Lebanon (Palestinians) -Multiple Indicator Cluster Survey - 2006

Publication date: 2006

1 Monitoring the Situation of Children and Women Multiple Indicator Cluster Survey, Palestinian Refugee Camps, Lebanon 2006 FINAL REPORT May 2007 The Palestinian Central Bureau of Statistics and Natural Resources UNITED NATIONS CHILDREN’S FUND Pan-Arab Project for Family Health League of Arab States 2 Monitoring the Situation of Women and Children Multiple Indicator Cluster Survey, Palestinian Refugee Camps, Lebanon 2006 The Palestinian Central Bureau of Statistics and Natural Resources UNICEF United Nations Children’s Fund Pan-Arab Project for Family Health League of the Arab States Final Report May 2007 3 Summary Table of Findings Multiple Indicator Cluster Surveys (MICS), Palestinian refugee camps and groups, Lebanon, 2006 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY 1 13 Under-five mortality rate 31 per thousand Child mortality 2 14 Infant mortality rate 26 per thousand NUTRITION 6 4 Underweight prevalence 4.6 percent 7 Stunting prevalence 19.8 percent Nutritional status 8 Wasting prevalence 4.6 percent 45 Timely initiation of breastfeeding 63.1 percent 15 Exclusive breastfeeding rate 0-5 months 18 Percent 16 Continued breastfeeding rate at 12-15 months 48 Percent 17 Timely complementary feeding rate 6-9 months 52.8 percent 18 Children aged 6-11 months who received breast milk and minimum recommended complementary feeding 29.2 percent Breastfeeding Salt iodization 41 Percent of households using salt containing >15 PPM of iodine 99.9 percent 42 Percent of children aged 6-59 months who received Vitamin A supplementation in last 6 months prior to survey 19,8 percent Vitamin A 43 Percent of women aged 15-49 who received vitamin A supplementation within 8 months of giving birth 35.3 percent 9 Percent of live birth weighing less than 2500 grams at birth 8.7 percent Low birth weight 10 Percent of live births weighed at birth 98.0 percent CHILD HEALTH 25 Tuberculosis immunization 97.3 percent Immunization 26 Polio immunization 1 Polio immunization 2 Polio immunization 3 98.8 percent 98.5 percent 97.8 percent 4 Topic MICS Indicator Number MDG Indicator Number Indicator Value 27 DPT immunization 1 DPT immunization 2 DPT immunization 3 98.5 percent 98.3 percent 97.3 percent 28 15 Measles immunization coverage 97.5 percent 31 Fully immunized children 93.1 percent Tetanus toxoid 32 Percent of women who gave birth within the last two years prior to survey who were immunized against tetanus 34.6 percent 33 Use of oral rehydration therapy (ORT) for children with diarrhoea 79.6 percent 34 Home management of diarrhoea 11.1 percent 35 Received ORT or increased fluids, and continued feeding 28.9 percent 23 Percent of children who had respiratory infection and received treatment at a healthcare centre 44.5 percent Care of illness 22 Percent of children who had respiratory infection and were treated using antibiotics 67.2 percent Solid fuel use 24 29 Percent of households using solid fuel 0.1 percent ENVIRONMENT 11 30 Percent of households using improved drinking water sources 91.2 percent 13 Water treatment at home 5.5 percent 12 31 Use of improved sanitation facilities 99.9 percent Water and Sanitation REPRODUCTIVE HEALTH 21 19c Percent of married women who use a contraceptive 68.3 percent Contraception 20 Percent of women who received antenatal care from a skilled person 90.5 percent 44 Content of antenatal care Blood test taken 95.3 percent Maternal and newborn health Blood pressure measured 96.5 percent 5 Topic MICS Indicator Number MDG Indicator Number Indicator Value Urine specimen taken 94.7 percent Weight measured 98.5 percent 4 17 Percent of women who had skilled attendant at their delivery 99.3 percent 5 Percent of women who gave birth at a health institution 97.7 percent Maternal mortality 3 16 Maternal mortality ratio 51 per 100,000 CHILD DEVELOPMENT 46 Percent of children whose family members engage in one or more of the activities that support learning and prepare for school 64.5 percent 47 Percent of children whose par engage in one or more of the activities that support learning and prepare for school 6.0 percent 48 Percent of children who are supported to learn by means of children’s books 21.4 percent 49 Percent of children who are supported to learn by means of non-children’s books 17.5 percent 50 Percent of children who have 3 toys or more 31.0 percent Child development 51 Percent of children who were left in the care of children 18.3 percent 6 Topic MICS Indicator Number MDG Indicator Number Indicator Value EDUCATION 52 Percent of children aged 3-4 years who attend pre-school 61.6 percent 53 Percent of children attending grade 1 who attended kindergarten 92.3 percent 54 Net intake rate in primary education 73.5 percent 55 6 Net primary school attendance rate 94.7 percent 56 Net secondary school attendance rate 63.4 percent 57 7 Children reaching grade five 97.5 percent 58 Transition rate to secondary school 73.9 percent 59 7b Primary completion rate 37.4 percent Education 61 9 Gender parity index primary school 1.00 (ratio) Literacy 60 8 Adult literacy rate 88.0 percent CHILD PROTECTION Birth registration 62 Birth registration 98.4 percent 71 Child labour 1.5 percent 72 Labourer students 67.6 percent Child labour 73 Student labourers 1.1 percent 67 Percent of women who were first married below the age of 18 32.6 percent Early marriage 68 Young women aged 15-19 currently married 4.7 percent 7 Topic MICS Indicator Number MDG Indicator Number Indicator Value HIV/AIDS, AND ORPHANED 82 19b Comprehensive knowledge about HIV prevention among young people 19.8 percent 89 Women who know three ways how HIV can be transmitted from mother to child 45.1 percent 86 Women who do not approve discriminating attitude towards people with HIV/AIDS 19.7 percent HIV/AIDS knowledge and attitudes 87 Women who know where to be tested for HIV 26.6 percent 75 Percent of children with at least one dead parent 3.8 percent 78 Children’s living with only one of their parents 0.1 percent Support to orphaned 8 Table of Contents Summary Table of Findings.3 Table of Contents .8 List of Tables .10 List of Figures.12 Foreword.13 I. Introduction .14 1-1 Background . 14 1-2 Survey Objectives . 15 II. Sample and Survey Methodology .16 2-1 Sample Design . 16 2-2 Questionnaires . 16 2- 3 Fieldwork and Data Processing . 17 III. Sample Coverage and the Characteristics of Households and Respondents .18 3- 1 Sample Coverage . 18 3- 2 Characteristics of Households . 18 3-3 Characteristics of Respondents . 18 IV. Child Mortality.20 V. Nutrition .23 5-1 Nutritional Status. 23 5-2 Breastfeeding . 25 5-3 Salt Iodization . 27 5-4 Vitamin A Supplements . 28 5-5 Low Birth Weight . 29 VI. Child Health.32 6-1 Immunization . 32 6-2 Tetanus Toxoid. 33 6-3 Oral Rehydration Treatment . 34 6-4 Care Seeking and Antibiotic Treatment of Pneumonia . 36 6-5 Solid Fuel Use. 37 VII. Environment.38 7-1 Water and Sanitation. 38 VIII. Reproductive Health .41 8-1 Contraception . 41 8-2 Antenatal Care . 41 8-3 Assistance at Delivery . 42 8-4 Maternal Mortality. 43 IX. Child Development .44 9-1 Early Learning . 44 9-2 Child Care . 45 9-3 Children living arrangements. 45 X. Education .46 10-1 Pre-School Attendance and School Readiness . 46 10-2 Primary and Secondary School Participation . 46 10-3 Adult Literacy . 48 XI. Child Protection .49 11-1 Birth Registration . 49 11-2 Child Labour . 49 9 11-3 Early Marriage . 50 XII. HIV/AIDS.52 12-1 Knowledge of HIV Transmission . 52 XIII.Conclusion and Recommendations .54 List of References .57 Table Appendices .58 Appendix A: Sample Design .119 Appendix B: Estimates of Sampling Errors.121 Appendix C: Data Quality Tables .129 Appendix D. MICS Indicators, Numerators and Denominators .137 10 List of Tables Table HH. 1: Results of household and individual interviews .57 Table HH.2: Household age distribution by sex .58 Table HH.3: Household composition .59 Table HH.4: Women’s background characteristics .60 Table HH.5: Children’s background characteristics .61 Table CM.1 Early childhood mortality.62 Table CM.2: Children ever born and proportion dead.63 Table NU.1: Child Nutrition.64 Table NU.2: Initial breastfeeding .65 Table NU. 3: Breastfeeding .66 Table NU3.W Infant feeding patterns by age .68 Table NU. 4: Adequately fed infants .69 Table NU.5 Iodized salt consumption .70 Table NU.6: Children’s vitamin A.71 Table NU.7: Post-partum mothers' vitamin A supplementation .72 Table NU.8: Low birth weight infants.73 Table CH.1: Vaccinations in first year of life .74 Table CH.2: Vaccinations by background characteristics.75 Table CH.3: Neonatal tetanus protection .76 Table CH.4: Oral rehydration treatment .78 Table CH.5: Home management of diarrhea.79 Table CH.6: Respiratory system infections .80 Table CH.7: Antibiotic treatment of pneumonia.81 Table CH.7A: Knowledge of the two danger signs of pneumonia .82 Table CH.8: Solid fuel use .83 Table EN.1: Use of improved water sources .84 Table EN.2: Household water treatment .85 Table EN.3: Time to source of water .86 Table EN.4: Use of sanitary means of excreta disposal .88 Table EN.5: Use of improved water sources and improved sanitation .89 Table RH.1: Use of contraception .90 Table RH.2: Antenatal care provider .92 Table RH.3: Antenatal care .93 Table RH.4: Assistance during delivery.94 Table RH.5: Maternal mortality ratio.95 Table CD.1: Family support for learning .96 Table CD.2: Learning materials .97 Table CD.3: Children left alone or with other children .98 Table CD.4: Child living arrangements and orphanhood .99 Table ED.1: Early childhood education.100 Table ED.2: Primary school entry .101 Table ED.3: Primary school net attendance ratio.102 Table ED.4: Secondary school net attendance ratio .103 Table ED.4w: Secondary school age children attending primary school .104 Table ED.5: Children reaching grade 5.105 Table ED.6: Primary school completion and transition rate to secondary education .106 11 Table ED.7: Education gender parity .107 Table ED.8: Adult literacy.108 Table CP.1: Birth registration .109 Table CP.2: Child labour .110 Table CP.3: Labourer students and student labourers .111 Table CP.4: Child discipline.112 Table CP.5: Early marriage.113 Table HA.1: Knowledge of preventing HIV transmission .114 Table HA.2: Identifying misconceptions about HIV/AIDS .115 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission .116 Table HA.4: Knowledge of mother-to-child HIV transmission .117 Table HA.5: Attitudes toward people living with HIV/AIDS .118 Table HA.6: Knowledge of a facility for HIV testing .119 12 List of Figures Figure HH.1: Age and sex distribution of household population.7 Figure CM.1: Under-5 mortality rates by background characteristics .9 Figure CM.2: Trend in under-5 mortality rates 10 Figure NU.1: Percentage of children under-5 who are undernourished .13 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth.15 Figure NU.3: Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group in months .17 Figure NU.4: Percentage of households consuming adequately iodized salt .18 Figure NU.5: Percentage of infants weighing less than 2500 grams at birth . 21 Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccination by 12 months .23 Figure CH.2: Percentage of women with a live birth in the last 12 months who are protected against neonatal tentanus.24 Figure CH.3: Percentage of children aged 0-59 months with diarrhoea who received oral rehydration treatment .26 Figure CH.4: Percentage of children aged 0-59 months with diarrhoea who received ORT or increased fluids, AND continued feeding .27 Figure EN.1: Percentage distribution of household members by source of drinking water .30 13 Foreword Humans are the target of any developmental process. The Multiple Indicator Cluster Survey, that was conducted by the Central Bureau of Statistics and Natural Resources (PCBS) in collaboration with UNICEF Lebanon Office and the Relief and Works Agency for Palestine Refugees (UNRWA), is a step in the right direction. This report is the fruit of the cooperation of the implementing and participating agencies with the sponsoring agencies; namely the UNICEF and the Pan-Arab Project for Family Health (PAPFAM). This survey provides detailed data for the health, environmental, educational and demographical aspects of the Palestinian refugee camps in Lebanon. The results of this survey are aimed at helping policy designers and decision makers to set and proper plans and programs for women and children. They are also meant to be a reference for researchers who conduct studies on health, reproductive health and child protection issues. The Central Bureau of Statistics and Natural Resources (PCBS) seizes this opportunity of issuing the Multiple Indicator Cluster Survey in Palestinian Refugee Camps in Lebanon report to acknowledge the efforts of the United Nations Children’s Fund (UNICEF) and the Pan-Arab Project for Family Health in providing substantial technical support to the Central Bureau of Statistics and Natural Resources (PCBS) that enabled it to issue this report. We extend our thanks to all the Palestinian institutions that participated in the survey. We appreciate the contributions of each interviewer, supervisor, and administrator to the completion of the survey. Yossef Al-Mady Technical manager, Central Bureau of Statistics and Natural Resources 14 I. Introduction 1-1 Background This report includes the results of the Multiple Indicator Cluster Survey III of Palestinian Refugee Camps and Gatherings in Lebanon, conducted in 2006 by the Palestinian Central Bureau of Statistics and Natural Resources (PCBS) in collaboration with UNICEF Lebanon Country Office, the Pan-Arab Project for Family Health (PAPFAM), and Palestinian NGO’s. The survey mainly focused on monitoring the progress towards targets set by international agreements such as the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of a World Fit for Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both these commitments build upon promises made by the international community at the 1990 World Summit for Children. The League of Arab States, together with interested organizations and institutions, also passed other resolutions setting framework of Arab child rights, the Cairo Declaration towards “An Arab World Fit for Children” and the Second Arab Plan of Action on the Child (2004-2015) that were adopted by Arab Summits. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards these targets. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action committed themselves to monitoring progress towards the goals and objectives: “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 national and subnational levels of progress in order to more effectively address obstacles and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” 15 It is worthwhile to mention that the Lebanese government and the United Nations Relief and Works Agency (UNRWA) are the main providers of health services offered to Palestinian refugee mothers and children in Lebanon. Both the Lebanese Ministry of Health and UNRWA have continued to monitor health indicators emanating from the 2001 MICS II Survey of Palestinian refugee camps in Lebanon in order to increase, according to those indicators, their support to the health, education and environment of Palestinian. This final report introduces the results of topics covered by the survey and some secondary indicators.1 1-2 Survey Objectives The 2006 Multiple Indicator Cluster Survey in Palestinian Refugee Camps and Gatherings in Lebanon has as its primary objectives: 1. To provide up-to-date information for assessing the situation of children and women in Palestinian Refugee Camps and Gatherings in Lebanon; 2. To provide data needed for monitoring progress towards goals established in the Millennium Declaration, the goals of A World Fit For Children, and other internationally agreed upon goals, as a basis for future action; 3. To contribute to the improvement of data and monitoring systems in Palestinian Refugee Camps and Gatherings in Lebanon; 4. To strengthen technical expertise in the design, implementation, and analysis of such systems. 1 For more information on definitions, numerators, denominators, logarithms of MICS3, and MDGs indicators covered by the Survey, refer to chapter 1, annex 1 and annex 7 of MICS guide – MICS 2005: Monitoring The Situation of Women and Children, also available at www.childinfo.org 16 II. Sample and Survey Methodology 2-1 Sample Design The sample for the Multiple Indicator Cluster Survey (MICS) in Palestinian Refugee Camps and Gatherings in Lebanon was designed to provide estimates on a large number of indicators on the situation of children and women at the geographical area and camp/gathering level, for urban and rural areas, and for 12 camps and 12 gatherings in 5 geographical areas. With this design we could monitor a large number of women and children indicators at the geographical area and camp level for urban and rural areas. The sample population (based on the Palestinian Refugee Camps and Gatherings in Lebanon Census of 1999) was divided into equal clusters each containing 20 households (totaling 1300 clusters). Sample clusters (310 clusters, i.e. 6200 households) were drawn with uniformity, random start and a sampling fraction of 0.25. The distribution of sample households by geographical area, each according to its weight (weighted sample), was as follows: Table 2 Distribution of Sample Households by Governorate Area Sample size (households) Tripoli 1200 Beirut 1420 Bekaa 440 Sidon 1840 Sur 1300 Total 6200 Each area’s sample was distributed on camps and gatherings of the same area, according to the weight of each camp or gathering. 2-2 Questionnaires Three sets of questionnaires were used in the survey: 1) a household questionnaire was used to collect information on all household members, the household, and the dwelling; 2) a women’s questionnaire administered in each household to all women aged 15-49 years; 3) an under-5 questionnaire, administered to mothers or caretakers of all children under 5 living in the household. The questionnaires included the following modules: Household Questionnaire: - Household Listing 17 - Education - Water and Sanitation Facilities - Household Background Characteristics - Child Labour - Salt Iodization Questionnaire for Individual Women: - Child Mortality - Tetanus Toxoid - Maternal and Newborn Health - Contraception - HIV/AIDS Questionnaire for Children Under Five: - Birth Registration and Early Learning - Vitamin A - Breastfeeding - Care of Illness - Immunization - Anthropometry The questionnaires are based on the MICS3 model questionnaire. Changes in format were made to the UNICEF MICS3 model Arabic version questionnaires that were pre-tested during March 2006. 2- 3 Fieldwork and Data Processing Training for the fieldwork team members (interviewers, measurers and supervisors) was conducted centrally (in Beirut) for 10 days from 15 to 24 December 2006. The data were collected by 10 teams; each comprised of 4 interviewers, one measurer and a supervisor. Fieldwork began on April 25 2005 and was concluded on February 5, 2006. Data were entered using the CSPro software. In order to ensure quality control, all questionnaires were entered simultaneously with ongoing fieldwork and internal consistency checks were performed. Procedures and standard programs developed under the global MICS3 project and adapted to the Palestinian Refugee Camps and Gatherings in Lebanon questionnaire were used throughout. Data entry and checking was completed on the first of June 2006. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software program. Data processing began simultaneously with data collection in January 2006 and was completed on the first of April 2006. 18 III. Sample Coverage and the Characteristics of Households and Respondents 3- 1 Sample Coverage The response rate of households, mothers and children was remarkably high. Of the 6200 households selected for the sample, only 33 households could not be interviewed thus making the household response rate 99.5 percent. In the interviewed households, 4001 ever married women (age 15-49) were identified. Of these, 3955 were successfully interviewed, yielding a response rate of 98.9 percent. In addition, 2431 children under age five were listed in the household questionnaire. Questionnaires were completed for 2381 of these children, which corresponds to a response rate of 97.9 percent (Table HH.1). 3- 2 Characteristics of Households Table HH.3 provides basic background information on the households. Within households, the sex of the household head, governorates, urban/rural status, and number of household members 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. The table also shows the proportions of households where at least one child under 18 years, at least one child under 5 years, and at least one eligible woman aged 15-49 were found. Figure 1 shows that the Palestinian community in Lebanon is still youthful in spite of the fact that women fertility rate has decreased within the past 10 years. 3-3 Characteristics of Respondents Tables HH.4 and HH.5 provide information on the background characteristics of female respondents 15-49 years of age and of children under age 5. In addition to providing useful information on the background characteristics of women and children, the tables are also intended to show the numbers of observations in each background category. These categories are used in the subsequent tabulations of this report. Table HH.4 provides background characteristics of female respondents 15-49 years of age. The table includes information on the distribution of women according to governorate, urban-rural areas, age, motherhood status, education2, 2 Unless otherwise stated, “education” refers to educational level attended by the respondent throughout this report when it is used as a background variable. 