Malawi Multiple Indicator Cluster Survey 2006: Preliminary Report

Publication date: 2007

Monitoring the Situation of Children and Women Malawi Multiple Indicator Cluster Survey 2006 PRELIMINARY REPORT National Statistical Office Zomba, Malawi United Nations Children’s Fund Lilongwe, Malawi ii iii MALAWI MULTIPLE INDICATOR CLUSTER SURVEY (MICS) 2006 PRELIMINARY REPORT National Statistical Office Zomba, Malawi United Nations Children’s Fund Lilongwe, Malawi February 2007 iv This report summarizes the findings of the 2006 Multiple Indicator Cluster Survey (MICS) carried out by the National Statistical Office (NSO) in collaboration with the United Nations Children’s Fund (UNICEF). The survey aims at providing statistically valid estimates at district level on a number of indicators related to the wellbeing of children and women in Malawi. For more information please write to: Demography & Social Statistics Division (DSS) National Statistical Office (NSO) P.O. Box 333, Zomba, Malawi Ph: 265-1-524 377, 265-1-524 111 Fax: 265-1-525 130 e-mail: enquiries@statistics.gov.mw website: www.nso.malawi.net M&E Unit, UNICEF P.O. Box 30375, Lilongwe 3, Malawi Ph: 265-1-770 788, 265-1-770 770 Fax: 265-1-773 162 e-mail: lilongwe@unicef.org For full set of resources on the Multiple Indicator Cluster Survey (MICS) visit UNICEF’s global website : www.childinfo.org February 2007 Acknowledgements: Technical and financial support for MICS activity was provided by UNICEF. NSO would also like to acknowledge the financial contribution from the Save the Children Fund (SCF). v CONTENTS FOREWORD. vii SUMMARY TABLE OF FINDINGS. viii BACKGROUND.1 INTRODUCTION .1 SURVEY OBJECTIVES .2 SAMPLING AND SURVEY METHODOLOGY.4 SAMPLE SIZE.4 SAMPLE DESIGN .4 QUESTIONNAIRES.4 FIELDWORK AND DATA PROCESSING .5 SAMPLE COVERAGE .6 PRELIMINARY RESULTS .7 BACKGROUND CHARACTERISTICS .7 FERTILITY .8 CHILD MORTALITY .9 NUTRITION .11 CHILD HEALTH .14 ENVIRONMENT.19 REPRODUCTIVE HEALTH .20 EDUCATION .23 CHILD PROTECTION .25 HIV/AIDS & ORPHANHOOD.27 ANNEXES .33 ANNEX 1 : EARLY CHILDHOOD MORTALITY RATES .33 ANNEX 2 : NUTRITIONAL STATUS.34 ANNEX 3 : BEDNETS COVERAGE.35 ANNEX 4 : USE OF IMPROVED WATER SOURCES.36 ANNEX 5 : PRIMARY SCHOOL NET ATTENDANCE RATIO .37 ANNEX 6 : COMPREHENSIVE KNOWLEDGE ABOUT HIV PREVENTION.38 ANNEX 7 : MDG INDICATORS .39 ANNEX 8 : INDICATORS DEFINITIONS .42 vi vii FOREWORD The 2006 Multiple Indicator Cluster Survey (MICS) is the largest , nationally representantive sample survey conducted by National Statistical Office. It covered a total of 31,200 households (1,200 households per district) . The survey’s main objective was to obtain statistically valid estimates at district level on a number of social development indicators related to Malawi Growth and Development Strategy (MGDS), the Millennium Development Goals (MDGs) and the goals of A World Fit for Children (WFFC). Information on more than 20 of the 48 MDG indicators has been collected in MICS, offering the largest single source of data for MDG monitoring. This report is a preliminary report of the 2006 MICS results, highlighting its findings. The report is intended to provide policy makers and programme managers with a first glimpse of the survey results. A more comprehensive and detailed report is scheduled later in the year. Figures in the final report are not expected to differ substantially from those in this report; however, the results presented here should be regarded as provisional and subject to modification. I wish to acknowledge the efforts of a number of organisations and individuals who contributed immensely towards the success of the survey. First I would like to acknowledge the technical and financial assistance from the United Nations Children’s Fund (UNICEF). Acknowledgements are also due to the Save the Children Fund for funding the survey. Finally, the hard work and dedication of the staff of the National Statistical Office (NSO) and the staff of the UNICEF for making the survey results available in time. Finally, I am grateful to the survey respondents who generously gave their time to provide the information that forms the basis of this and later reports. Charles Machinjili Commissioner of Statistics viii SUMMARY TABLE OF FINDINGS - MALAWI 2006 Topic Indicator Value Unit Total fertility rate 6.3 Per woman Fertility Crude birth rate 43.6 Per 1,000 population Neonatal mortality rate 31 Per 1,000 live births Infant mortality rate 69 Per 1,000 live births Child mortality Under-five mortality rate 118 Per 1,000 live births Stunting prevalence 45.9 Per cent Wasting prevalence 3.3 Per cent Underweight prevalence 19.4 Per cent Exclusive breastfeeding rate 0-3 months 71.0 Per cent Exclusive breastfeeding rate 0-5 months 56.4 Per cent Timely complementary feeding rate 89.0 Per cent Continued breastfeeding rate (12-15 months) 97.4 Per cent Nutrition Continued breastfeeding rate (20-23 months) 73.4 Per cent Tuberculosis immunization coverage 95.5 Per cent DPT 3 immunization coverage 86.2 Per cent Polio 3 immunization coverage 81.3 Per cent Measles immunization coverage 85.2 Per cent Fully immunization coverage 71.4 Per cent Antibiotic treatment of suspected pneumonia 29.2 Per cent Solid fuel use 98.8 Per cent HHs with at least one bednet 49.5 Per cent HHs with at least one insecticide-treated net (ITN) 35.0 Per cent Under-fives sleeping under bednets 29.0 Per cent Child health Under-fives sleeping under insecticide-treated nets (ITN) 23.0 Per cent Use of improved drinking water sources 74.2 Per cent Environment Use of improved sanitation facilities 88.2 Per cent Contraceptive prevalence 41.7 Per cent Antenatal care 91.8 Per cent TT injection 84.4 Per cent Iron supplementation 80.2 Per cent Skilled attendant at delivery 53.6 Per cent Reproductive health Institutional deliveries 53.8 Per cent Net primary school attendance rate 81.5 Per cent Education Gender Parity Index 1.04 Child labour 28.8 Per cent Marriage before age 15 and age 18 10.6/50.2 Per cent Child protection Young women 15-19 currently married or in union 32.1 Per cent Comprehensive knowledge about HIV prevention (15-24 women/men) 41.6/40.7 Per cent Condom use at last high-risk sex (15-24 women/men) 39.6/59.6 Per cent Children not living with a biological parent 17.4 Per cent Prevalence of orphans 12.6 Per cent HIV/AIDS & orphanhood School attendance of orphans versus non-orphans 0.97 1 BACKGROUND INTRODUCTION This preliminary report is based on the Multiple Indicator Cluster Survey (MICS), conducted in Malawi in 2006 by the National Statistical Office (NSO). The survey was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see Table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity- building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and sub-national levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” The Government of Malawi (GoM) has been developing and implementing long and medium term strategies that translate the national and internal goals and objectives into a reality. In 2000, GoM launched the Malawi Vision 2020. This policy framework sets out a long-term development perspective for Malawi. In May 2002, the Government launched a 3- year Malawi Poverty Reduction Strategy (MPRS) which presented a first attempt to translate 2 long-term strategy of Malawi Vision 2020 into medium term focused action plans. The MPRS was built around four cross cutting issues: HIV/AIDS, gender, environment and science & technology besides the main goal of achieving sustainable poverty reduction through empowerment of the poor. The lessons learnt in the implementation of MPRS have resulted in the development of much more comprehensive policy namely the Malawi Growth and Development Strategy (MGDS) which aims at stimulating the economic growth. Malawi remains committed to achieving the Millennium Development Goals (MDGs) localized to the Malawian context. The MDGs and the commitments made to the other international conventions are addressed in the MGDS with the targets and strategies. Some of key international conventions for which Malawi is signatory are – World Fit For Children, UNGASS on HIV/AIDS, Abuja targets on malaria, Convention on the Rights of the Children (CRC) and Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). A number of national policies and action plans have been prepared and being implemented to meet the goals set by the international community. MICS would serve as one of the main monitoring tools by providing the necessary data at national, regional and district levels. The information gathered in MICS would serve as a baseline for the new initiatives and assess the success of the ongoing programmes. MICS also strengthens the M&E component of the new UNDAF 2008-2011 by providing the latest data on a number of key indicators related to GoM-UN programme of cooperation. This preliminary report presents selected results on some of the principal topics covered in the survey and on a subset of indicators1. The results in this report are preliminary and are subject to change, although major changes are not expected. A comprehensive full report is scheduled for publication in April 2007. Since MICS is aiming at providing the statistically significant results at the district level for the effective monitoring of development programmes in the district, it is envisaged to publish and disseminate separate district level reports for all the districts of the country. This exercise is planned to start from June 2007. SURVEY OBJECTIVES Despite having a number of data sources, one of the challenges being faced by the policy makers and programme managers in Malawi is non availability of sub-national data. Many national and international agencies are interested in identifying districts with poor socio- economic status for intensive interventions but the present data sources are unable to meet this demand. They either provide district level data for a selected number of districts (MDHS) or calculated the district estimates based on a small sample sizes (IHS). In light of the decentralization of the governance and initiation of Malawi Growth and Development Strategy (MGDS), statistically significant district level estimates are warranted for a number of socio-economic indicators for planning the sub-national interventions by the District Assemblies and to provide baseline to measure the progress of these interventions over time. A number of new intervention programmes have been implemented by the Government of Malawi in the recent past which will have an impact on indicators which are expected to change over a short period of time. These include immunization coverage, malaria 1 For more information on the definitions, numerators, denominators and algorithms of Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) indicators covered in the survey: see Chapter 1, Appendix 1 and Appendix 7 of the MICS Manual – Multiple Indicator Cluster Survey Manual 2005: Monitoring the Situation of Children and Women, also available at www.childinfo.org. 3 prevention methods, access to water and sanitation and knowledge on HIV/AIDS. Latest data on these indicators will help programme managers for better planning and monitoring of the development activities. The primary objectives of 2006 Multiple Indicator Cluster Survey are: • To provide up-to-date information at the district level for assessing the situation of children and women in Malawi; • To support the monitoring of Malawi Growth and