Mongolia - Multiple Indicator Cluster Survey - 2005

Publication date: 2005

MONGOLIA MONITORING THE SITUATION OF CHILDREN AND WOMEN “CHILD AND DEVELOPMENT 2005” survey (MICS-3) “Child and development 2005” survey (MICS-3) Mongolia, 2007 M ONGOLIA 2007 “CHILD AND DEVELOPM ENT 2005” SURVEY (M ICS-3) “CHILD AND DEVELOPMENT 2005” survey ( M u l t i p l e I n d i c a t o r C l u s t e r S u r v e y - 3 ) FINAL REPORT Ulaanbaatar 2007 MONGOLIA English edition: Lois Lambert Prepared by: O.Baigalmaa Z.Munkhzul This report is also available in Mongolian. The opinions expressed here are only those of the authors and do not necessarily reflect those of the institutions involved. For comments, please contact the National Statistical Office at: Government building 3 Baga toiruu 44, Sukhbaatar district Ulaanbaatar, Mongolia E-mail: nso@magicnet.mn Fax: 976-11-324518 Phone: 976-51-264554, 976-51-266414 The Mongolia Child and development 2005 survey (Multiple Indicator Cluster Survey -3) was carried by National Statistical Office and financial and technical support was provided by the United Nations Children’s Fund (UNICEF). The survey has been conducted as part of the third round of MICS surveys (MICS3), carried out around the world in more than 50 countries, in 2005-2006, following the first two rounds of MICS surveys that were conducted in 1995 and the year 2000. Additional information on the global MICS project may be obtained from www.childinfo.org. Suggested citation: National Statistical Office, UNICEF. 2007. Mongolia “Child and Development 2005” survey (MICS-3), Final Report. Ulaanbaatar, Mongolia Cover photo: B.Rentsendorj Published by National Statistical Office Ulaanbaatar, Mongolia, 2007 TABLE OF CONTENTS Foreword iii Acknowledgement iv List of Tables v List of Figures vii List of Abbreviations viii List of References ix Summary Table of Findings x Executive Summary xiii I. Introduction Background 1 Survey Objectives 2 II. Sample and survey methodology Sampling design 3 Questionnaires 3 Training and data collection 4 Data processing 4 III. Sample coverage, characteristics of households and respondents Sample coverage 5 Characteristics of households and respondents 5 Data disaggregation 7 IV. Child mortality 8 V. Nutrition Nutritional Status 12 Breastfeeding 14 Salt Iodization 16 Consumption of flour fortified with vitamins and minerals 17 Vitamin A Supplements 18 Low Birth Weight 19 VI. Child Health Immunization 20 Oral Rehydration Treatment Oral Rehydration Treatment 22 1 i Care Seeking and Antibiotic Treatment of Pneumonia 24 Solid Fuel Use 25 VII. Water and Sanitation Water 26 Sanitation 27 VIII. Reproductive Health Contraception 29 Unmet Need for Contraception 29 Antenatal Care 30 Assistance at Delivery 31 IX. Child Development 33 X. Child Education Pre-school attendance 35 Primary and Secondary School Participation 36 Literacy 38 XI. Child Protection Birth Registration 39 Child Labour 39 Child Discipline 41 Early Marriage 42 Domestic Violence 43 Child Disability 43 XII. HIV/AIDS HIV/AIDS knowledge 45 HIV testing 47 TABLES 49 Appendix I. Sample Design 119 Appendix II. List of Personnel Involved in the Survey 123 Appendix III. Estimates of Sampling Errors 126 Appendix IV. Data Quality Tables 135 Appendix V. MICS Indicators: Numerators and Denominators 146 Appendix VI. Questionnaires 152 ii iii BERTRAND DESMOULINS UNICEF Representative, Mongolia P.BYAMBATSEREN Chairman National Statistical Office, Mongolia FOREWORD “Child Development 2005” is the third Multiple Indicator Cluster Survey to have been conducted in Mongolia, by the National Statistical Office with the joint funding support of the Government of Mongolia and UNICEF. UNICEF has provided technical and methodological recommendations at every stage of the survey process. In particular, the organisation of four training workshops greatly con- tributed to the success of the survey. The final report, published in Mongolian and English, is the result of effective data collec- tion and data processing, and it is to be hoped that our goal of making the findings accesible for reference and use by the public has been satisfactorily achieved. Our deep gratitude goes to members of the inter-sectoral Steering Committee and joint task force, representing the Ministry of Finance, the Ministry of Education, Culture and Sci- ence, the Ministry of Health, the Ministry of Social Welfare and Labour, the National Au- thority for Children, the Nutrition Research Center of the Public Health Institute under the Ministry of Health, the General Police Department and the UNICEF Office in Mongolia, each of whom have contributed valuable inputs and comments in the organzation of the survey, the development of questionnaires, as well as to the writing of the report. The aim of the survey is to review and examine progress made since the previous survey, which was conducted in 2000, and the accomplishments made in the implementation of the Plan of Action, A World Fit for Children and the Millennium Development Goals. The survey provides national data on the situation of Mongolia’s women and children, in com- parison to other countries, and updates the relevant data base. The survey results will serve as the baseline information for state and government policy and programming towards improving the health and life conditions of children and women. In addition, we believe that the survey will provide key sources and reference information for researchers and academics to conduct in-depth analysis and research studies in specific areas. ACKNOWLEDGEMENT The National Statistical Office of Mongolia has successfully carried out a ”Child Develop- ment Survey” (MICS) for the third time. The Primary objective of the current survey is to provide quantitative data, and up- to-date information for assessing the situation of children and women, particularly in the area of issues related to their right to education, health and the wellbeing. It is intended to furnish the necessary data for monitoring and evaluating the implementation status of the National Program of Action for the Development and Protection of Children and the Millen- nium Development Goals, and to contribute to further planning of the next strategies and programmes. We believe that the Child Development 2005 survey results generate not only key in- formation sources, which will facilitate preparation of the national report of Mongolia on the implementation of the Plan of Action for A World Fit for Children , it will also provide researchers and all users with comprehensive data and information on the current situa- tion of children and women. The NSO wishes to express its sincere gratitude to the Steering committee, the working group members, all other stakeholders who have provided valuable professional expertise in the successful organization and production of this Multiple Indicator Cluster Survey report, which has been carried out in accordance with international standards, as it has been carried out in over 50 countries of the world. Due acknowledgement goes to UNICEF, EAPRO and the UNICEF Representative Office in Mongolia for their technical and methodological support, and special thanks goes to Mrs. Gitte Robinson, UNICEF consultant, for her significant contribution and input in the report writing. G.GERELT-OD Chair, Steering Committee, Vice-chairman of the National Statistical Office iv LIST OF TABLES Table HH.1: Results of household and individual interviews 50 Table HH.2: Household age distribution by sex 51 Table HH.3: Household composition 52 Table HH.4: Women’s background characteristics 53 Table HH.5: Children’s background characteristics 54 Table CM.1: Child mortality 55 Table CM.2: Children ever born, children surviving, proportion dead 56 Table NU.1: Child malnourishment 57 Table NU.2: Intitial breastfeeding 58 Table NU.3: Breastfeeding 59 Table NU.4: Adequately fed infants 60 Table NU.5: Iodized salt consumption 61 Table NU.5A: Knowledge and use of flour enriched by minerals and vitamins 62 Table NU.6: Children’s vitamin A supplementation 63 Table NU.7: Post-partum mother’s Vitamin A supplementation 64 Table NU.8: Low birth weight infants 65 Table CH.1: Vaccinations in first year of life 66 Table CH.2: Vaccinations by background characteristics 67 Table CH.3: Oral rehydration treatment 68 Table CH.4: Home management of diarrhoea 69 Table CH.5: Care seeking for suspected pneumonia 70 Table CH.6: Antibiotic treatment of pneumonia 71 Table CH.6A: Knowledge of the two danger signs of pneumonia 72 Table CH.7: Fuel use 73 Table CH.8: Solid fuel use by type of stove or fire 74 Table CH.9: Source and cost of supplies for antibiotics 75 Table CH.10: Source and cost of supplies for oral rehydration salts 76 Table EN.1: Use of improved water sources 77 Table EN.2: Household water treatment 78 Table EN.3: Time to source of water 79 Table EN.4: Person collecting water 80 Table EN.5: Use of sanitary means of excreta disposal 81 Table EN.6: Disposal of child’s faeces 82 Table EN.7: Use of improved water sources and improved sanitation 83 Table RH.1: Use of contraception 84 Table RH.2: Unmet need for contraception 85 Table RH.3: Antenatal care provider 86 Table RH.4: Antenatal care content 87 Table RH.5: Assistance during delivery 88 Table CD.1: Family support for learning 89 v Table CD.2: Learning materials 90 Table CD.3: Children left alone or with other children 91 Table ED.1: Early childhood education 92 Table ED.2: Primary school entry 93 Table ED.3: Primary school net attendance ratio 94 Table ED.4: Secondary school net attendance ratio 95 Table ED.4A: Secondary school age children attending primary school 96 Table ED.5: Children reaching grade 5 97 Table ED.6: Primary school completion and transition to secondary education 98 Table ED.7: Education gender parity 99 Table ED.8: Adult literacy 100 Table CP.1: Birth registration 101 Table CP.2.1: Child labour (5-14) 102 Table CP.2.2: Child labour (5-17) 103 Table CP.3.1: Labourer students and student labourers (5-14) 104 Table CP.3.2: Labourer students and student labourers (5-17) 105 Table CP.4: Child discipline 106 Table CP.5: Early marriage 107 Table CP.6: Spousal age difference 108 Table CP.7: Attitudes toward domestic violence 109 Table CP.8: Child disability 110 Table HA.1: Knowledge of preventing HIV transmission 111 Table HA.2: Identifying misconceptions about HIV/AIDS 112 Table HA.3: Comprehensive knowledge of HIV/AIDS transmission 113 Table HA.4: Knowledge of mother-to-child HIV transmission 114 Table HA.5: Attitudes toward people living with HIV/AIDS 115 Table HA.6: Knowledge of a facility for HIV testing 116 Table ED.6: HIV testing and counseling coverage during antenatal care 117 Table HA.8: Children’s living arrangments and orphanhood 118 vi LIST OF FIGURES Figure III.1: Number of households, women (15-49 years) and children under 5 interviewed, response rate 5 Figure III.2: Age distribution of female respondents aged 15-49 years, by age groups 6 Figure III.3: Education level of female respondents of 15-49 years, by