Mongolia - Multiple Indicator Cluster Survey - 2000

Publication date: 2000

FIRST CALL FOR CHILDREN MONGOLIA CHILD and DEVELOPMENT survey-2000 (Multiple Indicator Cluster Survey-2) NATIONAL REPORT 2001· For information, contact the National Statistical Office at: Government Building III Baga toiruu 44, Sukhbaatar District, Ulaanbaatar, Mongolia E-mail:SSO@magicnet.mn Fax: 976-11-324518 Published by the National Statistical Office Ulaanbaatar, Mongolia 2001 CHILD AND DEVELOPMENT SURVEY-2000 (MICS-2) Contents List of Figures . iv Foreword . v Acknowledgements . vii Map of Mongolia . viii Executive Summary . ix Summary Indicators . xiii I. INTRODUCTION . 1 Background for the survey . 1 Background of Mongolia . 2 II. SURVEY METHODOLOGY . 7 2.1. Survey population and survey reference period . 7 2.2. Sampling . 7 2.3.Questionnaires . 9 2.4.Fieldwork and Data processing . 10 III. SAMPLE CHARACTERISTICS AND QUALITY OF INFORMATION . 13 3.1.Response Rate . 13 3.2.Missing data and age distribution: . 13 3.2 .l.Quality of information . . . . . . . . . . . 13 3.2 .2 .Age distribution of survey population . . . . . . . . . . . . . 13 3.2 .3. Demographic characteristics of the survey household . . 13 IV. THE RESULTS OF THE SURVEY . 17 A.Infant and US Mortality . 17 B.Education . 18 B.l.Early Childhood Education . . . . . . . : . 19 B .2 .Basic Education . . 19 B .3.Literacy . 21 C. Water and Sanitation . 23 C. I. Use of safe drinking water . 23 C .2. Use of sanitation . 25 D.Child Food and Nutrition . 26 D .].Nutritional status . 26 D .2 .Breastfeeding . 28 D.3.Salt iodization . . . . . . . . . . . . . 29 D.4.Vitamin A supplementation . 30 D.5 .Low Birth Weight . . . . . . . . . . . . . . . 31 E. Child Health . 33 E.l.Immunization coverage . 33 E.2.Diarrhea . . . . . . . . . . . . . . . 34 E.3.Acute Respiratory Infection . 35 E.4./ntegrated Management of Childhood Illnesses . . . . . . . . . . . 35 "Child and Development-2000" survey, Mongolia National report iii List of Figures F. HIV I AIDS . 37 Fl.AIDS knowledge . · . 37 F2.AIDS Testing . 39 G .Reproductive Health . 40 G.l.Contraception . . . . . . . . . . 40 G.2.Prenatal care . . . . . . . . . 41 G .3 .Assistance at delivery . . . . . . . . 42 H. Child Rights and Children in difficult circumstances . 42 H.l.Birth Registration . 42 H.2.0rphans and neglected children . . . : . . . . 43 H.3 .Child Labor . . . . . . . . . . 43 APPENDIX A . 45 APPENDIX B . 46 APPENDIX C . 49 List of Figure Figure 1: Single year age distribution of the household population by sex. Mongolia 2000 . 13 Figure 2: Age distribution: Women aged 15-49. Mongolia 2000 . . 13 Figure 3: Women aged 15-49 years by education level. Mongolia 2000 . 14 Figure 4: Age distribution, children under five age. Mongolia 2000 . 14 Figure 5: Percentage of children aged 36-59 months who are attending at Early childhood program. Mongolia 2000 . 19 Figure 6: Percentage of children of primary school age attending primary school. Mongolia 2000 . 20 Figure 7: Percentage of children entering first grade of primary school who eventually reach grade 5. Mongolia 2000 . 21 Figure 8: Percentage of distribution of the population by source of drinking water . 24 Figure 9: Percentage Distribution of the Population by type of sanitary facility used. Mongolia 2000 . 25 Figure 10: Percentage Distribution of the Population by location and sanitary facility used. Mongolia 2000 . 26 Figure 11: Percentage of Under 5 children who are undernourished. Mongolia 2000 . 28 Figure 12: Percent distribution of living children by breastfeeding status. Mongolia 2000 . 28 Figure 13: The consumption level of adequately iodized salt. Mongolia 2000 . , . 30 Figure 14: Children aged 6-59 months,receiving a high dose Vitamin "A" supplementation. Mongolia 2000 . 31 Figure 15: Incidence of Low weight and proportion of Infants weighed at birth by location. Mongolia 2000 . 32 Figure 16: Percentage of children aged 12-23 months who received immunizations by age 12 months. Mongolia 2000 . 33 Figure 17: Percentage of children aged under 5 with diarrhea in the 2 weeks prior to the survey, by drinking and eating status. Mongolia 2000 . 35 Figure 18: Percentage of children aged under 5,with ARI and treatment by health providers. Mongolia 2000 . 36 Figure 19: Percentage of caretakers of children under 5 years, who know at least 2 signs for seeking care immediately. Mongolia 2000 36 Figure 20: Percentage of women aged 15-49 who have sufficient knowledge of HIV/ AIDS transmission by level of education. Mongolia 2000 . 39 Figure 21: Percentage of women aged 15-49 who use contraceptive methods, Mongolia, 2000 . 41 Figure 22: Percent distribution of women who gave birth in the year prior to the survey by type of personnel assisting at delivery. Mongolia 2000 . 42 Figure 23: Children 0-14 years of age, not living with parents. Mongolia 2000 . 43 Figure 24: Percentage of children 5-14 years who are working. Mongolia 2000 . 44 iv "Child and Development-2000" survey, Mongolia National report Foreword The Child and Development Survey - 2000, which is the Mongolian title of the second Multi Indicator Cluster Survey (MICS-2) to have been conducted in Mongolia, has been implemented by the National Statistical Office of Mongolia with support from UNICEF. It has been a truly collaborative effort involving both international and national agencies. In the organisation of this Multiple Indicator Cluster Survey-2, and in the processing and analysis of the data collected, we have collaborated with the Ministry of Education, Science and Technology and Culture, the Ministry of Health, the State Police Department and the National Children 's Centre, now known as the National Committee for Children, as well as the Mongolian Child Rights Center. The project also benefited from four MICS-2 workshops, one in the capital city of Ulaanbaatar and three regional workshops in the East Asian Pacific region, two of which were held in Bangkok and one in Yangoon. These workshops were organized by UNICEF as part of the global MICS-2 effort associated with the end-decade assessment of the goals of the World Summit for Children, and were especially designed for the key organisations involved in the survey and their staff. Although the sample size of the survey was large, it has been very efficiently executed, in a short period of time, due to an effective consultative process, a strong team of interviewers, good technical and financial support and the special focus that was given to the data processing, report writing and analysis. The data processing and analysis was prepared within seven months of the completion of the fieldwork. In December 2000, a consultant was invited from the UNICEF regional office for East Asia and the Pacific to help in the analysis of the findings and to write the first draft of the report, and the resulting report, in both the Mongolian and English versions, and is now being distributed to the public. The report gives a profile of the current health and education situation of children and women in Mongolia, by region, by mother's education level and by mother 's and child's age group. This report provides accurate and systematic information for the evaluation of the National Programme of Action for Children 1990-2000 and base-line data for the new National Programme of Action for Children 2001- 2010. The survey makes available a rich information data-bank and analyses the factors that effect the situation and access to basic services of women and children in Mongolia. Moreover the survey provides data concerning the situation of children in need of special protection, such as children engaged in hazardous labor. The results of this report and the attached tables will be useful for development researchers whose interests focus on the situation of children, adolescents and "Child and Development-2000" survey, Mongolia National report v vi women. Many areas deserve a far greater in-depth focus and further studies. We hope that this survey will be useful for policy makers and planners, who work in the areas of social policy reform, and for those who will conceive, design and plan the National Programme of Action for Children for the next decade. This report is dedicated to our dear friend and colleague, Matthew Girvin, who was tragically killed in a helicopter crash in January 2001, while on a United Nations Disaster Assistance Mission. Matthew's dedicated work in the last four years, as UNICEF's Programme Officer, has laid much of the foundation for the work that will be conducted in service of children in the years to come. We hope you find this report useful. Ch. Davaasuren Gabriella De. Vita Chair person Assistant Representative NSO Mongolia UNICEF, Mongolia "Child and Development-2000" survey, Mongolia National report Acknowledgements This Child and Development Survey-2000 is Mongolia 's second multiple indicator cluster survey (MICS 2), which has been conducted, with the financial and technical support of UNICEF, among households, women of reproductive age and children. The purpose of this survey is to establish comprehensive statistical data to evaluate the impact of Mongolia's National Program of Action for Children in the 1990s, and to aid future planning and the organisation of a new National Programme of Action for Children 2001- 2010. This survey complements and completes the first Multiple Indicator Cluster Survey which was conducted in 1996. Overall, the findings of the Child and Development Survey -2000 (MICS-2) will be a valuable source of information in analysing the current situation of infants, children and women in Mongolia and the factors which impact their situation. It will also be extremely helpful in assessing the impact of the transition period on the status of women and children during the past ten years. Both National Statistical Office and UNICEF staff have dedicated a great deal of time and effort towards the successful completion of this project, both during the conducting of the survey and in the preparation of this report. First of all, I would like to express my deep appreciation to UNICEF, Mongolia, for its financial support for this second Multiple Indicator Cluster Survey on the situation of Mongolian women and children, and for the technical assistance provided by UNICEF consultants and staff from the Regional Office for East Asia and the Pacific, the Area Office for China and Mongolia and as well as the Country Office in Mongolia. Also, I wish to give my thanks to the Ministry of Education, Science and Technology and Culture, the Ministry of Health, the State Police Department and the National Children's Centre, now known as the National Committee for Children, as well as the Mongolian Child Rights Center (a non-governmental organization) for their invaluable contribution towards the organization and review of the questionnaire for this second Multiple Indicator Cluster Survey. I would also like to express my special gratitude to the staff of the National Statistical Office of Mongolia for their tremendous work, their dedication and commitment as the leading agency in the conduct of the survey and the writing of the report during the entire period of the project. It is hoped that the NSO staff, especially the statisticians and programmers have improved their professional knowledge and skills using the combined special software employed in the Multiple Indicator Cluster Survey Two. Special thanks are due to the leadership of both government and non-government agencies of Mongolia and UNICEF in Mongolia. Above all, we would like to pay tribute to the work of UNICEF's Programme Officer, Mr. Matthew Girvin, who was the driving force of the project from the outset. Matthew 's tragic death has meant the loss of a stron12: voice for Mongolia 's children and we all continue to feel his absence deeply. B. Batmunkh Project manager of MICS-2. "Child and Development-2000" survey, Mongolia National report vii Map of Mongolia ULG II (!) BAYAN-ULGII ULAA NGOM 0 uvs KHOVD 0 ZAVKHAN ULIASTAI 0 ALTAI 0 KHUVSGUL MURUN 0 ARKHANGAI TSETSERLEG 0 BA YANKHONGOR 0 (!) SUK'HBAATAR BULGAN SELENGE DARKHAN-UUL DARKHAN (!) ERDENET 0 0 0RKHON HULGAN FiJ ULAANB~TAR ZUUNMOD TUV ( HOIR ARVAIKHEER 0 KHENTII 0 UNDURKHAAN 0 GOBISUMBER DORNOD 0 CHOIBALSAN BARUUN-URT 0 SUKHBAATAR GOBI-ALTAI UVURKHANGAJ 0 DORNOGOVI BAYANKHONGOR The name of the aimags and somans involved in the survey Name of Aimags Name of Somans 1. Arkhangai Battsengel, Tsenkher, Tuvshruuleh , Eredenebulgan, Khotont, lkh tamir, Under-Uiaan, Tariat 2. Bayankhogor Bayankhongor, Hureemaral, Galuut, Bumbogor, Buutsagaan, Zag, Erdenetsogt 3. Gobi-Aitai Darvi, Sharga, Esonbulag, Biger, Delger 4. Dornogovi Urgen, Saikhan-Uut, Altanshiree, Oalanjargalan 5. Dornod Kherlen, Sergelen , Bayan-Uul , Malad 6. Dundgovi Adaatsag, Erdenedalai , Saikhan-Ovoo, Gurvansaikhan, Mandalgovi 7. Zavkhan Tsagaankhairkhan , Uliastai, Yaruu, Nomrog, Tosontsengel, lkh-Uul 8. Uverkhangai Uyanga, Taragt, Nariinteel, Zuunbayan-Uiaan , Kharkhorin , Esonzui l, Ulziit, Arvaikheer, Khairkhandulaan, Baruunbayan-Utaan 9. Umnogovi Dalanzadgad, Nomgon, Bayandalai, Khankhongor ·-- MANDALGOVI SAINSHAND DUNDGOVI 0 DALANZADGAD 0 UMNUGOVI Name of Aimags Name of Somans 10. Sukhbaatar Baruun-Urt, Khalzan, Munkhkhaan, Dariganga, Asgat, Sukhbaatar 11. Setenge Sukhbaatar, Tsagaannuur, Altanbulag, Orkhon, Shaamar, Eroo 12. Tov Bayanjargalan, Sayan, Bayantsagaan, Sergelen, Zuunmod, Jargalant, Bayanchandmani, Altanbulag, Bayankhangai 13. Uvs Tarialan , Sagil, Ulaangom, Tes, Naranbulag, Zuungovi 14. Khovsgol Moron, Ulaan-Uul, Khatgal , Chandmani-Under, Tarialan, lkh-Uul 15. Khentii Norovlin, Bayan-Adarga, Dadal, Binder, Batshireet 16. Darkhan-Uut Orkhon, Darkhan, Shariin-Gol 17. Utaanbaatar Songinokhairl<han, Khan-Uul, Bayangol, Chingeltei, Bayanzurl<h, Baganuur, Gachuurt, Bagakhangai Executive Summary The Multiple Indicator Cluster Survey (MICS) was prepared for monitoring progress towards the mid decade goals of the World Summit for Children 1990. It was expanded and revised to reflect all the end decade goals and to incorporate the experience gained in conducting some 60 multiple indicator cluster surveys between 1995 and 1996. It also addresses specific challenges identified in the evaluation of multiple indicator cluster surveys conducted in 1997 and it takes us an important step closer to measuring progress in the implementation of Children's Rights. The Child and Development Survey - 2000 Mongolia, is the second nationally representative multiple indicator cluster survey (MICS-2) of households, women and children. The main objectives of the survey were to assess the implemenation of the National Programme for Action for the Children and the main goals established at the World Summit for Children and to develop a basis for future action. Infant and Under Five Mortality • Mortality estimates were obtained using the United Nations QFIVE computer program. For Mongolia, the West model life table was considered to be th-e most appropriate choice. According to the current survey's indirect estimates, using WHO and international statistical methods, the infant mortality rate was 64 (per 1 ,000) and the under-five mortality rate 87 (per 1,000) for · the year 1996. Education • Only 21 per cent of the children between the ages of 36 and 59 months are presently attending an organized learning or early childhood education program (Table 9). • In Mongolia the official primary school age is 8-11 years. However, to allow international comparability date from the MICS-2 survey are tabulated for children 7-12 years. As Table 10 shows almost 76 per cent of children aged 7-12 years group are attending school. If tabulated for children in the 8-11 age group the attendance rate increases to 84.5 per cent. The attendance rate at primary school is about 10 percent higher in urban areas than in rural areas. • About 94.7 per cent of children who enter grade 1 reach grade 5 (Table 11). In urban areas, 97 per cent of children eventually reach the fifth grade, whereas in rural areas the figure is 4 percent lower, at 93.2 percent. • The survey found that, overall, 98 per cent of the population over 15 years old, are literate. The differential between men and women, and urban and rural areas is very small (98.6 % for men, 98.5 % for women).The MICS-2 findings correspond closely with figures from the 2000 population census, which found 97.8 per cent literacy in the total population aged 15 years and above, 98 per cent for men and 97.5 per cent for women (Table 12). Water and Sanitation • According to the survey results, 60.5 per cent of the Mongolian population is supplied with clean and safe drinking water. Clean drinking water reaches 90.8 per cent of the population in urban centers but only 34.4 per cent in rural areas (Table 13). There are also major variations between the geographic re- giOns. • Survey data indicate that 73.9 per cent of the population has access to improved sanitary facilities, which include flush toilets connected to sewage systems or septic tanks, "Child and Development-2000" survey, Mongolia National reporl ix X other flush toilets, improved pit latrines, traditional pit latrines. If this is disaggregated according to location, 96.9 per cent of the urban population uses improved sanitary facilities, compared to only 54.1 per cent in the countryside (Table 14). The supply of drinking water source and type of sanitary facilities used in Mongolia is closely associated with the type of housing and the location. Child Nutritional Status • One out of ten surveyed children under the age of 5 were found to be moderately or severely underweight, one in four (of the same age group were stunted and one in 20 children were found to be wasting (Table 15). • The cases of underweight, stunting and wasting in children under five in rural areas are twice as numerous as those in urban areas. • The MICS-2 indicates that there is a clear correlation between malnutrition in young children and mother's education. Children whose mothers had only primary schooling or less, are 3 times as likely to be stunted than those whose mothers had university education. Breastfeeding • About 64 per cent of babies under 4 months were breastfed exclusively, lower than the recommended 100 per cent but significantly higher than the average in many regions of the world (Table 16). Approximately 54 per cent of children aged 6-9 months were breastfed along with complementary feeding, 7 5 per cent aged 12- 15 months and 57 per cent of children aged 20-23 months were also still being breastfed. Salt Iodi::ation • Overall, 45 per cent of the surveyed households had adequately iodized salt, but there was found to be a very wide variability from region to region (Table 17). Vitamin A Supplementation • Within six months prior to the Child and Development Survey - 2000, about 32 per cent of children aged 6~59 months had been given the high dose vitamin A supplement. An additional 11 per cent had received the supplement more than 6 months ago, and 54 per cent are reported never to have received it (Table 18). • From all 6 regions, a total of 13 percent of children had recieved high dose vitamin "A" supplementation within 8 weeks after birth (Table 19). Low Birth weight • The survey found 5 per cent of newborns had low birth weight (Table 20). Immunization Coverage • About 96 per cent of surveyed children in the 12-23 month age group had been vaccinated for all six major antigens within the first 12 months after birth. • Measles still has the lowest coverage of all the vaccines, at 86 per cent (Table 21). Diarrhea • More than 60 per cent of children with diarrhea were fed breast milk and 56 per cent were given packaged ORS. (N.B. Multiple answers were accepted so percentages do not add up to 100) (Table 23). "Child and Development-2000" survey, Mongolia National report • About 98 per cent of the diarrhea cases received one or more recommended forms of treatment. • The most appropriate treatmemt - increased fluids and continued eating - was reported in only 32 per cent of the cases (Table 24). Acute Respiratory Infection • During the period of the survey, from May to August 2000, about 2 per cent of the children under five were found to have ARI. • About 78 per cent of these cases taken for treatment to a health provider, in most instances a hospital or health center. • One out of ten children, aged 6-23 months, have ARI and the numbers decrease as the age of the child increases (Table 25). Integrated Management of Childhood Illness Initiative • About 15 per cent of children under five years in the sample were reported to have diarrhea or some other illness in the two weeks prior to the survey.and 44 per cent of these were aged between 6-23 months, indicating that this age group is more vulnerable to sickness (Table 26). • 39 per cent of children were given more than usual to drink and 57 per cent were given the same or less. • 78 per cent of children were fed the same as usual and less than 20 per cent of children under 6 months old were given more than usual to drink, whereas the percentage among older children ranges from 35-50 per cent. • The number of women with knowledge of when it is appropriate to seek medical care is increasing. One out of 3 mothers or caretakers in the survey were able to properly identify two appropriate symptoms that indicate a sick child should be taken for professional treatment. • The most common response, given by 58 per cent of mothers and caretakers, was that a fever would be sufficient cause to take a child for professional treatment. Forty seven per cent of mothers said they would take a child for professional treatment if it they became increasingly sick (Table 27). HJV/AIDS • Three out of four women were able to identify two effective ways of preventing HIV infection (Table 30a). • One out of3 women of reproductive age were able to correctly identify 3 misconceptions about AIDS transmission (Table 31). • In Mongolia, more than half of the women surveyed (54 per cent) know where they can be tested for AIDS, and 14 per cent have actually been tested. Of those tested, a large majority have collected the results (Table 35). Contraception • Current use of some kind of contraception was reported by 67 per cent of the surveyed women who are married or living with a partner. • By far the most popular method is IUD, used by 33 per cent of these women. • About 54 per cent of women used a modem contraceptive method (Table 36). Prenatal Care • About 97 per cent of the women of reproductive age who gave birth in the year prior to the survey received prenatal care "Child and Development-2000" survey, Mongolia National report xi from professional medical practitioners and 60 per cent of these had deliveries assisted by a doctor (Table 38/39). Child Ri~hts and Children in Difficult Circumstances Birth Registration • About 98 per cent of children aged 0- 59 months have been registered. However, a significant proportion are not registered at or soon after birth, and only 85 per cent of children under 6 months of age were found to have been registered (See Table 40). Living Arrangements of Children, including Orphans • About 80 per cent of children are living with both biological parents, and less than 2 per cent do not live with a biological parent. • In the case of nearly 17 per cent of children, who live with only one parent, it is much more likely that this parent will be the mother. • Twelve per cent of children are living with their mother only, even though their father is still alive, and 0.3 per cent of children are living with their father only, even though their mother is still alive. • The survey found that 0.3 per cent of children under five, are orphans, with both of the parents deceased. Child Labor • More than 30 percent of children aged 5-14 are likely to be working for more than 4 hours per day. Of those who work for 4 or more hours a day, 20 per cent are working at home • According to the survey findings, about 1.4 per cent of children are engaged in paid work for someone other than a household member. xii "Child and Development-2000" survey, Mongolia National report Summary Indicators World Summit for Children Indicators Under-five mortality rate Probability of dying before reaching age five 87 per 1000 Infant mortality rate Probability of dying before reaching age one 64 per 1000 Underweight prevalence Proportion of under-fives who are too thin for their age 13 percent Stunting prevalence Proportion of under-fives who are too short for their age 25 percent Wasting prevalence Proportion of under fives who are too thin for their height 5 percent Use of safe drinking water Proportion of population who use a safe drinking water source 