19 and wealth index quintiles3. The table shows that two thirds of women in the sample were urban women and the remaining third was composed of rural women. It also shows that one of each ten married women had never given birth. Some background characteristics of children under 5 are presented in Table HH.5. These include distribution of children by several attributes: sex, governorate and area of residence, age in months, mother’s or caretaker’s education, and wealth. Figures in the table show that gender parity index for children under five was 94 and that 60 percent of children belonged to a medium wealth quintile household or below. Figure HH.1: Age and sex distribution of Palestinian refugees in Lebanon, in 2006 8 6 4 2 0 2 4 6 8 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+ Males Females 3 Principal components analysis was performed by using information on the ownership of household goods and amenities (assets) to assign weights to each household asset, and obtain wealth scores for each household in the sample (The assets used in these calculations were as follows: connection of the home to the public electricity grid, family possession of radio, television, telephone, refrigerator and number of rooms, type of ground material of floor and walls, type of cooking fuel, source of drinking water, time required to bring drinking water, type of toilet sanitation system). Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of households they were living in. The wealth index is assumed to capture the underlying long-term wealth through information on the household assets, and is intended to produce a ranking of households by wealth, from poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels, and the wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, and Filmer and Pritchett, 2001. 20 IV. Child Mortality One of the overarching goals of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce infant and under-five mortality. MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater training on research and supervision. On the other hand, indirect methods of measuring child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and the pitfalls of poor interviewing technique. The infant mortality rate is the probability of dying before the first birthday. The under-five mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for the same five-year age groups of women. The technique converts these data into probabilities of dying by taking into account both the mortality risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Palestinian Refugee Camps and Gatherings in Lebanon, the West model life table was selected as most appropriate. Table CM.1 provides estimates of child mortality by various background characteristics. Table CM.1 shows that infant mortality rate is 26 per thousand. This means that among each 1000 live births that took place during the year, 26 infants died. Meanwhile, the probability of dying under-5 mortality rate (U5MR) is 31 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 25-29 and 30-34, and refer to 2003. There is some difference between the probabilities of dying among males and females with an infant mortality rate of 30 per thousand in males and 21 per thousand in females. Infant mortality rate drops to 17 per thousand in Sur camps, whereas it rises to 31 per thousand in Tripoli camps. U5MR varies noticeably according to level of education and wealth. U5MR drops from 40 per thousand for poor households to 19 per thousand for rich households. Differentials in under-5 mortality rates by background characteristics are shown in Figure CM.1. 21 Figure CM.1 Under-5 Mortality Rates by Background Characteristics, Palestinians' refugee camps in lebanon, 2006 38 27 35 25 21 31 30 35 31 42 23 31 0 10 20 30 40 50 60 70 80 Regions Tripoli Beirut Bekaa Sidon Sur Area Urban Rural Mother's Education None Educated Wealth Quintiles Poorest 60 % Richest 40 % Total Per 1000 Figure CM.2 shows the series of U5MR estimates of the survey, based on responses of women in different age groups, and referring to various points in time, thus showing the trend in U5MR based on the survey. The MICS indicates a decline in mortality during the last 15 years as evidenced by U5MR estimate that declined from 50 per thousand in 1993 to 31 per thousand in 2006. 22 Figure CM.2: Under-five children mortality rate, Palestinian camps and gatherings, Lebanon, 2006 0 10 20 30 40 50 1990 1994 1998 2002 2006 Year P er 1 00 0 MICS3 2006 23 V. Nutrition 5-1 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. Malnutrition is the reason behind more than half of all children deaths worldwide. Undernourished children are more likely to die from childhood illnesses, and for those who survive, have recurring sicknesses and slow growth. Three-quarters of the children who die from causes related to malnutrition were mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development target is, therefore, to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. The World Fit for Children goal is to reduce the prevalence of malnutrition among children under five years of age by at least one-third (between 2000 and 2010), with special attention to children under 2 years of age. A reduction in the prevalence of malnutrition will assist 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 the reference of the World Health Organization (WHO), the Centre of Disease Control (CDC), and the National Centre for Health Surveys (NCHS). It is the same reference recommended for use by UNICEF and the World Health Organization at the time the survey was implemented. Each of the three nutritional status indicators 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. Finally, 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 24 the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. In MICS, weights and heights of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF (UNICEF, 2006). Findings in this section are based on the results of these height and weight measurements. Table NU.1 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. The table also includes the percentage of children who are overweight, i.e. those children whose weight for height is above 2 standard deviations from the median of the reference population. In Table NU.1, children who were not weighed and measured (approximately 21 percent of children) and those whose measurements are outside a plausible range are excluded. In addition, a small number of children whose birth dates are not known are excluded. Almost 5 of each one hundred of under-five children in Palestinian refugee camps and gatherings in Lebanon are moderately underweight (4.6 percent) and 1.1 percent are classified as severely underweight (Table NU.1). More than one fifth of children (19.8 percent) are moderately stunted or too short for their age and 4.6 percent are moderately wasted or too thin for their height. 15.3 percent of children were overweight. 25 The survey results have shown that children in Beirut camps are more likely to be underweight and stunted than other children. The results have also demonstrated that boys are more likely to be underweight, stunted, and wasted than girls. The age pattern shows that a higher percentage of children aged 12-23 months are undernourished according to all three indices in comparison to children who are younger and older (Figure NU.1). This observation is related to the age at which many children are weaned and begin to be exposed to contamination in water, food, and environment. 5-2 Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers are obliged to stop breastfeeding too soon and switch to infant formula, which can contribute to growth delay and malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continue to be breastfed with safe, appropriate and adequate complementary feeding for up to 2 years of age and beyond. WHO/UNICEF have the following feeding recommendations: • Exclusive breastfeeding for first six months • Continued breastfeeding for two years or more • Safe, appropriate and adequate complementary foods beginning at 6 months • Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators of recommended child feeding practices are as follows: • Exclusive breastfeeding rate (< 6 months & < 4 months) • Timely complementary feeding rate (6-9 months) • Continued breastfeeding rate (12-15 & 20-23 months) • Timely initiation of breastfeeding (within 1 hour of birth) • Frequency of complementary feeding (6-11 months) • Adequately fed infants (0-11 months) Table NU.2 provides the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth (which includes those who started within one hour). We observe that 63 percent of mothers breastfed their infants within one hour of birth while approximately 64 percent of mothers breastfed their infants during their first day of life. Ratios in urban areas are higher than rural areas. They are also higher in Beirut camps than they are in Sur camps. 26 In Table NU.3, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children aged 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. Approximately 18 percent of children aged less than six months are exclusively breastfed. This percent is considerably lower than recommended. At age 6-9 months, 52.8 percent of children are receiving breast milk and solid or semi-solid foods. By age 12-15 months, 48 percent of the children are still being breastfed and by age 20-23 months, more than one fifth of the children are still breastfed. Breastfeeding ratios were higher for mothers with secondary or higher education compared to mothers with primary or lower education. Breastfeeding ratios were higher for mothers in poorer households compared to mothers in richer households. Figure NU.3 shows the detailed pattern of breastfeeding by the child’s age in months (Figure is based on results shown in Table NU.3). Even at the earliest ages, the majority of children are receiving liquids or foods other than breast milk by the end of the sixth month. The adequacy of infant feeding in children under 58.8 72.7 64.5 68.3 54.7 68 49.8 63.8 58.8 70.1 64.5 68.3 53.8 67.4 48.9 63.1 0 10 20 30 40 50 60 70 80 Tripoli Beirut Bekaa Sidon Sur Urban Rural Total \\\ \\\ Figure NU.2: Percent of mothers who started breastfeeding within one hour and one day from giving birth, Palestinians' refugee camps, Lebanon, 2006 within f irst day within f irst hour 27 12 months is provided in Table NU.4. where different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding. Infants aged 6-8 months are considered to be adequately fed if they are receiving breast milk and complementary food at least two times per day, while infants aged 9-11 months are considered to be adequately fed if they are receiving breast milk and eating complementary food at least three times a day. The table shows that 39.8 percent of children aged 6-8 months are adequately fed compared to 18.9 percent for children aged 9-11 months. As a result of these feeding patterns, 29 percent of children aged 6-11 months are being adequately fed. The ratio goes up to 31.4 percent for boys and drops to 26.5 percent in boys. Ratios are higher in rural camps than in urban camps. In Tripoli and Bekaa camps, ratios are higher than in other camps. Adequate feeding among all infants (aged 0-11) drops to 24 percent. Figure NU.3 Infant feeding patterns by age: Percent distribution of children aged under 3 years by feeding pattern by age group, Palestinian Refugee Camps and Agglomerates in Syria, 2006 0 10 20 30 40 50 60 70 80 90 100 0- 1 2- 3 4- 5 6- 7 8- 9 10 -1 1 12 -1 3 14 -1 5 16 -1 7 18 -1 9 20 -2 1 22 -2 3 24 -2 5 26 -2 7 28 -2 9 30 -3 1 32 -3 3 34 -3 5 Age (in Months) Pe rc en t Weaned (not breastfed) Breast fed and complementary foods Breast fed and other milk/ formula Breast fed and non-milk liquids M ainly breastfed Exclusively breast fed 5-3 Salt Iodization Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in children. In its most extreme form, iodine deficiency causes cretinism which is a form of stunting, body figure distortion and mental retardation caused by a malfunctioning thyroid gland. Iodine deficiency also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goiter. IDD takes its greatest toll in impaired mental growth and development, contributing to poor school 28 performance, reduced intellectual ability, and impaired work performance. The international goal is to achieve sustainable elimination of iodine deficiency by 2005. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). In about 98.9 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodide or potassium iodate content or both. Table NU.5 shows that adequately iodized salt was used in 99.9 percent of interviewed households without any considerable variation by governorate, area of residence (rural/ urban), or wealth index. 5-4 Vitamin A Supplements Vitamin A is essential for eye health and proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, daily per capita intake is often insufficient to meet dietary requirements. Vitamin A requirements increase as children grow and during periods of illness, as well as during common childhood infections. As a result, vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of under-five deaths. The 1990 World Summit for Children set the goal of the elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal 99.7 99.9 99.8 99.9 99.9 99.9 99.8 99.9 0 20 40 60 80 100 120 P er ce nt Figure: NU.4 Percent of households using adequately iodized salt, Palestinians refugee camps, Lebanon, 2006 29 was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly's Special Session on Children in 2002. The critical role of vitamin A for child health and immune function also makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under-five mortality by the year 2015. For countries with vitamin A deficiency problems, current international recommendations call for high-dose vitamin A supplementation every four to six months, targeted to all children between the ages of six to 59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months of life and helps to replenish the mother's stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A supplementation programs, the definition of the indicator is the percent of children 6-59 months of age receiving at least one high dose vitamin A supplement in the last six months. UNICEF/WHO guidelines recommend that children aged 6-11 months be given one high dose Vitamin A capsules and children aged 12-59 months given a vitamin A capsule every 6 months. The guidelines also recommend that Vitamin A capsules are linked to immunization services and are given when the child gets his shots after six months of age. It is also recommended that mothers take a Vitamin A supplement within eight weeks of giving birth due to increased Vitamin A requirements during pregnancy and lactation. Within the six months prior to the MICS, 19.8 percent of children aged 6-59 months received a high dose Vitamin A supplement (Table NU.6). It was found that 5.2 percent did not receive the supplement in the last 6 months but did receive Vitamin A supplement prior to that time although their mother/caretaker was unable to specify when. Vitamin A supplementation coverage is higher in the Beirut camps (34.5 percent) than in other camps; it drops to 12.8 percent in Sur. Only about 35.5 percent of mothers with a birth in the previous two years before the MICS received a Vitamin A supplement within eight weeks of the birth (Table NU.7). This percentage is highest in the Beirut camps at 47.4 percent and Bekaa camps at 50 percent; and lowest in Tripoli camps at 19.8 percent. 5-5 Low Birth Weight Weight at birth is a good indicator of a mother's health and nutritional status and of the newborn's chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries grave health risks for children. Babies who were undernourished in the uterus face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children 30 born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother's poor health and nutrition. Three factors have most impact: the mother's poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy leads to underdevelopment of the placenta through which the foetus gets its nutrients. Moreover, diseases such as diarrhoea and malaria, which are common in many developing countries, can significantly impair placental and foetal growth if the mother becomes infected while pregnant. In the industrialized world, cigarette smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates are biased for most developing countries because the majority of newborns are not delivered in facilities, and those who are represent only a selected sample of all births. 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 birth4 . Overall, 98 percent of births were weighed at birth and 8.7 percent of infants are estimated to weigh less than 2500 grams at birth (Table NU.8). There was significant variation by region (Figure NU.5). The percentage of low birth weight varies very much between camps in governorates rising up to 10.2 percent in Tripoli camps and going down to 5.8 percent in Beirut. The percentage of low birth weight varies by level of mother’s education; it rises to 9.3 percent for children born to mothers who received basic education, wheras it is 6.4 percent for childen born to mothers with secondary education or higher. 4 For a detailed description of the methodology, see Boerma, Weinstein, Rutstein and Sommerfelt, 1996. 31 10 6 8 10 9 9 0 2 4 6 8 10 12 Tripoli Beirut Bekaa Sidon Sur Total pe rc en t Regions Figure NU.5: Percent of infants born within previous two years who weighed less than 2500 grams at birth, Palestinians' refugee camps, Lebanon, 2006 32 VI. Child Health 6-1 Immunization The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine-preventable diseases cause more than 2 million deaths every year. A World Fit for Children goal is to ensure full immunization of children under one year of age at 90 percent nationally, with at least 80 percent coverage in every administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. Mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Overall, 84.1 percent of children had health cards. If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio, how many times. The percentage of children aged 12 to 23 months who had health cards and received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children aged 12-23 months with health cards so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey according to the vaccination card. 97.3 percent of children aged 12-23 months received a BCG vaccination and the first dose of DPT was given to 98.5 percent. The percentage declines for subsequent doses of DPT to 98.3 percent for the second dose, and 97.3 percent for the third dose (Figure CH.1). Similarly, 98.3 percent of children received Polio 1 and this declines to 97.8 percent by the third dose. The coverage for measles vaccine by 12 months is 97.5 percent. As a result, the percentage of children who had all the recommended vaccinations is 93.1 percent. This proportion is particularly high because a Palestinian child would benefit from free health services offered by the Lebanon government as well as from the services offered by UNRWA to Palestinian. UNRWA provides dose 0 of polio vaccine within the first month of life in addition to the three basic booster doses of DPT and polio vaccines. 33 Figure CH.1 Percentage of children aged 12-23 months who their health cards were seen and received the recommended vaccinations, Palestinans' refugee camps in Lebanon, 2006 97.3 98.5 98.3 97.3 98.8 98.5 97.8 97.5 93.1 90 91 92 93 94 95 96 97 98 99 100 BCG DPT1DPT2DPT3 Polio1Polio2Polio3 Measles All P er ce nt Table CH.2 shows vaccination coverage rates among children 12-23 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 vaccination cards. No significant differentials are observed by camp and/or mother’s level of education. 6-2 Tetanus Toxoid One of the MDGs is to reduce by three quarters the maternal mortality ratio, with one strategy, to eliminate maternal tetanus. In addition, another goal is to reduce the incidence of neonatal tetanus to less than 1 case of neonatal tetanus per 1000 live births in every district. A World Fit for Children goal is to eliminate maternal and neonatal tetanus by 2005. Prevention of maternal and neonatal tetanus is to assure all pregnant women receive at least two doses of tetanus toxoid vaccine. However, if women have not received two doses of the vaccine during the pregnancy, they (and their newborn) are also considered to be protected if the following conditions are met: • Received at least two doses of tetanus toxoid vaccine, the last within the prior 3 years; • Received at least 3 doses, the last within the prior 5 years; • Received at least 4 doses, the last within 10 years; • Received at least 5 doses during lifetime. 34 Table CH.3 shows the protection status from tetanus of women who have had a live birth within the last two years before the survey. Figure CH.2 shows the protection of women against neonatal tetanus by major background characteristics. 34.6 percent of the women who have had a live birth within the last two years had a tetanus toxoid. The percentage is highest in Beirut (38.3 percent) and Bekaa (38.7 percent) and lowest in Sidon (30.8 percent). 6-3 Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are to: 1) reduce by one half deaths due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); 2) reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The indicators are: 33.9 38.3 38.7 30.8 36.9 36.1 29.4 34.6 0 10 20 30 40 50 gov… Tripoli Beirut Bekaa Sidon Sur Are… Urban Urban Total Percent Figure CH.2: Percent of women aged 15-49 with a live birth within two previous years who were immunized against neonatal tetanus, Palestinians' camps, Lebanon, 2006 35 • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • (ORT or increased fluids) and continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 9.9 percent of under five children had diarrhoea in the two weeks preceding the survey (Table CH.4). Diarrhoea prevalence was different among camps. 