Development Strategy (MGDS) indicators; • To furnish data needed for monitoring progress toward goals established by the Millennium Development Goals (MDGs), the goals of World Fit for Children (WFFC) and other internationally agreed upon goals, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Malawi and to strengthen technical expertise in the design, implementation, and analysis of such systems. ________________ 4 SAMPLING AND SURVEY METHODOLOGY SAMPLE SIZE Since the objective of the MICS is to obtain estimates at the district level on key indicators related to the wellbeing of children and women, the district is taken as the universe. It is estimated that a sample of size of 1,200 households (HHs) is required per district to obtain statistically valid estimates at 95 per cent confidence interval for the majority of indicators. Presently there are 28 districts in Malawi. However, two districts namely Likoma and Neno are too small to draw 1,200 HHs out of the total available HHs. Therefore Likoma has been merged with Nkhata Bay and Neno with Mwanza while drawing the sample. As a result, MICS has been conducted in 26 districts and results have been presented for 26 districts only. Weighted estimates for the three regions and Malawi as a whole have been obtained based on the data from the 26 districts. SAMPLE DESIGN A two-stage sampling methodology was adopted in MICS to select the 1,200 HHs. Within each district, 40 census enumeration areas (clusters) were selected with probability proportional to size. A household listing was carried out within each cluster and a systematic sample of 30 households was drawn. For reporting results at the regional and national levels, samples were weighted to reflect population size. A total of 31,200 HHs (26 districts X 1,200 HHs) were selected in 1,040 clusters (26 districts X 40 clusters) under MICS. All the selected 1,040 clusters have been covered during the fieldwork period. MICS is thus one of the largest household surveys undertaken in Malawi. QUESTIONNAIRES Four questionnaires were used in the survey namely household, children under five, women 15-49 and men 15-49. These questionnaires included the following modules: The Household Questionnaire was administered to the head of the household or any person who was able to provide the information. It was used to identify all eligible persons for the specific form included. The modules are: o Household Listing o Education o Water and Sanitation o Household Characteristics o Insecticide Treated Nets o Orphan-hood o Child Labour o Salt Iodization The Children under Five Questionnaire was administered to mothers or caretakers of children under 5 years of age2 living in the households. Normally, the questionnaire was administered to mothers; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: 2 The terms “children under 5”, “children age 0-4 years”, and “children aged 0-59 months” are used interchangeably in this report. 5 o Vitamin A o Breastfeeding o Care of Illness o Malaria o Immunization o Anthropometry The Individual Women Questionnaire was administered to all women aged 15-49 years living in the households, and included the following modules: o Child Mortality o Birth History o Tetanus Toxoid o Maternal and Newborn Health o Marriage/Union o Contraception o Sexual Behaviour o HIV/AIDS o Maternal Mortality The Individual Men Questionnaire was administered to men aged 15-49 years in every third household selected for the survey and included the following modules: o Marriage/Union o Contraception o Sexual Behaviour o HIV/AIDS The questionnaires are based on the global MICS model questionnaire. Under this survey, the global questionnaires were customized for Malawi needs, translated into Chichewa and Tumbuka and were pre-tested during the month of June 2006 in Chichewa and Tumbuka speaking areas and both urban and rural settings. Based on the results of the pre-test, modifications were made to the wording and translation of the questionnaires. FIELDWORK AND DATA PROCESSING The field staff was trained for 15 working days (3 weeks) during June/July 2006. The data were collected by 26 district level teams; each team comprised: four interviewers, one editor/measurer, one supervisor and a driver. Fieldwork took 4 months from mid-July to mid-November 2006. The fieldwork included house structure listing operation, household sample selection, interviewing the respondents and taking anthropometry measurements of children. Data were entered on 20 microcomputers using the CSPro software. Forty data entry clerks were engaged into data entry exercise. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed. Procedures and standard programs developed under the global MICS project and adapted to the Malawi questionnaire were used throughout. Data processing began in August 2006, simultaneously with the fieldwork, and finished by end of December 2006. Data were analysed with SPSS software using the model syntax and tabulation plans developed for this purpose. 6 SAMPLE COVERAGE Results of household and individual interviews Number of households, children under 5, women and men by results of the household, under-five's, women’s and men’s interviews and the response rates by residence and region, Malawi 2006. Residence Region Result Urban Rural North Central South Total Number of households Sampled 3,489 27,711 6,000 10,800 14,400 31,200 Occupied 3,489 27,711 6,000 10,800 14,400 31,200 Interviewed 3,409 27,144 5,871 10,551 14,131 30,553 Response rate 97.7 98.0 97.9 97.7 98.1 97.9 Number of children under 5 Eligible 2,367 20,871 4,622 8,536 10,080 23,238 Mother/Caretaker Interviewed 2,347 20,647 4,572 8,405 10,017 22,994 Response rate 99.2 98.9 98.9 98.5 99.4 98.9 Number of women Eligible 3,620 23,453 5,430 9,766 11,877 27,073 Interviewed 3,526 22,733 5,301 9,368 11,590 26,259 Response rate 97.4 96.9 97.6 95.9 97.6 97.0 Number of men Eligible 1,272 7,284 1,748 3,177 3,631 8,556 Interviewed 1,153 6,483 1,599 2,744 3,293 7,636 Response rate 90.6 89.0 91.5 86.4 90.7 89.2 Of the 31,200 households selected for the sample, all of them were found to be occupied. This is due the fact that the house listing operation and the canvassing of households have taken place at the same time. Of these, 30,553 were successfully interviewed for a household response rate of 97.9 per cent. For child questionnaire, 23,238 children under age five were listed in the household questionnaire. Of these, questionnaires were completed for 22,994 which correspond to a response rate of 98.9 per cent. In the interviewed households, 27,073 women (age 15-49) were identified. Of these, 26,259 were successfully interviewed, yielding a response rate of 97.0 per cent. In addition, 8,556 men (age 15-49) have been identified in every third household and 7,636 of them have been interviewed which gives a response rate of 89.2 per cent. ________________ 7 PRELIMINARY RESULTS BACKGROUND CHARACTERISTICS Table 1 show the per cent distribution (to determine appropriate weighting) and numbers of women age 15-49 and men age 15-49 interviewed in the MICS 2006 (unweighted) and their weighted numbers by background characteristics. Table 1 : Background characteristics of respondents: Per cent distribution of women and men by background characteristics, Malawi 2006 Women Men Background characteristic Weighted per cent Number weighted Number un- weighted Weighted per cent Number weighted Number un- weighted Region Northern 10.9 2,857 5,301 11.4 869 1,599 Central 44.5 11,685 9,368 46.0 3,512 2,744 Southern 44.6 11,716 11,590 42.6 3,255 3,293 Residence Urban 13.8 3,629 3,526 15.0 1,144 1,153 Rural 86.2 22,630 22,733 85.0 6,492 6,483 Age 15-19 19.8 5,196 5,226 20.7 1,583 1,622 20-24 24.0 6,315 6,285 19.4 1,482 1,514 25-29 19.0 4,996 4,893 18.1 1,379 1,376 30-34 14.1 3,712 3,738 15.2 1,163 1,136 35-39 9.6 2,527 2,540 10.8 827 815 40-44 7.5 1,962 2,009 8.6 659 642 45-49 5.9 1,550 1,568 7.1 544 531 Marital/Union status Currently married/in union 71.2 18,684 18,762 63.3 4,830 4,804 Formerly married/in union 12.6 3,317 3,321 4.0 303 272 Never married/in union 16.2 4,258 4,176 32.8 2,503 2,560 Education None 19.9 5,215 5,113 8.0 608 574 Primary 65.2 17,111 17,215 66.8 5,099 5,000 Secondary + 14.6 3,839 3,852 25.1 1,919 2,050 Non-standard curriculum 0.3 90 73 0.1 8 10 Total 100.0 26,259 26,259 100.0 7,636 7,636 Nearly 45 per cent of surveyed women were interviewed in the Central and Southern regions whereas 11 per cent in the Northern region. For men, a higher proportion was interviewed in the Central region whereas for Northern region, the distribution for men is similar to that of 8 women. Fourteen per cent of female respondents and 15 per cent of male respondents reside in urban households. As expected, higher proportion of women and men are in the younger age groups. Nearly 63 per cent of women interviewed in MICS were between ages of 15 and 29, the corresponding proportion for men is 58 per cent. Among female respondents, 71 per cent are currently married or in union and 16 per cent have never been married whereas 63 per cent men are currently married and 33 per cent (double the rate for women) in never married group. Regarding educational status, while the proportions of women and men with the primary education are similar, the proportion of women who have never attended school is 20 per cent compared to 8 per cent for men. It can also be seen that men are more likely (25 per cent) than women (15 per cent) to have reached secondary school. FERTILITY In MICS 2006, birth histories of women age 15-49 who were interviewed have been obtained to measure the currently fertility situation in Malawi. In the birth history module, each woman was asked about the number of sons and daughters living with her, the number living elsewhere and the number who have died. Also information on every child has been obtained in terms of month and year in which each child is born, the child’s name, sex, survival status and, if dead, the age at death. Table 2 : Current fertility Age-specific and cumulative fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence, Malawi 2006 Residence Age group Urban Rural Total 15-19 137 186 178 20-24 225 299 288 25-29 209 274 264 30-34 157 229 220 35-39 129 170 165 40-44 41 105 98 45-49 15 51 48 TFR 4.6 6.6 6.3 GFR 173 232 223 CBR 39.8 44.1 43.6 TFR: Total fertility rate for ages 15-49, expressed per woman. GFR: General fertility rate (births divided by the number of women age 15-44), expressed per 1,000 women. CBR: Crude birth rate, expressed per 1,000 population. Note: Rates for age group 45-49 may be slightly biased due to truncation. Table 2 provides the widely used current fertility measure namely the Total Fertility Rate (TFR) which is defined as the number of births a woman would have if she survived to age 50 and experienced the currently observed rates of age-specific fertility. In MICS, the 3-year period prior to the survey has been used to estimate the fertility. 9 The total fertility rate is estimated at 6.3 which indicate that if the fertility were to remain constant at the current levels measured in MICS, a woman in Malawi would have on an average, 6.3 children in her life time. This rate is significantly higher in rural areas (6.6) compared to urban areas (4.6). The data also shows the age specific fertility is highest (288 births per 1,000 women or nearly 29% of women have a baby each year) among women in the age group 20-24. It can also be seen that fertility in the rural areas is higher than urban fertility for every age group. CHILD MORTALITY One of the overarching goals of the MDGs and the World Fit for Children is to reduce infant and under-five mortality. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. In MICS, childhood mortality rates are estimated using information recorded in the birth history module of the Women’s Questionnaire and provides a reliable estimate of mortality for the years preceding the date of the survey. The infant mortality rate (IMR) is the probability of dying before the first birthday. The under five mortality rate (U5MR) is the probability of dying before the fifth birthday. While neonatal mortality (NN) is probability of death in the first month, post neonatal mortality (PNN) is the difference between infant mortality and neonatal mortality. Child mortality (CM) is defined as the probability of death between first and fifth birthday. Table 3 : Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Malawi 2006 Years preceding the survey Approximate calendar period Neonatal mortality (NN) Postneonatal mortality (PNN) Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) 0-4 2002-2006 31 38 69 53 118 5-9 1997-2001 40 46 86 74 154 10-14 1992-1996 34 50 84 90 166 The data from MICS show that the infant mortality rate is estimated at 69 per thousand live births, while the probability of dying under-5 mortality rate is around 118 per thousand live births. Figure 1 shows a comparison of early childhood mortality rates from MICS 2006 with MDHS 2004. One of the key purposes of MICS 2006 is to provide mortality estimates at the district level. To achieve this, each district has been assigned a sample size of 1,200 HHs so that a 10-year period (1997-2006) child mortality estimates would be available for all the districts. Annex 1 provides, for the first time in Malawi, a household survey based child mortality estimates for the 26 districts of the country. 10 This 10-year period estimates show that 50 per cent of the districts have infant mortality rates higher than the national average of 77. Three districts namely Balaka, Nsanje and Phalombe have IMR over 100. These are also the districts with U5MR above 150. Districts in the Northern region namely Chitipa, Karonga, Nkhata Bay, Rumphi have shown low levels of mortality rates compared to the other districts. This corroborates with the low mortality rates for the Northern region compared to Central and Southern regions. Figure 2 : Infant and Child (1-4) Mortality Rates by District 27 31 49 38 76 69 62 53 133 118 Neonatal Mortality Rate Postneonatal Mortality Rate Infant Mortality Rate Child (1-4) Mortality Rate Under-5 Mortality Rate Figure 1 : Early Childhood Mortality Rates MDHS 2004 MICS 2006 0 10 20 30 40 50 60 70 80 90 100 110 K ar on ga C hi tip a N kh at a B ay N kh ot ak ot a N tc hi si M ch in ji R um ph i D ow a M zi m ba Bl an ty re T hy ol o Sa lim a M ul an je M w an za C hi kw aw a D ed za M ac hi ng a K as un gu Z om ba N tc he u M an go ch i Li lo ng w e C hi ra dz ul u Ph al om be N sa nj e Ba la ka Infant Mortality Rate Child Mortality Rate 11 In Figure 2, district level estimates of infant and child (1-4) mortality arranged by low to high rates of infant mortality. A wide variation in child (1-4) mortality rates can be observed amongst districts, indicating large differences in health care of young children. NUTRITION 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. Under nourishment in a population can be gauged by comparing children to a reference distribution. The reference population used here is the WHO/CDC/NCHS reference, which is recommended for use by UNICEF and the World Health Organization (WHO). Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of this reference population. Weight for age is a measure of both acute and chronic malnutrition. Children whose weight for age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight for age is more than three standard deviations below the median are classified as severely underweight. Height for age is a measure of linear growth. Children whose height for age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height for age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. Finally, children whose weight for height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. Table 4 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. Children who were not weighed and measured (approximately 4 per cent of children) and those whose measurements are outside a plausible range are excluded. Almost two in ten children under age five in Malawi are moderately underweight (19.4%) and three per cent are classified as severely underweight (Table 4). Forty six per cent of children are stunted or too short for their age and three per cent are wasted or too thin for their height. Children in the Central region are more likely to be underweight and stunted than other children. In contrast, the percentage wasted is highest in the Northern region. Those children whose mothers have secondary or higher education are the least likely to be underweight and stunted compared to children of mothers with no education. Boys appear to be slightly more likely to be underweight, stunted, and wasted than girls. 12 Nutritional status of children under 5 by districts is given in Annex 2. While 12 districts have stunting levels higher than the national average, in 7 districts, more than half of the child population are stunted. Table 4 : Child Malnutrition Percentage of children aged 0-59 months who are severely or moderately malnourished, Malawi 2006 Height-for-age (Stunting) Weight-for-height (Wasting) Weight-for-age (Underweight) Background characteristic % below – 3 SD % below – 2 SD % below – 3 SD % below – 2 SD % below – 3 SD % below – 2 SD Number of children Sex Male 21.5 47.2 0.5 3.5 3.7 20.3 10,250 Female 19.5 44.5 0.4 3.1 3.2 18.5 10,497 Region Northern 14.6 39.7 0.8 4.4 2.7 16.7 2,294 Central 21.9 47.0 0.4 3.3 3.6 20.4 9,333 Southern 20.5 46.3 0.4 3.0 3.4 19.0 9,120 Residence Urban 14.8 36.9 0.5 3.3 2.5 16.4 2,318 Rural 21.2 47.0 0.5 3.3 3.6 19.8 18,430 Age < 6 months 2.3 11.1 0.5 3.7 0.1 1.9 1,637 6-11 months 9.6 29.2 0.3 4.5 2.9 15.7 2,349 12-23 months 25.0 55.0 0.9 5.4 5.6 26.2 4,516 24-35 months 22.0 49.9 0.4 2.8 4.2 23.3 4,839 36-47 months 24.7 51.8 0.3 1.9 2.8 18.8 4,306 48-59 months 23.3 49.2 0.3 1.7 2.2 16.1 3,100 Mother’s education None 24.4 49.7 0.5 3.3 4.7 22.8 4,706 Primary 20.4 46.4 0.4 3.4 3.3 19.6 13,759 Secondary 12.7 34.6 0.5 2.6 1.6 11.2 2,220 Non-standard curriculum 22.4 37.6 0.0 3.7 5.4 17.9 47 Wealth index quintile Lowest 23.0 50.0 0.5 3.8 4.7 22.8 4,538 Second 22.2 48.7 0.3 2.6 3.6 20.5 4,347 Middle 21.4 46.8 0.5 3.3 3.5 20.3 4,369 Fourth 19.5 44.8 0.3 3.7 2.7 17.8 3,920 Highest 15.0 37.2 0.6 2.9 2.4 14.3 3,573 Total 20.5 45.9 0.5 3.3 3.4 19.4 20,747 The age pattern shows that deterioration in nutrition status takes place within first 2 years of life according to all three indices (Figure 3). This pattern is frequently seen and is related to the factors like initiation of complimentary foods before 6 months, inadequate and poor 13 quality of complimentary foods are given and are exposed to infections through water, food and the environment. There is a consensus that the damage to physical growth, brain development, and human capital formation that occurs during this period is extensive and largely irreversible. Therefore interventions must focus on this window of opportunity in the first two years of life. Any investments after this critical period are much less likely to improve nutrition. It is notable that wealth has little effect on the prevalence of malnutrition, with even the highest quintile having significant levels. This implies the resource constraints are not the major factor, but rather education of mother, behaviours and the environment are more important causes of malnutrition. 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 reliably available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continued breastfeeding with safe, appropriate and adequate complementary feeding up to 2 years of age and beyond. In Table 5, breastfeeding status is based on the reports of mothers/caretakers of children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk and vitamins, mineral supplements, or medicine. The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12-15 and 20-23 months of age. Approximately 56 per cent of children aged less than six months are exclusively breastfed, a level considerably lower than recommended. At age 6-9 months, 89 per cent of children are receiving breast milk and solid/mushy food. By age 12-15 months, 97 per cent of children are still being breastfed and by age 20-23 months, 73 per cent are still breastfed. Though there is no significant difference between boys and girls, exclusively breastfeeding rates are higher in urban areas compared to rural areas. Notably, mothers with higher education and greater wealth were seen to exclusively breast feed more than the uneducated and poor. Figure 3 : Percentage of children aged 0-59 months who are undernourished, Malawi, 2006 0 10 20 30 40 50 60 70 0 6 12 18 24 30 36 42 48 54 60 Age (months) Pe rc en t Stunting Underweight Wasting 14 CHILD HEALTH Immunization According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 12 months. Mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the MICS questionnaire. Wherever the immunization card is available, the information is recorded from the cards. If the child did not have a card, the mother was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio, how many times. The percentage of children aged 12 to 23 months who received each of the vaccinations is shown in Table 6. Table 5 : Breastfeeding Percentage of living children according to breastfeeding status at each age group, Malawi 2006 Background characteristic Children 0-3 months excl. breastfed No. of children Children 0-5 months excl. breastfed No. of children Timely comple- mentary feeding rate* No. of children Children 12-15 months breastfed No. of children Children 20-23 months breastfed No. of children Sex Male 70.3 766 56.8 1,106 89.3 834 97.7 862 72.4 775 Female 71.8 775 56.0 1,207 88.8 851 97.2 903 74.2 810 Region Northern 62.0 156 51.6 231 84.8 166 97.4 180 76.3 185 Central 71.5 708 55.9 1,053 89.8 787 97.9 793 74.4 726 Southern 72.6 677 57.9 1,029 89.1 732 97.0 792 71.4 674 Residence Urban 80.8 194 65.4 273 88.1 206 95.1 182 63.4 170 Rural 69.6 1,348 55.2 2,041 89.1 1,480 97.7 1,582 74.6 1,416 Mother’s education None 69.0 322 56.4 482 91.4 417 94.7 363 75.3 330 Primary 69.7 1,000 54.9 1,508 88.0 1,065 98.5 1,191 72.7 1,063 Secondary 80.3 212 63.1 316 90.0 196 96.0 208 73.1 187 Non-standard curriculum 17.1 2 14.0 3 100.0 4 100.0 3 84.5 5 Wealth index quintile Lowest 63.4 351 48.1 532 90.4 374 98.0 415 83.7 312 Second 68.4 309 53.8 492 85.4 352 97.9 356 71.2 377 Middle 67.7 319 55.4 480 89.3 380 97.1 398 69.3 306 Fourth 80.0 281 65.8 398 90.7 305 97.5 342 74.3 347 Highest 78.3 282 62.2 411 89.5 275 96.2 254 67.2 243 Total 71.0 1,541 56.4 2,313 89.0 1,685 97.4 1,765 73.4 1,585 * : Infants 6-9 months receiving breast milk & solid/mushy food 15 Table 6 : Vaccinations in first year of life Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Malawi 2006 Source of information BCG DPT HepB 1 DPT HepB 2 DPT 3 HepB 3 Polio 0 Polio 1 Polio 2 Polio 3 Measles All* None