percent 6 Figure IV.1: Infant and under five mortality rates by background characteristics 8 Figure IV.2: Trend in under-five mortality rates 9 Figure V.1: Prevalence of malnutrition 13 Figure V.2: Percentage of children under-5 who is undernourished 13 Figure V.3: Percentage of children stunted and underweight, by number of children 14 Figure V.4: Percentage of mothers who started breastfeeding within one hour and within one day of birth 15 Figure V.5: Percent distribution of children under the age of one, by feeding pattern by age group 16 Figure V.6: Proportion of households using iodized salt by regions, rural and urban areas 17 Figure V.7: Proportion of households using fortified flour, by regions 18 Figure V.8: Percentage of children received Vitamin A supplement in last 6 months, by regions 19 Figure VI.1: Children of 12-23 months vaccinated at any time before the survey 21 Figure VI.2: Children aged 12-23 months immunized by first birthday and at any age before the survey 21 Figure VI.3: Percentage of children aged 0-59 months with diarrhea who received oral rehydration treatment 22 Figure VI.4: Percentage of children aged 0-59 months with diarrhea who received ORT or increased fluids and continued feeding 23 Figure VI.5: Type of fuel used for cooking 25 Figure VI.6: Percentage of households used solid fuels for cooking, by regions 25 Figure VII.1: Percentage distribution of household members by source of drinking water 26 Figure XI.1: Proportion of 5-17 children engaged in domestic work, by sex 40 Figure XI.2: Child labour within 5-17 years age group, by urban and rural areas 41 Figure XI.3: Percentage of women aged 20-49 in marriage or union before their 18th birthday, by background variables 43 Figure XII.1: Percentage of women with a comprehensive knowledge of HIV/AIDS transmission, by education level 46 vii LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome BCG Bacillus-Cereus-Guerin (Tuberculosis) CSPro Census and Survey Processing Software DPT Diphtheria-Pertussis-Tetanus GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorders IUD Intrauterine Device LAM Lactation Amenorrhea Method MDGs Millennium Development Goals MESC Ministry of Education, Science and Culture MF Ministry of Finance MICS Multiple Indicator Cluster Survey MICS2 Multiple Indicator Cluster Survey—2 nd Phase MICS3 Multiple Indicator Cluster Survey—3rd Phase MOH Ministry of Health MSWL Ministry of Social Welfare and Labour NAC National Authority for Children NAR Net Attendance Rate NCHS National Centre for Health Statistics NSO National Statistical Office ORS Oral Rehydration Salts ORT Oral Rehydration Treatment PPS Probability Proportional to Size PSU Primary Sampling Unit RHF Recommended Home Fluid RHS Reproductive Health Survey SPSS Statistical Package for Social Sciences STI Sexually transmitted infection UB Ulaanbaatar UNAIDS United Nations Programme on HIV/AIDS UNFPA United Nations Population Fund UNGASS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WFFC World Fit For Children WH World Health Organization viii LIST OF REFERENCES UNICEF, 2006. Monitoring the Situation of Children and Women. Multiple Indicator Cluster Survey Manual, New York. Rutstein, S.O. and Johnson, K., 2004. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. NSO, UNICEF, 2001. ”Child and development survey-2000” (MICS-2) National report Government of Mongolia, Implementation of the Millennium Development Goals in Mongolia, National report. Ulaanbaatar, 2004 Government of Mongolia, National programme of action for the development and protection of children, 2002-2010, Ulaanbaatar, 2002 NSO, UNFPA, Reproductive Health survey 2003, Ulaanbaatar, 2004 NSO, UNFPA, 2001. Reproductive Health series, Maternal and Child health and Determinants of infant and child mortality UNDP, Government of Mongolia, 2003. Mongolian Human Development Report National Statistical Office, International Labour Organization, 2004. Report of national child labour survey, 2002-2003 United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division www.childinfo.org ix Topic MICS Indicator Number MDG Indicator Number Indicator Value SUMMARY TABLE OF FINDINGS Multiple Indicator Cluster Surveys (MICS) and Millennium Development Goals (MDG) Indicators, Mongolia, 2005 x CHILD MORTALITY 1 13 Under-five mortality rate 51 per thousand Child mortality 2 14 Infant mortality rate 40 per thousand NUTRITION 6 4 Underweight prevalence 6.3 percent 7 Stunting prevalence 20.9 percent Nutritional status 8 Wasting prevalence 2.2 percent 45 Timely initiation of breastfeeding 77.5 percent 15 Exclusive breastfeeding rate 57.2 percent Continued breastfeeding rate percent at 12-15 months 82.3 percent 16 at 20-23 months 64.9 percent 17 Timely complementary feeding rate 57.4 percent 18 Frequency of complementary feeding 21.8 percent Breastfeeding 19 Adequately fed infants 40.0 percent Salt iodization 41 Iodized salt consumption 83.1 percent Vitamin A supplementation 42 (under-fives) 64.7 percent Vitamin A 43 (post-partum mothers) 56.2 percent 9 Low birth weight infants 5.5 percent Low birth weight 10 Infants weighed at birth 98.3 percent CHILD HEALTH 25 Tuberculosis immunization coverage 97.6 percent 26 Polio immunization coverage 93.0 percent 27 DPT immunization coverage 92.0 percent 28 15 Measles immunization coverage 76.1 percent Immunization 31 Fully immunized children 67.5 percent 33 Use of oral rehydration therapy (ORT) 62.8 percent 34 Home management of diarrhoea 20.9 percent 35 Received ORT or increased fluids, and continued feeding 46.6 percent 23 Care seeking for suspected pneumonia 62.6 percent Care of illness 22 Antibiotic treatment of suspected pneumonia 71.1 percent Solid fuel use 24 29 Solid fuels 76.5 percent Source (public) Antibiotics 33.4 percent Source and cost of supplies 96 Oral rehydration salts 51.3 percent xi Topic MICS Indicator Number MDG Indicator Number Indicator Value 97 Cost Antibiotics Public 1151 tugrug Private 1400 tugrug Oral rehydration salts Public 251 tugrug Private 350 tugrug ENVIRONMENT 11 30 Use of improved drinking water sources 71.6 percent 13 Water treatment 97.9 percent 12 31 Use of improved sanitation facilities 77.2 percent Water and Sanitation 14 Disposal of child's faeces 59.5 percent REPRODUCTIVE HEALTH 21 19c Contraceptive prevalence 66 percent 98 Unmet need for family planning 13.7 percentContraception and unmet need 99 Demand satisfied for family planning 82.8 percent 20 Antenatal care 98.9 percent Content of antenatal care Blood test taken 89.1 percent Blood pressure measured 98.2 percent Urine specimen taken 89.2 percent 44 Weight measured 88.1 percent 4 17 Skilled attendant at delivery 99.2 percent Maternal health 5 Institutional deliveries 98.6 percent CHILD DEVELOPMENT 46 Support for learning 55.4 percent 47 Father's support for learning 43.8 percent 48 Support for learning: children’s books 26.2 percent 49 Support for learning: non-children’s books 53.1 percent 50 Support for learning: materials for play 6.0 percent Child development 51 Non-adult care 13.1 percent EDUCATION 52 Pre-school attendance 37.3 percent 53 School readiness 80.5 percent 54 Net intake rate in primary education 79.7 percent 55 6 Net primary school attendance rate 95.3 percent 56 Net secondary school attendance rate 85.4 percent 57 7 Children reaching grade five 96.4 percent 58 Transition rate to secondary school 98.4 percent 59 7b Primary completion rate 93.6 percent 61 9 Gender parity index primary school 1.02 ratio Education secondary school 1.07 ratio Literacy 60 8 Adult literacy rate (women aged 15-24) 94.5 percent CHILD PROTECTION Birth registration 62 Birth registration 98.3 percent Topic MICS Indicator Number MDG Indicator Number Indicator Value xii 5-14 years 18.1 percent 5-17 years 22.5 percent Labourer students 5-14 years 86.8 percent 72 5-17 years 82.1 percent Student labourers 5-14 years 18.1 percent 73 5-17 years 21.3 percent Child discipline 74 Any psychological/physical punishment 79.4 percent 67 Marriage before age 18 7.7 percent 68 Young women aged 15-19 currently married/in union 3.3 percent 69 Spousal age difference Women aged 15-19 7.2 percent Early marriage Women aged 20-24 3.3 percent Domestic violence 100 Attitudes towards domestic violence 56.4 percent Disability 101 Child disability 16.6 percent 75 Prevalence of orphans 7.9 percent Orphaned children 78 Children’s living arrangements 3.8 percent HIV/AIDS, SEXUAL BEHAVIOUR, AND ORPHANED CHILDREN 82 19b Comprehensive knowledge about HIV prevention among young people 31.0 percent 86 Attitude towards people with HIV/AIDS 13.5 percent 87 Women who know where to be tested for HIV 56.9 percent 88 Women who have been tested for HIV 14.6 percent 89 Knowledge of mother- to-child transmission of HIV 48.8 percent 90 Counselling coverage for the prevention of mother-to-child transmission of HIV 62.1 percent HIV/AIDS knowledge and attitudes 91 Testing coverage for the prevention of mother- to-child transmission of HIV 34.9 percent Child labour 71 Child labour xiii EXECUTIVE SUMMARY The Child Development Survey 2005 is a multiple indicator cluster survey, which has been conducted in Mongolia for the third time. The objective of the third survey is to make detailed estimates of the health, education and wellbeing indicators and the exercise of their rights by the women and children of Mongolia. The results of the survey will be used in the preparation of a report which the Mongolian Government will present on progress of the implementation of the country com- mitment to the World Fit for Child Declaration. At the same time, the survey aims to assess and evaluate the monitoring indicators for progress in the implementation of the Millennium Development Goals. The Multiple Indicator Child Development Survey 2005 has produced data which can be compared with the findings of the second survey. Moreover it has enriched the content and definitions used in the second survey and collected new sets of data on child development and child discipline. Child Mortality The infant mortality rate has visibly reduced over the last few years since 2000, when the second MICS survey was conducted. Infant mortality per 1000 live births declined by 36 percent, from 64 in 2000 down to 40 in 2005. Similarly, the under five mortality rate per 1000 live births has decreased from 87 to 51, which is a reduction of almost 41 per- cent . The child mortality rate is as much as twice as high in rural areas than it is in urban ar- eas. Child nutrition • Malnutrition Around 6 percent of children under the age of five in Mongolia are moderately under- weight. Almost one in five children (21 percent) is moderately stunted or too short for their age and 6 percent are classified as severely stunted. Only 2 percent are moderately wasted or too thin for their height. Children in the Western region are more likely to be underweight and stunted than chil- dren from other regions. One in ten children under the age of five is overweight. In particular twenty five percent of children under the age of 6 months is overweight. • Breastfeeding 78 percent of mothers who gave birth within the two years preceding the survey started breastfeeding within one hour of giving birth and 91 percent within one day of giving birth. 