19.0 percent of Bekaa camp children had had diarrhoea during the previous two weeks. The percentage goes down to 7.9 per cent in Beirut camps. The peak of diarrhoea prevalence occurs in the teething period among children aged 6-11 months. Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name two types of liquid, the percentages do not necessarily add to 100. It was found that 24.3 percent received fluids from ORS packets; 37 percent received pre-packaged ORS fluids, and 64.3 percent received recommended homemade fluids. Children whose mothers received secondary education are less likely to receive oral rehydration treatment than other children. Approximately 79.6 percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF), while 20.4 percent received no treatment. 79 74 89 80 79 80 65 70 75 80 85 90 Tripoli Beirut Bekaa Sidon Sur Total Figure CH.3: Percent of children aged 0-59 months who had diarrhea in the two previous weeks and received oral rehydration treatment, Palestinians' refugee camps, Lebanon, 2006 36 Figure CH.4 Percentage of children aged 0-59 with diarrhoea who received ORT or increased fluids, AND continued feeding, Palestinains' refugee camps, Lebanon 2006 44.7 10.3 29.6 28.4 31.6 28 32.7 28.9 0 10 20 30 40 50 Governorate Tripoli Beirut Bekaa Sidon Sur Area Urban Rural Total A quarter of under-five children with diarrhoea drank more than usual while three quarters of them drank the same or less (Table CH.5). 38.3 percent ate somewhat less, same or more (continued feeding), but 60.4 percent ate much less or ate almost none. Given these figures, 11.1 percent children who were treated for diarrhoea at home received increased fluids and at the same time continued feeding. Combining the information in Table CH.5 with those in Table CH.4 on oral rehydration therapy, it is observed that 28.9 percent of children either received ORT or fluid intake was increased, and at the same time, feeding was continued, as is the recommendation. 6-4 Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. A World Fit for Children goal is to reduce by one-third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were not due to a problem in the chest and a blocked nose. The indicators are: • Prevalence of suspected pneumonia • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the danger signs of pneumonia Table CH.6 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care. 17.1 percent of children aged 0-59 months were reported to have had symptoms of pneumonia during the two 37 weeks preceding the survey. Of these children, 44.5 percent were taken to an appropriate provider. Medical advice was sought in private practices for 20.5 percent children and in UNRWA paediatric consultation clinics for 26.9 percent children. Table CH.7 presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, governorate, residence, and socioeconomic factors. In Palestinian Refugee Camps and Gatherings 67.2 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. The percentage was higher in the age group 24-35 months. Issues related to knowledge of danger signs of pneumonia are presented in Table CH.7A. Obviously, mothers’ knowledge of the danger signs is an important determinant of care-seeking behavior. Overall, 10.6 percent of women know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is child fever (87.1 percent). 35.4 percent of mothers identified difficult breathing and 21.5 percent of mothers identified fast breathing as symptoms for taking children immediately to a health care facility. 6-5 Solid Fuel Use More than 3 billion people around the world rely on solid fuels (biomass and coal) for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including CO, polyaromatic hydrocarbons, SO2, and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, and possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Overall, use of solid fuels in cooking is an almost nonexistent practice in Palestinian Refugee Camps and Gatherings in Lebanon. Most households use natural gas for cooking purposes. 38 VII. Environment 7-1 Water and Sanitation Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also contain chemical, physical and radiological contaminants with harmful effects on human health. In addition to its impact on health, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The indicators used in MICS are as follows: Water • Use of improved drinking water sources • Use of adequate water treatment method • Time to source of drinking water • Person collecting drinking water Sanitation • Use of improved sanitation facilities • Sanitary disposal of child’s feces The distribution of the population by source of drinking water is shown in Table EN.1 and Figure EN.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, yard or plot), public tap/standpipe, tubewell/borehole, protected well, protected spring, and rainwater collection. Bottled water is considered as an improved water source. 39 Figure EN.1 Percentage distribution of household members by source of drinking water, Palestinian Refugee Camps and Agglomerates in Syria, 2006 Piped into dw elling, yard or plot 69% Protected w ell 3% Sold in w ater tanks 21% Sold in w ater trucks 6% Other sources 1% Overall, 91.2 percent of the population is using an improved source of drinking water – 89.3 percent in urban areas and 97.7 percent in rural areas (Table EN.1). The percentage in Beirut camps is the lowest compared to other camps (68.6%), it was found that only 2.4 percent of those get improved water from a public source while others buy water from water tanks. Although public water pipelines are accessible for all camp residents, the existence of some calcium salts in public water in some camps makes water unpalatable. The source of drinking water for the population varies strongly by governorate. In all governorates (except Beirut) most of the population use drinking water that is piped into their dwellings or into their yards or plots. Use of in-house water treatment is presented in Table EN.2. Households were asked of ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine, using a filter, and using solar disinfection were considered as proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, for households using improved and unimproved drinking water sources. 5.5 percent of households use one of the home water treatment methods with boiling heading the list followed by the use of filters. The time taken to obtain water is presented in Table EN.3. The table shows that for 65.7 percent of households, the drinking water source is on the premises. For 22 percent of all households, it takes less than 15 minutes to get to the water source and bring water, while the remaining households spend more than 15 minutes for this purpose. Excluding those households with water on the premises, the average time to the source of drinking water is 30 minutes. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities for excreta disposal include: flush or pour flush to a piped sewer system, 40 septic tank, ventilated improved pit latrine, pit latrine with slab, and composting toilet. 86.7 percent of the population of Palestinian Refugee Camps and Gatherings in Lebanon is living in households using improved sanitation facilities (Table EN.5). This percentage is 97.2 in urban areas and 52.0 percent in rural areas. 41 VIII. Reproductive Health 8-1 Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. A World Fit for Children goal is access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. Current use of contraception was reported by 68.3 percent of women currently married (Table RH.1). The most popular method is the intrauterine device (IUD) which is used by 24.7 percent of the married women in Palestinian Refugee Camps and Gatherings in Lebanon. The next most popular method is the pill, which is used by 21.4 percent of married women. 6.5 percent of women reported that their husbands use the condom. 13.7 percent use abstinence around ovulation time, withdrawal, and other conventional methods. Contraceptive prevalence is highest in Sur camps at 70.8 percent followed by Beirut at 70.5 percent and Sidon at 68.8, while 67.5 percent of married women use contraceptive methods in Bekaa camps and 62.2 percent of married women in Tripoli camps. Adolescents are far less likely to use contraception than older women. Only about 22.5 percent of married women aged 15-19 currently use a method of contraception compared to 48.2 percent of 20-24 year old married women and 79.8 percent of 35-39 year old women. 8-2 Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well- being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother's health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. Tetanus immunization during pregnancy can be life- saving for both the mother and infant. The prevention and treatment of malaria among pregnant women, management of anaemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women's nutritional status and prevent infections (e.g., malaria and STIs) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and 42 care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: • Blood pressure measurement • Urine testing for bacteriuria and proteinuria • Blood testing to detect syphilis and severe anaemia • Weight/height measurement (optional) Coverage of antenatal care (by a doctor, nurse, or midwife) is relatively high in Palestinian Refugee Camps and Gatherings in Lebanon with 90.5 percent of women receiving antenatal care at least once during the pregnancy (Table RH.2). The type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding is presented in Table RH.2. 63.4 percent of women’s antenatal care were attended by a doctor while 27.1 percent had their care provided by nurses or midwives. The types of services pregnant women received are shown in table RH.3. Most pregnant women were provided by all basic types of care including weight and blood pressure measurement, urine testing, and blood testing. 8-3 Assistance at Delivery Three quarters of all maternal deaths occur during delivery and the immediate post-partum period. The single most critical intervention for safe motherhood is to ensure a competent health worker with midwifery skills is present at every birth, and transport is available to a referral facility for obstetric care in case of emergency. A World Fit for Children goal is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, midwife or auxiliary midwife. About 99.3 percent of births occurring in the year prior to the MICS survey were delivered by skilled personnel (Table RH.4). 61.3 percent of births were delivered with assistance by a doctor. Midwives/nurses assisted with the delivery of 37.8 percent of births. 97.7 percent of births took place in an obstetric facility. 43 8-4 Maternal Mortality The complications of pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. It is estimated worldwide that around 529,000 women die each year from maternal causes. For every woman who dies, approximately 20 more suffer injuries, infection and disabilities in pregnancy or childbirth. This means that at least 10 million women a year incur this type of damage. The most common fatal complication is post-partum haemorrhage. Sepsis, complications of unsafe abortion, prolonged or obstructed labour and the hypertensive disorders of pregnancy, especially eclampsia, claim further lives. These complications, which can occur at any time during pregnancy and childbirth, require prompt access to quality obstetric services equipped to provide lifesaving drugs, antibiotics and transfusions and to perform the caesarean sections and other surgical interventions that prevent deaths from obstructed labour, eclampsia and intractable haemorrhage. One MDG target is to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Maternal mortality is defined as the death of a woman from pregnancy-related causes, when pregnant or within 42 days of termination of pregnancy. The maternal mortality ratio is the number of maternal deaths per 100,000 live births. In MICS, the maternal mortality ratio is estimated by using indirect sisterhood method. To collect the information needed for the use of this estimation method, adult household members are asked a small number of questions regarding the survival of their sisters and the timing of death relative to pregnancy, childbirth and the postpartum period for deceased sisters. The information collected is then converted to lifetime risks of maternal death and maternal mortality ratios5. Palestinian Refugee Camps and Gatherings in Lebanon MICS results on maternal mortality are shown in Table RH.5. The results are also presented only for the national total, since maternal mortality ratios generally have very large sampling errors. Maternal mortality ratio in Palestinian Refugee Camps and Gatherings in Lebanon was 51 per 100,000. 5 For more information on the indirect sisterhood method, see WHO and UNICEF, 1997. 44 IX. Child Development It is well recognized that a period of rapid brain development occurs in the first 3- 4 years of life, and the quality of home care is the major determinant of the child’s development during this period. Adult activities with children, presence of books in the home, and the conditions of child care are important indicators of quality of home care. A World Fit for Children goal is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” 9-1 Early Learning Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. Approximately 65 percent of under-five children, an adult engaged in more than four activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.1). The average number of activities that adults engaged with children was 4. The table also indicates that the father’s involvement in such activities was low. Father’s involvement with one or more activities was only 6 percent. Only 0.8 percent of children were living in a household without their fathers. There were no gender differentials in terms of adult activities with children. The percentage reaches 70.5 percent in urban areas and 45.7 in rural areas. Differentials by governorate and socio-economic status are also observed: Adult engagement in activities with children was greatest in Sidon camps (79.3 percent) and lowest in Sur (50 percent), while the proportion was 70.8 percent for children living in the richest households, as opposed to those living in the poorest households at 50.6 percent. Father’s involvement showed a similar pattern in terms of adults’ engagement in such activities. Patterns of adults engaging in such activities are similar to patterns of parents engaging in these activities. Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Presence of books is important for later school performance and IQ scores. In Palestinian Refugee Camps and Gatherings in Lebanon, around 17.5 percent of children are living in households where at least 3 non-children’s books are present (Table CD.2). 21.4 percent of children aged 0-59 months have three or more children’s books. Gender differentials have been observed regarding the percent of families having 3 or more non-children’s books; 19 percent for males and 16 percent for females. The presence of both non-children’s and children’s books is positively correlated with the child’s age; in the homes of 22.1 percent of 45 children aged 24-59 months, there are 3 or more non-children’s books, while the figure is 9.7 percent for children aged 0-23 months. Similar differentials exist in terms of children’s books. Table CD.2 also shows that 31 percent of children aged 0-59 months had 3 or more playthings to play with in their homes. There was not a single child who had not at least one plaything (CD.2). The playthings in MICS included household objects, homemade toys, toys that came from a store, and objects and materials found outside the home. It is interesting to note that 70.6 percent of children play with toys that come from a store; however, the percentages for other homemade toys drops to 37.3 percent. The proportion of male children who have 3 or more playthings to play with is was equal the proportion of females who had 3 or more playthings (approximately 31 percent). Big differentials are observed between camps with the proportion of children having 3 or more toys is as high as 57.3 percent in Sidon camps dropping to 3.4 percent in Tripoli camps. 9-2 Child Care Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.3 shows that 18.3 percent of children aged 0-59 months were left in the care of other children, while 5.1 percent were left alone during the week preceding the interview. Combining the two indicators, it is calculated that 19.3 percent of children were left with inadequate care during the week preceding the survey. No differences were observed by the sex of the child but there are differences between urban and rural areas. The percentage was higher in urban areas reaching 22.1 percent down to 10.3 percent in rural areas. On the other hand, differences between individual camps were also observed. Percent of inadequate care among children of Sidon camps was 31.1 percent compared to 8.2 percent in Sur camps. The percentage of children left without adequate care was higher in the age group 24-59 months reaching 23.5 percent down to 12.2 percent for children aged 0-23 months. Differences were observed in regard to the mother’s level of education; the percent of 0-59 months old children left in inadequate care was 25.5 for uneducated mothers, compared to 14.3 for mothers who had secondary education or higher. 9-3 Children living arrangements Losing one of the parents or one of them has a considerable effect on bringing up the child and on his mental and physiological health. Moreover, children who do not live with one of their parents due to any reason such as divorce or migration are usually more prone to social and psychological problems than children who live with both parents. The results of the survey (Table CD.4) show that 96.2 percent of children below 18 years of age live with both parents, whereas 3.8 percent live with one parent or none of them. The percentage of children who do not live with any of their parents was only 0.1. 46 X. Education 10-1 Pre-School Attendance and School Readiness Attendance to pre-school education in an organized learning or child education program is important for the readiness of children to school. One of the World Fit for Children goals is the promotion of early childhood education. 61.6 percent of children aged 36-59 months are attending pre-school (Table ED.1). Attendance was lowest in Bekaa (53.2 percent). No remarkable gender differences were observed. The proportions of children attending pre-school at ages 36-47 months and 48-59 months are different (48.5 percent and 76.4 percent respectively). The table also shows the proportion of children in the first grade of primary school who attended pre-school the previous year, an important indicator of school readiness. Overall, 92.3 percent of children who are currently age 6 and attending the first grade of primary school were attending pre-school the previous year. The proportion among males is slightly higher (94.3 percent) than females (90.3 percent). 96.2 percent of children in urban areas had attended pre- school the previous year compared to 75.9 percent among children living in rural areas. Regional differentials are also significant; 97.4 percent of first graders in Beirut have attended pre-school compared to 70.4 percent in Sur. 10-2 Primary and Secondary School Participation Universal access to basic education and the achievement of primary education by the world’s children is one of the most important goals of the Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth. The indicators for primary and secondary school attendance include: • Net intake rate in primary education • Net primary school attendance rate • Net secondary school attendance rate • Net primary school attendance rate of children of secondary school age • Female to male education ratio (or gender parity index - GPI) 47 The indicators of school progression include: • Survival rate to grade five • Transition rate to secondary school • Net primary completion rate Of the children who are of primary school entry age (age 6), 73.5 percent are attending the first grade of primary school (Table ED.2). (The reason behind this low rate is that the Survey was conducted in January 2006 while schools had begun in September 2005). Sex differentials do not exist; however, significant differentials are present by region. In Tripoli, for instance, the value of the indicator reaches 83 percent, while it is 58.4 percent in Sur. Table ED.3 provides the percentage of children of primary school age attending primary or secondary (i.e. preparatory and secondary) school. The majority (94.7 percent) of children of primary school age are attending school. However 5.3 percent of the children are out of primary schools. Some may be attending the first grade of preparatory school while others are not in school being dropouts, sick, and/or handicapped. The table indicates that there are not major gender nor rural/urban differentials in net attendance rates, yet school attendance for girls in urban areas was 95.3 percent compared to 92.8 for girls in rural areas. The secondary school net attendance ratio is presented in Table ED.4. Worse than in primary school, is the fact that only 63.4 percent of the children of secondary school age (12-17 years) are attending secondary school. The remaining percentage is either out of school or attending primary school (see below). Table ED.4 shows that there are significant gender differences in the secondary school net attendance ratio. The ratio is 61 percent for males going up to 65.9 percent for females. Secondary school net attendance ratio in rural areas is as low as 60.2 percent going up to 64.5 percent in urban areas. The ratio goes down to 59.9 percent in Bekaa and up to 66.6 percent in Sidon. The percentage of children entering first grade who eventually reach grade 5 is presented in Table ED.5. Of all children starting grade one, 97.5 percent will eventually reach grade five. Notice that this number includes children that repeat grades and that eventually move up to reach grade five. There are no significant gender differences. The net primary school completion rate and transition rate to secondary education are presented in Table ED.6. At the moment of the survey, only 37.4 percent of the children of primary completion age (11 years) were attending the last grade of primary education. This value should be distinguished from the gross primary completion ratio which includes children of any age attending the last grade of primary. 