Lesotho - Multiple Indicator Cluster Survey - 2000

Publication date: 2000

KINGDOM OF LESOTHO 2000 END DECADE MULTIPLE INDICATOR CLUSTER SURVEY (EMICS) DRAFT PRELIMINARY REPORT Tuesday, May 28, 2002 Government of Lesotho Bureau of Statistics Post Office Box 455 MASERU End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report i May 28, 2002 Executive Summary This Draft Preliminary Report presents the initial results of the 2000 Lesotho End-Decade Multiple Indicator Cluster Survey (EMICS). These results were derived from a nationally representative survey of households, women, and children. The main objectives of the survey were: ð to provide up-to-date information for assessing the situation of children and women in Lesotho at the end of the decade, and; ð to furnish data needed for monitoring progress toward goals established at the World Summit for Children and as a basis for future action. It is organised in four main sections. Chapter One is a documentation of the background to the 2000 Lesotho EMICS, and its objectives. The technical details of the survey, including sampling procedures, data collection and analysis are reported in Chapter Two. Chapter Three presents an evaluation of the quality of the data collected during the survey and used to prepare the analysis presented in Chapter Four. The Appendices attach the questionnaire used in the survey, some key documentation and lists key personnel and organisations involved in the 2000 Lesotho EMICS. It is expected that this Draft Preliminary Report will generate discussion on the findings in respect of the health, education, and child labour situation in Lesotho amongst government agencies, non-governmental organisations (NGOs), multilateral donors, the press and the public. Primary School Attendance · Approximately sixty five percent of children of primary school age in Lesotho are attending primary school. School attendance in the all regions and districts averages above 58 percent. · More than two thirds of children who enter the first grade of primary school eventually reach grade five. Child Labour · The term “currently working” reflects those children who have done any paid or unpaid work for someone who is not a member of the household or who did more than 4 hours of housekeeping chores in the household or who did other family work. · Twenty nine percent of children aged 5-17 years is currently involved in some work activity. More male than female children currently working. More rural than urban children are engaged in work activity – 31.8 percent and 18.4 percent respectively. · About 63.3 percent of the children do some domestic work that lasts less than 4 hours per day. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report ii May 28, 2002 Water and Sanitation · About seventy seven percent of the population has access to safe drinking water – 88.4 percent and 73.6 percent in urban and rural areas respectively. The situation in Mokhotlong district is far below the national average (76.8 percent), with only 49.0 percent of the population in the district having access to safe water. · Approximately 54 percent of the population of Lesotho live in households with sanitary means of excreta disposal. The situation in the rural areas, at 44.2 percent, is far worse than in the urban areas, where 87.8 percent of the population has access to sanitary means of excreta disposal. Breastfeeding · Breastfeeding status is based on women’s reports of children’s consumption in the 24 hours prior to the interview. · Approximately 22 percent of the children 0-3 months are exclusively breastfed. At age 6- 9 months 51.2 percent of the children receive breastmilk and solid or semi-solid foods. By age 20-23 months, 58.1 percent of the children still continue to be breastfed. Vitamin A Supplementation · Within the six months prior to the 2000 Lesotho EMICS, 17.0 percent of children aged 6- 59 months received a high dose Vitamin A supplement. Approximately 6.5 percent did not receive a supplement in the last 6 months but did receive some prior to that time. · Data suggests that the mother’s level of education is related to the likelihood of Vitamin A supplementation. The percentage receiving a supplement in the last six months increases from 13.5 percent among children whose mothers have no education to 19.2 percent among children of mothers with secondary or higher education. · About 13.2 percent of the women who had delivered in the 12 months prior to the 2000 Lesotho EMICS were sure of having received Vitamin A Supplementation. Salt Iodization · Approximately sixty nine percent of households in Lesotho have adequately (15+ PPM) iodised salt. The percentage of households with adequately iodised salt ranges from a low 47.9 percent of the households in Quthing to 81.0 percent in Maseru. Households in urban areas with adequately iodised salt, at 90.6 percent, were higher than those in rural Lesotho at 62.6 percent. Immunisation Coverage · Close to 90.5 percent of children aged 12-23 months received a BCG vaccination by the age of 12 months and the first dose of DPT was given to 88.5 percent of these children. The percentage declines for subsequent doses of DPT to 87.8 percent for the second dose, and 83.9 percent for the third dose. · Similarly, 66.6 percent of children received Polio 0 by age 12 months and this declines to 82.4 percent by the third dose. This coverage is lower than that of Polio 1 and 2 at 87.8 percent and 86.0 percent respectively. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report iii May 28, 2002 · Coverage for measles vaccine is lower than for the other vaccines at 71.3 percent. About 62.6 percent of children had all eight recommended vaccinations before 12 months of age. · Male and female children are vaccinated at roughly the same rate - 84.4 and 85.4 percent respectively. Vaccination coverage is highest among children whose mothers have secondary or higher education. Coverage’s documented suggest that children of women with at least primary education drop out of the immunisation Programme at a higher rate than those with educated mothers. Knowledge of HIV/AIDS Transmission · Fifty percent of women aged 15-49 know all two main ways of preventing HIV transmission – having only one uninfected sex partner and using a condom every time. Amongst adolescents (age 15-19) out of 75.8 percent who have heard of HIV/AIDS, 55.6 percent know of at least one way of preventing HIV transmission. · Twenty three percent of women correctly identified three misconceptions about HIV transmission – that HIV can be transmitted through supernatural means, that it can be transmitted through mosquito bites, and that a healthy looking person cannot be infected. Approximately 51 percent of women identify the three possible means of HIV/AIDS transmission from mother to child – during pregnancy, at delivery, and through breastmilk. · About 18.8 percent of the women are deemed to have sufficient knowledge of HIV/AIDS transmission. A woman is deemed to have sufficient knowledge of HIV/AIDS if they know the 2 main ways of preventing HIV/AIDS transmission and can correctly identify 3 misconceptions about HIV/AIDS transmission. Assistance at Delivery · A doctor, nurse, or midwife delivered about 59.8 percent of births occurring in the year prior to the. This is highest in the lowlands region at 64.5 percent and lowest in the mountains at 37.1 percent. Amongst the districts Leribe has the highest deliveries by skilled personnel at 70.0 percent, while Mokhotlong, with 37.1 percent has the lowest. Birth Registration · Births of 50.6 percent of children under five years in Lesotho have been registered. There are no significant variations in birth registration across sex, age, or education categories. Disability Problems · The results suggest no significant problem with respect to disability. However, it is worth noting that positive responses to questions such as “whether the child seems to understand what you are saying,” yield only about 47.2 percent positive answers. Contraceptive Use · Approximately 69.6 percent of respondents indicated that they do not use any form of contraception at all. · Thirty percent of the married/in union women indicated that they used some form of contraception – 29.5 percent used any modern method and 1.0 percent used some form of traditional method for contraception. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report iv May 28, 2002 Acknowledgements This Draft Preliminary Report could not have been possible without the efforts of a number of institutions and individuals. To the Government of Lesotho, through its Bureau of Statistics for the tireless efforts made in carrying out its role as the implementing agency for the Multiple Indicator Cluster Surveys. To the various institutions, which provided support in terms of personnel, vehicles and equipment, that supported this initiative. To UNICEF, both the Maseru and ESARO offices for there dedicated provision of professional technical and financial support for the EMICS effort. To the EMICS National Co-ordinator who worked tirelessly to get the data from the field into the data processing and analysis cooking pot. To the many enumerators, and supervisors who spent their time and effort enduring arduous conditions to collect the information that enabled this report. To the people of the “Mountain Kingdom in the Sky”, the Kingdom of Lesotho who gave their time to answer the questions of the 2000 Lesotho EMICS and without whose co- operation, this report was a non-starter. May its results be seen in an improvement in the lives of its children, women, and men. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report v May 28, 2002 Table of Contents Executive Summary _________________________________________________________ i Acknowledgements_________________________________________________________ iv Table of Contents ___________________________________________________________ v List of Tables _____________________________________________________________vii List of Maps and Figures____________________________________________________ ix Acronyms _________________________________________________________________ x 1 Background and Objectives of the Survey____________________________________ 1 1.1 Introduction_________________________________________________________ 1 1.2 Kingdom of Lesotho – National Programme of Action for Children 1995 – 2000: A Brief Description ___________________________________________________ 1 1.3 Spatial Context of Lesotho _____________________________________________ 3 1.4 Survey Objectives ____________________________________________________ 6 1.5 Survey Organisation __________________________________________________ 6 2 Sample and Survey Methodology___________________________________________ 7 2.1 Sampling Frame _____________________________________________________ 7 2.2 Sample Design _______________________________________________________ 7 2.3 The Questionnaires __________________________________________________ 10 2.4 Data Collection, Processing and Analysis Procedures______________________ 11 2.5 Data Processing _____________________________________________________ 11 2.6 Data Analysis _______________________________________________________ 12 2.7 Organisational Structure _____________________________________________ 12 2.8 Constraints_________________________________________________________ 12 2.9 Characteristics of the Respondents _____________________________________ 17 2.10 Other Issues ______________________________________________________ 19 3 Evaluation of the Data Quality ___________________________________________ 20 3.1 Non-sampling Errors ________________________________________________ 20 3.2 Sampling Errors ____________________________________________________ 20 3.3 Response Rates _____________________________________________________ 21 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report vi May 28, 2002 4 Results_______________________________________________________________ 25 4.1 Primary School Attendance ___________________________________________ 25 4.2 Child Labour _______________________________________________________ 27 4.3 Water and Sanitation ________________________________________________ 28 4.4 Nutritional Status ___________________________________________________ 33 4.5 Breastfeeding _______________________________________________________ 35 4.6 Vitamin A Supplementation___________________________________________ 39 4.7 Salt Iodization ______________________________________________________ 41 4.8 Immunisation Coverage ______________________________________________ 42 4.8 Knowledge of HIV/AIDS Transmission _________________________________ 45 4.9 Assistance at Delivery ________________________________________________ 50 4.10 Birth Registration _________________________________________________ 50 4.11 Disability Problems ________________________________________________ 50 4.12 Contraceptive Use _________________________________________________ 50 Appendices to the Preliminary Report__________________________________________ 55 Appendix A – The Kingdom of Lesotho MICS Questionnaire ___________________ 56 Appendix B – Sampling Design ____________________________________________ 78 Appendix C – Listing Form, “Form 1” ______________________________________ 81 Appendix D – Steering Committee Members _________________________________ 83 Appendix E – Task Force Members ________________________________________ 84 Appendix F - Persons involved in the 2000 Lesotho EMICS ____________________ 85 Appendix G - Anthropometry Data Check___________________________________ 88 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report vii May 28, 2002 List of Tables Table 1.0: _________Selected list of indicators from the Lesotho National Programme of Action for Children 1995-2000_________________________________ 2 Table 2.0: Characteristics of the 2000 Kingdom of Lesotho EMICS Sampling Frame by District, 1996 ____________________________________________ 8 Table 2.1: Planned vs. Actual Sample for Lesotho MICS _____________________ 9 Table 2.2: General constraints during data collection _______________________ 11 Table 2.3: Percent distribution of households by background characteristics, Lesotho, 2000 _____________________________________________ 17 Table 2.4: Percent distribution of women 15-49 by background characteristics, Lesotho, 2000 _____________________________________________ 18 Table 2.5: Percent distribution of children under 5 by background characteristics, Lesotho, 2000 _____________________________________________ 19 Table 3.0: List of selected variables for sampling errors, Lesotho, 2000 ________ 21 Table 3.1: Number of households and women, and response rates, Lesotho, 2000_ 21 Table 3.2: _______ Percent of cases missing information for selected questions, Lesotho, 2000_____________________________________________________ 24 Table 3.3: Percent of under-5 children with missing height or weight, Lesotho, 2000 _________________________________________________________ 24 Table 4.0: Percentage of children of primary school age attending primary school, Lesotho, 2000 _____________________________________________ 25 Table 4.1: Percentage of children entering first grade of primary school who eventually reach grade 5, Lesotho, 2000_________________________ 26 Table 4.2: Percentage of children 5-17 years of age who are currently working, Lesotho, 2000 _____________________________________________ 27 Table 4.3: Percentage of the population using improved drinking water sources, Lesotho, 2000 _____________________________________________ 29 Table 4.4: Percentage of the population using sanitary means of excreta disposal, Lesotho, 2000 _____________________________________________ 30 Table 4.4a: Comparison between 2000 Lesotho EMICS Results and NPAC Goals _ 32 Table 4.5: Percentage of under-five children who are severely or moderately undernourished, Lesotho, 2000 ________________________________ 34 Table 4.6: Percent of living children by breastfeeding status, Lesotho, 2000 _____ 37 Table 4.7: Percent distribution of children aged 6-59 months by whether they received a high dose of Vitamin A supplement in the last 6 months, Lesotho, 2000 _____________________________________________ 39 Table 4.8: Percentage of women with a birth in the last 12 months by whether they received a high dose of Vitamin A supplement before the infant was 8 weeks old, Lesotho, 2000 ____________________________________ 40 Table 4.9: Percent of households consuming adequately iodised salt, Lesotho, 2000_ _________________________________________________________ 41 Table 4.9a: Percent of population consuming adequately iodized salt, Lesotho, 2000 _________________________________________________________ 41 Table 4.10: Percentage of children age 12-23 months currently vaccinated any time before the survey or before 12 months of age, Lesotho, 2000 ________ 43 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report viii May 28, 2002 Table 4.11 Percentage of children age 12-23 months currently vaccinated against childhood diseases, Lesotho, 2000 _____________________________ 44 Table 4.12: Percent of women 15-49 who know the main ways of preventing HIV transmission, Lesotho, 2000 __________________________________ 45 Table 4.12a: Percentage of women aged 15-19 who know the main ways of preventing HIV transmission, Lesotho, 2000 ______________________________ 46 Table 4.13: Women 15-49 who correctly identify misconceptions about HIV/AIDS, Lesotho, 2000 _____________________________________________ 47 Table 4.14: Percentage of women 15-49 who correctly identify means of HIV transmission from mother to child, Lesotho, 2000 _________________ 48 Table 4.15: Percentage of women aged 15-49 who have sufficient knowledge of HIV/AIDS transmission, Lesotho, 2000 _________________________ 49 Table 4.16: Percent distribution of women aged 15-49 with a birth in the last year by type of personnel assisting at delivery, Lesotho, 2000 _____________ 51 Table 4.17: Percent distribution of children aged 0-59 months by whether birth is registered and reasons for non-registration, Lesotho, 2000 __________ 52 Table 4.18: Percentage of children 24 to 108 months with disability problems, Lesotho, 2000 _____________________________________________ 53 Table 4.19: Percentage of married or in union women aged 15-49 who are using (or whose partner is using) a contraceptive method, Lesotho, 2000 ______ 54 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report ix May 28, 2002 List of Maps and Figures Map 1.0: 1996 population by geographical zones 4 Map 1.1: Lesotho administrative divisions 5 Figure 2.0: Data Collection Process 13 Figure 2.1: Data Processing Procedures 14 Figure 2.2: Preparation of Data Analysis Files 15 Figure 2.3: Organisational Structure for Data Collection, Processing, and Analysis 16 Figure 3.0: Single year age distribution by sex, Lesotho, 2000 22 Figure 4.0: Access to safe drinking water and sanitary means of excreta disposal by region, Lesotho, 2000 30 Figure 4.0a: Access to safe drinking water and sanitary means of excreta disposal by district, Lesotho, 2000 30 Figure 4.0b: Access to safe drinking water and sanitary means of excreta disposal by area, Lesotho, 2000 31 Figure 4.1: Percent of under-5 children who are undernourished, Lesotho, 2000 34 Figure 4.2: Percent distribution of children by breastfeeding status, Lesotho, 2000 37 Figure 4.3: Percent of children age 12-23 months currently vaccinated any time before the survey or before 12 months of age, Lesotho, 2000 42 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report x May 28, 2002 Acronyms BOS - Bureau of Statistics, Government of Lesotho EAs - Enumeration Areas EMICS - End-Decade Multiple Indicator Cluster Survey GOL - Government of Lesotho IMF - International Monetary Fund KOL - Kingdom of Lesotho MICS - Multiple Indicator Cluster Survey NGOs - Non Government Organisations UN - United Nations UNESCO - United Nations Education, Scientific, and Cultural Organisation UNICEF - United Nations Children’s Fund VAD - Vitamin A Deficiency WB - World Bank WHO - World Health Organisation PSUs - Primary Sampling Units Chapter One – Background and Objectives of the Survey 1 May 28, 2002 1 Background and Objectives of the Survey 1.1 Introduction At the World Summit for Children held in New York in 1990, the government of the Kingdom of Lesotho committed itself to a Declaration and Plan of Action for Children. Subsequently, a National Programme of Action for Children was developed and implemented. 