, 2014 100 98 98 96 88 99 98 97 94 0 0 20 40 60 80 100 BCG Polio at birth Polio1 Polio2 Polio3 HepB at birth Pentavalent DPT1+HepB1+Hib1 Pentavalent DPT2+HepB2+Hib2 Pentavalent DPT3+HepB3+Hib3 No vaccinations BCG Polio at birth Polio1 Polio2 Polio3 HepB at birth Pentavalent DPT1+HepB1+Hib1 Pentavalent DPT2+HepB2+Hib2 Pentavalent DPT3+HepB3+Hib3 Measles Fully vaccinated No vaccinations Percent Percent Children Age 12-23 months 99 98 97 95 85 98 97 96 91 96 80 1 0 50 100 Children Age 24-35 months Table CH.2 presents vaccination coverage estimates among children age 12-23 and 24-35 months by background characteristics. The figures indicate children receiving the vaccinations at any time up to the date of the survey, and are based on information from both the health facility records and mothers’(or caretakers’) reports. In Kyrgyzstan, by the date of interview, approximately 88 percent of children age 24-35 months received all the recommended vaccinations. This percentage is lower in urban areas (81.6 percent), in Bishkek city in particular (71.5 percent), than in rural areas (90.9 percent). 52 Kyrgyzstan MICS, 2014. Final Report Ta bl e C H .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s P er ce nt ag e of c hi ld re n ag e 12 -2 3 an d 24 -3 5 m on th s cu rr en tly v ac ci na te d ag ai ns t v ac ci ne p re ve nt ab le c hi ld ho od d is ea se s, K yr gy zs ta n, 2 01 4 Pe rc en ta ge o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed : P er ce nt ag e w ith h ea lth fa ci lit y re co rd s or va cc in at io n ca rd s ee n N um be r of ch ild re n ag e 12 -2 3 m on th s Pe rc en ta ge o f c hi ld re n ag e 24 -3 5 m on th s w ho re ce iv ed : P er ce nt ag e w ith h ea lth fa ci lit y re co rd s or va cc in at io n ca rd s ee n N um be r of c hi ld re n ag e 24 -3 5 m on th s B C G Po lio H ep B Pe nt av al en t (D PT +H eb B +H ib ) N on e A t b irt h 1 2 3 A t b irt h 1 2 3 M ea sl es (M M R ) Fu lla N on e To ta l 99 .6 98 .4 97 .8 96 .7 89 .8 98 .9 98 .0 97 .4 95 .5 0. 4 91 .4 88 0 96 .7 88 .0 1. 2 90 .1 93 9 Se x M al e 99 .9 98 .6 97 .7 97 .0 87 .9 99 .1 98 .0 97 .4 96 .1 0. 1 90 .7 48 1 97 .6 91 .1 0. 8 91 .0 45 1 Fe m al e 99 .2 98 .2 97 .8 96 .3 92 .0 98 .6 97 .9 97 .4 94 .7 0. 8 92 .1 39 9 95 .9 85 .0 1. 5 89 .2 48 7 R eg io n B at ke n 10 0. 0 10 0. 0 99 .0 99 .0 90 .2 98 .9 10 0. 0 99 .0 97 .7 0. 0 96 .4 66 98 .3 85 .0 0. 0 92 .4 88 D ja la l-A ba d 99 .4 99 .4 98 .0 97 .1 92 .0 99 .4 98 .5 98 .5 96 .1 0. 6 96 .2 19 4 97 .4 88 .0 0. 9 93 .6 19 7 Is sy k- K ul 10 0. 0 10 0. 0 10 0. 0 10 0. 0 94 .5 10 0. 0 10 0. 0 10 0. 0 10 0. 0 0. 0 98 .5 49 97 .8 93 .7 2. 2 93 .7 47 N ar yn 10 0. 0 99 .0 98 .6 94 .7 84 .6 10 0. 0 98 .6 96 .9 95 .9 0. 0 91 .3 34 97 .6 89 .9 0. 0 93 .1 38 O sh O bl as t 99 .1 98 .7 98 .2 97 .1 88 .5 98 .3 98 .8 98 .2 96 .8 0. 9 85 .0 21 9 98 .9 95 .5 0. 2 85 .5 18 8 Ta la s 99 .5 99 .0 97 .9 97 .9 96 .8 99 .0 97 .9 97 .9 97 .5 0. 