Libya - Multiple Indicator Cluster Survey - 2003

Publication date: 2003

Great Socialist People's Libyan Arab Jamahiriya People’s Committee Public Commission for Health Care Planning Multi Indicator Cluster Survey (MICS) Preliminary Report MICS Results 2003 Contents Introduction Sample and Research Methodology Research population Household Characteristics 1. Type of household 2. Material of dwelling floors 3. Rooms in dwelling 4. Bedrooms in dwelling 5. Source of drinking water 6. Type of Toilet facility 7. Salt Iodization Characteristics of Sample members 1. Gender and age Structure 2. Marital status 3. Orphaned children 4. Educational Status Characteristics of Female Sample Members 1. Marital Status 2. Educational Status 3. Health Care 4. Immunization against neonatal tetanus 5. Fertility 6. Family planning 7. AIDS 8. Maternal Mortality Characteristics of Children in the Sample 1. Birth registration and childhood education 2. Breastfeeding 3. Childhood Illnesses a. Diarrhoea b. Other illnesses 4. Immunizations 5. Anthropometry 6. Child Labour 7. Child Mortality Table summarizing the most significant indicators in Yemen Introduction In an effort to reinforce the national efforts to improve living conditions of the Libyan family, and based on our belief in the importance of developing the economic, social and health sectors, and complement the achievements realized since the Revolution of September; it was necessary to administer this survey known as Libyan Multi indicator Cluster Survey (MICS). This survey is the first national survey that targets health national indicators in both urban and rural areas. Work on this survey was commenced after an order was issued by the Deputy Secretary General for Service Affairs in the People’s Committee, order No. 255/ 2003. The order stipulated that a committee of 13 national experts will be formed, and they will be assisted with experts from UN agencies working in Libya. The study sample included 11900 Libyan households distributed on 700 regions. The sample also consisted of several clusters, with 17 households in each. Statistical means were used to identify the sample, and ensure the development of actual indicators and estimations. The efforts of the Libyan people made the rapid completion of field work possible, 300 researcher, coordinator and administrators, who underwent intensive training to ensure accuracy, cooperated to come up with the findings presented in this report. Since there is no clear definition for populations in urban and rural areas, we used numerical standard to distinguish between urban and rural areas, which is a common standard used in social sciences and researches. The numbers were taken from 1995 census, and any region that had more than 5000 people was considered an urban area. We would like to thank the members of the people’s committee for their interest and follow up. We would also like to thank the international and regional organizations that helped in the implementation of the survey. Our appreciation also extends to the staff members of the national centre for preventing contagious diseases, the Higher Committee for Children and the National Commission for information and documentation. Last but not least, I present to you the result of 6 months of hard work . And we are proud to address this work to the engineer of our welfare in Libya, President Qathafi, Libyan executive authorities in the country to help in the decision making process in addition to the Libyan people. May God Bless your efforts, and may his peace be upon you . Dr. Ikhrais Balqasem Ahmad Head of the Survey Team February 2004 Sample and Research Methodology The MICS in Libya was designed to assess health indicators on the national level in various regions, in addition to rural and urban areas. The country is divided to 12 regions as follows: No. Region Area No. Region Area 1 Al Batnan Al Batnan 9 Tripoli Tajoraa & Nawahi Darana Tripoli Al Qoba Al Jafara 2 Al Jabal Al Akhdar Al Jabal Al Akhdar 10 Al Zawya Al Zawya Al Marj Sarman & Sbarta 3 Banighazi Al Hizam Al Akhdar Al Niqat Al Khams Banighazi 11 Al Jabal Al Gharbi Ghrayan 4 Ajdabya Ajdabya Yfrin & Jado Al Wahat Naloot Al KAfra Mazda 5 Sartt Sartt Ghadames Al Jafra 12 Farran Sabha 6 Mosrata Mosrata Al Shate’ 7 Al Marqab Al Marqab Wadi il Haya 8 Tarhoona Bani Waleed Ghat Tarhoona & MIslata Marzouq The sample includes three levels, and 700 areas chosen from 7106 selected randomly and proportionately with the size of the region. The sample included 11900 families. The administered questionnaire included a section on the population’s characteristics and another focusing on the characteristics of female members (15 – 49), while the third part focused on under – five children. This questionnaire was based on the original cluster questionnaire developed by UNICEF, and which was translated into Arabic and adapted to fit the Libyan culture. A training course was developed for all field supervisors, it was held in the city of Zelteen between 21 – 24 June, 2003.Two other training programs on gathering data were organized between 30 June, 2009 and 9 July 2003 in Tripoli and Banighazi, and the questionnaire was tested at the end of the training. 90 teams worked on gathering data, each team consisted of two researchers in addition to a driver and field supervisor. Study Population The Libyan MICS, which was conducted between 7/7/2008 and 31/8/2008, covered 11900 households distributed on 700 areas, 101 of which were in the rural side of the country. The response rate was high; the number of households that were successfully interviewed was almost 11142 (93.6%). 