60 percent Use of sanitary means of Proportion of population who use a sanitary means of excreta 74 percent excreta disposal disposal Children reaching grade five Proportion of children entering first grade of primary school 95 percent who eventually reach grade five Net primary school attendance Proportion of children of primary school age attending primary 76'l percent rate school Literacy rate Proportion of population aged 15+ years who are able to read a 98 percent letter or newspaper Antenatal care Proportion of women aged 15-49 attended at least once during 97 percent pregnancy by skilled personnel Contraceptive prevalence Proportion of married women aged 15-49 who are using a 67 percent contraceptive method Childbirth care Proportion of births attended by skilled health personnel 97 percent Birth weight below 2.5 kg. Proportion of live births that weigh below 2500 grams 5 percent Iodized salt consumption Proportion of households consuming adequately iodized salt 45 percent Children receiving Vitamin A Proportion of children aged 6-59 months who have received a 32 percent supplementation Vitamin A supplement in the last 6 months Mothers receiving Vitamin A Proportion of mothers who received a Vitamin A supplement 13 percent supplementation before infant was 8 weeks old Exclusive breastfeeding rate Proportion of infants aged less than 4 months who are exclu- 64 percent sively breastfed Timely complementary feeding Proportion of infants aged 6-9 months who are receiving breast 54 percent rate milk and complementary food Continued breastfeeding rate Proportion of children aged 12-15 months and 20-23 months 75 percent (12-15) who are breastfeeding 57 percent (20-23) DPT immunization coverage Proportion of children immunized against diphtheria, pertussis 99 percent and tetanus by age one Measles immunization Proportion of children immunized against measles by age one 98 percent coverage Polio immunization coverage Proportion of children immunized against polio by age one 99 percent Tuberculosis immunization Proportion of children immunized against tuberculosis by age 99 percent coverage one ORT use Proportion of under-five children who had diarrhea in the last 2 . weeks who were treated with oral rehydration salts or an 56 percent appropriate household solution Home management of diarrhea Proportion of under-five children who had diarrhea in the last 2 weeks and received increased fluids and continued feeding 32 percent during the episode Care seeking for acute respira- Proportion of under-five children who had ARI in the last 2 78 percent tory infections weeks and were taken to an appropriate health provider 11 For the context See page 19 "Child and Development-2000" survey, Mongolia National report xiii Preschool development Proportion of children aged 36-59 months who are attending 21 percent some form of organized early childhood education program Indicators for Monitoring Children's Rights Birth registration Proportion of under-five children whose births are reported 98 percent registered Children's living arrangements Proportion of children aged 0-14 years in households not 20 percent living with a biological parent Orphans in household Proportion of children aged 0-14 years who are orphans living 0.3 percent in households (both parents) 5.6 percent (one parent) Child labor Proportion of children aged 5-14 years who are currently 1.4 percent workin_g Indicators for Monitoring IMCI Home management of illness Proportion of under-five children reported ill during the last 2 30 percent weeks who received increased fluids and continued feeding Care seeking knowledge Proportion of caretakers of under-five children who know at 38 percent least 2 signs for seeking care immediately Indicators for Monitoring HIV I AIDS Knowledge of preventing HIV I Proportion of women who correctly state the 3 main ways of 38 percent AIDS avoiding HIV infection Knowledge of misconceptions of Proportion of women who correctly identify 3 misconceptions 36 percent HIVIAIDS about HIVIAIDS Knowledge of mother to child Proportion of women who correctly identify means of trans- 27 percent transmission mission of HIV from mother to child Attitude to people with HIV I Proportion of women expressing a discriminatory attitude 57 percent AIDS towards people with HIVIAIDS Women who know where to be Proportion of women who know where to get a HIV test 54 percent tested for HIV Women who have been tested Proportion of women who have been tested for HIV 14 percent for HIV xiv "Child and Development-2000" survey, Mongolia National report I. INTRODUCTION Background for the survey At the World Summit for Children, held in New York in late 1990, the Government of Mongolia committed itself to the Summit Declaration and Plan of Action for Children. In addition to the establishment of goals and objectives for the decade of the 1990s, the Plan of Action also called for the establishment of mechanisms for monitoring progress toward these goals. One of the concrete steps taken by the Mongolian Government was a Child Development Survey /Multiple Indicator Cluster Survey (MICS), carried out in 1996 to measure progress at mid-decade. To facilitate a broader and more thorough assessment at the end of the decade, UNICEF, in collaboration with WHO, UNESCO and others developed a core set of 75 indicators of specific aspects of the situation of children. The 2000 Mongolia MICS survey, formally designated the "Child and Development Survey -2000" Mongolia, was carried out to provide end-decade information on many of these indicators and to expand and improve the stock of relevant and reliable data on children's and women 's issues. More specifically, the Multiple Indicator Cluster Survey Two, has as its main objectives: • To monitor and evaluate the implementation of Mongolia's National Program of Action for the Development of Children in the 1990s (NPA). • To furnish data for monitoring progress toward goals established at the World Summit for Children, and as a basis for further action in the first decade of the 21st century. • To contribute to the improvement of data and monitoring systems in Mongolia, to enhance technical expertise in the design and implementation of these systems, and to strengthen the capacity for analysis and use of their findings. Planning and preparation for the Child and Development Survey - 2000 (MICS) began in the last quarter of 1999. One of the first concrete steps was a workshop organized by UNICEF and held at Terelj outsitie Ulaanbaatar in October 1999, where issues related to sampling, questionnaire content and design, logistics and other key survey issues were considered. Participants included UNICEF staff from country, area and regional offices, and representatives of key government ministries and the National Statistical Office (NSO). Subsequently a Steering Committee and Working group, with members from NSO, MOSTEC, MOH, NCC, MCRC and the Police Department, was set up to provide coordination and overall guidance for the survey design, questionnaire development and field implementation. A Working Group, consisting of representatives from relevant sectional ministries and agencies, was also established to provide technical backup and support. The National Statistical Office was given the responsibility for the survey implementation. UNICEF Mongolia provided funding and additional technical assistance. The project also benefited from 3 regional MICS workshops, two held in Bangkok in Sept, 1999 and April 2000, and one in Yangoon in August 2000. These workshops were organized by UNICEF as part of the global MICS effort associated with the end-decade assessment of World Summit for Children goals. International experts in sampling and survey design , questionnaire construction , interview techniques, data processing and management, analysis and report preparation were used as "Chfld and De'-:elopment-2000'! survey, Mongolia National report 1 resource persons. Participants were government and UNICEF staff expected to play key roles in MICS exercises to be carried out in their respective countries. The workshops were scheduled to correspond as closely as possible to the phases of country-level preparation ~nd implementation. A 1 0-day training program for interviewers and other field personnel was carried out in early May 2000 in Ulaanbaatar. The program included training on the survey objectives and the guidance on the interviewing process from UNICEF. Trainers were those who had participated in the regional MICS-2 workshops in Bangkok. At the local training there were around 100 participants, including those who would work as interviewers, editors and supervisors. During the training the participators gained knowledge of the survey objectives and the questionnaire, and the manual for the filling out the questionnaire. All participants studied how to interview, how to fill out the questionnaire and how to make contact with the interviewees. Participants practiced having interviews and learnt how to measure the weight and height of child under 5 years old, and the iodization of table salt used by the surveyed households. Background of Mongolia Mongolia is situated in the center of Asia, between the Russian Federation to the north and the People 's Republic of China to the east, south and west. Mongolia has an extreme continental dry climate and four seasons. The winter is extremely cold, with temperatures falling to 2) Population and Housing Census: 2000 3) Repm ductil ·e Health Sun•e_v, NSOI UNFPA Ulaannhaatar 1999 INTRODUCTION minus 50-55 degrees centrigrade and in summer, especially June, increasing to +30 degrees centigrade. Mongolia is a landlocked country of 1565 thous.square kilometres and is located 1580 metres above sea level with a variety of terrain that includes mountains, forests, steppe and Gobi desert zones. According to the findings of the Population and Housing Census for the year 2000 , the population of Mongolia is 2.4 million with a population density of 1.5 person per square kilometre. According to the Census 2000, 32.5 per cent of the total population live in the capital city of Ulaanbaatar. In the last few years there has been increasing urbanizaion and 58.6 per cent of the population are now living in urban areas, with 41.4 per cent in rural areas2l . The average life expectancy of Mongolians is 64 years. Mongolia is still included among those countries where there is a high fertility rate3l and it is a youthful country with 46.6 per cent of the population being children and adolescents under 19 years old. Young people between the age of 19 and 24 represent 12.1 per cent. Almost 35.2 per cent of women are less than 15 years old and 54.1 per cent are of reproductive age, between 15 and 49. Around 96 per cent of the population are Mongolian. There are Kazakhs and a Turkish- speaking population who live in the western part of the country. There are also a small number of ethnic Chinese and Russian, most of whom live in Ulaanbaatar. The official language is Mongolian, which has its own unique alphabet, but the Cyrillic alphabet is used in official documents, books, newspapers and magazines. ' 2 "Child and Development-2000" survey, Mongolia National report INTRODUCTION Buddhism is the predominant religion. In the last few years, other religions have beyn coming to Mongolia and the Kazakh populations who live in the west of the country practice Islam. Mongolia is currently in transition from a centrally planned economy to a market economy. According to the World Bank Statistical Year Book (1999) in which Mongolia is still included as a developing country, the GDP per person was US$ 380 in 1998. Mongolia's GDP decreased by 3.9 and its industrial output by 30.9 per cent in 1999, at constant prices, from the equivalent in 1989. During this last decade the average income per person decreased by 16 percent due to the increasing population of Mongolia. Mongolia has implemented a program of economic and structural changes with the support of international financial and development agencies . The social and economic systems and patterns established during 70 years of socialism have broken down and social protection systems have been completely transformed during this transition period, giving rise to many new problems that significantly affect the situation of women and children. The poverty level was unregistered in 1990 and was thought to a minimum level at that time by the nature of the centrally planned economic system. The 1995 Living Standards Measurement Survey found that the 36.5 per cent of the population fell below the poverty line, and inequality had risen significantly4l. In 1998, a second Living Standards Measurement Survey5l, found that the number of poor had remained stable over the past three years at around 35.6 per cent. Moreover, it is clear from the 1998 Living Standards Measurement Survey, that the level of poverty is deepening. There are a number of alarming adverse phenomenon which are emerging. For example, a number of school aged children from poor households are dropping out of school in order to earn money by working in conditions that are often hazardous to their health, including a number of young girls who are engaging in prostitution. Due to the economic difficulties, the share of government budget devoted to the social sector has been diminishing significantly and investment in health and education sectors has been decreasing over time. As a result these sectors have been facing considerable difficulties and the availability and the quality of services have been deteriorating. In the past ten years, there has been almost no investment in the building of schools and hospitals. For example, almost no kindergartens were built and only one or two new schools have been built. In rural areas, due to the small number of schools and the relatively few places available, children aged 7 are not able to attend school and children who have graduated from the 8th grade, are not able to continue their education. One of the concerns of today's society is the fact that the number of children who live on the street has been increasing in Mongolia. In most cases, these children are living in the ducts of heating systems or in tunnels underneath buildings and are living by stealing coal, polishing shoes, and portering products or begging. Poverty, and violence and abuse within their families, often from a stepfather or stepmother, are the major reason that these children choose to live on the street. 4) Living Standards Measurement Survey 1995. (NSOIUNDP), Ulaanbaatar 1995 5) Living Standards Measurement Survey 1998. (NSOIUNDP) , Ulaanbaatar 1999 "Child and Development-2000" survey, Mongolia National report 3 I While the Government's commitment to children remains firm, it faces many obstacles and constraints as it attempts to cope with this wide array of social, economic and environmental problems despite seriously limited resources, including budgetary and technical resources. In certain areas, such as those related to exploitative child labor, street children, HIV/AIDS, disabled and homeless children, a serious challenge is the lack of reliable data for assessing and monitoring the magnitude, distribution and severity of the problem as a basis for formulating corrective policies and programs. The MICS-2 survey provides limited information on the current situation in some of these areas, such as knowledge and attitudes about HIV I AIDS, child labor and the living situation of orphans. Though much remains to be done, the findings of this survey may provide a baseline for monitoring trends over time and identifying certain aspects requiring more specific follow- up investigation. The government of Mongolia has committed itself to a Declaration and Plan of Action for Children. Subsequently, a National Program of Action for Children was developed and approved in 1993, and the National Program INTRODUCTION for Advancement of Women was formulated and approved by the Parliament in 1995. In order to improve the coordination of the activities for children and to implement the National Program of Action, the Government of Mongolia, in 1996, established a Working Committee that represents all the Ministries and government and non-governmental organisations working in child related matters. To promote the implementation of the NPA and raise the awareness of the government and the public, the President of Mongolia took the initiative to declare the year of 1995 as the "Year of the Child". The First National Assembly on "Child Development and Protection" was convened, by the decision of Parliament, in 1995. This was an important event to define government policy and create a favorable environment for children's survival, growth and development. The Law on the Protection of Child Rights was adopted by the Mongolian Parliament in May 1996. The present Law defines the legal norms for the protection of the rights of the child in line with the new socio-economic system in Mongolia. 4 ( "Child and Development-2000" survey, Mongolia National report -~ e a:: 0 E 8 .!!1 (.') 1J II. SURVEY METHODOLOGY The questionnaire design, manual and methodologies of the first Child and Develop- ment Survey (MICS-1) conducted in 1996 were improved and used for the development of re- lated materials for the current survey. The meth- odology used in this survey was developed us- . ing the manual for conducting multi indicator cluster surveys and the methodological guide- lines developed by South East Asian Regional Organizations of UNICEF. However the meth- odology also reflects the unique features of the country. The survey was conducted in close collaboration with the Regional Office of UNICEF, which provided support in determin- ing the sample size, selecting possible methods of sampling, developing the general design of the questionnaire and provided the survey team with common data processing methods, soft- ware and guidelines. All classifications, con- cepts and definitions of indicators and meth- ods of estimation used in this survey are based on internationally accepted standard indicators and methods. MACROS International con- ducted a training workshop for the survey team in April 2000 in Bangkok, and also prepared the software programmes ISSA and IMPS which were used in the MICS-2 for the data entry and data processing. 2.1. Survey population and survey reference period Survey population: According to the sur- vey objectives, the current survey subjects were women aged 15-49, children under 5 or of pre- school age, (which in Mongolia includes chil- dren up to the age of 8) and of basic education age (8-15) and disabled children under 18 years in the households of the interviewees. Survey Coverage: We selected 6000 households for the survey which were representative of all Mongolian households by regional, urban and rural stratification. They were taken from 16 aimags and the capital city. Reference period: This survey is not an annual survey. It covers only the year preceeding the survey -the one-year period from June 1999 to June 2000. Some indicators applied statistics only from the end of 1999 and the maternal births were surveyed only from the last time birth was given. 2.2. Sampling 2.2.1 . Sample design: The sample for the survey was designed to provide national estimates for the main indicators covered by the survey, with a margin of error of ±5 percentage points at a 95 per cent level of confidence. As Mongolia is a large country encompassing a wide variety of social, economic and geographic conditions, the survey was also designed to produce separate estimates for 6 regions( Western, Northern, Eastern, Southern, Central-1 and Central-2) as well as for urban and rural areas. The survey covereq the capital city and 16 aimags, with between three and six soums surveyed in each aimag. These sub-national estimates are of course subject to somewhat wider margins of error than applies at national level. 6) The technical manual, Monitoring Progress toward the Goals of the World Summit for Children, and other documentation related to the Multiple Indicator Cluster Survey can be found at www.childinfo.org. A detailed discussion of MJCS sampling · procedures, including the formula for determining the required sample size, is presented in Appendix 7 of the manual. "Child and Development-2000" survey, Mongolia National report 7 The sample size necessary to achieve the desired level of precision was calculated accord- ing to the formula described in the MICS-2 manual6l. Since the MICS-2 survey was in- tended to provide information on a variety of indicators and several specific target groups, the required sample size is based on the number of households needed to yield valid results with the desired level of precision for the "rarest" key indicator-target group combination. This ensures that findings on the less "rare" combi- nations will also be valid at the chosen level of precision or better. For the Mongolian survey the key indicator for calculating the required sample size was the measles immunization rate in the target group of children aged 12-23 months. Using the formula from the MICS-2 manual it was determined that a sample of 6000 households would be needed to obtain data on all survey indicators with a margin of error not greater than +/-5 percentage points at national level with a 95 per cent confidence level (See Appendix A, Estimation of Sample Size for MICS-2 in Mongolia, 2000). The MICS-2 planners estimated that, on average, each interview team could cover about 20 households per day. Thus it was determined that in order to reach the required total of 6000 households, 300 clusters averaging 20 households each would be needed. Sample selection was done in two stages. First, using the sampling frame developed for the Population and Housing Census-2000 , enumeration areas (EA) were listed according to urban, rural and regional categories and within these categories by aimag, soum and bag. From this listing 300 EA's were selected on the principle of probability proportional to size (pps)?l. In stage 2, selected EAs were divided into segments of approximately 20 households SURVEY METHODOLOGY each; one of which was selected randomly as a survey cluster. During the fieldwork phase of the survey, every household in each of the selected clusters was interviewed. 2.2.2 Sampling stratification: In the survey, sampling used 2 different stratifications: I. By region : Most tables in this report are broken down into 6 regions: Western, North- em, Eastern, Southern, Central 1 and Central 2. This is an official government classification based on petrol prices. Specifically, this regional delineation is as follows: 1 Western (Uvs, Zavkhan, Gobi-Altai, Bayan-Ulgii, and Khovd aimags) 2 Northern (Arhangai, Hovsgol, Bayankhongor, Uverhkangai and Bulgan aimags) 3 Eastern (Domod, Hentii and Suhkbaatar aimags) 4 Southern (Omnogovi, Dundgovi, Dornogovi and Govisumber aimags) 5 "Central-1" (Tuv, Selenge, Darhkan- Uul and Orhkon aimags) 6 "Cental-2" (Ulaanbaatar- capital city) 2 . By urhan and rural: The attached tables in this report are classified into urban and rural. · "Urban" population and households are defined as those located in the capital city 7) See Chapter 4 and Appendix 7 of the MICS manual for a detailed explanation of pps and its application in MICS sampling. 8 "Child and Development-2000" survey, Mongolia National report SURVEY METHODOLOGY of Ulaanbaatar and any aimag centers. · "Rural"- The rest of the population and all other households are classified as rural. 2.2.3 Sample unit: The sample unit is a household. A household is a single person or group of people residing in one dwelling, with common housekeeping arrangements. 2.3. Questionnaires The questionnaire used in the Mongolian Child and Development Survey-2000 (MICS- 2) closely followed the content and format of the model MICS-2 questionnaire recommended by UNICEp8J, with some revisions and adjustments to suit specific local circumstances. The MICS model actually consists of three sections; each designed to collect information on specific topics and distinct target groups. 