No. of children aged 12-23 months Vaccinated at any time before survey Vaccination card 75.6 76.4 75.3 73.5 24.9 76.5 75.4 73.1 66.8 65.4 0.3 4,979 Mother's report 19.9 19.8 17.8 12.7 11.1 19.2 15.5 8.2 18.4 6.0 2.3 4,979 Either 95.5 96.2 93.1 86.2 36.0 95.7 90.9 81.3 85.2 71.4 2.5 4,979 Vaccinated by 12 months of age 94.5 95.3 92.5 84.6 36.0 95.2 90.3 79.8 77.3 62.0 2.6 4,979 * BCG, measles and three doses of each of DPT- Hep B and Polio vaccine (excluding Polio 0 dose) Figure 4 : Percentage of children 12-23 months who received immunizations, Malawi 2006 96 9696 93 91 85 71 86 81 0 20 40 60 80 100 120 BCG DPT Polio Measles All Pe rc en t Dose 1 Dose 2 Dose 3 The denominator for the Table 6 is comprised of children aged 12-23 months so that only children who are old enough to be fully vaccinated are counted. The numerator includes all children who were vaccinated at any time before the survey according to the vaccination card or the mother’s report. In the lower portion of Table 6, 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. Approximately 96 per cent of children aged 12-23 months received a BCG vaccination and a same per cent were given the first dose of DPT. The percentage declines for subsequent doses of DPT to 93 per cent for the second dose, and 86 per cent for the third dose (Figure 4). Similarly, 96 per cent of children received Polio 1 and this declines to 81 per cent by the third dose. The coverage for measles vaccine is 85 per cent. Overall, 71 per cent of children age 12- 23 months has received all the recommended vaccines and 2.5 per cent received none. The percentage of children who had all eight recommended vaccinations by their first birthday has increased to 62 per cent in the last two years compared to 51 per cent in MDHS 2004. 16 Antibiotic treatment of suspected pneumonia Pneumonia is one of the leading causes of death in children and the use of antibiotics in under-5s with suspected pneumonia is a key intervention. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were due to a problem in the chest and a blocked nose. This question was limited to children who had suspected pneumonia within the previous two weeks and whether or not they had received an antibiotic within the previous two weeks. Table 7 presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, region, residence, age, and socio- economic factors. In Malawi, only 29 per cent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. The percentage was considerably higher in the urban areas, compared to rural Malawi. The table also shows that while antibiotic treatment of suspected pneumonia is low among the poorest households, there is not much difference in the treatment levels between uneducated and educated mothers. The use of antibiotics is slightly higher for boys compared to girls suffering from pneumonia. Region-wise, higher proportion of children in Northern and Southern regions are likely to receive antibiotics compared to the Central region. Table 7 : Antibiotic treatment of pneumonia Percentage of children aged 0-59 months with suspected pneumonia who received antibiotic treatment , Malawi 2006 Background character Percentage of children aged 0-59 months with suspected pneumonia who received antibiotics in the last two weeks Number of children aged 0-59 months with suspected pneumonia in the two weeks prior to the survey Sex Male 31.0 876 Female 27.6 955 Region Northern 40.7 196 Central 23.2 1,004 Southern 35.2 631 Residence Urban 39.8 172 Rural 28.1 1,659 Age 0-11 months 29.5 334 12-23 months 28.7 437 24-35 months 32.8 430 36-47 months 27.3 369 48-59 months 26.4 261 Mother's education None 27.1 440 Primary 30.4 1,220 Secondary 27.1 166 Wealth index quintile Lowest 24.3 461 Second 24.5 375 Middle 34.5 368 Fourth 32.6 355 Highest 32.4 271 Total 29.2 1,831 17 Solid fuels Cooking with solid fuels (biomass and coal) leads to high levels of indoor pollution and is a major cause of ill-health in the world, particularly among under-5 children, in the form of acute respiratory illness. Table 8 shows that a very high proportion of HHs in Malawi (98.8 per cent) use solid fuels for cooking. The use is almost universal in rural areas. Only the households belonging highest wealth index quintile have shown a modest use of electricity as type of cooking fuel (6 per cent). Malaria Malaria is a leading cause of death of children under age five in Malawi. It also contributes to anaemia in children and is a common cause of school absenteeism. Preventive measures, especially the use of mosquito nets treated with insecticide (ITNs), can dramatically reduce malaria mortality and morbidity rates among children. In areas where malaria is common, international recommendations suggest treating any fever in children as if it were malaria and immediately giving the child a full course of recommended anti-malarial tablets. Children with severe malaria symptoms, such as fever or convulsions, should be taken to a health facility. Also, children recovering from malaria should be given extra liquids and food and should continue breastfeeding. Table 8 : Solid fuel use Per cent distribution of households according to type of cooking fuel and percentage of households using solid fuels for cooking, Malawi 2006 Background characteristic Electricity Wood Charcoal Other solid fuels Total Solid fuels for cooking Number of HHs Region Northern 1.2 94.7 3.7 0.3 100.0 98.7 3,243 Central 0.5 95.9 2.6 1.1 100.0 99.4 13,012 Southern 1.5 85.8 10.1 2.6 100.0 98.4 14,298 Residence Urban 7.8 48.1 43.4 0.5 100.0 91.9 3,508 Rural 0.2 96.6 1.4 1.9 100.0 99.7 27,045 Wealth index quintile Lowest 0.0 99.8 0.1 0.2 100.0 100.0 6,235 Second 0.0 99.6 0.2 0.2 100.0 100.0 6,443 Middle 0.0 99.0 0.1 0.9 100.0 99.9 6,182 Fourth 0.0 89.5 4.0 6.4 100.0 99.8 6,061 Highest 5.8 64.4 28.8 1.0 100.0 94.0 5,632 Total 1.1 91.0 6.2 1.7 100.0 98.8 30,553 18 The MICS questionnaire incorporates questions on the use of bednets, both at household level and among children under five years of age. In Malawi, the results indicate that nearly 50 per cent of households have at least one bednet and 35 per cent insecticide treated. Results indicate that 29 per cent of children under the age of five slept under any mosquito net the night prior to the survey and 23 per cent slept under an insecticide treated net (Table 9). ITN use among children under five declines steadily with age and the use are more than double in urban areas compared to rural. District level estimates on possession and use of bednets by households are given in Annex 3. By and large, districts where households own bednets, the usage rates are high. Chitipa has the lowest coverage with only one fifth of the households possessing nets and less than 5 per cent children are sleeping under a bednet. Table 9 : Children sleeping under bednets Percentage of children aged 0-59 months who slept under an insecticide treated net during the previous night, Malawi 2006 Background characteristic % HHs with at least one bednet % HHs with at least one ITN Slept under a bednet Slept under an ITN Number of children aged 0-59 months Sex Male na na 28.9 23.1 11,304 Female na na 29.0 23.0 11,687 Region Northern 57.6 36.4 34.4 23.7 2,436 Central 47.7 35.3 26.4 21.8 10,517 Southern 49.2 34.5 30.3 24.2 10,041 Residence Urban 72.2 53.8 52.1 42.9 2,489 Rural 46.5 32.6 26.1 20.6 20,505 Age 0-11 months na na 32.2 26.4 4,947 12-23 months na na 30.3 23.7 4,979 24-35 months na na 28.2 21.9 5,157 36-47 months na na 27.2 21.9 4,601 48-59 months na na 25.8 20.2 3,310 Wealth index quintile Lowest 32.9 20.7 18.0 13.0 5,075 Second 40.4 28.0 23.7 18.6 4,770 Middle 51.0 35.7 28.4 22.5 4,881 Fourth 53.7 38.3 30.4 24.0 4,391 Highest 72.0 54.8 48.8 41.3 3,877 Total 49.5 35.0 29.0 23.0 22,994 Na : Not applicable 19 ENVIRONMENT Water Safe drinking water is a basic necessity for good health. Water can be a significant carrier of diseases such as cholera, typhoid, etc. 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, mainly in rural areas, who bear the primary responsibility for carrying water, often for long distances. The distribution of the population by source of drinking water is shown in Table 10. The population using improved drinking water sources are those who use any of the following types of supply: piped water, public tap, borehole/tubewell, protected well or protected spring. Overall, 74 per cent of the population has access to improved drinking water sources – 96 per cent in urban areas and 71 per cent in rural areas. The situation in the Central is considerably worse than in other regions; only 67 per cent of the population in this region gets its drinking water from an improved source compared to nearly 80 per cent in Northern and Southern regions. The source of drinking water for the population varies strongly by region (Table 10). In the Central region, only 9.5 per cent of the population uses drinking water that is piped into their dwelling or into their yard or plot. In the Southern and Northern regions, 22 and 24 per cent respectively used piped water. There is a vast difference in the use of piped water between urban and rural. Table 10 : Use of improved water sources Per cent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Malawi 2006 Improved sources Unimproved sources Background characteristic Piped water Tube Well/ Bore hole Prote- cted well Others Unpro- tected well Surface water Others Total Improved sources of drinking water Number of HH members Region Northern 23.7 52.0 3.4 0.1 9.7 9.8 1.3 100.0 79.2 14,485 Central 9.5 49.3 7.9 0.2 27.0 5.2 0.9 100.0 66.9 59,024 Southern 22.1 53.4 4.7 0.2 13.7 4.6 1.3 100.0 80.4 58,332 Residence Urban 77.0 16.7 2.5 0.0 3.0 0.4 0.4 100.0 96.2 15,665 Rural 8.5 56.1 6.5 0.2 21.4 6.1 1.2 100.0 71.3 116,176 Wealth index quintile Lower 1.8 54.8 5.1 0.2 28.6 8.2 1.3 100.0 61.9 26,450 Second 2.6 59.9 5.9 0.2 24.3 6.1 1.0 100.0 68.6 26,391 Middle 11.9 52.8 7.2 0.2 20.7 5.8 1.4 100.0 72.1 26,417 Fourth 17.9 53.3 6.7 0.1 15.6 5.2 1.2 100.0 78.0 26,307 Highest 49.1 36.1 5.1 0.2 7.1 1.9 0.5 100.0 90.5 26,276 Total 16.6 51.4 6.0 0.2 19.3 5.4 1.1 100.0 74.2 131,841 Figure 5 : Per cent distribution of the population by source of drinking water, Malawi 2006 Piped Water 17% Tubewell/Borehole 51% Protected well 6% Unprotected well 19% Others 7% 20 Results in Annex 4 provide district level estimates on the use of improved water sources by population. In 7 districts, less than 10 per cent of population are accessing water from a piped source. Overall, three-fourths of population have access to improved sources of drinking water in the 17 districts; Chiradzulu reporting the highest coverage of 90 per cent. Sanitation Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation facilities include: flush toilets connected to sewage systems, septic tanks or pit latrines, ventilated improved pit latrines and pit latrines. Eighty eight per cent of the population of Malawi is living in households using improved sanitation facilities (Table 11). This percentage is 97 in urban areas and 87 per cent in rural areas. Residents of the South are less likely than others to use improved facilities. Overall, 11 per cent of population in Malawi have no toilet facilities. The problem is more in rural areas (13 per cent) compared to urban areas (2 per cent). REPRODUCTIVE HEALTH Contraception Current use of contraception was reported by 42 per cent of women currently married or in union (Table 12). The