1633 households were interviewed in rural areas (96.1%) in comparison to 9509 in urban areas (93.2%). The number of households included in the sample was 84451, 71114 of which were in urban areas (84.2%). The sample included 232582 females, whose ages ranged between (15 – 49), and the percentage of successful interviews was (92%) in urban areas and (94.3%) in rural ones. The number of children (under 15 years) and who completed the interview successfully was 7232 children (%97.8) in both urban and rural areas. Table (1) Distribution of households according to the interview’s results and place of residence Details Urban Rural Total Number Percentage Number Percentage Number Percentage Interview completed 9509 93.2 1633 96.1 11142 93.6 Interview rejected 150 1.5 17 1.0 167 1.4 Family not at home 377 3.7 33 1.9 410 3.5 Family was not found 98 1.0 5 0.3 103 0.8 Other 66 0.6 12 0.7 78 0.7 Total 10200 100 1700 100 11900 100 Characteristics of Dwellings 1. Type of Dwelling The MICS revealed that 17% of Libyan households live in independent houses (Villa), this percentage is higher in urban areas (18.4%), while it is only (11.3%) in rural areas. The survey also revealed that 65.4% of Libyan households live in a regular house. This kind of dwelling is common in urban areas (83%); while in rural areas the percentage is only 62.4%. 14.3% of households live in apartment buildings; this percentage in urban areas reach 16.5%, while in rural areas it is 1.3% only. Table (2) shows the distribution and type of dwelling in urban and rural areas. Table (2): Distribution of the sample household according to the type of dwelling and place of residence Type of dwelling Urban% Rural% Total% Villa or modern house 18.4 11.3 17.3 Regular house 62.4 83.0 65.4 Apartment 16.5 1.3 14.3 Other 2.7 4.5 3.0 Total 100 100 100 2. Material of Dwelling floors Table (3) shows that almost 87% of Libyan households live in houses with tiled floors. This type of floor is common in urban areas (90%), and in rural areas the percentage is (71%). The percentage of dwellings with cement floors is 12.6%. Table (3) Distribution of households according to type of floor material and place of residence Type of floor Urban% Rural% total% Tiles or wood 89.5 70.9 86.7 Cement 9.9 28.2 12.6 Earth/ Sand 0.6 1.0 0.6 Other 0.1 0.0 0.0 Total 100 100 100 3. Rooms in the Dwelling The survey showed that 40% of Libyan households live in dwellings that consist of 4 rooms, while 25% of households live in 3 – room houses, and they are existent in both rural and urban areas in the same percentage almost. 25% of households live in dwellings that consist of five rooms or more as shown in table (4). Table (4): Distribution according to number of rooms in the dwelling Number of rooms Urban% Rural% Total% One room 0.8 0.9 0.8 Two rooms 5.6 5.3 5.6 Three rooms 24.2 24.6 24.3 Four rooms 39.5 41.7 39.8 Five rooms 18.9 20.3 19.1 Six rooms 6.3 4.5 6.1 Seven rooms or more 4.5 2.6 4.2 Total 100 100 100 4. Number of Bedrooms Two bedroom houses are common in Libya in both rural and urban areas 40%, followed by three bedroom houses and four-bedroom houses (10%), and they are more common in urban areas. Number of bedrooms Urban% Rural% Total% One Bedroom 7.8 7.5 7.8 Two bedrooms 39.5 39.4 39.5 Three bedrooms 40.6 38.4 40.3 Four bedrooms 9.4 11.8 9.8 Five bedrooms 1.9 2.1 1.9 Six bedrooms or more 0.8 0.8 0.8 Total 100 100 100 5. Source of Drinking Water Given the importance of water and its significance for general health, the survey gathered specific information on the major source of drinking water. The results show that the national water pipelines and water wells are the main two sources of water in both urban and rural areas. The percentage of households depending on the national water pipelines is 79%, 81% in urban areas and 72% in rural areas. Table (6): Distribution of households according to the source of drinking water and place of residence Source of drinking water Urban% Rural% Total% House connected to water pipes 50.6 43.5 49.5 Public water tap 9.3 1.2 8.1 Water pump 10.9 20.0 12.2 Protected water well 10.0 7.5 9.6 Rain water collection 9.4 13.3 10.0 Tanker (truck) 5.3 12.1 6.3 Bottled water 2.8 1.0 Other 1.7 1.4 1.6 Total 100 100 100 The results also showed that 75.8% of the households get their drinking water from inside the house and 78.6% from inside the building. The average time needed to bring water to the house was 45 minutes; 44.4 minutes in urban areas and 53.0 minutes in rural areas. 6. Type of Toilet Facility: The survey covered aspects relating to the sustainment of clean environment and disposing of human waste, and consequently the availability of toilet facilities. Results revealed that 94.8% of households have a toilet that flushes into a sewer system. In urban areas this percentage was 95.6%, while in rural areas it was 90.8%, Figure (1). The percentage of households that have a toilet facility inside the house was 95.7%, while the percentage of households that has a toilet outside their house was 4.3%, and this percentage does not differ between urban and rural areas. As for the feces of children below three years of age, results show that 73.2% of children use the toilet or their feces is thrown in it, while the feces of 12.4% of children is thrown outside the house yard. Figure (1): Household distribution according to the type of toilet facility and Place of residence Urban Rural Total Toilet with a connected flush box  Toilet with a flush box that is not connected Toilet with a tank Other Figure (2) 7. Salt Iodization: The survey’s results showed the 59% of households in Libya use iodized salt (54.2% use salt with (PPM15). This percentage was higher in urban areas (60.7%), while in rural areas it was only 48.4%. The percentage of households that use salt without Iodine (PPM – 0) is 37.6%, it was only noticed that this percentage was less in urban areas compared to rural ones, the percentages were 35.6% and 49.6% consecutively. Table (7): Distribution of households according to the usage of iodized salt and place of residence Details Urban% Rural% Total% Uniodized salt PPM – 0 