2.3.1. Sample survey questionnairies 2.3.1.1. Household Questionnaire col- lected information such as the construction of the housing; the sex, age, literacy, marital and orphanhood status of the household members. Also included in this questionnaire were ques- tions on education, child labor, supply of water and sanitation, and the use of iodized salt. 2.3.1.2. Women's Questionnaire (women of reproductive age, 15-49) included modules on: • Information about women • Child mortality • Maternal and infant health • Contraceptive use • HIV/AIDS. • Vitamin "D" deficiency 2.3.1.3. Questionnaire for children under age 5, includes: • Birth registration • Early childhood learning • Vitamin A supplementation • Breastfeeding • Care for childhood illness • Hepatitis • Child immunization • Anthropometry (measurement of height and weight) Modifications of the model questionnaire. were carried out with the guidance of and co- ordination by the Steering Committee. The original English version was translated into Mongolian, and circulated among relevant gov- ernment and non-governmental agencies for comments and suggestions, which were incor- porated in subsequent drafts. The MICS-2 Working Group ensured that the substantial inputs from the sectional ministries and other organizations were appropriately worded and consistent with the overall structure and for- mat of the questionnaire. Before finalization, the questionnaires were pre-tested in two sepa- rate locations. This field-testing helped to iden- tify and correct problems with physical and logical sequencing and to detect specific ques- tions where changes in wording were needed to make the meaning clear to respondents. In addition, it yielded an estimated average dura- tion of each household interview (about 90 minutes) and provided a basis for planning the number of interviewers required, the approxi- mate workload of each and the probable dura- tion of the entire survey exercise. Following the correction of problems identified by the pre- testing exercise, the questionnaires, along with the revised instruction manual for interviewers 8) The model questionnaire is included in the MICS manual at the end of" Chapter 3. "Child and Development~2000" survey, Mongolia National report 9 and supervisors, were given a final review and approval by the Steering Committee and the NSO. 2.4. Fieldwork and Data processing 2.4.1 Data collection: The official agree- ment on conducting Child and Development Survey- 2000 (MICS-2) was established in May 2000 between National Statistics Office of Mongolia and the Resident Representative of UNICEF. The interviewers for the survey were se- lected by the Steering Committee and Working Group with the guidance of UNICEF. All the selected interviwers and editors participated at the MICS-2 training, after which eight data col- lection teams were established, each team con- sisting of a team leader, 2 editors, 4 interviwers and 2 drivers. As agreed by the Steering Com- mittee and under the direct supervision of the Working Group, supervisors provided team members with plans of action and editors re- ceived and checked materials and information daily. Any errors, lack of clarity or omissions in the materials were immediately detected and edited in the field. One of the supervisors of each team was a staff member from the local statistical office. By agreement with the local authority, these staff were given one month's unpaid leave in order to serve on the MICS team. The participation of these local staff was very positive and made a significant contribution towards facilitating fieldwork, helping to reduce non-sampling er- ror and improving data quality. It should be noted that the Parliamentary Election Com pain was going on at the same time SURVEY METHODOLOGY as the survey and may have had an adverse ef- fect on the process of implementing the survey. Household interviews began at the end of May and concluded in early August 2000. Four monitoring units composed of Steering Com- mittee and Working Group members were set up to provide overall supervision of field work progress and interviewers' and supervisors' performance in 10 aimags and Ulaanbaatar, re- porting on shortcomings and successes and tak- ing timely action as necessary to ensure con- tinued smooth implementation. The data col- lection procedures were divided into 3 stages. After each team completed its work in one site and submitted the data to the working group in Ulaanbaatar, which was responsible for receiv- ing and entering data, it was given permission to move to the next site. Each team worked in two aimags and the third stage of fieldwork was in Ulaanbaatar. 2.4.2. Data Processing: ISSA computer software was used for data entry preparation and data collected was keyed into 5 microcom- puters. Computer operators for data entry were hired and trained for 4 days. The data process- ing team had the responsibility of checking the completeness of all received raw data, pre-en- try data quality control and preparation for en- try, data entry processing, testing and running controlling software, producing data error re- port, re-entry data correction, converting soft- ware provided by the UNICEF Resident Representative's Office in Ulaanbaatar and pro- cessing data according to the instructions. In order to ensure the quality of received data, a double entry method, comparing results was used for each questionnaire. The Team Leader and the computer programmer attended a Data Processing training course held in Bangkok in April 2000, during which the trainees received the necessary knowledge and skills to apply in 10 "ChiiQ and Development-2000" survey, Mongolia National report SURVEY METHODOLOGY the case of this particular survey. These skills included questionnaire computer design, data entry, quality control, correction and process, as well as the utilization of the commonly used software package, SPSS, for data integration and analysis for this survey. Some additional software work was carried out and applied to ensure consistency of the software to be used and country-specific questionnaires were de- signed for the Child and Development Survey- 2000. Data pre-entry preparation, quality control and data entry was carried out in July-August 2000 at a highly professional level and in a shorter time than expected. At this stage of the survey, the working group stayed in close con- tact with the survey regional office and some questions raised concerning software and math- ematical methodology were solved very effi- ciently. Survey data were processed using software based on the given designed questionnaire. The data processing was carried out in two stages. The goal of the first stage was to obtain a complete file of raw data according to the processing technology order and to ensure the quality of the data. This included following: 1.1 Data entry 1.2 Structure checks 1.3 Verification 1.4 Secondary editing 1.5 Production of verified and confirmed data set The second stage aimed to produce cross tables enabling further analysis to be carried out. This included the following: 2.1 Entry of a variety of options and simulations 2.2 Production of output tables After the completion of the data processing of the survey materials, statisticians analyzed particular indicators, checked consistency with other data sources, reviewed results, edited errors, and reviewed concepts and definitions of unclear indicators. Finally, based on these, they developed a working document, which would be useful for the next survey, and wrote the survey report. The other data sources used for analysis and consistency checks were other official statistics compiled by the National Statistical Office, the Statistical Year Book (NS0) 9l, and the Mongolian government's Population and Housing Census - 2000. Within the context of the Child and Development Survey-2000 (MICS-2), another survey concerning Children Living in Difficult Circumstances was conducted, by attaching a · further questionnaire (Child and Development Survey-2 or CDS-2) to the main survey, and collecting the data at the same time. This required each local government authority to provide information through questionnaire CDS-2, which was completed in August- September, 2000. Data from this second questionnaire was collected and processed, using similar pre-data preparation, quality control and software processing, and in addition, sets of handbooks and instruction were designed for this specific survey and approved by the working group. Children surviving in difficult circumstances were disaggregated by aimag and a database was established. All related original raw inputs were delivered to the archive after the data process was completed. A working report on the survey organization will be submitted separately. 9) National Statistical Year Book 1999. National Statistical Office of Mongolia . Ulaanbaatar, Mongolia "Child and Development-2000" survey, Mongolia National report 11 Photo by Giacomo Pirozzi Photo by Giacomo Pirozzi III. SAMPLE CHARACTERISTICS AND QUALITY OF INFORMATION 3.1. Response Rate The selected 6000 households for the "Child and Development Survey -2000 (MICS-2) com- pleted the interview (Table 1). About 8606 women aged between 15-49, identified as the select group, were eligible for the women's questionnaire. Out of these, 8257 were interviewed successfully, with a response rate of95.9 per cent. In addition, 6199 children under the age of 5 were found to be liv- ing in the selected households. Children's ques- tionnaires were completed for 6184 of these, yield- ing a response rate of 99.8 per cent. 3.2. Missing data and age distribution: 3.2.1. Quality of information As a basic check on the quality of the sur- vey data, the percentage of cases missing infor- mation on selected questions is shown in Table 3. 8.3 percent of household members (1764 per- sons) have missing information on their level of . education but 0.1 per cent (12 persons) have missing data on the year of education. Among female respondents, 0.1 per cent did not report a complete birth date (i.e., month and year). Of women who gave birth in the 12 months prior to the survey, 0.1 per cent did not report any data on AIDS testing. 6 5 ~ 4 (.) Q; 3 a. 2 1 1'1 Figure 1: Single year age distribution of the household population by sex. Mongolia 2000 %Male /\. tJ f'- , y I"'- ' h. I'-" IV\ 0 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70+ Age A small number of children under 5 years old and between 6 and 8 years old, gave incom- plete answers for the question on children with diarrhea in the last two weeks. The data on weight and height is missing in the case of approximately four percent of surveyed children under 5 years old, which may be the result of the child not being present, refusal, or other rea- sons. Date on weight and height is the most likely information to be missing, but, by international stan- dards, the above percentage of missing informa- tion is relatively low in comparison to other sur- veys in which anthropometric measurements have been taken (Sommerfelt and Boerma, 1994 ). 3.2.2. Age distribution of survey population Gender and age distribution among the survey population (the sample households) is more or less equal to the gender and age distri- bution in the total population, except in the under 5 age group and the 16-25 age group where there are slightly more males than in the general population of these age groups. 3.2.3. Demographic characteristics of the survey household Information on the demographic charac- teristics of the household population and the survey respondents is provided to assist in the interpretation of the survey findings and to serve Figure 2: Age distribution: Women aged 15-49. Mongolia 2000 5% [d 15-19 11!!!1 20-24 11% D 25-29 D 30-34 16% 22% 11!!!1 35-39 [] 40-44 21% 11!!!1 45-49 "Child and Development-2000" survey, Mongolia National report 13 ACTERISTICS and QUALITY of INFORMATION as a basic check on the sample implementation. By region: The number of households in- volved in the sampling is shown in Table 4 by re- gion; 49 per cent (2925) of the respondent house- holds are urban, 51 per cent (307 5) rural. The Cen- tral-2 region (Ulaanbaatar) accounts for the largest share of sample households among the 6 regions, while the Southern, which is comprised Df the sparsely populated aimags of Omnogovi, Dundgovi and Domogovi, contributed only 7 per cent. By family size: In terms of family size, most of the households (48 per cent) have 4-5 mem- bers, and 22 per cent have 6-7 members, only 0.1 per cent have a single member and about 10 per cent have 8 or more members. The survey results show that nearly 79 per cent of households have at least one child under age 5, and nearly all (99 per cent) have one or more women aged 15-49. By women's age composition: About 22 per cent of the surveyed women were aged be- tween 20-24 and 21 per cent between 25-29, and these constitute the largest proportion of the sample(Table 5). The proportion of older women in the sample is much smaller than in any of the other age groups, women between 45-49 representing only 5 per cent of the sample. Figure 3: Women aged 15-49 years by education level. Mongolia 2000 10% 10% 26% Less primary • Non-Completed secondary . 32% D Completed secondary D Vocational and College • Higher By women's marital status and education level: About 60 per cent of the sampled women were married or live with partners, and 76 percent had given birth at least once. About 10 per cent of women in the sample have completed primary education, 25 per cent have completed or have lower secondary education, and over 50 per cent had graduated from completed secondary schools, vocational institutions and colleges, and 10 per cent have graduated from university (Table 5). Children under 5: Table 6 shows the distribution of children under the age of 5 in terms of gender, place of residence, age group and mother's education. Of the children included in the study, about 11 per cent were less than 6 months or between 6-11 months old, and between 18 and 20 per cent of children are 2,3,4 and 5 years old respectively. Slightly over half (51 per cent) -are boys and 49 per cent are girls. Less than 1 per cent of the mothers with children under 5 years have no formal education, and a mere 5 per cent have completed only primary school, 27 per cent have lower secondary education, 33 per cent have completed secondary education, and over 30 per cent have graduated from vocational institutions and college or university. Figure 4: Age distribution, children under five age. Mongolia 2000 <6 months 6-11 months 12-23 months 19.3 D 24-35 months • 36-4 7 months • 48-59 months 14 "Child and Development-2000" survey, Mongolia National report Photo by Giacomo Pirozzi IV. THE RESULTS OF THE SURVEY A. Infant and US Mortality Goals. Global: Reduction of IMR and U5MR by one third, or to a /eve[ of 70 per 1000 live births. National: Reduction of IMR to 49 and US MR to 61 : The infant mortality rate is the probability of dying before the first birthday. The under- five mortality rate is the probability of dying before the fifth birthday. These rates are often expressed in terms of the number of deaths per thousand live births. In MICS, infant and under- five mortality have been calculated using an indirect estimation technique (the Brass method). The data used in the estimation are: the mean number of children born for each five- year age group of women aged 15-49 and the proportion of these children who are dead, also for five-year age groups of women. The technique converts these data into probabilities of dying by taking account of both the mortality risks to which children are exposed and the length of their exposure to the risk of dying. The data used for mortality estimation are shown in the Table 7. The mean number of children born rises from .128 for women of 15-19 years old to 5.325 for women aged 45- 49, as would be expected. The steady increase in the proportion of children dead, from .022 among 15-19 year old mothers to .130 among mothers in the 40-44 age group, is also plausible, though it is not immediately clear why the proportion of children dead among women aged 45-49 should be smaller than the proportion among the younger mothers in the 40-44 age group. The highest rate of fertility is among women aged between 25-34. Mortality estimates were obtained using the United Nations QFIVE computer program. For Mongolia, the West model life table was considered to be the most appropriate choice. By indirect estimates the infant mortality rate was 64 per 1,000 and the under-five mortality Number of children US yrs, per 1000 population U16 "Child and Development-2000" survey, Mongolia National report D 304 D 285 D 281 0 264 D 25o 0 248 17 rate 87 per 1,000 according to MICS, for the year1996. According to MICS, the infant and under-five mortality rate increased in both in- dicators between 1985 and1988, and there was a sharp decline from 1988 to 1991 (estimates for 1985 and 1988 are based on reports from women aged 45-49 and 40-44, respectively). There was a leveling off between 1994 and 1996 and after 1996 the mortality rate appears to de- cline sharply once again. Compared to other sources, the MICS infant and under 5 mortality estimates are somewhat higher than official sta- tistics based on administrative reports, but re- markably similar to the findings of the 1998 Re- productive Health Survey data for 1994-1998. Infant and under five mortality has been declining as a result of the improved legal environment for the protection of the rights of children and mothers, and as a result of measures undertaken by government and government agencies, and by international organizations and by other countries. However, the level remains high in comparison to the level in other countries. According to the results of a survey on "Mortality in Children Under Five . Causes and Influencing Factors " 10l , conducted in 2000, by the Ministry of Health and Social Welfare with the support of UNICEF, acute respiratory infettion and pneumonia, diarrhea, _ early infant diseases and cerebral and neurological disorders were found to be the most common causes of mortality in the early years of life. About 95 per cent of infants who died because of sepsis infection in 1999 (30 infants), died in care centres in Ulaanbaatar, in the Maternal and Child Research Center and other maternity homes. This indicates how important it is to concentrate on improving medical assistance and services for mothers and children. Of all the children covered by the survey who THE RESULTS OF THE SURVEY died at home, about 30 per cent died because of poor standards of parental care, 27 per cent died because the household was a great distance from medical assistance and 4 per cent died because of inappropriate treatment by doctors. Of the children covered by this survey who died at home, 22 per cent died before receiving medical assistance. B. Education Goals. Global: Universal access to basic education. Reduction of adult illiteracy rate 50 % of 1990 levels . National: 98 % of population aged between 8-15, will have completed secondary school education. Universal access to basic education and the completion of primary school education by all the world's children is one of the most important goals of the World Summit for children. Education is a fundamental condition for democracy, human rights, environmental protection, gender equity and the protection of children from hard and harmful labor. Photo by .Giacomo Pirozzi 10) Mortality in Children Under Five: Causes and Influencing Factors: (MOHSW/UNICEF) Ulaanbaatar 2000 (See page 1 and Table 2-39) - 18 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY B./. Early Childhood Education Findings from the current MICS-2 survey show that only 21 per cent of children between the ages of 36 and 59 months (or 3-5 years) are pres- ently attending an organized learning or early child- hood education program (Table 9). There is al- most no differentiation by gender, but there are wide gaps between urban and rural children and among different regions. Thirty-five per cent of urban chil- dren are participating in some form of education program, compared with only 10 per cent in the countryside. In Central-2 region (Ulaanbaatar) 41 per cent of this age group are participating in pre- school education programs, while in the North the participation rate is only 7 per cent. Analysis by household location shows a similar pattern. Whereas 41 per cent of children in the capital city are attending some kind of pre-school educaiion program, this percentage declines steadily in smaller settlements; 26 per cent in aimag centers, about 18 per cent in soum centers and a mere 6 per cent in other rural areas. Clearly, children living in the larger cities and towns have a great advantage over those who live in the countryside. A strong relationship between pre-school attendance and the mother's education is evi- Figure 5: Percentage of children aged 36-59 months who a re attending at Early childhood program. Mongolia 2000 J Total I 21.0 Countryside p 64 I[] Attending ,% Soman center I I 1 .5 Aimag center I I 2 .5 Capital city 1 41 .2 ./ ./ ./ ./ ./ 0 10 20 30 40 50 dent. Children whose mothers have a univer- sity education are much more likely to be en- rolled in a pre-school education program than those whose mothers have only primary school- ing or less. Every increase in the mother's edu- cational level is associated with an increase in the proportion of their children attending some kind of organized pre-school program. B.2. Basic Education In Mongolia the official primary school age is from 8-11 years. However, to allow interna- tional comparability, data from the MICS-2 survey were collected for children aged 7-12 years (Table 1 0). As the table shows, alll}ost 76 per cent of children in this age group are attending school. If disaggregated for children in the 8-11 age group, the attendance rate in- creases to 84 per cent. (The MICS-2 was con- ducted at the end of the academic year 1999- 2000, in May/June. The children who had be- gun the academic year in the 8-11 age group, by June 2000 were then in the 9-12 age group, for which the attendance rate at primary school was 92 per cent). The survey shows, however, that a significant number (26 per cent) of chil- dren are attending school at age 7. At the offi- cial starting school age of 8, only 63 per cent of children are in school, and the maximum atten- dance rate is 95 per cent at the age of 10. This Photo by Giacomo Pirozzi "Child and Development-2000" survey, Mongolia National report 19 THE RESULTS OF THE SURVEY Figure 6: Percentage of children of primary school age attending primary school. Mongolia 2000 90 80 70 OJ c i5 60 c a> 50 ~ c 40 a> ~ - 30 a> a. 20 10 0 seems to indicate that many parents prefer to start their children's schooling at a relatively late age. The attendance rate at primary school is about 10 per cent higher in urban areas than in rural areas. There is also a wide differentiation between regions, varying from 70 per cent in the Northern region to 83 per cent in Ulaanbaatar. Overall, girls' attendance is slightly higher than that for boys, but this pattern is not uniform throughout the country. In urban areas and in the Western and Central-2 regions, enrolment of boys is higher than enrolment among girls. The data show a drop in school attendance after the age of 10, especially for boys. The decline in attendance for male children is 5 per- centage points between the ages 10 to 12, while the attendance rate of girls only drops by 2.5. percentage points, or only half a much. Table 11 shows the survey findings on the proportion of children who enter the first grade of I• Boys • Girls primary school and eventually reach grade 5. This information was obtained by the interviewer ask- ing whether each child in the appropriate age group was attending school that year, and if so in what level and grade. A second set of questions was asked about the child's attendance and grade the previ- ous year. This information allowed the construc- tion of a flow diagram showing the progress of children from one grade to the next and made pos- sible a calculation of the survival rate at grade 5. The overall figure from the Child and De- velopment Survey -2000 (MICS-2) is about 95 per cent, and there is relatively little variation by sex or urban-rural residence. In urban areas, for example, 97 per cent of children eventually reach the fifth grade, whereas the rural percent- age is less than 4 per cent lower. Girls have a slightly higher survival rate than boys, but the difference is probably not significant. There is one major exception to this fairly uniform picture, however, in the Eastern region, 20 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY . _,. •C lik~ . ' Figure 7: Percentage of children entering first grade of primary school who eventually reach grade 5. Mongolia 2000 100 99 98 ~ 97 (.) . ~ 96 95 94 In grade 1 reaching grade 2 + Male • Female In grade 2 reaching grade 3 where just under 70 per cent of children ulti- mately reach grade 5, as compared with more than 90 per cent in all the other regions. The survey data show that at every step from grade 1 