73.9 percent of the children that completed successfully the last grade of primary school were found at the moment the survey to be attending the first grade of secondary school. No significant gender differences were noticed. 48 The ratio of girls to boys attending primary and secondary education is provided in Table ED.7. These ratios are better known as the Gender Parity Index (GPI). Notice that the ratios included here are obtained from net attendance ratios rather than gross attendance ratios. The last ratios provide an erroneous description of the GPI mainly because in most of the cases the majority of over-aged children attending primary education tend to be boys. The table shows that gender parity for primary school is 1.00 for primary school going up to 1.08 in secondary school. The advantage of girls is particularly pronounced in Beirut and Bekaa. 10-3 Adult Literacy One of the World Fit for Children goals is to assure adult literacy. Adult literacy is also an MDG indicator, relating to both men and women. In MICS, since only a women’s questionnaire was administered, the results are based only on females age 15-24. Literacy was assessed on the ability of women to read a short simple statement or on school attendance. The percent literate is presented in Table ED.8. The percentage of women that are able to read is 88 percent. No significant differentials were observed according to area of residence (rural/ urban) or according to governorate. 49 XI. Child Protection 11-1 Birth Registration The Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. The World Fit for Children states the goal to develop systems to ensure the registration of every child at or shortly after birth, and fulfil his or her right to acquire a name and a nationality, in accordance with national laws and relevant international instruments. The indicator is the percentage of children under 5 years of age whose birth is registered. The births of 98.4 percent of children under five years in Palestinian Refugee Camps and Gatherings in Lebanon have been registered (Table CP.1). There are no variations in birth registration across any variable including sex, age, or mother’s level of education. 11-2 Child Labour Article 32 of the Convention on the Rights of the Child states: "States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development." The World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions addressed the issue of child labour, that is, children 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: • Ages 5-11: at least one hour of economic work or 28 hours of domestic work per week. • Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiation between child labour and child work to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the prevalence of child labour since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained above. Table CP.2 presents the results of child labour by the type of work. Percentages do not add up to the total child labour as children may be involved in more than one type of work. Survey results indicate that 1.5 percent of children aged 5-14 were involved 50 in labour activities during the reference week. The indicator goes up to 1.8 percent in boys and down to 1.1 in girls. Child labour is particularly high among school dropouts reaching 8.9 percent in children not attending school in opposition to 1.1 percent among children attending schools regularly. In rural areas, the indicator is 1.7 percent down to 0.8 in urban area children. In Sidon camps it is as high as 2.4 percent while it drops to 0.6 in Bekaa camps. Table CP.3 presents the percentage of children classified as student labourers or as labourer students. Student labourers are the children attending school that were involved in child labour activities at the moment of the surveys. More specifically, of the 94.5 percent of the children 5-14 years of age attending school, 1.1 percent are also involved in child labour activities. Student labourers represent 67.6 percent of all child labourers. 11-3 Early Marriage Marriage before the age of 18 is a reality for many young girls. According to UNICEF's worldwide estimates, over 60 million women aged 20-24 were married before the age of 18. Factors that influence child marriage rates include: the state of the country's civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. In many parts of the world parents encourage the marriage of their daughters while they are still children in hopes that the marriage will benefit them both financially and socially, while also relieving financial burdens on the family. In fact, child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered (female) nature of poverty. The right to 'free and full' consent to a marriage is recognized in the Universal Declaration of Human Rights - with the recognition that consent cannot be 'free and full' when one of the parties involved is not sufficiently mature to make an informed decision about a life partner. The Convention on the Elimination of all Forms of Discrimination against Women mentions the right to protection from child marriage in article 16, which states: "The betrothal and the marriage of a child shall have no legal effect, and all necessary action, including legislation, shall be taken to specify a minimum age for marriage.” While marriage is not considered directly in the Convention on the Rights of the Child, child marriage is linked to other rights - such as the right to express their views freely, the right to protection from all forms of abuse, and the right to be protected from harmful traditional practices - and is frequently addressed by the Committee on the Rights of the Child. Other international agreements related to child marriage are the Convention on Consent to Marriage, Minimum Age for Marriage and Registration of Marriages and the African Charter on the Rights and Welfare of the Child and the Protocol to the African Charter on Human and People's Rights on the Rights of Women in Africa. Child marriage was also identified by the Pan-African Forum against the Sexual Exploitation of Children as a type of commercial sexual exploitation of children. 51 Young married girls are a unique, though often invisible, group. Required to perform heavy amounts of domestic work, under pressure to demonstrate fertility, and responsible for raising children while still children themselves, married girls and child mothers face constrained decision-making and reduced life choices. Boys are also affected by child marriage but the issue impacts girls in far larger numbers and with more intensity. Cohabitation - when a couple lives together as if married - raises the same human rights concerns as marriage. Where a girl lives with a man and takes on the role of caregiver for him, the assumption is often that she has become an adult woman, even if she has not yet reached the age of 18. Additional concerns due to the informality of the relationship - for example, inheritance, citizenship and social recognition - might make girls in informal unions vulnerable in different ways than those who are in formally recognized marriages. Research suggests that many factors interact to place a child at risk of marriage. Poverty, protection of girls, family honour and the provision of stability during unstable social periods are considered as significant factors in determining a girl's risk of becoming married while still a child. Women who married at younger ages were more likely to believe that it is sometimes acceptable for a husband to beat his wife and were more likely to experience domestic violence themselves. The age gap between spouses contributes to domestic violence and to increase the risk of untimely widowhood. Closely related to the issue of child marriage is the age at which girls become sexually active. Women who are married before the age of 18 tend to have more children than those who marry later in life. Pregnancy related deaths are known to be a leading cause of mortality for both married and unmarried girls between the ages of 15 and 19. There is evidence to suggest that girls who marry at young ages are more likely to marry older men which puts them at increased risk of HIV infection. Parents seek to marry off their girls to protect their honour, and men often seek younger women as wives as a means to assure choosing an HIV-free wife. The demand for this young wife to reproduce and the power imbalance resulting from the age differential lead to very low condom use among such couples. The percentage of women aged 15-49 that were married at an early age (before the age of 18) was around 32.6 percent and that 4.7 percent of the women aged 15-19 are currently married. 52 XII. HIV/AIDS 12-1 Knowledge of HIV Transmission One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect themselves from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in misconceptions although some appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on governments to improve the knowledge and skills of young people to protect themselves from HIV. The indicators to measure this goal as well as the MDG of reducing HIV infections by half include improving the level of knowledge of HIV and its prevention, and changing behaviours to prevent further spread of the disease. The HIV module was administered to women 15-49 years of age. One indicator which is both an MDG and UNGASS indicator is the percent of young women who have correct and comprehensive of HIV prevention and transmission. Women were asked whether they have heard of HIV transmission. The results are presented in Table HA.1. In Palestinian Refugee Camps and Gatherings in Lebanon, the majority of the interviewed women (91.8 percent) have heard of AIDS. Table HA.2 presents the percent of women who can correctly identify misconceptions concerning the transmission of HIV. The indicator is based on the two most common and relevant misconceptions in Palestinian Refugee Camps and Gatherings in Lebanon, that HIV can be transmitted by supernatural means and by sharing in food. The table also provides information on whether women know that HIV cannot be transmitted by mosquito bites (49 percent), whereas they know that HIV can be transmitted by sharing needles (88.7 percent). Of the interviewed women, 28.8 percent rejected the two most common misconceptions and knew that a healthy-looking person can be HIV infected. Knowledge of mother-to-child transmission of HIV is also an important first step for women to seek HIV testing when they are pregnant to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, delivery, and through breastfeeding. The level of knowledge among women age 15-49 years concerning mother-to-child transmission is presented in Table HA.4. Overall, 88.9 percent of women knew of the possibility of mother-to-child transmission. Mothers who know all three ways of mother-to-child transmission were 45.1 percent, while nearly 3 percent of women did not know of any specific way of HIV mother-to-child transmission. 53 The indicators on attitudes toward people living with HIV measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude on the following four questions: 1) would care for family member sick with AIDS; 2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; 4) would not want to keep HIV status of a family member a secret. Table HA.5 presents the attitudes of women towards people living with HIV/AIDS. The table indicates that 4.7 percent of women would refuse care for a family member sick with AIDS. 49.7 percent of women would want to keep HIV status of a family member a secret. 47 percent of women think that a teacher who is HIV positive should not be allowed to teach in school and 41 percent of women would refuse to buy food from an HIV positive person. The table indicates that two women in ten reject all the above mentioned discriminatory statements. Another important indicator is the knowledge of where to be tested for HIV and use of such services. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. Only 26.6 percent of women knew where to be tested. The percentage was 55.6 in Beirut camps down to 14.6 in Sidon camp. 54 XIII. Conclusion and Recommendations The Multiple Indicator Cluster Survey (MICS3) was conducted in the Palestinian camps and gatherings in Lebanon, with the purpose of monitoring the situation of women and children. The survey was conducted in the period from December 25, 2005 to February 5, 2005, using three questionnaires: the Household questionnaire, the Individual Women questionnaire, and the Under-Five Children questionnaire. The survey was done on a random self-weighted sample of 6167 households. The response rate was 99.5 percent. The number of women interviewed was 3955 women at a response rate of 98.9 percent. Under-five questionnaires were successfully completed for 2381 children below five years of age, at a response rate of 97.9 percent. The results of the survey can be summarized as follows: - The results of the survey show that the mortality rate has decreased over the past fifteen years. The results reveal that the mortality rate for children under five years of age decreased from 37.3 per thousand in 1998 to 31 per thousand in 2006. - The results show that approximately one child of every 20 children under five years of age is moderately or severely under-weight, and that more than twenty percent of under-fives are stunted. 4.6 percent of the under- five children are wasted, whereas 15.3 percent of children are obese. - The percentage of infants below 6 months of age who are fed on breast milk exclusively as low as 18 percent. Fifty three percent of infants at the age of 6-9 months are fed on breast milk and solid or semi solid foods. 21 percent of infants at the age of 20-23 months are still breastfed. - The percent of children at the age of 12-23 months who have taken all recommended vaccines are 93.1 percent. - 99.9 percent of camps dwellers live in houses that have to improved sanitation facilities. - 68.3 percent of currently married women said they were using a contraception method; they survey has sown that intrauterine device (IUD) is the most common contraceptive method, followed by the pill. - The percentage of women who received antenatal care from a skilled medical professional at least once during pregnancy was 90.5. The study reveals that during the last two years preceding the survey, 99.3 percent of deliveries took place in the presence of a skilled medical professional, whereas 97.7 percent of these deliveries took place in a health facility. - The results reveal that only 61.6 percent of children at the age of 36-59 attend preschool; 73.5 percent of children at the age of joining school (6 years) attend grade one of primary school; the reason behind this low percent is that the survey was conducted in December 2005 whereas the school year had begun in September 2005. 55 - The percent of women at the age of (15-49) who were married at an early age (below 18 years) was 32.6 - Most of women who were interviewed (91.8 percent) had heard of HIV/AIDS. 45.1 percent of women know that HIV can be transmitted from mother to child. The following recommendations are based on the results of the survey: - The healthcare umbrella should be extended to include advanced services and information on their places of availability and types of healthcare services. - Eliminate all unhealthy practices which are related to child and mother nutrition, through spreading the culture of breastfeeding and encouraging mothers to breastfeed their infants by pointing out the importance of breast milk for the child’s healthy growth, how it can protect infants against diseases, and how it can contribute to diminishing risks of child mortality. - Increase efforts to encourage consultation of health facilities through reducing fees; offering integrated health services: reproductive health services; mother and childcare services; and improving quality of service and performance of medical professionals. - Using all mass media to enhance health awareness among all family members about the importance of breastfeeding, adequate nutrition, and completion of recommended vaccines, as well as enhancing awareness of improper practices and how STD’s can be transmitted. - The last recommendation is to help policy makers and health programs by conducting further detailed studies on the trends of fertility, unmet medical needs, and children nutritional status. 56 List of References Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. Blanc, A. and Wardlaw, T. 2005. "Monitoring Low Birth Weight: An Evaluation of International Estimates and an Updated Estimation Procedure". WHO Bulletin, 83 (3), 178- 185. Filmer, D. and Pritchett, L., 2001. Estimating wealth effects without expenditure data – or tears: An application to educational enrolments in states of India. Demography 38(1): 115- 132. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN WHO and UNICEF, 1997. The Sisterhood Method for Estimating Maternal Mortality. Guidance notes for potential users, Geneva. www.Childinfo.org. 57 Table HH. 1: Results of household and individual interviews Number of households, women, and children under 5 by results of the household, women’s and under-five’s interviews, and household, women’s and under-five’s response rate, Palestinian refugee camps, Lebanon, 2006 Urban/ Rural Governorate Urban Rural Tripoli Beirut Bekaa Sidon Sur Total Number of households 4821 1379 1200 1420 440 1840 1300 6200 Number of occupied households 4821 1379 1200 1420 440 1840 1300 6200 Number of households interviewed 4796 1371 1200 1409 435 1826 1297 6167 Response rate 99.5 99.4 100.0 99.2 98.9 99.2 99.8 99.5 Number of eligible women 3135 866 754 890 264 1244 849 4001 Number of interviewed 3102 853 753 880 261 1225 836 3955 Response rate among women 98.9 98.5 99.9 98.9 98.9 98.5 98.5 98.9 Total response rate among women 98.5 97.9 99.9 98.1 97.8 97.7 98.3 98.4 Number of eligible children under 5 1850 581 483 504 142 742 560 2431 Interviewed mother/ caretaker 1808 573 473 492 142 724 550 2381 Response rate among children 97.7 98.6 97.9 97.6 100.0 97.6 98.2 97.9 Total response rate among children 97.2 98.0 97.9 96.8 98.9 96.8 98.0 97.5 58 Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, Palestinian refugee camps, Lebanon, 2006 Sex Total Male Female Number Rate Number Rate Number Rate 0 - 4 1182 8.2 1249 8.5 2431 8.3 5 - 9 1741 12.0 1586 10.8 3327 11.4 10 - 14 2001 13.8 1857 12.7 3858 13.2 15 - 19 1908 13.2 1758 12.0 3666 12.6 20 - 24 1514 10.5 1250 8.5 2764 9.5 25 - 29 934 6.5 1040 7.1 1974 6.8 30 - 34 885 6.1 1076 7.3 1961 6.7 35- 39 954 6.6 1147 7.8 2101 7.2 40 - 44 940 6.5 998 6.8 1938 6.7 45 - 49 603 4.2 580 4.0 1183 4.1 50 - 54 427 3.0 503 3.4 930 3.2 55 - 59 308 2.1 402 2.7 710 2.4 60 - 64 325 2.2 377 2.6 702 2.4 65 - 69 258 1.8 316 2.2 574 2.0 70 + 464 3.2 535 3.6 999 3.4 Age Missing/ DK 5 .0 3 .0 8 .0 < 15 4924 34.1 4692 32.0 9616 33.0 15 - 64 8798 60.9 9131 62.2 17929 61.6 65 + 722 5.0 851 5.8 1573 5.4 Dependency age groups Missing/DK 5 .0 3 .0 8 .0 Children aged 0-17 6102 42.2 5828 39.7 11930 41.0 Age Adults 18+/ Missing/ DK 8347 57.8 8849 60.3 17196 59.0 Total 14449 100.0 14677 100.0 29126 100.0 59 Table HH.3: Household composition Percent distribution of households by selected characteristics, Palestinian refugee camps, Lebanon, 2006 Weighted percent Number of weighted households Number of unweighted households Male 80.6 4972 4972 Sex of household head Female 19.4 1195 1195 Tripoli 19.5 1200 1200 Beirut 22.8 1409 1409 Bekaa 7.1 435 435 Sidon 29.6 1826 1826 Governorates Sur 21.0 1297 1297 Urban 77.8 4796 4796 Urban/ Rural Rural 22.2 1371 1371 1 8.3 509 509 2- 3 24.0 1482 1482 4 - 5 30.7 1891 1891 6 - 7 25.9 1596 1596 8 - 9 8.9 549 549 Family size 10+ 2.3 140 140 Total 100.0 6167 6167 At least one child aged < 18 years 63.9 6167 6167 At least one child aged < 5 years 30.4 6167 6167 At least one ever- married woman aged 15-49 64.3 6167 6167 60 Table HH.4: Women’s background characteristics Percent distribution of women aged 15-49 years by background characteristics, Palestinians’ refugee camps, Lebanon, 2006 Weighted percent of women Number of women Weighted Number of women Unweighted Tripoli 19.0 753 753 Beirut 22.3 880 880 Bekaa 6.6 261 261 Sidon 31.0 1225 1225 Governorates Sur 21.1 836 836 Urban 78.4 3102 3102 Urban/ Rural Rural 21.6 853 853 15-19 2.1 82 82 20-24 8.6 342 342 25-29 15.4 610 610 30-34 20.0 790 790 35-39 22.5 891 891 40-44 19.6 775 775 Age 45-49 11.8 465 465 Ever gave birth 93.8 3707 3707 Motherhood status Never gave birth 6.2 247 247 None 4.5 176 176 Basic 76.5 3024 3024 Education Secondary+ 19.1 755 755 Poorest 18.0 711 711 Second 19.0 750 750 Middle 21.0 829 829 Fourth 20.3 801 801 Wealth index quintiles Richest 21.8 864 864 Total 100.0 3955 3955 61 Table HH.5: Children’s background characteristics Percent distribution of children under five years of age by background characteristics, Palestinian refugee camps, Lebanon, 2006 Weighted percent Number of under-5 children Weighted Number of under-5 children Unweighted Male 48.4 1153 1153 Sex Female 51.6 1228 1228 Tripoli 19.9 473 473 Beirut 20.7 492 492 Bekaa 6.0 142 142 Sidon 30.4 724 724 Governorates Sur 23.1 550 550 Urban 75.9 1808 1808 Urban/ Rural Rural 24.1 573 573 < 6 months 7.9 189 189 6- 11 months 9.2 219 219 12-23 months 20.3 483 483 24-35 months 21.4 509 509 36-47 months 21.8 520 520 Child age 48-59 months 19.4 461 461 None 4.6 110 110 Basic 76.1 1811 1811 Mother education Secondary+ 19.3 460 460 Poorest 18.0 429 429 Second 18.1 430 430 Middle 23.7 565 565 Fourth 20.7 494 494 