5 98 .6 71 94 .4 92 .2 5. 0 90 .4 66 C hu i 10 0. 0 94 .7 97 .2 95 .4 92 .3 98 .3 97 .2 95 .6 91 .3 0. 0 91 .5 12 1 95 .6 88 .2 3. 0 91 .0 15 8 B is hk ek C ity 10 0. 0 97 .4 93 .4 92 .4 78 .9 98 .3 92 .4 91 .4 90 .1 0. 0 82 .4 90 91 .7 71 .5 0. 0 83 .5 10 9 O sh C ity 10 0. 0 10 0. 0 10 0. 0 98 .5 88 .0 10 0. 0 10 0. 0 99 .5 96 .3 0. 0 93 .0 37 99 .0 87 .8 0. 0 95 .3 46 A re a U rb an 99 .9 97 .0 94 .5 93 .8 85 .0 98 .4 95 .3 94 .8 92 .2 0. 1 89 .3 25 4 95 .6 81 .6 0. 9 88 .9 29 5 R ur al 99 .5 99 .0 99 .1 97 .9 91 .7 99 .0 99 .1 98 .4 96 .8 0. 5 92 .2 62 6 97 .2 90 .9 1. 3 90 .6 64 3 M ot he r’s e du ca tio n N on e/ pr im ar y (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 13 (* ) (* ) (* ) (* ) 9 B as ic s ec on da ry 10 0. 0 97 .5 97 .5 94 .1 89 .1 97 .8 97 .5 97 .0 95 .2 0. 0 87 .6 98 97 .2 92 .4 0. 0 91 .0 11 1 C om pl et e se co nd ar y 99 .9 99 .3 98 .9 97 .6 89 .5 99 .5 98 .8 98 .2 95 .9 0. 1 91 .5 41 8 97 .8 88 .0 1. 2 90 .4 44 1 P ro fe ss io na l pr im ar y/ m id dl e 10 0. 0 97 .7 98 .8 98 .5 90 .1 98 .8 97 .6 97 .5 94 .6 0. 0 91 .9 13 0 97 .3 88 .5 0. 7 90 .7 15 1 H ig he r 99 .5 98 .4 95 .9 95 .9 90 .8 99 .0 97 .6 96 .8 95 .9 0. 5 92 .8 22 0 93 .8 85 .0 2. 1 88 .0 22 6 53 Kyrgyzstan MICS, 2014. Final Report Pe rc en ta ge o f c hi ld re n ag e 12 -2 3 m on th s w ho re ce iv ed : P er ce nt ag e w ith h ea lth fa ci lit y re co rd s or va cc in at io n ca rd s ee n N um be r of ch ild re n ag e 12 -2 3 m on th s Pe rc en ta ge o f c hi ld re n ag e 24 -3 5 m on th s w ho re ce iv ed : P er ce nt ag e w ith h ea lth fa ci lit y re co rd s or va cc in at io n ca rd s ee n N um be r of c hi ld re n ag e 24 -3 5 m on th s B C G Po lio H ep B Pe nt av al en t (D PT +H eb B +H ib ) N on e A t b irt h 1 2 3 A t b irt h 1 2 3 M ea sl es (M M R ) Fu lla N on e W ea lth in de x qu in til e P oo re st 98 .5 98 .3 97 .9 96 .7 88 .8 97 .3 98 .2 97 .6 96 .5 1. 5 87 .8 21 0 94 .5 81 .0 0. 1 87 .4 19 3 S ec on d 10 0. 0 10 0. 0 99 .6 98 .3 92 .6 10 0. 0 99 .1 97 .7 95 .8 0. 0 95 .1 19 5 96 .6 85 .4 2. 1 91 .4 20 6 M id dl e 10 0. 0 97 .0 97 .7 95 .7 89 .6 99 .8 98 .4 97 .7 94 .6 0. 0 91 .3 18 1 95 .4 87 .1 3. 3 89 .7 19 8 Fo ur th 10 0. 0 99 .5 99 .5 99 .2 93 .7 10 0. 0 99 .5 99 .5 98 .4 0. 0 93 .2 16 1 97 .7 94 .8 0. 3 95 .9 15 8 R ic he st 99 .7 96 .9 92 .7 92 .7 82 .6 97 .0 93 .6 93 .5 90 .9 0. 3 89 .4 13 4 99 .4 92 .2 0. 0 86 .0 18 4 M ot he r t on gu e of h ou se ho ld h ea d K yr gy z 99 .8 98 .7 98 .2 97 .5 90 .2 99 .1 98 .6 97 .8 96 .3 0. 2 91 .5 68 1 97 .1 87 .2 1. 3 89 .5 71 2 R us si an (* ) (* ) (* ) (* ) (* ) 94 .9 (* ) (* ) (* ) (* ) (* ) 30 (* ) (* ) (* ) (* ) 43 U zb ek 10 0. 0 99 .3 97 .5 95 .8 89 .8 10 0. 0 98 .2 98 .1 94 .7 0. 0 92 .9 13 3 96 .1 88 .6 1. 4 92 .7 14 6 O th er la ng ua ge (9 3. 5) (9 2. 5) (9 2. 5) (8 5. 7) (8 0. 6) (9 3. 5) (9 2. 5) (9 2. 5) (8 5. 7) (6 .5 ) (8 0. 