to grade 5 the transition rates in the Eastern are lower than in any other region. The differ- ence is particularly marked at the earliest stage, where it appears that 15 per cent of the chil- dren who enroll in the first grade do not reach grade 2. With further attrition in succeeding years, the end result is that about 3 out of every 10 children who enroll in primary school do not complete four full years of education, the amount generally considered to be the neces- sary minimum to achieve a sustainable level of literacy. According to the Population and Housing Census - 2000 statistics, the attendance rate at primary school at age 7 is 29.4 per cent, 84.8 per cent at age 8 and 93.3 per cent at the age of 9. Between the ages of 10-19, 69.4 per cent of the age group are attending school. In grade 3 reaching grade 4 In grade 4 reaching grade 5 B.3. Literacy Who reach grade 5 of those who enter grade 1 The literacy rate is very high in Mongolia. The survey found that, overall, 98 per cent of the population above 15 years of age are literate. The difference between men and women is very small (98.6 %for men, 98.5 %for women), and there is only about 1 per cent difference between urban and rural areas. The only significant dif- ferences to emerge were between the population under age 55 and people aged 55 and over, es- pecially those aged 65 and above (See Table 12). The MICS-2 survey findings correspond closely with those of the Population and Housing Census -2000, which found 97.8 per cent literacy among the total population aged 15 years and over, 98 per cent for men and 97.5 per cent for women. In 1995 the Mongolian Government ap- proved a national program of Pre-school edu- cation which aimed to maintain the level of progress and development that had aready been "Child and Development-2000" survey, Mongolia National report 21 achieved in the field and to further develop pre- school education during the period of transi- tion. The Government's policies and strategies for the future are reflected in this document. According to the results of the Mongolian National Report on Education for All Assessment 2000 11 ), conducted by MOSTEC with the support of UNDP,UNICEF, UNFPA, and the World Bank, about 30.6 per cent of pre school age (aged 3-7) children (256924) were, at the time of the survey, attending a pre-school or early childhood education program. About 48.7 per cent of children in this age group in Ulaanbaatar, 43.2 per cent in other urban areas and 15.9 per cent in rural areas are attending an early childhood education program (By 2000, only 4.6 per cent of7 year olds (or 12,059) were attending primary school). From 1990 to 2000, the number of kindergartens fell by 28.4 per cent, now totalling 650, and the attendance rate fell by 23.9 per cent. Children who live either in herding families or poor households and disabled children have limited or no chance to attend an early childhood education program. Almost 99 per cent of rural administrative units do not have any early childhood education programs. According to the survey by MOSTEC, from the beginning of the transition period, the school dropout rate has increased considerably and this phenomenon is more prevalent in rural areas. One of the main causes of children drop- ping out of school is the structural changes that have taken place in the socio-economic system and the subsequent lowering of the overall liv- ing standard of the population. Of children aged 8-15, about 19.6 per cent in 1992, 17.9 per cent THE RESULTS OF THE SURVEY in 1994, 14.1 per cent in 1996, and 12.8 per cent in 1998, were not enrolled in school. The survey highlighted several main reasons for dropping out of school. These were: 1. School System: The school system has changed several times since 1990. For example, initially the school system had six years of primary education, 2 years of lower secondary and a further 2 years for complete secondary education (6+2+2). Then the primary education was reduced to four years. Now the school system has four years of primary education, Photo by Giacomo Pirozzi four years of lower secondary and two years of complete secondary (4+4+2). These attempts to change the educational structure have had a negative impact on the normal activities of schools and the quality of training 2. Privatization: One of the negative consequences of the privatization that has taken place during transition has been an increase in the utilization of child labor. Due to privatization of livestock, the number of livestock has been growing, which has had a positive effect on the living standards of households and, consequently, on the economic 11) Mongolian Natinal Report on Education for All Assessment 2000 (MOSTEC, UNDP,UNESCO , UNICEF, WORLD BANK) January 2000 · 22 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY ~. ~. -4:t~. growth of the country. However, the number of cases of children, from herding households, dropping out of school in order to help with the livestock is increasing in rural areas. 3. Dormitory Facilities in Schools: One of the important provisions which enabled children of Mongolian nomadic cattle breeders to attend school was dormitory facilities in schools. Since 1990, due to the economic environment and financial constraints, dormitory facilities have started to deteriorate , and have not been maintained. As a result, the number of schools with dormitory facilities decreased significantly, with a consequent decrease in the number of children from herding families attending school. 4. Deterioration of household living standard: During the transition period, the price of consumer goods and services has been increasing, and consequently, the cost of living has increased. Thus the gap between rich and poor has been increasing. Similarly, as a result of social-economic structural change , unemployment has become widespread. However, not everybody has been able to take advantage of social security and this has resulted in wide spread school drop out rate among children from vulnerable households. 3. Migration: As a result of a lack of plan- ning and implementation of regional development policies, there has been a steady stream of popula- tion migration towards to urban settlements, par- ticularly to Ulaanbaatar city. Newly arrived chil- dren to the city are more likely to dropout of school. 6. Capability of school teachers and their discipline: Because of a failure to predict prob- lems and difficulties which were likely to oc- cur during the implementation of a new educa- tional system and to undertake appropriate mea- sures that would ensure protection from unex- pected difficulties, a significant number of knowledgeable and capable teachers left school, resulting in a deterioration in the overall knowl- edge, capability and discipline of teachers. In tum, this has had a bad affect on the children. C. Water and Sanitation C.l. Use of safe drinking water Goals. Global: Universal access to safe drinking water. National: 85 % a_{ population with access to safe drinking water. Clean drinking water is fundamental for human health. Polluted water is a carrier of many infectious diseases, including cholera and typhoid. Pollution may also be caused by chemi- cal, physical and radioactive contaminants ' which can be harmful to human health. In ad- dition to health considerations, access to safe drinking water may be particularly important for children and women, especially in rural areas, because they often bear primary responsibility for carrying water from the source to the home. There are many well-known problems asso- ciated with assessments of "clean" or "safe" drink- ing water. Obviously, water quality varies from place to place, and even modem piped systems do not always provide water that is completely clean and safe. Nevertheless, it is known that water qual- ity from some types of sources is generally better than that from other types. Therefore, reasonably accurate estimates of safe water coverage based on the type of source can be obtained through·house- hold surveys. In line with UNICEF recommenda- tions and in order to maintain international compa- rability the following sources of drinking water were classified in the MICS-2 survey as safe: "Child and Development-2000" survey, Mongolia National report 23 (1) piped water to the household or yard, (2) public standpipe or tap, (3) tubewell or bore- hole with pump, ( 4) protected dug well, (5) pro- . tected spring and (6) rainwater. Figure 8, shows the results from the MICS about the sources of drinking water used by the survey households. According to the current survey results, 60 per cent of the Mongolian population is sup- plied with clean and safe drinking water (Table 13). However, there are big differences between city water supplies and those in the country- side. Clean drinking water reaches 91 per cent of the population in urban areas but only 34 per cent in rural areas. There is also major varia- tion among regions. Only about 22-32 per cent of the population in Northern and Western re- gions have access to safe drinking water, while in Central-! and Central-2 regions the propor- tions are 84 and 97 per cent, respectively. Figure 8: Percentage of distribution of the population by source of drinking water Ci::lEL 1 8% CEnt::raliz.Ed awl y 2 0 % Prote::t:Ed d.q v.ell 14% Pip3j into &ellirg 1% Nationally, the survey finds that 20 per cent of the population uses water piped directly into the dwelling, and a further 18 per cent are supplied from public taps. The situation is more diverse in the Southern and Eastern regions, where people obtain drinking water from a wider variety of sources. THE RESULTS OF THE SURVEY There is some concern that the water quality classification used in the Child and Development Survey - 2000, is not wholly appropriate for the Mongolian situation. In particular, it is widely believed that the lakes, streams and rivers that supply much of the drinking water in the Western and Northern regions are in fact a safe source and should be classified accordingly. It is argued that these areas are sparsely settled, with very little industry or modern agriculture of the sort that becomes a major source of water pollution else- where. The protected well is one major source of clean drinking water. In the last few years the num- ber of protected wells has reduced slightly. On the other hand, there is some debate as to whether the protected wells that supply 14 per cent of the drinking water nation-wide and are especially important in the Southern region, should actually be classified as safe sources, considering that many of these facilities were installed before 1990 and have not been well maintained since. According to the results of the "Living Standards Measurement Survey 1998" 12> about 50 per cent of the total urban population and 72 per cent of the residents of Ulaanbaatar had access to a central supply system of safe drink- ing water. In the countryside, 27-30 per cent of the rural population have access to safe drink- ing water from unprotected wells. However, Photo by Giacomo Pirozzi 12) Living Standards Measurement Survey 1998 (NSOIUNDP) U!aanbaatm; Mongolia /999 24 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY the percentage of the urban population who have access to a central supply system for safe drink- ing water has been decreasing in the last 3 years, 67.5 per cent in 1995 to 52.0 per cent in 1998. C.2. V se of sanitation Goals. Global: Universal access to sanitary means of excreta disposal. National: 75 % with flush toilets or latrines that meet sanitary standards. Inadequate or improper disposal of human excreta and poor personal hygienic are associ- ated with a range of diseases, including diar- rhea and polio. In the Child and Development Survey - 2000 sanitary facilities include: (1) flush toilets connected to sewage systems or septic tanks, (2) other flush toilets, (3) improved pit latrines and ( 4) traditional pit latrines. The data in the survey indicate that 74 per cent of the population has access to improved sanitary facilities (Table 14). However, as with improved sanitary facilities supply, the situation is very different in urban centers and rural areas and there is considerable variation among regions. More specifically, 97 per cent of the urban population uses improved sanitary facilities, compared to only 54 per cent in the countryside. In the capital city (Central-2 region) less than 5 per cent of the population do not have access to adequate sanitary facilities, while in Northern and Southern regions nearly half of the population has no access. Data from the MICS-2 survey indicate that 21 per cent of the whole population use flush toilets. Among regions, this percentage ranges from nearly zero in the Northern region and less than 10 per cent in the Southern and Western, to almost half the population in Central-2. The urban-rural difference is very striking. Only about 2 per cent of the rural population use a flush toilet, whereas in urban areas the figure rises to 42 per cent. Figure 9: Percentage Distribution of the Population by type of sanitary facility used. Mongolia 2000 Flush system • Traditional pit D Improved pit/other safe type 0 Open pit/other unsafe type • No facilities The type of sanitary facilities used is closely associated with housing type and more general living conditions. For example, for urban dwellers who live in apartments or other permanent dwellings with centralized heating, flush toilets are a practical and convenient solution to sanitation needs. For those living in ordinary gers (yurts) or houses, and especially nomadic people who move with their herds two or three times a year, flush toilets are not a Photo by Giacomo Pirozzi "Child and Development-2000" survey, Mongolia National reporl 25 practical alternative. These population groups commonly use pit latrines. Overall, there is relatively little geographical variation in the use of pit latrines. This type of facility is used by just over half of the population, with little difference between urban and rural locations. Even in the captial city almost of half of the population uses a pit latrine. Figure 10: Percentage Distribution of the Population by location and sanitary facility used. Mongolia 2000 100% c 0 ~ 80% 60% 6. 40% 0 Cl. Q) .c ;;:::: 20% 0 eft 0% Urban Rural Total • No facilities • Improved pit/other D Open pit/other unsafe type safe type D Traditional pit D Flush system It is most common in the Eastern region, where it accounts for about 63 per cent of the total, and least common in the South, where it is ·used by only 44 per cent. Even in the captial city almost of half of the population uses a pit latrine. The MICS-2 data show that over one third of the rural population have no toilet facility. According to the "Living Standard Mea- surement Survey" in 1998 (NSO/UNDP), about 72 per cent of households in the cities and ur- ban areas live in apartment buildings and houses, while around 22 per cent of the households live THE RESULTS OF THE SURVEY in gers. Also, 51 percent of the households liv- ing in the apartment buildings and houses have a connection to a sewage system of such houses is located in Ulaanbaatar and have flush toilets inside their houses. The majority. Eighty per- cent of the total households have garbage dis- posal areas and about 50 per cent have sewage pits. About 60 percent of the households have pit latrines. The majority of poor households in the cities and urban areas use pit latrines out- side the houses while households with better living standards have more improved sanitation facilities. The availability of adequate garbage disposal is an important necessity to maintain a healthy environment, which will contribute to the health of the population. Poor households, particularly those living in urban settlements, do not have adequate facilities that meet the sanitation requirements. It is important for city municipalities, aimag and local administrations to plan and implement a set of policies aiming to provide the population with safe drinking water and facilities that meet the sanitation requirements . D. Child Food and Nutrition D.l. Nutritional status Goals. Global: Reduction of severe and moderate malnutrition by half of 1990 levels. National: Reduction in severe and moderate · malnutrition among children under 5 by half of 1990 levels. Children's nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are well cared for and are not exposed to repeated 26 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY illnesses, they are able to achieve their growth potential and are considered to be well nourished. Nutritional status is conventionally assessed by comparison with a standard distribution of height and weight for children under the age of 5. For the Child and Development Survey - 2000 (MICS-2), measurements of height and weight were taken for children under 5 in the survey households. These measurements were used to compute 3 standard indicators of nutritional status for each child, from which the proportion of malnourished children in the sample was calculated. The 3 standard indicators of nutritional status are as follows: · Underweight (weight for age) is the best indicator for describing the overall level of malnutrition in a population and for assessing changes over time. Underweight reflects aspects of both stunting and wasting. 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 standards deviation below the median are classified as severely underweight. · Stunting (height for age) means that a child is relatively short compared with the Photo by Giacomo Pirozzi ,~.,~~:-,' ' '· ,,~ ~ ,i\, reference population. Stunting is an indicator of poor .growth over time~ and is usually associated with chronically insufficient dietary intake, frequent illness and poor feeding practices over a long period. 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 in whom height for age is more than three standard deviations below the median are classified as severely stunted. · Wasting (weight for height) is usually caused by recent nutritional deficiency, and therefore may show significant periodic variation associate with seasonal availability of food or disease prevalence. 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 below the median are severely wasted The U.S. National Center for Health Statis- tics (NCHS) standard, recommended by UNICEF and WHO, was used as the reference for determining the nutritional status of children covered by the survey. Two standard deviations below the median value in the NCHS reference population for a given indicator (underweight, stunting or wasting) is defined as moderate mal- nutrition as measured by that indicator. At 3 stan- dard deviations below the reference median a child is classified as severely malnourished. Children who were .not weighed and mea- sured for height (approximately 4.1 per cent) and whose measurements were outside the plau- sible range are not included in the calculations. In addition, a small number of children whose birth dates are unknown were excluded. "Child and Development-2000" survey, Mongolia National report 27 As shown in Table 15, nearly 13 per cent of the surveyed children under the age of 5 were found to be moderately or severely underweight. The underweight prevalence in rural areas, at 16 per cent, is considerably higher than in urban areas, where the rate is 9 per cent. Among the regions, the underweight prevalence in the Eastern region (21 per cent), is close to twice the national rate, while the lowest levels are found in Central-2 and the Southern regions, with 7 per cent, and 8 per cent respectively. There is no difference in underweight prevalence between boys and girls. The regional pattern varies somewhat for the other 2 indicators, though all types of malnutrition tend to be relatively high in the Eastern, Northern and Western region and lowest in the Southern region and Central-2. There is a clear correlation between mal- nutrition in young children and the mother's education. The relationship is especially pro- nounced with stunting, which is most closely associated with chronic dietary deficiencies and poor feeding practices over a long period. Chil- dren whose mothers had only primary school- ing or less are 3 times as likely to be stunted c ~ ::!2 .c u -0 ::!2. 0 Figure 11: Percentage of Under 5 children who are undernourished. Mongolia 2000 35 30 25 20 15 10 5 0 / ""' --, . I . l r- -+ J-- ~ - . 0 6 12 18 24 30 36 42 48 54 60 Age (months) Stunting (ht/age) Underweight (wt/age) Wasting (wt/ht) THE RESULTS OF THE SURVEY than those whose mothers had university edu- cation. The same general pattern holds for un- derweight and wasting as well. The prevalence of malnutrition also varies with the specific age of the child (Figure 11). In general, malnutri- tion is at its lowest level in the early months of life, when most children are still being breastfed, and reaches a maximum during the 12-23 month period. Stunting drops sharply in the third year then rises again at the age of 4 and 5. Underweight declines only very gradu- ally after the age of 2, while no particular trend is evident for wasting over the entire 5 years. D.2. Breastjeeding Goals. Global and National : Empowerment of women to exclusively breastfeed their children for 4-6 months after birth, and continue breastfeeding, with complementary foods, well into the child's second year. Breastfeeding in the first few years of life protects babies from infection, provides an ideal source of nutrition, and is economically optimal and safe. Nevertheless, many mothers stop Figure 12: Percent distribution of living children by breastfeeding status. Mongolia 2000 90.0 80.0 c 70.0 a.> 60.0 ~ 50.0 rf 40.0 30.0 20.0 10.0 Children Children 0-3 months 6-9 months exclusively receving breastfed solid/mushy food 0 Male Children Children breastfed breastfed with 12-15 with 20-23 months months 1!!!!1 Female 28 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY breastfeeding too soon, and this often has a negative influence on the child's health and nutritional status. Bottle feeding with infant formula may be particularly risky if clean drinking water is not readily available. The goal of the World Summit for Children recommends that children should receive only breast milk in their first 4-6 months, and that breastfeeding should continue, along with appropriate complementary foods, well into the second year. The data in Table 16 are based on informa- tion provided by mothers in the survey interviews on children's consumption during the preceeding 24 hours. Exclusive breastfeeding means that the child has received only breast milk (and possi- bly vitamins or medicine). Complementary feed- ing refers to children who are given solid or semi- solid food in addition to breast milk. The last 2 columns of Table 16 show the proportion of chil- dren who are still being breastfed at the age of 1 and 2 years. Breakdowns by region and mother's educational background are not shown due to the small sample size. For the same reason, the fig- ures on sex and urban-rural residence should be interpreted more cautiously. Approximately 64 per cent of babies un- der 4 months were breastfed exclusively, lower than the recommended 100 per cent but signifi- cantly higher than the average in many regions of the world. There appears to be little differ- ence between boys and girls, though the rate in rural areas is about 10 points higher than in ur- ban areas. About 54 per cent of children aged 6-9 months were breastfed along with comple- mentary feeding, 75 per cent aged 12-15 months. and 57 per cent of children aged 20-23 months were also still being breastfed. D.3. Salt iodization Goals. Global: Virtual elimination of iodine deficiency disorders. National: By 1995, carry out prevalence survey of iodine deficiency disorders among the population and initiate corrective action. A deficiency of dietary iodine is the world's greatest single cause of preventable mental retar- dation and can cause a reduction in the average intelligence quotient (IQ) in a population of 13 points. Salt iodization is an effective and low-cost way of preventing iodine deficiency disorders (IDD). Adequately iodized salt contains 15 ppm (parts per million) of iodine or more. In the current MICS, interviewers tested household salt for io- dine level by means of a testing kit. In more than 99 per cent of households salt was available for testing. The results are shown in Table 17. Overall, 45 per cent of the survey households had adequately iodized salt, but very wide variability was found "Child and Development-2000" survey, Mongolia National report 29 -,.:;, '."ir~:.