Wealth index quintiles Richest 19.4 463 463 Total 100.0 2381 2381 62 Table CM.1 Early childhood mortality Infant and under-5 mortality rates, Palestinians’ refugee camps, Lebanon, 2006 Infant mortality rate* Under-5 mortality rate** Sex Male 30 36 Female 21 25 Region Tripoli 31 38 Beirut 23 27 Bekaa 28 35 Sidon 21 25 Sur 17 21 Area Urban 26 31 Rural 25 30 Women’s education None 26 35 Degree holder 26 31 Wealth index quintiles Poorest 34 42 Second 13 15 Middle 32 40 Fourth 23 27 Richest 19 22 Total 26 31 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 63 Table CM.2: Children ever born and proportion dead Mean number of children ever born and proportion dead by age of women, Palestinians’ refugee camps, Lebanon, 2006 Mean number of children ever born Mean number children surviving Proportion dead Number of women Age 15-19 .561 .561 .000 82 20-24 1.421 1.392 .021 342 25-29 2.551 2.487 .025 610 30-34 3.546 3.423 .035 790 35-39 4.522 4.310 .047 891 40-44 4.872 4.639 .048 775 45-49 5.553 5.217 .060 465 Total 3.862 3.693 .044 3955 64 Table NU.1: Child Nutrition Percent of children aged 0-59 who are severely or moderately malnourished, Palestinians’ refugee camps, Lebanon, 2006 Weight for age (% below -2 SD*) Weight for age (%below - 3 SD*) Height for age (% below -2 SD**) Height for age (% below - 3 SD**) Weight for height (%below - 2 SD***) Weight for height (% below -3 SD***) Weight for height (% above + 2SD) Number of children Male 5.0 .3 20.6 9.2 4.5 1.4 16.4 918 Sex Female 4.2 1.8 19.1 7.1 4.7 .8 14.3 974 Tripoli 1.2 0.2 18.2 6.4 3.4 0.5 17.4 407 Beirut 8.1 1.9 26.5 14.8 5.6 0.8 13.6 359 Bekaa 0.8 0.8 15.8 4.2 .8 .0 10.0 120 Sidon 4.5 1.0 18.2 5.7 6.2 2.1 11.6 577 Governorates Sur 6.1 1.4 19.1 8.4 3.7 0.9 21.2 429 Urban 4.6 1.1 20.1 8.2 4.8 1.1 13.7 1449 Urban/ Rural Rural 4.7 1.1 19.0 7.7 3.8 1.1 20.5 443 < 6 months 2.1 .7 11.2 4.9 8.4 5.6 21.0 143 6-11 months 2.3 .6 18.0 2.9 2.3 .0 22.7 172 12-23 months 5.3 .6 23.5 9.5 5.0 .6 19.8 358 24-35 months 5.4 1.5 21.7 10.5 4.6 1.2 11.7 411 35-47 months 3.5 .5 18.3 7.7 3.7 .0 11.1 431 Child age 48-59 months 6.4 2.4 20.2 8.2 4.8 1.6 14.3 377 None 3.6 1.2 16.9 9.6 2.4 .0 24.1 83 Basic 4.4 1.0 20.3 8.3 4.6 1.3 16.3 1450 Mother’s education Secondary + 5.6 1.7 18.4 6.7 5.0 0.6 9.2 359 Poorest 4.3 1.6 20.8 7.5 3.4 0.6 21.1 322 Second 3.4 0.3 17.3 6.5 3.4 2.0 10.8 353 Middle 5.2 1.1 17.9 6.6 6.1 1.4 13.2 441 Fourth 5.6 1.5 22.0 9.5 6.1 0.5 13.0 409 Wealth index quintiles Richest 4.1 1.1 21.3 10.4 3.3 1.1 19.9 367 Total 4.6 1.1 19.8 8.1 4.6 1.1 15.3 1892 * MICS indicator 6; MDG indicator 4 ** MICS indicator 7 *** MICS indicator 8 65 Table NU.2: Initial breastfeeding Percentage of women aged 15-49 years with a birth in the two years preceding the survey who breastfed their baby within one hour of birth and within one day of birth, Palestinians’ refugee camps, 2006 Percentage of women who started breastfeeding immediately after birth Percentage of women who started breastfeeding within one hour of birth* Percentage of women who started breastfeeding within one day of birth** Number of women with a live birth in the two years preceding the survey Tripoli 58.8 58.8 58.8 177 Beirut 69.5 70.1 72.7 154 Bekaa 64.5 64.5 64.5 62 Sidon 68.3 68.3 68.3 331 Governorates Sur 53.8 53.8 54.7 225 Urban 67.3 67.4 68.0 728 Urban/ Rural Rural 48.9 48.9 49.8 221 Less than 6 months 62.0 62.6 62.6 179 6 – 8 months 65.0 65.0 65.0 206 Months since last birth 12-23 months 63.5 63.5 64.4 463 None 66.7 66.7 66.7 21 Basic 62.3 62.5 62.7 722 Mother’s education Secondary+ 65.0 65.0 67.0 206 Poorest 50.0 50.0 50.6 166 Second 65.6 65.6 68.3 183 Middle 70.4 70.4 70.4 233 Fourth 61.6 62.2 62.2 185 Wealth index quintiles Richest 64.3 64.3 64.3 182 Total 63.0 63.1 63.8 949 * * MICS indicator 45 66 Table NU. 3: Breastfeeding Percentage of living children according to breastfeeding status at each age group, Palestinians’ refugee camps, Lebanon, 2006 Children 0-3 months Children 0-5 months Children 6-9 months Children 12-15 months Children 20-23 months Percent exclusively breastfed Number of children Percent exclusively breastfed ** Number of children Percent receiving breast milk and solid/ mushy food *** Number of children Percent breastfed **** Number of children Percent breasted**** Number of children Male 32.1 53 23.7 97 52.3 86 43.5 69 18.8 69 Sex Female 18.2 55 12.0 92 53.6 56 51.9 79 22.7 88 Tripoli * 20 (25.0) 28 (53.8) 26 (43.3) 30 (14.3) 42 Beirut * 21 (11.8) 34 * 24 (20.0) 30 (14.8) 27 Bekaa * 7 * 14 * 19 * 1 * 11 Sidon (17.5) 40 20.6 63 (52.2) 46 59.6 52 (35.1) 37 Governorate Sur * 20 (16.0) 50 (51.9) 27 (57.1) 35 (22.5) 40 Urban 20.9 86 17.6 142 51.7 118 44.1 111 20.5 112 Urban/ Rural Rural * 22 (19.1) 47 * 24 (59.5) 37 (22.2) 45 None * 3 * 6 * 6 * 6 * 5 Basic 20.7 87 15.9 145 54.9 102 44.6 112 20.9 129 Mother’s education Secondary+ * 18 (23.7) 38 (47.1) 34 (63.3) 30 * 23 Poorest * 18 (20.0) 30 * 23 (42.9) 28 (19.4) 31 Second * 20 (27.3) 44 (48.4) 31 (55.2) 29 (17.2) 29 Middle (20.0) 25 (12.8) 47 (60.5) 43 (48.3) 29 (23.5) 34 Fourth * 24 (22.9) 35 * 21 (41.9) 31 (30.3) 33 Wealth index quintiles Richest * 21 (6.1) 33 * 24 (51.6) 31 (13.3) 30 Total 25.0 108 18.0 189 52.8 142 48.0 148 21.0 157 *Less than 25 children () number of cases from 20 to 25 ** MICS indicator 15 ***MICS indicator 17 **** MICS indicator 16 67 68 Table NU3.W Infant feeding patterns by age Percent distribution of children aged under 3 years by feeding pattern, Palestinians’ refugee camps, Lebanon, 2006 Infant feeding pattern Exclusive ly breastfed Breastfe d and plain water only Breastfe d and non-milk liquids Breastfe d and other milk/ formula Breastfed and other complimentar y foods Weaned (not breastfed ) Total Numbe r of childre n Age in months 0-1 (40.0) (8.9) (8.9) (24.4) (2.2) (15.6) 100.0 45 2-3 14.3 19.0 7.9 33.3 9.5 15.9 100.0 63 4-5 8.6 8.6 9.9 17.3 33.3 22.2 100.0 81 6-7 2.7 6.8 8.1 10.8 45.9 25.7 100.0 74 8-9 .0 2.9 4.4 4.4 60.3 27.9 100.0 68 10-11 1.3 5.2 2.6 7.8 50.6 32.5 100.0 77 12-13 .0 4.7 3.1 6.3 37.5 48.4 100.0 64 14-15 .0 .0 1.2 3.6 40.5 54.8 100.0 84 16-17 .0 .0 1.0 5.1 18.2 75.8 100.0 99 18-19 .0 .0 .0 1.3 13.9 84.8 100.0 79 20-21 .0 .0 1.2 6.1 17.1 75.6 100.0 82 22-23 .0 2.7 1.3 .0 13.3 82.7 100.0 75 24-25 .0 .0 1.2 .0 12.2 86.6 100.0 82 26-27 .0 .0 1.1 .0 5.4 93.5 100.0 93 28-29 .0 .0 .0 .0 3.3 96.7 100.0 90 30-31 .0 .0 .0 .0 1.4 98.6 100.0 70 32-33 .0 .0 .0 .0 1.5 98.5 100.0 67 34-35 .0 .0 .0 .0 4.7 95.3 100.0 107 Total 2.6 2.8 2.6 5.8 20.3 65.9 100.0 1400 () number of cases from 20 to 25 69 Table NU. 4: Adequately fed infants Percentage of infants under 6 months of age exclusively breastfed, percentage of infants aged 6-11 months who are breastfed and who ate solid/semi-solid food at least the minimum recommended number of times yesterday and percentage of infants who are adequately fed, Palestinians’ refugee camps, Lebanon, 2006 Percent of infants aged 0-5 months who are exclusively breastfed Percent of infants aged 6-8 months who received breast milk and complementary food at least 2 times in prior 24 hours Percent of infants aged 9- 11 months who received breast milk and complementary food at least 3 times in prior 24 hours Percent of infants aged 6- 11 months who received breast milk and complementary food at least the minimum recommended number of times per day** Percent of infants aged 0-11 months who were appropriately fed** Number of infants aged 0- 11 months Male 23.7 38.8 22.2 31.4 28.0 1153 Sex Female 12.0 41.5 15.8 26.5 19.5 1228 Tripoli 25.0 50.0 40.9 45.2 37.1 473 Beirut 11.8 38.9 10.0 23.7 18.1 492 Bekaa 14.3 58.3 33.3 47.6 34.3 142 Sidon 20.6 28.6 9.5 18.2 19.3 724 Governorates Sur 16.0 39.1 16.7 29.3 22.0 550 Urban 17.6 39.1 18.6 28.3 23.6 1808 Urban/ Rural Rural 19.1 42.9 21.4 34.3 25.6 573 None 33.3 50.0 .0 20.0 25.0 110 Basic 15.9 38.0 22.5 30.2 23.4 1811 Mother’s education Secondary+ 23.7 44.0 12.0 28.0 26.1 460 Poorest 20.0 58.8 35.7 48.4 34.4 429 Second 27.3 29.6 5.6 20.0 23.6 430 Middle 12.8 51.7 15.6 32.8 24.1 565 Fourth 22.9 21.1 13.6 17.1 19.7 494 Wealth index quintiles Richest 6.1 37.5 28.0 31.7 20.3 463 Total 18.0 39.8 18.9 29.2 24.0 2381 * MICS indicator 18 ** MICS indicator 19 70 Table NU.5 Iodized salt consumption Percentage of households consuming adequately iodized salt, Palestinians’ refugee camps, Lebanon, 2006 Percent of households with salt test result is Percent of households in which salt was tested Number of households interviewed <15 PPM 15+ PPM* Total Number of households in which salt was tested or with no salt Tripoli 100.0 1200 .3 99.7 100.0 1200 Beirut 100.0 1409 .1 99.9 100.0 1409 Bekaa 100.0 435 .2 99.8 100.0 435 Sidon 100.0 1826 .1 99.9 100.0 1826 Governorates Sur 95.0 1297 .1 99.9 100.0 1232 Urban 100.0 4796 .1 100.0 4796 Urban/ Rural Rural 95.3 1371 .2 99.8 100.0 1306 Poorest 95.6 1352 .2 99.8 100.0 1292 Second 99.8 1255 .1 99.9 100.0 1252 Middle 100.0 1257 .2 99.8 100.0 1257 Fourth 100.0 1191 .2 99.8 100.0 1191 Wealth index quintiles Richest 99.8 1112 .2 99.8 100.0 1110 Total 98.9 6167 .1 99.9 100.0 6102 *MICS indicator 41 71 Table NU.6: Children’s vitamin A Percent distribution of children aged 6-59 months by whether they have received a high dose vitamin A supplement in the last 6 months, Palestinians’ refugee camps, Lebanon, 2006 Percent of children who received vitamin A supplement Within last 6 months* Prior to last 6 months Not sure when Not sure if received vitamin A supplement Never received vitamin A supplement Total Number of children aged 6- 59 months Male 19.4 5.5 6.9 3.9 64.3 100.0 1056 Sex Female 20.2 4.8 5.9 4.9 64.2 100.0 1136 Tripoli 14.6 .7 2.7 .0 82.0 100.0 445 Beirut 34.5 .9 2.4 .4 61.8 100.0 458 Bekaa 28.1 3.1 16.4 4.7 47.7 100.0 128 Sidon 16.8 9.5 14.1 9.4 50.2 100.0 661 Governorate Sur 12.8 7.8 .6 5.4 73.4 100.0 500 Urban 22.3 5.3 8.2 4.3 59.9 100.0 1666 Urban/ Rural Rural 12.0 4.6 .6 4.9 77.9 100.0 526 6-11 months 24.2 3.7 6.4 3.7 62.1 100.0 219 12-23 months 25.3 4.8 5.2 5.2 59.6 100.0 483 24-35 months 20.0 8.1 5.1 3.1 63.7 100.0 509 36-47 months 14.4 4.4 9.6 4.8 66.7 100.0 520 Child age 48-59 months 17.8 3.9 5.4 5.0 67.9 100.0 461 None 25.0 8.7 1.0 7.7 57.7 100.0 104 Basic 19.4 4.9 6.8 4.9 64.0 100.0 1666 Mother’s education Secondary + 20.1 5.5 5.9 1.7 66.8 100.0 422 Poorest 19.5 7.0 2.3 3.8 67.4 100.0 399 Second 15.5 6.7 6.2 3.4 68.1 100.0 386 Middle 18.3 6.6 11.2 4.2 59.7 100.0 518 Fourth 22.4 2.0 6.3 6.5 62.7 100.0 459 Wealth index quintiles Richest 22.8 3.7 4.7 4.0 64.9 100.0 430 Total 19.8 5.2 6.4 4.4 64.2 100.0 2192 *MICS indicator 42 72 Table NU.7: Post-partum mothers' vitamin A supplementation Percentage of women aged 15-49 years with a live birth in the 2 years preceding the survey by whether they received a high dose vitamin A supplement before the infant was 8 weeks old, Palestinians’ refugee camps, Lebanon, 2006 Received vitamin A supplement** Not sure if received vitamin A Number of women aged 15-49 years Tripoli 19.8 1.1 177 Beirut 47.4 1.9 154 Bekaa 50.0 1.6 62 Sidon 33.8 4.2 331 Governorates Sur 37.3 .4 225 Urban 37.5 2.7 728 Urban/ Rural Rural 28.1 .5 221 None * * 21 Basic 35.9 2.5 722 Mother’s education Secondary + 31.1 1.5 206 Poorest 39.2 1.8 166 Second 41.5 1.1 183 Middle 35.6 3.0 233 Fourth 28.6 2.2 185 Wealth index quintiles Richest 31.9 2.7 182 Total 35.3 2.2 949 *Less than 25 cases **MICS indicator 43 73 Table NU.8: Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Palestinians’ refugee camps, Lebanon, 2006 Percent of live births below 2500 grams** Percent of live births weighed at birth *** Number of live births Tripoli 10.2 98.9 177 Beirut 5.8 99.4 154 Bekaa 8.0 93.5 62 Sidon 9.7 97.6 331 Governorate Sur 8.5 98.2 225 Urban 9.2 97.8 728 Urban/ Rural Rural 7.4 98.6 221 None * * 21 Basic 9.3 97.8 722 Mother’s education Secondary+ 6.4 98.5 206 Poorest 9.2 98.8 166 Second 10.5 96.7 183 Middle 8.1 98.7 233 Fourth 9.9 97.8 185 Wealth index quintiles Richest 6.2 97.8 182 Total 8.7 98.0 949 *Less than 25 cases ** MICS indicator 9 ***MICS indicator 10 74 Table CH.1: Vaccinations in first year of life Percentage of children aged 12-23 months with seen vaccination cards who were immunized against childhood diseases at any time before the survey and before the first birthday, Palestinians’ refugee camps, Lebanon, 2006 BCG* DPT1 DPT2 DPT3** Polio0 Polio1 Polio2 Polio3*** Measles**** All***** None Number of children aged 12- 23months Vaccinated at any time before the survey according to vaccination card 97.3 98.5 98.3 97.3 93.9 98.8 98.5 97.8 97.5 93.1 .0 408 *MICS indicator 25 **MICS indicator 27 ***MICS indicator 26 **** MICS indicator 28; MDG 15 *****MICS indicator 31 75 Table CH.2: Vaccinations by background characteristics Percentage of children aged 12-23 months with seen vaccination cards , who are currently vaccinated against childhood diseases, Palestinians’ refugee camps, Lebanon, 2006 BCG DPT 1 DPT2 DPT3 Polio0 Polio1 Polio2 Polio3 Measles All None Number of children aged 12-23 Male 94.6 97.8 97.3 97.3 92.9 97.8 98.4 98.9 98.4 91.3 .0 184 Sex Female 99.6 99.1 98.2 96.4 94.6 99.6 98.7 96.9 96.9 94.6 .0 224 Tripoli 97.9 100.0 100.0 100.0 99.0 100.0 100.0 100.0 100.0 97.9 .0 96 Beirut 91.1 100.0 98.2 100.0 91.1 100.0 100.0 100.0 100.0 89.3 .0 56 Bekaa 100.0 100.0 93.3 86.7 53.3 100.0 100.0 100.0 100.0 86.7 .0 15 Sidon 100.0 98.5 97.8 94.9 97.1 100.0 97.8 94.9 95.6 94.9 .0 136 Governorates Sur 96.2 96.2 96.2 96.2 92.4 95.2 97.1 98.1 96.2 89.5 .0 105 Urban 97.6 99.3 98.3 96.9 93.5 100.0 98.6 97.6 97.6 93.8 .0 292 Rural/ Urban Rural 96.6 96.6 96.6 96.6 94.8 95.7 98.3 98.3 97.4 91.4 .0 116 None 100.0 100.0 92.9 92.9 100.0 100.0 92.9 92.9 92.9 85.7 .0 14 Basic 96.6 98.8 98.4 97.8 92.8 98.4 99.1 98.8 98.4 93.5 .0 321 Mother’s education Secondary+ 100.0 97.3 95.9 93.2 97.3 100.0 97.3 94.5 94.5 93.2 .0 73 Poorest 97.3 97.3 93.3 96.0 92.0 97.3 97.3 100.0 98.7 94.7 .0 75 Second 92.3 97.4 100.0 96.2 84.6 96.2 100.0 97.4 97.4 84.6 .0 78 Middle 97.0 100.0 99.0 98.0 94.9 100.0 99.0 98.0 97.0 92.9 .0 99 Fourth 100.0 100.0 100.0 100.0 97.4 100.0 100.0 100.0 100.0 100.0 .0 78 Wealth index quintiles Richest 100.0 97.4 96.2 93.6 100.0 100.0 96.2 93.6 94.9 93.6 .0 78 Total 97.3 98.5 97.8 96.8 93.9 98.8 98.5 97.8 97.5 93.1 .0 408 *Less than 25 cases ()20-25 cases 76 Table CH.3: Neonatal tetanus protection Percent of mothers with a birth in the last 2 years prior to survey who were vaccinated against neonatal tetanus, Palestinians’ refugee camps, Lebanon, 2006 Percent of mothers with a birth in the last 2 years who received at least two doses in the last pregnancy Percent of mothers with a birth in the last 2 years who received at least 2 doses within prior three years Percent of mothers with a birth in the last 2 years who received at least 3 doses within prior 5 years Percent of mothers with a birth in the last 2 years who received at least 4 doses within prior 10 years Percent of mothers with a birth in the last 2 years who received at least 5 doses during lifetime Protected against tetanus** Number of women Tripoli 2.8 30.5 .0 .6 .0 33.9 177 Beirut 1.9 35.7 .0 .0 .6 38.3 154 Bekaa 6.5 32.3 .0 .0 .0 38.7 62 Sidon 6.9 23.3 .0 .0 .6 30.8 331 Governorates Sur 16.4 19.6 .0 .4 .4 36.9 225 Urban 6.2 29.4 .0 .1 .4 36.1 728 Urban/ Rural Rural 12.2 16.3 .0 .5 .5 29.4 221 15-19 (2.7) (10.8) (.0) (.0) (.0) (13.5) 37 20-24 4.3 13.4 .0 .0 1.1 18.7 187 25-29 6.8 28.5 .0 .0 .8 36.1 263 30-34 8.5 33.8 .0 .9 .0 43.2 213 35-39 11.6 30.5 .0 .0 .0 42.1 190 40-44 7.3 25.5 .0 .0 .0 32.7 55 Mother’s age 45-49 * * * * * * 4 None * * * * * * 21 Basic 7.1 26.5 .0 .3 .4 34.2 722 Mother’s education Secondary+ 7.8 27.7 .0 .0 .5 35.9 206 Poorest 9.0 20.5 .0 .0 .0 29.5 166 Second 9.8 27.3 .0 .5 1.1 38.8 183 Middle 10.3 22.7 .0 .4 .4 33.9 233 Fourth 3.8 34.6 .0 .0 .5 38.9 185 Wealth index quintiles Richest 4.4 26.9 .0 .0 .0 31.3 182 Total 7.6 26.3 .0 .2 .4 34.6 949 *Less than 25 () 25-50 cases **MICS indicator 32 77 78 Table CH.4: Oral rehydration treatment Percentage of children aged 0-59 months with diarrhea in the last two weeks who were treated with oral rehydration solution (ORS) or other oral rehydration treatment (ORT), Palestinians’ refugee camps, Lebanon, 2006 Percent of children who had diarrhea in the last two weeks prior to survey Number of children aged 0-59 Percent of children who had diarrhea in the last two weeks prior to survey who received ORS packet Percent of children who had diarrhea in the last two weeks prior to survey who received recommended homemade fluid Percent of children who had diarrhea in the last two weeks prior to survey who received prepackaged ORS fluid Percent of children who had diarrhea in the last two weeks prior to survey who received no treatment ORT use rate** Number of children aged 0- 59 months who had diarrhea Male 11.3 1153 20.8 64.6 31.5 23.8 76.2 130 Sex Female 8.6 1228 28.6 63.8 43.8 16.2 83.8 105 Tripoli 8.0 473 )21.1( )57.9( )47.4( )21.1( )78.9( 38 Beirut 7.9 492 )25.6( )56.4( )30.8( )25.6( )74.4( 39 Bekaa 19.0 142 )18.5( )81.5( )44.4( )11.1( )88.9( 27 Sidon 10.2 724 33.8 63.5 33.8 20.3 79.7 74 Governorate Sur 10.4 550 15.8 66.7 35.1 21.1 78.9 57 Urban 10.3 1808 26.3 62.4 36.6 21.5 78.5 186 Urban/ Rural Rural 8.6 573 )16.3( )71.4( )38.8( )16.3( )83.7( 49 <6 months 12.7 189 * * * * * 24 6- 11 months 22.4 219 (20.4) (55.1) (40.8) (26.5) (73.5) 49 12- 23 months 13.5 483 27.7 67.7 38.5 18.5 81.5 65 24-35 months 6.7 509 (29.4) (76.5) (32.4) (8.8) (91.2) 34 36-47 months 5.2 520 (18.5) (81.5) (33.3) (14.8) (85.2) 27 Child’s age 48- 59 months 7.8 461 (30.6) (72.2) (38.9) (11.1) (88.9) 36 None 5.5 110 * * * * * 6 Basic 10.9 1811 25.4 63.5 35.5 19.8 80.2 197 Mother’s education Secondary+ 7.0 460 )21.9( )68.8( )50.0( )21.9( )78.1( 32 Poorest 8.2 429 )20.0( )77.1( )51.4( )11.4( )88.6( 35 Second 13.7 430 22.0 59.3 32.2 25.4 74.6 59 Middle 12.0 565 26.5 69.1 36.8 14.7 85.3 68 Fourth 9.1 494 )33.3( )57.8( )33.3( )24.4( )75.6( 45 Wealth index quintiles Richest 6.0 463 )14.3( )57.1( )35.7( )28.6( )71.4( 28 Total 9.9 2381 24.3 64.3 37.0 20.4 79.6 235 ** MICS indicator 33 *Less than 25 cases ()25-50 cases 79 Table CH.5: Home management of diarrhea Percentage of children aged 0-59 months with diarrhea in the last two weeks who took increased fluids and continued to feed during the episode, Palestinians’ refugee camps, Lebanon, 2006 Percent of children who had diarrhea in last two weeks Number of children aged 0-59 months Children with diarrhea who drank more Children with diarrhea who drank more or less Children with diarrhea who ate the same or more Children with diarrhea who ate much less or none Home management of diarrhea** Received ORT or increased fluids AND continued feeding*** Children aged 0-59 months who had diarrhea in the last two week Male 11.3 1153 25.4 73.1 43.8 53.8 13.1 33.1 130 Sex Female 8.6 1228 24.8 75.2 31.4 68.6 8.6 23.8 105 Tripoli 8.0 473 )31.6( )68.4( )57.9( )42.1( )21.1( )44.7( 38 Beirut 7.9 492 )10.3( )89.7( )10.3( )89.7( ).0( )10.3( 39 Bekaa 19.0 142 )33.3( )66.7( )37.0( )59.3( )11.1( )29.6( 27 Sidon 10.2 724 21.6 78.4 47.3 52.7 8.1 28.4 74 Governorate Sur 10.4 550 31.6 64.9 33.3 63.2 15.8 31.6 57 Urban 10.3 1808 24.7 75.3 39.2 60.2 10.8 28.0 186 Urban/ Rural Rural 8.6 573 )26.5( )69.4( )34.7( )61.2( )12.2( )32.7( 49 0-11 months 17.9 408 11.0 87.7 46.6 50.7 6.8 27.4 73 12-23 months 13.5 483 27.7 70.8 26.2 72.3 9.2 23.1 65 24-35 months 6.7 509 (32.4) (67.6) (41.2) (58.8) (20.6) (41.2) 34 36-47 months 5.2 520 (29.6) (70.4) (40.7) (59.3) (18.5) (33.3) 27 Child 48-59 months 7.8 461 (38.9) (61.1) (38.9) (61.1) (8.3) (27.8) 36 None 5.5 110 * * * * * * 6 Basic 10.9 1811 26.4 72.6 38.1 60.4 11.2 29.4 197 Mother’s education Secondary+ 7.0 460 )15.6( )84.4( )40.6( )59.4( )12.5( )25.0( 32 Poorest 8.2 429 )20.0( )80.0( )28.6( )68.6( )8.6( )28.6( 35 Second 13.7 430 18.6 81.4 40.7 59.3 5.1 27.1 59 Middle 12.0 565 33.8 63.2 26.5 70.6 17.6 25.0 68 Fourth 9.1 494 )22.2( )77.8( )42.2( )57.8( )6.7( )24.4( 45 Wealth index quintiles Richest 6.0 463 )28.6( )71.4( )67.9( )32.1( )17.9( )50.0( 28 Total 9.9 2381 25.1 74.0 38.3 60.4 11.1 28.9 235 ** MICS indicator 34 ***MICS indicator 35 * Less than 25 () 25-50 cases 80 Table CH.6: Respiratory system infections Percentage of children aged 0-59 who had acute respiratory system infection within two weeks prior to the survey, Palestinians’ refugee camps, Lebanon, 2006 Had respiratory infection Number of children aged 0-59 Red Crescent Center UNRWA clinic Private hospital/ clinic Pharmacy Other Any appropriate healthcare provider* Number of children aged 0-59 who had respiratory infections Males 17.8 1153 2.9 28.3 42.4 3.7 2.0 47.6 378 Sex Females 16.5 1228 3.1 25.6 34.5 2.2 1.5 41.6 418 Tripoli 16.7 473 1.2 25.6 38.0 6.1 2.5 38.4 164 Beirut 14.8 492 .8 19.3 61.6 4.2 1.4 55.5 119 Bekaa 14.1 142 1.6 8.2 60.0 1.6 5.0 27.9 61 Sidon 20.2 724 3.2 43.4 32.9 1.4 1.4 63.0 219 Governorate Sur 16.4 550 5.6 21.0 24.4 1.7 1.1 30.0 233 Urban 17.1 1808 1.9 28.2 43.9 3.3 2.3 49.5 570 Urban/ Rural Rural 17.1 573 5.8 23.5 21.4 1.8 .0 31.9 226 0-11 months 18.6 408 3.3 28.7 44.7 2.0 .0 48.7 150 12-23 months 18.8 483 4.9 22.4 37.4 2.2 1.1 42.1 183 24-35 months 16.5 509 4.3 26.7 39.3 3.1 2.4 46.6 161 36-47 months 17.3 520 1.2 25.8 42.2 3.1 3.3 44.2 163 Age 48-59 months 14.5 461 .7 32.4 26.9 4.3 1.5 41.0 139 None 24.5 110 .0 27.3 33.3 .0 .0 47.7 44 Basic 17.6 1811 3.3 28.5 37.6 2.9 2.2 45.2 628 Mother’s education Secondary+ 13.5 460 2.4 18.5 45.2 4.0 .0 39.5 124 Poorest 15.9 429 4.4 23.5 26.5 .5 .0 31.7 183 Second 24.2 430 4.5 33.5 35.6 3.4 1.9 49.4 176 Middle 20.5 565 3.0 29.4 37.1 2.0 2.6 50.2 201 Fourth 12.3 494 1.8 24.8 44.3 4.4 1.6 48.7 113 Wealth index quintiles Richest 12.7 463 .0 20.3 54.2 5.7 1.7 43.1 123 Total 17.1 2381 3.0 26.9 38.5 2.9 1.7 44.5 796 *MICS indicator 23 () 25-50 cases 81 Table CH.7: Antibiotic treatment of pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment, Palestinians’ refugee camps, Lebanon, 2006 Percent of children with suspected pneumonia who received antibiotics in the two weeks prior to survey* Number of children aged 0-59 months with suspected pneumonia in the two weeks prior to the survey Male 66.8 205 Sex Female 67.5 203 Tripoli 36.7 79 Beirut 65.8 73 Bekaa 80.0 20 Sidon 80.8 146 Governorate Sur 70.0 90 Urban 71.6 310 Urban/Rural Rural 