6) 37 (* ) (* ) (* ) (* ) 37 a I nc lu de s: B C G , P ol io 3, P en ta va le nt 3 (D P T+ H ep B +H ib -3 ) a nd M ea sl es (M M R ) a s pe r t he v ac ci na tio n sc he du le in K yr gy zs ta n (* ) – F ig ur es th at a re b as ed o n fe w er th an 2 5 un w ei gh te d ca se s ( ) – F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 54 Kyrgyzstan MICS, 2014. Final Report Care of Illness A key strategy for accelerating progress toward MDG 4 is to tackle the diseases that are the leading killers of children under 5. Diarrhoea and pneumonia are two such diseases. The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) aims to end preventable pneumonia and diarrhoea death by reducing mortality from pneumonia to 3 deaths per 1000 live births and mortality from diarrhoea to 1 death per 1000 live births by 2025. Table CH.3 presents the percentage of children under 5 years of age who were reported to have had an episode of diarrhoea, symptoms of acute respiratory infection (ARI), or fever during the 2 weeks preceding the survey. These findings are not measures of true prevalence, and should not be used as such, but rather the period-prevalence of those illnesses over a two-week time window. The definition of a case of diarrhoea or fever, in this survey, was the mother’s (or caretaker’s) report that the child had such symptoms over the specified period; no other evidence were sought beside the opinion of the mother. A child was considered to have had an episode of ARI if the mother (or caretaker) reported that the child had, over the specified period, an illness with a cough with rapid or difficult breathing, and whose symptoms were perceived to be due to a problem in the chest or both a problem in the chest and a blocked nose. While this approach is reasonable in the context of a MICS survey, these basically simple case definitions must be kept in mind when interpreting the findings, as well as the potential for reporting and recall biases. Further, diarrhoea, fever and ARI are not only seasonal but are also characterized by the often rapid spread of localized outbreaks from one area to another at different points in time. The timing of the survey and the location of the teams might thus considerably affect the findings, which must consequently be interpreted with caution. For these reasons, although the period-prevalence over a two-week time window is reported, these data should not be used to assess the epidemiological characteristics of these diseases but rather to obtain denominators for the indicators related to use of health services and treatment. Table CH.3: Reported disease episodes Percentage of children age 0-59 months for whom the mother (or caretaker) reported an episode of diarrhoea, symptoms of acute respiratory infection (ARI), and/or fever in the last two weeks, Kyrgyzstan, 2014 Percentage of children who in the last two weeks had: Number of children age 0-59 months An episode of diarrhoea Symptoms of ARI An episode of fever Total 