most popular method is the injections which are used by 29 per cent married women in Malawi. This is a considerable increase compared to 18 per cent reported in MDHS 2004. The next most popular method is female sterilization, which accounts for 5 per cent of married women. About two per cent use pills. Less than one per cent use periodic Table 11 : Use of sanitary means of excreta disposal Per cent distribution of household population according to type of toilet facility used by the household, and the percentage of household population using sanitary means of excreta disposal, Malawi 2006 Improved sanitation facility Unimproved or no facility Percentage population using sanitary excreta disposal Background characteristic Flush/ Pour Flush Ventilated Improved Pit Latrine Pit Latrine Other No facility or bush/ field Total Including Pit Latrine Excluding Pit Latrine Number of HH members Region Northern 4.0 6.7 77.0 0.5 11.8 100.0 87.7 15.1 14,485 Central 1.7 9.3 78.5 0.7 9.8 100.0 89.5 14.0 59,024 Southern 2.5 11.9 72.4 0.1 13.0 100.0 86.8 20.0 58,332 Residence Urban 13.8 23.6 59.9 0.3 2.4 100.0 97.3 45.0 15,665 Rural 0.8 8.3 77.8 0.5 12.7 100.0 86.9 13.0 116,176 Wealth index quintiles Lowest 0.0 2.0 75.2 0.1 22.6 100.0 77.2 2.2 26,450 Second 0.0 4.0 79.0 0.8 16.1 100.0 83.0 5.3 26,391 Middle 0.0 10.2 78.8 0.5 10.5 100.0 89.0 13.1 26,417 Fourth 0.2 14.3 78.6 0.5 6.5 100.0 92.9 22.3 26,307 Highest 11.5 20.3 66.5 0.4 1.5 100.0 98.3 41.2 26,276 Total 2.3 10.2 75.7 0.4 11.4 100.0 88.2 16.9 131,841 21 Table 12 : Use of contraception Percentage of women aged 15-49 years currently married or in union who are using (or whose partners is using) a contraceptive method, Malawi 2006 Modern methods Traditional methods Ba ck gr ou nd ch ar ac te r N ot u si ng a ny m et ho d Fe m al e st er ili za tio n M al e st er ili za tio n Pi ll IU D In je ct io ns Im pl an ts M al e C on do m O th er s Pe ri od ic ab st in en ce W ith dr aw al O th er To ta l A ny m od er n m et ho d A ny tr ad iti on al m et ho d A ny m et ho d W om en c ur re nt ly m ar ri ed o r i n un io n Region Northern 60.5 5.2 0.1 5.5 0.3 14.5 1.1 5.4 0.2 0.5 6.0 0.6 100.0 32.3 7.2 39.5 2,109 Central 56.6 6.7 0.0 1.7 0.2 30.6 0.6 1.1 0.3 0.9 0.4 0.8 100.0 41.0 2.4 43.4 8,447 Southern 59.5 2.9 0.1 2.2 0.2 31.4 0.5 1.1 0.4 0.5 0.1 1.1 100.0 38.5 2.0 40.5 8,127 Residence Urban 54.6 5.1 0.0 3.7 0.4 31.4 1.8 1.3 0.5 0.5 0.4 0.3 100.0 43.9 1.5 45.4 2,300 Rural 58.8 4.8 0.1 2.2 0.2 28.9 0.4 1.6 0.3 0.7 1.0 1.0 100.0 38.2 2.9 41.2 16,383 Age 15-19 75.9 0.0 0.0 1.6 0.1 17.1 0.3 3.4 0.1 0.2 0.7 0.5 100.0 22.5 1.7 24.1 1,667 20-24 57.5 0.1 0.0 2.6 0.1 34.3 0.5 2.3 0.3 0.5 0.9 0.9 100.0 39.9 2.6 42.5 4,987 25-29 53.3 0.9 0.1 2.8 0.2 37.7 0.9 1.4 0.3 0.6 0.8 0.9 100.0 44.2 2.5 46.7 4,164 30-34 55.8 4.3 0.0 2.7 0.4 31.5 1.0 1.2 0.4 0.8 1.1 0.9 100.0 41.1 3.1 44.2 3,058 35-39 56.5 10.7 0.1 2.5 0.4 24.9 0.3 1.1 0.5 0.9 1.5 0.8 100.0 40.0 3.5 43.5 2,085 40-44 56.5 19.0 0.2 1.5 0.1 18.4 0.4 0.3 0.1 1.1 0.7 1.8 100.0 39.9 3.6 43.5 1,561 45-49 67.2 18.5 0.0 0.8 0.2 10.3 0.4 0.1 0.1 0.6 0.4 1.3 100.0 30.3 2.4 32.8 1,162 Number of living children 0 97.1 0.0 0.0 0.3 0.0 1.4 0.1 0.7 0.0 0.2 0.1 0.0 100.0 2.7 0.2 2.9 1,501 1 65.2 0.5 0.0 2.2 0.1 26.4 0.3 3.1 0.3 0.6 0.7 0.5 100.0 32.6 2.1 34.8 3,568 2 52.5 1.3 0.1 3.1 0.2 37.4 1.1 1.8 0.4 0.5 0.8 0.8 100.0 45.1 2.4 47.5 3,761 3 50.2 2.9 0.0 2.5 0.2 38.9 0.8 1.2 0.3 0.6 1.3 1.1 100.0 46.5 3.3 49.8 3,193 4+ 53.1 11.3 0.1 2.4 0.3 27.5 0.6 1.0 0.4 0.9 1.1 1.3 100.0 43.3 3.6 46.9 6,661 Education None 62.9 6.3 0.1 1.3 0.2 25.7 0.2 0.6 0.5 0.5 0.4 1.4 100.0 34.3 2.8 37.1 4,197 Primary 58.7 4.6 0.0 2.2 0.2 29.4 0.5 1.6 0.5 0.7 1.1 0.9 100.0 38.5 2.9 41.3 12,277 Secondary + 47.4 3.3 0.1 5.5 0.5 35.4 2.1 3.4 0.5 0.7 1.0 0.2 100.0 50.5 2.1 52.6 2,126 Non- standard curriculum 59.3 18.0 0.0 2.3 0.0 17.6 0.0 0.0 0.4 0.0 0.0 2.3 100.0 38.0 2.8 40.7 82 Wealth index quintiles Lowest 61.5 5.0 0.0 1.6 0.2 26.2 0.2 1.4 0.4 0.8 1.6 1.2 100.0 34.7 3.8 38.5 3,591 Second 59.6 4.7 0.0 1.5 0.2 28.5 0.5 1.8 0.4 0.8 0.9 1.2 100.0 37.1 3.3 40.4 3,670 Middle 58.7 3.7 0.0 1.9 0.2 30.6 0.4 1.5 0.4 0.6 0.9 1.4 100.0 38.2 3.1 41.3 4,024 Fourth 58.9 5.0 0.1 2.8 0.1 28.7 0.5 1.7 0.3 0.5 0.7 0.7 100.0 39.0 2.1 41.1 3,816 Highest 52.9 6.0 0.1 4.1 0.4 31.8 1.5 1.5 0.4 0.6 0.5 0.2 100.0 45.6 1.5 47.1 3,583 Total 58.3 4.9 0.0 2.4 0.2 29.2 0.6 1.6 0.4 0.6 0.9 0.9 100.0 38.9 2.8 41.7 18,684 22 abstinence, withdrawal, male sterilization, vaginal methods, or the lactational amenorrhea method (LAM). Overall, 58 per cent of currently married women have reported not using any contraceptive method. Contraceptive prevalence is highest in the Central region at 43 per cent and almost the same in the Northern and Southern parts of the country (40 per cent). Use of modern contraceptive method is also high in Central region and lowest in Northern region. Contraception use slightly higher among urban women compared to rural women. Adolescents are far less likely to use contraception than older women. Only about 24 per cent of married or in union women aged 15-19 currently use a method of contraception compared to 43 per cent of 20-24 year and 47 per cent of 25-29 year olds. Women’s education level is strongly associated with contraceptive prevalence. The percentage of women using any method of contraception rises from 37 per cent among those with no education to 53 per cent among women with secondary or higher education. Education is positively correlated with all modern methods, except for female sterilisation which is less among the educated. Maternal Care For maternal care indicators, data was collected from mothers on all live births that occurred in the two years preceding the survey. Table 13 shows that nearly 92 per cent of mothers received antenatal care from a health professional. Maternal age, urban-rural residence and level of education are not strongly related to use of antenatal care. Fully ten per cent more of women from Southern region received ANC compared to women in the Northern region. Tetanus injections are given to pregnant women to prevent neonatal tetanus, a cause of early infant deaths. Table 13 shows that 84 per cent of women, who had a birth in the last two years preceding the date of interview, received at least one tetanus toxoid injection during the pregnancy. Women in urban areas, educated women and women in highest wealth quintile are more likely to have received tetanus toxoid injection. Regarding iron supplementation, 80 per cent of women reported receiving iron supplementation during their pregnancy. The provision of delivery assistance by skilled attendants can greatly improve outcomes for mothers and infants by the 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. About 54 per cent of births occurring in the two years prior to the MICS survey were delivered by skilled personnel (Table 13). This percentage is highest in the Northern region at 58 per cent and lowest in the Central at less than 50 per cent. The more educated a woman is, the more likely she is to have delivered with the assistance of a skilled person. There is a significant difference between deliveries by health professional in urban and rural regions. Fifty four per cent of births take place in a health facility. Births in Northern region, urban areas, to educated and wealthy women are more likely to take place in a health facility. 23 Table 13 : Maternal care indicators by background characteristics Percentage of women who had a live birth in the two years preceding the survey by selected maternal care indicators, Malawi 2006 Background characteristic Percentage with antenatal care from health professional Percen- tage given at least one tetanus toxoid injection Percenta ge given iron tablets Percentage delivered by health professional Delivered in health facility Number of women who gave birth in the preceding two years Region Northern 82.4 81.7 82.3 58.1 60.6 1,067 Central 92.0 85.1 78.5 49.7 49.7 4,714 Southern 93.7 84.2 81.5 56.8 56.5 4,429 Residence Urban 96.0 87.6 85.0 81.6 81.7 1,074 Rural 91.3 84.0 79.7 50.4 50.5 9,136 Education None 89.3 83.4 74.9 41.7 41.7 2,194 Primary 92.1 84.2 81.0 53.6 53.7 6,795 Secondary + 95.0 87.6 85.6 76.4 77.2 1,194 Non-standard curriculum 77.9 60.1 72.2 29.8 29.8 26 Wealth index quintile Lowest 89.6 84.3 80.7 42.1 42.5 2,307 Second 89.3 84.4 77.9 48.3 48.3 2,209 Medium 93.7 84.0 80.5 52.0 51.9 2,151 Fourth 92.6 85.7 78.7 55.1 55.6 1,920 Highest 94.6 83.3 84.3 77.9 77.8 1,623 Total 91.8 84.4 80.2 53.6 53.8 10,210 EDUCATION Universal access to basic education and the achievement of primary education by the world’s children is one of the most important Millennium Development Goals and goals of A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment, and influencing population growth, and for the improvement of health and nutrition of children. Overall, 82 per cent of children of primary school age (6-13) in Malawi are attending primary school or secondary school (Table 14). In urban areas, 91 per cent of children attend school while in rural areas 80 per cent attend. However, the girls’ primary school attendance ratio (82.1 per cent) is slightly higher than that of boys (78.6 per cent) in rural areas. School attendance in the Southern region (79 per cent) is significantly lower than in the Northern region (90 per cent) of the country. 24 Table 14 : Primary school net attendance ratio Percentage of children of primary school age (6-13) attending primary or secondary school (NAR) and ratio of girls to boys attending primary education, Malawi 2006 Boys Girls Total Background characteristic Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio Number of children Gender Parity Index (GPI) Region Northern 89.3 1,833 91.2 1,862 90.3 3,695 1.02 Central 79.6 7,027 84.3 7,380 82.0 14,407 1.06 Southern 77.9 7,036 79.8 7,439 78.9 14,479 1.02 Residence Urban 91.2 1,730 90.0 1,870 90.6 3,601 0.99 Rural 78.6 14,165 82.1 14,811 80.4 28,980 1.05 Age 6 47.5 2,485 55.3 2,537 51.4 5,022 1.16 7 71.5 2,026 76.7 2,097 74.2 4,125 1.07 8 83.5 1,989 84.8 2,165 84.2 4,154 1.02 9 87.7 1,943 89.6 1,926 88.6 3,869 1.02 10 88.5 2,144 90.6 2,132 89.6 4,278 1.02 11 92.5 1,479 92.4 1,619 92.4 3,099 1.00 12 90.6 2,182 91.6 2,304 91.1 4,487 1.01 13 89.5 1,647 91.4 1,899 90.6 3,547 1.02 6-11 76.7 12,066 80.2 12,477 78.5 24,547 1.04 Mother’s education None 72.6 5,387 74.6 5,599 73.6 10,987 1.03 Primary 82.4 9,280 86.6 9,716 84.5 19,000 1.05 Secondary + 94.9 1,132 93.7 1,270 94.3 2,403 0.99 Non-standard curriculum 80.8 87 72.9 89 76.8 176 0.90 Wealth index quintile Lowest 73.2 3,270 78.2 3,400 75.7 6,672 1.07 Second 75.7 3,196 78.9 3,537 77.4 6,732 1.04 Middle 79.0 3,013 81.7 3,188 80.4 6,201 1.04 Fourth 82.1 3,300 85.0 3,206 83.5 6,509 1.04 Highest 90.2 3,117 91.7 3,349 91.0 6,466 1.02 Total 80.0 15,896 83.0 16,680 81.5 32,581 1.04 The ratio of girls to boys attending primary education is provided in the last column of Table 14. This shows that gender parity for primary school is 1.04 indicating no difference in the attendance of girls and boys to primary school. District level net attendance ratios in Annex 5 show that three districts – Chitipa, Rumphi and Mzima - of the Northern region have more than 90 per cent primary school net 25 attendance ratios whereas the ratio is less than 80 per cent in 10 districts with Dedza having only 70 per cent of 6-13 yrs. children attending primary or secondary school. CHILD PROTECTION Child Labour Table 15 : Child