57 percent of children aged 0-5 months were exclusively breastfed, which disaggregates to 55 percent in urban areas and 60 percent in rural areas. At the age of 6-9 months, 57 percent of children are receiving breast milk and solid or semi-solid foods. By the age of 12- 15 months, 82 percent of children are still being breastfed and by the age 20-23 months, 65 percent are still breastfed. 22 percent of children aged 6-11 months and 40 percent of children aged 0-11 months are being adequately fed. xiv • “Vitamin A supplement 65 percent of children aged 6-59 months received a high dose Vitamin A supplement. 56 percent of mothers who gave birth in the two years preceding the survey received a Vi- tamin A supplement within eight weeks of the birth. Vitamin A coverage was the highest in Ulaanbaatar and the lowest in the Western re- gion. • Low weight birth Overall, 98 percent of infants were weighed at birth and approximately 6 percent were estimated to weigh less than 2500 grams at birth. • Salt iodization In 83 percent of households iodized salt is used. The use of iodized salt was highest in Ulaanbaatar at 97 percent, compared to 58 percent in the Western region, and 74 percent in the Khangai region. Child health • Immunization 98 percent of children aged 12-23 months had received a BCG vaccination by the age of one. The first dose of DPT had been given to 93 percent, while the second and third dose had been given to 94 and 92 percent . The first dose of Polio vaccine had been received by 97 percent of children by the age 12 months, a figure which declined to 93 percent for the last dose. Measles vaccine coverage was 76 percent of children aged 12-23 months, which is the lowest coverage compared to other vaccines. As a result, the percentage of children aged 12-23 months who had received all eight recommended vaccinations was high at 68 per- cent by the age of 12 months and 82 percent for those who had received vaccinations at any time before the survey. • Oral rehydration treatment Overall, one in sixteen children (7 percent) of children under five had had diarrhoea in the two weeks preceding the survey. Diarrhoea was more prevalent in children aged 6-23 months . The prevalence was 8 percent in rural areas and 5 percent in urban areas. About 38 percent had received fluids from ORS packets and 30 percent received rec- ommended homemade fluids. Approximately 63 percent of the children with diarrhoea had received any of the rehydration treatments. • Solid fuel use The use of solid fuel is very high in Mongolia (77 percent) especially in rural areas (98 percent) where almost all households consume this type of fuel. Similarly, the use of solid fuel was found to be high in urban areas (61 percent). The percentage of usage by types of sold fuel was 33 percent for wood, 23 percent for dung and 20 percent for coal. • Safe drinking water and sanitation facilities Overall, 72 percent of the population is using an improved source of drinking water – 91 percent in urban areas and 46 percent in rural areas. xv The percentage of the population which has access to improved drinking water sources is the highest (95 percent) in Ulaanbaatar, while this percentage stands at 65 percent in the Central region and 54 percent in the Khangai region. Of the total population, 77 percent had access to improved sanitation facilities. The per- centage is 95 percent in urban areas and 53 percent in rural areas. Child development In the case of 55 percent of under-five children, an adult was engaging with them in more than four activities that promote learning and school readiness during the 3 days pre- ceding the survey. 12 percent of children aged 0-59 months had been left in the care of other children under 10 years of age, while 3 percent had been left alone, during the week preceding the interview Education • Pre school education 37 percent of all children aged 36-59 months attend a pre-school education pro- gramme. The attendance rate is 25 percent in rural areas compared to 50 percent in urban areas. By region, the attendance rate is highest in Ulaanabaatar at 48 percent, while it decreases to about 32 percent in the Western, Khangai and Central regions. • Primary and secondary education Overall, 95 percent of children of primary school age are attending school. The percent- age of girls attending primary school is 96 percent, while it is 94 percent for boys. Primary school attendance is lower (92 percent) in the Western region compared to other regions. The rate (93 percent) is lower in the coutryside than in Ulaanbaatar, aimag and soum centers. The findings of the survey reveal that 85 percent of children of secondary school age, were attending secondary school. Secondary school attendance is 91 percent in the Capital city and drops to 74 percent in rural areas. Gender parity index is 1.02 at primary school and 1.07 at secondary school. • Literacy rate The literacy rate of women of between the ages of 15- 24 years is 95 percent. Reproductive health • Contraception 66 percent of women currently married or in union reported using contraception. The most popular method is the IUD which is used by 29 percent of women in Mongolia. 14 percent of women are in unmet need for contraception. Unmet need for contracep- tion is also more frequently found among women with a low level of education. In addition, the proportion of women in unmet need for contraception is higher in the Western region (16 percent) than other regions. xvi • Antenatal care Nearly all the women (99 percent) who had given birth in the two years preceding the survey had received antenatal care from skilled personnel. Medical doctors had provided antenatal care to most of mothers (83 percent) followed by feldshers/midwives at 13 per- cent. • Assistance at delivery About 99 percent of births occurring in the two years prior to the survey had been deliv- ered by skilled personnel. Seventy percent of births had been attended by a medical doctor and 29 percent by a feldsher/nurse. About 80 percent of births in Ulaanbaatar had been attended by a medical doctor, while this figure was lowest in the Western region at 58 per- cent. In urban areas, births are more likely to be attended by a medical doctor Child protection • Birth registration The births of 98 percent of children under five years is registered. Of these, 99.8 percent of children of 12-59 months are registered, while the proportion of infants of 1-2 months who are registered is less than 77 percent. • Child labour 0.6 percent of children aged 15-17 years are engaged in paid work outside the house- hold, 1.0 percent in unpaid work, 9 percent in their own household business and 14 percent in domestic work for more than 28 hours. • Child discipline 79 percent of children aged 2-14 years had been subjected to at least one form of psy- chological or physical punishment by their mothers/caretakers or other household mem- bers. 15 percent of parents/caretakers responded that they believe that, in order to raise their children properly, they need to physically punish them, while in practice 38 percent indicated that they had physically punished their children. HIV/AIDS knowledge Overall, 88 percent of interviewed women had heard of AIDS and 56 percent of these women knew of all three of the main ways of preventing HIV transmission. The percentage of women who know about two ways of HIV prevention is 66 percent and the percentage of women who reject the three common misconceptions is 38 per- cent. Overall, the percentage of women who have a comprehensive knowledge of HIV/AIDS transmission is 31 percent. Overall, 79 percent of interviewed women know about mother to child transmission of HIV. Out of the women interviewed, 57 percent of women know where to be tested, while 15 percent have actually been tested. 62 percent of women had been provided with information on HIV/AIDS prevention during their antenatal care and 37 percent of them had been tested. 1 I. INTRODUCTION Background This report is based on the results of the survey “Child and Development 2005” (Multiple Indicator Cluster Survey) conducted by the National Statistical Office in 2005-2006, with the support and assistance of the Government of Mongolia and UNICEF. The survey was undertaken in Mongolia in order to monitor progress towards the goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of “A World Fit For Children”, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see Box.1). Box 1. A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and the Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: “We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets in this plan of action at national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and sub national levels of progress in order to more effectively address obstacles and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on progress: “…We request the General Assembly to review on a regular basis the progress made in implementing the provisions of this Declaration, and ask the Secretary-General to issue periodic reports for consideration by the General Assembly and as a basis for further action.” I 2 I. INTRODUCTION This survey has been a joint endeavour of the Government of Mongolia and UNICEF to do in-depth analysis of the situation of Mongolia’s children and women in terms of health, education, livelihood status and the realisation of their rights and to assess progress in the implementation of a National Programme for Development and Protection of Children (2002-2010). The survey was undertaken within the framework of the preparation process of the national report which the Government of Mongolia has been selected to present at the UN Special Session in 2007, regarding the country’s implementation of the Declaration of the World Fit for Children. The data will inform the preparation of this national report. It will also complement the monitoring of the progress in the implementation of the MDG’s. This report presents the topics and result indicators of the study undertaken. Survey Objectives The primary objectives of the Multiple Indicator Cluster Survey, which was executed in 2005-2006 are the following: Ù To update the necessary data for assessing the situation of children and women and the realization of their rights. Ù To furnish the data needed for monitoring progress towards the goals of Millenium Declaration and A World Fit for Children as a basis for the planning of future action; Ù To contribute to the improvement of the data and monitoring systems in Mongolia and strengthen expertise in the design, implementation and analysis of these systems. 