-- ~ . :-zii)~ Photo by Giacomo Pirozzi among regions. In nearly 83 per cent of households in Ulaanbaatar (Central-2) the salt was found to be adequately iodized, but in the Western region this figure was only 17 per cent. Among the other re- gions the iodization rate ranged between 26 per cent in the Northern region to 63 per cent in the South- em region (Table 17a). For all urban areas the iodization level was about 63 per cent, in compari- son to 29 per cent in rural areas. Figure 13: The consumption level of adequately iodized salt. Mongolia 2000 70.0 62 .7 c 50.0 Q) (.) ._ 30.0 Q) a. 10.0 f-- 44.9 f-- -~--28.7 1---- r l 1--f-- l I 1-- - I I - Urban Rural Total D.4. Vitamin A supplementation Goals. Global: Virtual elimination of vitamin A deficiency and consequences, including blindness. National: By 1995, define prevalence of vitamin A among children under 5, and initiate corrective action as necessary. THE RESULTS OF THE SURVEY Vitamin A deficiency (VAD) impairs a child's immune system, increasing its' chance of dying of common childhood diseases, and can cause eye damage and even blindness in chil- dren. It also impairs the health of pregnant and lactating women. Yet VAD can be easily pre- vented by vitamin "A" supplementation or food fortification. UNICEF and WHO recommend that all countries with an t.~.nder-five mortality rate greater than 70 per 1000 live births, or where vitamin "A" deficiency is widespread in the population, should establish programs to bring the problem under control. In accordance with recommendations by UNICEF and WHO, the Mongolian Ministry of Health suggests that chil- dren aged 6-12 months be given one vitamin A capsule of 100,000 IU every 6 months, and chil- dren older than 1 year should get one high dose capsule of 200,000 IU every 6 months. Within the six months prior to the Child and Development Survey-2000(MICS-2), about 32 per cent of children aged 6-59 months had been given the high dose vitamin "A" supplement (Table18). Approximately 10 per cent of others in the age group had received the supplement, but more than 6 months previously, and 54 per cent of children of this age were reported never to have received the supplement. For 3 per cent of the surveyed children, mothers or caretakers reported that the child had received a vitamin "A" supplement at some time in the past, but were not able to give a specific date. The survey found very little variation among regions in the percentage of children receiving the high dose supplement in the last 6 months, through the rate is significantly higher in the city (37 per cent) than in the countryside (27 per cent). Similarly, 45 per cent of urban children were re- ported to have received no supplement, while in rural areas this figure was much higher, at about 60 per cent. Regional differences in the propor- 30 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY tion of children who had never received a vita- min "A" supplement were also small relatively small. The only exception is the Southern re- gion, where only 46 per cent of children had never received the supplement, compared to between 52 and 56 per cent in other regions. Survey findings show that about 30 per cent of children aged 6-ll months had received vitamin "A" supplementation in the previous 6 months. This percentage increases to 36 per cent in the second year, then begins to decline, reaching 28 per cent in the fourth and fifth year. There is no clear trend in supplementation associated with the mother or caretaker's education. While the lowest rate (22 per cent) is for women with only a primary education, the supplementation level for all other educational categories shows little variation, from 31 to 34 per cent. It is interesting to note that in aimag centers every second child received vitamin "A" supplementation, more than in Ulaanbaatar. In Ulaanbaatar and soum centers the vitamin supplementation coverage is 25-28 percent. The percentage of children receiving a high Figure 14: Children aged 6-59 months,receiving a high dose Vitamin "A" supplementation. Mongolia 2000 1% 3% 0 Received: within last 6 months • Received: prior to last 6 months D Received: not sure when D Not sure if received • Not received . ;~r . ~:*,~~:=~' dose of vitamin "A" supplementation within 8 weeks after birth is 13 per cent nation-wide and highest among aimag centre mothers. The per- centage of children aged less than 56 days in the twelve months preceeding the survey receiv- ing a high dose of vitamin "A" supplementa- tion was 22 per cent in the Central-1 region and in the aimag centers which was the highest rate among the regions. The lowest rate was in the Western region. at 5.6 per cent (Table 19). D.S. Low Birth Weight Goals. Global: Reduction of the rate of low birth weights (less than 2.5kg) to less than 10%. National: Reduce the rate of low birth weight from 2% in 2000. And Reduce prevalence of vitamin D deficiency (rickets) 50% by the year 2000. Infants who weigh less than 2500 grams (2.5 kg) at birth are classified as low birth weight babies. In order to identify the proportion of low birth weights in the survey sample, two types of information were requested and ob- tained in interviews with mothers or caretak- ers. If a health card showing the child's weight at birth was available, or if the mother or care- taker could recall the child's birth weight, this information was recorded. In addition, moth- ers or caretakers were asked to assess whether the child had been very small, smaller than av- erage, average, larger than average or very large. For children who were weighed at birth, these weights were cross-tabulated with the mother's! caretaker's size assessment to obtain the pro- portion of births in each size category that were actually recorded as less than 2500 grams. Ap- plying these proportions to the number of unweight children in each size category yielded an estimate of the number of low birth weights among those babies who had not been weighed at birth. This estimate was then added to the "Child and Development-2000" survey, Mongolia National report 31 ~~;-~.!:';, ~- ~· ~ .,{!;;~"'< number of babies whose recorded weight was less than 2500 grams to obtain the total number of low birth weight children in the sample, and from this total the percentage of children with low birth weight was calculated. In fact, according to the findings of the survey, more than 95 per cent of the 1515 children born within the 12 months preceding this survey had been weighed at birth, so the estimation procedure described above was actually needed for only a small fraction of the total. In all, the survey found 5 per cent of newborns with low birth weight (Table 20). There was less than 1 per cent difference between urban and rural, though variations among regions were quite substantial. The Western region shows the highest incidence of low birth weight, at over 8 per cent. The lowest incidence of low birth weight, at 4 per cent, was THE RESULTS OF THE SURVEY found in the Northern region. There is no clear linear pattern according to mother's education level, though mothers with complete secondary school or less are more likely to have a low birth weight baby than better educated women. The number of births on which these statistics are based is relatively small, so caution should be used when interpreting these findings. In the last few years the living standard of the population has gone down and access to good quality food, that meets health requirements, has been reduced. Poor quality of food and nutrition negatively affects the health of mothers and children. Micronutrient deficiency, particularly a deficiency of vitamin "A" and "D", or iron and iodine deficiency, still remains a most acute health problem in Mongolia. It is important to improve the system of procurement of essential vitamins for mothers and children in the country and to strengthen the control over the implementation. Figure 15: Incidence of Low weight and proportion of Infants weighed at birth by location. Mongolia 2000 • Weighed at oirth 100 Northern Central-2 Eastern Southern Central-1 Western Urban Rural Total 32 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY E. Child Health E.l. Immunization coverage Goals. Global: Maintenance of high level of immunization coverage (at least 90 % children under one year of age by the year 2000) against diphtheria, pertussis, tetanus, measles, polio-militias, tuberculosis and against tetanus for women of childbearing age. National: Achieve 95 % coverage of infants for all antigens. According ~o recommendations by UNICEF and WHO, every child should receive first dose of BCG vaccination, within the first 12 months of life , as protection against tuberculosis, 3 doses of DPT vaccine as protection against diphtheria, pertussis (whooping cough) and tetanus, 3 doses of polio vaccine and a measles vaccination. In the current MICS-2 survey, vaccination cards for children under 5 years of age were checked, and information on the type and date of immunizations received was recorded on the questionnaire form. If no vaccination card was available, mothers were asked to provide this information from memory, if possible. Cards were available for about 81 per cent of the children surveyed. The figures in Table 21 are computed for children aged 12-23 months so only those children who are old enough to be fully vaccinated are counted. The table shows 2 coverage figures for each type of immunization, one based only on information obtained from vaccination cards and the other based on information from cards plus mother's reports in those instances when no card was available. According to information recorded on vaccination cards, coverage among surveyed children in the 12-23 month age group was high , and very uniform for all vaccines. The figure i~ 87 per cent for all doses of DPT. BCG coverage was slightly higher, at 90 per cent, and measles was significantly lower than the average, at 82 per cent. Using information provided by mothers or caretakers in addition to that from vaccination cards, coverage figures rise by 3-5 points for most vaccines. By this calculation the percentages are less uniform across different vaccines, probably indicating that mother's recall is a less reliable source of information than vaccination cards. Measles still has the lowest coverage, at 86 per cent (See Table 21), Polio 3 and DPT 3 are both a little below 90 per cent, and BCG is highest with 96 per cent. Dropout rates, as indicated by declining rates between the first and third doses of DPT and Polio, are very low, considerably less than 1 percentage point according to data from the vaccination cards (Table 22). We can see from Figure 16 that 96 per cent of children aged 12-23 months had been vaccinated by the first 12 months , within the period recommended by UNICEF and WHO. Figure 16: Percentage of children aged 12-23 months who received immunizations by age· 12 months. Mongolia 2000 I ' Tota I 96.2 I 197.9 99.0 Measles Polio . 99.7 9.7 99.8 - - ~- ~ ~ - -- - - ~ -~ ~- ----- DPT 95 96 97 98 iiDose 0 • Dose I D Dose 2 0 Dose 3 99 99.7 99.7 "Child and Development-2000" survey, Mongolia National report 33 In order to cover all children fully by vaccination the Ministry of Health has been organizing a "National Vaccination Day" and, as a result, the coverage of all types of vaccination has been increasing year by year. Moreover, special attention has been given to storage, protection, transportation and provision and appropriate measures were taken in these areas. As a result Mongolia has became one of the countries where child illness has been declining and no cases of polio have been reported. There are no significant differences in the level of coverage of any vaccination from region to region or according to residence. Similarly, there is no significant difference by mother's educational level. E.2. Diarrhea Goals. Global: Reduction by 50% in deaths due to diarrhea, and 25 %reduction of the diarrhea incidence rate, in children under 5 years. National: Reduce incidence by 50%. Dehydration caused by diarrhea is still a major cause of mortality among children in Mongolia. Home management of diarrhea- ei- ther through oral rehydration salts (ORS) or a recommended home fluid (RHF) - could pre- vent many of these deaths. Preventing dehydra- tion and malnutrition by increasing fluid intake and continuing to feed the child are also impor- tant strategies for managing diarrhea. In the MICS-2 questionnaire, mothers were asked to report whether their child had had diarrhea in the two weeks prior to the survey. If so, a series of additional questions were asked about what the child had to eat and drink during the episode and whether this was more or less than usual. Overall, 8 per cent of the under-5 children THE RESULTS OF THE SURVEY covered by the survey had diarrhea in the 2 weeks prior to the survey (Table 23). The highest incidence, about 14 per cent, occurred among children aged 12-23 months. This is a common pattern,as this is normally the age at which children are weaned. Among regions, the Northern region had a much lower incidence of childhood diarrhea, at just under 4 per cent, than any other, while the highest incidence was found in Western (nearly 12 per cent) and Southern region (10 per cent). Urban areas had a somewhat higher rate than rural areas, at 9 per cent and 7 per cent, respectively. Table 23 also shows the percentage of children receiving various kinds of home treatment during the diarrhea episode. Note that multiple answers were accepted, so percentages do not add to 100. In addition, the number of diarrhea cases in many of these categories is quite small, and should be interpreted cautiously. Overall, 98 per cent of the diarrhea cases received one or more recommended forms of treatment. More than 60 per cent of children with diarrhea were fed breast milk and 56 per cent were given packaged ORS. The recommendation to continue feeding during an episode of diarrhea seems to be gen- 34 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY erally accepted in Mongolia. Nearly three-quar- ters of children with diarrhea were fed about the same or more than usual (Table 24 ). Increas- ing the child's intake of fluids appears to be a less common practice. Only 41 per cent of moth- ers reported their child drank more during diar- rhea episodes, and 53 per cent said they drank less. The most appropriate treatment, which is to drink increased fluids and to continue eating, was reported in only 32 per cent of the cases. E.3. Acute Respiratory Infection Goals. Global: Reduction by one third in the deaths due to acute respiratory infections in children under 5 years. National: Reduce by 38%. Acute lower respiratory infection (ARI), particularly pneumonia, is one of the leading causes of child deaths in Mongolia. In the MICS- 2 questionnaire children with acute respiratory infection were defmed as those who were ill with a cough accompanied by rapid or difficult breath- ing and whose symptoms were due to a problem in the chest, or both the chest and a blocked nose. Survey data show that only 143 cases of ARI were reported to have occurred in the 2 weeks preceding the interview, which represents about 2 per cent of children under five (Table 25). About 78 per cent of these cases were taken for treatment to an appropriate health provider, in most instances a hospital or health center. Given the very small number of cases, more detailed breakdowns by region, mother's education, etc., would not be meaningful. E.4. Integrated Management of Childhood Illnesses The Integrated Management of Childhood Illnesses (IMCI) is a program developed by UNICEF and WHO that combines strategies for the control and treatment of the five major killers of children, acute lower respiratory tract infections, diarrhea, malaria, measles and malnutrition. The program focuses on the improvement of family and community practices in the prevention and early management of childhood illnesses. The IMCI approach teaches that appropriate home management of any of these major illnesses includes giving more fluids and continuing to feed sick children as they are normally fed. Table 26 presents information on the Figure 17: Percentage of children aged under S,with diarrhea in the 2 weeks prior to the survey, by drinking and eating status. Mongolia 2000 • Same/Less 0 Missing/DK 4% Eating status Somewhat less/ same/more • Much less/none 0 Missing/DK "Child and Development-2000" survey, Mongolia National report 35 ~:~Z '""'M reported drinking and eating behavior of sick children under the age of 5. About 15 per cent of the under-5 year olds in the sample were reported to have had diarrhea or some other illness in the two weeks prior to the survey. As was noted in the earlier section on diarrhea, children with any kind of illness tend to be fed more or less as usual (about 78 per cent), but the recommended practice of giving additional fluids is much less common (40 per cent). Both eating and drinking during illness vary by age. Less than 20 per cent of children aged less than 6 months old are given more than usual to drink, whereas the percentage among older children ranges from 35 to 50 per cent. On the other hand, a larger percentage of younger children tend to eat more during illness than older children. The IMCI recommendation that sick children should receive increased fluids and continue to eat as usual was followed in only 30 per cent of cases covered in the MICS-2 survey. There is relatively little variation across regions, or between urban-rural locations, and mother's educational level. The most notable exception is for children under the age of 6 months, where the percentage reported to be receiving both more fluids and continued feeding, is only half Figure 18: Percentage of children aged under S,with ARJ and treatment by health providers. Mongolia 2000 50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 ' \ \ ]i ·a. (/) 0 I \ \ \ \ \ \ \. -- THE RESULTS OF THE SURVEY of the percentage overall (under 16 per cent and 30 percent respectively). If this is a true reflection of reality it is a matter of considerable concern. However, this finding may be due at least in part to uncertainty about the terms "eating" and "drinking" when infants are being breastfed. Promoting knowledge among caretakers about when it is appropriate to seek medical care for children who are ill is another impor- tant component of the IMCI program. In the Child and Development Survey - 2000 (MICS- 2), mothers and other caretakers were asked to name the symptoms that would cause them to take their children to a health facility immedi- ately. The most common response, given by 58 per cent of mothers, was that a fever would be sufficient cause to take a child for professional treatment (Table 27). Another reason for seek- ing professional treatment, mentioned by 4 7 per cent of mothers, was if the child became in- creasingly sick. But while roughly half of the mothers or caretakers in the survey were able to properly identify one appropriate cause for taking a sick child for professional treatment, only 38 per cent were able to name two such Figure 19: Percentage of caretakers of children under 5 years, who know at least 2 signs for seeking care immedi- ately. Mongolia 2000 Rural Urban Total Central-2 Central-1 Eastern Southern Nortnern Western -: - j7.1 I I -- • - 38.5 I I - . - 37.9 I I • 42.8 --~ ~ 20.9 - 65.0 1- - :19.8 1 42 2 I ~ 324 Jill- 10.0 20.0 30.0 40.0 50.0 60.0 70.0 36 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY causes. This varies somewhat by mother's edu- cation, though the association is not as clear or as strong as might be expected. There are very striking differences among regions on this in- dicator, with about 20 per cent in Southern and Central-! regions knowing at least 2 symptoms, as compared with more than 40 per cent in Northern and Central-1 regions and 65 per cent in the Eastern region. There is very little differ- ence between urban and rural. Parents and caretakers do not have suffi- cient knowledge to take care of sick children at home and their health seeking behavior is low. Not all soums have creches, and 48 per cent of aimags have no day care centers for children. This situation has contributed to the increase of child mortality and child morbidity. F. HIV/AIDS F.l.AIDS knowledge One of the most important strategies for reducing the rate of HIV I AIDS infection is to propagate accurate knowledge of how AIDS is transmitted and how to prevent the spread of HIV infection in the population. The Child and Development Survey - 2000 (MICS-2) found .-";_Y!fi~ --::1~~ that 94 per cent of Mongolian women aged 15- 49 years have heard about AIDS (Table 30r This proportion represents about 98 per cent in urban centers and just under 91 per cent in rural areas. It varies somewhat among regions, with the low- est level, at 89 per cent, in Northern and South- em regions, and the highest level (99 per cent) in Central-2. Among age categories, the lowest percentage that has ever heard of AIDS is in the group 15-19 years of age, at about 90 per cent. During the survey all women aged 15-49 were presented with several statements about ways of preventing HIV/AIDS infection and were asked whether they believed them to be true or false. Eighty-two per cent of women believe that having only one uninfected sex partner can prevent HIV infection, while 80 per cent believe that always using a condom dur- ing sexual intercourse is an effective preven- tion measure. Three out of 4 women were able to identify both statements as effective ways of preventing HIV infection (Table 30a). Accurate knowledge about the means of preventing HIV I AIDS transmission is significantly higher among urban women. Women in the youngest age group were the least well informed, with only two-thirds in this group knowing both methods of prevention. There is a fairly consis- tent increase in knowledge as women's educa- tion increases. Between 43-58 per cent of those with only primary education or less, and 70 per cent with lower secondary education, knew both of the main ways of preventing HIV transmis- sion, while among better educated women the percentage ranges between 77 and 86 per cent. There are many misconceptions about AIDS transmission, and in the survey women were asked to indicate whether or not they believed the following statements: · AIDS can't be transmitted by supernatural means. "Child and Development-2000" survey, Mongolia National report 37 · AIDS can't be transmitted by mosquito bites. · A healthy-looking person may be infected with AIDS. Over three-quarters (76 per cent) of the women agreed with statement 1, 58 per cent agreed with statement 2 and 56 per cent agreed with statement 3 (Table 31 ). The responses show considerable variation across the different re- gions, between urban and rural residents, and most of all among different educational levels. The proportion able to identify all 3 misconcep- tions (that is, those who agreed with all of the statements) ranged from 24 per cent in the South- em region to 43 per cent in Central-2, a range of nearly 20 points. The figures for urban and rural women were 43 per cent and 31 per cent, re- spectively. Those with little or no formal educa- tion were much more likely to accept the mis- conceptions about HIV I AIDS transmission than women with higher levels of education. At the lowest level, (no education or only primary schooling), only 27 per cent correctly identified all 3 misconceptions, as compared with 50 per cent for women with university education. There appears to be little association between age and knowledge about HIVIAIDS, as roughly 36 per cent of all age groups were able to respond cor- rectly concerning all 3 misconceptions. Table 32 presents data on women 's knowl- edge about AIDS transmission from mother to child. When asked if AIDS can be transmitted from mother to child, 69 per cent of women in the 15-49 age group correctly responded "Yes". Women's education is closely associated with this knowledge, with increasing percentages knowing the correct answer as educational level increases. The percentage knowing that mother- to-child AIDS transmission is possible is about 5 points higher in urban areas than in rural places. The fact that a majority of urban women THE RESULTS OF THE SURVEY know about AIDS transmission and three means of preventing transmission, could be a result of the greater access that urban women have to radio, TV, mass media etc. which provide learn- ing opportunities. When asked specifically how this transmis- sion can take place, 58 per cent said that trans- mission during pregnancy was possible, 55 per cent said that transmission at delivery was pos- sible, but only one woman in 3 knew that AIDS could be transmitted from mother to child through breast milk. Only 27 per cent of these women knew all 3 modes of transmission. In general, women aged 30 and above were more likely to know about mother-to-child transmis- sion than younger women, and more education is associated with a greater likelihood of know- ing, but in neither case is the relationship very dramatic. At the other end of the spectrum, 34 per cent of the respondents did not know of any specific way in which AIDS could be transmit- ted from mother to child. On this indicator, the percentage of rural women was significantly higher than for urban women, with 38 and 32 per cent respectively. Nearly half (47 per cent) of young women in the 15-19 age group did not know any mode of transmission, and more than 50 per cent of those with primary educa- tion or less did not know. Among regions, the percentage varies between 28 in the Western to 44 in the Northern region. The MICS-2 survey also attempted to mea- sure discriminatory attitudes towards people living with HIV I AIDS. To this end, respondents were asked whether they agreed with two ques- tions. The first asked whether a teacher who has the HIV virus but is not sick should be al- lowed to continue teaching in school. The sec- ond question asked whether the respondent would buy food from a shopkeeper or food seller whom the respondent knew to be infected with 38 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY HIV or AIDS. The results are presented in Table 33. Forty-one per cent of women aged between 15-49 years of age believe that a teacher with HIV I AIDS should not be allowed to work and 14 per cent would not buy food from a person infected with AIDS. Overall43 per cent of women agree with one or both of the conditions, while 57 per cent agree with neither. The highest percentages of those who believe that a teacher with HIV should not be allowed to work are found in the Central-2 region (53 per cent) and among women with the highest level of education (62 per cent). The same two categories have the highest per- centages that would not buy food from a person with AIDS, 22 per cent in Ulaanbaatar (Central-2 region) and 27 per cent for women with a univer- sity education. In general, rural dwellers appear to be less prone to discriminatory attitudes than those living in urban areas. Only 46 per cent in the urban category agreed with neither discrimi- natory statement, while 2 out of 3 in rural areas agreed with neither. Similarly, women with the least education were much more likely to disagree with both discriminatory statements than those who were better educated. The overall level of know ledge about HIV I AIDS among Mongolian women is reflected in Figure 20: Percentage women aged 15-49 who have sufficient knowledge of HIV/ AIDS transmission by level 45.0 40.0 35.0 :no 25.0 2).0 150 10.0 42.1 39 .9 LY-;:1 25.8 1--- 2-2:4- ~- f-----1-7-:-4- 13.3 - ---<r f"-------1 . - -~ f--i :- _7'6 - f.