35.6 49.6 37.6 Iodized salt PPM15 4.4 6.3 4.7 Iodized salth PPM  15 56.3 42.1 54.2 Salt is not available at home 0.6 0.3 0.5 Salt was not examined 3.2 1.7 3.0 Total 100 100 100  Child uses toilet Stool is thrown in toilet  Stool is thrown outside the school yard  Diapers are thrown with garbage Figure (2): Disposal of Child Stool (0-3 years) Urban Rural Total Characteristcs of Sample Members 1. Gender and age Structure The MICS results showed that fertility in the countrey is dropping, as the percentage of people whose age is less than 5 years is 8.8% in comparison to 12.5% in the census conducted in 1995. The percentage of individuals whose age is less than 15 years old is 32.3% in comparison to 39% in 1995 census. Figure (3) illustrates the qualitiative and age structure of the research sample. Table (8) illustrates the Gender and age structure of the sample members according to the place of residence, and it shows that the percentage of population in the working age group (15 – 64) is 64.2%, while the percentage of population whose age does not fall within the working age (less than 15 or more than 64) is 35.5% in comparison to 43% in 1995 census. Figure (3): Gender and age structure % Females Males A ge G ro u p s Table (8): Distribution of age categories in the sample according to place of residence Age category Urban% Rural% Total% 0 – 4 8.7 9.1 8.8 5 – 14 23.2 25.0 23.5 15 – 64 64.6 62.2 64.2 +65 3.3 3.2 3.3 Unknown 0.2 0.5 0.3 Total 100 100 100 2. Marital Status Results shown in table (9) depicts that the percentage of unmarried people is 64% among males, and 56% among females, while the percentage of married people is 37%. The survey also revealed that the percentage of divorced and widowed people is higher among females than males. Table (9): Distribution of sample members (15 years or older) according to the marital status and gender Marital Status Males% Females% Total% Single 64.2 56.2 60.4 Married 35.1 38.3 36.6 Divorced 0.2 1.2 0.7 Widowed 0.5 4.3 2.3 Total 100 100 100 Figure (4) shows that the percentage of divorce and widowhood is higher in urban areas than rural areas 3. Orphaned Children Survey results for children below 15 years old show that there are 8 children who lost their mothers in every 1000 children, while there are 25 children who lost their father in every 1000 child. Table (10) shows that in every 1000 child, 5 don’t live with their biological mothers, and nine don’t live with their biological fathers. Table (10) Distribution of children according to the status of their biological parents, alive, diseased, lives with the family or does not live with the family Parents’ Status Biological mother Biological Father Number % Number % Alive 26992 99.1 26526 97.4 diseased 228 0.8 686 2.5 N. A 10 0.0 18 0.1 Lives with the family 26854 98.6 26285 96.5 Does not live with the family 138 0.5 241 0.9 Diseased/ not diseased 238 0.9 704 2.6 Number of children below 15 years of age – 27230 Figure (4): Marital status according to place of residence Urban Rural Total  Widowed  Divorced  Married Single 4. Educational Status The survey gathered data on the educational status of household members whose ages are above 5 years. Results showed that 86.2% of sample members whose ages are 5 years or more (76412) were enrolled in school at one point, 35662 (90.6%) males and (30206 (81.5%) females. The percentage of people who did not attend school was 10544 (13.8%). Table (11) shows the highest education level reached by individuals included in the survey. Table (11): Distribution according to gender and highest educational level Highest Educational Level Males% Females% Total% Elementary 26.9 30.1 28.4 Secondary 25.1 22.3 23.8 High school or its equivelant 31.2 31.1 31.1 University or its equivelant 16.1 16.1 16.1 Irregular Curricula 0.6 0.4 0.5 Not identified 0.2 0.1 0.1 Total Percentage 100 100 100 Number 35603 30166 65769 Table (12) shows the highest educational level Table (12): Distribution of sample’s household members (15 and older)according to the educational level, gender and place of residence Educational Level Male Female Urban Rural Total Illiterate 7.3 19.3 12.5 16.3 13.1 Literate 5.5 7.1 6.1 7.1 6.3 Elementary 16.7 12.7 14.8 14.7 14.7 Secondary 24.0 19.8 21.9 22.4 22.0 High School 34.2 30.7 32.8 31.3 32.5 University or higher 11.2 9.4 10.8 7.5 10.3 Irregular Curricula 0.6 0.4 0.6 0.2 0.5 N.A/ N.C 0.6 0.6 0.6 0.4 0.6 Total Percentage 100 100 100 100 100 Number 29623 27598 48426 8795 57221 Figure (5) shows the literacy percentage among surveyed household members whose ages are higher than 15 Figure (5): Literacy distribution for ages (+15) Male Female Total  Doesn’t know  illiterate  Reads with difficulty reads smoothly Table (13) shows that school attendance percentage between the ages (5 – 17) in 2002 was 94.2% and 98.4% in 2003. The attendance percentages were the same between males and females, and it was 94.2% in urban and rural areas in 2002 and 98.4% in 2003. Table (13): Distribution of sample member according to their enrollment in school in 2002 – 2003, gender and place of residence Details Academic Year (2001/2002) Academic Year (2002/2003) Attending school Not attending school Attending school Not attending school Urban 94.1 5.9 98.4 1.6 Rural 94.4 5.6 98.2 1.8 Total 94.2 5.8 98.4 1.6 Male 94.2 5.8 98.3 1.7 Female 94.2 5.8 98.5 1.5 Total Percentage 94.2 5.8 98.4 1.6 Number 21703 1338 22744 378 The educational for this age group during the past two years is clarified in the following table. Table (14): Distribution of sample members (5-17) according to the educational level during 2001 – 2002, 2002/ 2003. Details 2001/2002% 2002/2003% Preschool 3.5 0.1 Elementary 59.4 55.6 Secondary 27.8 29.7 High School 9.1 14.4 Irregular Curricula 0.2 0.2 N.A. 0.0 0.0 Total Percentage 100 100 Number 21690 22729 Characteristics of Females in the Sample This section illustrates