5.5 2.3 14.3 4577 Sex Male 6.0 2.1 13.6 2342 Female 5.1 2.5 15.0 2235 Region Batken 6.0 1.1 12.6 408 Djalal-Abad 2.5 1.2 12.9 956 Issyk-Kul 2.6 0.0 11.5 264 Naryn 2.4 0.9 11.7 195 Osh Oblast 10.1 6.2 17.5 1015 Talas 4.0 3.1 12.9 352 Chui 6.8 0.7 16.6 715 Bishkek City 3.5 0.9 11.3 474 Osh City 5.4 1.1 16.4 198 55 Kyrgyzstan MICS, 2014. Final Report Percentage of children who in the last two weeks had: Number of children age 0-59 months An episode of diarrhoea Symptoms of ARI An episode of fever Area Urban 5.3 1.2 13.8 1360 Rural 5.6 2.7 14.5 3217 Age 0-11 months 7.7 2.3 14.5 988 12-23 months 7.8 2.3 19.1 880 24-35 months 5.1 2.1 14.8 939 36-47 months 2.6 3.4 13.5 925 48-59 months 4.3 1.1 9.5 845 Mother’s education None/primary (3.6) (0.0) (4.0) 58 Basic secondary 5.8 3.4 15.3 529 Complete secondary 5.2 1.8 13.3 2102 Professional primary/middle 5.2 1.8 17.2 732 Higher 6.2 2.9 14.5 1155 Wealth index quintile Poorest 4.7 1.0 11.7 986 Second 7.5 4.4 15.4 1039 Middle 5.0 3.5 17.7 951 Fourth 4.8 1.0 13.6 823 Richest 5.3 0.8 12.9 778 Mother tongue of household head Kyrgyz 5.7 2.5 14.7 3534 Russian 6.8 0.0 12.1 180 Uzbek 5.4 1.7 14.0 656 Other language 1.8 1.8 10.4 205 Missing (*) (*) (*) 2 ( ) – Figures that are based on 25-49 unweighted cases (*) – Figures that are based on fewer than 25 unweighted cases Overall, 5.5 percent of under five children were reported to have had diarrhoea in the two weeks preceding the survey, and 2.3 percent symptoms of ARI, 14.3 percent had fever symptoms (Table CH.3). Period-prevalence for diarrhoea ranges from 3-4 percent for children age 36-59 months to almost 8 percent for children age 0-11 and 12-23 months. This can be linked to the weaning period. There are minor differences between urban and rural areas, particularly in the case of diarrhoea, but the period-prevalence of diarrhoea, fever and ARI appear to be highest in the Osh oblast (10.1, 17.5 and 6.2 percent respectively). Diarrhoea Diarrhoea is among the leading causes 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 – can prevent many of these deaths. In addition, provision of zinc supplements has been shown to reduce the duration and severity of the illness as well as the risk of future episodes within the next two or three months. Preventing dehydration and malnutrition 56 Kyrgyzstan MICS, 2014. Final Report by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. In the MICS, mothers (or caretakers) were asked whether their child under age five years had an episode of diarrhoea in the two weeks prior to the survey. In cases where mothers reported that the child had diarrhoea, a series of questions were asked about the treatment of the illness, including what the child had been given to drink and eat during the episode and whether this was more or less than what was usually given to the child. Table CH.4 shows the percentage of children with diarrhoea in the two weeks preceding the