-' !- f-------1 1- f-------1 ,., - Knows 3 ways Correctly Has sufficient to prevent identified 3 None • Primary • Secondary + • ~fl~j'~ 'l~.,:­ ·~.;_<(o, Table 34, which summarizes information from Tables 30 to 31. Table 34 shows that 38 per cent of women of reproductive age know 3 main methods to prevent HIV transmission and 36 per cent can correctly identify 3 misconceptions about AIDS transmission. "Sufficient" knowl- edge of HIV I AIDS transmission is defined as giving the correct response to all 6 items about prevention and transmission. The proportion of women who responded correctly on all 6 items is only 20 per cent. On this indicator, urban women are twice as likely as rural women to have "sufficient" know ledge, and better educated women are generally more likely to be knowl- edgeable than those with less education. There are no striking differences among the various age groups but on a regional basis, Central-2 with 28 per cent and the Western region with 20 per cent are places where women are much more likely to be knowledgeable about HIV I AIDS than those living in the Southern region. The knowl- edge level in each of the other 3 regions is the same for all three, at between 16 and17 per cent. F.2 . AIDS Testing Voluntary testing for AIDS, accompanied by counseling, allows those infected to seek health care and to prevent the infection of oth- ers. Testing is particularly important for preg- nant women who can then take steps to prevent infecting their babies. The indicators shown in Table 35 are designed to monitor whether women are aware of places to get tested for HIVIAIDS, the extent to which they have been tested, and the extent to which those tested have been told the results of the test. In some places, a relatively large proportion of people who are tested do not return to get their results due to fear of having the disease, fear that their pri- vacy will be violated, or other reasons. In Mongolia, more than half of the women sur- veyed (54 per cent) know where they can be "Child and Development-2000" survey, Mongolia National report 39 -"" __ . Ai' 1~~:, ' . "~-=~a tested for AIDS, and 14 per cent have actually been tested. Of those tested, a large majority has been given the result. Knowledge of where to be tested is much greater in cities (67 per cent) than in rural places (42 per cent), and much higher among well-educated women (nearly 80 per cent for university women) than among those with less education (roughly 1 in 3 for those with primary school or less). The percent- age of women under the age of 20 who know where to be tested for HIV/AIDS , which is about 40 per cent, is substantially lower than the 55-60 per cent figures for older groups. Women who have actually been tested are much more likely to have at least a completed sec- ondary education and to live in urban areas. Among regions, women living in Central-2 are 5-6 times more likely to have been tested than those living in the Western or Northern region. There is substan- tial variation in the proportion of those tested who have been given the results, ranging from as high as 91 per cent in Ulaanbaatar to as low as 61 per cent among women with primary schooling. G. Reproductive Health G.l. Contraception Goals. Global: Access by all couples to information and services to prevent pregnan- cies that are too early, too closely spaced, too late or too many. National: Organize con- sulting services on sexual life, birth spacing, and family planning. Organize educational courses, intended to reach young girls and all couples in need of guidance, on prevent- ing early and undesired pregnancies; to in- crease the percentage of women using effec- tive contraception. THE RESULTS OF THE SURVEY One of the key objectives of the Child and Development Survey (MICS-2) was to analyze the reproductive health situation. Questions, related to the use of contraceptives, care during pregnancy, and prenatal care were asked from women of reproductive age who were married or living with a partner. Current use of some kind of contraception was reported by 2 out of 3 of the surveyed women who are married or living with a partner (Table 36). By far the most popular method is IUD used by 34 per cent of these women. The pill was the second most common choice among modem methods, but only at about 8 per cent while in- jections were reported used by about 6 per cent. Almost 61 per cent of married women or women in union, aged between 15-49, reported using a contraceptive method of whom 54 per cent had used a modem contraceptive method and 13 per cent had used traditional methods. About 33 per cent of the surveyed women in the above category didn't use any contraceptive method. In rural areas, especially, modem con- traceptive methods were not commonly used. The use of any modern contraceptive method varies relatively little across back- ground categories, the main exceptions being the relatively low percentages in women with the least education. There are much wider dif- ferences among groups using traditional meth- ods. Interestingly, the use of any traditional method is significantly more common in urban areas than in rural places, at 16 per cent and 10 per cent respectively, the percentage using tra- ditional methods being highest of all among women with a university education. According to the Reproductive Health Sur- vey 1998 13) conducted by the National Statisti- cal Office, covering 6000 households, contra- 40 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY ~~~' "'" . :',> . ~~ . ', Figure 21: Percentage of women aged 15-49 who use contraceptive methods, Mongolia.2000 35 30 25 c 20 Q) () ._ Q) 15 0. 10 5 0 "0 Ql c c = 0 - 0 0 a:: .c C1l ·- ~ Q) Em Ql N -~ E u.= -~ ·c 0 Ql z en en Ql ro ~ 0 => 33.5 en c 0 u Ql ·c: en c C1l Ci. E E 0 "0 c 0 u ~ E C1l 0 E-o Ql c u. 0 (.) -- >-E= g>~ ._ E .c C1l a.o ro . 0 (.) Ql ·- (.) ~ a5 . c Ql ·- D. en .0 C1l 0.1 0 .3 Q; .c 6 Method ceptive use was highest among married women of reproductive age. The current MICS-2 sur- vey revealed that 84 of reproductive age women use some contraceptive method, and among these 74 percent reported that they use modem contraceptive methods. The most common method was IUD and more than half of women- respondents (56 per cent) said that they use IUD. The next popular method was condoms (29 per cent) and the pill (22 per cent). These two sur- veys both show that among the most popular methods are IUD and pills, although the fig- ures with reference to condoms are different. G.2. Prenatal care Quality prenatal care can contribute to the pre- vention of maternal mortality by detecting and managing potential complications and risk factors, including pre-eclampsia, anemia, and sexually transmitted diseases. Prenatal care also provides opportunities for women to learn the danger signs of pregnancy and delivery, to be immunized against tetanus, to learn about infant care, and to be treated for existing conditions, such as anemia. The MICS-2 survey found that 97 per cent of the 1515 women of reproductive age who gave birth in the year prior to the survey re- ceived prenatal care from professional medical practitioners (Table 38). Of these practitioners, 91 per cent were doctors and 5 per cent were feldshers (community health workers), mid- wives or nurses. Over all geographic and edu- cational categories, doctors provided prenatal care in 85-95 per cent of pregnancies, and some form of skilled professional assistance was pro- vided in 90 per cent or more of the cases. "Child and Development-2000" survey, Mongolia National report 41 G.3. Assistance at delivery Goals. Global: Access by all pregnant women to pre-natal care, trained attendants during child birth and referral facilities for high-risk pregnancies and obstetric emergencies. National: 75 % of pregnant women with pre-natal care during the first trimester of pregnancy, 100% deliveries supervised by doctors and midwives. The provision of delivery assistance by skilled attendants can greatly improve outcomes for mothers and children through the use of technically appropriate procedures and by accurate and speedy diagnosis and treatment of complications. Table 39 presents the survey's findings on assistance during delivery. Again, the respondents were those women, aged 15- 49, who had given birth in the previous 12 months, of whom 97 per cent had antenatal care. As with antenatal care, the proportion of births assisted by skilled medical personnel is very high. Across virtually all-geographic and educational categories, the figure is 95 per cent or more. The only significant exception is the very small group of women with no formal schooling, with only 80 per cent of deliveries assisted by skilled personnel. However, this educational category includes only 10 births, so the finding may not be significant. Skilled assistance at delivery is assistance provided by a doctor, nurse or midwife. Skilled personnel delivered about 97 per cent of births occurring in the 12 months prior to the MICS-2 survey. There are considerable differences among regions and between urban and rural locations. Two-thirds or more of obstetric cases in Central- ! and Central-2 regions, and roughly half in Western, Northern and Eastern regions, were attended by doctors, but, in the Southern region, doctors provided assistance in only 38 per cent THE RESULTS OF THE SURVEY of the cases. Doctors attend two out of 3 urban deliveries as compared with 53 per cent (just over half) in the countryside. Figure 22: Percent distribution of women who gave birth in the year prior to the survey by type of personnel assisting at delivery. Mongolia 2000 Rural Urban Countryside Soman center Aimag center Capital city Total 96 4 9514 96.9 1~5.9 ~ 6.6 98.5 98.3 93 94 95 96 97 98 99 Accessibility, availability and quality of prenatal and postnatal care are not sufficient in the country, especially in terms of rural health services. Mongolia is still among the countries with high maternal mortality. Causes of mater- nal mortality are pre-eclampsia, post-pregnancy toxication, other diseases combined with preg- nancy, and bleeding, infection etc. The supply of essential drugs is not enough, and the drug management system and the supply and service system do not meet modem requirements. H. Child Rights and Children in difficult circumstances Goals. Global: Improved protection of children in especially difficult circumstances, National: Formulate legislation to increase social service coverage for families & children. H.l . Birth Registration The Convention on the Rights of the Child emphasizes the right of every child to a name 42 "Child and Development-2000" survey, Mongolia National report THE RESULTS OF THE SURVEY and a nationality and to the right of protection from being deprived of his or her identity. Birth registration is a fundamental basis for securing these rights. Data from the Child and Develop- ment Survey (MICS-2) revealed that about 98 per cent of children aged 0-59 months have been registered (Table 40). There is very little variation across sex, region, urban-rural residence or edu- cational categories. The survey findings do indi- cate, however, that a significant proportion of chil- dren are not registered at or soon after birth. Only 85 per cent of children under 6 months of age were found to be registered. But this delay is not pro- longed; for children aged 2 and above, essentially all (99+ per cent) have been registered. H.2. Orphans and neglected children Children who are orphaned or neglected by their parents may be at increased risk of impoverishment, discrimination, denial of prop- erty or inheritance rights, or may be subject to various forms of abuse, neglect, and exploitation. Photo by Giacomo Pirozzi Monitoring the level of orphanhood and the living arrangements of children assists in identifying those who may be at risk and in tracking changes over time. In Mongolia, of 12,806 children, aged 0-14, who are covered by the survey, 80 per cent are living with both biological parents, and less than 2 per cent do not live with a biological parent (Table 41). In the case of the 17 per cent of children living with only one parent, it is much more likely that this parent will be the mother. Sixteen per cent of children are living with their mother only. Among these, the fathers of 4 per cent of the children are dead, while the fathers of 12 per cent are still alive. By contrast, the mothers of only 0.3 per cent of the children who are liv- ing only with their father, are still alive. The incidence of orphaned children aged 5-9 is 0.1 per cent, rising to about 0.7 per cent for chil- dren aged 10-14. According to the findings of the survey, 0.3 per cent of children under 5 years are fully orphaned. Figure 23: Children 0-14 years of age, not living with parents. Mongolia 2000 2.0 4.0 • One of both parents dead D Not living with a biological parent D Full orphaned H.3. Child Labor 6.0 Per nt Living with father only mother dead D Living with father only mother alive It is important to monitor the extent to which children work and the type of work they do, for several reasons. Children who are working are less likely to attend school and more likely to drop out. They can be trapped in a cycle of poverty and disadvantage from an early age. Conditions of labor for children are often unregulated, with few safeguards against "Child and Development-2000" survey, Mongolia National report 43 -_. '~-'-,:i:~ , , v' ~ . ~ ~"".J~~ potential abuse. In addition, many types of work are hazardous, including jobs involving exposure to chemicals and those requiring the lifting of heavy weights. Photo by Giacomo Pirozzi Data gathered in the current MICS-2 survey on the number of children aged 5-14 who were working , and on some of the characteristics of that work, are presented in Table 42 . The survey finds that nearly all children help out with domestic work. However, for 70 per cent of the children, this type of work requires less than 4 hours per day, though for about 20 per cent, domestic work was reported to require 4 or more hours per day. Overall, the survey estimates that 1.4 per cent of children between 5 and14 years of age are engaged in paid or unpaid work for someone other than a household membr. There are some differences among regions, with paid work for children in the Eastern region and in soum centers nationwide at more than twice the level for the country as a whole. Older children, aged 10-14, are much more likely to be involved in paid work than those in the younger age group. For domestic work requiring less than 4 hours per day there appear to be no major geographical differences, though a greater than average proportion of children in the Southern region are engaged in this category of work, and in the THE RESULTS OF THE SURVEY Figure 24: Percentage of children 5-14 years who are working . Mongolia 2000 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 D D Ell Paid work Total Urban Rural Unpaid work I' ;); , . "' }/., ;y] H\;TIIF Domestic Domestic work: <4 work: 4 or hours/day more hours/day Western region the proportion is somewhat lower than average. There is more variability for domestic work of 4 or more hours per day, which involves relatively small percentages of children in the Southern and Central-2 regions and significantly larger than average percentages in the Western and Eastern regions. Children aged 10-14 are much more likely to be working for 4 or more hours per day than are the younger children. As much as 70 percent of all children doing paid work for someone other than a household member, are in rural areas, out of which 35 per cent work with the livestock and 20 per cent work on the farm. 44 · "Child and Development-2000" survey, Mongolia National report <i :!. 0:: Ql ::J a. 0 (!) < (!) 0 "'0 3 (!) ;a. I 1\) 0 0 ~ (/) c: ~ '::< s::: 0 ::J co Q. iii' ~ § ~ (iJ ~ ~ .f>. (]1 Target group, thous Percent of population Population, thous Key indicator Prevalence Design effect Average household size Sample size ~ Total of sample size The estimation of the sample size for MICS, in Mongolia 2000 Immunization coverage, children aged Iodized Percentage of between 12-23 months Vitamin "A" salt Use ofORT(l) children with supplement consump- in diarrhoeo, low weight. DPT3 Measles OPV3 BCG tion of US yrs US yrs household M.J 42.5 42.5 42.5 42.5 3.7 535.3 15.0 1.9 1.9 1.9 1.9 2290.8 23.4 50.0 2290.8 2290.8 2290.8 2290.8 2290.8 0.23 0.92 0.9 0.9 0.9 0.9 1.75 0.32 0.92 2 3 3 3 3 4.3 2 2 4.3 4.3 4.3 4.3 4.3 4.3 4.3 3463 404 5985 5985 5985 5985 766 121 - -5985 School enrolment I Safe water I Sanitation 5-9 yrs/ pop/ /pop/ 140 6.1 51.9 82.0 2290.8 2290.8 2290.8 0.92 0.92 0.92 2 2 2 4.3 4.3 4.3 990 117 74 ··- ···- -- -, > ""C ""C tr'l z ~ ~ > 46 APPENDIX B List of contributors MICS Head of the steering committee: Members: A. Steenng committee B. Batmunkh, Ph.D in Economics Deputy chairman, National Statistical office Mongolia A. Batjargal, MatheMatician Head of division, Ministry of Education, Culture and Science Ch. Dagvadorj, Economist Head of division, Ministry of Social, Health and Welfare N. Bolormaa, Leader Mongolian Child Rigth s center Ch. Tserensodnom, Chairman National center for Children, Mongolia B. Uranchimeg, M.A in Pedagogics Project officer, UNICEF in Mongolia "Child and Development-2000" survey, Mongolia National report APPENDIX B List of contributors MI CS Head of working group: Secretary: Members: H Working group D. Oyunchimeg, M.A in Economics, Economics tat- istician Head of division, National Statistical Office, Mongolia Yu. Tuul, M.A in Economics, Economic statistician Senior officer, National Statistical Office, Mqngolia T. Amarjargal, Worker for Child Officer, National Centre for Children, Mongolia Baigalmaa, Economic statistician Officer, National Statistical Office, Mongolia G. Boldbaatar, Police Officer General office of Police, Children s Department IS. Do Igor I Economic statistician Senior officer, National Statistical Office, Mongolia Ts. Myagmarsuren, Economic statistician Officer, Ministry of Education, Culture and Science B. Tserenkhand, Programmer and computer engi- neer Senior officer, National Statistical Office, Mongolia B. Khachinchuluun. Social Worker. Officer. Mongolian Children s right centre Sh. Erdenetsetseg. Economic statistician. Senior.National Statistical Office. Mongolia E.Erdenechimeg. M.A in Medical Science. Head of Division. Ministry of Health "Child and Development-2000" survey, Mongolia National report 47 APPENDIX B Persons involved in the MICS -2000 year National Director National co-ordinator Project officcer Supervisors: Field editors: Interviewers: 0. Baigalmaa L. Batsuren Yu. Alt-Ochir N. Altantuya D. Ayush B. Bayaraa N. Ganbold Ts. Dorjpalam Ch. Altantsetseg E. Ariunaa B. Ariuntungalag B. Baasan Ts. Badam B. Badamkhand B. Batbayar D. Battsengel R. Bayasgalan B. Bolormaa T. Bolormaa N. Buyansuren Data processing staff: Programmers: Operators: B. Tserenkhand M. Luvsan B. Ariuntuya B. Jargal Kh . Zolzaya B. Batmunkh Yu. Tuul B. Uranchimeg Ch, Dagvadorj S. Dolgor T. Jargal B. Narmandakh J. Narmandakh N. Oyun Ts. Od- Ochir D. Polooj D. Bujinlkham P. Gantuya L. Dolgorsuren D. Doljinsuren B. Dorjkhand J. Jambalsuren S. Munkhtsetseg M. Myagmarsukh S. Narangerel S. Narmandakh S. Nyamkhishig P. Odgerel G. Munkhtuya G . Munkhtsetseg A. Otgonjargal S. Munkhoo R. Oidovdanzan D. Purevdorj S. Rentsendorj Ts. Samdan L. Sukh G . Tuul D. Urnaa --- S. Odonchimeg Ch. Oyun J. Oyungerel S. Oyuntulga T. Oyunchimeg D. Saran A. Tuya Z. Togsjargal L. Tungalag G . Tungalag E. Tungalag D. Uranchimeg - -- E. Togosmaa V. Urtnasan B. Tsend-Ayush 48 "Child and Development-2000" survey, Mongolia National reporl S. Oyuntsetseg Sh. Erdenetsetseg G. Kherlen 0. Khonkhor 0. Tserendulam B. Enkhtuya Ts. Enkhbayar P. Erdene J. Erdenesuren G. Uzmee Ch. Unen B. Uurtsaikh B. Khumbaa J . Khureltsetseg S. Enkhbat N. Enkhtaivan D. Enkhbaatar Ts. Enkhtsetseg R. Erdenemandal B. Enkhtuya G. Yumed M. Chantsalnyam L. Erdenetsetseg L. Enkhtaivan APPENDIX C List of Tables Table 1: Table 2: Table 3: Table 4: Table 5: Table 6: Table 7: Table 8: Table 9: Table 10: Table 11: Table 12: Table 13: Table 14: Table 15: Table 16: Table 17: Table 18: Table 19: Table 20: Table 21: Number of households and women, and response rates, Mongolia, 2000. Single year age distribution of household population by sex, Mongolia, 2000. Percentage of cases missing information for selected questions, Mongolia, 2000. Percent distribution of households by background characteristics, Mongolia, 2000. Percent distribution of women 15-49 by background characteristics, Mongolia, 2000. Percent distribution of children under five by background characteristics, Mongolia,2000. Mean number of children ever born (CEB) and proportion dead by mother's ag~, Mongolia, 2000. Infant and under-five mortality rates, Mongolia, 2000 Percentage of children aged 36-59 months who are attending some form of organized early childhood education programme, Mongolia, 2000. Percentage of children entering first grade of primary school who eventually reach grade 5, Mongolia, 2000. Percentage of children of primary school age attending primary school, Mongolia, 2000. Percentage of the population aged 15 years and older that is literate, Mongolia, 2000. Percentage of the population with access to safe drinking water, Mongolia, 2000. Percentage of the population with access to sanitary means of excreta disposal, Mongolia, 2000. Percentage of under-five children who are severely or moderately undernourished, . Mongolia, 2000. Percent of living children by breastfeeding status, Mongolia, 2000. Percentage of households consuming adequately iodized salt, Mongolia, 2000. Percent distribution of children aged 6-59 months by whether they have received a high dose Vitamin A supplement in the last 6 months, Mongolia, 2000. Percentage of women with a birth in the last 12 months by whether they received a high dose Vitamin A supplement before the infant was 8 weeks old, Mongolia, 2000. Percentage of live births in the last 12 months that weighed below 2500 grams at birth, Mongolia, 2000. Percentage of children age 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Mongolia, 2000. "Child and Development-2000" survey, Mongolia National report 49 APPENDIX C Table 22: Table 23: Table 24: Table 25: Table 26: Table 27: Table 30: Table 31: Table 32: Table 33: Table 34: Table 35: Table 36: Table 38: Table 39: Table 40: Percentage of children age 12-23 months currently vaccinated against childhood dis eases, Mongolia, 2000. Percentage of under-five children with diarrhoea in the last two weeks and treatment with ORS or ORT, Mongolia, 2000. Percentage of under-five children with diarrhoea in the last two weeks who took increased fluids and continued to feed during the episode, Mongolia, 2000. Percentage of under-five children with acute respiratory infection in the last two weeks and treatment by health providers, Mongolia, 2000. Percentage of children 0-59 months of age reported ill during the last two weeks who received increased fluids and continued feeding, Mongolia, 2000. Percentage of caretakers of children 0-59 months who know at least 2 signs for seeking care immediately, Mongolia, 2000. Percentage of women aged 15-49 who know the main ways of preventing HIV transmission, Mongolia, 2000. Percentage of women aged 15-49 who correctly identify misconceptions about HIV/ AIDS, Mongolia, 2000. Percentage of women aged 15-49 who correctly identify Percentage of women aged 15-49 who express a discriminatory attitude toward people with HIV/AIDS, Mongolia, 2000. Percent of women aged 15-49 who have sufficient knowledge of HIV /AIDS transmis sion, Mongolia, 2000. Percentage of women aged 15-49 who know where to get an AIDS test and who have been tested, Mongolia, 2000. Percentage of married or in union women aged 15-49 who are using (or whose partner is using) a contraceptive method, Mongolia, 2000. Percent distribution of women age 15-49 with a birth in the last year by type of personnel delivering antenatal care, Mongolia, 2000. Percent distribution of women aged 15-49 with a birth in the last year by type of personnel assisting at delivery, Mongolia, 2000. Percent distribution of children aged 0-59 months by whether birth is registered and reasons for non-registration, Mongolia, 2000. Table 41: · Percentage of children 0-14 years of age in households not living with a biological parent, Mongolia, 2000. Table 42: Percentage of children 5-14 years of age who are currently working, Mongolia, 2000. 