labour Percentage of children aged 5-14 years who are involved in child labour activities by type of work, Malawi 2006 Working outside household Background characteristic Paid work Unpaid work Household chores for 28+ hours/week Working for family business Total child labour * Number of children aged 5-14 years Sex Male 2.9 8.2 4.2 18.2 28.2 19,960 Female 2.8 10.5 7.0 14.8 29.3 20,858 Region Northern 0.8 10.0 6.7 19.9 32.7 4,629 Central 2.9 7.9 6.1 16.3 27.7 18,234 Southern 3.3 10.7 4.9 15.6 28.9 17,963 Residence Urban 1.4 4.6 4.3 7.0 15.7 4,545 Rural 3.0 9.9 5.8 17.6 30.4 36,281 Age 5-11 years 3.1 11.9 3.3 18.3 30.4 29,258 12-14 years 2.3 3.0 11.7 11.7 24.6 11,567 School participation Attending school 3.0 9.9 6.1 18.1 31.1 32,693 Not attending school 2.3 7.1 3.7 10.0 19.7 8,133 Wealth index quintile Lowest 3.1 8.0 5.6 18.4 29.5 8,399 Second 3.4 11.8 6.2 18.4 32.8 8,314 Middle 3.1 11.5 5.7 18.9 32.9 7,881 Fourth 3.5 9.6 6.0 15.7 29.1 8,067 Highest 1.2 5.9 4.8 10.8 19.7 8,164 Total 2.8 9.4 5.6 16.4 28.8 40,826 * : Proportion of children 5-14 years of age who are currently working (paid or unpaid; inside or outside home), more than 4 hours per day. Article 32 of the Convention on the Rights of the Child states: "States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the 26 child’s health or physical, mental, spiritual, moral or social development." The World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. In the MICS questionnaire, a number of questions addressed the issue of child labour, that is, children 5-14 years of age involved in labour activities. A child is considered to be involved in child labour activities at the moment of the survey if during the week preceding the survey: • Ages 5-11: at least 1 hour of economic work or 28 hours of domestic work per week. • Ages 12-14: at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows differentiating child labour from child work to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum of the prevalence of child labour since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained before. Table 15 presents the results of child labour by the type of work. Table 15 shows that the total child labour rate in Malawi is nearly 29 per cent, eight per cent points lower than that reported in MDHS 2004 (37 per cent). Children in Northern region are more in labour, though mostly engaged in unpaid work and family business. There is no difference in the total child labour rates between boys and girls but children engaged in work in the rural areas almost double the number of children working in urban areas. Nearly one third of working children are able to attend school. Children belonging to higher wealth quintile are less likely involved in child labour, but still, one in five is. Age at marriage Marriage before the age of 18 is a reality for many young girls. According to UNICEF's worldwide estimates, over 60 million women aged 20-24 were married/in union before the age of 18. Factors that influence child marriage rates include: the state of the country's civil registration system, which provides proof of age for children; the existence of an adequate legislative framework with an accompanying enforcement mechanism to address cases of child marriage; and the existence of customary or religious laws that condone the practice. Child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. Women married at younger ages are more likely to dropout of school, experience higher levels of fertility, domestic violence, and maternal mortality. The percentage of women married at various ages is provided in Table 16. Two of the indictors are to estimate the percentage of women married before 15 years of age and percentage married before 18 years of age. Nearly 11 per cent of women aged 15-49 years were in marriage or in union before their 15th birthday with higher proportions in rural and lower literacy groups. Half of the Malawian women aged 20-49 reported married or in union before their 18th birthday. Malawi, in the absence of registration of births and marriages act has a daunting task in rising the age at marriage for girls. It is notable, however that while wealth showed little influence on the age of marriage, far fewer girls who attended secondary school married at a young age. Thus, schooling offers a key strategy to delayed marriage as well as numerous other benefits. 27 Table 16 : Early marriage Percentage of women aged 15-49 years in marriage or union before their 15th birthday, percentage of women aged 20-49 years in marriage or union before their 18th birthday, Malawi 2006 Background characteristic Percentage married before age 15 Number of women aged 15-49 years Percentage married before age 18 Number of women aged 20-49 years Percentage of women 15-19 years married/ in union Number of women aged 15-19 years Region Northern 10.8 2,857 52.6 2,256 40.0 602 Central 9.1 11,685 46.7 9,427 26.5 2,268 Southern 12.0 11,716 53.1 9,392 35.5 2,326 Residence Urban 8.1 3,629 39.9 2,818 23.5 814 Rural 11.0 22,630 51.8 18,257 33.7 4,382 Age 15-19 5.7 5,196 56.0 12 32.1 5,196 20-24 9.7 6,315 50.6 6,315 - 0 25-29 12.2 4,996 49.7 4,996 - 0 30-34 12.2 3,712 49.9 3,712 - 0 35-39 14.1 2,527 49.3 2,527 - 0 40-44 13.6 1,962 54.7 1,962 - 0 45-49 11.8 1,549 46.4 1,549 0 Education None 17.3 5,215 56.2 4,960 53.6 255 Primary 10.4 17,111 54.8 13,102 34.2 4,016 Secondary + 2.2 3,839 18.8 2,920 16.8 924 Non- standard curriculum 18.5 90 62.6 90 - 0 Wealth index quintile Lowest 11.4 5,166 51.8 4,197 33.6 970 Second 11.1 5,167 53.1 4,189 40.0 982 Middle 11.7 5,212 53.8 4,224 39.9 989 Fourth 11.2 5,114 52.5 4,142 32.5 973 Highest 7.9 5,600 40.2 4,322 18.5 1,282 Total 10.6 26,259 50.2 21,075 32.1 5,196 HIV/AIDS & ORPHANHOOD One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and giving young people the tools to protect them from infection. Misconceptions about HIV are common and can confuse young people and hinder prevention efforts. Different regions are likely to have variations in 28 misconceptions although some appear to be universal (for example that sharing food can transmit HIV or mosquito bites can transmit HIV). A key indicator used to measure countries’ responses to the HIV epidemic is the proportion of young people 15-24 years who know two methods of preventing HIV reject two most common misconceptions in Malawi (that HIV can be transmitted by mosquito bites and supernatural means) and know that a healthy looking person can have HIV. Table 17 shows that around 41 per cent young women and men 15-24 years have comprehensive correct knowledge of HIV. Level of education and residence are highly associated with knowledge Table 17 : Comprehensive knowledge about HIV Prevention Percentage of adults aged 15-49 years who have comprehensive knowledge about HIV prevention, Malawi 2006 Have comprehensive knowledge* (identify 2 prevention methods and 3 misconceptions) Women Men Background characteristic Per cent Number Per cent Number Region Northern 36.9 2,857 42.6 869 Central 34.2 11,685 29.9 3,512 Southern 47.3 11,716 50.6 3,255 Residence Urban 54.9 3,629 51.0 1,144 Rural 38.0 22,630 38.3 6,492 Age 15-19 41.0 5,196 41.0 1,583 20-24 42.0 6,315 40.4 1,482 15-24 41.6 11,511 40.7 3,064 25-29 44.3 4,996 39.4 1,379 30-34 37.7 3,712 42.9 1,163 35-39 37.1 2,527 39.8 827 40-44 35.8 1,962 37.5 659 45-49 36.0 1,549 37.4 544 Education None 31.4 5,215 29.7 608 Primary 39.9 17,111 37.3 5,099 Secondary + 54.6 3,839 51.3 1,919 Non-standard curriculum 40.2 90 6.2 8 Wealth index quintile Lowest 32.3 5,166 31.5 1,188 Second 36.3 5,167 38.8 1,403 Middle 37.4 5,212 38.5 1,607 Fourth 42.9 5,114 39.7 1,666 Highest 51.9 5,600 49.1 1,771 Total 40.3 26,259 40.2 7,636 * : Respondents with comprehensive knowledge say that use of condom for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, say that a health-looking person can have the AIDS virus, and reject the two most common local misconceptions (mosquito bites & supernatural means). 29 of HIV. It can also be seen from the table that knowledge among adult women and men aged 15-49 years is also same. Annex 6 provides the district level knowledge levels among women and men about HIV prevention. While Mulanje has an equally highest level of knowledge for both women and men, in Balaka, Mwanza, Zomba, less number of women are knowledgeable compared to men. Promoting safer sexual behaviour is critical for reducing HIV prevalence. The use of condoms during sex, especially with non-regular partners is very important for reducing the spread of HIV. Over half of new HIV infections are among young people 15-24 years, thus a change in behaviour among this age group will be especially important to reduce new infections. Table 18 : Condom use at last high-risk sex - Women Percentage of young women aged 15-24 years who had high risk sex in the previous year and who used a condom in last high risk sex, Malawi 2006 Background characteristic Ever had sex Had sex in the last 12 months Had sex with more than one partner in the last 12 months Number of women aged 15- 24 Per cent who had sex with non- marital, non- cohabiting partner Number of women aged 15-24 years who had sex in last 12 months Per cent who used a condom at last sex with a non- marital, non- cohabiting partner Number of women aged 15-24 years who had sex in last 12 months with a non- marital, non- cohabiting partner Region Northern 72.7 65.4 1.0 1,259 7.7 824 51.8 63 Central 72.5 67.0 2.0 5,114 13.1 3,426 37.3 450 Southern 79.8 72.5 1.2 5,126 15.8 3,716 40.0 586 Residence Urban 71.6 63.0 0.6 1,719 23.5 1,083 51.9 255 Rural 76.5 70.4 1.7 9,780 12.3 6,884 35.8 845 Age 15-19 51.4 45.7 1.7 5,196 27.6 2,377 38.4 655 20-24 95.9 88.7 1.4 6,302 8.0 5,590 41.3 445 Education None 91.0 86.0 1.5 927 7.7 797 23.8 62 Primary 75.5 70.0 1.7 8,342 11.7 5,842 36.3 685 Secondary + 70.5 59.5 1.0 2,222 26.6 1,322 48.8 352 Wealth index quintile Lowest 75.6 70.3 2.2 2,250 11.1 1,581 27.3 175 Second 82.7 75.9 2.0 2,261 13.0 1,716 33.6 223 Middle 80.7 76.1 2.0 2,318 11.0 1,764 45.8 195 Fourth 74.7 69.1 0.4 2,183 11.6 1,508 33.1 174 Highest 66.2 56.2 1.0 2,486 23.8 1,396 49.7 333 Total 75.8 69.3 1.5 11,498 13.8 7,966 39.6 1,100 30 Condom use during sex with live-in partners (non-marital, non-cohabiting) was assessed in women and men of 15-24 years of age who had sex with such a partner in the previous year (Table 18 & 19). Nearly 14 per cent of women 15-24 years report having sex with a non- regular partner in the 12 months prior to the MICS. Of them, 40 per cent report using a condom when they had sex with the high risk partner. Among men, 57 per cent engaged in high risk sex and nearly 60 per cent of them report using a condom when they had sex with the high risk partner. Urban-Rural differentials and level of education have been correlated to the use of condom in high risk sex practice. As the HIV epidemic progresses, more and more children are becoming orphaned due to AIDS. Children who are orphaned or living away from their parents may be at increased risk of neglect or exploitation if the parents are not available to assist them. Monitoring the variations in educational outcomes for children who have lost both parents (double orphans) versus children whose parents are alive (and who live with at least one of these parents) is Table 19 : Condom use at last high-risk sex - Men Percentage of young men aged 15-24 years who had high risk in the previous year and who used a condom in last high risk