the characteristics of females (married and unmarried) in the sample, their ages range between the ages of (15 – 49), and their total number is 23552 distributed between urban and rural areas, 84.6% and 15.4 consecutively: 1. Marital status The MICS revealed that 65.4% of females (15 – 49) were not married, this percentage is higher in rural areas (67.5%) in comparison to urban areas (65.1%). The percentage of married women was 32.3%; 32.5% in urban areas and 30.7% in rural areas. Percentages of divorced and widowed women are higher in urban areas, and they are detailed in the table below: Table (15): Distribution of femal members (15 – 49) according to marital status and place of residence Marital Status Urban% Rural% Total% Married 32.5 30.7 32.3 Divorced 1.2 0.9 1.2 Widowed 1.2 0.9 1.2 Bachelor 65.1 67.5 65.4 Total Percentage 100 100 100 Number 19926 3626 23552 Table (16) shows the age distribution for females according to age groups and marital status Table (16): Distribution of female members according to marital status and age groups Age groups Married Widowed Divorced Seperated Bachelor Total 15 – 19 0.2 0.4 0.4 6.3 33.4 21.9 20 – 24 3.2 0.7 4.3 0.0 30.2 20.8 25 – 29 11.8 4.1 15.6 12.5 19.3 16.6 30 – 34 21.6 8.1 25.8 31.3 11.3 14.8 35 – 39 25.1 8.1 25.8 31.3 11.3 14.8 40 – 44 22.5 27.3 16.4 12.5 4.4 11.5 45 – 49 15.7 44.3 10.2 25.0 0.2 5.8 Total 100 100 100 100 100 100 7596 271 256 16 15413 23552 The table shows that marriage percentage increases with age, and it is highest in the age group (35 – 39). This phenomena applies to the categories of divorced and widowed women. The table also shows that the percentage of married women is 93.3%, while the percentage of widowed and divorced women is 3.3%. 2. The Academic Status of females (15 – 49) The research showed that out of 23552 females 86.7% can read easily, while 4.3% can read with difficulty. The percentage of illiteracy is 8.7%; 12.5% in rural areas and 8.1% in urban areas. Table (17) shows the ability of married women (8107) to read was (71.7%); (73.7%) in urban areas and (60%) in rural areas. Illiteracy percentages are higher in rural areas (28%), and in urban areas it is (19%). Table (17): Distribution of married women according to their ability to read and place of residence Ability to read Urban% Rurual% Total% Can easily read 73.7 59.8 71.7 Can read with difficulty 7.3 11.8 8.0 Illiterate 18.8 28.1 20.2 N. A 0.1 0.3 0.1 Total Percentage 100 100 100 Number 6934 1173 8107 3. Health care during pregnancy and labour: The number of pregnant women who gave birth to live babies in the year preceding the one in which the MICS was conducted was 1489 women in urban and rural areas 83.8% and 16.7% consecutively. The percentage of women who gave live births within the previous year and received a dosage of vitamin (a) during the first two months after the last delivery was 32%, while 60% of them did not receive this dosage. Table (18) details the medical follow up during pregnancy in urban and rural areas, and it shows that the percentage of women who have received medical attention during the period of their pregnancy from a doctor is 87.0% in urban areas, and 80.6% in rural areas, and this is the largest percentage of pregnant women. The percentage of women who have not received medical attention is 7.1%; 10.1% in rural areas and 6.5% in urban areas. Figure (6): Distribution of mothers who gave live births during the past year according to the availability of vitamin (a)  Did not receive VA  Received VA  NA Table (18): Percentage of women who gave birth to live children during the previous year according to the provision of medical care during pregnancy Provider of medical care Urban% Rural% Total% Doctor 87.0 80.6 86.0 Nurse/ Midwife 3.4 2.8 3.3 Midwife assistant 0 1.6 0.3 Traditional midwife (not qualified) 0.4 1.2 0.3 Relative/ friend 0.2 1.2 0.3 Others 0.1 0 0.1 Did not receive medical care 6.5 10.1 7.1 Number of mothers 1241 248 1489 Results have shown that pregnant women who have given birth under medical supervision was 1432 (96.5%), in 6.5% of the cases a doctor attended the delivery; (67.6%) in urban areas and (52%) in rural areas. 28.0% of the deliveries were attended by a nurse/ midwife, this percentage is higher in rural areas as shown in table (19) and figure (7). Table (19): Distribution of women who have given live births during the previous year according to delivery attendant and place of residence. Attendant Urban% Rural% Total% Doctor 67.6 52.0 65.0 Nurse/ Midwife 26.3 36.7 28.0 Midwife assistant 0.7 2.8 1.1 Traditional midwife (not qualified) 0.4 0.2 0.3 Relative/ friend 0.3 1.6 0.5 Others 0.2 0 0.1 Did not receive medical care 1.6 1.0 1.1 N. A. 3.6 4.8 3.8 Number of mothers 1241 248 1489 Among the problems that faced women during pregnancy were sight problems during the day. 155 woman suffered from that problem (10.4%), while 90 others (6%) suffered from sight problems during the night. The survey also revealed that 85.6% of born children (1489 birth) were weighed immediatley after birth, this percentage was higher in urban areas than in rural ones; 87% and 77.8% consecutively. The percentage of infants who were weighed at birth was 4.2%, and there was no significant difference between urban and rural areas. The survey also showed that the weight of 355 children was registered In a card (27.9%), while 799 others did not have a card, and their mothers gave the required information (62.7%). The average weight for new borns was 3.26 kg, 50% of live births weighed 3.2 kg or less, while 75% weighed 3.6. Figure (7): Distribution of mothers who gave live births during the past year according to the type of attending help and place of distribution Doctor Midwife Midwife assistant Other Did not receive help NA  Urban  rural  Total % Table (20): Distribution of women who gave live births during the previous year