3 II. SAMPLE AND SURVEY METHODOLOGY Sampling design The sample for the Mongolia Multiple Indicator Cluster Survey (MICS) was designed to provide estimates on a number of indicators on the situation of children and women at the national level, for urban and rural areas, and for the regions. The five regions (Western, Khangai, Central, Eastern and Ulaanbaatar) were taken as the main sampling domains and a two stage sampling design was used. Within each region, households were selected with probability proportional to size. The administrative record of households and population is updated on an annual basis across the country, so bagh and khoroos were taken as the primary sampling units. Baghs and khoroos with a large population were divided into 2-3 sampling units, in order to keep a similar number of households for all sampling units. Bagh and khoroos (the primary sampling unit) were selected with probability proportional to size and 25 households within each of these selected units were sampled using the systematic sampling method. A total of 6325 households in 253 primary sampling units were selected to represent 21 aimags and Ulaanbaatar city, and data were collected from all sampled households. The sample was stratified by region and is not self-weighting. Sampile weights were used for reporting national level results. A more detailed description of the sampling design can be found in Appendix I. Questionnaires In line with the objectives and coverage of the survey, three sets of questionnaires, as proposed by UNICEF, were used in the survey: 1. A household questionnaire, which was used to collect information on housing, living conditions and household members; 2. A questionnaire for individual women aged 15-49 years living in the households; 3. A questionnaire for children under five years of age; These questionnaires included the following modules: II 1 Mongolia is divided administratively into 21 aimags (provinces) and the capital city, Ulaanbaatar. Aimags are divided into soums, which are further divided into baghs. Household questionnaire Women’s questionnaire (15-49 years) Under five children questionnaire Household listing Women listing Child listing Education Child mortality Birth registration and early learning Water and sanitation Maternal and newborn health Child development Household characteristics Marriage and Union Vitamin A Child labour Contraception Care of illness Child discipline Attitudes towards domestic violence Immunization Disability HIV/AIDS knowledge Anthropometry Salt iodization 4 II. SAMPLE AND SURVEY METHODOLOGY To reflect the country specific characteristics, the “Salt Iodization” module of the Household Questionnaire was enlarged by the question about the vitamin and mineral fortified flour and the “Child Discipline” module was combined with a sub-module on child behaviour. These additions were made, based on the decisions made by the members of the working group and Steering Committee. The Household Questionnaire was administered to an adult household member who could best represent the other members, the Women Questionnaire to the women themselves and the Under Five Questionnaire to the mothers or caretakers of children under 5 years old. Child weights and heights were measured during the interviews. In the meantime, the salt used for household cooking was on site tested, in order to measure the iodine content. A copy of Mongolia MICS questionnaires is provided in Appendix VI. In order to check the clarity and logical sequence of the questions, to determine the duration of the interview per household and to test the entry programme, a pretest was conducted in September 2005, covering selected households in Erdene soum of Tuv aimag. Based on the results of the pretest, modifications were made to the wording and the logical sequence of the questions was improved. Training and data collection A 10 day training for field staff was conducted at the National Statistics Office in October and November, 2005. Training included lectures on interviewing techniques by instructors specialised in the specific issues dealt with in the survey. At the end of training participants practiced their interviewing skills during a 2 days fieldwork exercise. Once training was completed, trainees were required to sit a test and the trainees who scored the highest in the test were selected as field staff. The data were collected by 11 teams; each comprising a supervisor, an editor and 5 interviewers. Fieldwork began at the beginning of November 2005 and was concluded by the end of December 2005. The monitoring procedure was set up by the staff of NSO, UNICEF and members of the MICS Steering Committee. The monitoring team assessed the field work activities, provided instructions and took prompt action in the case of issues raised during the field work. Data processing Data were entered on computers using the CSPro software. Data entry began simultaneously with data collection in December 2005 on seven microcomputers and continued for 2 months. In order to ensure quality control, the data were double entered and internal consistency checks were regularly performed. Data were analysed using the SPSS (Statistical Package for Social Sciences) software program, Version 14, and the model syntax and tabulation plans developed by UNICEF for this purpose. 5 III. SAMPLE COVERAGE, CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Sample coverage Of the 6325 households selected for the sample, 6220 were successfully interviewed resulting in a household response rate of 98.3 percent. In the interviewed houiseholds, 8057 women (age 15-49) were identified. Out of the listed 8057 women, 7459 women were successfully interviewed, yielding a response rate of 92.6 percent. In addition, 3568 children under age five were listed in the household questionnaire. Questionnaires were completed for 3547 of these children, which corresponds to a response rate of 99.4 percent (Figure III.1). It was calculated that overall response rates were 91.0 and 97.8 percent respectively for the women’s and under-5’s interviews. (Table HH.1). Characteristics of households and respondents The survey data covers 26713 members of 6220 households. Table HH.3 shows the basic background information on the households. Of the households interviewed within the survey 57.4 percent, or 3570 households, are urban and 42.6 percent, or 2650, are rural. In terms of residence and population density, the largest propostion, or 34.8 percent, of the interviewed households were in Ulaanbaatar while the smallest percentage of households were in the Eastern region at 8.1 percent. The estimate of household size reveals that 50.2 percent of the total households have 4- 5 members. Households with 2-3 members account for 30 percent, while those with 6-7 members and more than 8 members account for 15 percent and 3.5 percent respectively. The percentage households with a single member is 1.2 percent. These figures indicate that the survey estimated the average household size at 4.3 persons. Female headed households amount to 17.6 percent of the total. Table HH.2 demonstrates the age and sex distribution of the survey population. Of 26713 members of 6220 households, 47.9 percent or 12,790 are male and 52.1 percent or 13,923 are female. By age group, 34 percent of females are under the age of 15 and 64 percent are between 15-64 years old, while the corresponding percentages for males are 38 percent and 60 percent respectively. As ages increase for both male and female, their proportion in the total population decreases. The percentage of males and females above the years of 65 is between 2.1 - 2.8 percent. Among the total population, 43 percent are under the age of 17 and 57 percent are above the age of 18. The age disaggregation shows a similar age distribution for male and female, while more females are covered between the years of 20-44, III Figure III.1 Number of households, women (15-49 yearsr) and children under 5 interviewed, response rate 6 III. SAMPLE COVERAGE, CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS and more males between the years of 0-19. The survey estimates that 88 percent of interviewed households have at least one child under 18 years, 95 percent have one and more than one female member of 15-49 years and 48 percent have one child under five years. A total of 7459 females between 15-49 years old were interviewed by the survey, of which 17 percent were 15-19 year olds, 16 percent were 20- 24 years and 18 percent were between 25-29 years old. As females grow older , their proportion of the total declines with 45-49 year olds accounting for only 9 percent. More than 60 percent of females of 15-49 years old are either married or in union and 75 percent had given birth to a child. By education level, 4 percent of females have no education, 10 percent are primary level educated, 26 percent have incomplete secondary education, 25 percent have complete secondary education and 9 percent are have vocational education, while 26 percent have graduate and post graduate diplomas. The number of females with complete secondary education has reduced since the second MICS, whereas those with higher education has risen (Figure III.3). A total number of 3547 children under five years old, were covered by the survey. Table HH.5 presents some background characteristics of children under 5 by sex, region, area of residence, age in months, mother’s or caretaker’s education and household wealth. Children under five, who were covered by the survey disaggregate into 52 percent for boys and 48 percent for girls. Of mothers of children under five, 4 percent have no education, 8 percent are primary educated, 25 percent have incomplete secondary education, 29 percent have complete secondary education and 33 percent have graduated from vocational school and higher education schools. The weighted and unweighted numbers of households (female respondents and of children under age 5) are equal, since sample weights were normalized (See Appendix I). Figure III.2. Age distribution of female respondents aged 15-49 years, by age groups, Mongolia 2005 Figure III.3. Education level of female respondents of 15-49 years ,by percent, Mongolia, 2005 7 III. SAMPLE COVERAGE, CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Data disaggregation Survey findings are provided for the national average, regions as well as location, urban and rural, mother’s education level and wealth quintile. Regions: Western, Khangai, Central, Eastern and Ulaanbaatar Location: Capital city, aimag center, soum center, rural Urban, rural: Capital city and aimag centers are counted as urban areas and soum centers and rural make up the category of rural areas. Education level: Mother’s education was categorised as non-educated (with no primary education), with primary education, incomplete (8th grade) secondary, complete (10th grade) secondary, vocational education and graduate (post graduate). Wealth index: Wealth status is another key factor in explaining and analysing findings. Traditionally, wealth status is measured through the income or consumption level of a household. However, this information is time consuming to collect (requires many questions to