survey for whom advice or treatment was sought and where. Overall, a health facility or provider was seen in 51.9 percent of cases, predominantly in the public sector (50.9 percent). The percentage of advice or treatment sought from a health facility or provider was higher among children living in rural areas (56.3 percent) compared to those in urban areas (41.0 percent). Table CH.5 provides statistics on drinking and feeding practices during diarrhoea. Less than one third (31.4 percent) of under five children with diarrhoea were given to drink more than usual while practically the same percentage (31.8 percent) were given about the same. About 22.4 percent were given somewhat less, while 14.5 percent were given much less to drink. 68.6 percent were given to eat somewhat less, same or more (continued feeding), but one in five (20.0 percent) were given much less and 11.4 percent of children were given nothing to eat during the episode of diarrhoea. 57 Kyrgyzstan MICS, 2014. Final Report Ta bl e C H .4 : C ar e- se ek in g du rin g di ar rh oe a P er ce nt ag e of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks fo r w ho m a dv ic e or tr ea tm en t w as s ou gh t, by s ou rc e of a dv ic e or tr ea tm en t, K yr gy zs ta n, 2 01 4 Pe rc en ta ge o f c hi ld re n w ith d ia rr ho ea fo r w ho m : N um be r o f c hi ld re n ag e 0- 59 m on th s w ith di ar rh oe a in th e la st tw o w ee ks A dv ic e or tr ea tm en t w as s ou gh t f ro m : N o ad vi ce o r tre at m en t s ou gh t H ea lth fa ci lit ie s or p ro vi de rs O th er s ou rc e A he al th fa ci lit y or pr ov id er 1, b P ub lic P riv at e C om m un ity h ea lth pr ov id er a To ta l 50 .9 4. 0 0. 0 1. 2 51 .9 45 .6 25 3 Se x M al e 50 .8 3. 9 0. 0 2. 2 51 .1 45 .6 14 0 Fe m al e 50 .9 4. 1 0. 0 0. 0 52 .9 45 .6 11 4 R eg io n B at ke n (3 2. 7) (3 .2 ) (0 .0 ) (0 .0 ) (3 5. 8) (6 4. 2) 24 D ja la l-A ba d (* ) (* ) (* ) (* ) (* ) (* ) 24 Is sy k- K ul (* ) (* ) (* ) (* ) (* ) (* ) 7 N ar yn (* ) (* ) (* ) (* ) (* ) (* ) 5 O sh O bl as t 47 .8 2. 2 0. 0 1. 3 49 .3 49 .3 10 3 Ta la s (4 2. 8) (2 .8 ) (0 .0 ) (0 .0 ) (4 5. 6) (5 4. 4) 14 C hu i (6 9. 1) (0 .0 ) (0 .0 ) (0 .0 ) (6 9. 1) (3 0. 9) 49 B is hk ek C ity (* ) (* ) (* ) (* ) (* ) (* ) 16 O sh C ity (* ) (* ) (* ) (* ) (* ) (* ) 11 A re a U rb an 39 .4 9. 3 0. 0 2. 3 41 .0 52 .3 72 R ur al 55 .4 1. 8 0. 0 0. 8 56 .3 43 .0 18 1 A ge 0- 11 m on th s 63 .1 5. 4 0. 0 2. 1 64 .1 33 .8 76 12 -2 3 m on th s 45 .3 4. 7 0. 0 2. 0 45 .3 48 .0 68 24 -3 5 m on th s (3 6. 4) (4 .8 ) (0 .0 ) (0 .0 ) (3 9. 7) (6 0. 3) 48 36 -4 7 m on th s (* ) (* ) (* ) (* ) (* ) (* ) 24 48 -5 9 m on th s (5 5. 4) (1 .1 ) (0 .0 ) (0 .0 ) (5 6. 5) (4 3. 