sex, Malawi 2006 Background characteristic Ever had sex Had sex in the last 12 months Had sex with more than one partner in the last 12 months Number of men aged 15-24 Per cent who had sex with non- marital, non- cohabiting partner Number of men aged 15-24 years who had sex in last 12 months Per cent who used a condom at last sex with a non- marital, non- cohabiting partner Number of men aged 15-24 years who had sex in last 12 months with a non-marital, non-cohabiting partner Region Northern 62.1 51.0 2.6 360 54.3 183 63.3 99 Central 66.4 48.3 4.4 1,382 51.4 667 57.5 343 Southern 70.3 58.7 7.1 1,323 61.9 777 60.4 481 Residence Urban 68.5 46.3 5.7 469 70.3 217 69.1 153 Rural 67.4 54.3 5.2 2,596 54.6 1,410 57.8 770 Age 15-19 46.9 32.2 3.9 1,583 90.9 509 58.1 463 20-24 89.7 75.5 6.8 1,482 41.1 1,118 61.2 460 Education None 74.5 71.1 5.9 82 39.6 58 42.7 23 Primary 64.6 52.1 5.2 2,222 54.1 1,157 56.0 626 Secondary + 75.5 54.3 5.6 759 66.6 412 69.2 274 Wealth index quintile Lowest 65.8 56.5 3.1 466 44.4 263 66.5 117 Second 72.9 55.7 5.8 559 49.8 311 58.4 155 Middle 70.8 58.8 5.6 605 52.2 355 53.4 186 Fourth 63.5 51.0 6.6 674 57.3 344 54.0 197 Highest 65.8 46.5 5.0 760 75.9 353 65.7 268 Total 67.6 53.1 5.3 3,064 56.7 1,627 59.6 923 31 one way to ensure that children’s rights are being met even after their parents have died or are no longer able to care for them. Table 20: Children's living arrangements and orphanhood Per cent distribution of children aged 0-17 years according to living arrangements & orphanhood, Malawi 2006 Background characteristic Living with both parents Living with mother only Living with father only Children not living with a biological parent Impossible to determine Total Prevalence of orphans* Number of children Sex Male 60.1 19.9 3.0 16.4 0.7 100.0 12.9 35,052 Female 59.1 19.5 2.3 18.4 0.7 100.0 12.2 35,656 Region Northern 59.8 16.8 5.0 17.6 0.8 100.0 11.2 7,809 Central 65.1 17.0 2.6 14.7 0.6 100.0 10.2 31,870 Southern 53.9 23.1 2.0 20.3 0.7 100.0 15.3 31,040 Residence Urban 57.7 17.6 3.9 19.7 1.0 100.0 14.5 8,009 Rural 59.8 20.0 2.4 17.1 0.6 100.0 12.3 62,710 Age 0-4 years 74.1 20.7 0.6 4.4 0.2 100.0 3.3 22,971 5-9 years 59.3 19.6 2.7 17.9 0.4 100.0 11.3 21,882 10-14 years 49.0 18.9 4.3 27.1 0.6 100.0 20.8 18,941 15-17 years 41.4 18.5 4.2 32.9 3.0 100.0 24.8 6,925 Wealth index quintile Lowest 57.3 24.9 2.1 15.2 0.6 100.0 11.8 14,678 Second 57.0 23.3 1.5 17.5 0.6 100.0 13.1 14,366 Middle 64.7 17.3 2.3 15.2 0.5 100.0 10.7 14,041 Fourth 61.1 16.8 3.0 18.6 0.7 100.0 13.3 13,901 Highest 58.1 15.6 4.3 20.9 1.0 100.0 14.1 13,734 Total 59.6 19.7 2.6 17.4 0.7 100.0 12.6 70,719 * : Children with at least one dead parent In Malawi, nearly 13 per cent of children aged 0-17 are orphans meaning they have lost one or both parents (Table 20). The prevalence of orphans is high in Southern region (15.3 per cent) and low in the Central region (10.2 per cent). The table also shows that 17.4 per cent children are not living with a biological parent. Table 21 provides schooling of children aged 10-14 years by orphanhood. Among children 10-14 who are orphans, 89 per cent are currently attending school. Among the children ages 10-14 who are not orphans, 91 per cent are attending school. The table also shows that ratio of school attendance of orphans to school attendance of non-orphans age 10-14 years is 0.97 in MICS. This indicates a rather good response of caretakers insuring that even orphans are in school along with peers whose parents are alive. 32 Table 21 : Schooling of children age 10-14 by orphanhood School attendance of children aged 10-14 years by orphanhood, Malawi 2006 Background characteristic Per cent of children who are orphaned School attendance of children who are orphaned Per cent of children who are not orphans School attendance of children who are not orphans School attendance of orphans versus non- orphans Total number of children aged 10-14 years Sex Male 26.3 87.3 73.7 90.8 0.96 9,169 Female 25.9 90.3 74.1 91.4 0.99 9,768 Region Northern 23.1 95.3 76.9 96.7 0.99 2,138 Central 21.4 87.6 78.6 91.3 0.96 8,646 Southern 32.0 88.5 68.0 89.2 0.99 8,156 Residence Urban 28.3 93.7 71.7 94.0 1.00 2,235 Rural 25.9 88.1 74.1 90.7 0.97 16,706 Wealth index quintile 1 24.2 85.4 75.8 87.1 0.98 3,729 2 26.4 84.9 73.6 89.3 0.95 3,753 3 25.2 88.2 74.8 90.8 0.97 3,462 4 27.9 90.2 72.1 92.7 0.97 3,856 5 26.8 94.3 73.2 95.3 0.99 4,141 Total 26.1 88.6 73.9 91.0 0.97 18,941 ________________ 33 ANNEXES Annex 1 : Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, Malawi 2006 Area Neonatal mortality (NN) Postneonatal mortality (PNN) Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Region Northern 35 28 63 41 101 Central 34 40 74 72 141 Southern 37 47 84 56 136 District Balaka 39 65 104 63 160 Blantyre 30 43 74 51 121 Chikwawa 33 45 78 75 147 Chiradzulu 47 51 98 67 159 Chitipa 31 21 52 49 99 Dedza 43 36 79 87 160 Dowa 36 32 68 76 139 Karonga 28 24 52 32 83 Kasungu 30 50 80 57 132 Lilongwe 49 44 93 80 166 Machinga 43 36 79 41 117 Mangochi 24 66 90 66 150 Mchinji 24 41 65 73 133 Mulanje 39 39 77 33 107 Mwanza 41 37 78 63 137 Mzimba 44 27 71 47 115 Nkhata Bay 21 37 58 25 81 Nkhotakota 22 36 59 63 118 Nsanje 39 64 104 75 171 Ntcheu 31 55 87 68 149 Ntchisi 27 34 61 62 119 Phalombe 40 64 104 63 161 Rumphi 34 33 66 35 99 Salima 34 43 77 73 144 Thyolo 26 49 75 52 123 Zomba 48 36 85 58 138 Malawi 35 42 77 63 134 34 Annex 2 : Nutritional status Percentage of children aged 0-59 months who are severely or moderately malnourished, Malawi 2006 Height-for-age (Stunting) Weight-for-height (Wasting) Weight-for-age (Underweight) Area % below – 3 SD % below – 2 SD % below – 3 SD % below – 2 SD % below – 3 SD % below – 2 SD Number of children Region Northern 14.6 39.7 0.8 4.4 2.7 16.7 2,294 Central 21.9 47.0 0.4 3.3 3.6 20.4 9,333 Southern 20.5 46.3 0.4 3.0 3.4 19.0 9,120 District Balaka 14.0 40.5 0.5 2.3 2.5 14.5 505 Blantyre 16.3 41.8 0.1 1.1 2.2 14.6 1,509 Chikwawa 17.1 39.7 1.1 6.2 4.7 22.7 666 Chiradzulu 17.5 45.7 0.6 5.3 3.4 18.3 641 Chitipa 14.4 38.8 0.7 4.7 3.8 19.5 316 Dedza 28.1 57.0 1.1 4.6 5.8 29.1 412 Dowa 20.0 42.5 0.4 3.3 3.8 18.1 2,946 Karonga 11.8 30.1 1.5 7.9 1.4 13.4 427 Kasungu 18.9 46.7 0.2 1.9 3.1 18.2 1,021 Lilongwe 22.6 46.3 0.8 5.0 4.3 24.1 1,077 Machinga 28.6 57.0 0.1 2.3 5.1 22.6 1,258 Mangochi 19.9 44.6 0.1 1.7 4.0 22.2 817 Mchinji 30.3 56.9 0.1 2.9 3.1 20.6 1,215 Mulanje 18.8 42.4 0.4 3.1 2.4 15.9 562 Mwanza 20.8 50.8 0.1 1.9 2.9 18.6 412 Mzimba 16.4 46.1 0.5 3.1 3.1 18.3 995 Nkhata Bay 15.6 37.5 1.5 6.3 3.4 15.6 264 Nkhotakota 21.2 44.3 0.5 3.7 3.8 21.4 402 Nsanje 13.4 38.4 0.9 4.4 4.1 24.6 389 Ntcheu 22.6 50.9 0.2 3.4 3.1 21.7 819 Ntchisi 29.0 56.0 0.2 1.5 3.9 21.9 477 Phalombe 23.3 46.7 0.4 4.0 3.4 20.2 441 Rumphi 11.8 35.0 0.6 1.9 1.9 14.0 293 Salima 13.2 37.9 0.4 3.1 2.6 19.2 964 Thyolo 22.8 47.5 1.0 4.8 3.3 19.5 977 Zomba 24.6 51.4 0.4 2.4 3.1 17.6 941 Malawi 20.5 45.9 0.5 3.3 3.4 19.4 20,747 35 Annex 3 : Bednets coverage Percentage of children aged 0-59 months who slept under an insecticide treated net during the previous night, Malawi 2006 Area % HHs with at least one bednet % HHs with at least one ITN No. of HHs Slept under a bednet Slept under an insecticide treated net Number of children aged 0-59 months Region Northern 57.6 36.4 3,243 34.4 23.7 2436 Central 47.7 35.3 13,012 26.4 21.8 10,517 Southern 49.2 34.5 14,298 30.3 24.2 10,041 District Balaka 63.3 46.6 720 38.4 29.5 525 Blantyre 54.7 41.4 2,398 39.5 33.1 1,606 Chikwawa 54.1 36.1 1,178 34.5 27.3 843 Chiradzulu 37.5 30.0 972 22.6 20.4 703 Chitipa 35.4 20.7 370 6.9 4.6 329 Dedza 39.8 30.7 570 22.5 18.2 448 Dowa 37.6 27.7 4,360 14.7 12.5 3,379 Karonga 76.9 39.3 625 73.1 41.2 473 Kasungu 52.1 31.8 1,135 21.2 16.8 1,080 Lilongwe 53.3 41.0 1,399 33.4 27.2 1,152 Machinga 52.4 30.3 1,921 20.9 14.0 1,378 Mangochi 63.0 42.6 1,046 37.3 27.9 890 Mchinji 52.1 42.1 1,836 36.6 31.1 1,453 Mulanje 26.3 22.1 1,221 26.4 22.2 666 Mwanza 45.6 21.2 534 25.5 20.0 433 Mzimba 55.6 39.4 1,512 30.4 25.6 1,047 Nkhata Bay 53.9 30.2 399 28.0 15.0 284 Nkhotakota 70.2 51.3 510 54.4 41.5 453 Nsanje 52.9 38.1 568 43.1 32.0 425 Ntcheu 48.3 36.2 1,186 21.9 18.7 888 Ntchisi 29.6 22.7 630 15.4 12.9 504 Phalombe 57.8 28.7 666 27.4 21.4 503 Rumphi 60.1 41.6 337 23.7 18.8 302 Salima 67.3 48.9 1,385 44.4 36.2 1,160 Thyolo 30.6 23.3 1,497 20.5 17.3 1,068 Zomba 56.7 45.2 1,579 31.1 26.4 1,002 Malawi 49.5 35.0 30,553 29.0 23.0 22,994 36 Annex 4 : Use of improved water sources Per cent distribution of household population according to main source of drinking water and percentage of household population using improved drinking water sources, Malawi 2006 Area Piped Water Tube well/ Borehole Protected well Others Improved Sources Number of household members Region Northern 23.7 52.0 3.4 0.1 79.2 14,485 Central 9.5 49.3 7.9 0.2 66.9 59,024 Southern 22.1 53.4 4.7 0.2 80.4 58,332 District Balaka 21.8 50.2 14.3 0.0 86.3 3,103 Blantyre 56.3 30.4 1.2 0.0 87.9 10,322 Chikwawa 16.1 54.9 1.2 0.0 72.2 5,035 Chiradzulu 1.7 86.4 1.9 0.0 90.0 3,855 Chitipa 15.4 48.6 1.9 0.3 66.2 1,705 Dedza 3.2 52.9 5.8 0.3 62.2 2,483 Dowa 1.6 48.9 9.5 0.0 60.0 19,891 Karonga 16.9 64.4 3.3 0.4 85.0 2,803 Kasungu 9.3 44.2 13 0.3 66.8 5,805 Lilongwe 25.1 38.1 7.6 1.0 71.8 5,875 Machinga 18.0 50.0 2.6 0.0 70.6 7,391 Mangochi 10.8 58.7 4.9 0.4 74.8 4,569 Mchinji 11.0 42.3 8.5 0.2 62.0 8,323 Mulanje 28.1 47.6 4.6 0.4 80.7 4,475 Mwanza 5.3 66.0 4.5 0.2 76.0 2,373 Mzimba 24.0 51.4 4.3 0.0 79.7 6,629 Nkhata Bay 16.2 57.5 3.3 0.0 77.0 1,705 Nkhotakota 19.7 53.8 3.5 0.2 77.2 2,412 Nsanje 3.5 74.4 1.9 1.1 80.9 2,419 Ntcheu 15.6 61.7 3.6 0.5 81.4 4,949 Ntchisi 5.6 47.0 6.4 0.2 59.2 2,830 Phalombe 35.7 48.7 0.6 0.1 85.1 2,746 Rumphi 51.0 31.9 1.6 0.0 84.5 1,643 Salima 12.8 62.8 4.5 0.0 80.1 6,457 Thyolo 10.2 54.3 15 0.0 79.5 5,712 Zomba 11.3 63.6 6.2 0.5 81.6 6,332 Malawi 16.6 51.4 6.0 0.2 74.2 131,841 37 Annex 5 : Primary school net attendance ratio Percentage of children of primary school age (6-13) attending primary or secondary school (NAR), Malawi 2006 Boys Girls Total Area Net attendance ratio Number of children Net attendance ratio Number of children Net attendance ratio Number of children Region Northern 89.3 1,833 91.2 1,862 90.3 3,695 Central 79.6 7,027 84.3 7,380 82.0 14,407 Southern 77.9 7,036 79.8 7,439 78.9 14,479 District Balaka 87.3 397 88.2 417 87.7 814 Blantyre 88.1 1,208 88.2 1,181 88.1 2,390 Chikwawa 71.3 631 70.0 673 70.6 1,305 Chiradzulu 86.3 453 88.7 467 87.5 920 Chitipa 92.6 229 93.9 218 93.2 446 Dedza 67.7 319 72.6 317 70.2 636 Dowa 77.7 2,349 86.4 2,493 82.2 4,842 Karonga 82.3 344 84.7 389 83.6 733 Kasungu 86.0 721 88.1 724 87.1 1,445 Lilongwe 81.1 640 84.5 725 82.9 1,365 Machinga 70.2 914 71.4 949 70.8 1,863 Mangochi 70.6 564 73.6 591 72.1 1,155 Mchinji 79.0 969 78.8 983 78.9 1,952 Mulanje 74.7 522 79.0 592 77.0 1,115 Mwanza 77.8 274 87.7 326 83.2 601 Mzimba 90.7 837 93.5 827 92.1 1,664 Nkhata Bay 89.7 221 88.9 213 89.3 435 Nkhotakota 80.1 296 82.6 299 81.4 595 Nsanje 74.6 304 75.9 290 75.3 594 Ntcheu 82.2 598 86.9 616 84.6 1,214 Ntchisi 80.8 314 84.6 384 82.9 698 Phalombe 69.4 333 75.3 379 72.5 712 Rumphi 91.3 202 93.6 215 92.5 418 Salima 81.3 821 83.5 839 82.4 1,660 Thyolo 78.8 682 80.2 748 79.5 1,430 Zomba 78.3 754 80.8 825 79.6 1,579 Malawi 80.0 15,896 83.0 16,680 81.5 32,581 38 Annex 6 : Comprehensive knowledge about HIV prevention Percentage of adults aged 15-49 years who have comprehensive knowledge about HIV prevention, Malawi 2006 Women Men Area Have