capture all sources of income for all household members), is prone to misstatement (understatement is common as is lack of precise knowledge of income or expenditure of other household members), provides problems in terms of how to deal with variability in income, how to value home production, and how to capture large but irregular expenditures. Instead a wealth index was used as a measurement of household wealth status for MICS. The wealth index is more easily measured as it requires fewer and less sensitive questions, and to a large extent makes use of information which has already been collected for other purposes (access to clean water, sanitation, housing type, housing materials, and access to electricity etc). For the Mongolia MICS, the following goods and assets were used for calculating the wealth index: housing type and condition, source of drinking water and type of sanitary facility, availability of electricity, household consumerables (communications and transportation means, household electrical appliances etc). Using the above mentioned information, each sampled households was given scores. Each household was then weighted by the number of household members, and the household population was divided into five groups of equal size, from the poorest quintile to the richest quintile, based on the wealth scores of the households they were living in. The wealth index is assumed to capture the underlying long- term wealth, through information on the household assets, and is intended to produce a ranking of households by wealth, from the poorest to the richest. All interviewed households were divided into wealth quintiles, according to obtained scores,as the following: poorest (I), second (II), middle (III), fourth (IV) and reachest (V). 8 IV. CHILD MORTALITY One of the overarching goals of the Millennium Development Goals (MDGs) and the World Fit for Children (WFFC) is to reduce infant and under-five mortality. Specifically, the MDGs call for the reduction in under-five mortality by two-thirds between 1990 and 2015. Monitoring progress towards this goal is an important but difficult objective. Measuring childhood mortality may seem easy, but attempts using direct questions, such as “Has anyone in this household died in the last year?” give inaccurate results. Using direct measures of child mortality from birth histories is time consuming, more expensive, and requires greater attention to training and supervision. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate is the probability of dying before the first birthday. The under- five mortality rate is the probability of dying before the fifth birthday. In MICS surveys, infant and under five mortality rates are calculated based on an indirect estimation technique known as the Brass method (United Nations, 1983; 1990a; 1990b). The data used in the estimation are: the mean number of children ever born for five year age groups of women from age 15 to 49, and the proportion of these children who are dead, also for five-year age groups of women. The technique converts these data into probabilities of dying, by taking into account both the mortality risks to which children are exposed and their length of exposure to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Mongolia, the West model life table was selected as the most appropriate. Figure IV.1. Infant and under five mortality rates by background characteristics, Mongolia, 2005 IV 9 IV. CHILD MORTALITY Table CM.1 provides estimates of child mortality by various background characteristics, while Table CM.2 provides the basic data used in the calculation of the mortality rates for the national total. The infant mortality rate is estimated at 40 per thousand, while the probability of dying under-5 mortality rate (U5MR) is 51 per thousand. These estimates have been calculated by averaging mortality estimates obtained from women age 20-29, and refer to the end of 2002. There is some difference between the probabilities of dying among males and females. The mortality risk is higher for male infants and under 5s than their female counterparts by 20-25 percent. There are also significant differences in mortality in terms of mother’s educational levels, wealth, residence and location (Figure IV.1). Both mortality estimates of infants and under- 5 children are nearly twice as high in rural areas than in urban areas. With regard to the education level of mothers, infant and under five mortality rates (66 and 90 per 1,000 live births) are the highest for mothers who are not educated or have only primary education whereas for educated mothers, the corresponding rates are 18 and 22 per 1,000 live births. The probabilities of dying among infants and children under 5 years living in the richest 40 percent of households are considerably lower than the national average and stand at 25 and 30 per 1,000 live births. When the poorest 60 percent is compared to the richest 40 percent, the infant (46 per 1,000 live births) and under-five mortality (60 per 1,000 live births) rates are twice as high. Figure IV.2 shows the series of U5MR estimates from various surveys and other sources, since the mid-1980s, thus showing the estimated trends in U5MR during the last two decades. The MICS estimates, as well as estimates from other sources, indicate a decline in mortality during the last 20 years. The U5MR estimates from MICS are about 10-20 per thousand higher than the estimates from the health administrative records, while the trend indicated by the survey results are in broad agreement with those estimated in the previous MICS survey as well as with indirect estimates of Reproductive Health Surveys in 1998 and 2003 (Figure IV.2). The mortality trend depicted by the health records is also a declining one; however, MICS results are somewhat higher than those indicated by the annual health records. Some possible explanations for the discrepancies in estimates are discussed below. Fig IV.2 Under five mortality rates by different sources, Mongolia, 1984-2005 10 IV. CHILD MORTALITY 1.Comparison with routine data – undercounting and underreporting of neonatal deaths The Mongolian situation mirrors a common trend in many of the transitional countries, where survey estimates and official mortality rates, based on routine data collection, differ considerably, with survey data being up to four times as high as the official data (Aleshina & Redmond, 2003). Researchers analysing the reasons of this phenomenon in transition countries, suggest that neonatal deaths are being underreported in routine data for three main reasons related to: 1. The definition of live births 2. Misreporting of pregnancy outcomes by medical staff 3. Under registration by parents of births and infant deaths. Box 2 Classification of mortality during early childhood Under-5 mortality (<5 years) Infant mortality (<1 year) Child mortality (1-4 years) Neonatal mortality (0-28 days) Post neonatal mortality (29-365 days) Early neonatal mortality (0-6 days) Late neonatal mortality (7 – 28 days) The definition of ‘live birth’ is a crucial determinant of the infant mortality rate, since a poor pregnancy outcome cannot be registered as an infant death if the foetus was not acknowledged as having been born alive in the first place. This is particularly relevant to Mongolia (and many other transition countries) as the old Soviet protocols, which were in use in Mongolia until 2003, have a narrower definition of live birth than the WHO definition now used almost universally throughout the world. The Soviet definition differs in two ways: firstly, the only indicator used to establish if infants are born alive is the presence of breathing; no other signs of life are taken into account. If an infant shows other signs of life before dying, it will be counted as a still birth rather than as an early neonatal death. Since many infant deaths take place shortly after birth, the differences in definition can greatly influence the recorded level of infant mortality. According to the Mongolia Reproductive Health Surveys 1998 and 2003, (which are based on birth histories and thus allow more in-depth analysis of when exactly children die), close to half of all infant mortality deaths in Mongolia (45 of every 100) take place during the first month of life2. In the majority of cases (75 percent) these neonatal deaths take place within the first week (early neonatal death) often just within hours or a few days of having been born. In total, almost a third or 32 percent of all under-five deaths in Mongolia occur within the first week of life3. 2 NSO, UNFPA, Reproductive Health survey 2003, Ulaanbaatar 2004 3 NSO, UNFPA, 2001. Reproductive Health series, Maternal and Child health and Determinants of infant and child mortality 11 IV. CHILD MORTALITY Another explanation for the undercounting of neonatal deaths is misreporting of deaths, either intentionally to improve the mortality figures or accidental misreporting due to inadequate knowledge. Since a birth under the Soviet definition had to fulfil several criteria regarding gestation, weight and length in order to be considered a live birth, this gave more discretion in making a final assessment. With the pressure on individual medical staff to reduce the number of infants who officially died in their care, to avoid investigation and possible punishment, and the pressure on hospitals and clinics to play their part in meeting the national goals for the health care system, this provided incentives in some transitional countries to classify deaths as still births, rather than as early neonatal deaths, whenever there was doubt. A somewhat similar situation may prevail in Mongolia where aimags and soums are under pressure to perform well in the area of infant, child and maternal mortality figures, which are seen as key performance indicators for the health system. The third explanation given is undercounting of neonatal deaths related to underreporting by parents of births and deaths. Although birth registration is virtually universal for children over the age of one in Mongolia the same does not apply for younger children. Ninety percent of children under the age of one are registered according to MICS3 findings, a coverage rate which declines the younger the child. By law the birth of a child must be registered within a month, but in many cases this is not followed in practice, As the ratio of early neonatal deaths increases, as a proportion of total infant deaths, any undercounting of these neonatal deaths will tend to further bias infant mortality and under five mortality rates. 2. Comparison with RHS In 2003 the RHS reported an infant mortality rate of 29.5, based on the direct estimation method, and 34 based on the indirect estimation method, in both cases considerably lower than the MICS3 estimation of 40. Since the method of data collection, the calculations of estimations and the assumptions underlying the direct and indirect method of estimation differ, the results are not directly comparable4. In the current MICS, the estimates for infant and under-five mortality have been calculated by averaging mortality estimates obtained from women aged 20-29. However, the age group used in the RHS is 15-19, and this difference explains the discrepancy in the infant mortality levels quoted in the two surveys. 