53.1 98 0-11 months 72.4 76 12-23 months 65.9 91 24-35 months 77.4 84 36-47 months 60.0 90 Child’s age 48-59 months 59.7 67 None 48.1 27 Basic 69.3 319 Mother’s education Secondary+ 64.5 62 Poorest 70.6 68 Second 63.5 104 Middle 62.1 116 Fourth 75.4 61 Wealth index quintiles Richest 71.2 59 Total 67.2 408 82 * MICS indicator 22 Table CH.7A: Knowledge of the two danger signs of pneumonia Percentage of mothers/caretakers of children aged 0-59 months by knowledge of types of symptoms for taking a child immediately to a health facility, and percentage of mothers/caretakers who recognize fast and difficult breathing as signs for seeking care immediately, Palestinians’ refugee camps, Lebanon 2006 Percentage of mothers/caretakers of children aged 0-59 months who think that a child should be taken immediately to a health facility if the child: Unable to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has difficulty breathing Has blood in stool Is drinking poorly Has other symptoms Mothers/caretakers who recognize the two danger signs of pneumonia Number of mothers/caretakers of children aged 0- 59 months Tripoli 8.0 41.6 88.6 9.9 21.1 10.1 0.4 4.0 1.7 473 Beirut 11.6 16.3 87.8 24.2 50.8 4.5 0.8 15.0 14.4 492 Bekaa 7.0 64.8 84.5 16.9 34.5 3.5 .0 21.8 4.2 142 Sidon 4.8 28.0 90.1 40.2 41.4 5.5 0.6 10.2 22.7 724 Governorates Sur 6.2 21.8 81.8 5.5 26.0 1.1 0.9 20.4 0.7 550 Urban 7.5 30.5 88.1 26.7 38.9 5.3 0.7 11.0 13.7 1808 Urban/ Rural Rural 6.8 24.6 83.8 5.1 24.1 4.4 0.5 19.5 .9 573 None 3.6 32.7 80.9 19.1 24.5 2.7 0.9 11.8 7.3 110 Basic 7.8 29.6 86.3 22.3 36.3 5.2 0.7 13.6 11.3 1811 Mother’s education Secondary+ 6.1 26.1 91.5 18.7 34.1 5.2 0.4 10.9 8.9 460 Poorest 5.8 29.6 77.4 8.6 27.0 4.2 0.5 18.9 4.2 429 Second 8.4 32.8 82.3 20.9 31.6 4.7 0.9 7.2 10.5 430 Middle 6.7 31.2 91.2 27.3 35.8 5.3 0.9 10.6 13.5 565 Fourth 7.1 27.3 89.7 27.7 41.5 5.9 .0 13.6 15.4 494 Wealth index quintiles Richest 8.6 24.4 92.7 20.1 39.5 5.2 0.9 15.3 8.2 463 Total 7.3 29.1 87.1 21.5 35.4 5.1 0.6 13.0 10.6 2381 83 Table CH.8: Solid fuel use Percent distribution of households according to type of cooking fuel, and percentage of households using solid fuels for cooking, Palestinians’ refugee camps, Lebanon 2006 Electricity Natural Gas Kerosene Wood Other source Total Solid fuels for cooking* Number of households Tripoli 3.3 96.3 0.4 .0 0.1 100.0 0.0 1200 Beirut 4.5 94.6 0.9 0.1 .0 100.0 0.1 1409 Bekaa 0.7 98.2 0.5 0.7 .0 100.0 0.7 435 Sidon 4.5 95.1 0.4 .0 .0 100.0 .0 1826 Governorates Sur 3.4 95.3 0.6 0.2 0.5 100.0 0.2 1297 Urban 4.0 95.4 0.5 0.1 .0 100.0 0.1 4796 Urban/ Rural Rural 3.0 95.6 0.7 0.2 0.5 100.0 0.2 1371 Poorest 6.1 90.9 2.1 0.5 0.3 100.0 0.5 1352 Second 5.6 94.0 .4 .0 .0 100.0 .0 1255 Middle 5.6 94.1 .0 .0 0.2 100.0 .0 1257 Fourth 0.4 99.6 .0 .0 .0 100.0 .0 1191 Wealth index quintiles Richest 0.2 99.8 .0 .0 .0 100.0 .0 1112 Total 3.7 95.5 .6 0.1 0.1 100.0 0.1 6167 84 Table EN.1: Use of improved water sources Percent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Palestinian refugee camps, Lebanon, 2006 Source of drinking water Improved sources Unimproved sources Piped into dwelling Piped into yard/ plot Public tap/ stand- pipe Tube- well/ bore- hole Protected well Protected spring Bottled water Tanker truck Bottled water1 Other Total Improved source of drinking water* Number of household members Tripoli 82.8 .7 .1 .2 .7 .2 10.7 4.3 .0 .3 100.0 95.3 6165 Beirut 2.4 .0 .1 .0 .2 .0 66.0 30.7 .3 .3 100.0 68.6 6086 Bekaa 83.8 .9 3.5 2.0 1.3 1.3 5.0 1.4 .3 .4 100.0 97.9 2108 Sidon 88.5 .2 .0 1.3 4.1 .1 3.3 1.5 .2 .8 100.0 97.5 8496 Governorate Sur 63.1 4.0 .7 5.5 1.4 .9 22.7 .3 .9 .4 100.0 98.4 6271 Urban 63.7 .2 .4 .7 1.8 .2 22.2 9.9 .4 .5 100.0 89.3 22359 Urban/ Rural Rural 62.9 4.0 .7 5.1 1.7 .9 22.4 1.6 .2 .4 100.0 97.7 6767 Poorest 66.5 4.5 .7 6.6 .7 .5 17.3 2.1 .1 .9 100.0 96.9 5820 Second 64.7 1.1 .5 1.4 .8 .6 24.8 5.5 .7 .0 100.0 93.8 5844 Middle 83.9 .0 .0 .5 1.5 .3 11.0 2.3 .2 .3 100.0 97.2 5884 Fourth 58.4 .0 .3 .0 2.3 .1 26.2 11.6 .3 .7 100.0 87.4 5754 Wealth index quintiles Richest 43.7 .0 .8 .3 3.6 .3 32.1 18.2 .3 .7 100.0 80.7 5824 Total 63.5 1.1 .5 1.8 1.8 .4 22.3 7.9 .3 .5 100.0 91.2 29126 *MICS indicator 11; MDG indicator 30 1 For households using bottled water as the main source of drinking water, the source used for other purposes such as cooking and handwashing is used to determine whether to classify the source as improved 85 Table EN.2: Household water treatment Percentage of household population according to drinking water treatment method used in the household, and percentage of household population that applied an appropriate water treatment method, Palestinian refugee camps, Lebanon, 2006 Water treatment method used in the household None Boil Add bleach/ chlorine Strain through a cloth Use water filter Let it stand and settle All drinking water sources Appropriate water treatment method* Number of household members Improved drinking water sources Appropriate water treatment method Number of household members Unimproved drinking water sources Appropriate water treatment method Number of household members Tripoli 87.1 2.1 .9 .6 8.4 .7 11.0 6165 11.4 5878 3.8 287 Beirut 98.4 .9 .0 .2 .4 .2 1.3 6086 1.6 4178 .6 1908 Bekaa 90.8 2.8 .2 .6 6.2 .0 8.4 2108 8.6 2064 .0 44 Sidon 94.3 .0 .0 .0 5.0 .0 5.0 8496 5.0 8282 8.9 214 Governorate Sur 79.2 .5 .0 .9 3.5 17.2 4.0 6271 3.9 6169 13.7 102 Urban 89.4 1.1 .2 .2 4.6 4.2 5.8 22359 6.3 19958 1.6 2401 Urban/ Rural Rural 92.3 .5 .1 1.0 4.2 3.0 4.8 6767 4.7 6613 11.0 154 Poorest 89.8 .9 .0 .9 4.0 5.4 5.0 5820 5.1 5639 .0 181 Second 92.7 1.1 .2 .4 3.5 2.6 4.5 5844 4.6 5483 3.3 361 Middle 91.9 .7 .2 .3 3.4 3.2 4.4 5884 4.4 5717 3.6 167 Fourth 90.4 1.2 .2 .1 4.2 3.7 5.3 5754 5.9 5030 1.4 724 Wealth Index quintiles Richest 85.8 .7 .5 .3 7.5 4.6 8.5 5824 10.0 4702 2.4 1122 Total 90.1 .9 .2 .4 4.5 3.9 5.5 29126 5.9 26571 2.2 2555 *MICS indicator 13 86 Table EN.3: Time to source of water Percent distribution of households according to time to go to source of drinking water, get water and return, and mean time to source of drinking water, Palestinian refugee camps, Lebanon, 2006 Time to source of drinking water Water on premises Water on premises 15 minutes to less than 30 minutes 30 minutes to less than 1 hour 1 hour or more Don't know Total Mean time to source of drinking water* Number of households Tripoli 84.5 8.5 5.0 .7 .7 .6 100.0 72.6 1200 Beirut 3.2 64.7 18.0 7.2 7.0 .0 100.0 14.8 1409 Bekaa 93.6 1.4 2.4 1.2 1.4 .0 100.0 373.1 435 Sidon 89.2 2.1 1.2 3.3 4.2 .0 100.0 38.4 1826 Governorate Sur 74.1 22.9 1.1 1.6 .4 .0 100.0 16.7 1297 Urban 63.6 22.0 6.8 3.5 4.0 .1 100.0 32.6 4796 Urban/ Rural Rural 73.1 22.1 2.3 1.9 .3 .1 100.0 16.3 1371 Poorest 78.7 14.2 4.2 1.7 1.2 .0 100.0 31.5 1352 Second 65.4 17.6 10.2 2.9 3.8 .1 100.0 35.5 1255 Middle 82.8 12.0 2.2 1.5 1.5 .0 100.0 32.8 1257 Fourth 54.7 31.6 6.2 3.8 3.6 .1 100.0 21.5 1191 Wealth index quintiles Richest 42.5 37.6 6.7 6.5 6.1 .5 100.0 30.9 1112 Total 65.7 22.0 5.8 3.2 3.1 .1 100.0 29.8 6167 * The mean time to source of drinking water is calculated based on those households that do not have water on the premises. 87 Table EN.4: Person collecting water Percent distribution of households according to the person collecting drinking water used in the household, Palestinian refugee camps, Lebanon, 2006 Person collecting drinking water Adult woman Adult man Female child under age 15 Male child under age 15 Don't know Total Number of households Tripoli 27.6 70.4 .5 1.0 .5 100.0 199 Beirut 12.4 82.2 1.9 3.5 .0 100.0 1385 Bekaa (24.4) (73.3) (2.2) (.0) (.0) 100.0 45 Sidon 7.5 90.5 .0 1.0 1.0 100.0 201 Governorate Sur 47.5 42.9 4.9 4.3 .3 100.0 345 Urban 14.1 81.2 1.6 2.8 .2 100.0 1797 Urban/ Rural Rural 43.1 47.9 4.5 4.2 .3 100.0 378 Poorest 29.4 59.2 5.7 5.7 .0 100.0 299 Second 15.3 78.8 2.4 3.3 .2 100.0 458 Middle 23.7 69.7 .4 5.3 .9 100.0 228 Fourth 18.9 76.1 2.2 2.8 .0 100.0 544 Wealth index quintiles Richest 15.8 82.0 .8 1.2 .2 100.0 646 Total 19.2 75.4 2.1 3.1 .2 100.0 2175 () Number of cases 25 - 50 88 Table EN.4: Use of sanitary means of excreta disposal Percent distribution of household population according to type of toilet facility used by the household, and the percentage of household population using sanitary means of excreta disposal, Palestinian refugee camps, Lebanon, 2006 Type of toilet facility used by household Improved sanitation facility Unimproved sanitation facility Piped sewer system Septic tank Pit latrine Other Total Percentage of population using sanitary means of excreta disposal* Number of household members Tripoli 98.3 .2 1.3 .1 100.0 99.9 6165 Beirut 99.1 .9 .0 .0 100.0 100.0 6086 Bekaa 79.6 19.1 1.2 .0 100.0 100.0 2108 Sidon 99.7 .3 .0 .0 100.0 100.0 8496 Governorate Sur 48.0 43.0 8.8 .2 100.0 99.8 6271 Urban 97.2 2.2 .6 .0 100.0 100.0 22359 Urban /Rural Rural 52.0 39.8 8.0 .3 100.0 99.7 6767 Poorest 47.4 41.9 10.5 .2 100.0 99.8 5820 Second 86.6 12.6 .9 .0 100.0 100.0 5844 Middle 99.5 .3 .0 .1 100.0 99.9 5884 Fourth 100.0 .0 .0 .0 100.0 100.0 5754 Wealth index quintiles Richest 100.0 .0 .0 .0 100.0 100.0 5824 Total 86.7 11.0 2.3 .1 100.0 99.9 29126 *MICS indicator 12; MDG indicator 31 89 Table EN.5: Use of improved water sources and improved sanitation Percentage of household population using both improved drinking water sources and sanitary means of excreta disposal, Palestinian refugee camps, Lebanon, 2006 Using improved sources of drinking water* Using sanitary means of excreta disposal** Using improved sources of drinking water and using sanitary means of excreta disposal*** Number of household members Tripoli 95.3 99.9 95.2 6165 Beirut 68.6 100.0 68.6 6086 Bekaa 97.9 100.0 97.9 2108 Sidon 97.5 100.0 97.5 8496 Governorate Sur 98.4 99.8 98.2 6271 Urban 89.3 100.0 89.3 22359 Urban/ Rural Rural 97.7 99.7 97.4 6767 Poorest 96.9 99.8 96.7 5820 Second 93.8 100.0 93.8 5844 Middle 97.2 99.9 97.0 5884 Fourth 87.4 100.0 87.4 5754 Wealth index quintiles Richest 80.7 100.0 80.7 5824 Total 95.3 91.2 99.9 29126 *MICS indicator 11; MDG indicator 30 **MICS indicator 12; MDG indicator 31 90 Table RH.1: Use of contraception Percentage of women aged 15-49 years currently married or in union who are using (or whose partner is using) a contraceptive method, Palestinian refugee camps, Lebanon, 2006 Percent of women currently married who are using: Not using any method Female sterilization Pill IUD Condom Withdrawal Periodic abstinence Other Total Any modern method Any traditional method Any method* Number of women currently married Tripoli 37.8 2.5 12.4 29.9 9.1 1.4 3.2 3.8 100.0 53.8 8.4 62.2 693 Beirut 29.5 .5 22.8 22.0 7.7 12.1 2.9 2.5 100.0 53.1 17.5 70.5 801 Bekaa 32.5 3.7 11.8 33.7 7.3 2.0 6.5 2.4 100.0 56.5 11.0 67.5 246 Sidon 31.2 1.9 24.1 22.8 5.4 8.0 4.0 2.6 100.0 54.2 14.6 68.8 1162 Governorate Sur 29.2 3.0 27.3 22.3 4.1 6.2 5.5 2.4 100.0 56.8 14.1 70.8 761 Urban 31.3 1.7 21.4 24.8 7.0 7.1 4.0 2.7 100.0 54.8 13.9 68.7 2888 Urban/ Rural Rural 33.3 3.5 21.7 24.0 4.4 5.9 4.5 2.7 100.0 53.5 13.2 66.7 775 15-19 77.5 .0 17.5 3.8 .0 .0 .0 1.3 100.0 21.3 1.3 22.5 80 20-24 51.8 .0 19.2 12.3 6.3 7.2 2.1 1.2 100.0 37.7 10.5 48.2 334 25-29 33.7 .0 27.3 20.3 8.5 4.4 2.2 3.7 100.0 56.1 10.2 66.3 597 30-34 27.3 .7 24.3 27.8 7.4 5.3 4.9 2.3 100.0 60.2 12.6 72.7 748 35-39 20.2 2.6 24.3 29.8 7.1 7.6 5.4 3.0 100.0 63.8 16.0 79.8 846 40-44 27.6 4.4 15.7 30.1 5.1 10.3 4.1 2.8 100.0 55.3 17.2 72.4 682 Woman’s age 45-49 43.4 4.8 13.3 18.9 4.0 7.4 5.1 3.2 100.0 41.0 15.7 56.6 376 0 91.0 .0 2.4 3.9 1.2 .8 .4 .4 100.0 7.5 1.6 9.0 255 1 64.1 .3 17.9 4.6 4.6 5.8 1.8 .9 100.0 27.4 8.5 35.9 329 2 31.3 .0 23.6 21.0 10.3 6.9 3.9 3.0 100.0 54.9 13.7 68.7 466 3 24.1 .4 24.6 27.2 7.4 8.5 4.8 3.0 100.0 59.5 16.3 75.9 692 Number of living children 4+ 21.1 3.7 23.0 30.7 6.2 7.3 4.8 3.2 100.0 63.6 15.3 78.9 1921 None 42.4 4.0 22.5 18.5 3.3 7.3 .0 2.0 100.0 48.3 9.3 57.6 151 Basic 31.7 2.2 21.7 25.2 6.1 6.8 3.8 2.7 100.0 55.0 13.3 68.3 2807 Woman’s level of education Secondary+ 29.5 1.1 20.4 23.7 8.8 7.2 6.1 3.1 100.0 54.0 16.5 70.5 705 Poorest 32.1 3.8 22.8 22.0 6.6 6.3 4.3 2.2 100.0 55.1 12.8 67.9 624 Second 33.2 1.8 20.2 24.6 6.1 8.0 3.8 2.3 100.0 52.6 14.2 66.8 684 Middle 31.5 1.8 19.5 29.3 5.4 6.4 3.5 2.6 100.0 56.0 12.5 68.5 778 Fourth 34.5 1.9 22.0 22.3 7.0 6.5 3.0 2.8 100.0 53.2 12.3 65.5 741 Wealth index quintiles Richest 28.0 1.3 22.8 24.3 7.2 7.2 5.7 3.5 100.0 55.6 16.4 72.0 836 Total 31.7 2.0 21.5 24.6 6.5 6.9 4.1 2.7 100.0 54.6 13.7 68.3 3663 * MICS indicator 21, MDG indicator 19c 91 92 Table RH.2: Antenatal care provider Percent distribution of women aged 15-49 who gave birth in the two years preceding the survey by type of personnel providing antenatal care, Palestinian refugee camps Lebanon, 2006 Person providing antenatal care Medical doctor Nurse/ midwife Relative/ friend Other/Missing Total Any skilled personnel Number of women who gave birth in the preceding two years Tripoli 59.9 31.6 .0 8.5 100.0 91.5 177 Beirut 84.4 15.6 .0 .0 100.0 100.0 154 Bekaa 75.8 22.6 .0 1.6 100.0 98.4 62 Sidon 55.9 23.0 20.8 .3 100.0 78.9 331 Governorate Sur 59.6 38.7 .0 1.8 100.0 98.2 225 Urban 65.0 23.5 9.5 2.1 100.0 88.5 728 Urban/ Rural Rural 58.4 38.9 .0 2.7 100.0 97.3 221 15-19 (67.6) (16.2) (16.2) (.0) 100.0 (83.8) 37 20-24 67.4 25.1 4.8 2.7 100.0 92.5 187 25-29 63.9 26.2 8.4 1.5 100.0 90.1 263 30-34 59.2 30.5 7.0 3.3 100.0 89.7 213 35-39 64.2 26.3 7.9 1.6 100.0 90.5 190 40-44 58.2 34.5 3.6 3.6 100.0 92.7 55 Woman’s age 45-49 * * * * 100.0 100.0 4 None * * * * 100.0 100.0 21 Basic 62.5 26.7 8.0 2.8 100.0 89.2 722 Woman’s education Secondary 67.0 27.2 5.3 .5 100.0 94.2 206 Poorest 60.8 36.1 .6 2.4 100.0 97.0 166 Second 70.5 26.2 2.2 1.1 100.0 96.7 183 Middle 54.1 34.3 9.0 2.6 100.0 88.4 233 Fourth 64.9 17.8 14.6 2.7 100.0 82.7 185 Wealth index quintiles Richest 69.2 19.8 8.8 2.2 100.0 89.0 182 Total 63.4 27.1 7.3 2.2 100.0 90.5 949 * less than 25 () between 25 and 50 ** * MICS indicator 20 93 Table RH.3: Antenatal care Percentage of pregnant women receiving antenatal care among women aged 15-49 years who gave birth in two years preceding the survey and percentage of pregnant women receiving specific care as part of the antenatal care received, Palestinian refugee camps, Lebanon, 2006 Percent of pregnant women who had: Percent of pregnant women receiving ANC one or more times during pregnancy Blood test taken Blood pressure measured Urine specimen taken Weight measured Number of women who gave birth in two years preceding survey Tripoli 100.0 96.6 97.7 95.5 100.0 177 Beirut 100.0 97.4 94.8 97.4 100.0 154 Bekaa 100.0 95.2 96.8 93.5 98.4 62 Sidon 99.7 96.4 98.5 97.0 99.1 331 Governorate Sur 99.6 91.1 93.8 89.3 95.6 225 Urban 99.9 96.0 97.1 96.3 99.0 728 Urban/ Rural Rural 99.5 92.8 94.6 89.6 96.8 221 15-19 (100.0) (100.0) (97.3) (94.6) (100.0) 37 20-24 99.5 94.1 96.3 94.1 99.5 187 25-29 100.0 97.0 97.3 96.2 99.2 263 30-34 99.5 96.7 95.8 95.3 98.1 213 35-39 100.0 92.6 97.4 93.7 97.9 190 40-44 100.0 92.7 94.5 92.7 94.5 55 Woman’s age 45-49 * * * * * 4 None * * * * * 21 Basic 99.7 95.2 96.4 93.8 98.3 722 Woman’s level of education Secondary + 100.0 95.6 97.1 98.1 99.0 206 Poorest 100.0 92.8 94.0 92.2 96.4 166 Second 99.5 97.3 96.2 95.1 97.8 183 Middle 100.0 94.0 97.9 92.3 100.0 233 Fourth 99.5 95.1 97.3 95.7 97.8 185 Wealth index quintiles Richest 100.0 97.3 96.7 98.9 100.0 182 Total 99.8 95.3 96.5 94.7 98.5 949 * Number of cases is less than 25 cases () Number of cases between 25 and 50 cases ** * MICS indicator 44 94 Table RH.4: Assistance during delivery Percent distribution of women aged 15-49 with a birth in two years preceding the survey by type of personnel assisting at delivery, Palestinian, Lebanon, 2006 Person assisting at delivery Medical doctor Nurse/ midwife Auxiliary midwife Traditional birth attendant Other Total Any skilled personnel* Delivered in health facility** Number of women who gave birth in preceding two years Tripoli 55.9 42.4 .6 .6 .6 100.0 98.9 98.3 177 Beirut 74.0 26.0 .0 .0 .0 100.0 100.0 99.4 154 Bekaa 85.5 14.5 .0 .0 .0 100.0 100.0 95.2 62 Sidon 52.9 45.6 .0 1.5 .0 100.0 98.5 96.4 331 Governorate Sur 62.7 37.3 .0 .0 .0 100.0 100.0 98.7 225 Urban 62.5 36.8 .0 .5 .1 100.0 99.3 97.1 728 Urban/ Rural Rural 57.5 41.2 .5 .9 .0 100.0 99.1 99.5 221 15-19 (70.3) (29.7) (.0) (.0) (.0) 100.0 (100.0) (94.6) 37 20-24 63.1 36.9 .0 .0 .0 100.0 100.0 98.9 187 25-29 55.1 43.7 .0 .8 .4 100.0 98.9 97.7 263 30-34 65.3 33.8 .5 .5 .0 100.0 99.5 97.2 213 35-39 61.1 37.9 .0 1.1 .0 100.0 98.9 97.9 190 40-44 63.6 34.5 .0 1.8 .0 100.0 98.2 96.4 55 Woman’s age 45-49 * * * * * 100.0 * * 4 None * * * * * 100.0 * * 21 Primary 59.7 39.3 .1 .7 .1 100.0 99.2 98.2 722 Woman’s level of education Secondary + 68.0 31.6 .0 .5 .0 100.0 99.5 96.6 206 Poorest 61.4 38.6 .0 .0 .0 100.0 100.0 98.2 166 Second 62.8 37.2 .0 .0 .0 100.0 100.0 97.3 183 Middle 53.6 45.5 .4 .4 .0 100.0 99.6 98.3 233 Fourth 59.5 37.8 .0 2.7 .0 100.0 97.3 96.8 185 Wealth index quintiles Richest 71.4 28.0 .0 .0 .5 100.0 99.5 97.8 182 Total 61.3 37.8 .1 .6 .1 100.0 99.3 97.7 949 * Number of cases is less than 25 cases () Number of cases between 25 and 50 cases ** MICS indicator 4; MDG indicator 17 ** *MICS indicator 5 95 Table RH.5: Maternal mortality ratio Lifetime risk of maternal death and proportion of dead sisters dying of maternal causes, Palestinian refugee camps, Number of adult household respondents Sisters who reached age 15 Sisters who reached age 15 (adjusted) Sisters who reached aged 15 and who died Maternal deaths Adjustment factor Sister units of risk exposure Lifetime risk of maternal death Proportion of dead sisters dying of maternal causes Total fertility rate for girls at the age 10-14 Maternal mortality ratio* 15-19 82 215 757 1 0 .107 81 .000 .0 . . 20-24 342 923 3248 15 2 .206 669 .003 13.3 . . 25-29 610 1925 6775 38 0 .343 2324 .000 .0 . . 30-34 789 2859 2859 51 5 .503 1438 .003 9.8 . . 35-39 890 3503 3503 126 8 .664 2326 .003 6.3 . . 40-44 775 2735 2735 124 9 .802 2193 .004 7.3 . . Respondent’s age 45-49 465 1752 1752 113 6 .900 1577 .004 5.3 . . Total 3953 13912 21629 468 30 . 10608 .003 6.4 5.50 51 *MICS indicator 3; MDG indicator 16 96 Table CD.1: Family support for learning Percentage of children aged 0-59 months for whom household members are engaged in activities that promote learning and school readiness, Palestinian refugee camps, Lebanon, 2006 Number of children aged 0-59 months For whom household members engaged in four or more activities that promote learning and school readiness* Mean number of activities household members engage in with the child For whom the father engaged in one or more activities that promote learning and school readiness** Mean number of activities the father engaged in with the child Living in a household without their natural father Number of children aged 0-59 months Male 63.7 1.2 6.0 .1 1.0 1153 Sex Female 65.2 1.2 5.9 .1 .5 1228 Tripoli 55.8 .9 5.9 .1 .4 473 Beirut 68.9 1.2 14.0 .1 .2 492 Bekaa 59.2 1.0 4.2 .1 .0 142 Sidon 79.3 1.5 4.4 .1 .8 724 Governorate Sur 50.0 1.1 1.3 .0 1.6 550 Urban 70.5 1.3 7.2 .1 .4 1808 Urban/ Rural Rural 45.7 .9 2.1 .0 1.9 573 0-23 months 58.7 .9 3.1 .0 .6 891 Age 24-59 months 68.0 1.4 7.7 .1 .9 1490 None 47.3 .9 5.5 .1 4.5 110 Basic 62.9 1.2 5.8 .1 .7 1811 Mother’s education Secondary + 74.8 1.3 6.7 .1 .0 460 Poorest 50.6 1.1 2.6 .0 1.2 429 Second 64.4 1.2 4.2 .1 .0 430 Middle 66.2 1.2 4.6 .1 1.2 565 Fourth 69.4 1.3 6.1 .1 1.0 494 Wealth index quintiles Richest 70.2 1.2 12.3 .1 .2 463 Total 64.5 1.2 6.0 .1 .8 2381 *MICS indicator 46 **MICS Indicator 47 97 Table CD.2: Learning materials Percentage of children aged 0-59 months living in households containing learning materials, Palestinian refugee camps, Lebanon, 2006 Child plays with: 3 or more non- children's books* 3 or more children's books** Household objects Objects and materials found outside the home Home- made toys Toys that came from a store No playthings mentioned 3 or more types of playthings *** Number of children aged 0 – 59 months Male 18.7 19.6 43.9 34.3 38.0 69.6 .0 30.6 1153 Sex Female 16.3 23.1 50.7 26.1 36.6 71.5 .0 31.4 1228 Tripoli 15.0 12.7 23.0 17.3 27.3 64.1 .0 3.4 473 Beirut 9.3 31.3 56.9 50.6 35.2 60.6 .0 40.7 492 Bekaa 26.1 18.3 39.4 43.7 54.9 59.9 .0 38.7 142 Sidon 19.8 29.6 69.3 29.0 64.2 74.2 .0 57.3 724 Governorate Sur 21.6 10.2 33.1 20.5 7.8 83.1 .0 9.5 550 Urban 16.7 24.6 50.9 33.0 45.0 68.6 .0 38.7 1808 Urban/ Rural Rural 19.9 11.3 36.3 20.8 12.9 76.8 .0 6.8 573 0-23 months 9.7 18.2 38.3 12.3 29.3 57.1 .0 17.7 891 Age 24-59 months 22.1 23.4 52.9 40.7 42.1 78.6 .0 38.9 1490 None 8.2 23.6 49.1 25.5 30.9 67.3 .0 21.8 110 Basic 16.8 20.8 48.7 30.9 37.7 71.1 .0 31.9 1811 Mother’s education Secondary + 22.4 23.3 42.0 28.0 37.2 69.3 .0 29.8 460 Poorest 16.1 14.0 40.6 21.9 17.2 71.8 .0 12.6 429 Second 17.4 19.5 45.1 25.8 32.6 69.1 .0 30.5 430 Middle 16.5 22.7 48.7 29.9 47.3 71.7 .0 36.6 565 Fourth 19.2 26.5 49.0 36.0 42.7 71.7 .0 34.8 494 Wealth index quintiles Richest 18.1 23.1 52.7 35.4 42.3 68.3 .0 37.6 463 Total 17.5 21.4 47.4 30.1 37.3 70.6 .0 31.0 2381 *MICS indicator 49 **MICS indicator 48 ***MICS indicator 50 98 Table CD.3: Children left alone or with other children Percentage of children aged 0-59 months left in the care of other children under the age of 10 years or left alone in the past week, Palestinian refugee camps, 2006 Left in the care of children under the age of 10 years in past week* Left alone in the past week Left with inadequate care in past week* Number of children aged 0-59 months Male 18.6 5.8 19.9 1153 Sex Female 18.0 4.4 18.6 1228 Tripoli 19.7 10.4 21.6 473 Beirut 9.1 4.3 10.4 492 Bekaa 25.4 .7 25.4 142 Sidon 29.8 5.4 31.1 724 Governorate Sur 8.2 2.0 8.2 550 Urban 21.0 5.3 22.1 1808 Urban/ Rural Rural 9.6 4.4 10.3 573 0-23 months 11.0 3.4 12.2 891 Age 24-59 months 22.6 6.1 23.5 1490 None 24.5 8.2 25.5 110 Basic 19.1 5.1 20.2 1811 Mother’s education Secondary + 13.7 4.3 14.3 460 Poorest 12.6 2.6 12.8 429 Second 15.8 5.3 17.7 430 Middle 23.5 7.4 24.4 565 Fourth 19.6 5.3 20.6 494 Wealth index quintiles Richest 17.9 4.1 19.0 463 Total 18.3 5.1 19.3 2381 *MICS indicator 51 99 Table CD.4: Child living arrangements and orphanhood Percentage distribution of children aged 0-17 years old by living arrangements and children aged 0-17 years who live in households without their parents and percent of orphans, in Palestinian refugee camps, Lebanon, 2006 Not living with parents Living with mother Living with mother Living with both parents Both parents are dead Father is dead Mother is dead Total Not living with any of his parents At least one parent is dead** دﺪﻋ لﺎﻔﻃﻷا Male 96.1 .2 3.1 .6 100.0 .2 3.9 6102 Sex Female 96.3 .1 2.8 .8 100.0 .1 3.7 5828 Tripoli 96.2 .3 2.8 .6 100.0 .3 3.8 2539 Beirut 96.3 .0 3.2 .4 100.0 .0 3.7 2301 Bekaa 96.7 .4 2.2 .7 100.0 .4 3.3 826 Sidon 95.6 .1 2.9 1.3 100.0 .1 4.4 3574 Governorate Sur 96.7 .0 3.2 .1 100.0 .0 3.3 2690 Urban 96.3 .1 2.8 .8 100.0 .1 3.7 9036 Urban/ Rural Rural 95.9 .1 3.5 .5 100.0 .1 4.1 2894 0-4 years 99.1 .0 .7 .2 100.0 .0 .9 2431 5-9 years 97.6 .1 1.8 .5 100.0 .1 2.4 3327 10-14 95.6 .2 3.4 .9 100.0 .2 4.4 3858 Age 15-17 92.1 .3 6.3 1.2 100.0 .3 7.8 2314 Poorest 94.3 .3 4.6 .7 100.0 .3 5.7 2271 Second 95.7 .1 2.9 1.3 100.0 .1 4.2 2307 Middle 96.7 .2 2.9 .2 100.0 .2 3.3 2511 Fourth 96.0 .0 3.3 .7 100.0 .0 4.0 2372 Wealth index quintiles Richest 98.1 .1 1.3 .5 100.0 .1 1.9 2469 Total 96.2 .1 3.0 .7 100.0 .1 3.8 11930 *MICS indicator 78 **MICS indicator 75 100 Table ED.1: Early childhood education Percentage of children aged 36-59 months who are attending some form of organized early childhood education program and percentage of first graders who attended pre-school, Palestinian refugee camps, Lebanon, 2006 Percentage of children aged 36-59 months currently attending early childhood education** Number of children aged 36-59 months Percentage of children attending first grade who attended preschool program in previous year*** Number of children attending first grade Male 62.4 479 94.3 211 Sex Female 60.8 502 90.3 206 Tripoli 69.3 202 97.2 109 Beirut 66.5 206 97.4 76 Bekaa 53.2 62 93.9 33 Sidon 57.0 291 96.9 128 Governorate Sur 58.2 220 70.4 71 Urban 63.1 732 96.2 338 Urban/ Rural Rural 57.0 249 75.9 79 36-47 months 48.5 520 . 