1.2 Kingdom of Lesotho – National Programme of Action for Children 1995 – 2000: A Brief Description The National Programme of Action developed by the government of the Kingdom of Lesotho attempts to show how the commitments made at the World Summit for Children in 1990 would be met. It discusses the short and medium term developmental goals of the government of the Kingdom of Lesotho. These include: qq Fostering labour-intensive growth by investing in rural infrastructure which supports agricultural intensification, marketable crop production, agro as well as small scale industries; qq Ensuring women’s ownership rights to land; qq Improving access to capital and business advice in the small business sector; qq Removing restrictions on women’s ability to obtain credit and do business; qq Ensuring environmental sustainability of development strategies through the involvement of communities in natural resource use management; qq Implementation of a population policy; qq Decentralising planning and implementation and choosing labour intensive techniques in the development of socio-economic infrastructure; qq Privatisation and rationalisation of public sector activities and enterprises; qq Increasing investment in education and health in poorer areas and encouraging teachers and health personnel to stay in such areas by paying an improved hardship allowance. Implementation of the National Programme of Action for Children was to be carried out within the existing central and local government systems. An integrated development approach was adopted with the government aiming at improving the decentralisation of services, decision making and a focus on bottom-up approach to planning. This involved improved communication and co-ordination within the government sector and amongst NGOs. Community mobilisation and sensitisation was to receive priority under this Programme. The financing of this National Programme of Action for Children was to be done through comprehensive targeting and costing of the planned interventions at the sectoral and constituency levels as well as encouraging all the partners in development to ensure that resources trickled down to the grassroots level. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 2 May 28, 2002 The National Programme of Action for Children also called for the establishment of mechanisms for monitoring progress toward the goals and objectives set for the year 2000. Toward this end, UNICEF, in collaboration with WHO, UNESCO, and others developed a core set of indicators of specific aspects of the situation of children. The 2000 Lesotho EMICS was conducted in order to provide end-decade information on many of these and other indicators. Table 1.0: Selected list of indicators from the Lesotho National Programme of Action for Children 1995-2000 INDICATOR TARGETED GOALS FOR THE YEAR 20001 Infant Mortality Rate Reduce from 82 per 1000 to 37 per 1000 live births Under Five Mortality Rate Reduce from 60 to 30 per 1000 live births Maternal Mortality Rate Reduce 282 to 141 per 100,000 Increase DPT coverage from 80 to 90 per cent Increase Measles coverage from 77 to 90 percent Increase Polio coverage from 76 to 90 percent Sustain BCG coverage at 98 percent Increase Tetanus Toxoid from 11.8 to 50 percent Immunisation Coverage Increase Hepatitis B coverage from 0 to 80 percent Diarrhoea Reduce incidence rate from 300 to 100 Reduce underweight from 18 to 9 percent Reduce wasting from 5.7 to 2.8 percent Nutrition Status (under 5 children) Reduce stunting from 42 to 21 percent Iodine and Vitamin A Deficiencies Virtually eliminate the deficiencies and their consequences Urban from 44 to 58 percent Access to Safe Drinking Water Rural from 58 to 81 percent Urban from 42 to 73 percent Access to Sanitary Means of Excreta Disposal Rural from 25 to 52 percent Provide Universal Access to basic education for at least 80 percent of primary school-age children Increase Primary School completion rates from 30 to 65 percent Boys 29 to 64 percent Girls 51 to 85 percent Education Reduce illiteracy rates from 38 to 10 percent Males 54 to 25 percent Females from 30 to 10 percent Source: Kingdom of Lesotho (1995) 1995-2000 National Programme of Action for Children The Lesotho National Programme of Action for Children developed a set of indicators by which progress would be monitored would monitor progress. Table 1.0 above lists some of these giving the expected year 2000 targets. 1 Current status year is 1993-4 Chapter One – Background and Objectives of the Survey 3 May 28, 2002 This preliminary report presents selected results on some of the principal topics covered in the survey and on a subset of indicators. A comprehensive Full Technical Report is scheduled for publication towards the end of the year 2000. 1.3 Spatial Context of Lesotho2 Lesotho, the “Mountain Kingdom in the Sky”, has a land mass area of approximately 30,350 km2 and is completely land locked, being entirely surrounded by the Republic of South Africa. It is divided into four ecological regions: the lowlands, foothills, mountains, and the Senqu River Valley, as is clearly shown in Map 1.0. The mountains cover about 59 percent of the country and are characterised by steep topographical features and thin soils. Mountain climate is harsh with cool summers and cold winters, often accompanied by snow. The lowlands consist of areas below 1800 meters above sea level and cover approximately 17 percent of Lesotho’s surface area. Summers are warm in the lowlands, with occasional rain and the land is suitable for agriculture. The foothills lie at altitude between 1800 and 2000 meters above sea level. They lie between the lowlands and the Maluti Mountains. It is a narrow strip that makes up about 15 percent of the surface area of Lesotho. The Senqu River Valley is a zone that penetrates deep into the Maluti Mountains and comprises about 9 percent of the land area. The altitude and the climate in this zone do not vary much from that in the lowlands, and hence is suitable for cultivation. Ten districts comprise the administrative disposition of Lesotho, as Map 1.1 shows. These are Butha-Buthe, Leribe, Berea, Maseru, Mafeteng, Mohale’s Hoek, Quthing, Qacha’s Nek, Mokhotlong and Thaba-Tseka. Most of its population is consists of the Basotho with a tiny sprinkling of other Africans, Europeans, and Asians. Most economic activity is found on 25 % of the country that falls along the western and southwestern borders. These are commonly referred to as the lowlands. 2 This section is derived largely from the Bureau of Statistics (1996) Population Census Analytical Report: Volume IIIA – Population Dynamics. Bureau of Statistics, Maseru. Pp. 21-31. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 4 May 28, 2002 Map 1.0 Chapter One – Background and Objectives of the Survey 5 May 28, 2002 Map 1.1: Lesotho Administrative Divisions End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 6 May 28, 2002 1.4 Survey Objectives The 2000 Lesotho End-Decade Multiple Indicator Cluster Survey had as its primary objectives: qq To provide up-to-date information for assessing the situation of children and women in Lesotho at the end of the decade and for looking forward to the next decade; qq To furnish data needed for monitoring progress toward goals established at the World Summit for Children and as a basis for future action; qq To contribute to the improvement of data and monitoring systems in Lesotho and to strengthen technical expertise in the design, implementation, and analysis of such systems. 1.5 Survey Organisation The Government of Lesotho through the Ministry of Development Planning (Bureau of Statistics) conducted the 2000 Lesotho End-Decade Multiple Indicator Cluster Survey, with the UNICEF (Maseru) office providing the requisite technical and funding support. Conduct of the 2000 Lesotho EMICS is discussed in the next chapter, under sample and survey methodology. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 7 May 28, 2002 2 Sample and Survey Methodology Sample survey design, data collection and analysis procedures used in the 2000 Lesotho EMICS Survey are discussed in the following sections. 2.1 Sampling Frame The Bureau of Statistics provided the information that was utilised in constructing the 2000 Lesotho MICS, including the Rural Master Sampling Frame, the 1996 Population Census Frame, Urban Population Sampling Units File. Information availed through these documents included Enumeration Area (EA) Numbers, Number of Villages in the EAs, and the Number of Households. Table 2.0 shows the characteristics of this constructed sampling frame. 2.2 Sample Design The 2000 Lesotho EMICS covered the whole country. Thus, the sample was designed to provide estimates of health indicators at four levels, viz.: qq The National Level; qq The Urban and Rural Levels; qq The Regional Level; §§ Lowland §§ Foothill §§ Mountain + Senqu Valley qq The District Level §§ Butha-Buthe §§ Leribe §§ Berea §§ Maseru §§ Mafeteng §§ Mohale’s Hoek §§ Quthing §§ Qacha’s Nek §§ Mokhotlong §§ Thaba-Tseka. The largest sample size was regarded as the required sample size that would provide adequate information on all the indicators (see Appendix B). It would have been ideal to maintain the distinction in the four ecological strata, however for practical reasons this was not possible. Senqu River Valley and the Mountains were combined, because having them reported separately, would have required a much larger sample to detect differences between the two. Chapter Two – Sample and Survey Methodology 8 May 28, 2002 Table 2.0: Characteristics of the 2000 Kingdom of Lesotho EMICS Sampling Frame by District, 1996 RURAL URBAN Lowlands Foothills Mountains Senqu River Valley LESOTHO DISTRICT Pop. HHLDS PROP. Pop. HHLDS PROP. Pop. HHLDS PROP. Pop. HHLDS PROP. Pop. HHLDS PROP. Total HHLDS Butha-Buthe 23,065 4,613 0.012 39,000 7,800 0.021 43,865 8,773 0.024 5,595 1,119 0.003 - - - 111,525 22,305 Leribe 41,880 8,376 0.023 169,545 33,909 0.091 42,970 8,594 0.023 22,040 4,408 0.012 - - - 276,435 55,287 Berea 20,550 4,110 0.011 151,530 30,306 0.081 36,670 7,334 0.020 - - - - - - 208,750 41,750 Maseru 240,715 48,143 0.129 135,860 27,172 0.073 63,410 12,682 0.034 34,345 6,869 0.018 - - - 474,330 94,866 Mafeteng 27,450 5,490 0.015 166,080 33,216 0.089 14,950 2,990 0.008 - - - - - - 208,480 41,696 Mohale's Hoek 25,655 5,131 0.014 86,860 17,372 0.047 18,860 3,772 0.010 33,900 6,780 0.018 23,460 4,692 0.013 188,735 37,747 Quthing 12,740 2,548 0.007 - - - - - - 36,545 7,309 0.020 65,445 13,089 0.035 114,730 22,946 Qacha's Nek 5,855 1,171 0.003 - - - - - - 47,930 9,586 0.026 14,185 2,837 0.008 67,970 13,594 Mokhotlong 6,685 1,337 0.004 - - - - - - 80,010 16,002 0.043 - - - 86,695 17,339 Thaba Tseka 5,430 1,086 0.003 - - - - - - 116,865 23,373 0.063 - - - 122,295 24,459 LESOTHO 410,025 82,005 0.220 748,875 149,775 0.403 220,725 44,145 0.119 377,230 75,446 0.203 103,090 20,618 0.055 1,859,945 371,989 Notes to Table 2.0 Pop. - Population HHLDS - Number of Households PROP. - Proportional Distribution of Households In determining the population of Lesotho by district it was assumed that each household composed of an average of 5 persons. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 9 May 28, 2002 Two stage cluster sampling was applied in selecting the sample for the 2000 Lesotho EMICS exercise, using an updated sampling frame from the 1996 population census (see Table 2.0). A number of variables indicators and assumptions were taken into consideration when determining the sample size for the 2000 Lesotho EMICS. These included: qq The number of households by district, both urban and rural qq Ecological considerations were employed in the rural areas qq Measles was used as a key indicator qq Design effect of 2 for most variables qq Level of estimation. In addition to national estimates, district estimates for comparison were required. qq The error margins were approximately 10 percent for district level data and five percent for national level data. Thus, the ecological strata were used for the ten districts, which were the main domains. Enumeration areas were the first stages of selecting sampling units on a systematic basis. Selection of primary sampling units was from each of the four ecological zones in the rural and urban areas. The second stage involved a systematic selection of twenty (20) households to cover the entire selected village of the selected enumeration areas. Consequently, 380 PSUs were identified, from which in each PSU twenty households were systematically selected, to give an expected sample of 7,600 households. Table 2.1: Planned vs. Actual Sample for Lesotho MICS CLUSTERS HOUSEHOLDS PROPORTIONS (%) DISTRICT Planned Actual Diff. Planned Actual Diff. Planned* Actual Butha-Buthe 23 24 1 460 461 1 6.0 6.2 Leribe 57 57 0 1140 1125 -15 14.9 15.1 Berea 43 44 1 860 858 -2 11.2 11.5 Maseru 96 96 0 1920 1842 -78 25.5 24.7 Mafeteng 43 43 0 860 856 -4 11.2 11.5 Mohale’s Hoek 38 38 0 760 730 -30 10.1 9.8 Quthing 23 23 0 460 459 -1 6.2 6.1 Qacha's Nek 14 14 0 280 280 0 3.7 3.7 Mokhotlong 18 18 0 360 360 0 4.7 4.8 Thaba-Tseka 25 25 0 500 499 -1 6.6 6.7 All Districts 380 382 2 7600 7470 -130 100.1 100.0 Notes to Table 2.1: Diff. – Difference * - Total not equal to 100 due to rounding off errors The systematic selection of the households involved a listing procedure, where all the households in the selected village were listed. A systematic sample was to be selected and interviewed. To achieve this two- (2) enumerators were selected and assigned to each village to undertake the listing of households and were provided with a map or a sketch showing the boundaries of the areas under consideration. Once the listing was accomplished the supervisor collected the completed household listing forms (Form 1 – see Appendix C) and together with the enumerator systematically drew a sample of twenty (20) households from each selected village. Chapter Two – Sample and Survey Methodology 10 May 28, 2002 Table 2.1 describes a consideration of the sample that was planned using the procedure discussed above and the actual sample that actually resulted during the field survey. The End- Decade Multiple Indicator Survey Manual3, identifies several features of proper probability sample design. These are: qq Use of accepted probability-sampling methods at every stage of sample selection; qq Selection of a nationally representative sample; qq Ensuring faithfulness in field implementation to the sample design. qq Ensuring that the sample size is sufficient to achieve reliability requirements The foregoing discussion has indicated that the 2000 Lesotho EMICS sample design met these requirements, with expected deviations4. 2.3 The Questionnaires The questionnaire applied in the 2000 Lesotho EMICS comprised a household questionnaire, questionnaires were administered in each household for women aged 15 – 49 and children under age five. The questionnaires were based on the MICS model questionnaire with additional modules. In all the following modules and panels constituted the 2000 Lesotho EMICS questionnaire5: qq The Household Questionnaire §§ Household Information Panel §§ Household Listing Form §§ Education Module §§ Child Labour Module §§ Water and Sanitation Module §§ Salt Iodization Module §§ Disability Module qq Individual Women Questionnaire §§ Women’s Information Panel §§ Child Mortality Module §§ Tetanus Toxoid (TT) Module §§ Maternal and Newborn Health Module §§ Contraceptive Use Module §§ HIV/AIDS Module qq The Children Under Five Questionnaire §§ The Birth Registration and Early Learning Module §§ The Vitamin A Module §§ The Breast Feeding Module §§ Care of Illness Module §§ Immunisation Module §§ Anthropometry Module 3 UNICEF (2000) End-Decade Multiple Indicator Survey Manual: Monitoring Progress Toward the Goals of the 1990 World Summit for Children. Division of Evaluation, Policy and Planning, New York. 4 See discussion on response rates in Chapter 3 on “Evaluation of Data Quality”. 5 See Appendix One for Complete 2000 Kingdom of Lesotho MICS Questionnaire. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 11 May 28, 2002 The questionnaire was translated into the Sesotho Language. A pretest of the questionnaire was performed on the 21st of January 2000. It involved two teams of three each supervised by the National Co-ordinator, EMICS and the MICS Consultant. The pretest was done in Ha Foso Village of Berea district, which was selected for its accessibility to Maseru. Questionnaires were pretested for questionnaire administration time, key questions were tested for reliability and consistency and last but not least the logistics for successful questionnaire administration were tested. Based on the findings of this pretest, modifications to the questionnaire were made in respect of the wording and the translation as well as instructions to the enumerators aimed at ensuring proper questionnaire administration. Selection of the interview households was randomly done. 2.4 Data Collection, Processing and Analysis Procedures Figure 2.0 describes the overall process of the fieldwork. Field staff was trained for five days in early March 2000. As part of the training a pilot test was conducted for a further five days. This was between the 13th to the 17th of March 2000. Eighty persons, comprising 65 enumerators and 15 supervisors, were involved. In this exercise, a dummy run of the actual survey was done. Listing and sampling procedures as well as the process of questionnaire administration were tested. Supervisors made notes of the issues identified during the pilot survey and a session was held with the enumerators to correct any shortcomings. Questionnaire administration time was about sixty (60) minutes per questionnaire. Fifteen teams collected data; each comprised of four interviewers, one driver, and supervisor. The MICS Co-ordinator provided overall supervision. UNICEF Programme Officers and their GOL counterparts strengthened the overall supervision. The fieldwork begun in March 2000 and was concluded in May 2000. Table 2.2: General constraints during data collection qq Lack of accommodation near clusters qq Shortage of transport qq Inadequate maps - names of clusters on ground different from that on maps qq Publicity of EMICS on ground poor. Some Chief s were uncooperative qq Some personnel withdrew in the middle of the survey qq Delayed payment of allowances Table 2.2 describes some of the constraints encountered during the fieldwork. 2.5 Data Processing Data was entered on twenty-two microcomputers using the IMPS Software. Figure 2.1 illustrates the data processing procedures highlighting the main steps taken to ensure quality control. All the questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under MICS and adapted to the Lesotho questionnaire were applied. Data processing began in July 2000 and was completed in October 2000. Data entry was accomplished through the IMPS software. Customised applications were included within the software that performed range and consistency checks. Chapter Two – Sample and Survey Methodology 12 May 28, 2002 2.6 Data Analysis Data analysis was undertaken using the Statistical Package for Social Sciences (SPSS) version 10.0, MS Excel and ISSA version 5.2. Figure 2.2 illustrates the main stages that comprised the data analysis phase prior to drafting of the preliminary report. The entered data was verified, secondary edited and concatenated to create global national files for households, eligible women, and children under five. These were imported into SPSS using READ Applications, four files were created, namely the household information file, the household listing file, the women’s file and the children’s file. These new files were labelled and further variables that were needed for the analysis phase were created via the MAKE and TABLE Applications. Appendix G provides a list of variables created. The resulting four analysis files corresponded to the four units of analysis that were the focus of the 2000 Lesotho EMICS. These were: qq The Household Analysis File (HH.SAV) qq The Household Members (Listing) File (HL.SAV) qq The Women’s File (WM.SAV) qq The Children Under Five File (CH.SAV) Figure 2.3 describes the personnel involved in data analysis. 2.7 Organisational Structure The fieldwork, data processing, data analysis and report dissemination was carried out within an organisational structure described by Figure 2.3. Personnel who formed the entities described in this structure are documented in Appendices D, E, and F. 2.8 Constraints The 2000 Lesotho EMICS faced a number of challenges that caused it to surpass its original planned timeframe. Data collection was hampered by lack of transportation in a few of the districts. Data entry had to be put on hold for over a month so that the 2000 Lesotho EMICS could benefit from the insights provided at the MICS Data Processing Workshop in Nairobi. This was a worthwhile delay as it strengthened the mechanisms for ensuring data integrity. In the data processing phase, one of the main challenges was the lack of transportation that would have enabled the secondary editing and subsequent phases to be undertaken on time. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 13 May 28, 2002 DATA HANDLINGDATA HANDLING Figure 2.0: Data Collection Process DETERMINATION & SELECTION OF SAMPLE DETERMINATION & SELECTION OF SAMPLE SELECTION OF FIELD STAFF SELECTION OF FIELD STAFF TRAINING OF FIELD STAFF TRAINING OF FIELD STAFF MAIN DATA COLLECTION MAIN DATA COLLECTION Collection of Completed Questionnaires Office Editing Questionnaire Ok? Data Coding DATA ENTRYDATA ENTRY Questionnaire Sent Back To Field For Correction OR Office Editing Done NONO YESYES PILOT SURVEYPILOT SURVEY Field Editing of Questionnaires Chapter Two – Sample and Survey Methodology 14 May 28, 2002 Figure 2.1: Data Processing Procedures DATA ENTRYDATA ENTRY STRUCTURE CHECKSTRUCTURE CHECK OK? VERIFICATION DATA ENTRY VERIFICATION DATA ENTRY RAW DATA BACK-UPRAW DATA BACK-UP SECONDARY EDITINGSECONDARY EDITING OK? BACK-UP FINAL DATABACK-UP FINAL DATA EXPORT TO SPSSEXPORT TO SPSS Structure Report CORRECT EDITING Editing Listing NONO YESYES NONO YESYES End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 15 May 28, 2002 Figure 2.2: Preparation of Analysis Files CONCATENATE CLUSTER FILES CONCATENATE CLUSTER FILES Run ALLCLUST.BAT Output: • HH.BCH • CH.BCH • WM.BCH • CHZSCORE.DAT CONVERT IMPS BATCH FILES TO SPSS FILES (Generated SPSS Files Correspond to A Unit of Analysis) CONVERT IMPS BATCH FILES TO SPSS FILES (Generated SPSS Files Correspond to A Unit of Analysis) Use READ SPSS Applications • READHH.SPS • READHL.SPS • READWM.SPS • READCH.SPS Output: • HH.SAV • HL.SAV • WM.SAV • CH.SAV CREATE ANALYSIS FILES • Add Labels • Add Variables • Create Variables • Recode Variables • Check for Inconsistencies/Mismatches • Add Weights CREATE ANALYSIS FILES • Add Labels • Add Variables • Create Variables • Recode Variables • Check for Inconsistencies/Mismatches • Add Weights Use LABEL SPSS Applications • LABELHH.SPS • LABELHL.SPS • LABELWM.SPS • LABELCH.SPS Use MAKE SPSS Applications • MAKEHL.SPS • MAKEWM.SPS • MAKECH.SPS To Add Weights • Run WGTTAB.SPS • Complete WEIGHTS.XLS Spreadsheet • Create WEIGHTS.SPS • Run BADWOMEN.SPS Output - Analysis Files: • HH.SAV • HL.SAV • WM.SAV • CH.SAV TABULATE TABULATE Use TABLE SPSS Applications • T1.SPS….to T42.SPS 1 2 3 4 Chapter Two – Sample and Survey Methodology 16 May 28, 2002 S T E E R I N G C O M M I T T E E E T A S K F O R C E F i g u r e 2 . 3 : Organizat ional Structure for Data Col lec t ion , Process ing and Analys i s E n u m e r a t o r s E n u m e r a t o r s E n u m e r a t o r s E n u m e r a t o r s Field Superv i sors Field Superv i sors N A T I O N A L M I C S C O O R D I N A T O R U N I C E F G O V E R N M E N T O F L E S O T H O (Bureau o f S ta t i s t i c s ) S u p p o r t S u p e r v i s o r s D a t a E n t r y C l e r k s D a t a E n t r y C l e r k s D a t a E n t r y C l e r k s D a t a E n t r y C l e r k s D a t a E n t r y C l e r k s D a t a E n t r y C l e r k s D a t a E n t r y C l e r k s D a t a E n t r y C l e r k s Data Col l ec t ion Superv i sorsSuperv i sorsSuperv i sorsSuperv i sors Superv i sorsSuperv i sors P r o g r a m m e r / A n a l y s t (Bureau o f S ta t i s t i c s ) P r o g r a m m e r / A n a l y s t (Bureau o f S ta t i s t i c s ) C o n s u l t a t i o n F e e d b a c k Data P rocess ing & Ana lys i s End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 17 May 28, 2002 2.9 Characteristics of the Respondents Information on the characteristics of the household population and the survey respondents is provided to assist in the interpretation of the survey findings and to serve as a basic check on the sample implementation. Table 2.3 below describes the sample population for the 2000 Lesotho EMICS in terms of its location, household size, and age/gender distinction. Table 2.3: Percent distribution of households by background characteristics, Lesotho, 2000 AREA CHARACTERISTICS Urban Rural TOTAL Lowland 91.5 51.5 61.3 Foothill .1 14.7 11.1 Mountain 8.2 27.1 22.5 Region Senqu Valley .2 6.7 5.1 Butha-Buthe 4.4 6.8 6.2 Leribe 10.1 16.7 15.1 Berea 4.8 13.7 11.5 Maseru 57.6 13.9 24.7 Mafeteng 6.6 13.0 11.5 Mohale's Hoek 7.7 10.5 9.8 Quthing 2.7 7.3 6.1 Qacha's Nek 1.1 4.6 3.7 Mokhotlong 2.3 5.6 4.8 District Thaba-Tseka 2.8 8.0 6.7 1 14.8 10.6 11.6 2-3 32.5 26.3 27.8 4-5 31.4 30.1 30.4 6-7 15.4 20.1 19.0 8-9 4.2 9.4 8.1 Number of Household Members 10+ 1.8 3.4 3.0 Total 100.0 100.0 100.0 Number 1821 5593 7414 At least one child age < 17 66.3 75.4 73.1 At least one child age < 5 33.9 43.3 41.0 At least one woman age 15-49 74.9 71.1 72.0 Number 1818 5583 7401 Notes to Table2.3: Missing values in this Table equal 57 households. This is 0.8 percent of the total number households. As expected majority of the households that appear in this sample, at 61.3 percent, were located in the lowlands. Of the households interviewed, 1821 were urban and 5593 were rural. Majority of the households comprised between 2-5 members – 58.2 percent. Approximately 73 percent of the households had at least one child below age 17 years, 41 percent with at least one child under five years of age, and 72.0 percent of the interviewed households comprised at least one eligible woman. Chapter Two – Sample and Survey Methodology 18 May 28, 2002 Table 2.4: Percent distribution of women 15-49 by background characteristics, Lesotho, 2000 CHARACTERISTIC Percent Number of Eligible Women Lowland 60.1 4052 Foothill 11.0 739 Mountain 23.9 1609 Region Senqu Valley 5.0 338 Butha-Buthe 6.6 447 Leribe 14.7 993 Berea 11.9 805 Maseru 23.4 1580 Mafeteng 11.7 790 Mohale's Hoek 8.2 553 Quthing 7.0 472 Qacha's Nek 3.5 239 Mokhotlong 5.5 371 District Thaba-Tseka 7.2 488 Urban 25.4 1712 Area Rural 74.6 5026 15-19 21.0 1413 20-24 20.6 1384 25-29 15.2 1024 30-34 11.9 798 35-39 12.8 860 40-44 10.3 693 Age 45-49 8.2 552 Never Married 31.7 2137 Married/in union 56.1 3779 Separated 4.9 330 Divorced 1.1 72 Marital Status Widowed 6.3 423 Yes 69.9 4709 Ever given birth No 30.1 2032 Primary 4.5 301 Secondary/High 92.4 6230 Higher/Tertiary 2.7 183 Non-standard curriculum .1 4 Vocational .1 8 Woman's education level Missing/DK .2 15 Total 100.0 6741 Table 2.4 describes the women age 15-49 in respect of their educational levels, their location and whether they have ever given birth. In terms of educational levels, over 90 percent of the eligible women interviewed had secondary education. Approximately 69.9 percent of them had given birth at one time before the 2000 Lesotho EMICS. Fifty six percent of them were married, while 31.7 percent were never married. About 25.4 percent of them were urban, while 74.6 percent were rural based. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 19 May 28, 2002 Table 2.5: Percent distribution of children under 5 by background characteristics, Lesotho, 2000 CHARACTERISTIC Percent Number Male 50.0 1867 Sex Female 50.0 1867 Lowland 55.5 2074 Foothill 12.2 456 Mountain 26.6 994 Region Senqu Valley 5.6 210 Butha-Buthe 5.8 217 Leribe 16.3 609 Berea 12.1 453 Maseru 20.1 750 Mafeteng 10.9 408 Mohale's Hoek 8.6 321 Quthing 6.7 252 Qacha's Nek 4.0 150 Mokhotlong 6.9 257 District Thaba-Tseka 8.5 317 Urban 19.2 717 Area Rural 80.8 3017 < 6 months 9.9 369 6-11 months 11.0 411 12-23 months 20.4 762 24-35 months 21.7 810 36-47 months 19.1 711 Age 48-59 months 17.8 665 None 6.6 246 Primary 66.1 2471 Secondary 27.2 1018 Mother's education level Non-standard curriculum .1 2 Total 100.0 3737 Table 2.5 describes the under five children who comprised the 2000 Lesotho EMICS. Approximately 80.8 percent of them came from rural areas as compared to 19.2 percent urban. Majority of their mothers/caretakers had received primary level education – 66.1 percent. About 55.5 percent were found in the lowlands. Maseru had 20.1 percent of the under five children who comprised the 2000 Lesotho EMICS sample. It had the largest share amongst the districts. 2.10 Other Issues The 2000 Lesotho EMICS is the first survey that has made attempts to make estimates in respect of the child labour situation. It will therefore, provide good basis information in that respect. With this data it will be possible to look at the child survival differentials because the survey already has covered a number of important social indicators in this regard. Chapter 3 – Evaluation of Data Quality 20 May 28, 2002 3 Evaluation of the Data Quality Two types of errors usually affect the quality of data collected and hence the estimates derived from the survey sample data, viz.: qq Non-sampling Errors qq Sampling Errors An evaluation of the data quality for the 2000 Lesotho EMICS will involve a description of the non-sampling errors and the measures undertaken to mitigate these. Secondly, an evaluation of sampling errors is undertaken for selected variables. Thirdly, and analysis of the response rates, the reasons for the response rates status and an analysis of key variables in respect of the proportions of missing data was done. 3.1 Non-sampling Errors Non-sampling errors result from mistakes during the implementation of data collection and data processing. This include failure to locate and interview the correct households, misunderstanding of the questions on the part of the interviewer or interviewee (respondent), and data entry errors. During the 2000 Kingdom of Lesotho MICS exercise a number of measures were incorporated in the data collection and processing procedures to minimise the effect of non- sampling errors, which are impossible to avoid and difficult to evaluate statistically. These included: qq Training of Enumerators qq Conducting of a Pilot Survey qq Field and Office Editing Procedures qq Documentation of the Data Handling and Management Procedures qq Double Entry of Collected Data qq 100 percent verification of data 3.2 Sampling Errors Sampling errors on the other hand can be evaluated statistically. Consider the fact that the 2000 Kingdom of Lesotho MICS Sample is only one of the many possible samples that could have been chosen using the same sample design and expected size. Sampling errors in this regard are a measure of the variability between all possible samples. These sampling errors are usually measured in terms of the standard errors for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to determine the confidence intervals within which the true value for the population can be reasonably assumed to fall. Table 3.0 documents the variables for which sampling errors would be estimated and their base populations. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 21 May 28, 2002 Table 3.0: List of selected variables for sampling errors, Lesotho, 2000 VARIABLE DESCRIPTION BASE POPULATION Women with no education Proportion Eligible women age 15-49 With secondary or higher education Proportion Eligible women age 15-49 Currently married or in union Proportion Eligible women age 15-49 Children ever born Mean Eligible women age 15-49 Currently using any contraceptive method Proportion Eligible women age 15-49 Currently using modern contraceptive method Proportion Eligible women age 15-49 Vitamin A Supplementation Proportion Children 6-59 months Fully immunised Proportion Children 12-23 months Weight for height (wasting) Proportion Children under five years Height for age (stunting) Proportion Children under five years Weight for age (underweight) Proportion Children under five years 3.3 Response Rates Table 3.1 shows the response rates for the 2000 Lesotho EMICS, which go to discuss the completeness of reporting of the 2000 Lesotho EMICS. Overall the household response rate is about 99.7 percent, the eligible women’s response rate is 93.6 percent, and that of under five children is 98.0 percent. This are higher than the 90 percent response rates normally expected from surveys similar to the 2000 Lesotho EMICS. In respect of the households, the planned sample was to select and interview 7,600 households. Based on this planned figure the response rate would be a slightly lower 97.4 percent, but still higher than the base 90 percent for similar surveys. One can therefore conclude that the 2000 Lesotho EMICS had a good response rate and its results would be, all things considered, reliable. Table 3.1: Number of households and women, and response rates, Lesotho, 2000 DISTRICT CHARACTERISTIC Butha- Buthe Leribe Berea Maseru Mafeten g Mohale' s Hoek Quthing Qacha's Nek Mokhotl ong Thaba- Tseka TOTAL Sampled households 461 1125 858 1842 856 730 459 280 360 499 7471 Occupied households 461 1122 857 1828 853 702 459 280 360 499 7422 Completed households 459 1120 856 1813 853 701 459 280 360 498 7399 Household response rate 99.6 99.8 99.9 99.2 100.0 99.9 100.0 100.0 100.0 99.8 99.7 Eligible women 464 1048 842 1748 804 674 475 265 373 511 7204 Interviewed women 447 992 811 1578 790 564 472 236 368 488 6746 Women response rate 96.3 94.7 96.3 90.3 98.3 83.7 99.4 89.1 98.7 95.5 93.6 Children under 5 218 623 459 773 415 343 253 156 257 331 3828 Interviewed children under 5 218 615 455 751 406 328 253 151 255 319 3751 Child response rate 100.0 98.7 99.1 97.2 97.8 95.6 100.0 96.8 99.2 96.4 98.0 Figure 3.0 describes the single year age distribution of the sample for the 2000 Lesotho EMICS. It shows the enumeration pattern amongst the sexes across the various ages that comprised the 2000 Lesotho EMICS. Tables 3.2 and 3.4 describe the percentage of cases with missing information for selected questions and children under-five whose height or weight measurements are missing, the percentages seen are small. Chapter 3 – Evaluation of Data Quality 22 May 28, 2002 Figure 3.0: Single year age distribution by sex, Lesotho, 20006 6 In Figure 3.0, the age 70+ is an aggregation of all household members who are aged 70 years and above. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 23 May 28, 2002 0 5 0 100 150 200 250 300 350 400 450 500 550 600 650 700 750 0 5 1 0 1 5 2 0 2 5 3 0 3 5 4 0 4 5 5 0 5 5 6 0 6 5 70+ Age (in years) N um be r o f R es po nd en ts Male Female Chapter 3 – Evaluation of Data Quality 24 May 28, 2002 Table 3.2: Percent of cases missing information for selected questions, Lesotho, 2000 Selected Question Percent missing Number Level of education .0 23511 Year of education .0 23484 Number of hours worked .0 735 Complete birth date for eligible women .0 6509 Date of last tetanus Toxoid injection .0 125 Ever been tested for HIV .0 5572 Complete birth date children under 5 .0 3602 Diarrhoea in last 2 weeks .0 3602 Weight .7 3602 Height .3 3602 Table 3.3: Percent of under-5 children with missing height or weight, Lesotho, 20007 CHARACTERISTIC Missing height or weight No. of children Male .9 1867 Sex Female .9 1867 Lowland 1.0 2074 Foothill .2 456 Mountain 1.1 994 Region Senqu Valley .0 210 Butha-Buthe .9 217 Leribe 1.0 609 Berea 1.3 453 Maseru .8 750 Mafeteng .7 408 Mohale's Hoek .6 321 Quthing .8 252 Qacha's Nek .7 150 Mokhotlong .8 257 District Thaba-Tseka .9 317 Urban 1.1 717 Area Rural .8 3017 < 6 months .8 369 6-11 months .7 411 12-23 months 2.0 762 24-35 months .9 810 36-47 months .4 711 Age 48-59 months .3 665 None .4 246 Primary .8 2471 Secondary 1.1 1018 Mother's education level Non-standard curriculum .0 2 Total .9 3737 Some parent’s declined to have their children measured because the children were sleeping, or they were ill, or for cultural reasons that only dead people lie on boards. Some children declined to be measured and ran away. 7 World Summit for Children Goal => Number 3, 9, 26 Chapter Four – The Results 25 May 28, 2002 4 Results The results of the 2000 Lesotho EMICS as described in the foregoing sections are documented in this section of the report. 4.1 Primary School Attendance 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 World Summit 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. Table 4.0: Percentage of children of primary school age attending primary school, Lesotho, 20008 SEX Male Female TOTAL CHARACTERISTIC Attending Number Attending Number Attending Number Lowland 66.8 1724 71.9 1586 69.2 3310 Foothill 55.4 354 61.8 338 58.5 692 Mountain 55.0 717 62.1 770 58.6 1487 Region Senqu Valley 57.8 173 70.8 171 64.2 344 Urban 68.8 565 72.3 541 70.5 1106 Area Rural 60.5 2403 67.0 2324 63.7 4727 Butha-Buthe 63.5 189 71.3 171 67.2 360 Leribe 68.3 400 71.7 371 69.9 771 Berea 64.7 391 66.6 350 65.6 741 Maseru 65.7 612 69.1 601 67.4 1213 Mafeteng 58.3 403 71.5 355 64.5 758 Mohale's Hoek 57.9 285 64.3 269 61.0 554 Quthing 62.7 201 68.3 218 65.6 419 Qacha's Nek 72.3 112 69.7 109 71.0 221 Mokhotlong 47.7 149 64.7 173 56.8 322 District Thaba-Tseka 51.3 226 59.7 248 55.7 474 6 17.3 421 19.4 422 18.4 843 7 43.7 371 48.8 379 46.3 750 8 62.2 373 73.7 388 68.1 761 9 73.2 380 77.0 352 75.0 732 10 73.4 553 84.8 500 78.8 1053 11 79.1 401 83.9 373 81.4 774 Age 12 79.7 469 85.8 451 82.7 920 Total 62.1 2968 68.0 2865 65.0 5833 8 World Summit for Children Goal => Number 6 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 26 May 28, 2002 Overall, 65 percent of primary school age children in Lesotho are attending primary school as shown in Table 4.0. More girls attend school than boys – 68.0 percent and 62.1 percent respectively. In urban areas 70.5 percent attend primary school as compared to 63.7 percent in the rural areas. Across the districts, Qacha’s Nek has the highest overall attendance at 71.0 percent, while Thaba-Tseka has the lowest attendance rate at 55.7 percent. These attendance rates are highest in the lowlands as compared to the Foothills posting 69.2 and 58.5 percent respectively. Table 4.1: Percentage of children entering first grade of primary school who eventually reach grade 5, Lesotho, 20009 CHARACTERISTIC Grade 1 reaching grade 2 Grade 2 reaching grade 3 Grade 3 reaching grade 4 Grade 4 reaching grade 5 Percent who reach grade 5 of those who enter grade 110 Male 93.5 94.7 92.0 92.0 75.0 Sex Female 95.2 94.7 92.9 93.9 78.6 Butha-Buthe 93.2 89.8 88.4 89.7 66.4 Leribe 96.0 95.1 93.3 95.5 81.3 Berea 91.9 92.7 88.7 93.4 70.5 Maseru 94.7 96.1 92.7 91.8 77.4 Mafeteng 92.3 96.5 91.7 93.5 76.4 Mohale’s Hoek 92.8 92.2 93.7 93.4 74.9 Quthing 95.4 91.7 89.8 90.0 70.7 Qacha’s Nek 94.6 97.5 96.9 96.3 86.0 Mokhotlong - 95.7 97.1 92.0 - District Thaba-Tseka 96.7 97.3 - 97.4 - Urban 93.1 97.2 95.0 94.8 81.5 Area Rural 94.6 94.1 91.8 92.6 75.6 TOTAL 94.3 94.7 92.4 93.0 76.8 Table 4.1 determines the cumulative probability that a child entering first grade will eventually reach fifth grade. From Table 4.1, we see that overall 76.8 percent of the children who enter first grade in primary school eventually reach grade 5. However, there are disparities across the sexes, district and area divide. For instance, 75.0 percent of male children who enter first grade eventually reach fifth grade compared to 78.6 percent for the female. In the districts this ranges from a low of 70.5 percent in Berea to 86.0 percent in Qacha’s Nek. The urban rate at 81.5 percent is higher than the 75.6 percent achieved in the rural areas. 