according to the caracteristics of the new born and place of residence Details Urban% Rural% Total% Infant was weighed at birth 87.1 77.8 85.6 Infant not weighed at birth 4.1 4.4 4.2 N.A./ Does not know 8.8 17.7 10.5 Total 100 100 100 Weight taken from card 26.8 33.7 27.9 Weight given from mother’s memory 64.7 51.8 62.7 Not available 8.5 14.5 9.4 Total 100 100 100 4. Immunization against Tetanus: The MICS gathered data on the immunizations received by mothers (who gave live births), the number of mothers who completed the interview was 1489, the Immunization cards of 123 women were presented (8.3%), while the numbers of women who had cards but did not show them was 16.7%. The percentage of women who did not have an immunization card was 68.9%. Results showed that 20.1% of the mothers received the tetanus vaccination during the last pregnancy; 19.7% in urban areas and 22.2% in rural areas. The next table shows the number of vaccinations the mothers received. Table (21): Distribution of mothers according to the number of Tetanus vaccination shots they received during the last pregnancy, between pregnancies or during their lifetime. Number of shots During the last pregnancy Before the last pregnancy and between pregnancies Total (During their lifetime) Number % Number % Number % Did not receive any (Zero) 1030 69.2 900 67.9 1016 68.2 One shot (1) 111 7.5 47 3.5 86 5.8 Two shots (2) 146 9.8 67 5.1 200 13.4 Three shots (3) 37 2.5 43 3.2 85 5.7 Four Shots (4) 5 0.3 37 2.8 45 3.0 Five shots (5) or more - - 45 3.4 57 3.8 N.A./ does not know 160 10.8 187 14.1 0 - Total 1489 100.0 1326 100 1489 100.0 The table shows that 69.2% of mothers did not receive tetanus vaccinations during the last pregnancy, while 68% did not receive tetanus shots before the last preganacy or between pregnancies. The table also shows that 5.8% of mothers who had the shot received one dosage only. Table (22): Distribution of women who received Tetanus shots during their lifetime according to the place of residence Details Urban Rural Total Number % Number % Number % Did not receive the shot 856 69 160 64.5 10106 68.2 One shot at least 385 31.0 88 35.5 473 31.8 Two shots at least 299 24.1 71 28.6 370 24.8 Three shots at least 152 12.2 34 13.7 186 12.5 Four shots at least 85 6.8 17 6.9 102 6.9 Five Shots at least 47 3.8 10 4.0 57 3.8 Total 1241 248 1489 Table (22) shows that 31.8% of mothers receive at least one shot against tetanus during their lifetime, while 25% receive two shots and the percentages do not differ significantly between urban and rural areas. 5. Fertility The MICS results showed that the average number of live births born to women in the age category (15 – 49) was 5.2; 5.1 in urban areas and 5.8 in rural ones. On the other hand, results show that the infant mortality rate was 5%, and it is higher among males 5.3% than among females (4.7%). Table (23): Relationship between themother’s education and fertility level expressed through the average live births for women whose ages range between (15 – 49) Educational Level Average births Urban% Rural% Total% Illiterate 7.6 7.9 7.7 Can read 5.7 6.2 5.8 Elementary 5.7 6.0 5.8 Secondary 4.8 5.2 4.8 High School 3.9 4.1 4.0 University & above 3.1 2.6 3.1 Irregular curricuka 3.8 6.0 4.1 N.A./ Does not know 6.2 - 6.2 Total 5.1 5.8 5.2 The table shows that the average number of births is inversely proportionate with the mother’s educational level. The percentage among illiterate women is %7.7, while it is 3.1% among women who completed their higher education. In urban areas the percentage is 5.1% and in rural ones it 5.8%. 6. Family Planning The MICS showed that the number of married women in the sample was 7596, and the number of women still living with their husbands during the survey was 7433. The number of women who were not pregnant was 6367. As for family planning, the number of women who used some kind of contraceptive was 3381 (53.7%), this percentage was higher in urban areas (54.3%) in comparison to rural areas (46.0%). Table (24) shows the distribution of married women (ages 15 – 49) who use contraceptives and that depending on the safe period is the most popular form of contraception (%31.4), followed by contraceptive pill (25.7%), and then the loop (23%). Table (24): Percentage of married women (15 – 49) who use contraceptives and place of residency Contraception Urban% Rural% Total% Safe period 31.9 29.1 31.6 Contraception pills 25.8 24.8 25.7 Loop 23.2 20.6 22.9 Prolonged breastfeeding 8.7 16.5 9.7 Withdrawal 3.9 2.3 3.7 Male condom 3.4 1.6 3.2 Female condom 1.5 1.4 1.5 Other 4.6 4.0 4.6 Number of women 2954 427 3381 7. AIDS The data gathered during the survey on women whose ages range between 15 – 49 (21685) show that 96.1% heard of HIV/ AIDS. Table (25) displays that distribution of respondents opinions on a number of inidicators that show the level of their knowledge about this disease and how to avoid it. Figure (8): Distribution of married women (15 – 49) according to type of contraceptive Safe period Pills Loop Prolonged breastfeedi ng Withdrawal M. Condom F. Condom Other Table (25): Distribution of females’ opinion (15 – 49) on AIDS Respondent’s opinion in Yes% No% Don’t Know Total% 1. Can a person avoid infection with AIDS 87.7 6.9 5.4 100 2. Can people protect themselves from AIDS through limiting sexual activity with one partner, who is not infected and who does not practice sexual activities with any other partners 73.7 16.6 9.7 100 3. Can a person become infected with AIDS through unnatural means 29.7 38.0 32.3 100 4. Can people protect themselves from AIDs by using male condoms 29.7 38.0 32.3 100 5. Is AIDS transferred through mosquito bites 43.1 41.8 14.9 100 6. Can people protect themselves from AIDS through abstinence 27.4 59.6 12.9 100 7. Can people who are infected with AIDS look healthy 45.7 43.1 11.3 100 8. Can HIV be transferred from