4 While direct estimation tends to suffer more from under- and misreporting, the indirect method runs the risk of overestimating mortal- ity somewhat by failing to take into account the effect of rapidly declining fertility. 12 V. NUTRITION Nutritional Status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of all child deaths worldwide. Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately malnourished – showing no outward sign of their vulnerability. The Millennium Development target is to reduce by half the proportion of people who suffer from hunger between 1990 and 2015. The World Fit for Children goal is to reduce the prevalence of malnutrition among children under five years of age by at least one-third (between 2000 and 2010), with special attention to children under 2 years of age. A reduction in the prevalence of malnutrition will assist in the goal to reduce child mortality. In a well-nourished population, there is a reference distribution of height and weight for children under age five. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is the WHO/ CDC/NCHS reference, which was recommended for use by UNICEF and the World Health Organization at the time the survey was implemented. Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. 1. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. 2. Height-for-age is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Those whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness. 3. Finally, children whose weight-for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence. V 13 V. NUTRITION In MICS, weights and heights of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF. Findings in this section are based on the results of these measurements. Table NU.1 shows percentages of children classified into each of these categories, based on the anthropometric measurements that were taken during fieldwork. Additionally, the table includes the percentage of children who are overweight, which takes into account those children whose weight for height is above 2 standard deviations from the median of the reference population. In Table NU.1, children who were not weighed and measured and those whose measurements are outside a plausible range are excluded. Around 6 percent of children under age five in Mongolia are moderately underweight (Table NU.1). Almost one in five children (21 percent) is moderately stunted or too short for their age and 6 percent are classified as severely stunted. Only 2 percent are moderately wasted or too thin for their height. Children in the Western region are more likely to be underweight and stunted than other children. In contrast, the percentage of children that are wasted is highest in Ulaanbaatar. Boys appear to be slightly more likely to be stunted whereas girls are slightly more likely to be underweight and wasted. Those children whose mothers have vocational or higher education are the least likely to be underweight and stunted compared to children of mothers with lower education. Figure V.2 shows the pattern of under nourishment by age. In general, children under the age of 6 months, who are mainly breastfed are less likely to be found underweight, stunted or wasted compared to children of older age groups. Moderate underweight is more commonly observed among children aged 24- 35 months. However, children aged 48-59 months are more likely to be severely underweight. The highest percentage (26 percent) of stunted children is observed among children aged 12-23 months. Severe stunting, on the other hand, is more frequent among those aged 36-47 months (9 percent). As expected, children of the poorest quintile are more likely to be found Figure V.2 Underweight and stunted children aged 0-59 months by age in months, Mongolia, 2005 Figure V.1 Prevalence of malnutrition, Mongolia, 2005 14 V. NUTRITION underweight, stunted and wasted. Thus, poor children are twice as likely to be underweight and stunted when compared to the ones in the richest quintile (Table NU.1). Another important determinant of malnutrition is the number of children in the household. Figure V.3 shows that the number of children under age five in a household positively correlates with the prevalence of under nourishment. The percentage of underweight (stunted) children living in a household with 3 or more children is higher by 3 (20) percentage points compared to households with one child. Survey results reveal that one in ten children under age five is overweight. In particular, twenty five percent of children under the age of 6 months is overweight. When children start crawling and walking, the percentage of overweight decreases, and by the time they are aged 4-5 years, the percentage has decreased to five percent. Fourteen percent of overweight children are from the richest households and 11-13 percent has mothers with professional and higher education. From the regions, the Eastern region and Ulaanbaatar demonstrate the highest prevalence of overweight (14 and 15 percent respectively), which is relatively higher than the other regions (6-9 percent). Breastfeeding Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers stop breastfeeding too soon and there are often pressures to switch to infant formula, which can contribute to growth faltering and micronutrient malnutrition and is unsafe if clean water is not readily available. The World Fit for Children goal states that children should be exclusively breastfed for 6 months and continue to be breastfed with safe, appropriate and adequate complementary feeding for up to 2 years of age and beyond. WHO/UNICEF have the following feeding recommendations: Ù Exclusive breastfeeding for the first six months Ù Continued breastfeeding for two years or more Ù Safe, appropriate and adequate complementary foods beginning at 6 months Ù Frequency of complementary feeding: 2 times per day for 6-8 month olds; 3 times per day for 9-11 month olds It is also recommended that breastfeeding be initiated within one hour of birth. The indicators of recommended child feeding practices are as follows: Ù Exclusive breastfeeding rate (< 6 months & < 4 months) Ù Timely complementary feeding rate (6-9 months) Figure V.3 Percentage of children stunted and underweight, by number of children, Mongolia, 2005 15 V. NUTRITION Ù Continued breastfeeding rate (12-15 & 20-23 months) Ù Timely initiation of breastfeeding (within 1 hour of birth) Ù Frequency of complementary feeding (6-11 months) Ù Adequately fed infants (0-11 months) Mongolia is implementing a breastfeeding policy. However, advertisements promoting breast milk substitutes have resulted in an increase in sales as well as consumption of infant formula. Consequently, breastfeeding, particularly exclusive breastfeeding, has been substantially decreasing in recent years. According to the Second National Nutrition Survey (1999), the percentage of mothers with children aged 6-59 months, who started breastfeeding their infants within 30 minutes of birth was 93.4 percent whereas the results of the Third National Nutrition Survey (2004) show that this indicator has dropped to 83.5 percent. Figure V.4 indicates the proportion of women who started breastfeeding their infants within one hour of birth, and women who started breastfeeding within one day of birth. The figure shows that 78 percent of mothers who had birth within two years preceding the survey started breastfeeding within one hour of birth and 91 percent within one day of birth. For rural areas, this indicator is 81 and 94 percent respectively, while for urban areas it is 75 and 89 percent respectively. By region, the above indicators in Ulaanbaatar city are 72 and 89 percent, while in the Western region they are 74 and 94 percent, slightly lower than Khangai (75 and 93 percent), Central (83 and 92 percent) and Eastern regions (75 and 93 percent). The policy of the Government of Mongolia has supported exclusive breastfeeding for 4 months since 1992 and for 6 months since 2000. Survey findings reveal that 57 percent of children aged 0-5 months were exclusively breastfed, which disaggregates by location as 55 percent in urban areas, and 60 per cent in rural areas. In Table NU.3, the breastfeeding status is based on reports from mothers/caretakers of their children’s consumption of food and fluids in the 24 hours prior to the interview. Exclusively breastfed refers to infants who received only breast milk (and vitamins, mineral supplements, or medicine). The table shows exclusive breastfeeding of infants during the first six months of life (separately for 0-3 months and 0-5 months), as well as complementary feeding of children 6-9 months and continued breastfeeding of children at 12-15 and 20- 23 months of age. At the age of 6-9 months, 57 percent of children are receiving breast milk and solid or semi-solid foods. By the age of 12-15 months, 82 percent of children are still being breastfed and 20-23 months, 65 percent are still breastfed. The prevalence of exclusive breastfeeding up until 6 months old is higher for those infants whose mothers are uneducated and mothers with primary education (64 and 73 percent Figure V.4. Percentage of mothers who started breastfeeding within one hour and within one day of birth, Mongolia, 2005 16 V. NUTRITION respectively) compared to infants with mothers who have vocational and higher education ( 53 and 51 percent) Figure V.5 shows the detailed pattern of breastfeeding of children under the age of one. As this figure demonstrates, 3 percent of infants aged 0-1 months received breast milk and water, and 7 percent breast milk with other liquids. This exposes inadequate knowledge of mothers and caretakers on how to feed infants. This feeding pattern increases with the child’s age, as for 2-3 and 4-5 months. In addition, the number of observations in many of the categories of background characteristics is small. Nonetheless, it can be seen from the Table NU.3 that breastfeeding, both exclusive and continued, is practiced more in rural areas. The adequacy of infant feeding in children under 12 months is demonstrated in Table NU.4. Different criteria of adequate feeding are used, depending on the age of the child. For infants aged 0-5 months, adequate feeding is considered to be exclusive breastfeeding. Infants aged 6-8 months are considered to be adequately fed if they are receiving breast milk and complementary food at least two times per day, while infants aged 9-11 months are considered to be adequately fed if they are receiving breast milk and eating complementary food at least three times a day. The proportion of adequately fed infants of 0-5 months old was 57 percent. 