9 World Summit for Children Goal => Number 6 10 This percentage is calculated as the product of four probabilities. The probability that a child graduates from first grade and enters second grade, probability that a child graduates from second grade and enters third grade, probability that a child graduates from third grade and enters fourth grade, and the probability that a child graduates from fourth grade and enters fifth grade. To calculate the first probability, the number of children in second grade at the time of the survey (ED20 = 2, 02) and who were in first grade last year (ED22 = 2, 01) are divided by the number of children who were in first grade last year (ED22 = 2, 01) and graduated to second grade (ED20 = 2, 02) or dropped out of school (ED17 = 2). The children who repeated first grade do not enter the calculation because it is not known whether they will eventually graduate. Calculation of the other grades is similar. The number who graduated from one grade is divided by the number who graduated or dropped out of that grade. These four probabilities are multiplied together to obtain the cumulative probability that a child reaching fifth grade is amongst those who entered first grade. – Please refer to questionnaire in Appendix A. Chapter Four – The Results 27 May 28, 2002 4.2 Child Labour It is important to monitor the extent to which children work and the type of work in which they participate for several reasons. Children who are working are less likely to attend school and more likely to drop out. This pattern can trap children in a cycle of poverty and disadvantage. Working conditions for children are often unregulated with few safeguards against potential abuse. In addition, many types of work are intrinsically hazardous and others present less obvious hazards to children, such as exposure to pesticides in agricultural work, carrying heavy weights and scavenging in garbage dumps. Table 4.2: Percentage of children 5-17 years of age who are currently working, Lesotho, 200011 CHARACTERISTIC Paid work Unpaid work Domestic work: < 4 hours/day Domestic work: 4 or more hours/day Family work (farm or business) Currently working No. of children Male 3.0 5.3 60.3 6.4 23.50 32.6 5350 Sex Female 1.1 5.1 66.4 8.2 15.36 25.7 5150 Lowland 1.8 4.4 68.0 6.1 17.18 26.1 6090 Foothill 2.3 3.5 63.4 6.0 28.53 35.6 1241 Mountain 2.3 7.0 53.3 8.6 21.29 32.1 2579 Region Senqu Valley 3.2 9.5 58.0 16.3 16.78 34.9 590 Urban 1.4 3.2 66.7 4.5 10.67 18.4 2033 Area Rural 2.2 5.7 62.5 8.0 21.63 31.8 8467 Butha-Buthe .7 7.8 60.8 9.5 24.82 34.8 681 Leribe 2.0 1.2 64.2 3.0 19.84 25.0 1381 Berea 1.6 .7 69.1 5.6 15.76 21.0 1339 Maseru 1.8 4.1 70.3 4.2 22.44 29.1 2219 Mafeteng 2.4 10.7 78.1 6.1 23.68 35.8 1368 Mohale's Hoek 3.2 2.3 43.6 15.1 8.73 26.2 1065 Quthing 3.3 14.6 60.7 13.8 17.46 35.9 733 Qacha's Nek .8 14.0 51.8 24.4 28.85 49.9 357 Mokhotlong 3.8 4.9 59.7 4.7 23.45 31.7 533 District Thaba-Tseka 1.2 2.8 46.1 4.1 14.93 21.5 824 5-9 years .5 4.5 50.6 2.8 10.14 15.5 3739 10-14 years 1.8 5.2 72.5 7.5 22.69 32.3 4584 Age 15-17 years 5.4 6.4 65.7 14.7 28.89 46.2 2177 Total 2.1 5.2 63.3 7.3 19.50 29.2 10500 Table 4.2 describes the status regarding working of children aged between 5-17 years in Lesotho. It describes in terms of sex, region, district and age group. Overall, 29.2 percent of the children aged between 5-17 are currently working. More of the male children are currently working, as compared with the female – 32.6 percent for the male and 25.7 percent for the female. In this age group, 15.5 percent of those aged 5-9 years are currently working as compared to 32.3 percent for those aged 10-14 years old and 46.2 percent for the 15-17 year olds. It is worth noting that, most of these currently working are found in the rural as compared to the urban areas of Lesotho – 18.4 percent in the urban areas and 31.8 percent in the rural areas. 11 Monitoring Children's Rights Indicator End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 28 May 28, 2002 Qacha’s Nek has the largest group, in percentage terms, currently working - 49.9 percent of those surveyed currently being involved in work of some sort. Approximately 63.3 percent of this age group are involved in domestic work for less than 4 hours each day, with more female than male children being involved – 66.4 percent and 60.3 percent respectively. Berea has the lowest showing, at 21.0 percent amongst the districts. 4.3 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 be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, particularly in the rural areas, who bear the primary responsibility for carrying water, often for long distances. Table 4.3 describes the distribution of the overall population in terms of their main source of drinking water. About fifty-three percent of the population draws its water from public taps, and only about 9.6 percent having piped water into their dwelling or yards/plots. Inspite of the fact that Lesotho is blessed by an abundance of rain, rainwater is a source for a very small 0.2 percent of the households. The population using safe drinking water sources is described as those using piped water, public taps, boreholes/tubewells, protected wells, protected springs, or rainwater. Overall, 76.8 percent of the population of Lesotho has access to safe drinking water – 88.4 percent and 73.6 percent in urban and rural areas respectively. The district of Mokhotlong has 49.0 percent of its population having access to safe drinking water. This is far below the national average of 76.8 percent. Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrheal diseases and polio. Sanitary means of excreta disposal include: flush toilets connected to sewage systems or septic tanks, other flush toilets, improved pit latrines, and traditional pit latrines. As described in Table 4.4, 53.6 percent of the overall population has access to sanitary means of excreta disposal – 87.8 percent in urban areas and 44.2 percent in rural areas. Again, Mokhotlong exhibits the lowest indicator in this regard, with 12.1 percent of its population having access to sanitary means of excreta disposal. Figure 4.0 makes a comparative assessment between access to safe water and sanitary means of excreta disposal at the district, urban, rural and national levels. The results described in Tables 4.3 and 4.4 become clearer, showing a disparity – more persons have access to safe water, less have access to sanitary means of excreta disposal. This has enormous environmental and public health implications. Chapter Four – The Results 29 May 28, 2002 Table 4.3: Percentage of the population using improved drinking water sources, Lesotho, 200012 MAIN SOURCE OF WATER CHARACTERISTIC Pi pe d in to dw el lin g Pi pe d in to ya rd o r pl ot P ub lic ta p T ub ew el l/b o re ho le w ith pu m p P ro te ct ed du g w el l P ro te ct ed sp ri ng R ai nw at er co lle ct io n B ot tle d w at er U np ro te ct ed du g w el l U np ro te ct ed sp ri ng Po nd , r iv er or s tr ea m T an ke r tr uc k ve nd or O th er M is si ng /D K Total with safe drinking water No. of persons Lowland 4.9 8.9 55.4 9.3 1.9 3.1 .3 .0 3.9 9.4 .2 .4 2.2 .0 83.8 19456 Foothill .3 .2 50.5 2.2 3.8 11.3 .2 .0 11.2 18.0 2.3 .0 .0 .0 68.5 3772 Mountain .6 4.7 44.8 .2 5.6 8.8 .0 .1 12.0 22.5 .2 .0 .4 .0 64.7 7793 Region Senqu Valley .3 .9 60.9 .6 3.9 4.2 .3 .0 2.5 23.2 2.5 .0 .0 .7 71.1 1723 Butha-Buthe .5 1.3 62.7 11.9 4.6 4.1 .0 .0 8.0 6.0 .6 .2 .0 .0 85.1 2039 Leribe 2.5 4.7 47.1 3.1 4.7 10.4 .1 .0 7.1 18.1 1.3 .2 .6 .0 72.6 4610 Berea 1.5 1.6 66.1 3.6 3.3 2.2 .1 .0 9.4 11.0 .6 .5 .3 .0 78.3 3993 Maseru 8.1 14.7 47.5 4.8 .6 6.0 .2 .0 3.7 9.1 .2 .5 4.5 .0 81.9 7513 Mafeteng 2.6 6.3 59.5 17.8 .3 .2 .5 .0 1.6 10.0 .1 .0 1.1 .0 87.2 3965 Mohale's Hoek 2.4 3.0 46.6 9.5 4.7 5.3 .5 .0 6.7 20.4 .5 .2 .2 .2 71.9 3208 Quthing 1.2 5.8 59.3 .5 3.0 4.1 .3 .0 1.4 21.4 2.1 .0 1.0 .0 74.1 2080 Qacha's Nek 1.8 5.2 74.2 .1 1.5 .9 .0 .0 1.7 14.2 .0 .0 .0 .3 83.7 1145 Mokhotlong .3 5.7 36.1 .0 .3 6.6 .0 .0 3.8 46.6 .0 .0 .6 .0 49.0 1677 District Thaba-Tseka .2 3.3 40.7 .3 11.5 11.8 .0 .3 25.3 6.0 .6 .0 .1 .0 67.7 2514 Urban 12.0 25.0 44.3 4.2 .7 2.0 .1 .0 2.9 3.0 .1 .3 5.3 .0 88.4 7098 Area Rural .7 1.3 54.9 6.3 3.8 6.4 .2 .0 7.7 17.4 .7 .2 .3 .0 73.6 25646 Total 3.1 6.5 52.6 5.9 3.1 5.4 .2 .0 6.6 14.3 .6 .2 1.4 .0 76.8 32744 12 World Summit for Children Goal => Number 4 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 30 May 28, 2002 Table 4.4: Percentage of the population using sanitary means of excreta disposal, Lesotho, 200013 Type of toilet facility CHARACTERISTIC F lu sh t o se w ag e sy st em /s e pt ic ta nk P ou r fl us h la tr in e Im pr ov ed pi t la tr in e T ra di ti on al p it la tr in e O pe n pi t B uc ke t O th er N o fa ci li ti es / bu sh /f ie ld Total with sanitary means of excreta disposal Number of persons Lowland 2.1 .9 22.5 44.7 2.6 .0 1.0 26.3 70.1 19456 Foothill .0 .0 13.5 31.3 1.9 .0 1.2 52.2 44.7 3772 Mountain .1 .2 9.0 11.6 2.3 .1 9.0 67.7 20.9 7793 Region Senqu Valley .8 .0 13.9 19.9 6.2 .0 13.5 45.6 34.6 1723 Butha-Buthe .2 .2 15.2 36.4 .7 .0 .0 47.2 52.1 2039 Leribe 1.5 .0 17.8 49.4 .1 .0 1.8 29.4 68.7 4610 Berea .7 .1 14.7 41.1 3.7 .0 2.1 37.7 56.5 3993 Maseru 3.4 2.2 25.2 43.0 2.1 .0 1.5 22.7 73.7 7513 Mafeteng 1.4 .1 21.9 40.5 .5 .0 .0 35.6 63.9 3965 Mohale's Hoek .3 .0 16.9 18.6 14.7 .0 1.2 48.3 35.8 3208 Quthing .7 .7 17.5 23.5 .7 .0 17.9 39.1 42.4 2080 Qacha's Nek .4 .0 8.3 25.0 .0 .0 .8 65.5 33.7 1145 Mokhotlong .0 .0 9.3 2.8 .5 .0 .0 87.4 12.1 1677 District Thaba-Tseka .0 .0 7.4 8.0 1.1 .2 18.8 64.6 15.4 2514 Urban 4.7 2.3 36.9 44.0 1.2 .0 .7 10.2 87.8 7098 Area Rural .4 .1 12.5 31.2 3.0 .0 4.4 48.4 44.2 25646 Total 1.3 .6 17.8 34.0 2.6 .0 3.6 40.1 53.6 32744 13 World Summit for Children Goal => Number 5 Chapter Four – The Results 31 May 28, 2002 Figure 4.0a: Access to Safe Drinking Water and Sanitary Means of Excreta Disposal by District, Lesotho, 2000 85.1 72.6 78.3 81.9 87.2 71.9 74.1 83.7 49.0 67.7 76.8 53.6 15.4 12.1 33.7 42.4 35.8 73.7 63.9 52.1 68.7 56.5 Butha-Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba-Tseka Total District P er ce nt ag e Total with Safe Drinking Water Total with Sanitary Means of Excreta Disposal Figure 4.0: Access to Safe Drinking Water and Sanitary Means of Excreta Disposal by Region, Lesotho 2000 83.8 68.5 64.7 71.1 76.8 70.1 44.7 20.9 34.6 53.6 Lowland Foothill Mountain Senqu Valley Total Region P er ce nt ag e Total with Safe Drinking Water Total with Sanitary Means of Excreta Disposal End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 32 May 28, 2002 Based on the results depicted in Figures 4.0, 4.0a, and 4.0b, a meaningful comparison can be made between the 2000 Lesotho EMICS and the year 2000 target goals in respect of water and sanitation by the 1995-2000 Kingdom of Lesotho National Programme of Action for Children14. Table 4.4a: Comparison between 2000 Lesotho EMICS Results and NPAC15 Goals ASPECT AREA 1993/94 Status (%) Year 2000 NPAC target Goals (%) 2000 Lesotho EMICS (%) Deviation (% Points) Urban 44.0 58 88.4 30.4 Access to Safe Drinking Water Rural 58.0 81 73.6 -6.4 Urban 42.0 73 87.8 14.8 Access to Sanitary Excreta Disposal Rural 25.0 52 44.2 -7.8 From Table 4.4a, it is clear that Lesotho has made positive efforts in meeting its stated goals in the National Programme of Action for Children, only facing challenges in meeting access to safe drinking water and sanitary means for excreta disposal in the rural areas. 14 See Table 1.0 in Chapter 1. 15 1995-2000 Kingdom of Lesotho National Programme of Action for Children Figure 4.0b: Access to Safe Drinking Water and Sanitary Means of Excreta Disposal by Area, Lesotho, 2000 76.8 73.688.4 53.6 44.2 87.8 Urban Rural Total Area P er ce nt ag e Total with Safe Drinking Water Total with Sanitary Means of Excreta Disposal National Average for Sanitary Means of Excreta Disposal National Average for Safe Drinking Water Chapter Four – The Results 33 May 28, 2002 4.4 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. In a well-nourished population, there is a standard distribution of height and weight for children under age five. Undernourishment in a population can be gauged by comparing children to this standard distribution. The standard of reference here is the NCHS standard, which is recommended for use by UNICEF and the World Health Organisation. Each of the three nutritional status indicators16 is expressed in standard deviation units (z-scores) from the median of this reference population. The nutritional status data for the 2000 Lesotho EMICS is reported in Table 4.5 and Figure 4.1. Table 4.5 describes the percentage of under-five children who are severely or moderately undernourished17. The percent below 2 standard deviations in this table is used to create Figure 4.1 that describes the prevalence status. This data should be interpreted with caution given indications that there were problems with height measurements (see Appendix G - Anthropometry Data Check). 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 is more than three standard deviations below the main median are classified as severely underweight. According to Figure 4.3, the prevalence of those amongst the 12-23 month olds that are severely underweight is about 25.8 percent. Height for age is a measure of linear growth. Children whose height for age is more than two standard deviations below the median of 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 because of failure to receive adequate nutrition over a long period and recurrent or chronic illness. In the 12-23 month old age bracket, prevalence of stunting is about 55.6 percent. Figure 4.118 above intimates that stunting is a severe problem in Lesotho. This should be read conservatively given the results of the Anthropometry Data Check as indicated in Appendix G. 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 falling more than three standard deviations below the median are severely wasted. 16 These are weight for age, height for age, and weight for height. 17 The percent “below – 2 standard deviations” includes those who fall 3 or more standard deviations below the median. 18 The apparent drop in the prevalence rates between age groups of 12-23 months and 24-35 months are of no statistical consequence, because the reference populations utilized in determining the z-scores are different. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 34 May 28, 2002 Table 4.5: Percentage of under-five children who are severely or moderately undernourished, Lesotho, 200019 UNDERWEIGHT STUNTING WASTNG CHARACTERISTICS Weight for age: -2 SDWeight for age: -3 SDHeight for age: -2 SD Height for age: -3 SD Weight for height: -2 SDWeight for height: -3 SD No. of children Male 19.6 3.9 47.5 23.1 5.8 1.6 1487 Sex Female 16.0 3.7 43.3 19.1 5.0 1.1 1470 Lowland 14.7 3.1 42.7 18.2 4.8 1.4 1706 Foothill 21.4 3.9 53.0 27.7 3.6 .6 336 Mountain 23.0 5.5 48.0 24.1 8.6 2.1 734 Region Senqu Valley 19.3 3.3 46.4 23.2 2.2 .0 181 Butha-Buthe 20.6 3.3 58.3 36.1 5.0 1.1 180 Leribe 17.4 3.7 44.6 18.9 3.9 .9 538 Berea 13.4 3.8 44.1 18.4 4.9 1.6 368 Maseru 13.2 1.6 41.7 19.0 4.6 1.0 505 Mafeteng 15.4 2.7 41.8 16.2 4.1 1.1 366 Mohale's Hoek 24.5 7.1 52.2 27.7 5.5 1.6 255 Quthing 17.7 4.3 40.2 15.3 5.3 1.0 211 Qacha's Nek 26.2 2.9 48.5 25.2 7.8 1.9 104 Mokhotlong 22.4 6.3 54.6 29.8 4.9 2.0 207 District Thaba-Tseka 22.7 5.0 40.5 19.1 13.6 2.7 223 Urban 13.5 3.2 39.0 16.7 5.6 .9 563 Area Rural 18.8 4.0 46.9 22.1 5.4 1.5 2394 < 6 months 3.3 .8 19.2 3.8 5.0 .8 240 6-11 months 16.6 4.4 34.8 13.9 6.8 .7 298 12-23 months 25.8 6.4 55.6 30.1 8.7 3.7 575 24-35 months 19.3 4.0 44.1 21.5 5.3 1.3 678 36-47 months 17.8 3.4 48.9 19.8 3.9 .3 618 Age 48-59 months 14.8 2.4 49.8 24.2 3.3 .7 547 None 18.6 4.3 54.3 26.6 5.9 1.6 188 Primary 20.3 4.8 47.4 22.4 5.8 1.6 1935 Secondary 11.8 1.5 38.7 16.7 4.5 .7 832 Mother's education level Non-standard curriculum 50.0 .0 50.0 .0 .0 .0 2 Total 17.8 3.8 45.4 21.1 5.4 1.4 295720 19 World Summit for Children Goal => Number 3, 9, 26 20 780 children are missing from this data. This constitutes about 20 percent of the sampled under-five children. This was due the fact that the children ran away, the mother refused the child to be measured or others were ill at the time of the survey. Chapter Four – The Results 35 May 28, 2002 Wasting is usually the result of recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. The prevalence of wasting amongst those aged 12-23 months is approximately 8.7 percent. During the 2000 Lesotho EMICS, a number of challenges were encountered by the enumerators while getting data on the base variables for nutritional status indicators. For instance some children simply refused to be measured for height or weight. In other cases, traditional values mitigated against such measurement as the mothers considered that this would bring misfortune. 4.5 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 stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Summit for Children goal states that children should be exclusively breastfed for four to six months, and that breastfeeding should continue with timely and sound complimentary food, well into the second year of life. Many countries have adopted the recommendations of exclusive breastfeeding for about six months. Figure 4.1: Percent of under-five children who are undernourished, Lesotho, 2000 14.8 19.2 34.8 55.6 3.33.3 16.6 25.8 19.3 17.8 49.848.9 44.1 3.9 5.3 8.7 6.8 5 0 10 20 30 40 50 60 < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Age (in months) P er ce nt Underweight Stunting Wasting End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 36 May 28, 2002 In Table 4.6, the breastfeeding status is based on women’s reports of children’s consumption in the 24 hours prior to the interview. Exclusive breastfeeding refers to children who receive only breast milk and vitamins, mineral supplements, or medicine. Complimentary breastfeeding refers to children who receive breast milk and solid or semi-solid food. The last two columns of Table 4.6 include children who are continuing to be breastfed at one and at two years of age. Percentages according to districts should be interpreted with caution since the sample sizes applied are small. This caveat applies to the sex and area percentages. Data in Table 4.6 shows that 22.2 percent of the 0-3 months are exclusively breastfed. At 6-9 months, 51.2 percent of the children are receiving solid foods in addition to breastmilk. By the age of 12-15 months, 85.7 percent of the children are still being breastfed and by 20-23 months, 58.1 percent are still breastfeeding. In all the age groupings, except age group 12-15 months, boys are breastfed more than girls are. The children in Butha-Buthe district, as described by the results in Table 4.6, breastfeed on average longer than children in other districts as well as in comparison with the national average. The relation between the mother’s level of education and the duration of the breastfeeding phase is not clear. It is however safe to point out that in all cases, the level of breastfeeding continues, but declines sharply with children aged 20-23 months. Figure 4.2 shows the same results but differently. It shows that the percentage of children who are not breastfed is low in the early month’s upto 15 months of age, and then it rises sharply. Children who are exclusively breastfed are more in the early months of life, but this declines rapidly after 3 months of age. Those children that receive breast milk are few and decline quickly as shown in Figure 4.2. The children that receive breast milk and supplementary food form the largest proportion of this group, but are rapidly weaned of breastmilk from about 15 months of age. Chapter Four – The Results 37 May 28, 2002 Table 4.6: Percent of living children by breastfeeding status, Lesotho, 20002122 Exclusive breastfeeding Solid foods Breastfed Breastfed CHARACTERISTIC Children 0-3 months Number of children Children 6-9 months Number of children Children 12-15 months Number of children Children 20-23 months Number of children Male 29.4 109 54.2 144 83.8 130 60.2 123 Sex Female 15.2 112 48.4 159 87.8 115 55.9 118 Butha-Buthe 41.7 12 66.7 21 100.0 12 80.0 15 Leribe 23.1 39 49.0 49 83.7 43 51.3 39 Berea 22.6 31 48.6 37 83.3 30 54.5 33 Maseru 12.8 39 55.4 65 85.5 55 51.0 51 Mafeteng 10.7 28 75.0 32 85.0 20 59.4 32 Mohale's Hoek 22.2 18 34.6 26 76.0 25 58.8 17 Quthing 11.1 9 52.9 17 84.2 19 46.2 13 Qacha's Nek 11.1 9 54.5 11 92.3 13 88.9 9 Mokhotlong 25.0 20 53.3 15 100.0 10 66.7 15 District Thaba-Tseka 56.3 16 23.3 30 88.9 18 64.7 17 Urban 18.2 44 48.5 68 76.6 47 52.2 46 Area Rural 23.2 177 51.9 235 87.9 198 59.5 195 None 18.2 11 50.0 14 100.0 10 52.6 19 Primary 21.9 137 47.9 192 83.4 163 60.0 160 Mother's education level Secondary 23.3 73 57.7 97 88.9 72 54.8 62 Total 22.2 221 51.2 303 85.7 245 58.1 241 21 World Summit for Children Goal => Number 16 22 Breastfeeding status is based on women’s reports of children’s consumption in the 24 hours prior to the interview. Exclusive breastfeeding refers to children who receive only breastmilk and vitamins, mineral supplements or medicine. Complimentary breastfeeding refers to children who re breastmilk and solid or semi-solid food. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 38 May 28, 2002 Exclusively breastfed includes vitamin, mineral supplements and medicine Figure 4.2: Percent distribution of children by breasfeeding status, Lesotho, 2000 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-27 28-29 30-31 32-33 34-35 Age (in months) Pe rc en ta ge Not breastfeeding Exclusively breastfed Breast milk and water only Breast milk and supplementary food Chapter Four – The Results 39 May 28, 2002 4.6 Vitamin A Supplementation Vitamin A deficiency (VAD) impairs children’s immune systems, increasing their chances of dying of common childhood diseases and undermines the health of pregnant and lactating women. It can also cause eye damage and blindness in children. Yet it can be easily prevented by vitamin A supplementation or food fortification. Table 4.7: Percent distribution of children aged 6-59 months by whether they received a high dose of Vitamin A supplement in the last 6 months, Lesotho, 200023 Vitamin A CHARACTERISTIC Received: within last 6 months Received: prior to last 6 months Received: not sure when Not received No. of children Male 15.8 7.1 1.8 75.3 1600 Sex Female 18.2 5.9 1.8 74.1 1572 Lowland 20.4 6.2 1.2 72.2 1765 Foothill 18.8 5.8 2.0 73.4 394 Mountain 10.7 8.3 2.4 78.6 824 Region Senqu Valley 9.0 3.7 3.7 83.6 189 Butha-Buthe 42.3 7.4 3.2 47.1 189 Leribe 17.6 2.5 .6 79.3 518 Berea 16.4 7.1 1.0 75.5 396 Maseru 8.4 5.0 1.1 85.5 621 Mafeteng 32.0 10.1 2.0 55.9 347 Mohale's Hoek 26.0 8.7 3.6 61.7 277 Quthing 3.7 2.3 .5 93.5 214 Qacha's Nek 14.9 7.5 6.7 70.9 134 Mokhotlong 12.0 2.4 1.0 84.7 209 District Thaba-Tseka 5.6 15.7 3.0 75.7 267 Urban 13.4 5.8 2.5 78.3 599 Area Rural 17.8 6.7 1.6 73.8 2573 6-11 months 2.2 .7 .7 96.3 402 12-23 months 18.1 4.9 1.5 75.6 741 24-35 months 18.6 9.0 2.0 70.4 768 36-47 months 19.3 6.3 2.1 72.2 662 Age 48-59 months 20.9 9.5 2.3 67.3 599 None 13.5 6.7 1.0 78.8 208 Primary 16.5 6.5 1.6 75.5 2102 Mother's education level Secondary 19.2 6.5 2.6 71.7 860 Total 17.0 6.5 1.8 74.7 3172 UNICEF and WHO recommend that all countries with an under five mortality rate exceeding 70 per 1000 live births, or where vitamin A deficiency is a public health problem, should put in place a programme for control of vitamin A deficiency. Based on UNICEF/WHO guidelines children aged 6-12 months should be given one dose of Vitamin A capsule of 100,000 IU every six months, and children older than one year be given one high dose of 200,000 IU every six months. 