50 "Child and Development-2000" survey, Mongolia National report AppendiH C Table'.t Table 1: Number of households and women, and response rates, Mongolia,2000 By location Total Urban Rural Sampled households 2925 3075 6000 Occupied households 2925 3075 6000 Completed households 2925 3075 6000 Household response rate 100 100 100 Eligtble women 4199 4407 8606 Interviewed women 3993 4264 8257 Women response rate 95.1 96.8 95.9 Children under 5 2711 3488 6199 Interviewed children under 5 2703 3481 6184 Child response rate 99.7 99.8 99.8 Table 3: Percentage of cases missing information for selected questions, Mongolia, 2000 Reference population Percent missing Number Level of education Household members 8,3 21230 Year of education Household members 0,1 21230 Number of hours worked Working child age 15- 14 146 Complete birth date Women 15-49 0,1 8257 Ever been tested for HIV Women :::i-49 0,1 7769 Complete birth date Children under 5 6184 Diarrhoea in last 2 weeks Children under 5 0,1 6184 Weight Children unde1 5 4,1 6184 Height 1 ' ' . ,.~ under 5 4,1 6184 51 AppendiK C Table'.t Table 2: Single year age distribution of household population by sex, Mongolia, 2000 Age 0 2 3 4 5 6 7 8 9 10 II 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Male No 721 629 612 563 630 333 345 340 332 380 365 308 298 325 298 287 244 202 228 200 202 175 221 190 239 331 287 291 269 262 326 253 241 216 197 155 % 5.1 4.5 4.3 4.0 4.5 2.4 2.4 2.4 2.3 2.7 2.6 2.2 2.1 2.3 2.1 2.0 1.7 1.4 1.6 1.4 1.4 1.2 1.6 1.3 1.7 2.3 2.0 2.1 1.9 1.9 2.3 1.8 1.7 1.5 1.4 1.1 Female No 698 629 581 559 576 303 303 340 366 334 337 327 315 326 333 353 305 281 319 297 370 365 348 355 413 459 385 368 346 305 354 240 270 243 209 206 % 4.4 4.0 3.7 3.5 3.6 1.9 1.9 2.1 2.3 2.1 2.1 2.1 2.0 2.1 2.1 2.2 1.9 1.8 2.0 1.9 2.3 2.3 2.2 2.2 2.6 2.9 2.4 2.3 2.2 1.9 2.2 1.5 1.7 1.5 1.3 1.3 52 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70+ Total Male No 207 237 190 138 188 113 127 106 82 111 84 60 73 74 86 47 57 59 49 47 31 37 35 42 55 23 33 30 18 37 18 17 19 16 89 14130 continue Female % No 1.5 224 1.7 208 1.3 164 1.0 156 1.3 168 0.8 117 0.9 129 0.8 118 0.6 125 0.8 121 0.6 85 0.4 68 0.5 88 0.5 44 0.6 88 0.3 46 0.4 56 0.4 37 0.3 45 0.3 47 0.2 37 0.3 42 0.2 54 0.3 31 0.4 51 0.2 15 0.2 32 0.2 31 0.1 20 0.3 28 0.1 18 0.1 18 0.1 20 0.1 18 0.6 151 100 15818 % 1.4 1.3 1.0 1.0 1.1 0.7 0.8 0.7 0.8 0.8 0.5 0.4 0.6 0.3 0.6 0.3 0.4 0.2 0.3 0.3 0.2 0.3 0.3 0.2 0.3 0.1 0.2 0.2 0.1 0.2 0.1 0.1 0.1 0.1 1.0 100 AppendiH C Table'J Table 4: Percent distribution of household s by background Table 4a: Percent distribution of households by background characteristics. characteristics. Mongolia, 2000 Mongolia, 2000. Area Total Percent Number Urban Rural P-.:rcent Number Western 18,2 1090 Western 25,7 74 ,3 18 ,2 1090 Northern 22 ,5 1350 Northern 17,4 82 ,6 22 ,5 1350 Southern 7,3 435 Southern 27 ,8 72 ,2 7,3 435 Region Region Eastern 8 ,8 530 Eastern 34,0 66 ,0 8 ,8 530 Central-! 15,8 950 Central-! 48,8 51,2 15,8 950 Central-2 27 ,4 1645 Central-2 100 27,4 1645 Ca pital city 27 ,4 1645 48 ,8 51 ,2 7 H o usehold Aimag center 21,3 1280 2-3 46,4 53,6 20,3 1215 location Soman center 17 ,7 1059 Number of 4-5 57 ,9 42,1 47 ,9 2874 Countryside 33 ,6 2016 HH members 6-7 47 ,8 52 ,2 21 ,9 1312 Urban Residence 48 ,8 2925 8-9 66,3 33 ,7 7 ,4 441 Rural 51,2 3075 10+ 48 ,6 51,4 2,5 151 7 2-3 20 ,3 1215 At least one child age< 5 2205 2552 79 ,3 4757 Number ofHH 4-5 47,9 2874 members 6-7 21 ,9 1312 At least one child age< 15 2730 2976 95' 1 5706 8-9 7,4 441 10+ 2,5 151 At le a st one woman a ge 15-49 2887 3054 99 ,0 5941 Total 100 6000 Total 2925 3075 100 6000 53 AppendiH C Table'J Table 5: Percent distribution of women 15-49 by background Table 6: Percent distribution of children under 5 by characteristics. Mongolia, 2000 background characteristics. Mongolia, 2000 Percent Number Percent Number Western 17 ,9 1475 Western 19 ,2 1186 Northern 21,6 1784 Northern 25,8 1598 Region Southern 6,9 570 Region Southern 7,0 430 Eastern 9,9 821 Eastern 9,3 575 Central-! 16,3 1342 Central-! 14,6 903 Centra 1-2 27,4 2265 Central-2 24,1 1492 Capital city 27,4 2265 Capital city 24,1 1492 Household location Aimag center 20,9 1728 Household location Aimag center 19 ,6 1211 Soman center 18 ,2 1502 Soman center 18 ,6 1152 Countryside 33,5 2762 Countryside 37,7 2329 Residence Urban 48,4 3993 Residence Urban 43,7 2703 Rural 51 ,6 4264 Rural 56 ,3 3481 15-19 16,9 1394 < 6 months I 0,6 656 20-24 21,6 1784 6-11 months II ,4 708 25-29 21,4 1767 Age gro up 12-23 months 20,3 1255 Age group 30-34 16 ,1 1326 24-35 months 19 ,3 1193 35-3 9 11 ,5 949 36-4 7 months 18,3 1131 40-44 7,9 649 48-59 months 20,1 1241 45-49 4 ,7 388 Sex Male 50,9 3150 Currently married 60 ,4 4990 Female 49,1 3034 M ari ta I sta tus Formerly married 14,1 1161 None 0,8 48 Never marri ed 25,5 2106 Prim a ry 5, I 313 Yes 76,4 6309 Non-Completed 26 ,6 1645 Ever given birth Secondary No 23 ,6 1948 Completed Secondary 33,4 2064 None 1, 1 92 Mother's ed uca ti on Vocational I 0,5 648 level Vocational training Primary 9,2 759 and College 13,2 818 Non-Completed 25 ,4 2099 Hi gher 9,7 599 Woman's education Secondary level Completed Secondary 31,3 2582 Missing/DK 0,8 49 Vocational 9,2 760 Total 100 6184 Vocational training 12,2 1008 and College Hi gher I 0,3 849 Missing/DK 1,3 108 Total 100 8257 54 AppendiH C Table'J Table 7: Mean number of children ever born (CEB) and proportion dead by mother's age. Mongolia, 2000 By age group Mean number ofCEB Proportion dead Number of women 15-19 0.128 0.022 1394 20-24 0.953 0.051 1784 25-29 1.865 0.082 1767 30-34 2.859 0.088 1326 35-39 3.778 0.099 949 40-44 4.855 0.130 649 45-49 5.325 0.123 388 Total 2.152 0.097 8257 Table 7a: Sex ratio at birth by mother's age, Mongolia, 2000 Total number of By age group boys girls Sex ratio at birth 15-19 89 90 0.99 20-24 857 844 1.02 25-29 1762 1533 1.15 30-34 1953 1838 J .06 35-39 1751 1834 0 .95 40-44 1490 1661 0.90 45-49 993 1073 0.93 Table 8: Infant and under 5 mortality rate. Mongolia, 2000 By modei"West" Reference period Infant Under 5 1999-YI 26 31 1998-III 47 61 1996-1 64 87 1993-Y 64 87 1990-YI 66 91 1987-YI 79 110 1984-YI 69 95 55 AppendiH C Table'J Table 9: Percentage of children aged 36-59 months who are attending some from organized early childhood programme, Mongolia, 2000 Sex Region Household location -------------------- Residence Age group Mother's education level Male Female We ste rn Northern Southern Eastern Central-! Central-2 Capital city Aim ag center Soman center Countryside Urban Rural 36-47 months 48-59 months None Primary Non-Completed Secondary Completed Secondary Vocational Vocational training and College Higher Missing/DK Total World Summit for Children Goal=> Number 26 56 Attending programm e % Number of children 20.9 12 16 21. 1 1156 18.0 466 7 .I 616 13 .8 160 12.8 211 22.9 315 41.2 604 41.2 604 26.5 438 17 .5 434 6.4 896 35.0 1042 10 .0 1330 16.2 1131 25 .4 1241 16 3.4 118 8.6 60 5 19 .0 717 21.2 288 32 .8 351 49.4 259 II. I 18 21.0 2372 AppendiH C Table'J' Table 10 :Percentage of children of primary school age attending primary school. Mongolia, 2000 Sex Total Male Female Attending Number Attending Number Attending Number We stern 74,9 410 72,4 420 73.6 830 Northern 68,1 464 71 ,4 458 69.7 922 Southern 75 .6 160 80,7 !50 78.1 310 Region Eastern 70,5 207 74,5 192 72.4 399 Central-! 7 5,8 376 80, 0 431 78 , I 807 Central-2 85,2 406 80,4 368 82,9 774 Capital city 85 ,2 406 80,4 368 82 ,9 774 Househo ld Aimag center 79,0 476 80,9 465 79 ,9 941 location Som a n center 73,9 456 77,8 477 75 ,9 933 Countryside 67 ,4 685 69,5 709 68 ,5 1394 Urban 81,9 8.82 Residence 80,7 83 3 81.3 1715 Rural 70 ,0 1141 72.8 1186 71 ,5 2327 7 25,6 340 26,5 340 26,0 680 8 62,0 332 63, I 366 62 .6 6')8 9 87 ,6 380 87, I 334 87.4 714 Age group 10 94 ,0 365 95,5 337 94 ,7 702 II 93,2 308 94,5 327 93,9 635 12 88 ,9 298 93.0 315 91,0 613 7-10 68,4 1417 67,8 13 77 68 , I 2794 7 -I I 72,8 1725 72,9 1704 72 ,9 3429 Total (by age 7-12 75,2 2023 76, I 2019 75,6 4042 group) 8-9 75,7 712 74 ,6 700 75, I 1412 8-1 I 84,4 1385 84,5 1364 84,5 2749 9-12 90,9 1351 92,5 1313 91,7 2664 World Summit for Children Goal=> Number 6 Table 11: Percentage of children entering first grade of primary school who eventually reach grade 5. Mongolia,2000 Percent in Percent in Percent in Percent in grade I grade 2 grade 3 grade 4 Percent who reach grade 5 of reaching reaching reaching reaching those who enter grade I grade 2 grade 3 grade 4 grade 5 Male 98,9 98,8 97,9 98, I 93.9 Sex Female 98,8 100 98,6 98 .0 95 .5 Western 98,5 99 ,2 98,2 98.6 94,7 Northern 100 99 ,3 96,3 97,6 93,5 Southern 97 ,8 100 100 100 97.8 Region Eastern 84,4 95,5 87,3 88, I 69,7 Central-! 99.5 100 99,0 100 98 ,5 Central-2 100 100 100 100 100,0 Urban 99 ,4 99 ,7 99,6 98,3 97.0 Residence Rural 98 ,4 99,3 97,4 9 7,8 93.2 Total 98,9 99,4 98,3 98,1 94,7 57 AppendiH C Table'J' Table 12 : Percentage of the population aged 15 years and older that is literate. Mongolia, 2000 Sex Total Male Female Literate Not Number Literate Not Number Literate Not Number known known known Western 99.0 1.0 1370 98 .8 1.2 1614 98 .9 1.1 2984 Northern 98.5 1.5 1693 97.4 2.5 2001 97 .9 2.1 3694 Southern 98.0 2.0 538 98 .0 1.8 654 98 .0 1.9 1192 Region Eastern 97 .3 2.7 710 98 .9 1.1 925 98 .2 1.8 1635 Central-! 98.1 1.9 1236 98 .0 2.0 1607 98 . 1 1.9 2843 Central-2 99 .3 0.7 2104 99.4 0 .6 2690 99.4 0.6 4794 Capital city 99.3 0.7 2104 99.4 0.6 2690 99.4 0 .6 4794 Aimag center 99.1 0.9 1588 98 .4 1.6 2030 98.7 1.3 3618 Household location Soman center 98.3 1.7 1376 99 .2 0 .8 1682 98 .8 1.2 3058 Countryside 97.9 2.1 2583 97.4 2.5 3089 97.7 2.3 5672 Urban 99.2 0.8 3692 99.0 1.0 4720 99.1 0 .9 8412 Residence Rural 98.0 2.0 3959 98 .1 1.9 4771 98 .0 1.9 8730 15-24 97.6 2.4 2188 99.2 0.7 3406 98.6 1.4 5594 25-34 99.2 0.8 2673 99 .3 0.7 3179 99.2 0 .8 5852 Age group 35-44 99 .0 1.0 1543 98 .8 1.2 1615 98 .9 1.1 3158 45-54 99.1 0.9 700 99 . 1 0.9 678 99 . 1 0.9 1378 55-64 98.6 1.4 351 94 .4 5.6 360 96.5 3.5 711 65+ 96.9 3.1 196 81.4 18 .6 253 88 .2 11.8 449 Total 98.6 1.4 7651 98.5 1.5 9491 98.5 1.4 17142 World Summit for Children Goal=> Number 7 58 AppendiK C Table' I' Table 13: Percentage of the population using improved drinking water sources. Mongolia, 2000 Main source of water Piped Piped into Public Tubewell Protected Protected Bottled Unprotected into /borehole dwelling yard or plot tap with pump dug well spring water dug well Western 8 .I 0.4 2.3 8.5 12.7 0.1 0.1 5.8 Northern 0.3 0.0 8.4 3.1 10.9 0.0 0.1 6.5 Southern 5.8 0.0 23.8 12 .5 38.4 0.0 0.0 13.9 Region Eastern 15.5 0.3 12.0 3.2 22.3 0.0 0.3 18 .3 Central-! 27.2 2.4 19.8 18.6 15.6 0.0 0.1 4.5 Central-2 49.2 0.1 38.1 1.7 7.9 0.1 0.0 0.4 Capital city 49.2 0.1 38 .1 1.7 7.9 0.1 0.0 0.4 Household Aimag center 33 .6 1.4 26.4 5.3 16.4 0.1 0.0 2. 1 location Soman center 4.2 0.1 12.5 17. 1 15.9 0.0 0.3 5.9 Countryside 0.4 0.6 1.6 6.4 16.8 0.0 0.0 12.9 Residence Urban 42.1 0.7 32.8 3.3 11.7 0.1 0.0 1.2 Rural 1.8 0.4 5.5 10.2 16.5 0.0 0.1 I 0.4 Total 20.4 0.6 18.1 7.0 14.3 0.0 0.1 6.1 World Summit for Children Goal=> Number 4 Table 13: Continuation Main source of water Total with T anker Total safe Number of persons U nprotec Pond, river truck Other drinking ted spring or stream vendor water Western 0.5 49.5 6.1 5.9 100 32.2 5504 Northern 0.1 67.9 0.6 2.1 100 22.6 6894 Southern 0.3 2.6 2.6 0.0 100 80.6 2120 Region Eastern 0.1 25.5 1.1 1.4 100 53.3 2848 Central-! 0.0 5.8 2.6 3.4 100 83.7 5035 Central-2 0.0 0.0 2.5 0.0 100 97.1 7547 Capital city 0.0 0.0 2.5 0.0 100 97.1 7547 Household Aimag center 0.0 7.0 6.9 0.9 100 83.1 6299 location Soman center 0.0 40.2 1.9 1.8 100 49.8 5722 Countryside 0 .4 55.3 0.6 5.0 100 25.9 10380 Residence Urban 0.0 3.2 4.5 0.4 100 90.8 13846 Rural 0 .3 49.9 1.0 3.9 100 34.4 16102 Total 0.1 28.3 2.6 2.3 100 60.5 29948 World Summit for Children Goal=> Number 4 59 AppendiH C Table'.t Table 14: Percentage of the population using sanitary means of excreta disposal. Mongolia, 2000 Kind of toilet facility Total with Flush to Pour sa nitary Number of sewage flush Improved Traditiona l Open pit Other No facilities or Total means of system or pit latrine pit latrine bush or field excreta persons septic tank latrine disposa l Western 8.0 0.3 0 .7 51.7 5.8 0.0 33.4 100 60 .8 5504 Northern 0 .2 0.1 0.3 52.1 14 .2 0 .3 32.7 100 52 .8 6894 Southern 7.5 0.0 0.4 44.4 6 .6 0.0 41.1 100 52.4 2120 Region Eastern 15.7 0.0 0.3 63.4 5.4 0 .0 15.2 100 79.4 284 8 Central-! 28 . 1 0.3 1.3 59 . 1 0 .7 0. 1 10 .3 100 88 .8 5035 Central-2 49 . 1 0.1 1.8 45.7 2.9 0 .1 0.2 100 96.8 7547 Capital city 49.1 0.1 1.8 45 .7 2 .9 0.1 0.2 100 96.8 7547 Household Aimag center 33.6 0.3 0 .6 62 .5 2 .0 0.1 0 .9 100 97.0 6299 location Soman center 4 .8 0.3 1.1 80 .6 7 .7 0 .1 5.4 100 86.8 5722 Countryside 0.8 0.0 0.4 34 .8 10 .3 0.1 53 .5 100 36.1 10380 Urban 42.1 0.2 1.3 53.4 2 .5 0 . 1 0.5 100 96.9 13846 Residence Rural 2.3 0.1 0.6 51.1 9 .4 0 . 1 36.4 100 54.1 16102 Total 20.7 0.1 0.9 52.1 6.2 0.1 19.8 100 73.9 29948 World Summit for Children Goal=> Number 5 60 AppendiH C Table'J' O:i Table 15: Percentage of under-five children who are severely or moderately undernourished, Mongolia, 2000 Weight for age: Height for age: Weight for height: Number of percent percent percent percent percent percent children below -2SD below -3SD below ~2SD below -3SD below -2SD below -3SD Sex Male 12,7 2,6 25,4 8,6 5,6 1,2 2939 Female 12,7 3, l 23,8 8,5 5,5 1,2 2845 Western 14,3 3,5 29,2 ll ,8 4,9 1,3 1071 Northern 16,2 3,7 32,2 11 ,5 6,4 1,4 1526 Region Southern 7,9 1,5 23,2 5,1 4,1 0,3 393 Eastern 21,3 4,4 27,7 10,0 8,5 1,7 541 Central-! 10,7 2,0 21,2 6,4 5,8 1,0 859 Central-2 6,9 1,6 14,1 4,6 4,3 0,9 1394 Urban 9,0 1,9 18,1 5,8 4,5 1,0 2530 Residence Rural 15,6 3,5 29,7 10,6 6,4 1,3 3254 < 6 months 4,0 1,0 8,1 1,9 5,0 0,5 619 6-11 months 12,3 2,4 21,6 6,2 6,6 1,2 666 12-23 months 15,1 4,1 31,9 11 '7 7,2 1,2 1169 Age group 24-35 months 13,8 2,9 23,4 8,8 4,2 1,1 1131 36-47 months 13,7 2,9 26,7 9,5 4,7 0,8 1067 48-59 months 13,2 2,7 27,1 9,2 5,7 1,9 1132 None 19,6 8,7 34,8 10,9 8,7 2,2 46 Primary 18, I 4,1 34,8 16,0 7,2 1,0 293 Non-Completed Secondary 16,7 3,9 31 , I 11 ,5 7,2 1, I 1547 Mother's Completed Secondary 11,2 ? ? 23,8 7,5 4,9 1,0 1944 - ,- education level Vocational 14,2 3, I 23, I 7,9 6,3 2,0 605 Vocational training and College 9,0 2,1 19, I 5,7 4,2 1,4 759 Higher 6, I 1, I 10,8 4,0 2,9 0,7 545 Missing/DK 17,8 8,9 42,2 I I, I 6,7 ? ? 45 -·- Total 12,7 2,8 24,6 8,5 5,5 1,2 5784 World Summit for Children Goal=> Number 3, 6, 9 61 AppendiH C Table 16: Percent of living children by breastfeeding status. Mongolia, 2000 Male Sex Female Western Northern Southern Region Eastern Central-! Central-2 Capital city Household location Aimag center Soman center Countryside Urban Residence Rural None Primary Non-Completed Secondary Mother's education level Completed Secondary Vocational Vocational training and Collee:e Higher Missing/DK Total Children 0-3 months exclusively breastfed 64,4 63,6 67' 1 70,8 82,1 62,2 60,6 52,9 52,9 65,3 61,3 71,9 58,1 68,5 50,0 69,6 65, I 67' 1 60,9 61,0 48,1 66,7 64,0 World Summit for Children Goal=> Number 16 62 Children 6-9 months receiving solid/ mushy food 57,2 51,9 56,8 43,5 51' 7 53,2 58,2 66,0 66,0 54,1 46,9 51,4 60,3 50,0 57' 1 48,8 55,8 52,4 52,9 68,1 50,0 54,5 Children breastfed with 12-15 months with 20-23 months 76,3 57,2 74,1 56,6 83,5 60,2 74,3 49,4 92,1 69,0 67,9 33,3 76,9 55,6 67,2 63,9 67,2 63,9 84,4 60,7 78,7 53,2 74,1 52,2 74,7 62,3 75,7 52,6 75,0 100 53,8 62,5 74,8 55,6 75,3 56,8 86,8 74,3 72,9 47,8 78,9 51,9 100,0 75,2 56,9 Table'.r AppendiH C Table'' Table 17: Percentage of households consuming adeuqately iodized salt. Mongolia, 2000 Percent of Percent of households in Result oftest Number of households which salt was households with no salt tested interviewed < 15 PPM 15+ PPM Western 0.3 99.3 15.2 3.0 1090 North em 0.1 99.8 16.8 5.8 1350 Southern 0.5 98.4 2.7 4.5 435 By region Eastern 0.6 99.1 4.6 4.2 530 Central-! 0.2 98.9 11.0 4.7 950 Central-2 0.3 99.3 4.8 22.7 1645 Capital city 0.3 99.3 4.8 22.7 1645 Household Aimag center 0.4 99.0 13.5 7.7 1280 location Soman center 0.2 99.2 11.7 5.9 1059 Countryside 0.2 99.5 25.1 8.5 2016 Residence Urban 0.3 99.2 18.3 30.4 2925 Rural 0.2 99.3 36.8 14.5 3075 Total 0.3 99.3 55.1 44.9 6000 World Summit for Ch ildrcn Goal=> Number 14 Table 17a: Incidence of households consuming adequately iodized salt. Mongolia, 2000 Percent of Percent of Percent ofhouseholds Number of households households in with salt testing households with no salt which salt was interviewed tested < 15 PPM <15+ PPM West 0.3 99.3 83.1 16.9 1090 North 0.1 99.8 74.0 26.0 1350 Region South 0.5 98.4 37.2 62.8 435 East 0.6 99.1 51.9 48.1 530 Central-2 0.2 98.9 69.3 30.7 950 Central-3 0.3 99.3 17.2 82.8 1645 Capital city 0.3 99.3 17.2 82.8 1645 Household Aimag center 0.4 99.0 63.0 37.0 1280 location Sornan center 0.2 99.2 65.7 34.3 1059 . Countryside 0.2 99.5 74.3 25.7 2016 Residence Urban 0.3 99.2 37.3 62.7 2925 Rural 0.2 99.3 71.3 28.7 3075 Total 0.3 99.3 55.1 44.9 6000 World Summit for Children Goal=> Number 14 63 AppendiH C Table'.t Table 18: Percent distribution of children aged 6-59 months by whether they received a high dose of Vitamin" A" supplement in the last 6 months. Mongolia, 2000 Vitamin "A" received Not sure if Not Total within last 6 prior to last 6 not sure received received Number of months months when % children Sex Male 30.6 11.0 3.3 1.2 53.9 100 2820 Female 32 .5 9 .9 2.9 1.3 53.4 100 2708 Western 32.4 I 0 .3 2.0 0 .7 54.6 100 1076 Northern 32.5 8.0 2.2 0.4 56.8 100 1429 Region Southern 32.4 17 .8 2.9 0.5 46 .3 100 376 Eastern 32.4 8 .7 3 .9 1.2 53 .8 100 515 Centra l-! 33.6 10.6 2.0 1.6 52.2 100 803 Central-2 28.0 11.7 5.3 2.6 52.4 100 1329 Capital city 28 .0 11.7 5.3 2 .6 52.4 100 1329 Household Aimag center 47.9 12 .0 2.9 1.5 35.7 100 1086 location Soman center 31.8 11.1 2.0 0.5 54 .6 100 1037 Countryside 25.2 8.6 2.2 0 .6 63.4 100 2076 Residence Urban 36.9 11.8 4.3 2.1 44 .9 100 2415 Rural 27.4 9 .4 2.2 0.6 60.5 100 3113 6-11 months 30.1 1.0 1.1 0.4 67 .4 100 708 12-23 months 35 .9 6 . 1 1.7 0 .6 55 .7 100 1255 Age group 24-35 months 35.1 I 0.7 2.8 I.! 50.3 100 1193 36-47 months 28.2 13 .3 5.0 1.7 51.8 100 1131 48-59 months 27 .7 17.4 4 . 1 2 .0 48.8 100 1241 None 30.0 12 .5 2 .5 55 .0 100 40 Primary 22.3 7 .3 2.2 2.6 65 .7 100 274 Non-Completed Secondary 30.7 7 .5 2.4 0.9 58 .5 100 1478 Mother's Completed Secondary 33.5 9.8 2.9 1.4 52 .3 100 1808 education level Vocational 32.5 12 .7 3.8 1.2 49.7 100 581 Vocational training and College 31.8 14 .0 3.2 0 .8 . 50 .2 100 751 Higher 30.3 15.1 5.3 1.5 47 .9 100 551 Missing/DK 37 .8 4 .4 57 .8 100 45 Total 31.6 10.5 3.1 1.2 53.7 100 5528 World Summit for Children Goal=> Number 15 64 AppendiK C Table'.t Table 19: Percentage of women with a birth in the last 12 months by whether they received a high dose of Vitamin A Table 20: Percentage of Jive births in the last 12 months that supplement before the infant was 8 weeks old. Mongolia, weighed below 2500 grams at birth, Mongolia, 2000 2000 Received Not sure Percent of live Percent of Number live births ·Number of Vitamin A if of women births below weighed at live births supplement received 2500 grams birth Western 5,7 4,5 245 Western 8,3 88 ,6 245 Northern 10,2 1,0 403 Northern 3,7 96,5 403 Southern 15,5 2,7 110 Southern 5,8 96 ,4 110 Region Eastern 12,3 0 ,7 146 Region Eastern 5,7 100 146 Central-! 21,7 1,4 221 Central-! 6,9 95,9 221 Central-2 16,2 4,1 390 Central-2 4,8 96,2 390 Capital city 16,2 4 , 1 390 Capital city 4,8 96 ,2 390 Household Aimag center 22,0 2, I 291 Household Aimag center 6, I 98 ,3 291 location Soman center 10,3 0 ,7 272 location Soman center 5,4 97, I 272 Countryside 8,2 2,5 562 Countryside 5,8 92,5 562 Urban 18,6 3,2 681 Urban 5,4 97,1 681 Residence Residence Rural 8,9 I ,9 834 Rural 5,7 94,0 834 None 10 None 7,0 90,0 10 Primary 6,0 84 Primary 5,3 92,9 84 Non-Completed 12,8 2,0 391 Non-Completed 6, I 94 , I 391 Secondary Secondary Woman's Completed 15 ,0 1,9 572 . Mother's Completed 5,7 97,2 572 education Secondary education Secondary level Vocational I 0,5 I ,5 133 level Vocational 4,4 96,2 133 Vocational training Vocational and College 11,0 6,4 172 training and 5,3 93 ,6 172 College Higher 16,5 4,3 139 Higher 4,6 96 ,4 139 Missing/DK 28,6 14 Missing/DK 6,4 78,6 14 Total 13,3 2,5 1515 Total 5,5 95,4 1515 World Summit for Children Goal=> Number 15 World Summit for Children Goal => Number 12 65 AppendiH C Table'.t Table 21. Percentage of children age 12-23 months immunized against childhood diseases at any time before the first birthday, Mongolia, 2000 BCG DPT1 DPT2 DPT3 Polio 0 Polio 1 Polio 2 Polio 3 Measles Vaccination Card 89,8 86,9 86,9 86,8 89 ,8 87,1 87, I 86,9 82,3 Vaccinated at Mother's Report 5,8 5,0 4,0 2,4 4,0 5,2 3,4 2,0 3,3 any time before the survey according to: Either 95,6 91,9 90,9 89,2 93 ,8 92 ,3 90 ,5 88 ,8 85,7 Not vaccinated 4,4 8, I 9,1 10,8 6,2 7,7 9,5 11,2 14,3 Vaccinated by 12 months ago 99,8 99,7 . 99,7 98,4 99,8 99 ,7 99 ,7 99 ,0 97,9 World Summit for Children Goal=> No 22 66 All No vaccinations vaccinations 80,7 4,2 80,7 4,2 17,6 4,2 96,2 3,8 Number of children 1128 1255 1128 AppendiH C Table 22: Percentage of children age 12-23 months currently vaccinated against childhood diseases, Mongolia. 2000. Sex ----- Region ----- Male Female Western Northern Southern Eastern Central-! Central-2 Capital city Household Aimag center location Residence ----- Mother's education level Soman center Countryside Urban Rural None Primary Non-Completed Secondary Completed Secondary Vocational Vocational training and College Higher Missing/DK Total BCG 95.3 95 .9 96.9 99.0 100 89.3 88 .2 97.3 97.3 89 .8 96.0 97.6 93.8 97.0 100.0 98.4 96.2 94.8 93.4 98.6 93.4 100 95.6 OPT I 92 .3 91.5 91.2 93.2 97.8 87 .5 84 .2 96.2 96.2 87.9 92.0 91.2 92.3 91.5 87 .5 82.5 92.9 91.5 87.6 97.2 92.6 100 91.9 OPT 2 90 .7 91.2 91.9 92 .5 97.8 85 .7 79 .8 95.9 95.9 85.2 92.4 90 . 