moth to child 77.2 15.1 7.7 100 9. Can AIDs be transferred from mother to fetus 93.7 2.2 4.1 100 10. Can Aids be transferred from mother to child during labor 85.1 6.6 8.3 100 11. Can AIDS be transferred from mother to child through breastfeeding 77.4 15.2 7.5 100 12. Can a teacher infected with AIDS and does not show any symptoms continue teaching 21.1 75.9 3.0 100 13. Will you buy food from a person if you know he/ she has AIDS 9.8 89.0 1.2 100 14. Did you test yourself to check if you were HIV positive 20.1 79.9 - 100 15. Were you informed of the test results 97.1 2.9 - 100 16. Do you know where you can get tested 62.6 37.4 - 100 Table (26) displays the distrubtion of respondents who answered yes according to their place of residence (rural/ urban). Table (26) Distribution of respondents who answered yes in the table above according to their place of residence (yes/ no) Respondent’s opinion in Urban Rural Total 1. Can a person avoid infection with AIDS 88.8 81.3 87.7 2. Can people protect themselves from AIDS through limiting sexual activity with one partner, who is not infected and who does not practice sexual activities with any other partners 74.0 71.5 73.7 3. Can a person become infected with AIDS through unnatural means 66.4 68.2 66.6 4. Can people protect themselves from AIDs by using male condoms 29.6 30.5 29.7 5. Is AIDS transferred through mosquito bites 43.5 41.8 43.2 6. Can people protect themselves from AIDS through abstinence 27.4 27.9 27.4 7. Can people who are infected with AIDS look healthy 46.6 40.1 45.7 8. Can HIV be transferred from moth to child 77.1 77.9 77.2 9. Can AIDs be transferred from mother to fetus 93.8 92.7 93.7 10. Can Aids be transferred from mother to child during labor 85.9 80.5 85.1 11. Can AIDS be transferred from mother to child through breastfeeding 77.6 76.0 77.4 12. Can a teacher infected with AIDS and does not show any symptoms continue teaching 22.0 16.1 21.1 13. Will you buy food from a person if you know he/ she has AIDS 10.2 7.9 9.8 14. Did you test yourself to check if you were HIV positive 21.6 11.6 20.1 15. Were you informed of the test results 97.1 97.7 97.1 16. Do you know where you can get tested 63.0 60.0 62.6 The table shows that 97.1% of respondents who were tested to find out if they were HIV positive were informed of the result, 93.7% know that Aids can be transferred from mother to fetus, 87.7% believe that they can avoid infection, while 77.2% know that AIDS can be transferred from mother to child. Also only 9.8% of respondents were willing to buy food from someone who has AIDS and 21% are willing to allow an infected teacher to continue teaching. 8. Maternal mortality Maternal mortality is identified as the number of deaths among women that results from pregnancy, labor or postpartum causes during a year compared to the number of live births during the same year. To find out this percentage it is necessary to identify the number of all deceased women according to their age and cause of death. Since it was not possible to obtain this type of information the MICS gathered information on maternal mortality indirectly through questions addressed to females between 15 – 49 years of age. The respondents included married and unmarried women and they were asked about their sisters who are married or who were married, and the ones who died during pregnancy, labor or post partum. The number of respondents was 23552 (all females and their ages ranged between 15 – 49), and the number of their married and unmarried sisters was 31921, while the number of diceased women among these (for maternal reasons) was 36. Results revealed that the rate of maternal mortality was 51 deaths for every 100,000 live birth during the past 12 years that preceded the survey. 60 cases in rural areas and 17 in urban areas for every 100,000 live birth. Children’s Characteristcs 1. Birth Registration and Early Education The survey focused on birth registration and childhood education for children who are less than 5 years old (7232 children in the sample). Table (28) displays the age distribution for this category. Table (28): Distribution of under five children according to age and gender Age Males% Females% Total% Less than one year (0) 18.3 17.5 17.9 One year (1) 20.3 18.9 19.6 Two years (2) 19.5 21.1 20.3 Three years (3) 23.1 22.8 23.0 Four years (4) 18.8 19.6 19.2 Total Percentage 100 100 100 Number 3608 3624 7232 The survey also revealed that the percentage of under five children who have birth certificates is 98.4%; 98.5% in urban areas and 97.8% in rural areas. The percentage of children registered at birth in civil authorities was 99.5%. As for childhood education, the survey revealed that the percentage of children whose ages range between 3 and 5 and who are enrolled in various educational programs (in mosques and kindergartens) is 5.6%, while the average time a child spends in an educational institution was 9.4 hours during the week that preceded the survey. 2. Breastfeeding The first right a child enjoys at birth is the right to receive good nutrition , the survey showed that breastfeeding is widely practiced in Libya (92.4%), and that there is no substantial difference between urban and rural areas; 92.6% in urban areas and 91.2% in rural areas. The percentage of under- two children who are still breastfeeding was 53.5%; 56.4% in rural areas and 53% in urban areas. Table (29) shows the type of liquids and soft solids children under two have in addition to mother’s milk. Table (29): Distribution of under – two children according to the type of liquids, supplementary foods and place of residence Type of Supplementary food Urban% Rural% Total% Supplementary vitamins and minerals or medicine 13.0 16.7 13.7 Regular water 64.3 70.1 65.3 Sweetened or flavored water, fruit juice 43.5 38.9 42.7 Oral rehydration solution 6.5 5.0 6.2 Formula 61.6 55.7 60.6 