23 World Summit for Children Goal => Number 15 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 40 May 28, 2002 Table 4.7 describes the distribution of children (6-59 months) who had received a high dose Vitamin A Supplement in the six months prior to the 2000 Lesotho EMICS. It shows that 17.0 percent of the children had received a high dose Vitamin A supplement in the six months prior to the 2000 Lesotho EMICS. Fewer than 2.0 percent received a Vitamin A Supplement at some time in the past, but their mother/caretaker was unable to specify when. Approximately 6.5 percent had received the Vitamin A Supplement prior to the last six months. In terms of region, the Senqu valley had the lowest coverage. Quthing, Thaba-Tseka, and Maseru displayed coverages below 10 percent. The age pattern of Vitamin A Supplementation in the last six months was 2.2 percent amongst children aged 6-11 months to 20.9 percent amongst those 48-59 months. The mother’s educational level does not really seem to have a bearing on the Vitamin A Supplementation in Lesotho. It is 13.6 percent amongst children whose mothers/caretakers have no education, 16.9 and 19.5 percent respectively for those whose mothers have primary or secondary education in that order. Table 4.8: Percentage of women with a birth in the last 12 months by whether they received a high dose of Vitamin A supplement before the infant was 8 weeks old, Lesotho, 200024 CHARACTERISTIC Received Vitamin A supplement Not sure if received No. of women Lowland 13.0 .0 485 Foothill 13.9 .0 101 Mountain 10.8 .0 222 Region Senqu Valley 26.8 .0 41 Butha-Buthe 30.4 .0 46 Leribe 15.4 .0 130 Berea 6.1 .0 115 Maseru 14.8 .0 183 Mafeteng 7.4 .0 95 Mohale's Hoek 14.3 .0 70 Quthing 19.1 .0 47 Qacha's Nek 7.4 .0 27 Mokhotlong 8.1 .0 62 District Thaba-Tseka 14.9 .0 74 Urban 16.4 .0 177 Area Rural 12.4 .0 672 Primary 16.3 .0 43 Secondary/High 13.0 .0 784 Woman's education level Higher/Tertiary 13.6 .0 22 Total 13.2 .0 850 Table 4.8 provides a description of the women who have given birth in the last 12 months prior to the survey who have or have not received Vitamin A supplementation. Overall, only 13.2 percent of the women who have delivered in the 12 months prior to the 2000 Lesotho EMICS were certain of having received Vitamin A Supplementation. In all the areas, except the Senqu Valley, this indicator posts 26.8 percent of the women being sure of having received Vitamin A Supplementation. 24 World Summit for Children Goal => Number 15 Chapter Four – The Results 41 May 28, 2002 4.7 Salt Iodization Deficiency of iodine in the diet is the world’s single greatest cause of preventable mental retardation and can lower average intelligence quotient (IQ) by as much as 13 points. Table 4.9: Percent of households consuming adequately iodised salt, Lesotho, 200025 Result of test CHARACTERISTIC Percent of households with no salt Percent of households in which salt was tested < 15 PPM 15+ PPM Number of households interviewed Lowland 2.9 95.6 23.0 77.0 4583 Foothill 8.0 90.6 42.4 57.6 828 Mountain 4.8 94.2 43.8 56.2 1681 Region Senqu Valley 4.7 92.6 56.1 43.9 379 Urban 1.5 97.3 9.3 90.7 1835 Area Rural 4.8 93.7 38.8 61.2 5636 Butha-Buthe 3.7 95.7 30.4 69.6 461 Leribe 1.5 97.6 21.9 78.1 1125 Berea 4.8 94.3 30.7 69.3 858 Maseru 4.5 93.4 18.0 82.0 1842 Mafeteng 6.1 93.2 34.7 65.3 856 Mohale's Hoek 2.9 92.7 48.0 52.0 730 Quthing 5.2 94.6 52.1 47.9 459 Qacha's Nek 4.6 95.0 39.1 60.9 280 Mokhotlong 3.9 96.1 50.3 49.7 360 District Thaba-Tseka 3.8 95.8 37.2 62.8 499 Total 4.0 94.6 31.3 68.7 7470 Table 4.9a: Percent of population consuming adequately iodized salt, Lesotho, 2000 Result of test CHARACTERISTIC Percent of population with no salt Percent of population in which salt was tested < 15 PPM 15+ PPM Number of persons Lowland 2.6 97.1 23.1 76.9 19456 Foothill 7.3 92.2 39.9 60.1 3772 Mountain 4.8 94.8 42.5 57.5 7793 Region Senqu Valley 4.5 94.8 55.4 44.6 1723 Urban .9 98.8 9.4 90.6 7098 Area Rural 4.5 95.1 37.4 62.6 25646 Butha-Buthe 3.1 96.8 29.9 70.1 2039 Leribe 1.4 98.4 19.8 80.2 4610 Berea 3.9 95.6 30.8 69.2 3993 Maseru 4.1 95.4 19.0 81.0 7513 Mafeteng 5.7 93.8 33.5 66.5 3965 Mohale's Hoek 3.2 96.3 46.1 53.9 3208 Quthing 4.1 95.7 51.6 48.4 2080 Qacha's Nek 4.5 95.5 36.4 63.6 1145 Mokhotlong 4.2 95.8 47.8 52.2 1677 District Thaba-Tseka 3.9 95.7 37.5 62.5 2514 Total 3.7 95.9 31.2 68.8 32744 25 World Summit for Children Goal => Number 14 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 42 May 28, 2002 Salt Iodization is an effective, low-cost way of preventing iodine deficiency disorders (IDD). Adequately iodised salt contains 15 PPM (part per million) of iodine or more. In the 2000 Lesotho EMICS, interviewers tested household salt for iodine levels by means of a testing kit. Overall, according to Table 4.9, approximately 94.6 percent of the households interviewed had their salt tested. Of those that had their salt tested 68.7 percent had salt that was adequately iodised. Amongst the districts Mokhotlong displayed the lowest reporting of households that had adequately iodised salt at 47.9 percent, as compared with Maseru, where 82 percent of the households had adequately iodised salt for consumption. Approximately 90.7 percent of the urban households had adequately iodised salt as compared to 61.2 percent in the rural areas. Table 4.9a on the other hand describes the distribution of the population of Lesotho that has access to adequately iodised salt. The figures do not significantly differ from those displayed in Table 4.9. Table 4.9a shows that 95.9 percent of the household members had the salt that they use tested. Of those that had this test done, 68.8 percent were shown to be using adequately iodised salt, whilst 31.2 percent had their salt showing less than 15 ppm of Iodine in the salt that they used. 4.8 Immunisation Coverage 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. The 2000 Kingdom of Lesotho MICS asked mothers to provide vaccination cards for children under the age of five. Interviewers copied this vaccination information from the cards onto the MICS questionnaire. 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, for DPT and Polio, how many times. Table 4.10 shows the percentage of children age 12-23 months who received each of the vaccinations. The denominator of the table is comprised of children aged 12-23 months so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator included all the children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. The last column of Table 4.10 shows the immunisation coverage for each vaccine for children who had received it by their first birthday. This information is represented graphically in Figure 4.3. Table 4.11 describes the immunisation status for children age 12-23 months in Lesotho. It shows that overall 84.9 percent of the children had health cards. It clearly shows that the more educated the mother of the child, the higher the level of immunisation against childhood diseases. Immunisation coverage is higher in the urban as compared to the rural areas – 76.3 percent for urban and 69.8 percent for the rural areas. The gender disparity is minimal with male coverage at 71.6 percent as compared to 70.6 percent for the females. It is highest in the lowlands, 73.8 percent and lowest in the Senqu Valley at 58.3 percent. Amongst the districts, it is highest in Butha-Buthe and lowest in Quthing at 59.1 percent Chapter Four – The Results 43 May 28, 2002 Table 4.10: Percentage of children age 12-23 months currently vaccinated any time before the survey or before 12 months of age, Lesotho, 2000 STATUS Vaccination Card Mother's Report Either Not vaccinated Does not have all vaccinations a Has some vaccinations b No. of Children Vaccinat ed by 12 months age BCG 83.1 8.4 91.5 8.5 - - 762 90.5 DPT 1 81.9 8.5 90.4 9.6 - - 762 88.5 DPT 2 81.8 7.2 89.0 11 - - 762 87.8 DPT 3 79.9 5.5 85.4 14.6 - - 762 83.9 Polio 0 62.9 4.1 67.0 33.1 - - 762 66.6 Polio 1 82.2 7 89.2 10.9 - - 762 87.8 Polio 2 81.5 5.9 87.4 12.6 - - 762 86.0 Polio 3 79.4 4.1 83.5 16.5 - - 762 82.4 Measles 69.6 7.6 77.2 22.8 - - 762 71.3 All vaccinations 67.8 3.3 71.1 - 28.9 - 762 62.6 No vaccinations 1 6.6 7.6 - - 92.4 762 0.0 Notes to Table 4.10 a This refers to All Vaccinations shown in the status column b This refers to No Vaccinations in the status column . Figure 4.3: Percent of children age 12-23 months cuurently vaccinated any time before the survey or before 12 months of age, Lesotho, 2000 67.8 69.679.4 81.5 82.262.979.981.881.983.1 3.3 7.6 4.1 5.97 4.15.5 7.28.58.4 0 10 20 30 40 50 60 70 80 90 BCG DPT 1 DPT 2 DPT 3 Polio 0 Polio 1 Polio 2 Polio 3 Measles All vaccinat ions Vaccinations Received P er ce n ta ge Vaccination Card Mother's Report Either Vaccinated by 12 months age End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 44 May 28, 2002 Table 4.11 Percentage of children age 12-23 months currently vaccinated against childhood diseases, Lesotho, 2000 CHARACTERISTIC BCG DPT 1 DPT 2 DPT 3 Polio 0 Polio 1 Polio 2 Polio 3 Measles All None % with health card No. of children Male 91.9 89.6 88.3 84.6 64.3 89.1 87.8 83.3 77.3 71.6 7.8 84.4 384 Sex Female 91.0 91.3 89.7 86.2 69.6 89.2 87.0 83.6 77.0 70.6 7.4 85.4 378 Lowland 93.0 92.3 90.5 88.0 73.1 91.4 89.6 85.6 79.5 73.8 5.6 86.2 443 Foothill 89.0 89.0 86.8 82.4 67.0 84.6 79.1 76.9 75.8 65.9 11.0 84.6 91 Mountain 88.5 86.5 86.5 82.3 52.6 85.9 86.5 83.3 75.0 69.8 10.9 81.8 192 Region Senqu Valley 94.4 91.7 88.9 77.8 66.7 88.9 86.1 75.0 63.9 58.3 5.6 86.1 36 Butha-Buthe 100.0 100.0 97.7 93.2 81.8 100.0 95.5 95.5 95.5 86.4 .0 90.9 44 Leribe 90.4 92.0 89.6 88.0 79.2 88.0 86.4 84.0 81.6 76.0 8.0 88.8 125 Berea 90.8 91.8 89.8 83.7 62.2 89.8 85.7 80.6 73.5 68.4 7.1 83.7 98 Maseru 91.9 91.3 90.7 88.2 71.4 90.1 89.4 87.0 80.1 77.0 8.1 87.6 161 Mafeteng 91.3 87.5 85.0 82.5 58.8 87.5 82.5 77.5 73.8 60.0 7.5 76.3 80 Mohale's Hoek 94.4 90.1 90.1 85.9 74.6 91.5 91.5 81.7 74.6 67.6 4.2 88.7 71 Quthing 88.6 86.4 84.1 75.0 56.8 81.8 81.8 75.0 63.6 59.1 11.4 81.8 44 Qacha's Nek 94.1 94.1 94.1 91.2 79.4 94.1 94.1 91.2 73.5 73.5 5.9 91.2 34 Mokhotlong 95.9 89.8 87.8 83.7 36.7 91.8 91.8 87.8 73.5 61.2 4.1 73.5 49 District Thaba-Tseka 80.4 80.4 80.4 78.6 51.8 78.6 78.6 76.8 75.0 73.2 17.9 82.1 56 Urban 94.1 94.7 93.4 91.4 85.5 92.8 92.8 87.5 81.6 76.3 5.3 89.5 152 Area Rural 90.8 89.3 87.9 83.9 62.3 88.2 86.1 82.5 76.1 69.8 8.2 83.8 610 None 87.8 82.9 82.9 68.3 41.5 82.9 78.0 68.3 70.7 56.1 12.2 75.6 41 Primary 90.1 88.3 86.5 83.6 62.8 86.7 85.3 81.8 74.1 68.3 9.1 82.4 495 Mother's education level Secondary 95.1 96.5 95.6 92.5 80.5 95.6 93.8 89.8 85.0 80.1 3.5 92.0 226 Total 91.5 90.4 89.0 85.4 66.9 89.1 87.4 83.5 77.2 71.1 7.6 84.9 762 Chapter Four – The Results 45 May 28, 2002 4.8 Knowledge of HIV/AIDS Transmission One of the most important strategies for reducing HIV/AIDS infection rates is the promotion of accurate knowledge of how AIDS is transmitted and how to prevent transmission. Table 4.12: Percent of women 15-49 who know the main ways of preventing HIV transmission, Lesotho, 200026 Characteristic Heard of AIDS Have only one faithful uninfected sex partner Using a condom every time Knows both (two) ways Knows at least one way Doesn't know any way No. of women Lowland 89.6 58.9 67.7 54.8 71.8 28.2 4052 Foothill 84.4 51.8 59.4 48.7 62.5 37.5 739 Mountain 76.9 44.8 50.8 41.2 54.4 45.6 1609 Region Senqu Valley 81.4 48.8 53.0 45.3 56.5 43.5 338 Urban 91.6 63.7 73.8 60.1 77.4 22.6 1712 Area Rural 83.5 51.0 58.0 47.1 61.9 38.1 5026 Butha-Buthe 94.9 60.0 67.6 55.5 72.0 28.0 447 Leribe 88.9 57.5 67.8 54.2 71.1 28.9 993 Berea 87.0 51.7 62.5 47.3 66.8 33.2 805 Maseru 87.5 60.8 67.5 57.0 71.3 28.7 1580 Mafeteng 88.7 58.1 63.0 53.0 68.1 31.9 790 Mohale's Hoek 81.7 47.0 58.0 44.5 60.6 39.4 553 Quthing 79.7 48.9 51.3 44.9 55.3 44.7 472 Qacha's Nek 75.3 50.2 57.7 44.8 63.2 36.8 239 Mokhotlong 67.9 25.9 31.0 22.1 34.8 65.2 371 District Thaba-Tseka 85.0 55.9 65.6 54.1 67.4 32.6 488 15-19 75.8 43.8 50.4 40.0 54.2 45.8 1413 20-24 86.7 56.4 65.4 53.3 68.5 31.5 1384 25-29 87.4 58.7 65.9 54.0 70.6 29.4 1024 30-34 90.5 59.8 68.4 55.9 72.3 27.7 798 35-39 87.8 54.9 64.5 51.4 68.0 32.0 860 40-44 90.8 57.4 63.5 53.4 67.5 32.5 693 Age 45-49 87.5 54.9 61.6 50.7 65.8 34.2 552 Primary 61.5 31.2 34.2 28.9 36.5 63.5 301 Secondary/High 86.4 54.8 62.7 51.0 66.5 33.5 6230 Woman's education level Higher/Tertiary 99.5 76.0 84.7 68.9 91.8 8.2 183 Total 85.6 54.3 62.0 50.4 65.8 34.2 6741 Amongst the women age 15-49 in Lesotho, 85.6 percent have ever heard of AIDS, according to Table 4.12. In the urban areas the percentage is 91.6 percent compared to 83.5 percent in the rural areas. Women in the 2000 Lesotho EMICS were read several statements about the means of HIV/AIDS transmission and asked to state whether they believed those statements were true. Fifty-four percent believed that having only one uninfected partner could prevent HIV transmission. Sixty-two percent believe that using a condom every time one has sex can prevent HIV transmission and 42.5 percent agreed that abstaining from sex prevents HIV transmission. Overall, 33.3 percent knew all three ways of preventing HIV/AIDS transmission and 67.3 percent knew at least one way of preventing HIV/AIDS transmission. About 32.7 percent did not know any way of preventing HIV/AIDS transmission. 26 Monitoring HIV/AIDS Indicator End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 46 May 28, 2002 In Mokhotlong, approximately 41.0 percent of women knew of the three ways identified. It was the only district where less than 70 percent of the women had ever heard about HIV/AIDS. Differences are apparent amongst the age groups. In all age groups knowledge is above 85 percent, except in the 15-19 year age set. In terms of the educational level, the trend exhibited is that the higher the level of education the more knowledgeable the women. Table 4.12a: Percentage of women aged 15-19 who know the main ways of preventing HIV transmission, Lesotho, 200027 CHARACTERISTIC Hear d of AIDS Have only one faithful uninfected sex partner Using condom every time Abstainin g from sex Knows all three ways Knows at least one way Doesn't know any way No. of women Lowland 79.6 47.9 54.3 42.8 31.2 60.3 39.7 849 Foothill 78.1 40.6 50.6 37.5 27.5 54.4 45.6 160 Mountain 65.0 34.1 40.2 26.0 18.4 44.7 55.3 331 Region Senqu Valley 75.3 46.6 50.7 34.2 27.4 53.4 46.6 73 Urban 82.8 50.5 60.2 45.5 36.4 64.3 35.7 319 Area Rural 73.8 41.9 47.5 35.6 25.0 53.1 46.9 1094 Butha-Buthe 91.2 52.8 62.4 46.4 33.6 67.2 32.8 125 Leribe 84.8 51.0 57.6 37.4 29.8 61.6 38.4 198 Berea 71.4 38.5 44.5 41.8 27.5 52.2 47.8 182 Maseru 75.2 47.3 51.7 43.6 33.9 57.4 42.6 298 Mafeteng 77.3 48.3 54.1 42.4 28.5 61.0 39.0 172 Mohale's Hoek 72.5 34.9 43.1 31.2 22.0 47.7 52.3 109 Quthing 72.3 45.5 47.5 34.7 27.7 52.5 47.5 101 Qacha's Nek 65.9 40.9 61.4 22.7 18.2 61.4 38.6 44 Mokhotlong 54.7 18.6 22.1 19.8 10.5 29.1 70.9 86 District Thaba-Tseka 75.5 40.8 52.0 27.6 20.4 53.1 46.9 98 Age 15-19 75.8 43.8 50.4 37.8 27.6 55.6 44.4 1413 Primary 47.4 28.9 28.9 21.1 18.4 31.6 68.4 38 Woman's education level Secondary/High 76.5 44.1 50.9 38.2 27.8 56.0 44.0 1360 Total 75.8 43.8 50.4 37.8 27.6 55.6 44.4 1413 Table 4.12a describes the same picture as does Table 4.12, only this time it looks at the women aged 15-19 years old. In this age group 75.8 percent have ever heard about HIV/AIDS. About 27.6 percent know all three ways of preventing HIV/AIDS transmission, while 55.6 percent know of at least one way. Approximately 44 percent do not know any way at all. These figures are much lower than those shown for women in the 15-49 years group in Table 4.12. Table 4.13 describes the identification of various misconceptions about AIDS amongst women 15-49. Overall 60.5 percent of them state that mosquitoes cannot transmit HIV/AIDS. There is a variation across the regions, districts, areas, ages and the educational level. In respect of the regions, only 45.6 percent of the women in the Senqu Valley identify this as a misconception, compared to 89.7 percent in the lowlands. Amongst the districts, 94.9 percent of the women in Butha-Buthe identify this as a misconception. A low 23.9 percent of the women are able to identify all three misconceptions about the transmittal of HIV/AIDS compared to the 71.7 percent who know at least one of them, a surprisingly low figure. 27 Monitoring HIV/AIDS Indicator Chapter Four – The Results 47 May 28, 2002 Table 4.13: Women 15-49 who correctly identify misconceptions about HIV/AIDS, Lesotho, 200028 CHARACTERISTIC Heard of AIDS Can't be transmitted by supernatural means Can't be transmitted by mosquito bites A healthy looking person can be infected Knows all three misconceptions Knows at least one misconception Doesn't correctly identify any misconception No. of women Lowland 89.6 66.3 39.7 56.7 26.1 77.6 22.4 4052 Foothill 84.4 56.6 34.2 45.6 20.7 67.7 32.3 739 Mountain 76.9 49.8 32.6 41.0 20.2 60.0 40.0 1609 Region Senqu Valley 81.4 45.6 29.9 45.0 18.6 60.7 39.3 338 Butha-Buthe 94.9 65.8 40.7 55.3 23.9 79.4 20.6 447 Leribe 88.9 63.4 39.7 49.7 25.9 73.4 26.6 993 Berea 87.0 64.8 40.4 51.1 24.7 73.5 26.5 805 Maseru 87.5 63.2 37.5 59.1 26.2 76.2 23.8 1580 Mafeteng 88.7 67.2 36.7 52.9 22.3 77.1 22.9 790 Mohale's Hoek 81.7 51.5 30.4 47.4 19.0 64.6 35.4 553 Quthing 79.7 43.0 28.6 47.5 19.3 59.5 40.5 472 Qacha's Nek 75.3 61.1 42.3 44.4 28.9 67.4 32.6 239 Mokhotlong 67.9 41.0 24.8 17.8 7.0 47.2 52.8 371 District Thaba-Tseka 85.0 61.1 42.6 58.4 31.6 72.3 27.7 488 Urban 91.6 71.6 43.9 67.6 33.0 83.5 16.5 1712 Area Rural 83.5 56.4 34.5 45.5 20.6 67.4 32.6 5026 15-19 75.8 47.8 31.3 39.8 18.5 58.0 42.0 1413 20-24 86.7 64.2 40.5 52.5 25.9 74.8 25.2 1384 25-29 87.4 65.2 40.9 54.2 26.1 76.3 23.7 1024 30-34 90.5 67.2 40.2 59.1 28.4 78.2 21.8 798 35-39 87.8 60.3 34.8 52.6 22.0 73.0 27.0 860 40-44 90.8 62.3 35.6 55.0 22.7 75.5 24.5 693 Age 45-49 87.5 60.7 35.7 52.2 24.6 71.7 28.3 552 Primary 61.5 31.6 22.9 25.9 10.0 42.9 57.1 301 Secondary/High 86.4 60.9 36.8 51.3 23.3 72.2 27.8 6230 Woman's education level Higher/Tertiary 99.5 90.2 66.7 89.6 60.1 98.4 1.6 183 Total 85.6 60.3 36.9 51.1 23.7 71.5 28.5 6741 28 Monitoring HIV/AIDS Indicator End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 48 May 28, 2002 Table 4.14: Percentage of women 15-49 who correctly identify means of HIV transmission from mother to child, Lesotho, 200029 CHARACTERISTIC Can be transmitted from mother to child Transmission during pregnancy possible Transmission at delivery possible Transmission through breastmilk possible Knows all three Did not know any specific way Number of women Lowland 75.8 74.1 66.5 61.3 55.6 24.6 4052 Foothill 68.3 66.8 59.4 57.0 51.6 32.1 739 Mountain 56.0 54.8 45.1 48.6 40.2 44.1 1609 Region Senqu Valley 65.1 62.1 51.2 53.0 42.6 35.2 338 Butha-Buthe 85.0 81.7 77.9 72.0 66.7 15.4 447 Leribe 70.3 69.5 62.0 57.2 52.8 30.1 993 Berea 71.6 70.3 64.7 58.9 53.4 28.2 805 Maseru 75.4 73.8 65.7 62.8 57.0 25.2 1580 Mafeteng 74.2 72.8 62.5 59.1 52.8 26.5 790 Mohale's Hoek 64.6 61.8 51.2 45.2 35.6 35.6 553 Quthing 65.0 62.3 50.8 54.2 44.1 35.4 472 Qacha's Nek 69.0 68.6 62.3 60.7 55.2 31.0 239 Mokhotlong 54.2 52.6 44.7 50.1 41.2 45.8 371 District Thaba-Tseka 48.4 47.5 36.7 42.4 34.0 51.8 488 Urban 79.0 77.5 69.3 64.0 57.6 21.3 1712 Area Rural 66.5 64.9 56.7 55.1 48.5 33.8 5026 15-19 52.4 49.7 43.0 42.9 36.9 48.6 1413 20-24 72.2 70.1 60.3 59.3 51.4 28.0 1384 25-29 73.9 72.5 64.3 61.3 55.1 26.5 1024 30-34 80.3 79.9 69.3 66.2 59.8 19.7 798 35-39 73.4 72.3 65.0 60.3 54.0 26.6 860 40-44 76.3 74.9 67.5 62.3 55.7 23.8 693 Age 45-49 71.0 70.3 62.7 59.2 53.4 29.0 552 Primary 43.9 42.5 35.9 36.5 29.9 56.8 301 Secondary/High 70.3 68.7 60.3 58.0 51.4 30.0 6230 Woman's education level Higher/Tertiary 94.0 91.3 85.8 72.1 66.7 6.0 183 Total 69.7 68.1 59.9 57.4 50.9 30.6 6741 29 Monitoring