5) 37 58 Kyrgyzstan MICS, 2014. Final Report Pe rc en ta ge o f c hi ld re n w ith d ia rr ho ea fo r w ho m : N um be r o f c hi ld re n ag e 0- 59 m on th s w ith di ar rh oe a in th e la st tw o w ee ks A dv ic e or tr ea tm en t w as s ou gh t f ro m : N o ad vi ce o r tre at m en t s ou gh t H ea lth fa ci lit ie s or p ro vi de rs O th er s ou rc e A he al th fa ci lit y or pr ov id er 1, b P ub lic P riv at e C om m un ity h ea lth pr ov id er a M ot he r’s e du ca tio n N on e/ pr im ar y (* ) (* ) (* ) (* ) (* ) (* ) 2 B as ic s ec on da ry (5 3. 9) (0 .0 ) (0 .0 ) (0 .0 ) (5 3. 9) (4 6. 1) 31 C om pl et e se co nd ar y 49 .6 1. 6 0. 0 2. 7 49 .6 49 .2 11 0 P ro fe ss io na l p rim ar y/ m id dl e (5 9. 1) (6 .0 ) (0 .0 ) (0 .0 ) (6 3. 1) (3 6. 9) 38 H ig he r 48 .6 8. 4 0. 0 0. 0 50 .3 43 .0 72 W ea lth in de x qu in til e P oo re st (4 3. 4) (3 .3 ) (0 .0 ) (0 .0 ) (4 6. 8) (5 3. 2) 47 S ec on d 57 .1 0. 0 0. 0 1. 8 57 .1 41 .2 78 M id dl e (5 6. 9) (6 .8 ) (0 .0 ) (0 .0 ) (5 8. 5) (4 1. 5) 48 Fo ur th (4 7. 1) (1 .0 ) (0 .0 ) (0 .0 ) (4 8. 1) (5 1. 9) 40 R ic he st (4 4. 1) (1 1. 8) (0 .0 ) (4 .0 ) (4 4. 1) (4 4. 1) 41 M ot he r t on gu e of h ou se ho ld h ea d K yr gy z 51 .3 3. 8 0. 0 1. 5 52 .6 44 .3 20 1 R us si an (* ) (* ) (* ) (* ) (* ) (* ) 12 U zb ek (4 9. 1) (6 .9 ) 0. 0 (0 .0 ) (4 9. 1) (5 0. 9) 36 O th er la ng ua ge (* ) (* ) (* ) (* ) (* ) (* ) 4 1 M IC S in di ca to r 3 .1 0 - C ar e- se ek in g fo r d ia rr ho ea a C om m un ity h ea lth p ro vi de r i nc lu de s bo th p ub lic (M ob ile /O ut re ac h cl in ic ) a nd p riv at e (M ob ile c lin ic ) h ea lth fa ci lit ie s b I nc lu de s al l p ub lic a nd p riv at e he al th fa ci lit ie s an d pr ov id er s, b ut e xc lu de s pr iv at e ph ar m ac y (* ) – F ig ur es th at a re b as ed o n fe w er th an 2 5 un w ei gh te d ca se s ( ) – F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 59 Kyrgyzstan MICS, 2014. Final Report Ta bl e C H .5 : F ee di ng p ra ct ic es d ur in g di ar rh oe a P er ce nt d is tri bu tio n of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks b y am ou nt o f l iq ui ds a nd fo od g iv en d ur in g ep is od e of d ia rr ho ea , K yr gy zs ta n, 2 01 4 D rin ki ng p ra ct ic es d ur in g di ar rh oe a Ea tin g pr ac tic es d ur in g di ar rh oe a N um be r o f ch ild re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks C hi ld w as g iv en to d rin k: To ta l C hi ld w as g iv en to e at : To ta l M uc h le ss S om ew ha t le ss A bo ut th e sa m e M or e M uc h le ss S om ew ha t le ss A bo ut th e sa m e M or e N ot hi ng To ta l 14 .5 22 .4 31 .8 31 .4 10 0. 0 20 .0 28 .1 32 .0 8. 5 11 .4 10 0. 0 25 3 Se x M al e 17 .6 22 .3 33 .3 26 .8 10 0. 0 24 .4 24 .2 31 .5 9. 7 10 .1 10 0. 0 14 0 Fe m al e 10 .6 22 .4 29 .9 37 .0 10 0. 0 14 .7 32 .9 32 .6 6. 9 12 .9 10 0. 0 11 4 R eg io n B at ke n (6 .2 ) (9 .8 ) (4 8. 7) (3 5. 3) 10 0. 0 (1 7. 8) (3 5. 5) (4 6. 7) (0 .0 ) (0 .0 ) 10 0. 0 24 D ja la l-A ba d (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 24 Is sy k- K ul (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 7 N ar yn (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 5 O sh O bl as t 23 .0 36 .8 32 .3 7. 