Other liquids 23.8 20.8 23.3 Solids or semi solids 38.1 28.1 36.3 3. Childhood Illnesses The MISC surveyed the most common illnesses that affect children, data on illnessess during the two weeks that preceded the survey were gathered. a. Diarrhoea Diarrhoea is one of the most dangerous illnesses children can suffer from at an early age, especially that it causes dehidration and other complications that threatens a child’s life. For mothers and caretakers diarrhoea is identified as passing stool three times or more daily, and when the stool is runny or blood appears in it. The survey revealed that the percentage of children who suffered from diarrhoea in the two weeks that preceded the survey was 14.3%, and there is no substantial Figure (9): Distribution of under two children according to nutritional supplements and place of residence Vitamins & minerals water Flavoured water ORS Formula milk Other Solids/ semi solids  Urban% Rural% Total% difference between rural and urban areas; 13.9% and 14.4% consecutively. Note that the survey was conducted during summer. The percentage of other illnesses such as cough and fever during the two weeks that preceded the survey was 12.4%, and there is no substantial difference between rural and urban areas. Table (30) shows the distribution of liquids given to children during their last infection with Diarrhoea. Table (30): Distribution of liquids given to children suffering from Diarrhoea and place of residence Type of fluid Urban% Rural% Total% 1. Mother’s milk 27.4 34.4 28.6 2. Soup 28.3 29.2 28.5 3. Other homemade fluids 54.9 53.2 54.6 4. Rehydration solution 35.4 33.8 35.1 5. Formula milk 49.5 53.9 50.2 6. Water with salt 54.4 63.6 55.9 7. Water 66.0 69.5 66.5 8. Fizzy drinks 25.1 16.9 23.7 9. Child given no liquids 2.0 0.0 1.7 As a result of contacting a disease, a child’s appetite may be affected, the table below shows how this appetite changed: Table (31): Changes in eating habits among children who contacted diahrrea during the two weeks that Preceded the MICS and according to place of residence Details Urban% Rural% Total% Drank much less than he/ she usually does 18.4 13.3 17.6 Drank almost the same amount 41.9 37.6 41.2 Drank more than the usual amount 38.4 48.0 40.0 Did not eat anything 9.9 15.4 10.8 Ate much less than usual 22.3 18.2 21.6 Ate the same amount 29.1 32.3 29.6 Ate more than the usual amount 1.5 0.0 1.2 b. Other Illnesses The survey revealed that the percentage of under five children who contacted illnesses accompanied with a cough during the two weeks that preceded the survey was 30.6%, and there is no substantial difference between urban and rural areas. Also the percentage of children who suffered from rapid breathing or difficulty in breathing was 50%; 55.6% in rural areas and 48.7% in urban areas. The table below illustrates the reasons: Table (32): Distribution of under-five children who suffered from coughing and difficulty breathing Symptoms Urban% Rural% Total% Blocked nose 52.1 72.0 55.9 Problems in the chest 32.9 18.0 30.0 Both reasons above 4.7 2.0 4.2 Other 5.6 4.0 5.3 Don’t know 4.7 4.0 4.6 Total 100 100 100 The survey showed that 83.8% of children who suffered from symptoms resulting from problems in the chest solicited medical help or treatment; 91% in rural areas and 83% in urban areas. The next table shows the entities in which children received help. Table (33): Distribution of children suffering from symptoms resulting from chest problems according to place of residence Entity Urban% Rural% Total% Hospital 65.7 60.0 65.1 Medical center 8.2 0.0 7.2 Clinic 11.0 20.0 12.1 Health worker in the local community 1.4 0.0 1.2 Maternal and childhood clinic 7.0 0.0 6.2 Private clinic 16.4 20.0 16.9 Traditional medicine 1.4 0.0 1.2 Pharmacy 1.4 0.0 1.2 Relative or friend 4.1 0,0 3.6 The survey also revealed that the percentage of children who suffered from sever conditions, and who had to be taken to the medical center varied according to their status and it reached 89.3% in cases of fever. Table (34): Distribution of mothers and caretakers opinions on symptoms that require taking the child to the medical center immidiatley. Symptoms Urban% Rural% Total% 1. The child can not drink or breastfeed 27.9 27.5 27.9 2. The child’s health is detriorating 48.1 42.8 47.3 3. The child has a fever 89.5 88.2 89.3 4. Child is breathing rapidly 47.9 49.6 48.1 5. Child has difficulty breathing 47.9 49.6 48.1 6. There is blood in the child’s stool 41.0 38.7 40.6 7. The child is drinking very little liquids 19.2 20.1 19.4 4. Immunizations The survey showed that 79.7% of surveyed children (12 – 23 months old) had Immunization cards that were shown to the interviewer, while 20.3% children had Immunization cards but did not show them. The percentage was the same in both rural and urban areas. Table (35): Percentage of Immunization covering for children (12 – 23 months) according to gender and place of residence Details T.B Polio DTP Measles Hepatitis Males 90.6 85.0 80.9 84.8 73.5 Females 91.5 85.0 80.6 85.1 72.0 Urban 91.4 85.4 81.1 85.9 73.3 Rural 89.2 82.8 77.6 88.8 85.0 Total 91.0 85.0 80.7 85.0 72.8 Figure (10) shows the percentage of coverage among children (12 – 23) months in urban and rural areas 5. Anthropometry The MICS aims to identify the nutritional status of under – five Libyan children through taking physical measures. The weight and height of children in the sample were taken, and they were compared to the measures in the reference population identified by WHO. Listed below are the most important indicators for the nutritional status of under – five children in Libya. 