0 48-59 months 76.4 461 . 0 5 years . 0 92.3 417 Child’ age 6 years 47.3 188 83.1 59 Poorest 60.6 170 90.8 76 Second 59.1 230 94.9 118 Middle 64.6 212 90.1 91 Fourth 76.8 181 100.0 73 Wealth index quintiles Richest 62.4 479 94.3 211 Total 61.6 981 92.3 417 *less than 25 ()25-50 cases ** MICS indicator 52 *** MICS indicator 53 101 Table ED.2: Primary school entry Percentage of children at primary school entry age who are attending grade 1, Palestinian refugee camps, Lebanon, 2006 Percentage of children of primary school entry age currently attending grade 1* Number of children of primary school entry age Male 72.9 306 Sex Female 74.2 302 Tripoli 83.0 135 Beirut 74.6 122 Bekaa (75.6) 45 Sidon 76.9 169 Governorate Sur 58.4 137 Urban 77.7 466 Urban/ Rural Rural 59.9 142 Child’s age 6 years 73.5 608 Poorest 61.2 103 Second 72.9 118 Middle 78.1 155 Fourth 75.4 126 Wealth index quintiles Richest 77.4 106 Total 73.5 608 () Number of cases between 25- 50 cases *MICS indicator 54 102 Table ED.3: Primary school net attendance ratio Percentage of children at primary school age** who are attending primary or secondary school (preparatory/ secondary) (net attendance ratio), Palestinian refugee camps, Lebanon, 2006 Male Females Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio* Number of children Tripoli 95.6 456 95.9 440 95.8 896 Beirut 95.1 430 94.1 355 94.6 785 Bekaa 98.1 158 95.7 138 97.0 296 Sidon 93.7 618 95.9 585 94.8 1203 Governorate Sur 93.9 444 92.1 430 93.0 874 Urban 94.9 1600 95.3 1492 95.1 3092 Urban/ Rural Rural 94.5 506 92.8 456 93.7 962 6 77.0 291 76.7 300 76.8 591 7 98.4 315 97.5 281 98.0 596 8 98.6 358 98.4 320 98.5 678 9 98.1 377 98.3 303 98.2 680 10 96.8 407 97.8 415 97.3 822 Age in years 11 96.4 358 97.9 329 97.1 687 Poorest 96.1 382 93.6 360 94.9 742 Second 93.3 405 93.4 365 93.4 770 Middle 93.7 428 95.1 430 94.4 858 Fourth 95.3 444 94.7 378 95.0 822 Wealth index quintiles Richest 95.5 447 96.4 415 95.9 862 Total 94.8 2106 94.7 1948 94.7 4054 *MICS indicator 55 ؛ MDG indicator 6 103 Table ED.4: Secondary school net attendance ratio Percentage of children of secondary school age** attending secondary school or higher (NAR), Palestinian refugee camps, Lebanon, 2006 Male Female Total Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio* Number of children Tripoli 58.3 499 64.1 496 61.2 995 Beirut 59.4 433 67.0 412 63.1 845 Bekaa 57.0 193 63.5 159 59.9 352 Sidon 65.1 707 68.2 657 66.6 1364 Governorate Sur 60.8 582 64.8 525 62.7 1107 Urban 61.9 1789 67.2 1682 64.5 3471 Urban/ Rural Rural 58.2 625 62.3 567 60.2 1192 12 41.1 394 43.8 390 42.5 784 13 71.4 398 71.2 375 71.3 773 14 77.7 444 78.7 348 78.2 792 15 66.5 427 78.4 389 72.2 816 16 55.0 407 65.9 378 60.3 785 Age in years 17 50.3 344 58.8 369 54.7 713 Poorest 53.9 514 57.4 451 55.5 965 Second 55.1 497 60.8 469 57.9 966 Middle 58.1 468 66.0 420 61.8 888 Fourth 67.5 443 67.5 425 67.5 868 Wealth index quintiles Richest 71.1 492 77.5 484 74.3 976 Total 61.0 2414 65.9 2249 63.4 4663 *MICS indicator 56 104 Table ED.4w: Secondary school age children attending primary school Percentage of children of secondary school age attending primary school, Palestinian refugee camps, Lebanon, 2006 Male Female Total Percent attending primary school Number of children Percent attending primary school Number of children Percent attending primary school Number of children Tripoli 14.4 499 14.7 496 14.6 995 Beirut 9.0 433 11.4 412 10.2 845 Bekaa 17.1 193 18.9 159 17.9 352 Sidon 12.4 707 15.1 657 13.7 1364 Governorate Sur 14.6 582 14.1 525 14.4 1107 Urban 12.6 1789 14.2 1682 13.4 3471 Urban/ Rural Rural 14.6 625 14.8 567 14.7 1192 12 53.6 394 52.6 390 53.1 784 13 17.1 398 20.3 375 18.6 773 14 6.1 444 8.6 348 7.2 792 15 1.9 427 2.8 389 2.3 816 16 .2 407 .3 378 .3 785 Age in years 17 .6 344 .0 369 .3 713 Poorest 15.6 514 16.2 451 15.9 965 Second 12.3 497 15.6 469 13.9 966 Middle 16.0 468 13.6 420 14.9 888 Fourth 9.9 443 16.2 425 13.0 868 Wealth index quintiles Richest 11.6 492 10.5 484 11.1 976 Total 13.1 2414 14.4 2249 13.7 4663 105 Table ED.5: Children reaching grade 5 Percentage of children entering first grade of primary school who eventually reach grade 5, Palestinian refugee camps, Lebanon, 2006 Percent attending 2nd grade who were in 1st grade last year Percent attending 3rd grade who were in 2nd grade last year Percent attending 4th grade who were in 3rd grade last year Percent attending 5th grade who were in 4th grade last year Percent who reach grade 5 of those who enter 1st grade* Male 99.7 100.0 99.7 99.1 98.6 Sex Female 99.3 99.1 98.8 99.2 96.4 Tripoli 97.8 99.4 100.0 98.8 96.1 Beirut 100.0 100.0 99.3 100.0 99.3 Bekaa 100.0 100.0 100.0 100.0 100.0 Sidon 100.0 99.5 100.0 99.2 98.7 Governorate Sur 100.0 99.1 95.5 98.0 92.7 Urban 99.8 99.6 99.8 99.3 98.6 Urban/ Rural Rural 98.1 99.3 96.2 98.3 92.0 Poorest 100.0 98.9 95.6 97.9 92.5 Second 100.0 99.2 99.3 100.0 98.5 Middle 99.3 99.4 100.0 98.8 97.4 Fourth 99.2 100.0 100.0 98.7 98.0 Wealth index quintiles Richest 99.3 100.0 100.0 100.0 99.3 Total 99.5 99.6 99.3 99.1 97.5 *MICS indicator 57 ؛ MDG indicator 7 106 Table ED.6: Primary school completion and transition rate to secondary education Primary school completion rate and transition rate to secondary education, Palestinian refugee camps, Lebanon, 2006 Net primary school completion rate* Number of children of primary school completion age Transition rate to secondary education** Number of children who were in the last grade of primary school the previous year Male 33.5 358 73.8 248 Sex Female 41.6 329 74.0 269 Tripoli 48.6 138 75.8 99 Beirut 40.0 125 90.4 94 Bekaa 54.8 42 84.2 38 Sidon 41.3 218 85.9 149 Governorate Sur 16.5 164 45.3 137 Urban 41.9 516 84.9 371 Urban/ Rural Rural 24.0 171 45.9 146 Poorest 16.8 131 38.5 104 Second 32.8 134 69.0 87 Middle 41.1 129 85.9 85 Fourth 49.0 145 88.9 117 Wealth index quintiles Richest 45.3 148 84.7 124 Total 37.4 687 73.9 517 *MICS indicator 59 ؛ MDG indicator 7b **MICS indicator 58 Note: Secondary refers to preparatory and secondary schools as one educational stage 107 Table ED.7: Education gender parity Ration of girls to boys attending primary education and ratio of girls to boys attending secondary education, Palestinian refugee camps, Lebanon, 2006 Primary school net attendance ratio (NAR), girls Primary school net attendance ratio (NAR), boys Gender parity index (GPI) for primary school NAR* Secondary school net attendance ratio (NAR), girls Secondary school net attendance ratio (NAR), boys Gender parity index (GPI) for secondary school NAR* Male . 94.8 . . 61.0 . Sex Female 94.7 . . 65.9 . . Tripoli 95.9 95.6 1.00 64.1 58.3 1.10 Beirut 94.1 95.1 .99 67.0 59.4 1.13 Bekaa 95.7 98.1 .98 63.5 57.0 1.11 Sidon 95.9 93.7 1.02 68.2 65.1 1.05 Governorate Sur 92.1 93.9 .98 64.8 60.8 1.06 Urban 95.3 94.9 1.00 67.2 61.9 1.08 Urban/ Rural Rural 92.8 94.5 .98 62.3 58.2 1.07 Poorest 93.6 96.1 .97 57.4 53.9 1.07 Second 93.4 93.3 1.00 60.8 55.1 1.10 Middle 95.1 93.7 1.02 66.0 58.1 1.13 Fourth 94.7 95.3 .99 67.5 67.5 1.00 Wealth index quintiles Richest 96.4 95.5 1.01 77.5 71.1 1.09 Total 94.6 94.8 1.00 65.8 61.2 1.08 *MICS indicator 61 ؛ MDG indicator 9 108 Table ED.8: Adult literacy Percentage of women aged 15-24 years who are literate, Palestinian refugee camps, Lebanon, 2006 Percentage of literate women** Number of women aged 15-24 years Tripoli 87.1 70 Beirut 87.1 93 Bekaa * 19 Sidon 89.5 153 Governorate Sur 88.8 89 Urban 87.7 332 Urban/ Rural Rural 89.1 92 None * 6 Primary 87.1 349 Woman’s education Secondary+ 100.0 69 15-19 84.1 82 Woman’s age 20-24 88.9 342 Poorest 82.4 74 Second 87.5 96 Middle 88.7 115 Fourth 90.7 75 Wealth index quintiles Richest 90.6 64 Total 88.0 424 * Number of cases less than 25 * *MICS indicator 60 ؛ MDG indicator 8 109 Table CP.1: Birth registration Percent distribution of children aged 0-59 months by whether birth is registered and reasons for non-registration, Palestinian refugee camp, Lebanon, 2006 Percentage of children aged 0-59 months whose birth is not registered because Birth is registered ** Not sure if birth is registered Number of children aged 0- 59 months Costs too much Must travel too far Doesn’t know where to register Other Don’t know Total Number of children aged 0-59 months without birth registration Male 98.4 .2 1153 * * * * * 100.0 17 Sex Female 98.3 .3 1228 * * * * * 100.0 17 Tripoli 97.9 1.1 473 * * * * * 100.0 6 Beirut 99.0 0.0 492 * * * * * 100.0 5 Bekaa 97.2 0.7 142 * * * * * 100.0 3 Sidon 99.2 0.0 724 * * * * * 100.0 6 Governorate Sur 97.5 0.0 550 * * * * * 100.0 14 Urban 98.7 0.3 1808 * * * * * 100.0 19 Urban/ Rural Rural 97.4 0.0 573 * * * * * 100.0 15 0-11 96.1 .2 408 * * * * * 100.0 15 12-23 98.8 .4 483 * * * * * 100.0 4 24-35 98.6 .0 509 * * * * * 100.0 7 36-47 98.8 .2 520 * * * * * 100.0 6 Child’s age in months 48-59 99.1 .4 461 * * * * * 100.0 2 None 95.5 1.8 110 * * * * * 100.0 3 Primary 98.2 0.2 1811 )17.2( )20.7( )6.9( )51.7( ) 3.4( 100.0 29 Mother’s education Secondary+ 99.6 0.0 460 * * * * * 100.0 2 Poorest 94.4 0.5 429 * * * * * 100.0 22 Second 99.3 .0 430 * * * * * 100.0 3 Middle 99.3 0.2 565 * * * * * 100.0 3 Fourth 99.0 0.6 494 * * * * * 100.0 3 Wealth index quintiles Richest 99.4 0.0 463 * * * * * 100.0 3 Total 98.4 .3 2381 )14.7( )26.5( )11.8( )44.1( )2.9( 100.0 34 * Number of cases is less than 25 () Number of cases between 25-50 cases **MICS indicator 62 110 Table CP.2: Child labour Percentage of children aged 5-14 years who are involved in child labour activities by type of work, Palestinian refugee camps, Lebanon, 2006 Working outside household Household chores for 28+ hours/ week Working for family business Total child labour* Number of children aged 5-14 years Male .9 .4 .7 1.8 3742 Sex Female .1 .9 .1 1.1 3443 Tripoli .8 .3 .5 1.3 1575 Beirut .8 .3 .5 1.4 1388 Bekaa .4 .0 .2 .6 498 Sidon .5 1.4 .6 2.4 2174 Governorate Sur .2 .5 .2 .8 1550 Urban .6 .7 .5 1.7 5486 Urban/ Rural Rural .2 .5 .2 .9 1699 5-11 .1 .4 .4 1.0 4836 Child’s age in years 12-14 1.4 1.1 .5 2.6 2349 Yes .1 .6 .4 1.1 6792 Attending school No 7.9 .5 1.8 8.9 393 Poorest .2 .5 .5 1.1 1320 Second .7 1.0 .7 2.3 1375 Middle .7 .9 .5 2.1 1506 Fourth .5 .6 .2 1.2 1457 Wealth index quintiles Richest .6 .2 .3 .9 1527 Total .5 .6 .4 1.5 7185 *MICS indicator 71 111 Table CP.3: Labourer students and student labourers Percentage of children aged 5-14 years who are labourer students and student labourers, Palestinian refugee camps, Lebanon, 2006 Percentage of children in child labour Percentage of children attending school Number of children 5-14 years of age Percentage of child labourers who are also attending school* Number of child labourers aged 5-14 Percentage of students who are also involved in child labour** Number of students aged 5- 14 Male 1.8 93.6 3742 55.1 69 1.1 3503 Sex Female 1.1 95.5 3443 89.7 39 1.1 3289 Tripoli 1.3 93.6 1575 38.1 21 .5 1474 Beirut 1.4 94.6 1388 63.2 19 .9 1313 Bekaa .6 94.0 498 .0 3 .0 468 Sidon 2.4 94.5 2174 82.7 52 2.1 2054 Governorate Sur .8 95.7 1550 76.9 13 .7 1483 Urban 1.7 94.3 5486 67.4 92 1.2 5176 Urban/ Rural Rural .9 95.1 1699 68.8 16 .7 1616 5-11 1.0 96.5 4836 91.3 46 .9 4668 Age in years 12-14 2.6 90.4 2349 50.0 62 1.5 2124 Poorest 1.1 93.8 1320 86.7 15 1.1 1238 Second 2.3 92.8 1375 71.0 31 1.7 1276 Middle 2.1 93.4 1506 61.3 31 1.4 1407 Fourth 1.2 95.2 1457 66.7 18 .9 1387 Wealth index quintiles Richest .9 97.2 1527 53.8 13 .5 1484 Total 1.5 94.5 7185 67.6 108 1.1 6792 * MICS indicator 72 ** MICS indicator 73 112 Table CP.4: Child discipline Percentage of children aged 2-14 years according to method of disciplining the child, Palestinian refugee camps, Lebanon, 2006 Percentage of children 2-14 years of age who experience: Only non- violent discipline Psychologic al punishment Minor physical punishme nt Severe physical punishme nt Any psychologic al or physical punishment* No discipline or punishme nt Mother/care taker believes that the child needs to be physically punished Number of children aged 2- 14 years** Male 3.6 91.8 79.8 27.5 95.9 .5 24.5 1686 Sex Female 4.8 88.4 74.3 27.5 94.2 .8 22.0 1511 Tripoli 6.6 87.8 73.1 32.2 92.6 .8 41.1 609 Beirut 4.0 91.8 75.0 10.6 96.0 .0 18.6 708 Bekaa 3.9 90.9 73.5 30.4 94.3 1.7 40.0 230 Sidon 2.2 93.0 83.3 31.7 97.7 .1 6.5 966 Governorate Sur 5.1 86.4 75.7 34.1 93.0 1.6 30.4 684 Urban 3.2 91.6 78.9 28.1 96.1 .6 22.0 2502 Urban/ Rural Rural 7.5 85.2 71.2 25.5 91.5 .7 28.1 695 2-4 3.5 86.8 78.7 28.0 94.9 1.6 22.1 371 5-9 4.0 90.5 83.0 27.8 95.3 .6 24.8 1285 Age in years 10-14 4.4 90.7 72.0 27.2 95.0 .5 22.3 1541 Poorest 5.8 89.2 72.9 27.9 93.7 .5 30.1 584 Second 3.8 90.5 74.5 27.6 95.0 .9 28.4 580 Middle 3.3 91.1 82.0 33.0 95.6 1.1 18.6 639 Fourth 3.3 91.9 79.0 27.4 96.3 .4 20.8 667 Wealth index quintiles Richest 4.7 88.3 76.9 22.4 94.9 .4 20.1 727 Total 4.2 90.2 77.2 27.5 95.1 .7 23.3 3197 * MICS indicator 74 113 Table CP.5: Early marriage Percentage of women aged 15-49 years in marriage before their 15th birthday, percentage of women aged 20-49 years in marriage before their 18th birthday, percentage of women aged 15-19 years currently married, Palestinian refugee camps, Lebanon, 2006 Percentage married before age 15* Number of women aged 15-49 years Percentage married before age 18* Number of women aged 20- 49 years Percentage of women 15-19 married** Number of women aged 15-19 years Tripoli 5.8 753 37.4 740 3.3 369 Beirut 3.8 880 27.8 862 5.8 325 Bekaa 2.7 261 29.2 257 3.7 134 Sidon 4.7 1225 35.1 1190 6.8 514 Governorate Sur 6.1 836 30.8 824 2.6 416 Urban 4.5 3102 32.2 3035 5.1 1322 Urban/ Rural Rural 6.1 853 34.1 838 3.2 436 15-19 8.5 82 . 0 4.7 1758 20-24 3.8 342 31.0 342 25-29 3.9 610 35.2 610 30-34 4.6 790 32.4 790 35-39 4.2 891 33.4 891 40-44 5.8 775 33.0 775 Woman’s age 45-49 6.7 465 28.6 465 None 12.5 176 34.3 175 2.2 45 Basic 5.2 3024 37.9 2948 5.8 1320 Woman’s education Secondary+ 1.7 755 11.5 750 1.3 393 Poorest 6.9 711 33.2 699 3.1 358 Second 6.7 750 31.6 725 6.6 381 Middle 4.6 829 32.7 805 7.1 337 Fourth 4.1 801 31.5 788 4.5 308 Wealth index quintiles Richest 2.7 864 34.1 856 2.1 374 Total 4.9 3955 32.6 3873 4.7 1758 * MICS indicator 67 ** MICS indicator 68 *** MICS indicator 70 114 Table HA.1: Knowledge of preventing HIV transmission Percentage of women aged 15-49 years who know the main ways of preventing HIV transmission, Palestinian refugee camps, Lebanon, 2006 Heard of AIDS Abstaining from sex Number of women Tripoli 87.5 34.9 753 Beirut 94.5 18.5 880 Bekaa 95.4 31.8 261 Sidon 88.5 19.3 1225 Governorate Sur 96.7 42.3 836 Urban 91.5 23.2 3102 Urban/ Rural Rural 93.2 44.5 853 15-19 82.9 22.0 82 20-24 91.2 28.1 342 25-29 91.1 25.1 610 30-34 93.2 25.3 790 35-39 93.3 31.4 891 40-44 92.3 28.9 775 Woman’s age 45-49 89.0 27.7 465 None 75.6 21.6 176 Basic 91.4 29.0 3024 Woman’s education Secondary+ 97.4 24.6 755 Poorest 91.4 40.1 711 Second 89.3 27.7 750 Middle 88.4 24.0 829 Fourth 93.0 25.8 801 Wealth index quintiles Richest 96.5 23.3 864 Total 91.8 27.8 3955 115 Table HA.2: Identifying misconceptions about HIV/AIDS Percentage of women aged 15-49 years who correctly identify misconceptions about HIV/AIDS, Palestinian refugee camps, Lebanon, 2006 Percent of women who know that: HIV cannot be transmitted by supernatural means HIV cannot be transmitted by sharing food A healthy looking person can be infected Reject two most common misconceptions and know a healthy- looking person can be infected Percent of women who know that HIV cannot be transmitted by mosquito bites Percent of women who know that HIV can be transmitted by sharing needles Number of women Tripoli 77.0 62.9 28.8 19.5 39.0 84.6 753 Beirut 82.7 77.7 29.1 24.3 51.6 90.8 880 Bekaa 76.2 79.3 49.8 40.2 47.5 90.0 261 Sidon 67.4 73.6 38.9 29.2 48.4 86.1 1225 Governorate Sur 72.6 86.6 52.6 37.8 56.5 93.4 836 Urban 75.7 74.0 37.7 29.3 49.1 88.3 3102 Urban/ Rural Rural 69.4 81.6 40.9 27.0 48.5 90.2 853 15-19 57.3 68.3 20.7 17.1 35.4 81.7 82 20-24 77.5 76.6 38.6 31.6 43.9 88.3 342 25-29 75.2 75.2 38.0 29.0 50.0 87.9 610 30-34 74.2 77.2 41.6 29.4 49.2 91.0 790 35-39 76.8 78.6 37.8 30.1 54.1 90.3 891 40-44 71.4 74.1 38.2 27.1 49.4 87.6 775 Woman’s age 45-49 74.4 70.8 37.8 28.2 42.8 85.8 465 None 56.3 56.8 25.6 17.6 44.3 71.6 176 Basic 72.7 74.9 36.9 27.2 46.6 88.1 3024 Woman’s education Secondary+ 85.2 82.9 47.5 37.7 59.6 95.1 755 Poorest 68.4 75.8 46.0 31.6 45.6 87.3 711 Second 71.3 75.1 36.0 27.2 50.8 85.6 750 Middle 70.8 71.8 33.3 25.6 45.2 85.0 829 Fourth 77.0 74.8 35.2 26.5 47.6 91.0 801 Wealth index quintiles Richest 82.8 80.3 42.1 33.2 55.1 93.8 864 Total 74.3 75.6 38.4 28.8 49.0 88.7 3955 116 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission Percentage of women aged 15-49 years who have comprehensive knowledge of HIV/AIDS transmission, Palestinian refugee camps, Lebanon, 2006 Know 2 ways to prevent HIV transmission Correctly identify 3 misconceptions about HIV transmission Have comprehensive knowledge (identify 2 prevention methods and 3 misconceptions)* Number of women Tripoli 37.8 19.5 10.2 753 Beirut 76.7 24.3 20.1 880 Bekaa 50.6 40.2 25.7 261 Sidon 51.3 29.2 19.8 1225 Governorate Sur 59.9 37.8 26.2 836 Urban 58.5 29.3 21.2 3102 Urban/ Rural Rural 47.6 27.0 14.4 853 15-19 43.9 17.1 12.2 82 20-24 55.0 31.6 21.1 342 15-24 52.8 28.8 19.3 424 25-29 54.9 29.0 19.5 610 30-34 56.3 29.4 19.9 790 35-39 60.3 30.1 21.5 891 40-44 53.5 27.1 18.1 775 Woman’s age 45-49 57.0 28.2 19.8 465 None 43.2 17.6 12.5 176 Basic 54.8 27.2 18.5 3024 Woman’s education Secondary+ 64.5 37.7 26.5 755 Poorest 49.5 31.6 19.5 711 Second 48.5 27.2 16.8 750 Middle 50.5 25.6 18.6 829 Fourth 60.4 26.5 18.4 801 Wealth index quintiles Richest 69.7 33.2 25.0 864 Total 56.2 28.8 19.8 3955 * MICS indicator 82; MDG indicator 19b 117 Table HA.4: Knowledge of mother-to-child HIV transmission Percentage of women aged 15-49 years who correctly identify means of HIV transmission from mother to child, Palestinian refugee camps, Lebanon, 2006 Percent who know AIDS can be transmitted: Percent of women who knew that AIDS can be transmitted from mother to child During pregnancy At delivery Through breast milk All three ways* Did not know any specific way Number of women Tripoli 85.3 83.8 65.9 46.1 44.4 2.3 753 Beirut 91.1 90.6 78.1 47.4 44.9 3.4 880 Bekaa 92.0 90.4 65.5 47.9 38.7 3.4 261 Sidon 87.0 86.9 67.3 47.0 43.0 1.5 1225 Governorate Sur 91.6 90.7 63.2 53.1 51.1 5.1 836 Urban 89.1 88.6 67.8 45.7 42.3 2.4 3102 Urban/ Rural Rural 88.3 86.5 70.6 57.6 55.2 5.0 853 15-19 81.7 81.7 54.9 41.5 39.0 1.2 82 20-24 88.9 88.3 69.3 50.6 45.9 2.3 342 25-29 87.9 85.9 68.2 43.9 40.2 3.3 610 30-34 90.0 89.6 67.5 45.9 42.7 3.2 790 35-39 90.3 89.9 68.5 52.1 48.7 2.9 891 40-44 88.5 87.9 69.9 50.2 47.6 3.9 775 Woman’s age 45-49 87.5 86.9 69.5 46.9 45.2 1.5 465 None 69.3 68.8 50.0 35.8 34.7 6.3 176 Basic 88.3 87.5 68.0 49.1 45.8 3.2 3024 Woman’s education Secondary+ 96.0 95.4 74.4 47.9 44.8 1.3 755 Poorest 84.8 84.2 65.5 50.9 49.4 6.6 711 Second 86.3 85.2 70.7 52.0 48.5 3.1 750 Middle 85.4 85.0 60.8 43.8 39.9 3.0 829 Fourth 91.6 91.1 69.5 44.9 41.8 1.5 801 Wealth index quintiles Richest 95.4 94.2 75.1 50.2 46.6 1.2 864 Total 88.9 88.2 68.4 48.3 45.1 3.0 3955 *MICS indicator 89 118 Table HA.5: Attitudes toward people living with HIV/AIDS Percentage of women aged 15-49 years who have heard of AIDS who express a discriminatory attitude towards people living with HIV/AIDS, Palestinian refugee camps, Lebanon, 2006 Percent of women who: Would not care for a family member who was sick with AIDS Believe that a teacher with HIV should not be allowed to work Would not buy food from a person with HIV/AIDS Agree with at least one discriminatory statement Agree with none of the discriminatory statements* Number of women who have heard of AIDS Tripoli 5.2 62.1 56.8 58.0 88.0 12.0 659 Beirut 2.3 63.2 42.8 31.5 83.9 16.1 832 Bekaa 9.6 45.0 43.8 42.6 75.5 24.5 249 Sidon 5.4 35.0 45.2 38.2 73.6 26.4 1084 Governorate Sur 4.3 46.9 46.9 39.4 80.6 19.4 808 Urban 4.7 48.8 47.5 39.6 79.8 20.2 2837 Urban/ Rural Rural 4.7 52.8 45.3 45.2 81.9 18.1 795 15-19 4.4 45.6 47.1 48.5 88.2 11.8 68 20-24 3.5 54.8 44.6 39.4 82.7 17.3 312 25-29 5.0 50.7 46.8 36.7 79.5 20.5 556 30-34 5.0 50.1 49.3 41.0 81.0 19.0 736 35-39 4.6 46.7 46.7 43.9 78.6 