31 percent of infants of 6-8 months old have been reported as receiving breast milk and complementary food at least two times per day and only 12 percent (one out of eight) infants aged 9-11 months received breast milk and ate complementary food at least three times per day. As a result of these feeding patterns, 22 percent of children aged 6-11 months and 40 percent of children aged 0-11 months are being adequately fed. Salt Iodization Iodine Deficiency Disorder (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Iodine deficiency is most commonly and visibly associated with goitre. IDD takes its greatest toll in impaired mental growth and development, contributing in turn to poor school performance, reduced intellectual ability, and impaired work performance. The international goal is to achieve sustainable elimination of iodine deficiency by 2005. The indicator is the percentage of households consuming adequately iodized salt (>15 parts per million). In Mongolia, iodized salt was introduced in 1995. The Government of Mongolia adopted the National Programme on Elimination of Iodine Deficiency Disorder in 1996, which was revised in July 2002 and renamed as the National Programme on Iodine Deficiency Disorders Prevention. In 2003, the Law on Salt Iodization and Prevention of Iodine Deficiency was adopted. Furthermore, the Joint Decree of the State Agency of Professional Inspection, the Figure V.5 Percent distribution of children under the age of one, by feeding pattern by age group, Mongolia, 2005 17 V. NUTRITION Ministry of Health, the Ministry of Food and Agriculture on the Guidelines on Quality Control on the Fortified Food Products, the Technical Requirements for testing iodine content in iodised salt and the Methodology for Salt Iodization were issued in June 2005 and standardized. Salt used for cooking in the surveyed households was tested, using salt test kits. A sample of salt used for cooking in each household was put aside and drops of testing soluble were added. The iodine content was identified by adding the drops of soluble to the salt and determining whether the colour of the salt becomes tinted with blue. WHO has recommended that the iodine content in salt used for cooking should be not less than 15 parts per million (ppm). Salt was tested in 98 percent of surveyed households. As can be seen in Figure V.6, 83 percent of the households use iodized salt. However the use of iodized salt in households varies by regions, location and wealth status, as can be seen Table NU.5. By region, the use of iodized salt was lowest in the Western region (58 percent) and highest in Ulaanbaatar (97 percent). The lowest use of iodized salt in the Western region can be explained by the fact that there are abundant natural salt deposits in the region. Research conducted by the Nutrition Research Center, explored the large discrepancies between regions and attributed them mainly to differences in the supply of iodized salt in the regions, variations of market prices, geographic features, as well as the consumption behaviour patterns of the population and many other factors. Consumption of flour fortified with vitamins and minerals The consumption of food fortified with iron is an effective and cost efficient way of preventing iron deficiency anaemia, which is commonly found among young children and women. In 2000, within the framework of the project “Improvement of mother and child nutrition JFPR 9005” and the continuation of this project “Improving public health through better food JFPR 9005” financed by Japan Fund for Poverty Reduction and grants from the Asian Development Bank, new technology (micro feeders) designed to fortify flour with minerals and vitamins was introduced into selected flour mills in Mongolia. In addition, to promote the consumption of fortified food, advocacy and awareness raising campaigns among the population have been conducted with Figure V.6. Proportion of households using iodized salt by regions, rural and urban areas, Mongolia, 2005 Figure V.7. Proportion of households using fortified flour, by regions, Mongolia, 2005 18 V. NUTRITION the participation of both government and non-government organizations. In the respondent’s answers to the household questionnaire, it was revealed that 55 had heard about fortified flour and of these, 36 percent of total households use it regularly and 31 percent occasionally (Table NU.5A). Awareness of fortified flour is higher in urban areas (59 percent) compared to rural areas (48 percent). 42 percent of urban households use fortified flour regularly (26 percent occasionally) while 30 percent of rural households use it regularly (26 percent occasionally). As seen in Figure V.7, 27 percent of households in the Western region, 66 percent of those in the Khangai region, 64 percent in the Central region, 70 percent in the Eastern region and 78 percent in Ulaanbaatar use fortified flour. The data shows that the use of fortified flour is highest in Ulaanbaatar as opposed to the Western region, where it is lowest. Vitamin A Supplements Vitamin A is essential for eye health and the proper functioning of the immune system. It is found in foods such as milk, liver, eggs, red and orange fruits, red palm oil and green leafy vegetables, although the amount of vitamin A readily available to the body from these sources varies widely. In developing areas of the world, where vitamin A is largely consumed in the form of fruits and vegetables, the daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased need for the vitamin as children grow or during periods of illness, as well as increased losses during common childhood infections. As a result, vitamin A deficiency is quite prevalent in the developing world and particularly in countries with the highest burden of under-five deaths. The 1990 World Summit for Children set the goal of the virtual elimination of vitamin A deficiency and its consequences, including blindness, by the year 2000. This goal was also endorsed at the Policy Conference on Ending Hidden Hunger in 1991, the 1992 International Conference on Nutrition, and the UN General Assembly’s Special Session on Children in 2002. The critical role of vitamin A for child health and the immune function also makes control of deficiency a primary component of child survival efforts, and therefore critical to the achievement of the fourth Millennium Development Goal: a two-thirds reduction in under- five mortality by the year 2015. For countries with vitamin A deficiency problems, current international recommendations call for a high-dose vitamin A supplementation every four to six months, targeted to all children between the ages of six to 59 months living in affected areas. Providing young children with two high-dose vitamin A capsules a year is a safe, cost-effective, efficient strategy for eliminating vitamin A deficiency and improving child survival. Giving vitamin A to new mothers who are breastfeeding helps protect their children during the first months of life and helps to replenish the mother’s stores of vitamin A, which are depleted during pregnancy and lactation. For countries with vitamin A supplementation programs, the definition of the indicator is the percentage of children 6-59 months of age receiving at least one high dose vitamin A supplement in the last six months. The Government of Mongolia approved the “Mother and child micronutrient deficiency prevention strategy” in 2005. In Mongolia, since 1998, based on WHO guidelines and with financial and technical assistance of UNICEF, high dose Vitamin A capsules have been given to children aged 6-59 months and to mothers after having a birth within 8 months. Within the six months prior to the MICS, 65 percent of children aged 6-59 months received a high dose Vitamin A supplement (Table NU.6). Approximately 17 percent did not receive the supplement in the last 6 months but did receive one prior to that time. Only 19 V. NUTRITION four percent of children received Vitamin A supplement at some time in the past but their mother/caretaker was unable to specify when. The percentage receiving vitamin A is highest among children of 12-23 months and this percentage decreases with the age of the child. The percentage of children who received vitamin A is higher by 17 percentage points among children aged 12-23 months compared with those of 48-59 months and higher by 9 percentage points compared to those of 6-11 months. By region, the percentage receiving Vitamin A supplement is lower in the Western and Eastern regions (55 and 57 percent respectively) than in other regions (61-73 percent). (Figure V.8) More than half (56 percent) of mothers who gave birth in the two years preceding the survey received a Vitamin A supplement within eight weeks of the birth. Differences between regions are relatively modest and vary between 50-60 percent. Low Birth Weight Weight at birth is a good indicator, not only of a mother’s health and nutritional status but also of the newborn’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born underweight also tend to have a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults. In the developing world, low birth weight stems primarily from the mother’s poor health and nutrition. Three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during the pregnancy. Inadequate weight gain during pregnancy is particularly important since it accounts for a large proportion of foetal growth retardation. Moreover, diseases such as diarrhoea, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. The percentage of births weighing below 2500 grams is estimated from two items in the questionnaire: the mother’s assessment of the child’s size at birth (i.e., very small, smaller than average, average, larger than average, very large) and the mother’s recall of the child’s weight or the weight as recorded on a health card if the child was weighed at birth. Overall, 98 percent of births were weighed immediately after birth. Among the regions, the lowest percentage of births that were weighed was in the Western region, where the percentage was 93 percent. Overall, the proportion of infants with a low birth rate among all infants who have been weighed at birth stands at 5.5 percent. The percentage of low weight infants is slightly lower in Western region compared with other regions. Figure V.8 Percentage of children received Vitamin A supplement in last 6 months, by regions, Mongolia, 2005 20 VI. CHILD HEALTH Immunization The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in this goal. Immunizations have saved the lives of millions of children in the three decades since the launch of the Expanded Programme on Immunization (EPI) in 1974. Worldwide there are still 27 million children overlooked by routine immunization and as a result, vaccine- preventable diseases cause more than 2 million deaths every year. One of the World Fit for Children goals is to ensure full immunization of children under one year of age, with a figure of 90 percent nationally, representing at least 80 percent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT to protect