1. Stunting The survey showed that the percentage of under – five children who were stunt (their height is less than the average for their age) was 12.1%; 16.9% in rural areas and 11.2% in urban areas. The percentage of this condition was 13.0% among males and 11.2% among females, figure (11). Figure (10): Distribution of vaccination coverage (12 – 13) month in urban & rural areas TB Polio DTeP Measles Hepatitis  Urban  Rural  Total 2. Underweight (Weight average in proportion with age) The survey showed that the percentage of under – five children suffering from underweight in Libya was 5.3%, and that this condition is more common among children in rural areas 8.0%, in comparison to 4.8% in urban areas, and that there is no significant difference between males and females, figure (12). 3. Underweight (Weight average in proportion with age) Figure (13) shows that children suffering from underweight according to height was 3.6% and that there is no significant difference between males and females. The percentage was 3.6% in urban areas and 4.1% in rural areas. Figure (11): Percentage of under five children who suffer from stunting and place of residence % Females males Rural Urban Total % Females males Rural Urban Total Figure (12): Percentage of underweight children (under five) according to age, gender and place of residence Table (36) shows the percentage of under – five children who suffer from sever under growth. Table (36): Percentage of children who suffer from severe malnutrition according to gender and place of residence Details Place of residence Gender Total Urban Rural Male Female Stunting 3.7 6.2 4.6 3.6 4.1 Underweight according to age 0.8 0.9 0.7 0.9 0.8 Underweight according to height 0.8 1.0 0.9 0.7 0.8 6. Child Labor Recruiting children between (5 – 14) contradicts with children’s rights and international conventions and legislations. Child labor in Libya is almost non – existent, the thing which was confirmed by the survey. During the two weeks that preceded the survey it was found that out of 19347 children (5 – 14) only 13 were working in return for a wage (outside the family). The survey also revealed that 9 children out of 19263 worked for a wage during the last year. 7. Handicapped children The survey gathered data on handicapped children (2 – 9 years old), and it included a number of variables. Table (37) shows the percentage of handicapped children (2 - 9) in urban and rural areas. % Figure (13): Percentage of underweight (thin) children (under five) according to age, gender and place of residence Females Males Rural Urban Total Females Total Table (37): Distribution of indicators for handicapped children (2 – 9) according to place of residence Type of handicap Urban% Rural% Total% Delay in sitting, standing or walking 2.9 2.8 2.9 Difficulty seeing during day or night 2.0 1.5 1.9 Difficulty in hearing 1.3 1.0 1.2 Difficulty in understanding 4.8 3.8 4.7 Difficulty in walking 2.2 1.9 2.2 Suffers from seizures and loses consciousness 1.7 1.2 1.6 Learning difficulties 2.7 2.4 2.7 Difficulty in expressing themselves 4.4 3.7 4.3 Difficulty in naming things (2 years) 19.0 17.7 18.8 Mental retardation 2.5 2.8 2.6 8. Infant and under – five Mortality Rates The survey used an indirect way to assess infant mortality rates among under – five children, since the questionnaire did not include questions on the date of death. It is worth noting that indirect estimations are usually higher than direct ones. A general form from the UN demographic forms was used for this purpose. Table (38) shows infant mortality rates and under – five mortality rates. Table (38): Infant and under – five mortality rates according to gender and place of residence Rates (thousands) Gender Place of residence Total Male Female Urban Rural Infant mortality rates 24 24 25 28 25 Children mortality rates (1- 4) years 5 5 5 7 6 Under – five mortality rates 29 29 30 35 31 The table above shows that there are no significant differences between the two sexes, and that the rates are higher in rural areas especially among children between 1-4 although the difference is not substantial. Estimations suggest that mortality rates are dropping, although this drop is slowing down with time. MICS Summary, the survey was conducted between 7 July and 31 August 2003 Details Urban Rural Total 1. Some basic numbers: number of households included in the sample 10200 1700 11900 Number of households interviewed 9509 1633 11142 Number of interviewed household members 71114 13337 84451 Number of interviewed females (15 – 49) 18265 3420 21685 Number of interviewed married women or who have been married 6962 1177 8139 Number of women who gave birth to a live child in the previous year 1241 248 1489 Interviewed under – five children 6056 1176 7232 2. Percentage of coverage: % % % Percentage of interviewed households 93.3 96.1 93.6 Percentage of interviewed women (15 – 49) 91.7 94.3 92.0 Percentage of Interviewed under – five children 97.8 97.7 97.8 3. Dwelling conditions: Percentage of households that use the water network 50.6 43.5 49.5 Percentage of households that use toilets connected to a sewage network 79.7 58.1 76.5 4. Characteristics of eligible women Percentage of married women 34.9 32.5 34.6 Percentage of illiteracy between married women 18.8 28.1 20.2 5. Maternal Health Percentage of pregnant women at the time of the survey 12.7 13.6 12.8 Percentage of pregnant women who completed their term 93.5 89.9 92.9 6. Fertility Average fertility 5.1 5.8 5.2 7. Use of contraceptives Safe period 31.9 29.1 31.6 Contraceptive pills 25.8 24.8 25.7 Loop 23.2 20.6 22.9 8. Children diseases (2 weeks preceding the survey): Diarrhoea 14.4 13.9 14.3 Cough 30.4 31.7 30.6 Cough with difficulty breathing 48.8 55.6 50.0 9. Immunizations (12 – 23 months) TB 91.4 89.2 91.0 Polio 85.4 82.8 85.0 DTP 81.4 77.6 80.7 Measles 82.9 88.8 85.0 Hepatitis 73.3 70.4 72.8 10. Percentage of stunt children 11.2 16.9 12.1 11. Percentage of underweight children (according to age 4.8 8.0 5.3 12. Underweight children 3.6 4.1 3.6 13. Infant mortality rates 25 28 25

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