comprehensive knowledge Number Have comprehensive knowledge Number Region Northern 36.9 2,857 42.6 869 Central 34.2 11,685 29.9 3,512 Southern 47.3 11,716 50.6 3,255 District Balaka 51.1 588 81.1 175 Blantyre 58.9 2,278 53.8 688 Chikwawa 34.9 913 54.5 307 Chiradzulu 58.5 804 50.9 200 Chitipa 31.8 322 24.0 85 Dedza 28.7 496 31.0 124 Dowa 36.0 3,988 27.5 1,221 Karonga 50.8 562 26.3 164 Kasungu 44.3 1,113 35.5 385 Lilongwe 42.8 1,211 43.7 381 Machinga 38.4 1,525 16.5 349 Mangochi 46.4 880 26.8 225 Mchinji 33.3 1,581 17.3 501 Mulanje 73.6 913 72.4 249 Mwanza 32.1 482 57.1 136 Mzimba 34.0 1,304 57.3 424 Nkhata Bay 27.3 336 11.7 98 Nkhotakota 28.3 479 39.4 133 Nsanje 46.9 435 41.8 123 Ntcheu 23.7 991 18.6 234 Ntchisi 18.7 544 8.3 178 Phalombe 24.8 528 35.1 143 Rumphi 39.4 334 54.0 98 Salima 31.6 1,283 49.3 357 Thyolo 34.5 1,135 43.5 275 Zomba 45.9 1,236 70.1 384 Malawi 40.3 26,259 40.2 7,636 39 Annex 7 : MDG Indicators : Malawi Data for 20 of 48 MDG indicators have been collected in MICS. The following tables provide information on 16 key MDG indicators to help monitoring the progress made by Malawi in the achievement of seven MDGs. Data on the remaining 4 MDG indicators namely (i) Proportion of pupils starting grade 1 who reach grade 5 (ii) Literacy rate of 15-24 year-olds (iii) Ratio of literary women to men, 15-24 years old and (iv) Maternal mortality ratio will be published in the MICS Main Report. Except for Maternal Mortality Ratio, data for all the MDG indicators will be available by district. MDG 1 : Eradication of extreme poverty and hunger Stunting Wasting Underweight* Source - 3 SD -2 SD - 3 SD -2 SD - 3 SD -2 SD MICS 2006 20.5 45.9 0.5 3.3 3.4 19.4 MDHS 2004 22.2 47.8 1.6 5.2 4.5 22.0 * : MDG Indicator 4 MDG 2 : Achieve universal primary education Primary school net attendance ratio Source Total Boys Girls MICS 2006 81.5 80.0 83.0 MDHS 2004 82.0 80.1 83.9 MDG Indicator 6 MDG 3 : Promote gender equality and empower women Ratio of girls to boys in primary school Source Total Urban Rural MICS 2006 1.04 0.99 1.05 MDHS 2004 0.94 0.93 0.95 MDG Indicator 9 MDG 4 : Reduce child mortality Source Neonatal Mortality (NN) Post neonatal Mortality (PNN) Infant Mortality ** (IMR) Child Mortality (1-4) Under Five Mortality * (U5MR) MICS 2006 31 38 69 53 118 MDHS 2004 27 49 76 62 133 * : MDG Indicators 13 ** : MDG Indicators 14 40 Childhood vaccinations Source BCG DPT1 DPT 2 DPT 3 Polio1 Polio2 Polio3 Measles* All MICS 2006 95.5 96.2 93.1 86.2 95.7 90.9 81.3 85.2 71.4 MDHS 2004 91.4 95.0 90.6 81.5 94.9 89.7 77.7 78.7 64.4 * : MDG Indicator 15 MDG 5: Improve maternal health Proportion of births attended by skilled health personnel Source Total Urban Rural MICS 2006 53.6 81.6 50.4 MDHS 2004 57.1 83.8 52.0 MDG Indicator 17 MDG 6 : Combat HIV/AIDS, malaria and other diseases Condom use rate of the contraceptive prevalence rate Source Total Urban Rural MICS 2006 1.6 1.3 1.6 MDHS 2004 1.8 1.1 1.9 MDG Indicator 19 Condom use at last high-risk sex (among 15-24) Women Men Source Total Urban Rural Total Urban Rural MICS 2006 39.6 51.9 35.8 59.6 69.1 57.8 MDHS 2004 35.2 48.6 29.2 46.8 58.2 43.3 MDG Indicator 19.a Percentage of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS Source Women Men MICS 2006 41.6 40.7 MDHS 2004 23.6 36.3 MDG Indicator 19.b Contraceptive prevalence rate Source Total Urban Rural MICS 2006 41.7 45.4 41.2 MDHS 2004 32.5 37.2 31.6 MDG Indicator 19.c 41 Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years Source Total Boys Girls MICS 2006 0.97 0.96 0.99 MDHS 2004 1.00 1.00 1.00 MDG Indicator 20 Proportion of population in malaria-risk areas using effective malaria prevention measures Slept under a bednet Slept under an ITN* Source At least one Bednet At least one ITN T U R T U R MICS 2006 49.5 35.0 29.0 52.1 26.1 23.0 42.9 20.6 MDHS 2004 41.9 27.4 20.2 19.4 21.0 14.8 35.2 15.0 * : MDG Indicator 22 MDG 7 : Ensure environmental sustainability Proportion population using solid fuels Source Total Urban Rural MICS 2006 98.8 91.9 99.7 MDHS 2004 97.9 88.7 99.7 MDG Indicator 29 Proportion of population with sustainable access to an improved water source Source Total Urban Rural MICS 2006 74.2 96.2 71.3 MDHS 2004 62.4 91.4 56.9 MDG Indicator 30 Proportion of population with access to improved sanitation Source Total Urban Rural MICS 2006 88.2 97.3 86.9 MDHS 2004 85.4 94.8 83.7 MDG Indicator 31 42 Annex 8 : Indicators Definitions # Indicator Numerator Denominator 1. Neonatal mortality rate Probability of dying within the first month of life 2. Postneonatal mortality rate Difference between infant and neonatal mortality 3. Infant mortality rate Probability of dying by exact age 1 year 4. Child mortality Probability of dying between the first and the fifth birthday 5. Under-five mortality rate Probability of dying by exact age 5 years 6. Stunting prevalence Number of children under age five that fall below minus two standard deviations from the median height for age of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe) Total number of children under age five measured 7. Wasting prevalence Number of children under age five that fall below minus two standard deviations from the median weight for height of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe) Total number of children under age five weighed and measured 8. Underweight prevalence Number of children under age five that fall below minus two standard deviations from the median weight for age of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe) Total number of children under age five that were weighed 9. Exclusive breastfeeding rate Number of infants aged 0-3 months, and 0-5 months that are exclusively breastfed Total number of infants aged 0-3 months, and 0-5 months surveyed 10. Timely complementary feeding rate Number of infants aged 6-9 months that are receiving breastmilk and complementary foods Total number of infants aged 6-9 months surveyed 11. Continued breastfeeding rate Number of infants aged 12-15 months, and 20-23 months, that are currently breastfeeding Total number of children aged 12-15 months and 20-23 months surveyed 12. Tuberculosis immunization coverage Number of children aged 12-23 months receiving BCG vaccine before their first birthday Total number of children aged 12-23 months surveyed 13. Immunization coverage for diphtheria, pertussis and tetanus (DPT) Number of children aged 12-23 months receiving DPT3 vaccine before their first birthday Total number of children aged 12-23 months surveyed 43 # Indicator Numerator Denominator 14. Polio immunization coverage Number of children aged 12-23 months receiving OPV3 vaccine before their first birthday Total number of children aged 12-23 months surveyed 15. Measles immunization coverage Number of children aged 12-2 months receiving measles vaccine before their first birthday Total number of children aged 12-23 months surveyed 16. Fully immunized children Number of children aged 12-23 months receiving DPT1-3, OPV-1-3, BCG and measles vaccines before their first birthday Total number of children aged 12-23 months surveyed 17. Antibiotic treatment of suspected pneumonia Number of children aged 0-59 months with suspected pneumonia in the previous 2 weeks receiving antibiotics Total number of children aged 0-59 months with suspected pneumonia in the previous 2 weeks 18. Solid fuels Number of residents in households that use solid fuels (wood, charcoal, crop residues and dung) as the primary source of domestic energy to cook Total number of residents in households surveyed 19. Under-fives sleeping under mosquito nets Number of children aged 0-59 months that slept under a mosquito net the previous night Total number of children aged 0-59 months surveyed 20. Under-fives sleeping under insecticide- treated nets Number of children aged 0-59 months that slept under an insecticide-treated mosquito net the previous night Total number of children aged 0-59 months surveyed 21. Use of improved drinking water sources Number of household members living in households using improved sources of drinking water Total number of household members in households surveyed 22. Use of improved sanitation facilities Number of household members using improved sanitation facilities Total number of household members in households surveyed 23. Contraceptive prevalence Number of women currently married or in union aged 15-49 years that are using (or whose partner is using) a contraceptive method (either modern or traditional) Total number of women aged 15-49 years that are currently married or in union 24. Antenatal care Number of women aged 15-49 years that were attended at least once during pregnancy in the last 2 years preceding the survey by skilled health personnel Total number of women surveyed aged 15-49 years with a birth in the 2 years preceding the survey 25. Skilled attendant at delivery Number of women aged 15-49 years with a birth in the 2 years preceding the survey that were attended during childbirth by skilled health personnel Total number of women surveyed aged 15-49 years with a birth in the 2 years preceding the survey 44 # Indicator Numerator Denominator 26. Institutional deliveries Number of women aged 15-49 years with a birth in the 2 years preceding the survey that delivered in a health facility Total number of women surveyed aged 15-49 years with a birth in 2 years preceding the surey 27. Net primary school attendance rate Number of children of primary- school age currently attending primary or secondary school Total number of children of primary- school age surveyed 28. Gender parity index Proportion of girls in primary education Proportion of boys in primary education 29. Child labour Number of children aged 5-14 years that are involved in child labour Total number of children aged 5-14 years surveyed 30. Marriage before age 15 and age 18 Number of women that were first married or in union by the exact age of 15 and the exact age of 18, by age groups Total number of women aged 15-49 years and 20-49 years surveyed, by age groups 31. Young women aged 15-19 years currently married or in union Number of women aged 15-19 years currently married or in union Total number of women aged 15-19 years surveyed 32. Comprehensive knowledge about HIV prevention among adults aged 15-49 Number of women and men aged 15-49 years that correctly identify two ways of avoiding HIV infection and reject three common misconceptions about HIV transmission Total number of women and men aged 15-49 years surveyed 33. Condom use at last high-risk sex Number of women and men aged 15-24 years reporting the use of a condom during sexual intercourse with their last non-marital, non- cohabiting sex partner in the previous 12 months Total number of women and men aged 15-24 years surveyed that had a non- marital, non-cohabiting partner in the previous 12 months 34. Children not living with a biological parent Number of children aged 0-17 years not living with a biological parent Total number of children aged 0-17 years surveyed 35. Prevalence of orphans Number of children under age 18 with at least one dead parent Total number of children under age 18 surveyed 36. School attendance of orphans versus non-orphans Proportion of double orphans (both mother and father dead) aged 10-14 years attending school Proportion of children aged 10-14 years, both of whose parents are alive, that are living with at least one parent and are attending school

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