HIV/AIDS Indicator Chapter Four – The Results 49 May 28, 2002 Table 4.14 describes the percentage of women who correctly identify the means of HIV transmission from mother to child. Overall, 69.7 percent of the women know that HIV can be transmitted from mother to child. Slightly more than 50 percent of women are aware of all three possible ways of transmission of HIV from mother to child. Knowledge of at least one of the three possible ways ranges from 57.4 percent for breastmilk to 68.1 percent as transmittal during pregnancy being possible. Approximately 30 percent did not know of any specific way of transmission of HIV from mother to child. Table 4.15: Percentage of women aged 15-49 who have sufficient knowledge of HIV/AIDS transmission, Lesotho, 200030 CHARACTERISTIC Heard of AIDS Know 2 ways to prevent HIV transmission Correctly identify 3 misconceptions about HIV transmission Have sufficient knowledge No. of women Lowland 89.6 54.8 26.1 20.7 4052 Foothill 84.4 48.7 20.7 15.6 739 Mountain 76.9 41.2 20.2 16.1 1609 Region Senqu Valley 81.4 45.3 18.6 17.2 338 Urban 91.6 60.1 33.0 26.7 1712 Area Rural 83.5 47.1 20.6 16.2 5026 Butha-Buthe 94.9 55.5 23.9 17.2 447 Leribe 88.9 54.2 25.9 20.8 993 Berea 87.0 47.3 24.7 17.9 805 Maseru 87.5 57.0 26.2 21.8 1580 Mafeteng 88.7 53.0 22.3 16.6 790 Mohale's Hoek 81.7 44.5 19.0 15.7 553 Quthing 79.7 44.9 19.3 18.0 472 Qacha's Nek 75.3 44.8 28.9 23.0 239 Mokhotlong 67.9 22.1 7.0 3.0 371 District Thaba-Tseka 85.0 54.1 31.6 26.2 488 15-19 75.8 40.0 18.5 14.4 1413 20-24 86.7 53.3 25.9 20.8 1384 25-29 87.4 54.0 26.1 20.0 1024 30-34 90.5 55.9 28.4 23.1 798 35-39 87.8 51.4 22.0 17.6 860 40-44 90.8 53.4 22.7 18.3 693 Age 45-49 87.5 50.7 24.6 19.6 552 Primary 61.5 28.9 10.0 9.0 301 Secondary/High 86.4 51.0 23.3 18.6 6230 Woman's education level Higher/Tertiary 99.5 68.9 60.1 44.8 183 Total 85.6 50.4 23.7 18.8 6741 Table 4.15 describes the percentage of women aged 15-49 deemed to have sufficient knowledge of HIV/AIDS transmission. Approximately 86 percent of the women has heard about HIV/AIDS. But only 33.3 percent have knowledge of three ways in which HIV transmission can be prevented. Only a shocking 23.3 percent correctly identify three misconceptions about HIV transmission. Overall, according to Table 4.14, only 11.9 percent of the women age 15-49 have sufficient knowledge about HIV/AIDS. Amongst the 15-19 year old eligible women, only 9.6 percent have sufficient knowledge about HIV/AIDS. The more educated the woman the more knowledgeable they are about HIV/AIDS. 30 Monitoring HIV/AIDS Indicator End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 50 May 28, 2002 4.9 Assistance at Delivery Provision of delivery assistance by skilled attendants can greatly improve outcomes for mothers and children by use of technically appropriate procedures, and accurate and speedy diagnosis and treatment of complications. Skilled assistance at delivery is defined as assistance provided by a doctor, nurse, or midwife. Overall, 59.8 percent of the deliveries in the last year were carried out by skilled personnel, according to Table 4.16. This percentage is highest amongst women who live in the lowlands, in Leribe district, in the urban areas and women with a higher/tertiary level of education. Midwifes carried out 36.1 percent of the deliveries compared with 12.0 percent for the Doctor, 11.6 percent for the Auxiliary Midwife, and 9.1 percent for the Traditional Birth Attendant. A relative or a friend carried out about 23 percent of the deliveries. 4.10 Birth Registration The International 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. Table 4.17 describes the distribution of children (0-59 months) by their birth registration status. Slightly over 50 percent of the children had their births registered. The female children were registered more than the males. Interestingly enough, registration was highest in the Senqu Valley, at 62.4 percent, higher than the national indicator. Birth registration was highest in Butha-Buthe and lowest in Leribe. The rural children were registered more than the urban ones – 53.0 percent and 40.7 percent respectively. Amongst the age groups there was not much of a difference in registration levels. It is worth noting that women with no education seemed to register their children more than the other more educated women. The reasons were varying, with 28.2 percent of the mothers/caretakers indicating that they did not know that births should be registered and 6.5 percent said they did not know where to register. 4.11 Disability Problems Table 4.18 describes the prevalence of disability problems amongst children 24-108 months. At face value the description paints a picture that disability problems are low. The surprising result is the low percentages for affirmative responses to questions such as, “Does the child seem to understand what you are saying?” and “Does he/she speak at all?” 4.12 Contraceptive Use Table 4.19 describes the pattern of contraceptive use in Lesotho at the time of the EMICS by women age 15-49 who are married or in union or by their partners. Approximately 69.6 percent of the respondents indicated that they do not use any form of contraception at all. Usage of the other contraception methods such as the pill, the condom, or the IUD are all used minimally, as Table 4.19 shows. Approximately 30.4 percent of the married/in union women indicated that they used some form of contraception – 29.5 percent used any modern method and 1.0 percent used some form of traditional method for contraception. Chapter Four – The Results 51 May 28, 2002 Table 4.16: Percent distribution of women aged 15-49 with a birth in the last year by type of personnel assisting at delivery, Lesotho, 2000 31 Person assisting at delivery CHARACTERISTIC Doctor Nurse/midwife Auxiliary midwife Traditional birth attendant Relative/frien d Other/missing No assistance received Any skilled personnel No. of women Lowland 12.8 43.5 8.2 9.1 16.3 4.7 5.4 64.5 485 Foothill 12.9 31.7 12.9 5.9 29.7 2.0 5.0 57.4 101 Mountain 9.0 24.3 17.6 10.8 32.9 .5 5.0 50.9 222 Region Senqu Valley 17.1 24.4 17.1 4.9 31.7 2.4 2.4 58.5 41 Butha-Buthe 13.0 39.1 13.0 8.7 21.7 .0 4.3 65.2 46 Leribe 12.3 50.0 7.7 6.9 16.2 2.3 4.6 70.0 130 Berea 8.7 47.0 6.1 5.2 23.5 6.1 3.5 61.7 115 Maseru 16.9 35.0 10.4 9.3 16.9 5.5 6.0 62.3 183 Mafeteng 8.4 38.9 8.4 14.7 21.1 5.3 3.2 55.8 95 Mohale's Hoek 12.9 30.0 17.1 5.7 24.3 .0 10.0 60.0 70 Quthing 12.8 38.3 10.6 .0 34.0 2.1 2.1 61.7 47 Qacha's Nek 25.9 29.6 11.1 7.4 18.5 .0 7.4 66.7 27 Mokhotlong 6.5 8.1 22.6 12.9 45.2 .0 4.8 37.1 62 District Thaba-Tseka 6.8 23.0 20.3 16.2 27.0 1.4 5.4 50.0 74 Urban 20.3 43.5 11.9 4.5 11.9 2.8 5.1 75.7 177 Area Rural 9.8 34.2 11.6 10.1 25.9 3.3 5.1 55.7 672 Primary 11.6 18.6 9.3 18.6 34.9 .0 7.0 39.5 43 Woman's education level Secondary/High 11.7 36.9 11.6 8.8 22.6 3.4 5.0 60.2 784 Total 12.0 36.1 11.6 9.1 22.9 3.2 5.1 59.8 850 31 World Summit for Children Goal => Numbers 11 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 52 May 28, 2002 Table 4.17: Percent distribution of children aged 0-59 months by whether birth is registered and reasons for non-registration, Lesotho, 200032 REGISTRATION STATUS REASONS FOR NON-REGISTRATION CHARACTERISTIC Birth registered DK if birth registered Must travel too far Didn't know it should be registered Late & didn't want to pay fine Doesn't know where to register Other Reason DK or Missing No. of children Male 49.1 6.8 .9 28.9 1.0 6.7 2.8 3.7 1867 Sex Female 52.1 7.6 .9 27.5 .6 6.3 2.2 2.9 1867 Lowland 43.6 7.4 .6 33.6 .8 7.6 3.4 2.9 2074 Foothill 53.1 7.9 1.3 25.0 .4 6.4 1.8 4.2 456 Mountain 61.6 6.4 1.3 20.4 .9 4.2 1.5 3.6 994 Region Senqu Valley 62.4 7.1 1.0 19.0 1.0 6.7 .5 2.4 210 Butha-Buthe 89.9 2.3 1.4 1.4 .0 1.4 1.8 1.8 217 Leribe 31.4 5.7 .7 48.8 .8 6.9 1.3 4.4 609 Berea 45.9 9.5 .4 20.3 1.3 14.6 3.3 4.6 453 Maseru 35.6 8.7 1.3 39.5 .4 6.5 5.3 2.7 750 Mafeteng 53.9 7.1 .2 27.5 1.2 5.6 2.2 2.2 408 Mohale's Hoek 62.6 8.4 .0 19.3 .6 5.6 1.2 2.2 321 Quthing 67.1 7.5 1.6 17.5 .0 3.6 1.6 1.2 252 Qacha's Nek 54.0 4.7 2.7 14.7 1.3 11.3 .7 10.7 150 Mokhotlong 86.0 4.7 .4 3.5 1.9 .4 .8 2.3 257 District Thaba-Tseka 43.2 8.2 1.3 36.9 .6 4.7 2.2 2.8 317 Urban 40.7 7.7 1.7 34.9 .7 6.7 4.5 3.2 717 Area Rural 53.0 7.1 .7 26.6 .8 6.5 2.1 3.3 3017 < 6 months 40.1 7.9 2.2 31.4 1.1 7.9 6.2 3.3 369 6-11 months 48.2 5.6 1.0 31.6 .7 7.3 2.2 3.4 411 12-23 months 51.6 6.3 .1 29.1 .9 7.0 2.5 2.5 762 24-35 months 52.6 6.4 .7 26.8 .5 6.8 1.6 4.6 810 36-47 months 53.2 7.6 1.0 26.6 1.0 5.9 2.8 1.9 711 Age (in months) 48-59 months 51.9 9.3 1.1 26.6 .8 5.1 1.5 3.8 665 None 58.9 7.7 .4 20.3 1.2 7.3 1.6 2.4 246 Primary 50.3 7.2 .9 28.8 .8 6.4 2.2 3.4 2471 Mother's education level Secondary 49.2 7.0 .9 28.8 .8 6.8 3.4 3.1 1018 Total 50.6 7.2 .9 28.2 .8 6.5 2.5 3.3 3737 32 Monitoring Children's Rights Indicator Chapter Four – The Results 53 May 28, 2002 Table 4.18: Percentage of children 24 to 108 months with disability problems, Lesotho, 2000 CHARACTERISTIC Serious delay in sitting standing, or walking Difficulty seeing compared with other children Appears to have difficulty hearing Seem to understand what you are saying Difficulty with limbs? Fits, become rigid, or lose consciousn ess Learn to do things like other children his/her age Does speak at all? Speech different from normal? Can name at least one object? Appear in any way mentally backward, dull or slow? No. of Caretakers Lowland 7.5 2.2 2.0 46.9 1.4 1.8 49.1 44.8 7.7 12.3 4.9 2074 Foothill 7.7 2.2 2.4 46.7 3.1 1.8 52.0 47.4 7.0 12.1 9.6 456 Mountain 9.7 4.0 3.3 47.4 2.5 2.2 50.1 45.9 10.8 12.8 5.1 994 Region Senqu Valley 13.3 5.2 5.7 51.9 3.8 3.8 56.2 51.9 10.5 16.2 7.1 210 Butha-Buthe 12.0 2.3 4.6 52.1 2.8 .9 56.2 54.8 8.3 16.1 8.3 217 Leribe 6.7 1.8 1.3 49.9 2.0 2.5 51.2 47.5 7.4 11.0 6.4 609 Berea 5.1 .9 2.4 48.8 1.1 .9 48.8 45.0 8.6 12.4 7.3 453 Maseru 6.1 2.4 2.0 44.9 2.7 2.0 48.7 44.1 6.5 11.5 5.1 750 Mafeteng 10.8 2.7 2.0 51.5 .2 2.0 53.9 46.3 8.3 14.0 2.0 408 Mohale's Hoek 13.1 5.0 3.1 30.2 2.8 3.7 37.4 34.9 10.9 9.7 7.5 321 Quthing 11.5 2.4 3.2 53.6 2.8 4.4 58.7 50.8 7.9 16.3 4.4 252 Qacha's Nek 15.3 5.3 4.7 50.0 2.7 2.0 57.3 52.0 14.0 12.7 8.7 150 Mokhotlong 7.8 6.6 5.1 47.9 3.9 1.2 49.8 47.9 12.1 9.3 6.2 257 District Thaba-Tseka 6.3 3.2 2.2 47.3 .6 .9 47.3 43.5 9.1 17.4 3.5 317 Urban 6.7 2.2 2.1 44.2 2.4 2.2 46.0 42.8 5.4 10.7 5.3 717 Area Rural 8.8 3.0 2.7 48.0 2.0 2.0 51.1 46.5 9.3 13.1 5.7 3017 None 9.3 4.9 3.7 52.0 3.7 1.6 55.7 50.8 7.7 12.6 7.3 246 Primary 8.8 2.8 3.1 48.3 2.0 2.3 51.0 47.1 9.6 13.1 6.2 2471 Mother's education level Secondary 7.1 2.5 1.2 43.3 1.7 1.6 46.6 41.4 6.5 11.4 3.8 1018 Total 8.4 2.8 2.6 47.2 2.0 2.0 50.1 45.8 8.6 12.6 5.6 3737 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 54 May 28, 2002 Table 4.19: Percentage of married or in union women aged 15-49 who are using (or whose partner is using) a contraceptive method, Lesotho, 200033 Current method CHARACTERISTIC No method Female sterilization Male sterilization Pill IUD Injection s Implants Condom Female condom Diaphragm /foam/jelly LAM Periodic abstinence Withdraw al Other Any modern method Any traditional method Any method No. of currently married women Lowland 62.4 1.8 .1 12.3 3.8 16.5 .1 1.7 .0 .2 .1 .0 .4 .5 36.6 1.0 37.6 2212 Foothill 71.7 .9 .0 8.4 2.6 11.9 .0 2.8 .0 .0 .2 .0 .5 .9 26.6 1.6 28.3 428 Mountain 84.1 .5 .0 4.3 .1 8.2 .1 1.6 .1 .3 .1 .1 .4 .1 15.1 .7 15.9 964 Region Senqu Valley 74.6 1.2 .0 4.6 .0 17.3 .0 1.7 .0 .0 .0 .0 .0 .6 24.9 .6 25.4 173 Butha-Buthe 58.6 1.3 .0 14.3 3.8 17.7 .0 3.0 .0 .0 .0 .0 1.3 .0 40.1 1.3 41.4 237 Leribe 61.9 1.4 .2 11.1 3.9 18.1 .0 2.4 .2 .0 .0 .0 .3 .5 37.2 .9 38.1 586 Berea 65.1 1.4 .0 9.7 5.1 13.4 .2 3.2 .0 .0 .2 .0 .5 1.2 33.0 1.8 34.9 433 Maseru 68.1 2.0 .0 10.6 2.7 14.1 .2 1.3 .0 .0 .4 .0 .1 .5 31.0 .9 31.9 849 Mafeteng 63.6 2.2 .2 13.7 2.6 15.6 .0 1.1 .0 .4 .0 .0 .4 .2 35.8 .7 36.4 461 Mohale's Hoek 70.1 .3 .0 8.6 2.3 15.1 .0 1.6 .0 1.0 .0 .0 .3 .7 28.9 1.0 29.9 304 Quthing 80.9 .8 .0 3.3 .0 12.2 .0 2.0 .0 .4 .0 .0 .0 .4 18.7 .4 19.1 246 Qacha's Nek 77.2 1.6 .0 9.4 .0 9.4 .0 1.6 .0 .0 .0 .0 .8 .0 22.0 .8 22.8 127 Mokhotlong 86.5 .0 .0 2.3 .5 6.5 .0 1.9 .0 .9 .0 .5 .9 .0 12.1 1.4 13.5 215 District Thaba-Tseka 86.5 .3 .0 3.8 .0 8.2 .3 .3 .0 .0 .3 .0 .0 .3 12.9 .6 13.5 319 Urban 61.2 2.0 .0 11.0 5.0 16.7 .3 2.1 .0 .6 .3 .0 .5 .3 37.6 1.2 38.8 858 Area Rural 72.0 1.1 .1 9.0 1.8 13.1 .0 1.7 .0 .1 .1 .0 .3 .5 27.1 .9 28.0 2919 15-19 84.6 .0 .0 4.2 .7 8.1 .0 1.4 .0 .4 .0 .0 .7 .0 14.7 .7 15.4 285 20-24 66.3 .1 .1 11.9 1.5 16.0 .3 2.8 .1 .1 .1 .0 .3 .3 33.0 .7 33.7 748 Age 25-49 68.9 1.8 .0 9.3 3.1 13.9 .1 1.6 .0 .2 .1 .0 .4 .5 30.0 1.1 31.1 2746 Primary 86.9 .0 .0 2.2 1.1 7.1 .0 .0 .0 .0 .5 .0 1.1 1.1 10.4 2.7 13.1 183 Secondary/High 69.2 1.3 .1 9.8 2.5 14.2 .1 1.9 .0 .2 .1 .0 .3 .4 30.0 .8 30.8 3477 Woman's education level34 Higher/Tertiary 52.4 4.9 .0 12.6 6.8 14.6 1.9 1.9 .0 1.9 1.0 .0 1.0 1.0 44.7 2.9 47.6 103 Total 69.6 1.3 .1 9.4 2.6 13.9 .1 1.8 .0 .2 .1 .0 .4 .4 29.5 1.0 30.4 3779 33 World Summit for Children Goal => Number 10 34 Non-standard curriculum and higher/tertiary education not displayed because the cases are less than 25. Missing Values in this case are 9. Appendices 55 May 28, 2002 Appendices to the Preliminary Report End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 56 May 28, 2002 Appendix A – The Kingdom of Lesotho MICS Questionnaire CONFIDENTIAL KINGDOM OF LESOTHO MULTIPLE INDICATOR CLUSTER SURVEY (MICS) FOR THE END OF DECADE GOALS MARCH 2000 DISTRICT…………………………. INTERVIEWER…………………………. VILLAGE…………………………. SUPERVISOR……………………………. HOUSEHOLD INFORMATIO N PANEL 1.Cluster number: 2. Household number: 3. Date of interview (day/month/year) 4. Interviewer number: 5. Name of Head of H/H 6. Area: Urban………………… 1 Rural…………………. 2 6a. District: Butha-Buthe………… 01 Leribe………………. 02 Berea………………… 03 Maseru……………… 04 Mafeteng……………. 05 Mohale`s Hoek……. 06 Quthing……………. 07 Qacha`s Nek………. 08 Mokhotlong………… 09 Thaba-Tseka………. 10 7. Region: Lowland…………. 1 Foothill……………. 2 Mountain…………. 3 Senqu Valley……… 4 8.Material of main house floor: Natural floor Earth/sand………………. 01 Dung……………………. 02 Rudimentary floor Wood planks……………. 03 Palm/bamboo…………. 04 Finished floor Parquet/polished wood. 05 Vinyl/asphalt strips……. 06 Ceramic tiles…………. 07 Cement………………. 08 Carpet…………….……. 09 Other (specify) ………………. 10 8(a). No. Persons in H/H usually resident: __ __ 9. (a) Number of rooms in dwelling: __ __ (b) How many are used for sleeping __ __ 9 © H/H has: Electricity……………… 1 Radio……………….…. 2 Television………… … 3 Refrigerator……… …. 4 None…………….……. 5 9.(d) Any member of H/H owns: Bicycle…………………. 1 Motorcycle/scooter…… . 2 Car or truck……………. 3 Scotch cart………… …. 4 Horse…………………… 5 None……………………. 6 9. (e) Main cooking fuel used by H/H: Electricity……… . 01 LPG/Natural Gas…… 02 Biogas……………. 03 Kerosene…….……. 04 Coal, Lignite………. 05 Charcoal…………… 06 Firewood/straw……. 07 Dung………………. 08 Other (specify) ……… 09 10. Result of HH interview: Completed………….…. 1 Refused…………………. 2 Not at home……………… 3 HH not found……………. 4 Other (specify) …………………….….… 5 11. No. of women 15 – 49 __ __ 12. No. of women interviews completed: __ __ 13. No. of children under age 5: __ __ 14. Number of children interviews completed __ __ 14a. Editing and coding ……………………………. 15. Data entry clerk ………………………………… Interviewer/supervisor notes record notes about the interview e.g. call-back times ………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………… Appendices 57 May 28, 2002 CLUSTER NO__ __ __ HOUSEHOLD NO.__ __ __ HOUSEHOLD LISTING FORM First, please tell me the name of each person who usually lives here, starting with the head of the household (i.e. `de jure` population) Eligible for: Women’ s modules Child labour module Child health modules For persons age 15 or over ask Qs. 7a - 9 For children under age 15 years ask Qs. 10-13 1. Line no. 2. Name 3. Is (name) male or female ? 1 Male 2 Female 4. How old is (name)? How old was (name) on his/her last birthday? Record in complete Years 99=DK 5. Circle Line no. if woman is age 15-49 6. For each child age 5-14: Who is the mother or primary caretaker of this child? Record Line no. of mother/ caretaker 7. For each child under 5: Who is the mother or primary caretaker of this child? Record Line no. of mother/ caretaker 7a. What was (name) employment status since (the same day last week)? 1 Paid employee 2 Own account 3 Employer 4 Subsistence farmer 5 Unpaid family worker 6 Job seeker 98 NA 8. Can he/she read a letter or newspaper easily, with difficulty or not at all? 1 Easily 2 Difficult 3 Not at all 9 dk 9. What is the marital status of (name)?** 1Currently married/ in union 2 Widowed 3 Divorced 4 Separated 5 Never married 10. Is(name’s natural mother alive? 1 Yes 2 NoðQ12 9 DKðQ12 11. If alive: Does (name’s) natural mother live in this house- hold? 1 Yes 2 No 12. Is (name’s) natural father alive? 1 Yes 2 No 9 DK If 2 or DK ðEducatio n module 13. If alive: Does (name’s) natural father live in this house- hold? 1 Yes 2 No Line Name M F Age 15-49 Mother Mother P O E S U J N E D N DK M W D S N Y N DK Y N Y N DK Y N 01 1 2 ____ ____ 01 ___ ___ ___ ___ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 02 1 2 ____ ____ 02 ___ ___ ___ ___ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 03 1 2 ____ ____ 03 ___ ___ ___ ___ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 04 1 2 ____ ____ 04 ___ ___ ___ ___ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 05 1 2 ____ ____ 05 ___ ___ ___ ___ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 06 1 2 ____ ____ 06 ___ ___ ___ ___ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 07 1 2 ____ ____ 07 ___ ___ ___ ___ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 08 1 2 ____ ____ 08 ___ ___ ___ __ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 09 1 2 ____ ____ 09 ___ ___ ____ ___ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 10 1 2 ____ ____ 10 ___ ___ ____ ____ 1 2 3 4 5 6 98 1 2 3 9 1 2 3 4 5 1 2 9 1 2 1 2 9 1 2 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 58 May 28, 2002 CLUSTER NO. __ __ __ HOUSEHOLD NO. __ __ __ 1. EDUCATION MODULE If interview takes place between two school years, use alternative wording found in Appendix 1. For persons age 5 or over ask Qs. 15 and 16 For children age 5 through 17 years, continue on, asking Qs. 17-22 14. Line no. 15. Has (name) ever attended school? 1 Yes ð Q.16 2 No ø next line 16. What is the highest level of school (name) attended? What is the highest grade (name) completed at this level? Level: 1 Primary 2 Secondary/High 3 Higher/Tertiary 4 Non-Standard Curriculum 5 Vocational 6 Literacy 98 NA/Preschool 99 DK GRADE: If less than 1 grade, enter 00. 17. IS (name) currently attending school? 1 Yes 2 No 18. During the year, 2000 did (name) attend school at any time? 1 Yes 2 No ð Q.21 19. Since last (day of the week), how many days did (name) attend school? Insert number of days in space below. 20. During 2000, which level and grade is/was (name) attending? Level: 1 Preschool 2 Primary 3 Secondary/high 4 Non-standard curriculum 5 Vocational 6 Higher/tertiary 7 Literacy 99 Dk Grade: 99 Dk 21. Did (name) attend school year before last? 1 Yes 2 No ø next line 9 DK ø next line 22. Which level and grade did (name) attend last year? level: 1 preschool 2 primary 3 secondary 4 non-standard curriculum 5 Vocational 6 Higher/Tertiary 7 Literacy 99 DK Grade: 99 DK Line Y No Level Grade Yes No Yes No Days Level Grade Y N DK Level Grade 01 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 02 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 03 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 04 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 05 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 06 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 07 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 08 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 09 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ 10 1 2ðnext line 1 2 3 4 5 6 98 99 ___ ___ 1 2 1 2 ____ 12 3 4 5 6 98 99 __ ___ 1 2 9 1 2 3 4 9 ___ ___ Now for each woman age 15-49 years, write her name and line number at the top of each page in the Women’s Questionnaire. For each child under age 5, write his/her name and line number AND the line number of his/her mother or caretaker at the top of each page in the Children’s Questionnaire. You should now have a separate questionnaire for each eligible woman and child in the household. Appendices 59 May 28, 2002 CLUSTER NO………………… HOUSEHOLD NO…………………… 2. CHILD LABOUR MODULE To be administered to caretaker of each child resident in the household age 5 through 17 years. Copy the number of each eligible child from household listing now I would like to ask about any work children in this house may do 1 Line no. 2 Name 2a During the past week, did (name) do any kind of work for someone who is a member of this house hold? If yes: for pay? 1 Yes, for pay (cash or kind) 2 Yes, unpaid 3 No 3. During the past week did (name) do any kind of work for someone who is not a member of this household? If yes: for pay? 1 Yes, for pay (cash or kind) 2 Yes, unpaid 3 Noðq.5 4. If yes: since last (day of the week) about how many hours did he/she do his work for someone who is not a member of the household? If more than one job ,include all hours at all jobs. Record response then 4a. At any time during the past year did (name) do any kind of work for someone who is a member of this household? If yes: for pay? 1 Yes, for pay (cash or kind) 2 Yes, unpaid 3 No 5 At any time during the past year did (name) do any kind of work for someone who is not a member of this household? If yes: for pay? 1 Yes, for pay (cash or kind) 2 Yes, unpaid 3 No 5a. For what reason did (name) work? 1.No more school opportunity 2. Self support 3. School fees 4. Lodging 5. Clothing 6. H/H food 7. Pocket money 8. Volunteer 9. Other (specify) Circle main reason 6. During the past week did (name) help with the housekeeping chores such as Cooking, Shopping, Cleaning, washing, Clothes, Fetching water, or Caring for children? 