9 10 0. 0 30 .5 24 .8 29 .6 6. 7 8. 3 10 0. 0 10 3 Ta la s (2 3. 9) (1 8. 7) (9 .6 ) (4 7. 8) 10 0. 0 (2 5. 1) (3 7. 9) (1 1. 9) (2 5. 1) (0 .0 ) 10 0. 0 14 C hu i (7 .7 ) (2 1. 8) (2 6. 7) (4 3. 8) 10 0. 0 (3 .7 ) (2 9. 1) (2 7. 7) (7 .3 ) (3 2. 2) 10 0. 0 49 B is hk ek C ity (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 16 O sh C ity (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 11 A re a U rb an 12 .7 13 .7 24 .7 48 .9 10 0. 0 11 .0 29 .3 38 .6 11 .6 9. 5 10 0. 0 72 R ur al 15 .2 25 .8 34 .6 24 .4 10 0. 0 23 .7 27 .6 29 .3 7. 2 12 .1 10 0. 0 18 1 A ge 0- 11 m on th s 16 .8 25 .7 37 .1 20 .4 10 0. 0 17 .0 21 .0 27 .4 10 .7 23 .9 10 0. 0 76 12 -2 3 m on th s 10 .1 18 .8 29 .6 41 .5 10 0. 0 19 .2 34 .6 36 .8 1. 1 8. 3 10 0. 0 68 24 -3 5 m on th s (1 7. 0) (2 1. 4) (3 0. 2) (3 1. 5) 10 0. 0 (2 0. 0) (2 3. 5) (3 9. 6) (9 .8 ) (7 .1 ) 10 0. 0 48 36 -4 7 m on th s (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 24 48 -5 9 m on th s (1 0. 7) (1 8. 2) (3 0. 3) (4 0. 7) 10 0. 0 (2 1. 1) (3 9. 2) (2 6. 4) (9 .4 ) (3 .9 ) 10 0. 0 37 60 Kyrgyzstan MICS, 2014. Final Report D rin ki ng p ra ct ic es d ur in g di ar rh oe a Ea tin g pr ac tic es d ur in g di ar rh oe a N um be r o f ch ild re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks C hi ld w as g iv en to d rin k: To ta l C hi ld w as g iv en to e at : To ta l M uc h le ss S om ew ha t le ss A bo ut th e sa m e M or e M uc h le ss S om ew ha t le ss A bo ut th e sa m e M or e N ot hi ng M ot he r’s e du ca tio n N on e/ pr im ar y (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 2 B as ic s ec on da ry (1 8. 7) (3 7. 7) (2 3. 7) (2 0. 0) 10 0. 0 (3 7. 0) (1 1. 4) (1 8. 6) (1 1. 8) (2 1. 2) 10 0. 0 31 C om pl et e se co nd ar y 16 .1 20 .3 37 .9 25 .7 10 0. 0 21 .9 25 .7 38 .0 4. 3 10 .0 10 0. 0 11 0 P ro fe ss io na l p rim ar y/ m id dl e (1 5. 8) (2 5. 1) (2 0. 9) (3 8. 1) 10 0. 0 (2 1. 4) (4 5. 8) (1 2. 2) (1 4. 9) (5 .8 ) 10 0. 0 38 H ig he r 7. 0 18 .1 32 .6 42 .3 10 0. 0 6. 8 30 .4 39 .9 10 .2 12 .6 10 0. 0 72 W ea lth in de x qu in til e P oo re st (8 .4 ) (2 5. 0) (4 0. 4) (2 6. 3) 10 0. 0 (1 9. 9) (3 6. 2) (3 8. 3) (4 .9 ) (0 .7 ) 10 0. 0 47 S ec on d 18 .0 37 .4 21 .8 22 .9 10 0. 0 31 .4 22 .7 23 .8 5. 7 16 .5 10 0. 0 78 M id dl e (2 2. 0) (1 8. 4) (3 8. 4) (2 1. 2) 10 0. 0 (2 8. 0) (2 4. 4) (3 2. 8) (6 .0 ) (8 .8 ) 10 0. 0 48 Fo ur th (1 3. 7) (7 .0 ) (3 9. 2) (4 0. 1) 10 0. 0 (8 .0 ) (2 4. 5) (3 0. 3) (2 2. 3) (1 5. 0) 10 0. 0 40 R ic he st (6 .9 ) (1 0. 4) (2 6. 0) (5 6. 7) 10 0. 0 (1 .1 ) (3 7. 1) (4 1. 0) (7 .4 ) (1 3. 4) 10 0. 0 41 M ot he r t on gu e of h ou se ho ld h ea d K yr gy z 13 .4 24 .2 32 .5 29 .9 10 0. 0 16 .9 31 .0 33 .6 7. 2 11 .3 10 0. 0 20 1 R us si an (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 12 U zb ek (2 7. 0) (2 0. 6) (2 9. 8) (2 2. 6) 10 0. 0 (4 1. 4) (1 6. 9) (1 6. 8) (1 3. 8) (1 1. 1) 10 0. 