21.4 831 40-44 4.6 48.4 47.0 39.0 79.4 20.6 715 Woman’s age 45-49 5.1 52.7 45.9 42.5 81.6 18.4 414 None 9.8 51.1 54.1 51.9 90.2 9.8 133 Primary 4.5 49.9 48.0 42.4 80.6 19.4 2764 Woman’s education Secondary+ 4.5 48.8 42.0 32.7 77.1 22.9 735 Poorest 7.8 50.9 44.0 42.0 81.4 18.6 650 Second 2.5 55.8 44.3 40.4 83.1 16.9 670 Middle 6.1 44.2 50.2 42.6 79.1 20.9 733 Fourth 3.8 47.1 50.1 44.7 80.0 20.0 745 Wealth index quintiles Richest 3.6 51.0 46.0 35.1 78.3 21.7 834 Total 4.7 49.7 47.0 40.8 80.3 19.7 3632 *MICS indicator 86 119 Table HA.6: Knowledge of a facility for HIV testing Percentage of women aged 15-49 years who know where to get an HIV test, percentage of women who have been tested and, of those tested the percentage who have been told the result, Palestinian refugee camps, Lebanon, 2006 Know a place to get tested* Number of women Tripoli 19.3 753 Beirut 55.6 880 Bekaa 16.1 261 Sidon 14.6 1225 Governorate Sur 23.4 836 Urban 29.9 3102 Urban/ Rural Rural 14.5 853 15-19 18.3 82 20-24 22.8 342 25-29 29.2 610 30-34 27.1 790 35-39 25.8 891 40-44 26.8 775 Woman’s age 45-49 27.5 465 None 18.2 176 Primary 24.3 3024 Woman’s education Secondary+ 37.7 755 Poorest 18.6 711 Second 26.4 750 Middle 17.5 829 Fourth 30.3 801 Wealth index quintiles Richest 38.5 864 Total 26.6 3955 *MICS indicator 87 120 Appendix A. Sample Design The major features of sample design are described in this appendix. Sample design features include target sample size, sample allocation, sample frame and listing, choice of domains, and sampling stages. The primary objective of the sample design for the Palestinians’ Refugee Camps in Lebanon Multiple Indicator Cluster Survey was to produce statistically reliable estimates of most indicators, at the national level, for urban and rural areas, and for the five regions (Tripoli, Beirut, Bekaa, Sidon and Sur). Sample Size and Sample Allocation The target sample size for the Palestinians’ Refugee Camps in Lebanon MICS was calculated as 6200 households. For the calculation of the sample size, the key indicator used was the diarrhoea prevalence among children aged 0-4 years. The following formula was used to estimate the required sample size for these indicators: [ 4 (r) (1-r) (f) (1.1) ] n = [ (0.12r)2 (p) (nh) ] where • n is the required sample size, expressed as number of households • 4 is a factor to achieve the 95 per cent level of confidence • r is the predicted or anticipated prevalence (coverage rate) of the indicator • 1.1 is the factor necessary to raise the sample size by 10 per cent for non- response • f is the shortened symbol for deff (design effect) • 0.12r is the margin of error to be tolerated at the 95 per cent level of confidence, defined as 12 per cent of r (relative sampling error of r) • p is the proportion of the total population upon which the indicator, r, is based • nh is the average household size. For the calculation, r (diarrhoea prevalence) was assumed to be 16 percent. The value of deff (design effect) was taken as 1.5 based on estimates from previous surveys, p (percentage of children aged 0-4 years in the total population) was taken as 12 percent, and nh (average household size) was taken as 5.2 households. Sampling Frame and Selection of Clusters The sample population (based on the Palestinian Refugee Camps and Gatherings in Lebanon Census of 1999) was divided into equal clusters each containing 20 households (totaling 1300 121 clusters). Sample clusters (310 clusters, i.e. 6200 households) were drawn with uniformity, random start and a sampling fraction of 0.25. Table SD.1: Distribution of Sample Households by Governorate Area Sample size (households) Tripoli 1200 Beirut 1420 Bekaa 440 Sidon 1840 Sur 1300 Total 6200 122 Appendix B. Estimates of Sampling Errors The sample of respondents selected in the Palestinians’ Refugee Camps in Lebanon Multiple Indicator Cluster Survey is only one of the samples that could have been selected from the same population, using the same design and size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. The extent of variability is not known exactly, but can be estimated statistically from the survey results. The following sampling error measures are presented in this appendix for each of the selected indicators: ƒ Standard error (se): Sampling errors are usually measured in terms of standard errors for particular indicators (means, proportions etc). Standard error is the square root of the variance. The Taylor linearization method is used for the estimation of standard errors. ƒ Coefficient of variation (se/r) is the ratio of the standard error to the value of the indicator ƒ Design effect (deff) is the ratio of the actual variance of an indicator, under the sampling method used in the survey, to the variance calculated under the assumption of simple random sampling. The square root of the design effect (deft) is used to show the efficiency of the sample design. A deft value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a deft value above 1.0 indicates the increase in the standard error due to the use of a more complex sample design. ƒ Confidence limits are calculated to show the interval within which the true value for the population can be reasonably assumed to fall. For any given statistic calculated from the survey, the value of that statistics will fall within a range of plus or minus two times the standard error (p + 2.se or p – 2.se) of the statistic in 95 percent of all possible samples of identical size and design. For the calculation of sampling errors from MICS data, SPSS Version 14 Complex Samples module has been used. The results are shown in the tables that follow. In addition to the sampling error measures described above, the tables also include weighted and unweighted counts of denominators for each indicator. Sampling errors are calculated for indicators of primary interest, for the national total and for each of the five regions. Two of the selected indicators are based on households, 7 are based on household members, 8 are based on women, and 12 are based on children under 5. All indicators presented here are in the form of proportions. Table SE.1 shows the list of indicators for which sampling errors are calculated, including the base population (denominator) for each indicator. Tables SE.2 to SE.7 show the calculated sampling errors. 123 Table SE.1: Indicators selected for sampling error calculations List of indicators selected for sampling error calculations, and base populations (denominators) for each indicator, Palestinians’ Refugee Camps in Lebanon, 2006 MICS Indicator Base Population HOUSEHOLDS 41 Iodized salt consumption All households 74 Child discipline Children aged 2-14 years selected HOUSEHOLD MEMBERS 11 Use of improved drinking water sources All household members 12 Use of improved sanitation facilities All household members 55 Net primary school attendance rate Children of primary school age 56 Net secondary school attendance rate Children of secondary school age 59 Primary completion rate Children of primary school completion age 71 Child labour Children aged 5-14 years 75 Prevalence of orphans Children aged under 18 WOMEN 4 Skilled attendant at delivery Women aged 15-49 years with a live birth in the last 2 years 20 Antenatal care Women aged 15-49 years with a live birth in the last 2 years 21 Contraceptive prevalence Women aged 15-49 currently married 60 Adult literacy Women aged 15-24 years 63 Prevalence of female genital mutilation/cutting (FGM/C) Women aged 15-49 years 67 Marriage before age 18 Women aged 20-49 years 70 Polygyny Women aged 15-49 years currently married 82 Comprehensive knowledge about HIV prevention among young people Women aged 15-24 years 86 Attitude towards people with HIV/AIDS Women aged 15-49 years 89 Knowledge of mother- to-child transmission of HIV Women aged 15-49 years UNDER-5s 6 Underweight prevalence Children under age 5 25 Tuberculosis immunization coverage Children aged 12-23 months 26 Polio immunization coverage Children aged 12-23 months 27 Immunization coverage for DPT Children aged 12-23 months 28 Measles immunization coverage Children aged 12-23 months 31 Fully immunized children Children aged 12-23 months - Acute respiratory infection in last two weeks Children under age 5 22 Antibiotic treatment of suspected pneumonia Children under age 5 with suspected pneumonia in the last 2 weeks - Diarrhoea in last two weeks Children under age 5 35 Received ORT or increased fluids and continued feeding Children under age 5 with diarrhoea in the last 2 weeks 46 Support for learning Children under age 5 62 Birth registration Children under age 5 124 Table SE.2: Sampling errors: Total sample Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Palestinians’ Refugee Camps in Lebanon, 2006 Confidence limits Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.999 0.001 0.001 1.224 1.106 6102 6102 0.997 1.000 Child discipline CP.4 0.950 0.004 0.005 1.287 1.134 3282 3282 0.942 0.959 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.912 0.008 0.008 4.600 2.145 29126 6167 0.897 0.928 Use of improved sanitation facilities EN.5 0.999 0.000 0.000 1.248 1.117 29126 6167 0.999 1.000 Net primary school attendance rate ED.3 0.947 0.004 0.004 1.166 1.080 4054 4054 0.940 0.955 Net secondary school attendance rate ED.4 0.634 0.009 0.015 1.786 1.336 4663 4663 0.615 0.653 Primary completion rate ED.6 0.374 0.019 0.050 1.019 1.009 687 687 0.337 0.411 Child labour CP.2 0.015 0.002 0.151 2.504 1.582 7185 7185 0.010 0.020 Prevalence of orphans HA.10 0.038 0.003 0.082 3.192 1.787 11930 11930 0.032 0.044 WOMEN Skilled attendant at delivery RH.5 0.993 0.003 0.003 0.861 0.928 949 949 0.987 0.998 Antenatal care RH.3 0.905 0.009 0.010 0.885 0.941 949 949 0.887 0.923 Contraceptive prevalence RH.1 0.683 0.008 0.012 1.197 1.094 3663 3663 0.666 0.700 Adult literacy ED.8 0.880 0.014 0.015 0.737 0.858 424 424 0.853 0.907 Marriage before age 18 CP.5 0.326 0.009 0.027 1.355 1.164 3873 3873 0.309 0.344 Comprehensive knowledge about HIV prevention among young people HA.3 0.198 0.008 0.040 1.527 1.236 3955 3955 0.182 0.213 Attitude towards people with HIV/AIDS HA.5 0.197 0.009 0.045 1.785 1.336 3632 3632 0.180 0.215 Knowledge of mother- to-child transmission of HIV HA.4 0.451 0.010 0.023 1.760 1.327 3955 3955 0.430 0.472 UNDER-5s Underweight prevalence NU.1 0.046 0.005 0.099 0.896 0.946 1892 1892 0.037 0.055 Tuberculosis immunization coverage CH.2 0.973 0.009 0.009 1.165 1.079 408 408 0.956 0.990 Polio immunization coverage CH.2 0.978 0.007 0.007 0.913 0.955 408 408 0.964 0.992 Immunization coverage for DPT CH.2 0.973 0.007 0.007 0.755 0.869 406 406 0.959 0.987 Measles immunization coverage CH.2 0.975 0.008 0.008 1.030 1.015 408 408 0.960 0.991 Fully immunized children CH.2 0.931 0.011 0.011 0.711 0.843 408 408 0.910 0.953 Acute respiratory infection in last two weeks CH.6 0.171 0.010 0.056 1.541 1.241 2381 2381 0.152 0.191 Antibiotic treatment of suspected pneumonia CH.7 0.672 0.021 0.031 0.776 0.881 408 408 0.631 0.713 Diarrhoea in last two weeks CH.4 0.099 0.007 0.069 1.249 1.118 2381 2381 0.085 0.112 Received ORT or increased fluids and continued feeding CH.5 0.289 0.023 0.080 0.614 0.784 235 235 0.243 0.336 Support for learning CD.1 0.645 0.012 0.019 1.617 1.272 2381 2381 0.620 0.670 Birth registration CP.1 0.984 0.003 0.003 1.316 1.147 2381 2381 0.978 0.990 125 Table SE.3: Sampling errors: Tripoli Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Palestinians’ Refugee Camps in Lebanon, 2006 Confidence limits Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.997 0.002 0.002 1.502 1.226 1200 1200 0.993 1.000 Child discipline CP.4 0.925 0.012 0.013 1.268 1.126 643 643 0.902 0.949 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.953 0.009 0.009 1.983 1.408 6165 1200 0.936 0.971 Use of improved sanitation facilities EN.5 0.999 0.001 0.001 1.186 1.089 6165 1200 0.997 1.000 Net primary school attendance rate ED.3 0.958 0.008 0.008 1.275 1.129 896 896 0.942 0.973 Net secondary school attendance rate ED.4 0.612 0.017 0.028 1.216 1.103 995 995 0.578 0.646 Primary completion rate ED.6 0.486 0.048 0.099 1.272 1.128 138 138 0.389 0.582 Child labour CP.2 0.013 0.003 0.253 1.358 1.165 1575 1575 0.007 0.020 Prevalence of orphans HA.10 0.038 0.006 0.153 2.328 1.526 2539 2539 0.026 0.049 WOMEN Skilled attendant at delivery RH.5 0.989 0.008 0.008 0.988 0.994 177 177 0.973 1.000 Antenatal care RH.3 0.915 0.028 0.031 1.828 1.352 177 177 0.858 0.972 Contraceptive prevalence RH.1 0.622 0.022 0.035 1.406 1.186 693 693 0.578 0.666 Adult literacy ED.8 0.871 0.033 0.038 0.666 0.816 70 70 0.806 0.937 Marriage before age 18 CP.5 0.374 0.020 0.053 1.245 1.116 740 740 0.335 0.414 Comprehensive knowledge about HIV prevention among young people HA.3 0.102 0.013 0.123 1.304 1.142 753 753 0.077 0.127 Attitude towards people with HIV/AIDS HA.5 0.120 0.012 0.101 0.912 0.955 659 659 0.096 0.144 Knowledge of mother- to-child transmission of HIV HA.4 0.444 0.022 0.050 1.484 1.218 753 753 0.399 0.488 UNDER-5s Underweight prevalence NU.1 0.012 0.005 0.428 0.925 0.962 407 407 0.002 0.023 Tuberculosis immunization coverage CH.2 0.979 0.010 0.010 0.474 0.688 96 96 0.959 0.999 Polio immunization coverage CH.2 1.000 0.000 0.000 . . 96 96 1.000 1.000 Immunization coverage for DPT CH.2 1.000 0.000 0.000 . . 96 96 1.000 1.000 Measles immunization coverage CH.2 1.000 0.000 0.000 . . 96 96 1.000 1.000 Fully immunized children CH.2 0.979 0.010 0.010 0.474 0.688 96 96 0.959 0.999 Acute respiratory infection in last two weeks CH.6 0.167 0.026 0.155 2.260 1.503 473 473 0.115 0.219 Antibiotic treatment of suspected pneumonia CH.7 0.367 0.030 0.082 0.305 0.552 79 79 0.307 0.427 Diarrhoea in last two weeks CH.4 0.080 0.012 0.145 0.866 0.931 473 473 0.057 0.104 Received ORT or increased fluids and continued feeding CH.5 * * * * * 38 38 * * Support for learning CD.1 0.558 0.028 0.050 1.510 1.229 473 473 0.502 0.614 Birth registration CP.1 0.979 0.008 0.008 1.337 1.156 473 473 0.964 0.994 126 Table SE.4: Sampling errors: Beirut Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Palestinians’ Refugee Camps in Lebanon, 2006 Confidence limits Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.999 0.001 0.001 1.000 1.000 1409 1409 0.998 1.000 Child discipline CP.4 0.960 0.009 0.010 1.625 1.275 720 720 0.941 0.978 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.686 0.035 0.051 7.907 2.812 6086 1409 0.617 0.756 Use of improved sanitation facilities EN.5 1.000 0.000 0.000 . . 6086 1409 1.000 1.000 Net primary school attendance rate ED.3 0.946 0.008 0.008 0.919 0.959 785 785 0.931 0.962 Net secondary school attendance rate ED.4 0.631 0.025 0.039 2.201 1.484 845 845 0.581 0.680 Primary completion rate ED.6 0.400 0.044 0.111 1.018 1.009 125 125 0.311 0.489 Child labour CP.2 0.014 0.003 0.239 1.096 1.047 1388 1388 0.007 0.020 Prevalence of orphans HA.10 0.037 0.006 0.167 2.431 1.559 2301 2301 0.024 0.049 WOMEN Skilled attendant at delivery RH.5 1.000 0.000 0.000 . . 154 154 1.000 1.000 Antenatal care RH.3 1.000 0.000 0.000 . . 154 154 1.000 1.000 Contraceptive prevalence RH.1 0.705 0.016 0.023 1.008 1.004 801 801 0.673 0.738 Adult literacy ED.8 0.871 0.038 0.043 1.160 1.077 93 93 0.796 0.946 Marriage before age 18 CP.5 0.278 0.015 0.053 0.925 0.962 862 862 0.249 0.308 Comprehensive knowledge about HIV prevention among young people HA.3 0.201 0.016 0.079 1.390 1.179 880 880 0.169 0.233 Attitude towards people with HIV/AIDS HA.5 0.161 0.014 0.090 1.287 1.135 832 832 0.132 0.190 Knowledge of mother- to-child transmission of HIV HA.4 0.449 0.022 0.050 1.779 1.334 880 880 0.404 0.494 UNDER-5s Underweight prevalence NU.1 0.081 0.012 0.144 0.655 0.809 359 359 0.057 0.104 Tuberculosis immunization coverage CH.2 0.911 0.050 0.055 1.716 1.310 56 56 0.810 1.000 Polio immunization coverage CH.2 1.000 0.000 0.000 . . 56 56 1.000 1.000 Immunization coverage for DPT CH.2 1.000 0.000 0.000 . . 56 56 1.000 1.000 Measles immunization coverage CH.2 1.000 0.000 0.000 . . 56 56 1.000 1.000 Fully immunized children CH.2 0.893 0.041 0.046 0.958 0.979 56 56 0.811 0.975 Acute respiratory infection in last two weeks CH.6 0.148 0.019 0.130 1.453 1.205 492 492 0.110 0.187 Antibiotic treatment of suspected pneumonia CH.7 0.658 0.082 0.125 2.167 1.472 73 73 0.493 0.822 Diarrhoea in last two weeks CH.4 0.079 0.016 0.199 1.681 1.297 492 492 0.048 0.111 Received ORT or increased fluids and continued feeding CH.5 * * * * * 39 39 * * Support for learning CD.1 0.689 0.023 0.033 1.168 1.081 492 492 0.644 0.734 Birth registration CP.1 0.990 0.005 0.005 1.393 1.180 492 492 0.979 1.000 127 Table SE.5: Sampling errors: Bekaa Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Palestinians’ Refugee Camps in Lebanon, 2006 Confidence limits Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.998 0.002 0.002 1.000 1.000 435 435 0.993 1.000 Child discipline CP.4 0.940 0.018 0.020 1.382 1.176 233 233 0.903 0.977 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.979 0.013 0.014 3.742 1.934 2108 435 0.953 1.000 Use of improved sanitation facilities EN.5 1.000 0.000 0.000 . . 2108 435 1.000 1.000 Net primary school attendance rate ED.3 0.970 0.009 0.010 0.851 0.922 296 296 0.951 0.988 Net secondary school attendance rate ED.4 0.599 0.042 0.070 2.560 1.600 352 352 0.516 0.683 Primary completion rate ED.6 0.548 0.071 0.129 0.823 0.907 42 42 0.407 0.689 Child labour CP.2 0.006 0.004 0.746 1.678 1.295 498 498 0.000 0.015 Prevalence of orphans HA.10 0.033 0.010 0.312 2.709 1.646 826 826 0.012 0.053 WOMEN Skilled attendant at delivery RH.5 1.000 0.000 0.000 . . 62 62 1.000 1.000 Antenatal care RH.3 0.984 0.016 0.016 0.946 0.973 62 62 0.952 1.000 Contraceptive prevalence RH.1 0.675 0.031 0.047 1.107 1.052 246 246 0.612 0.738 Adult literacy ED.8 * * * * * 19 19 * * Marriage before age 18 CP.5 0.292 0.024 0.082 0.705 0.840 257 257 0.244 0.340 Comprehensive knowledge about HIV prevention among young people HA.3 0.257 0.021 0.083 0.622 0.788 261 261 0.214 0.299 Attitude towards people with HIV/AIDS HA.5 0.245 0.031 0.128 1.327 1.152 249 249 0.182 0.308 Knowledge of mother- to-child transmission of HIV HA.4 0.387 0.046 0.118 2.279 1.510 261 261 0.296 0.478 UNDER-5s Underweight prevalence NU.1 0.008 0.009 1.037 1.074 1.037 120 120 0.000 0.026 Tuberculosis immunization coverage CH.2 * * * * * 15 15 * * Polio immunization coverage CH.2 * * * * * 15 15 * * Immunization coverage for DPT CH.2 * * * * * 15 15 * * Measles immunization coverage CH.2 * * * * * 15 15 * * Fully immunized children CH.2 * * * * * 15 15 * * Acute respiratory infection in last two weeks CH.6 0.141 0.033 0.231 1.237 1.112 142 142 0.076 0.206 Antibiotic treatment of suspected pneumonia CH.7 0.800 0.100 0.125 1.188 1.090 20 20 * * Diarrhoea in last two weeks CH.4 0.190 0.025 0.130 0.561 0.749 142 142 0.141 0.240 Received ORT or increased fluids and continued feeding CH.5 * * * * * 27 27 * * Support for learning CD.1 0.592 0.038 0.064 0.825 0.908 142 142 0.516 0.667 Birth registration CP.1 0.972 0.015 0.015 1.130 1.063 142 142 0.942 1.000 128 Table SE.6: Sampling errors: Sidon Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Palestinians’ Refugee Camps in Lebanon, 2006 Confidence limits Table Value (r) Standard error (se) Coefficient of variation (se/r) Design effect (deff) Square root of design effect (deft) Weighted count Unweighted count r - 2se r + 2se HOUSEHOLDS Iodized salt consumption NU.5 0.999 0.001 0.001 1.001 1.000 1826 1826 0.997 1.000 Child discipline CP.4 0.977 0.005 0.005 1.104 1.051 992 992 0.967 0.987 HOUSEHOLD MEMBERS Use of improved drinking water sources EN.1 0.975 0.006 0.006 2.859 1.691 8496 1826 0.962 0.987 Use of improved sanitation facilities EN.5 1.000 0.000 0.000 . . 8496 1826 1.000 1.000 Net primary school attendance rate ED.3 0.948 0.007 0.007 1.093 1.045 1203 1203 0.934 0.961 Net secondary school attendance rate ED.4 0.666 0.016 0.024 1.612 1.270 1364 1364 0.633 0.698 Primary completion rate ED.6 0.413 0.032 0.079 0.944 0.972 218 218 0.348 0.478 Child labour CP.2 0.024 0.006 0.267 3.802 1.950 2174 2174 0.011 0.037 Prevalence of orphans HA.10 0.044 0.007 0.154 3.893 1.973 3574 3574 0.030 0.057 WOMEN Skilled attendant at delivery RH.5 0.985 0.006 0.006 0.816 0.903 331 331 0.973 0.997 Antenatal care RH.3 0.789 0.021 0.027 0.881 0.939 331 331 0.746 0.831 Contraceptive prevalence RH.1 0.688 0.015 0.021 1.143 1.069 1162 1162 0.659 0.718 Adult literacy ED.8 0.895 0.015 0.017 0.356 0.596 153 153 0.866 0.925 Marriage before age 18 CP.5 0.351 0.018 0.051 1.662 1.289 1190 1190 0.316 0.387 Comprehensive knowledge about HIV prevention among young people HA.3 0.198 0.018 0.091 2.513 1.585 1225 1225 0.161 0.234 Attitude towards people with HIV/AIDS HA.5 0.264 0.021 0.081 2.575 1.605 1084 1084 0.221 0.307 Knowledge of mother- to-child transmission of HIV HA.4 0.430 0.021 0.048 2.151 1.467 1225 1225 0.389 0.472 UNDER-5s Underweight prevalence NU.1 0.045 0.007 0.151 0.624 0.790 577 577 0.031 0.059 Tuberculosis immunization coverage CH.2 1.000 0.000 0.000 . . 136 136 1.000 1.000 Polio immunization coverage CH.2 0.949 0.019 0.020 0.992 0.996 136 136 0.911 0.986 Immunization coverage for DPT CH.2 0.949 0.019 0.020 0.992 0.996 136 136 0.911 0.986 Measles immunization coverage CH.2 0.956 0.019 0.020 1.128 1.062 136 136 0.918 0.993 Fully immunized children CH.2 0.949 0.019 0.020 0.992 0.996 136 136 0.911 0.986 Acute respiratory infection in last two weeks CH.6 0.202 0.019 0.093 1.587 1.260 724 724 0.164 0.239 Antibiotic treatment of suspected pneumonia CH.7 0.808 0.025 0.031 0.572 0.757 146 146 0.759 0.858 Diarrhoea in last two weeks CH.4 0.102 0.012 0.114 1.073 1.036 724 724 0.079 0.126 Received ORT or increased fluids and continued feeding CH.5 0.284 0.041 0.145 0.606 0.778 74 74 0.202 0.366 Support for learning CD.1 0.793 0.016 0.020 1.071 1.035 724 724 0.762 0.824 Birth registration CP.1 0.992 0.003 0.003 0.648 0.805 724 724 0.986 0.997 129 Table SE.7: Sampling errors: Sur Region Standard errors, coefficients of variation, design effects (deff), square root of design effects (deft) and confidence intervals for selected indicators, Palestinians’ Refugee Camps in Leba

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