1.Yes 2.NoðQ.8 7. if yes: Since last (day of the week), about how many hours did he/she spend doing these chores? 8. During the past week did (name) do any other family work (on the farm or in a business)? 1 Yes 2Noð next line 9. . if yes: Since last (day of the week) about how many hours did he/she do this work? Line no. Yes paid Yes unpaid No Yes paid Yes unpaid No No of hours Yes paid Yes unpaid No Yes paid Yes unpaid No Reason for work Yes No No. hours Yes No No .of hours __ 1 2 3 1 2 3 __ __ 1 2 3 1 2 3 1 2 3 4 5 6 7 8 9 1 2 1 2 __ __ __ 1 2 3 1 2 3 __ __ 1 2 3 1 2 3 1 2 3 4 5 6 7 8 9 1 2 1 2 __ __ __ 1 2 3 1 2 3 __ __ 1 2 3 1 2 3 1 2 3 4 5 6 7 8 9 1 2 1 2 __ __ __ 1 2 3 1 2 3 __ __ 1 2 3 1 2 3 1 2 3 4 5 6 7 8 9 1 2 1 2 __ __ __ 1 2 3 1 2 3 __ __ 1 2 3 1 2 3 1 2 3 4 5 6 7 8 9 1 2 1 2 __ __ __ 1 2 3 1 2 3 __ __ 1 2 3 1 2 3 1 2 3 4 5 6 7 8 9 1 2 1 2 __ __ __ 1 2 3 1 2 3 __ __ 1 2 3 1 2 3 1 2 3 4 5 6 7 8 9 1 2 1 2 __ __ When all children in the age range have been covered, GO TO WATER AND SANITATION MODULE ð End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 60 May 28, 2002 CLUSTER NO. __ __ __ HOUSEHOLD NO. __ __ __ 4.WATER AND SANITATION MODULE This module is to be administered once for each household visited. Record only one response for each question. If more than one response is given, record the most usual source or facility. 1. WHAT IS THE MAIN SOURCE OF DRINKING WATER FOR MEMBERS OF YOUR HOUSEHOLD? Piped into dwelling. 01 Piped into yard or plot. 02 Public tap . 03 Tubewell/borehole with pump. 04 Protected dug well. 05 Protected spring. 06 Rainwater collection. 07 Bottled water. 08 Unprotected dug well. 09 Unprotected spring. 10 Pond, river or stream. 11 Tanker-truck, vendor. 12 Other (specify) ______________________________ 13 No answer or DK. 99 2. HOW LONG DOES IT TAKE TO GO THERE , GET WATER, AND COME BACK? No. of minutes. __ __ __ Water on premises. 888 DK. 999 2a HOW FAR FROM THE HOESEHOLD IS THE WATER DRAWN Inside the house/yard/compound………………………….1 Within 150 meters………………………………….………2 Within 1 Kilometer…………………………………………3 More than 1 kilometer……………………………….…….4 Other (specify)……………………………………….…….5 3. WHAT KIND OF TOILET FACILITY DOES YOUR HOUSEHOLD USE ? Flush to sewage system or septic tank. 1 Pour flush latrine (water seal type). 2 Improved pit latrine (e.g., VIP). 3 Traditional pit latrine . 4 Open pit . 5 Bucket. 6 Other (specify) ______________________________ 7 No facilities or bush or field . 8 8ðQ.5 4. IS THIS FACILITY LOCATED WITHIN YOUR DWELLING, OR YARD OR COMPOUND?** Yes, in dwelling/yard/compound. 1 No, outside dwelling/yard/compound. 2 DK. 9 5. WHAT HAPPENS WITH THE STOOLS OF YOUNG CHILDREN (0-3 YEARS) WHEN THEY DO NOT USE THE LATRINE OR TOILET FACILITY? Children always use toilet or latrine. 1 Thrown into toilet or latrine. 2 Thrown outside the yard. 3 Buried in the yard. 4 Not disposed of or left on the ground. 5 Other (specify) _______________________________ 6 No young children in household. 8 GO TO SALT IODIZATION MODULE ð Appendices 61 May 28, 2002 CLUSTER NO. __ __ __ HOUSEHOLD NO. __ __ __ 5. SALT IODIZATION MODULE 1. WE WOULD LIKE TO CHECK WHETHER THE SALT USED IN YOUR HOUSEHOLD IS IODIZED. MAY I SEE A SAMPLE OF THE SALT USED TO COOK THE MAIN MEAL EATEN BY MEMBERS OF YOUR HOUSEHOLD LAST NIGHT? Once you have examined the salt, circle number that corresponds to test outcome. Categories correspond to test kit recommended by UNICEF to be used in all MICS surveys. Not iodized 0 PPM (no colour) . 1 Less than 15 PPM (weak colour) . 2 15 PPM or more (strong colour) . 3 No salt in home . 8 Salt not tested. 9 GO TO DISABILITY MODULE ð End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 62 May 28, 2002 CLUSTER NO__ __ __ HOUSEHOLD NUMBER__ __ __ 5. DISABILITY MODULE. TO BE ADMINISTERED TO CARETAKERS OF ALL CHILDREN 2 THROUGH 9 YEARS OLD LIVING IN THE HOUSEHOLD. INTERVIEWER: I WOULD LIKE TO ASK YOU IF ANY CHILDREN IN THIS HOUSEHOLD AGED 2 THROUGH 9 (READ NAMES LISTED IN THE HOUSEHOLD ROSTER) HAS ANY OF THE HEALTH CONDITIONS I AM GOING TO MENTION TO YOU. IF THE ANSWER TO ANY QUESTION IS “YES” , ASK FOR THE NAME OF THE CHILD, AND ENTER THE NAME AND LINE NO. IN SPACE PROVIDED. CIRCLE RESPONSE IN CORRESPONDING BOX. IF RESPONSE IS “NO”, CROSS THROUGH EACH SPACE AS QUESTION IS ASKED. 1.CHILD`S NAME 2. LINE NO. 3 COMPARED WITH OTHER CHILDREN, DOES (NAME) HAVE ANY SERIOUS DELAY IN SITTING, STANDING, OR WALKING? YES….1 NO…….2 4. COMPARED WITH OTHER CHILDREN, DOES (NAME) HAVE DIFFUCULTY SEEING, EITHER IN THE DAYTIME OR AT NIGHT? YES….1 NO……2 5. DOES (NAME) APPEAR TO HAVE DIFFICULTY HEARING? (USES HEARING AID, HEARS WITH DIFFICULTY, COMPLETELY DEAF)? YES….1 NO….2 6. WHEN YOU TELL (NAME) TO DO SOMETHING, DOES SHE/HE SEEM TO UNDERSTAND WHAT YOU ARE SAYING? YES….1 NO….2 7. DOES (NAME) HAVE DIFFICULTY IN WALKING OR MOVING HIS/HER ARMS OR DOES HE/SHE HAVE WEAKNESS AND/OR STIFFNESS IN THE ARMS OR LEGS? YES….1 NO….2 8. DOES (NAME) SOMETIMES HAVE FITS, BECOME RIGID, OR LOSE CONSCIOUSNESS? YES….1 NO……2 9. DOES (NAME) LEARN TO DO THINGS LIKE OTHER CHILDREN HIS/HER AGE? YES….1 NO….2 10. DOES (NAME) SPEAK AT ALL (CAN HE/SHE MAKE HIM OR HERSELF UNDERSTOOD IN WORDS; CAN SAY RECOGNIZABLE WORDS? YES….1 NO……2 11. A. (FOR 3 – 9 YEAR OLDS): IS (NAME) `S SPEECH IN ANY WAY DIFFERENT FROM NORMAL (NOT CLEAR ENOUGH TO BE UNDERSTOOD BY PEOPLE OTHER THAN THE IMMIDIATE FAMILY)? YES….1 NO….2 11. B. (FOR 2 YEAR OLDS): CAN (CHILD) NAME AT LEAST ONE OBJECT (FOR EXAMPLE, AN ANIMAL, A TOY, A CUP, A SPOON)? YES….1 NO….2 12. COMPARED TO OTHER CHILDREN OF THE SAME AGE, DOES (NAME) APPEAR IN ANY WAY MENTALLY BACKWARD, DULL OR SLOW? YES….1 NO……2 WHEN ALL THE CHILDREN IN THE AGE RANGE HAVE BEEN COVERED, GO TO WOMEN`S MODULE ðð Appendices 63 May 28, 2002 CLUSTER NO. __ __ __ HOUSEHOLD NO. __ __ __ WOMAN LINE NO. __ __ QUESTIONNAIRE FOR INDIVIDUAL WOMEN 6. WOMEN’S INFORMATION PANEL This module is to be administered to all women age 15 through 49 (see column 5 of HH listing). Fill in one form for each eligible woman. 1. Woman’s line number (from HH listing). Line number.__ __ 2. Woman’s name. Name ________________________________ 3A. IN WHAT MONTH AND YEAR WERE YOU BORN? Or: 3B. HOW OLD WERE YOU AT YOUR LAST BIRTHDAY? Date of birth Month/Year .__ __ / __ __ __ __ DK date of birth . 999999 Or: Age (in completed years).__ __ DKð3 B GO TO CHILD MORTALITY MODULE ð End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 64 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ 7. CHILD MORTALITY MODULE This module is to be administered to all women age 15-49. All questions refer only to LIVE births. Follow instructions as provided in training. See Instructions for Interviewers. 1. Now I would like to ask about all the births you have had during your life. Have you ever given birth? If “NO” probe by asking: I mean, to a child who ever breathed or cried or showed other signs of life – even if he or she lived only a few minutes or hours? Yes . No. 2ð contraceptive use module 1a. How old were you when you had your first child? 2b. How many years ago did you have your first birth? Age in completed years……………. __ __ DK . Completed years since first birth .__ __ DKð2B 3. Do you have any sons or daughters to whom you have given birth who are now living with you? Yes . No. 2ðQ.5 4. How many sons live with you? How many daughters live with you? Sons at home .__ __ Daughters at home .__ __ 5. Do you have any sons or daughters to whom you have given birth who are alive but do not live with you? Yes . No. 2ðQ.7 6. How many sons are alive but do not live with you? How many daughters are alive but do not live with you? Sons elsewhere .__ __ Daughters elsewhere.__ __ 7. Have you ever given birth to a boy or girl who was born alive but later died? Yes . No. 2ðQ.9 8. How many boys have died? How many girls have died? Boys dead.__ __ Girls dead.__ __ 9. Sum answers to Q. 4, 6, and 8. Sum.__ __ 10. Just to make sure that I have this right, you have had in total (total number) births during your life. Is this correct? ¨ Yes ð Go to Q.11 ¨ NO ð CHECK RESPONSES AND MAKE CORRECTIONS BEFORE PROCEEDING TO Q.11 11. OF these (total number) births you have had, when did you deliver the last one (even if he or she has died)? Date of last birth Day/Month/Year.__ __/__ __/__ __ __ __ Did the woman’s last birth occur within the last year, that is, since __/March/1999? ¨ Yes, live birth in last year. ð GO TO TETANUS TOXOID MODULE ¨ No live birth in last year. ð GO TO CONTRACEPTIVE USE MODULE Appendices 65 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ 8. TETANUS TOXOID (TT) MODULE SKIP THIS MODULE IF WOMAN HAD NO LIVE BIRTHS IN THE PAST YEAR This module is to be administered to all women with a live birth in the year preceding date of interview. 1. Do you have a card or other document with your own immunizations listed? If a card is presented, use it to assist with answers to the following questions. Yes (card seen). 1 Yes (card not seen). 2 No . 3 DK . 9 2. When you were pregnant with your last child, did you receive any injection to prevent him or her from getting convulsions after birth (an anti- tetanus shot, an injection at the top of the arm or shoulder)? Yes. 1 No . 2 DK . 9 2ðQ.4 9ðQ.4 3. If yes: How many doses of tetanus toxoid (anti- tetanus injections) did you receive during your last pregnancy? No. of doses .__ __ DK . 99 How many TT doses were reported during last pregnancy in Q.3? ¨ At least two TT injections during last pregnancy. ð GO TO MATERNAL AND NEWBORN HEALTH MODULE ¨ Fewer than two TT injections during last pregnancy. ð CONTINUE WITH Q.4 4. Did you receive any tetanus toxoid injection (additional probes) at any time before your last pregnancy, including during a previous pregnancy or between pregnancies? Yes. 1 No . 2 DK . 9 2ðQ.7 9ðQ.7 5. If yes: How many doses did you receive? No. of doses .__ __ 6a. When was the last dose received? Date of last dose Month/Year .__ __ / __ __ __ __ DK date. 999999 DKð6B 7. Add responses to Q.3 and Q.5 to obtain total number of doses in lifetime. Total no. of doses.__ __ GO TO MATERNAL AND NEWBORN HEALTH MODULE ðð End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 66 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ 9. MATERNAL AND NEWBORN HEALTH MODULE This module is to be administered to all women with a live birth in the year preceding date of interview. 1. In the first two months after your last birth, did you receive a vitamin A dose like this? Show red capsule . Yes. 1 No . 2 DK . 9 2. Did you see anyone for antenatal care for this pregnancy? If yes: Whom did you see? Anyone else? Probe for the type of person seen and circle all answers given. Health professional: Doctor. 1 Nurse/midwife . 2 Nursing Assistant . 3 Other person Traditional birth attendant. 4 Relative/friend…………………………….5 Other (specify ) _________________________6 No one. 0 4 ðQ3 5ð Q3 6ð Q3 0ð Q3 2a How many times did you attend the antenatal clinic Number of times……………………… __ __ 3. Who assisted with the delivery of your last child (or name)? Anyone else? Probe for the type of person assisting and circle all answers given. Health professional: Doctor. 1 Nurse/midwife . 2 Nursing Assistant . 3 Other person Traditional birth attendant. 4 Relative/friend . 5 Other (specify ) _________________________6 No one. 0 3a. where was (name) born? At home……………………………………….1 Health Centre…………………………………2 Hospital……………………………………….3 Private Practitioner………………………….4 Other (specify)……………………………….5 DK…………………………………………….99 4. When your last child (name) was born, was he/she very large, larger than average, average, smaller than average, or very small? Very big . 1 Bigger than average. 2 Average. 3 Smaller than average. 4 Very small . 5 DK . 99 5. Was (name) weighed at birth? Yes. 1 No . 2 DK . 9 2ðQ.7 9ðQ.7 6. How much did (name) weigh? Record weight from health card, if available. From card . 1 (grams) __ , __ __ __ From recall . 2 (grams) __ , __ __ __ DK 99999 7. When you were pregnant with your last child, did you have difficulty with your vision during the daylight? Yes. 1 No . 2 DK . 9 8. During that pregnancy, did you suffer from night blindness? Yes. 1 No . 2 DK . 9 GO TO CONTRACEPTIVE MODULE ðð Appendices 67 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ 10. CONTRACEPTIVE USE MODULE Ask all women age 15-49 and then follow the skip instruction carefully. 1. what is (name`s) marital status? Never Married . 1 Married/in union . 2 Separated…………………………………….3 Divorced……………………………………….4 Widowed………………………………………5 2. Now I am going to change topics. I would like to talk with you about another subject – family planning – and your reproductive health. I know this is a difficult subject to talk about, but it is important that we obtain this information. Of course, all the information you supply will remain strictly confidential. You will never be identified with the answers to these questions. Are you pregnant now? Yes, currently pregnant. 1 No . 2 Unsure or DK . 3 1ðNEXT MODULE 3. Some couples use various ways or methods to delay or avoid a pregnancy. Are you currently doing something or using any method to delay or avoid getting pregnant? Yes. 1 No . 2 2ðNEXT MODULE 4. Which method are you using? Do not prompt. If more than one method is mentioned, circle each one. Female sterilization . 01 Male sterilization . 02 Pill . 03 IUD. 04 Injections. 05 Implants . 06 Condom. 07 Female condom. 08 Diaphragm. 09 Foam/jelly . 10 Lactational amenorrhoea method (LAM). 11 Periodic abstinence. 12 Withdrawal. 13 Other (specify ) _______________________ 14 4a. where do you get your contraceptives? Family Planning…………………………….1 Health Centre……………………………….2 Hospital……………………………………….3 Private Practitioner………………………….4 Shop………………………………………….5 Other ( Specify)…………………………….6 GO TO HIV/AIDS MODULE ðð End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 68 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ 11. 11. HIV/AIDS MODULE This module is to be administered to all women age 15-49. See Instructions for Interviewers for further discussion of these questions. 1. Now I would like to talk with you about what you know about serious illness, in particular, about HIV and AIDS. Have you ever heard of the virus HIV or an illness called AIDS? Yes. 1 No . 2 2ðQ.18 2. Is there anything a person can do to avoid getting HIV, the virus that causes AIDS? Yes. 1 No . 2 DK . 9 2ðQ.8 9ðQ.8 3. Now I will read some questions about how people can protect themselves from the AIDS virus. These questions include issues related to sexuality, which some people might find difficult to answer. However, your answers are very important to help understand the needs of people in (country name). Again, this information is all completely private and anonymous. Please answer yes or no to each question. Can people protect themselves from getting infected with the AIDS virus by having one uninfected sex partner who also has no other partners? Yes. 1 No . 2 DK . 9 4. Do you think a person can get infected with the AIDS virus through supernatural means? Yes. 1 No . 2 DK . 9 5. Can people protect themselves from the AIDS virus by using a condom correctly every time they have sex? Yes. 1 No . 2 DK . 9 6. Can a person get the AIDS virus from mosquito bites? Yes. 1 No . 2 DK . 9 7. Can people protect themselves from getting infected with the AIDS virus by not having sex at all? Yes. 1 No . 2 DK . 9 8. Is it possible for a healthy-looking person to have the AIDS virus? Yes. 1 No . 2 DK . 9 Appendices 69 May 28, 2002 9. Can the AIDS virus be transmitted from a mother to a child? Yes. 1 No . 2 DK . 9 2ðQ.13 9ðQ.13 10. Can the AIDS virus be transmitted from a mother to a child during pregnancy? Yes. 1 No . 2 DK . 9 11. Can the AIDS virus be transmitted from a mother to a child at delivery? Yes. 1 No . 2 DK . 9 12. Can the AIDS virus be transmitted from a mother to a child through breast milk? Yes. 1 No . 2 DK . 9 13. If a teacher has the AIDS virus but is not sick, should he or she be allowed to continue teaching in school? Yes. 1 No . 2 DK . 9 14. If you knew that a shopkeeper or food seller had AIDS or the virus that causes it, would you buy food from him or her? Yes. 1 No . 2 DK . 9 15. I am not going to ask you about your HIV status (use term understood locally), but we are interested to know how much demand there is in your community for HIV testing and counseling. So, I would like to ask you: I do not want to know the results, but have you ever been tested to see if you have HIV, the virus that causes AIDS? Yes. 1 No . 2 2ðQ.17 16. I do not want you to tell me the results of the test, but have you been told the results? Yes. 1 No . 2 17. At this time, do you know of a place where you can go to get such a test to see if you have the AIDS virus? Yes. 1 No . 2 18. Is the woman a caretaker of any children under five years of age? ¨ Yes. ð GO TO QUESTIONNAIRE FOR CHILDREN UNDER FIVE and administer one questionnaire for each child under five for whom she is the caretaker. ¨ No. ð CONTINUE WITH Q.19 19. Does another eligible woman reside in the household? ¨ Yes. ð End the current interview by thanking the woman for her cooperation and GO TO QUESTIONNAIRE FOR INDIVIDUAL WOMEN to administer the questionnaire to the next eligible woman. ¨ No. ð End the interview with this woman by thanking her for her cooperation. Gather together all questionnaires for this household and tally the number of interviews completed on the cover page. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 70 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Caretaker line no. __ __ Child line no. __ __ QUESTIONNAIRE FOR CHILDREN UNDER FIVE This questionnaire is to be administered to all women who care for a child that lives with them and is under the age of 5 years (see Q.4 of the HH listing). A separate form should be used for each eligible child. Questions should be administered to the mother or caretaker of the eligible child (see Q.7 of the HH listing). Fill in the line number of each child, the line number of the child’s mother or caretaker, and the household and cluster numbers in the space at the top of each page. 12. BIRTH REGISTRATION AND EARLY LEARNING MODULE 1. Child’s name. Name ________________________________ 2. Child’s age (copy from Q.4 of HH listing). Age (in completed years).__ __ 3. Now I would like to ask you some questions about the health of each child under the age of 5 in your care, who lives with you now. Now I want to ask you about (name). In what month and year was (name) born? PROBE: WHAT IS HIS/HER BIRTHDAY? Date of birth Day/Month/Year . __ __/__ __/__ __ __ __ 4. Does (name) have a birth certificate? May I see it? Verify reported date using an official document such as the birth certificate, national ID, passport, bukana etc. Yes, seen. 1 Yes, not seen. 2 No . 3 DK . 9 1ðQ.8 5. Has (name’s) birth been registered? Yes. 1 No . 2 DK . 9 1ðQ.8 9ðQ.7 6. Why is (name’s) birth not registered? Must travel too far . 1 Did not know it should be registered. 2 Late, and did not want to pay fine. 3 Does not know where to register. 4 Other (specify ) _________________________5 DK . 9 7. Do you know how to register your child’s birth? Yes. 1 No . 2 No answer. 3 8. Does (name) attend any organized learning or early childhood education programme, such as a private or government facility, including kindergarten or community childcare? Yes. 1 No . 2 DK . 9 2ðNEXT MODULE 9ðNEXT MODULE 9. Within the last seven days, about how many hours did (name) attend? Number of hours .__ __ GO TO VITAMIN A MODULE ðð Appendices 71 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Caretaker line no. __ __ Child line no. __ __ 13. VITAMIN A MODULE 1. Has (name) ever received a vitamin A capsule (supplement) like this one? Show blue capsule. Yes. 1 No . 