1 90.9 90.9 87.5 84.1 91.2 91.3 85 . 1 95.8 91.8 100 90.9 OPT 3 88.9 89.4 92.3 92.5 96.7 83.0 72.4 94.5 94.5 80.5 91.2 89.5 88.0 90.1 87 .5 84.1 89.6 89.6 82.6 93.1 90 .2 100 89.2 Polio 0 Polio I 93.6 94.0 96.2 98.6 100 85.7 82 .3 95.9 95.9 84.0 95.2 97 .I 90.3 96.5 I 00.0 95.2 94.5 92.9 91.7 97.9 90.2 100 93.8 67 92.4 92.1 90.8 94 .9 97.8 89.3 83 .7 96.2 96 .2 88.3 92.4 91.9 92.5 92.1 87.5 85.7 92.9 91.5 89 .3 97.9 92.6 100 92.3 Polio 2 Polio 3 Measles 89.9 91.2 91.5 93 .2 97.8 84.8 77.8 95.6 95.6 84.0 92.0 90.1 90.2 90.8 87.5 85.7 91.0 90.1 86.0 95.1 91.8 100 90.5 88.2 89.4 92.3 92.9 96.7 82.1 70 .9 94.2 94.2 79.7 91.2 89.2 87.4 89.9 87.5 84.1 89.9 88.7 82.6 92.4 90.2 100 88.8 85.8 85.5 87.7 82 .4 96.7 75.0 76.4 94.2 94.2 78.9 85.3 84.2 87 .I 84.6 87.5 81.0 84.9 84.7 86 .0 89.6 88.5 85.7 85.7 All 82.8 82.0 84.6 81.4 95.7 71.4 67 .0 92.2 92.2 73.8 82.5 80.9 83.6 81.4 87.5 74.6 81.9 81.9 80.2 85.4 87.7 85.7 82.4 None 4.3 4.1 3 .l 1.0 8.9 11.8 2.7 2.7 10.2 3.6 2.2 6.2 2.7 1.6 3.6 5.2 5.8 1.4 6.6 4.2 Percentage children with health card 89.5 90 .5 96 .:2 96.9 100 79.5 73 .4 90 . 1 90.1 76.6 94.4 95.2 83 .8 94.9 100 92.1 92 .3 88.7 86.8 91.7 86.9 I 00.0 90.0 Table'.t Number of children 621 634 260 295 92 112 203 293 293 256 251 455 549 706 8 63 365 425 121 144 122 7 1255 AppendiH C Table 23: Percentage of under-five children with diarrhea in the last two weeks and treatment with ORS or ORT. Mongolia, 2000 Sex ------ Region ------ Household Joe a tion ------ Residence ------ Age group ------ Mother's Male Female Western Northern Southern Ea stern Central-! Central-2 Capital city Aimag center Som a n center Countryside Urban Rural < 6 months 6-ll months 12-23 months 24-35 months 36-47 months 48-59 months None Primary Non-Completed Secondary Completed Secondary education level Vocational Vocational tra ining and Colle!!e Higher Missing/DK Total Had diarrhea in last two weeks 7 .9 8. 2 11.9 3.8 I 0.5 9 .4 6 .6 9.2 9 .2 8 .6 Breast milk 62.4 59 .8 58 .9 67 .2 55 .6 55 .6 68 .3 61.6 61.6 62.5 8.0 65 .2 7 . I 57 .6 9 .0 62 .0 7.4 60.3 7.3 85 .4 13 .8 85.7 14.5 75 .3 6 . 1 46 .6 4 .2 10 .6 4.1 7 .8 8.3 25 .0 8.3 53.8 6.6 58 .7 8.4 64.9 7.7 60 .0 8.9 63.0 9 .8 55.9 8.2 I 00 8.1 61.1 World Summit for Children Goal=> Number 23 Local ORS Gruel acceptable packet 50.8 60 .6 51.1 50.8 51.1 63 .0 65.0 57.2 57 .2 56.7 58 .7 52 . 1 57 .0 54.5 25 .0 55 . 1 63.7 60 .3 55.3 51.0 50 .0 50 .0 43.1 54 .6 64 .0 61.6 69.5 75.0 55 .7 68 64.4 63 . 1 72 .3 60.7 42 .2 66 .7 63.3 62.3 62.3 59 .6 57 .2 54 .6 53 .9 3 7. 7 68 .9 59.3 63 .3 57.2 57 .2 57 .7 60 .9 68.5 69 . .1 46 .7 61.2 57.4 66 . 1 54.5 20.8 31 .3 68.4 58 .2 68.1 60.4 69 .9 47 .9 68 . 1 57.4 66 .7 68.6 75.0 100 61.5 46 .2 60.6 51.4 64 .9 54.0 60 .0 58 .0 65 .8 64.4 66 . 1 57.6 75 .0 75 .0 63.7 55.9 Other milk o r infant formula 53.2 47.4 55.3 41.0 37 .8 50 .0 55.0 51.4 51 .4 43 .3 52 .2 52 .7 47 .9 52.5 18 .8 51.0 54.4 58 .9 66 .0 3 7.3 46 .2 42 .2 48.3 56 .0 58.9 59 .3 75 .0 50.3 Water Any with recom- mended feeding 30.8 31.3 22.0 24.6 17.8 33.3 45.0 40.6 40.6 32 .7 27.2 24.2 37 .2 25.3 14 .6 30.6 33.5 32.9 34 .0 33.3 30. 8 31.2 31.0 24 .0 3 I. 5 3 7.3 50 .0 31.1 treatm ent 98.0 98.0 98.6 93.4 97.8 100.0 100.0 97 .8 97 .8 97 . 1 100.0 97 .6 97 .5 98.4 95 .8 100 .0 98.4 97 .3 97 .9 96 . 1 100 100 .0 96.3 98.3 98 .0 98.6 98.3 100 98 .0 Number of No children with treatment diarrh ea 2.0 2.0 1.4 6.6 2 .2 2.2 2.2 2 .9 2.4 2 .5 1.6 4 .2 1.6 2.7 2 . 1 3 .9 3 .7 1.7 2 .0 1.4 1.7 2.0 250 249 141 61 45 54 60 138 138 104 92 165 242 257 48 98 182 73 47 51 4 26 109 174 50 73 59 4 499 Table'J AppendiH C Table 24: Percentage of under-five children with diarrhea in the last two weeks who took increased fluids and continued to feed during the episode, Mongolia, 2000 Sex ------ Region ------ Household location ------ Residence ------ Age group ------ Woman's education level Male Female Western Northern Southern Eastern Central-! Central-2 Capital city Aimag center Soman center Countryside Urban Rural < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months None Primary Non-Com plcted Secondary Completed Secondary Vocational Vocational training and College Higher Missing/DK Had diarrhea in last two weeks Drinking during diarrhea M Same/ Missing/ ore Less DK 7,9 42,4 51,2 8,2 39,4 55,0 11 ,9 40,4 54,6 3,8 32,8 60,7 10,5 46 ,7 51,1 9,4 53,7 42 ,6 6,6 45,0 48,3 9,2 36,2 55 , 1 9,2 36,2 55, I 8,6 33,7 58,7 8,0 45,7 52,2 7,1 46,7 48,5 9,0 35, I 56,6 7,4 46,3 49,8 7,3 20 ,8 66,7 13,8 42,9 53,1 14,5 44,5 52,2 6,1 37,0 53,4 4,2 42,6 48,9 4,1 47,1 47,1 8,3 50,0 50,0 8,3 23,1 76,9 6,6 44,0 47,7 8,4 39,7 55 , 7 7,7 44,0 52,0 8,9 9,8 8,2 45,2 47,9 35,6 54,2 75,0 25 ,0 6,4 5,6 5,0 6,6 2,2 3,7 6,7 8,7 8,7 7,7 2,2 4,8 8 ,3 3,9 12,5 4,1 3,3 9,6 8,5 5,9 0 ,0 0,0 8,3 4 ,6 4,0 Total 8,1 40,9 53,1 6,8 10,2 0,0 6,0 World Summit for Children Goal=> Number 23 69 Total 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Eating during diarrhea Some what Much less/ same/ less/ none more 74,8 73,9 68,8 80,3 88,9 72,2 71,7 74,6 74,6 76,0 79,3 70,3 75,2 73,5 79,2 77,6 76,9 64 ,4 74,5 68,6 100 69,2 66,1 79,3 70,0 80,8 69,5 100 74,3 20,4 22, I 27,0 19,7 8,9 27,8 21,7 17,4 17,4 19,2 19,6 26,7 18 ,2 24, I 14,6 18,4 20,3 27 ,4 19 , I 29,4 0,0 30,8 28,4 I 7,8 28,0 13 ,7 20,3 0 ,0 21,2 Missing /DK 4,8 4 ,0 4 ,3 0,0 2,2 0,0 6,7 8,0 8,0 4,8 1, 1 3,0 6,6 2,3 6,3 4 , 1 2,7 8,2 6,4 2,0 0 ,0 0,0 5,5 2,9 2,0 5,5 10,2 0 ,0 4 4 Total 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 Received increased fluids and continued eating 33,6 29 ,3 30,5 27,9 42 ,2 33,3 31 ,7 29,7 29,7 26,9 34,8 33,9 28,5 34,2 16,7 31,6 36,8 24,7 36,2 31,4 50 ,0 11,5 32, I 32,8 32,0 37,0 23 ,7 75,0 31,5 Number of children with diarrhea 250 249 141 61 45 54 60 138 138 104 92 165 242 257 48 98 182 73 47 51 4 26 109 174 50 73 59 4 499 Table'.t AppendiH C Table'J Table 25: Percentage of under-five children with acute repiratory infection in the last two weeks and treatment by health providers, Mongolia.2000 Children with ARI who were taken to: Had acute Village Mobile/ :rradi - Any Number of res pi tory Hospital Health Dispensa ry hea lth MCH outreach Priva te tiona! Other appropriate children infection centre worker clinic clinic physician healer provider with ARI Sex Male 2 ,3 47 ,2 26 ,4 1,4 1,4 1,4 4,2 4,2 77,8 72 Female 2,3 46 ,5 26,8 1,4 2,8 1,4 I ,4 4,2 77 ,5 71 Western 3, I 56, 8 18 ,9 5,4 2,7 81 ,I 37 Northern 1,2 52,6 I 0,5 5,3 5,3 10,5 15,8 73,7 19 Reg ion Southern I ,4 66 ,7 33 ,3 16 ,7 100 6 Eastern 4,2 37,5 45 ,8 4,2 87 ,5 24 Central-! 3,3 33 ,3 26 ,7 3,3 60 ,0 30 Central-2 I ,8 48, I 29 ,6 3,7 7,4 3,7 81 ,5 27 Capital city 1,8 48 ,1 29,6 3,7 7,4 3,7 81 ,5 27 Household Aimag center 3,0 30 ,6 44 ,4 2,8 2,8 77 ,8 36 location Soman center 2,9 54,5 21,2 3,0 6 , 1 3,0 75 ,8 33 Countryside 2,0 53,2 14 ,9 2, I 4 ,3 2, I 6,4 76,6 47 Residence Urban 2,3 38,1 38, I 1,6 1,6 3,2 3,2 79,4 63 Rural 2,3 53,8 17 ,5 1,3 2 ,5 2,5 2,5 5,0 76,3 80 < 6 months 1,4 55,6 11, I 11,1 66,7 9 6-Il months 4 ,4 38 ,7 25 ,8 3,2 9,7 3,2 3 ,2 6,5 80 ,6 31 Age group 12-23 months 3,7 44 ,7 29 ,8 4,3 74,5 47 24-35 months 1,4 41 ,2 41 ,2 II ,8 82 ,4 17 36-47 months 1,4 62,5 18,8 6,3 6,3 6,3 87 ,5 16 48-59 months I ,9 52 ,2 21,7 4 ,3 73,9 23 None 6,3 33,3 33 ,3 66 ,7 3 Primary 3,5 45 ,5 18 ,2 9,1 9,1 72,7 II Non-Completed 2, I 55,9 17,6 2,9 5,9 76,5 34 Woman's Secondary educa tion Completed Secondary 2,3 53 ,2 23 ,4 2,1 2, I 4,~ 4,3 80 ,9 47 level Vocational 2,0 30 ,8 30 ,8 7,7 69 ,2 13 Vocational training I, 7 64,3 21,4 7, I 85 ,7 14 and College Higher 2,8 11 ,8 58 ,8 5,9 11 ,8 76 ,5 17 Missing/DK 8,2 50 ,0 25 ,0 25 ,0 75,0 4 Total 2,3 46 9 26,6 0,7 0,0 0,7 2 I I 4 2,8 42 77,6 143 World Summit for Children Goal=> Number 24 70 AppendiH C Table'J Table 26: Percentage of children 0-59 months of age reported ill during the last two weeks who received increased fluids and continued feeding, Mongolia. 2000 Children with an illness who Reported Number of ill ness in last Drank Ate Took increased children two weeks Somewhat Much less fluids and More Same or less less , or more continued eating or none Sex Male 14,6 40,7 54,9 78,4 I8,3 3I ,8 459 Female 14,8 36,7 60,0 77 ,8 19,8 27,8 450 Western 19 , 1 3 8, I 58,0 73 ,9 23 ,0 28 ,3 226 Northern 7,7 35,0 61,8 82, I I7 ,9 29,3 I23 Region Southern 16 ,5 36,6 62 ,0 90 , 1 8,5 32 ,4 71 Eastern 18,3 50,5 46,7 74 ,3 23 ,8 34,3 I05 Central-! 18 ,3 37,0 59,4 78 ,2 I 8,8 27,9 165 Central-2 14,7 37,9 56 ,6 78 , I 16 ,9 30 , 1 219 Capital city I 4, 7 37,9 56,6 78 , 1 I 6,9 30,1 219 Household Aimag ce nter I 8, 7 35,7 59 ,5 78 ,9 18 , I 28 ,2 227 location Soman center 14 ,4 40,4 57,8 81,3 I 6,9 30,7 166 Country side 12 ,8 40,7 56,2 7 5,8 22,6 30,3 297 Residence Urban 16,5 36,8 58 , I 78 ,5 I 7 .5 29 , I 446 Rural I 3,3 40,6 56,8 77,8 20 ,5 30,5 463 < 6 months 14 ,6 18 ,8 71 ,9 83 ,3 12 ,5 15,6 96 6-1 I months 22,2 38,2 59,2 82 ,8 14.6 30 ,6 157 Age group 12-23 months 21 ,9 43,6 54 ,2 79 ,6 I 8 ,5 36,0 275 24-35 months 12 , 1 34,7 59 ,7 73,6 20 .8 25 ,7 144 36-47 months I 0,3 37,9 58,6 74 , I 23,3 26,7 116 48-59 m o nths 9 ,8 49 ,6 4 7, I 73 ,6 24. 8 33 ,9 121 None 16,7 37,5 62,5 87 ,5 12.5 37,5 8 Primary 12 ,5 23, I 76,9 76,9 23, I 15,4 39 Woman's Non-Completed Secondary II ,3 40,9 53 ,8 71 ,5 24 ,7 30 , 1 186 educa tion Completed Secondary 15 ,3 35,4 62,0 82,3 16, I 28,5 316 level Voca tional 16 ,4 43 ,4 53, 8 77 ,4 19. 8 32 , I 106 Voca tional tra ining and College 16 ,7 42,3 51,8 80 ,3 16 , I 35,0 137 Hi gher 18 ,4 39, I 5 5,5 73 ,6 20. 9 26,4 I 10 Missing/DK 14 ,3 71 ,4 28.6 100 71 ,4 7 Total 14,7 38 7 57,4 78,1 19,0 29 8 909 M onitorin g IMCI 71 AppendiH C Table'.t Table 27: Percentage of caretakers of children 0-59 months who know at least 2 signs for seeking care immediately,. Mongolia. 2000 Not able to Becomes Develops Has fast Has Has Is Knows a t Number of drink sicker a fever breathing difficult blood in drinking least two caretakers /breastfeed breathing stool poorly signs Western 0 .6 41.7 57.5 10.1 6.9 2.4 0.8 32.4 1186 Northern 11.0 50.1 57.9 13.5 19.8 11.3 1.4 42.2 1598 Southern 4.7 47.2 52.8 10.0 8. 1 I 0. 7 1.4 19 .8 430 Region Eastern 14.3 47.8 61.7 23 . 1 18 .1 10 .6 2.3 65 .0 575 Central-! 1.8 32 .3 61.5 7.2 6 .8 2.2 2.0 20 .6 903 Central-2 5.5 55 . 1 56.4 14 .4 13.5 6.0 1.7 42. 8 1492 Capital city 5.5 55.1 56.4 14 .4 13 .5 6.0 1.7 42.8 1492 Household Aim a g center 6.1 42. 8 55.9 14 .9 13 .6 7 .3 1.7 33.2 1211 location Som a n center 6.7 42.4 58.9 13 .0 I 0 .5 6 .3 1. 7 36 .8 1152 Countryside 6.4 45 .5 59.6 I 0.6 13.4 7.5 1.2 37.7 2329 Urba n 5.8 49 .6 56 .2 14.6 13 .5 6.6 1.7 38 .5 2703 Residence Rural 6.5 44.5 59.4 11.4 12 .4 7 . I 1.4 37.4 3481 None I 0.4 43. 8 56.3 6 .3 12 .5 6.3 4.2 25.0 48 Primary 4.5 44.4 59.1 9.6 8 .9 4.5 1.6 29.7 313 Non-Completed 7.2 46 . 1 58.1 12 .6 13 .6 7 .6 1.3 37.6 1645 Secondary Woman's Completed Secondary 7.2 46.4 58.0 12 .I 13 .7 7.6 1.3 39.6 2064 educa tion level Voca tional 2.9 47 . 1 56.2 12 .5 10.2 3.9 1.9 33.6 648 Vocational training 4.4 47.4 60.0 15.3 12. 6 6.7 1.3 40.1 818 a nd College Higher 6.0 50.1 57.8 14 .0 13 .7 7.0 2.5 39 .6 599 Missing/DK 10.2 38 .8 38 .8 24 .5 16 .3 8 .2 34.7 49 Total 6.2 46.7 58.0 12.8 12.9 6.9 1.5 37.9 6184 Monitoring IMCI a nd Malaria Indicator 72 AppendiH C Table'.t Table 30: Percentage of women aged 15-49 who know the main ways of preventing HIV transmission. Mongolia,2000 Have only one Using a Knows at Heard of faithful condom Abstaining Knows a ll least one Doesn't know N urn ber of AIDS uninfected sex every time from sex three wa ys any way women artner way Western 94 .9 81.6 78 .0 44.1 37.9 87.6 12.4 1475 Northern 89 . 1 75 .9 76 . 1 35.8 29 .0 83.0 17 .0 1784 Region Southern 88.8 79 .3 78 .6 37.2 32.5 84.4 15 .6 570 , Eastern 95.9 76 .2 80 . 1 46.2 31.5 89.5 10.5 821 Central-1 92 .9 79 .6 77 .2 43.3 36.7 86.0 14.0 1342 Central-2 98.9 91.8 87.9 55.2 50.6 95.1 4.9 2265 Capital city 98 .9 91.8 87.9 55.2 50.6 95.1 4 .9 2265 Household Aimag center 95 .7 82 .2 82 .6 51.0 40 .8 91.1 8 .9 1728 location Soman center 94 .0 80.6 79.2 40 .5 33.7 87 .I 12 .9 1502 Countryside 89 .2 75.0 73.6 35.2 29.1 81.8 18.2 2762 Residence Urba n 97 .5 87 .7 85 .6 53 .4 46.3 93.4 6 .6 3993 Rural 90 .9 77.0 75.6 3 7.1 30.7 83.7 16.3 4264 15-19 89 .7 74.0 72.7 43.1 36.2 81.3 18.7 1394 20-24 95 .0 82.2 80.4 45.4 38.4 88 .7 I 1.3 1784 25-29 95 .5 84.5 83 . 1 45 .5 39.0 90.4 9 .6 1767 Age group 30-34 94.9 84.2 83.5 45.2 39.3 90.1 9.9 1326 35-39 94 .4 85 .6 82 .2 48.9 42.4 90.3 9 .7 949 40-44 94 .0 81.2 79.7 42.1 33.6 88.6 11.4 649 45-49 96.1 87.1 82 .5 41.5 35.8 91.8 8 .2 388 None 63 .0 47 .8 47 .8 23 .9 18.5 53.3 46. 7 92 Primary 84 .2 65.2 65.6 33 . 1 25.8 73.6 26.4 759 Non-Completed Secondary 91.7 77.1 76.1 38.1 31.5 83.9 16.1 2099 Woman's Completed Secondary 97 . 1 86 .4 84.4 49 .3 42.1 92 .7 7. 3 2582 educa.tion level Vocational 96.4 84.7 81.6 44.3 38.0 90.8 9.2 760 Voca tiona! training and College 99 .5 90 .9 88.9 50.3 44.3 95.6 4 .4 1008 Higher 98 .9 92.8 89 .0 59 .0 52 .2 97.2 2.8 849 Missing/DK 61.1 44.4 45.4 20.4 17.6 49.1 50 .9 108 Total 94.1 82.2 80.4 45.0 38.3 88.4 11.6 8257 Monito ring HIV/AIDS Indicator 73 -----· - AppendiH C Table' I' Table 30a: Percentage of women aged 15-49 who know the main ways of preventing HIV transmission~ Mongolia~ 2000 Hea rd of Have onl y one Using a Knows all Knows at Doesn't Number of faithful uninfected condom least one know any AIDS two wa ys women sex partner every time way way Western 94 .9 81.6 78 .0 73.5 86. I I 3.9 I475 Northern 89. I 75.9 76. I 69.5 82.5 I 7.5 1784 Southern 88 .8 79.3 78 .6 74.6 83 .3 16 .7 570 Region Eastern 95.9 76.2 80. I 67.6 88.8 I 1.2 82I Central- I 92.9 79.6 77 .2 72.4 84 .4 I5 .6 1342 Central-2 98.9 91. 8 87.9 85.2 94.5 5.5 2265 Urban 97.5 87 .7 85 .6 80 .8 92.5 7 .5 3993 Residence Rural 90.9 77.0 75.6 69.9 82.7 17.3 4264 I 5-19 89.7 74 .0 72 .7 66.5 80 .2 19 .8 1394 20-24 95.0 82.2 80.4 74.9 87.6 I2.4 1784 25-29 95.5 84.5 83 . I 77 .9 89 .7 10 .3 1767 Age group 30-34 94.9 84.2 83 .5 78.4 89.3 I 0 . 7 1326 35-39 94.4 85.6 82 .2 78.1 89 .7 I 0.3 949 40-44 94.0 81.2 79.7 73.3 87.5 I 2 . 5 649 45-49 96.1 87 . 1 82 .5 79. I 90 .5 9 .5 388 None 63.0 47.8 47 .8 43.5 52.2 47.8 92 Primary 84.2 65 .2 65.6 58 .6 72.2 27 .8 759 Non-Completed Secondary 91.7 77.1 76.1 70.1 83.1 !6 .9 2099 Woman's education Completed Secondary 97.1 86 .4 84 .4 79.0 9!.8 8 .2 2582 level Vocational 96.4 84 .7 81.6 76 .6 89 .7 [ 0. 3 760 Voca tiona! training and College 99.5 90.9 88 .9 84 .7 95.0 5.0 1008 Higher 98.9 92.8 89 .0 85.7 96 . 1 3.9 849 Missing/DK 61.! 44.4 45.4 40.7 49.1 50.9 108 Total 94.1 82.2 80.4 75.1 87.4 12.6 8257 Monitoring HIV/AIDS Indicator 74 AppendiH C Table'J Table 31: Percentage of women aged 15-49 who correctly identify misconceptions about HIV /AIDS. Mongolia, 2000 AIDS can't be AIDS can't be A healthy Knows all Knows at Doesn't Heard of transmitted by transmitted by looking three least one correctly Number of AIDS supernatural mosquito bites person can misconcept misconcept identify any women means be infected ions ion misconception Western 94.9 72.8 56.6 49.2 31.0 85.1 14.9 I475 Northern 89.1 72.5 62.3 55.3 41.1 81.3 18.7 1784 Region Southern 88.8 68.4 48.2 44.9 24.0 79.8 20.2 570 Eastern 95 .9 78.8 59.1 50 .7 36.5 88.2 11.8 82I Central-! 92.9 71.5 52.4 51.9 29 .7 83 .8 16.2 1342 Central-2 98.9 85.9 61.5 67.7 43.4 93.4 6 .6 2265 Capita l city 98.9 85.9 61.5 67.7 43.4 93.4 6.6 2265 Household Airnag center 95.7 81.8 61.2 60.9 41.6 90.3 9 .7 I728 location Sornan center 94.0 73.7 57.5 52.9 34.5 84.6 15.4 1502 Countryside 89.2 66.7 53.9 44.7 28.6 78.8 21.2 2762 Residence Urban 97.5 84. I 61.4 64.7 42.6 92.1 7.9 3993 Rural 90.9 69.2 55.2 47.6 30 .7 80.9 19. I 4264 15-19 89.7 69.9 56.4 54.3 35.9 80 .8 19.2 1394 20-24 95.0 77 .6 59.9 58 .5 38.5 88.3 11 .7 1784 25-29 95 .5 79.3 59 .8 55.7 36 .8 87.7 12 .3 1767 Age group 30-34 94.9 76 .2 59.3 54.1 35.4 86.3 13 .7 1326 35-39 94.4 77.8 56.5 57.9 35 .7 88.1 11.9 949 40-44 94.0 75.8 54.5 53.0 35.1 84.6 I 5.4 649 45-49 96.1 79.I 55.7 56.2 35.1 88.4 11.6 388 None 63.0 38.0 34.8 33.7 17.4 53.3 46.7 92 Primary 84 .2 58.2 48.9 43.1 27.1 71.1 28.9 759 Non-Corn pleted 91.7 68.7 55.6 50.6 32.1 81.4 18.6 2099 Woman's Secondary Completed Secondary 97 . 1 82 .2 60 .7 59.3 39.9 90.2 9 .8 2582 education Vocational 96.4 74.6 53.9 52.8 29 .2 87 .9 12 . I 760 level Vocational training and College 99.5 88.4 64 .8 61.7 41.7 95.1 4.9 1008 Higher 98.9 90.2 66.9 72.1 49 .9 96 .5 3.5 849 Missing/DK 61.1 40.7 33.3 25.9 17.6 48.1 51.9 108 Total 94.1 76.4 58.2 55.9 36.4 86.3 13.7 8257 Monitoring HIV/AIDS Indicator 75 AppendiH C Table'/' Table 32: Percentage ohmmen aged 15-49 ooo correctly identify means of IDV transmission from mother to child, Mongolia. 2000 Know AIDS can Transmission Transmission Transmission Did not be transmitted during at delivery through Knows all know any Number of women from mother to pregnancy possible breastmilk three specific way child possible possible Western 74.9 68.1 62.6 42.7 37 .3 27.7 1475 Northern 61.4 43 .3 43.9 24. 1 18.8 43 .6 1784 Region Southern 64.9 56.1 52.5 34.7 26.3 37.4 570 Eastern 75.6 53 .6 62.2 30 .7 24. 8 28.6 821 Central-! 66.6 57 .0 50.8 37 .7 29.6 36.4 1342 Central-2 71.3 64.2 58.3 29.7 24.9 31.1 2265 Capital city 71.3 64.2 58 .3 29 .7 24.9 31.1 2265 Household Aimag center 71.8 57 .5 56.0 33.7 28.1 32.3 1728 location Soman center 69.6 57.3 54.2 33.3 26.5 34.4 1502 Countryside 65 .1 52. 5 51.3 33 .8 27.3 38 .0 2762 Residence Urban 71.5 61.3 57.3 31.4 26.2 31.6 3993 Rural 66.7 54.2 52.3 33 .6 27.0 36.7 4264 15-19 57.2 44.8 44.5 24.5 19.5 46.6 1394 20-24 67 .9 54.3 53.7 30.3 24.6 36.0 1784 25-29 72.6 61.3 57.8 34.2 27 .7 30.2 1767 Age group 30-34 74.7 64.0 59 .6 37 .2 31.1 28.4 1326 35-39 72.0 63 .5 57 .5 35.8 29.8 30.7 949 40-44 70.4 60.4 55.2 35.4 28.8 32.8 649 45-49 71.4 60.6 58.0 35.6 30.4 31.4 388 None 41.3 31.5 30.4 25.0 20.7 62 .0 92 Primary 52.8 41.2 41.0 26.9 20.3 51.0 759 Non-Completed 64.7 50.9 51.0 32.3 25 .8 38.7 2099 Woman's Secondary education Completed Secondary 71.3 58 .6 56.6 33 .3 27 .8 32 .5 2582 level Vocational 74.5 65.3 58.0 40.0 31.4 28 .2 760 Vocational training and 79.8 72.1 66.6 34.8 30.4 22.5 1008 College Higher 76.7 67 .6 59.7 29.2 24.1 26.4 849 Missing/DK 38.0 32.4 26.9 18.5 15 .7 63 .9 108 Total 69.0 57.6 54.7 32.6 26.6 34.2 8257 Monitoring HIV/AIDS Indicator 76 AppendiH C Table'.r Table 33: Percentage of women aged 15-49 who express a discriminatory attitude towards people with HIV/AIDS, Mongolia, 2000 Believe that a teacher Would not buy food Agree with at least Agree with with HIV should not from a person with one discriminatory neither Number of discriminatory women be allowed to work HIV/AIDS statement statement Western 35 ,2 12,8 36,9 63 , 1 1475 Northern 40,2 7,0 42,1 57,9 1784 Region Southern 25,4 10,7 27,0 73,0 570 Eastern 38,5 6,7 40,1 59,9 821 Central-! 38 ,9 15,9 41 ,0 59,0 1342 Central-2 52 ,9 21,9 54,6 45 ,4 2265 Capital city 52,9 21,9 54,6 45,4 2265 Household Aimag center 49,8 16,8 52,1 47,9 1728 location Soman center 37, I 10,9 38,6 61,4 1502 Countryside 29,0 6,8 30,7 69,3 2762 Residence Urban 51 ,6 19,7 53 ,5 46,5 3993 Rural 31 '9 8,3 33,5 66,5 4264 15-19 42,3 14,6 44,0 56,0 1394 20-24 44,3 14,2 46 ,4 53 ,6 1784 25-29 41 ,4 14,2 42,8 57,2 1767 Age group 30-34 38,8 12,9 40,7 59,3 1326 35-39 39,5 14, I 41,5 58,5 949 40-44 40,5 II ,7 41,9 58,1 649 45-49 39 ,7 13 ,1 41 ,2 58 ,8 388 None 28 ,3 3,3 29 ,3 70,7 92 Primary 31,4 9,6 33,5 66 ,5 759 Woman's Non-Completed Secondary 34,7 9,6 36,5 63,5 2099 education Completed Secondary 44,5 15, I 46,0 54,0 2582 level Vocational 33 ,8 10,9 35,9 64,1 760 Voca tional training and College 46 ,7 15,6 48 ,2 51 ,8 1008 Higher 62,1 26,7 64,3 35 ,7 849 Missing/DK 20,4 4,6 21,3 78,7 108 Total 41,4 13 8 43,2 56,8 8257 Monitoring HIV/AIDS Indicator 77 AppendiH C Table'J Table 34: Percentage of women aged 15-49 who have sufficient knowledge of HIV /AIDS transmission, Mongolia, 2000 Know 3 ways to Correctly identify 3 Heard of prevent H IV misconceptions H ave sufTicicnt Number of AIDS transmission about HIV knowledge women transmission Western 94.9 37.9 31.0 20.1 1475 Northern 89.1 29.0 41.1 16.9 1784 Region Southern 88.8 32.5 24.0 I 0.5 570 Eastern 95.9 31.5 36.5 16.7 821 Central-! 92.9 36.7 29.7 16.3 1342 Ccntral-2 98.9 50.6 43.4 27.7 2265 Capital city 98.9 50 .6 43.4 27.7 2265 . Aimag center 95.7 40. 8 41.6 23.0 1728 Household loca twn ~ 94.0 1502 Soman center 33.7 34.5 16.9 Countryside 89.2 29.1 28.6 13.1 2762 Urban 97.5 46.3 42.6 25.7 3993 Residence Rural 90.9 30.7 4264 30.7 14.5 15-19 89.7 36.2 35.9 20.7 1394 20-24 95.0 38 .4 38.5 20.7 1784 25-29 95.5 39.0 36.8 18.8 1767 Age group 30-34 94.9 39.3 35.4 20.1 1326 35-39 94.4 42.4 35.7 21.0 949 40-44 94.0 33.6 35.1 17.6 649 45-49 96.1 35.8 35.1 18.6 388 None 63.0 18.5 17.4 7.6 92 Primary 84.2 25.8 27.1 13.3 759 Non-Completed Secondary 91.7 31.5 32.1 16.1 2099 Woman's education Completed Secondary 97.1 42.1 39.9 22.4 2582 level Vocational 96.4 38.0 29.2 l 5.5 760 Vocational training and College 99.5 44.3 41.7 23.1 1008 Higher 98.9 52.2 49.9 30.9 849 Missing/DK 61.1 17.6 17.6 4.6 108 Total 94.1 38.3 36.4 19.9 8257 Monitoring HIV/AIDS Indicator 78 -·- ----- AppendiH C Table'.t Table 35: Percentage of women aged 15-49 who know where to get an AIDS test and who have been tested. Mongolia,2000 Know a place to get Have been Iftested, have Number of tested tested been told result women Western 46 ,6 4,5 73, I 1475 Northern 49 ,4 5,2 76, I 1784 Region Southern 44 ,9 14,9 70 ,6 570 Eastern 56,6 10,7 87 ,5 821 Central-! 46,3 17 ,0 76,8 1342 Central-2 69,4 27 ,2 90 ,7 2265 Capital city 69,4 27 ,2 90,7 2265 Household location Aimag center 63,5 19,0 83,8 1728 Soman center 49,6 6,5 72,2 1502 Countryside 38 ,7 4,9 63,7 2762 Residence Urban 66 ,9 23,6 88 ,3 3993 Rural 42 ,5 5,4 67,2 4264 15-19 39 ,9 5,5 64,9 1394 20-24 54,9 15 , 1 85,2 1784 25-29 57,8 15 ,7 87,4 1767 Age group 30-34 59,8 19 ,5 83,8 1326 35-39 58,6 17 ,4 86, I 949 40-44 56, I 13 ,7 83, I 649 45-49 55 ,4 9,8 89 ,5 388 None 26,1 5,4 100 92 Primary 34 ,4 3,7 60 ,7 759 Non-Completed Secondary 44 ,4 8 , 1 72 ,8 2099 Woman's education Completed Secondary 57 ,4 16 ,2 84,4 2582 level Vocational 52,4 14,2 83,3 760 Vocational train ing and College 68,7 19 ,5 90,4 1008 Higher 78,8 28 ,9 89,8 849 Missing/DK 25,9 5,6 66,7 108 Total 54,3 14,2 84,2 8257 Monitoring HIV/AIDS Indicator 79 AppendiH C Table' I' Table 36: Percentage of married or in union women aged 15-49 who are using (or whose partner is using) a contraceptive method, Mongolia, 2000 Current method No method Female Male Female sterilization sterilization Pill IUD Injections Implants Condom condom Western 27,7 0,4 5,4 36,2 7,4 0, 1 4,1 0,5 Northern 41,1 1,4 0,4 5,8 35,7 6,8 0,2 2,7 0,9 Region Southern 32,2 2,0 13,4 37,0 4 ,5 0,6 4,5 Eastern 37,0 I ,6 6,I 34,8 5,4 0,7 4,3 I , I Central-! 25,3 I ,7 13 ,4 31,8 6,5 0,4 2,8 0, 1 Ccntral-2 3I ,8 I ,3 0,4 9,0 29,4 3,7 0,2 6,7 0,5 Capital city 3I ,8 I ,3 0,4 9,0 29,4 3,7 0,2 6,7 0,5 Household Aimag center 28,4 I ,3 8,5 34,7 6,7 0,6 3,6 0,6 location Soman center 28,8 I ,0 O,I 9,4 33,4 8, I O,I 4 ,8 0,7 Countryside 37,8 1,5 0 ,2 7,1 36 , 1 5,5 0,2 2,7 0,5 Residence Urban 30,3 I ,3 0,2 8,8 31,7 5,0 0,4 5,4 0,5 Rural 34,7 I ,3 0,2 7,9 35,2 6,4 0,2 3,4 0,6 15-19 64 ,8 4 ,5 15 ,9 4 ,5 5,7 I, I Age group 20-24 37,3 0, I 0, I 8,0 32,7 6,6 0, 1 5,0 0 , 1 25-49 30,9 I ,6 0,2 8,5 34, I 5,6 0,3 4,1 0,6 None 58,6 31,0 3,4 3,4 Primary 48,2 2,2 I ,8 32,6 5,8 0,4 I ,3 Non-Com pletcd 39,9 1,4 0,3 5,4 36 ,3 4 ,7 0,4 3,2 0,3 Secondary Woman's Completed Secondary 32,3 1,1 0, I 8,9 33,6 6,4 0, I 3,0 0,7 education level Vocational 29,9 I ,8 0,4 8,8 35,6 7,0 3,0 0,2 Vocational training 27,8 I ,8 0, 1 9,9 33,5 5,4 0,2 5,6 0,9 and College Higher 21,0 0,3 0,2 12,8 27,3 4,7 0,8 10,6 0,8 Missing/DK 51,7 20,7 20 ,7 Total 32,6 1,3 0,2 8,3 33,5 5,8 0,3 4,3 0,6 World Summit for Children Goal=> Number I 0 80 AppendiH C Table'.1 Table 38: Percent distribution of women aged 15-49 with a birth in the last year by type of personnel delivering antenatal care, Mongolia,2000 Person delivering antenatal care Any skilled Number of Nurse/ Auxiliary Other/ No antenatal Total Doctor midwife midwife missing care received personnel women Western 84.9 9.8 3.7 1.6 100 94.7 245 Northern 93.1 5.2 0.2 0.5 1.0 100 98.5 403 Region Southern 89.1 8.2 2.7 100 97.3 110 Eastern 91.1 8.2 0.7 100 99.3 146 Central-! 93.7 2.7 1.8 1.8 100 96.4 221 - Central-2 93.1 2.1 1.3 3.6 100 95.1 390 Capital city 93.1 2.1 1.3 3.6 100 95.1 390 Household location Aimag center 96.2 1.7 1.4 0.7 100 97.9 291 Soman center 93.4 4.8 0.4 0.7 0.7 100 98.5 272 Countryside 86.7 9.6 2.1 1.6 100 96.3 562 Residence Urban 94.4 ·1.9 1.3 2.3 100 96.3 681 Rural 88.8 8.0 0.1 1.7 1.3 100 97.0 834 None 90.0 10.0 100 90.0 10 Primary 96.4 1.2

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