0 36 O th er la ng ua ge (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) 10 0. 0 4 (* ) – F ig ur es th at a re b as ed o n fe w er th an 2 5 un w ei gh te d ca se s ( ) – F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s 61 Kyrgyzstan MICS, 2014. Final Report Table CH.6 shows the percentage of children receiving ORS, various types of recommended homemade fluids and zinc during the episode of diarrhoea. Since children may have been given more than one type of liquid, the percentages do not necessarily add to 100. 93.9 percent received one of the recommended homemade fluids (cultured milk foods such as airan or kefir and boiled rice water): this percentage is 89.6 in urban areas and 95.6 percent in rural areas. About a third (33.4 percent) received fluids from ORS packets or pre-packaged ORS fluids. Zinc was more often received in urban areas (19.7 percent) than in rural areas (13.6 percent). Diarrhoea was treated with ORS and zinc in 8.6 percent of cases. Figure CH.2 complements the data in Table CH.6. Figure CH.2: Children under-5 with diarrhoea who received ORS , Kyrgyzstan, 2014 34 33 33 33 34 Pe rc en t Ur ba n Ru ral Ma le Fe ma le Ky rgy zst an 62 Kyrgyzstan MICS, 2014. Final Report Ta bl e C H .6 : O ra l r eh yd ra tio n so lu tio ns , r ec om m en de d ho m em ad e lu id s, a nd z in c P er ce nt ag e of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks , a nd tr ea tm en t w ith o ra l r eh yd ra tio n sa lts (O R S ), re co m m en de d ho m em ad e flu id s, a nd z in c, K yr gy zs ta n, 2 01 4 Pe rc en ta ge o f c hi ld re n w ith d ia rr ho ea w ho re ce iv ed : Number of children age 0-59 months with diarrhoea in the last two weeks O ra l r eh yd ra tio n sa lts (O R S) R ec om m en de d ho m em ad e flu id s ORS or any recommended homemade fluid Zi nc O R S a nd zi nc 1 Fl ui d fro m p ac ke t A ny O R S B oi le d w at er R ic e w at er C ul tu re d m ilk fo od s (a ira n, ke fir ) A ny re co m m en de d ho m em ad e flu id Ta bl et S yr up A ny z in c To ta l 33 .4 33 .4 88 .9 51 .9 40 .6 93 .9 95 .9 8. 1 10 .9 15 .3 8. 6 25 3 Se x M al e 32 .7 32 .7 90 .9 52 .3 39 .1 94 .7 97 .2 9. 3 13 .1 17 .1 10 .1 14 0 Fe m al e 34 .2 34 .2 86 .6 51 .4 42 .5 92 .9 94 .3 6. 5 8. 2 13 .1 6. 8 11 4 R eg io n B at ke n (2 2. 1) (2 2. 1) (9 1. 2) (2 5. 3) (5 1. 0) (1 00 .0 ) (1 00 .0 ) (1 5. 7) (6 .2 ) (1 8. 8) (3 .1 ) 24 D ja la l-A ba d (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 24 Is sy k- K ul (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 7 N ar yn (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 O sh O bl as t 31 .9 31 .9 88 .4 81 .6 39 .9 94 .7 97 .0 1. 8 3. 1 3. 8 1. 8 10 3 Ta la s (4 6. 9) (4 6. 9) (7 5. 4) (3 1. 5) (6 5. 6) (8 4. 2) (8 4. 2) (3 2. 7) (2 9. 7) (3 5. 4) (2 7. 6) 14 C hu i (3 2. 0) (3 2. 0) (9 0. 8) (1 9. 3) (3 7. 5) (9 0. 8) (9 6. 5) (1 0. 1) (1 8. 6) (2 6. 2) (1 0.

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