2 DK . 99 2ðNEXT MODULE 99ðNEX T MODULE 2. How many months ago did (name) take the last dose? Months ago.__ __ DK . 99 3. Where did (name) get this last dose? On routine visit to health centre . 1 Sick child visit to health centre . 2 National Immunization Day campaign . 3 Other (specify ) _________________________4 DK . 99 GO TO BREASTFEEDING MODULE ðð End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 72 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Caretaker line no. __ __ Child line no. __ __ 14. BREASTFEEDING MODULE 1. HAS (name) EVER BEEN BREASTFED? Yes. 1 No . 2 DK . 99 2ðQ.4 99ðQ.4 2. IS HE/SHE STILL BEING BREASTFED? Yes. 1 No . 2 DK . 99 2ðQ.4 99ðQ.4 3. SINCE THIS TIME YESTERDAY, DID HE/SHE RECEIVE ANY OF THE FOLLOWING: Read each item aloud and record response before proceeding to the next item. 3A. VITAMIN, MINERAL SUPPLEMENTS OR MEDICINE? 3B. PLAIN WATER? 3C. SWEETENED, FLAVOURED WATER OR FRUIT JUICE OR TEA OR INFUSION? 3D. ORAL REHYDRATION SOLUTION (ORS)? 3E. TINNED, POWDERED OR FRESH MILK OR INFANT FORMULA? 3F. ANY OTHER LIQUIDS? 3G. SOLID OR SEMI-SOLID (MUSHY) FOOD? Y N DK A. Vitamin supplements . 1 2 99 B. Plain water . 1 2 99 C. Sweetened water or juice. 1 2 99 D. ORS. 1 2 99 E. Milk. 1 2 99 F. Other liquids (specify) ____________ 1 2 99 G. Mushy food. 1 2 99 4. SINCE THIS TIME YESTERDAY, HAS (name) BEEN GIVEN ANYTHING TO DRINK FROM A BOTTLE WITH A NIPPLE OR TEAT? Yes. 1 No . 2 DK . 99 5. WHAT DO YOU USE TO GIVE (NAME) FLUIDS? Baby bottle…………………………………….1 Baby mug………………………………………2 Ordinary mug………………………………….3 Hand……………….………………………….4 DK…………………………………………….99 GO TO CARE OF ILLNESS MODULE ðð Appendices 73 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Caretaker line no. __ __ Child line no. __ __ 15. CARE OF ILLNESS MODULE 1. Has (name) had diarrhoea in the last two weeks, that is, since (day of the week) of the week before last? Yes. 1 No . 2 DK . 99 1ðQ.3 2. In the last two weeks, has (name) had any other illness, such as cough or fever, or any other health problem? Yes. 1 No . 2 DK . 99 1ðQ.4 2ðQ.11 99ðQ.11 3. During this last episode of diarrhoea, did (name) drink any of the following: Read each item aloud and record response before proceeding to the next item. 3a. breast milk? 3b. cereal-based gruel or gruel made from roots or soup? 3c. other locally defined acceptable home fluids (e.g., SSS, yogurt drink)? 3d. ORS packet solution? 3e. other milk or infant formula? 3f. water with feeding during some part of the day? 3g. water alone? 3h. Fluids such as (local beer, coke, etc) 3i. nothing Y N DK A. Breast milk. 1 2 99 B. Gruel . 1 2 99 C. Other acceptable . 1 2 99 D. ORS packet. 1 2 99 E. Other milk . 1 2 99 F. Water with feeding. 1 2 99 G. Water alone. 1 2 99 H. Unacceptable fluids. 1 2 99 I. Nothing . 1 2 99 1ðQ.5 4. During (name’s) illness, did he/she drink much less, about the same, or more than usual? Much less or none. 1 About the same (or somewhat less). 2 More . 3 DK . 99 5. During (name’s) illness, did he/she eat less, about the same, or more food than usual? If “less”, probe: much less or a little less? None. 1 Much less. 2 Somewhat less. 3 About the same . 4 More . 5 DK . 99 6. Has (name) had an illness with a cough at any time in the last two weeks, that is, since (day of the week ) of the week before last? Yes. 1 No . 2 DK . 99 2ðQ.11 99ðQ.11 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 74 May 28, 2002 7. WHEN (name) HAD AN ILLNESS WITH A COUGH, DID HE/SHE BREATHE FASTER THAN USUAL WITH SHORT , QUICK BREATHS OR HAVE DIFFICULTY BREATHING? Yes. 1 No . 2 DK . 9 2ðQ.11 9ðQ.11 8. WERE THE SYMPTOMS DUE TO A PROBLEM IN THE CHEST OR A BLOCKED NOSE? Blocked nose. 1 Problem in chest. 2 Both. 3 Other (specify ) _________________________4 DK . 9 1ðQ.11 4ðQ.11 9. DID YOU SEEK ADVICE OR TREATMENT FOR THE ILLNESS OUTSIDE THE HOME? Yes. 1 No . 2 2ðQ.11 10. FROM WHERE DID YOU SEEK CARE? ANYWHERE ELSE? Hospital. 01 Health centre . 02 Dispensary. 03 Village health worker. 04 MCH clinic . 05 Mobile/outreach clinic . 06 Private physician. 07 Traditional healer. 08 Pharmacy or drug seller. 09 Relative or friend . 10 Other (specify ) ________________________11 11. SOMETIMES CHILDREN HAVE SEVERE ILLNESSES AND SHOULD BE TAKEN IMMEDIATELY TO A HEALTH FACILITY. WHAT TYPES OF SYMPTOMS WOULD CAUSE YOU TO TAKE YOUR CHILD TO A HEALTH FACILITY RIGHT AWAY? Keep asking for more signs or symptoms until the caretaker cannot recall any additional symptoms. Circle all symptoms mentioned, but do NOT prompt with any suggestions. Child not able to drink or breastfeed. 01 Child becomes sicker . 02 Child develops a fever. 03 Child has fast breathing. 04 Child has difficult breathing . 05 Child has blood in stool. 06 Child is drinking poorly . 07 Other (specify ) ________________________08 Other (specify ) ________________________09 Other (specify ) ________________________10 GO TO IMMUNIZATION MODULE ðð Appendices 75 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Caretaker line no. __ __ Child line no. __ __ 16. IMMUNIZATION MODULE If an immunization card is available, copy the dates in Qs.2-5 for each type of immunization recorded on the card. Qs.7-15 are for recording vaccinations that are not recorded on the card. Qs.7-15 will only be asked when a card is not available. 1. IS THERE A VACCINATION RECORD FOR (name)? Yes. 1 No . 2 DK . 99 2ðQ.7 99ðQ.7 Copy dates of all vaccinations from the card. Date of Immunization DAY MONTH YEAR 2. BCG BCG 3A. OPV0 OPV0 3B. OPV1 OPV1 3C. OPV2 OPV2 3D. OPV3 OPV3 4A. DPT1 DPT1 4B. DPT2 DPT2 4C. DPT3 DPT3 5. MEASLES MEASLES 5A. CHECK LEFT FOREARM (MOST COMMON SITE) FOR BCG SCAR OR RIGHT UPPER ARM (FOR RSA). Scar present………………………………….1 Scar absent……………………………………2 Unable to examine/cannot tell……………….3 Now I would like to ask you questions relating to other vaccinations (which (name) received including those that he/she received during the National Immunization Days 6. IN ADDITION TO THE VACCINATIONS SHOWN ON THIS CARD, DID (name) RECEIVE ANY OTHER VACCINATIONS - INCLUDING VACCINATIONS RECEIVED IN A NATIONAL IMMUNIZATION DAY? Record ‘Yes’ only if respondent mentions BCG, OPV 0-3, DPT 1-3, and/or Measles vaccine(s). Go to Q.15 after you finish. Yes. 1 (Probe for vaccinations and write ‘66’ in the corresponding day column on Q. 2 to Q. 5.) No . 2 DK . 99 1ðQ.15 2ðQ.15 99ðQ.15 7. HAS (name) EVER RECEIVED ANY VACCINATIONS TO PREVENT HIM/HER FROM GETTING DISEASES, INCLUDING VACCINATIONS RECEIVED IN A NATIONAL IMMUNIZATION DAY CAMPAIGN? Yes. 1 No . 2 DK . 99 2ðQ.15 99ðQ.15 8. HAS (name) EVER BEEN GIVEN A BCG VACCINATION AGAINST TUBERCULOSIS – THAT IS, AN INJECTION IN THE LEFT SHOULDER THAT CAUSED A SCAR? Yes. 1 No . 2 DK . 99 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 76 May 28, 2002 9. HAS (name) EVER BEEN GIVEN ANY “VACCINATION DROPS IN THE MOUTH” TO PROTECT HIM/HER FROM GETTING DISEASES – THAT IS, POLIO? Yes. 1 No . 2 DK . 99 2ðQ.12 99ðQ.12 10. HOW OLD WAS HE/SHE WHEN THE FIRST DOSE WAS GIVEN – JUST AFTER BIRTH OR LATER? Just after birth. 1 Later . 2 DK…………………………………………….99 11. HOW MANY TIMES HAS HE/SHE BEEN GIVEN THESE DROPS? No. of times.__ __ 12. HAS (name) EVER BEEN GIVEN “VACCINATION INJECTIONS” – THAT IS, AN INJECTION IN THE THIGH OR BUTTOCKS – TO PREVENT HIM/HER FROM GETTING TETANUS, WHOOPING COUGH, DIPHTHERIA? (SOMETIMES GIVEN AT THE SAME TIME AS POLIO) Yes. 1 No . 2 DK . 99 2ðQ.14 99ðQ.14 13. HOW MANY TIMES? No. of times.__ __ 14. HAS (name) EVER BEEN GIVEN “VACCINATION INJECTIONS” – THAT IS, A SHOT IN THE ARM AT THE AGE OF 9 MONTHS OR OLDER - TO PREVENT HIM/HER FROM GETTING MEASLES? Yes. 1 No . 2 DK . 99 15. PLEASE TELL ME IF (name) HAS PARTICIPATED IN ANY OF THE FOLLOWING NATIONAL IMMUNIZATION DAYS: A Measles Sep – Oct 1999 B Polio 1998 C Polio 1997 D Polio 1996 Y N DK Campaign A. 1 2 99 Campaign B. 1 2 99 Campaign C. 1 2 99 Campaign C. 1 2 99 GO TO ANTHROPOMETRY MODULE ðð Appendices 77 May 28, 2002 Cluster no. __ __ __ Household no. __ __ __ Woman line no. __ __ Child line no. __ __ 17. ANTHROPOMETRY MODULE After questionnaires for all children are complete, the measurer weighs and measures each child. Record weight and length/height below, taking care to record the measurements on the correct questionnaire for each child. Check the child’s name and line number on the HH listing before recording measurements. 1. Child’s weight. Kilograms (kg) . ___ ___ . ___ 2. Child’s length or height. Check age of child: ¨ Child under 2 years old. ð Measure length (lying down). ¨ Child ages 2 or more years. ð Measure height (standing up). Length (cm) Lying down . 1 ___ ___ ___ . ___ Height (cm) Standing up. 2 ___ ___ ___ . ___ 3. Measurer’s identification code. Measurer . ___ ___ ___ 4. Result. Measured. 1 Not present. 2 Refused. 3 Other (specify ) _________________________4 5. Is there another child in the household who is eligible for measurement? ¨ Yes. ð Record measurements for next child. ¨ No. ð End the interview with this household by thanking all participants for their cooperation. Gather together all questionnaires for this household and check that identification numbers are at the top of each page. Tally on the Household Information Panel the number of interviews completed. End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 78 May 28, 2002 Appendix B – Sampling Design SAMPLE SIZE DETERMINATION FOR LESOTHO EDG MICS Key indicator Measles immunization among 12-23mo olds National Revised May '97 National 73.8 71 boys 73.1 71 Equation used: girls 74.5 71 n = [4r(1-r) * f * NR / e^2 * p(h) * n(h)] rural 76 69 Ref. Demographic and Health Surveys: Sampling Manual, Basic Documentation - 8, Macro International Inc., Calverton, Maryland, 1987 indicator value source notes alpha 0.05 deff (f) 1.5 MICS 95 national, r1 0.71 rev. MICS 1996 national, r2 0.738 unrev. MICS 1996 error margin, e 0.047 e, urban strat. 0.086 MICS2 manual Lesotho U:R is 22:78 NR adjustment 1.05 prop 1-2yr, p (h) 0.02 CENSUS prop Males 1-2, p(m) 0.01 CENSUS num pers/hh, n(h) 5 CENSUS a= b= Number of HH strata r 4r(1-r) 4r(1- r)*f*NR e^2*p(h)*n(h) sample size assumptions natl (none) r1 0.71 0.8236 1.297 0.0001714 7568 12-23m=2% pop; e=4.4% natl (none) r2 0.74 0.8236 1.297 0.00025 4873 12-23m=2% pop; e=6% urban/rural 0.69 0.8556 1.348 0.00018 7562 + u=22%pop, e=9% U/LL/FT/MTS 0.66 0.8976 1.414 0.00012 11781 + FT (12%) = -2se of natl cov, se=1, mrg SRV+mts, e=10% Column a Column b error change as a result of stratification sample size e^2*p(h)*n( h) / pr*n(h) sqrt. `b/pr*n(h) 7568 0.000171 0.0017 0.0414 national 7568 0.000171 0.0078 0.088 urban/rural 7568 0.000171 0.0143 0.120 geological Appendices 79 May 28, 2002 CENSUS PARAMETERS Table 1. Population of Lesotho, by district, from 1996 census, assuming average of 5 persons per HH Urban Rural Total District Lowlands Foothills Mountains SRV Butha Buthe 23,065 39,000 43,865 5,595 111,525 Leribe 41,880 169,545 42,970 22,040 276,435 Berea 20,550 151,530 36,670 208,750 Maseru 240,715 135,860 63,410 34,345 474,330 Mafeteng 27,450 166,080 14,950 208,480 Mohale's Hoek 25,655 86,860 18,860 33,900 23,460 188,735 Quthing 12,740 36,545 65,445 114,730 Qacha’s Nek 5,855 47,930 14,185 67,970 Mokhotlong 6,685 80,010 86,695 Thaba Tseka 5,430 116,865 122,295 Lesotho 410,025 748,875 220,725 377,230 103,090 1,859,945 Table 2. Number of households distribution Urban Rural Total District Lowlands Foothills Mountains SRV Butha Buthe 4613 7800 8773 1119 22305 Leribe 8376 33909 8594 4408 55287 Berea 4110 30306 7334 41750 Maseru 48143 27172 12682 6869 94866 Mafeteng 5490 33216 2990 41696 Mohale's Hoek 5131 17372 3772 6780 4692 37747 Quthing 2548 7309 13089 22946 Qacha’s Nek 1171 9586 2837 13594 Mokhotlong 1337 16002 17339 Thaba Tseka 1086 23373 24459 Lesotho 82005 149775 44145 75446 20618 371989 Table 3. Proportional allocation distribution of households Urban Rural Total District Lowlands Foothills Mountains SRV Butha Buthe 0.012 0.021 0.024 0.003 0.060 Leribe 0.023 0.091 0.023 0.012 0.149 Berea 0.011 0.081 0.020 0.000 0.112 Maseru 0.129 0.073 0.034 0.018 0.255 Mafeteng 0.015 0.089 0.008 0.112 Mohale's Hoek 0.014 0.047 0.010 0.018 0.013 0.101 Quthing 0.007 0.020 0.035 0.062 Qacha’s Nek 0.003 0.026 0.008 0.037 Mokhotlong 0.004 0.043 0.047 Thaba Tseka 0.003 0.063 0.066 Lesotho 0.220 0.403 0.119 0.203 0.055 1.000 Urban/Rural 0.220 0.780 End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 80 May 28, 2002 clusters, take 350, 16 5600 380, 16 6080 380, 20 7600 300, 16 4800 Table 4a. Number of EAs to be selected for pps and 350 clusters clusters 350 Urban Rural Total District Lowlands Foothills Mountains SRV Butha Buthe 4 7 8 1 0 21 Leribe 8 32 8 4 0 52 Berea 4 29 7 0 0 39 Maseru 45 26 12 6 0 89 Mafeteng 5 31 3 0 0 39 Mohale's Hoek 5 16 4 6 4 36 Quthing 2 0 0 7 12 22 Qacha’s Nek 1 0 0 9 3 13 Mokhotlong 1 0 0 15 0 16 Thaba T seka 1 0 0 22 0 23 Total 77 273 350 take 20 1543 5457 7000 Table 4b. Number of EAs to be selected for pps and 380 clusters of 20hh each; SAMPLE=7600 clusters 350 Urban Rural Total District Lowlands Foothills Mountains SRV Butha Buthe 5 8 9 1 0 23 Leribe 9 35 9 5 0 56 Berea 4 31 7 0 0 43 Maseru 49 28 13 7 0 97 Mafeteng 6 34 3 0 0 43 Mohale's Hoek 5 18 4 7 5 39 Quthing 3 0 0 7 13 23 Qacha’s Nek 1 0 0 10 3 14 Mokhotlong 1 0 0 16 0 17 Thaba Tseka 1 0 0 24 0 25 Total 84 296 380 take 16 1340 4740 6080 National take 20 1675 5925 7600 National - Option Selected Table 4c. Number of EAs to be selected for pps and 300 clusters of 20hh each; SAMPLE=6000 clusters 300 Urban Rural Total District Lowlands Foothills Mountains SRV Butha Buthe 4 8 9 1 0 23 Leribe 7 35 9 5 0 56 Berea 3 31 7 0 0 43 Maseru 39 28 13 7 0 97 Mafeteng 4 34 3 0 0 43 Mohale's Hoek 4 18 4 7 5 39 Quthing 2 0 0 7 13 23 Qacha’s Nek 1 0 0 10 3 14 Mokhotlong 1 0 0 16 0 17 Thaba Tseka 1 0 0 24 0 25 Total 300 66 234 6000 take 16 1058 3742 4800 take 20 1323 4677 6000 National Appendices 81 May 28, 2002 Appendix C – Listing Form, “Form 1” Confidential Kingdom of Lesotho Multiple Indicator Cluster Survey for the End Decade Goals MICS HOUSEHOLD LISTING FORM 1 DISTRICT: ………………………………. VILLAGE: …………………………………. CLUSTER: …………………………………. RURAL/URBAN: …………………………. Serial No. of H/H Head of Household Sex 1. M. 2. F. No. of Under Fives COMMENTS 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. NAME OF ENUMERATOR: ……………………………. DATE: ………… SIGNATURE: ……………… NAME OF SUPERVISOR: ……………………………. DATE: ………… SIGNATURE: ……………… End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 82 May 28, 2002 Appendices 83 May 28, 2002 Appendix D – Steering Committee Members NAME DESIGNATION INSTITUTION Ms. L. Hlasoa Director, Sectoral Planning Ministry of Development Planning Ms. M. Makhakhe Director of Health Planning Ministry of Health Dr. M. Moteetee Director of Primary Health Care Ministry of Health Ms. L. Chisepo Director of Social Welfare Ministry of Health Ms. M. Makakole Director of Planning Ministry of Education Ms. M. Motselebane Director of Planning Ministry of Agriculture Chief Legal Officer Ministry of Justice Ms. M. Mosae Director of Rural Development Ministry of Local Government Ms. M. Tsepane PAS Ministry of Employment and Labour Mr. Mile Mokhahlane Director Bureau of Statistics, Lesotho Mr. Igor Marincek Representative World Food Programme Dr. R. Tshabalala Representative World Health Organization Mr. E.C. Iwuji Technical Adviser International Labour Organization Mr. E. Omotoso Resident Coordinator United Nations Ms. G. Nchee Executive Secretary CHAL End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 84 May 28, 2002 Appendix E – Task Force Members NAME INSTITUTION Mr. M. Khahlane Bureau of Statistics Ms. T. Makoa Bureau of Statistics Mr. T. Mpeka Bureau of Statistics Ms. B. Hloaele Bureau of Statistics Ms. M. Rantekoa LDTC, Education. Lesotho Distance Teaching Ms. A.P. Raithule Ministry of Local Government Ms. M. Mohapi Ministry of Health and Social Welfare Ms. M. Chabane Ministry of Justice and Human Rights Ms. M. Sebotsa Food and Nutrition Coordinating Office Mr. T. Thulo Ministry of Local Government Ms. M. Khali Christian Health Association of Lesotho (CHAL) Ms. M. Matji Ministry of Health and Social Welfare Ms. T. Ramonono Ministry of Health and Social Welfare Ms. M. Ntsike Food and Nutrition Coordinating Office Mr. B. Majara Ministry of Health and Social Welfare Ms. N. Matsoso Ministry of Health and Social Welfare Ms. A. Mothibeli Ministry of Education Ms. M. Morojele UNICEF Appendices 85 May 28, 2002 Appendix F - Persons involved in the 2000 Lesotho EMICS The 2000 Lesotho MICS involved a multi-disciplinary team. The list of these persons is hereby provided and is delineated according to the main phases that comprised the survey. 1. Preparatory Phase a). Questionnaire Design Ü The Task Force35 Ü Ms. Mpho Morojele b). Translation of Questionnaire Ü Ms. Mpho Morojele Ü Ms. M. Matji Ü Ms. T. Ramonono c). Enumerator Selection and Training Ü The Task Force Ü Mr. T. Mpeka d). Sampling Ü Ms. Kate Spring, MICS Consultant Ü Ms. Mpho Morojele Ü Mr. T. Mpeka 2. Data Collection a). Field Enumerators N. Lebesa M. Ntoi M. Molapo M. Kompi M. Lerotholi M. Ntjatji M. Mpatsi M. Sehloho B. Ts'oene M. Mokhele M. Khoarane M. Ramoabi M. Sesing N. Chobokoane T. Mohapi V. Kolobe S. Nkhapetla T. Maseru M. Selete M. Joele S. Ramonono M. Mofolo D. Lenka P. Nthinya N. Phalang M. Mphanya P. Stragom N. Mosala M. Kapeng T. Thibathiba C. Khesi M. Ntaisane N. M. Lerotholi M. Mokete M. Lephole P. Swatzi M. Maboee L. Lemphane T. Mokobocho M. Seithleko T. Damane M. Sula N. Mopeli L. Kharasi N. Makutle N. Mohapi R. Mphanya M. Letela M. Mphoto M Ntoi P. Ramokoena M. Mokatjane M. Pheko T. Pheko T. Manyeli T. Ramohlabi M. Khoiti M. Tefo R. Lepholisa P. Hlalele M. Tseiso M. Mpakanyane N. Lesoma 35 List of Task Force Members is in Appendix E End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 86 May 28, 2002 b). Field Supervisors Butha-Buthe P. Chabane Leribe M. Rantekoa M. Makhasane M. Sekants’i Berea A. Raithule C. Khachane M. Sebotsa Mafeteng B. Litabe Maseru M. Mohapi Mohale’s Hoek M. Shale N. Matsoso Quthing T. Ramonono Qacha’s Nek E. Moshesha Mokhotlong M. Makoa Thaba Tseka T. Mpeka UNICEF Programme Officers Government Counter Parts Dr. Margaret Ngau Ms. M. Setlolela Ms. M. Shai Ms. P. Kaloli Ms. M. Molapo Ms. A. Kalaka Ms. A. Maieane Ms. M. Matsoai Support Supervisors Ms. M. Moeketse Ms. M. Marsoai Ms. M. Phakisi c). EMICS National Coordinator Ü Ms. Mpho Morojele 3. Data Processing a). Data Entry and Verification M. Mokherane M. Tsosane M. Lefa L. Shelile N. Shale F. Pitso M. Phate M. Sebalo M. Maqelepo M. Mokhele M. Ts'epe S. Ntoane P. Pheko Ntsopa Mokitimi Litsoanelo Mphahama 'Mantlali Rakhoabe 'Maleloko Khoiti 'Mantoetsi Mohale 'Maserobanyane Serobanyane Relebohile Jane Mahlaha Moejane Data Entry Clerks 'Mathabo Molapo R. Motloheloa P. Mahone G. Makojoa Supervisors M. Mokhethi b). Secondary Editing Ü Ms. Botsoa Hloaele, Technical Director MICS Ü Mr. Rampa Motloheloa c). Adaptation of Programmes Ü Dr. Eric A. Magolo Ü Ms. Botsoa Hloaele Ü Ms. M. Makoa d). Analysis Ü Ms. Mpho Morojele Ü Dr. Eric A. Magolo Ü Ms. M. Makoa Appendices 87 May 28, 2002 4. Drafting of Preliminary Report a). Ms. Mpho Morojele b). Ms. N. Makoa c). Dr. Eric A. Magolo 5. Dissemination of Preliminary Report - Distribution List a). Permanent Secretary, Ministry of Development Planning b). Permanent Secretary, Ministry of Health and Social Welfare c). Ms. Kimberly Gamble-Payne, Country Representative, UNICEF Maseru d). Dr. Tibebu Haile Selassie, Programme Coordinator, UNICEF Maseru e). Director, Bureau of Statistics, Lesotho f). The Task Force g). The Steering Committee h). Ms. M. Motsepe, Programme Officer, UNICEF Maseru i). Ms. Agnes Kalaka, Programme Officer Health , UNICEF Maseru j). Ms. Malibuseng Moeketse, Programme Officer Nutrition, UNICEF Maseru k). Dr. Margaret Ngau, Programme Officer Education, UNICEF Maseru l). Ms. Mpho Morojele, National Coordinator 2000 MICS Lesotho m). Ms. Mathulo Moletsane, Information and Documentation Assistant, UNICEF Maseru n). National Press, Lesotho o). Dr. Eric A. Magolo, Technical Assistance, 2000 EMICS End Decade Multiple Indicator Cluster Survey – Draft Preliminary Report 88 May 28, 2002 Appendix G - Anthropometry Data Check Standard Deviations Unit of Analysis No. of Cases Stunting Height for Age Underweight Weight for Age Wasting Weight for Height Acceptable Range Lesotho 2910 1.75 1.25 1.38 1.00 - 1.30 Butha-Buthe 178 1.89 1.21 1.37 1.00 - 1.30 Leribe 533 1.59 1.19 1.31 1.00 - 1.30 Berea 360 1.65 1.30 1.35 1.00 - 1.30 Maseru 493 1.85 1.19 1.37 1.00 - 1.30 Mafeteng 362 1.59 1.24 1.28 1.00 - 1.30 Mohale's Hoek 252 1.62 1.26 1.44 1.00 - 1.30 Quthing 208 1.68 1.47 1.47 1.00 - 1.30 Qacha's Nek 101 1.80 1.20 1.54 1.00 - 1.30 Mokhotlong 203 1.90 1.24 1.27 1.00 - 1.30 Thaba-Tseka 220 1.99 1.14 1.44 1.00 - 1.30

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