against diphtheria, pertussis, and tetanus, three doses of polio vaccine, and a measles vaccination by the age of 11 months and 29 days. Within the Survey, the mothers were asked to provide vaccination cards for children under the age of five. Interviewers copied vaccination information from the cards onto the questionnaire. The vaccination records of 80.5 percent of children under the age of 5 years within the surveyed households were copied from the child health card and in the case of children where it was not possible to look at the health card, the mother was asked to recall whether or not the child had received each of the vaccinations and how many times. The percentage of children aged 12 to 23 months who received each of the vaccinations is shown in Table CH.1. The denominator for the table is comprised of children aged 12- 23 months, so that only children who are old enough to be fully vaccinated are counted. In the top panel, the numerator includes all children who were vaccinated at any time before the survey, according to the vaccination card or the mother’s report. In the bottom panel, only those who were vaccinated before their first birthday are included. For children without vaccination cards, the proportion of vaccinations given before the first birthday is assumed to be the same as for children with vaccination cards. In Mongolia, the vaccination coverage rate is relatively high for all types of vaccines. This also has slightly increased over the past 5 years (Figure VI.1). When the present figures are compared to the previous survey, the percentage of vaccination records obtained from the child health card decreased slightly and information obtained from mothers/care takers verbal reports increased. The child health card normally has to be kept by the household. However to prevent loss of the health card, it is common for the health card to be kept by the family practitioner. For this reason, it was not possible to record information from the health cards of all of the surveyed children, and the survey team has done their best to obtain vaccination records VI 21 VI. CHILD HEALTH from the health cards, by visiting the family practitioners. The highest coverage rate is 98 percent for BCG vaccine, which has to be vaccinated within 24 hours after birth. Vaccination rates decline slightly for antigens which are due at later ages. The dropout rate between DPT1 and DPT3 vaccinations is low – dropping from 94 percent to 93 percent. A dropout rate occurs for Polio1 to Polio3 - dropping from 98 percent to 94 percent. Although Polio and DPT immunizations are given at the same time (2 months, 3 months, and 4 months of age) Polio immunization remains higher than DPT for all three doses. For all of the antigens discussed above (BCG, DPT1-3, and Polio1-3) there is very little difference between the proportion of children who received these vaccinations before the age of one and those receiving them any time before the survey. This is not surprising as BCG, DPT1-3 and Polio1-3 are all supposed to be completed by the time the child is 4 months old, and it would be unlikely to have many children delaying these vaccines beyond the age of one. The coverage for measles vaccine is relatively lower than for the other vaccines. According to the immunization schedule, a child should be given the Measles vaccine at 8-11 months. However, according to the findings of the survey, only 76 percent of children aged 12-23 months had had their measles vaccination before the age of one as recommended, while 88 percent of children had been vaccinated at any time before the survey. Some of these children have had vaccination delayed, which is likely to have been due to the shortage in the supply of Measles vaccines which occurred in Mongolia during the period between August – November 2005. The proportion of children who had received all recommended vaccinations by their first birthday is 68 percent. The tendency to delay measles immunization brings down this figure for fully AND timely immunization. If we include children who have received all eight antigens, but have completed this immunization schedule after the age of one, the figure rises to 82 percent of children aged 12-23 months, who have been immunized with all eight antigens. There are no significant differences by background variables. Disaggregated by region, full Figure VI.1 Children of 12-23 months vaccinated at any time before the survey, Mongolia, 2000, 2005 FigureVI.2: Children aged 12-23 months immunized by first birthday and at any age before the survey, Mongolia, 2005 22 VI. CHILD HEALTH vaccination coverage rate is highest in the Central region (90 percent), and lowest in the Eastern region (70 percent). Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five worldwide. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) - can prevent many of these deaths. Preventing dehydration and malnutrition by increasing fluid intake and continuing to feed the child are also important strategies for managing diarrhoea. The goals are : 1) By 2010, compared to 2000, to reduce, by one half, deaths due to diarrhoea among children under five. (A World Fit for Children); and 2) By 2015 compared to 1990, to reduce by two thirds the mortality rate among children under five (Millennium Development Goals). In addition, A World Fit for Children calls for a 25 percent reduction in the incidence of diarrhoea. The indicators are: Ù Prevalence of diarrhoea Ù Oral rehydration therapy (ORT) Ù Home management of diarrhoea Ù (ORT or increased fluids) AND continued feeding In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had had diarrhoea in the two weeks prior to the survey. If so, the mother was asked a series of questions about what the child had to drink and eat during the episode and whether this was more or less than the child usually ate and drank. Overall, 7 percent of children under five had diarrhoea in the two weeks preceding the survey (Table CH.3). The peak of diarrhoea prevalence occurs in the weaning period, among children age 6-23 months, of which 11 percent of children were aged 6-11 months, and 10 percent of children were 12-23 months. In Ulaanbaatar 4.2 percent of children had diarrhoea which is lower than other regions, while the prevalence of diarrhoea is high in the Khangai (8.7 percent), Western (7.4 percent) and Eastern (7.2 percent) regions. The prevalence of diarrhoea is 8 percent in rural areas and 5 percent in urban areas. The Figure VI.3. Percentage of children aged 0-59 months with diar- rhea who received oral rehydration treatment, Mongolia, 2005 23 VI. CHILD HEALTH poorest households are more likely to have children with diarrhoea (8 percent), whilethe prevalence is 5 percent for children from the richest households. Table CH.3 also shows the percentage of children receiving various types of recommended liquids during an episode of diarrhoea. About 38 percent received fluids from ORS packets and 30 percent received recommended homemade fluids. Approximately 63 percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or RHF), while 37 percent received no treatment. Mongolia follows the WHO recommendation of increased fluids and continued feeding during diarrhoea. About one third (33 percent) of children under 5 with diarrhoea drank more than usual, while 65 percent drank the same or less (Table CH.4). Seventy two percent ate somewhat less, the same or more than usual (continued feeding), but twenty eight percent ate much less or ate almost nothing. According to these figures, only 21 percent children received increased fluids and at the same time continued feeding. When the information in Table CH.4 is combined with the data in Table CH.3 on oral rehydration therapy, it can be observed that 47 percent of children either received ORT or their fluid intake was increased, and at the same time, received continued feeding, as recommended (Figure VI.4). There are slight differences in the home management of diarrhoea by urban or rural, by region and by mother’s education. In rural areas, 49 percent of children received ORT or increased fluids and continued feeding, while the figure is 42 percent in urban areas. By regions, in the Western region 38 percent of children received the above treatment, while in the Central and Eastern regions every second child received it. Care Seeking and Antibiotic Treatment of Pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics for under- 5s with suspected pneumonia is a key intervention. One of the goals of A World Fit for Children is to reduce by one-third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who have an illness with a cough accompanied by rapid or difficult breathing and whose symptoms are NOT due to a problem in the chest and a blocked nose. The indicators are: Figure VI.4. Percentage of children aged 0-59 months with diarrhea who received ORT or increased fluids and contin- ued feeding, Mongolia, 2005 24 VI. CHILD HEALTH Ù Prevalence of suspected pneumonia Ù Care seeking for suspected pneumonia Ù Antibiotic treatment for suspected pneumonia Ù Knowledge of the danger signs of pneumonia Table CH.5 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of the care. About 9 percent of children aged 0-59 months were reported to have had symptoms of pneumonia during the two weeks preceding the survey. By regions, the proportion was relatively high in the Khangai region at 12 percent, and 7-8 percent in other regions. By mother’s education level, more children whose mother was uneducated or with primary education and children from poor households, had symptoms of pneumonia. Of the children who had suspected pneumonia, 63 percent were taken to an appropriate provider, of which 28 percent were taken to the family doctor, 27 percent to a soum/bagh health worker, and 5 percent to a Government health centre. Table CH.6 presents the use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, age, region, location, and socioeconomic factors. In Mongolia, 71 percent of under-5 children with suspected pneumonia had received an antibiotic during the two weeks prior to the survey. Four in every five children in the Western region and three in every five children in the Khangai region had been given antibiotics. Despite these small differences by region, the number of children who had suspected pneumonia was relatively small in the Western, Eastern and Khangai regions. The use of antibiotics is almost the same by urban and rural areas and household location (capital city, aimag center and soum center as well as the countryside). Issues related to knowledge of the danger signs of pneumonia are presented in Table CH.6A. Obviously, the mothers’ knowledge of the danger signs is an important determinant of care-seeking behaviour. In MICS, mothers/care takers were asked what types of symptoms would cause them to take a child to a health facility. The most commonly identified reason for taking a child to a health facility was the child developing a fever (85.6 percent). Another symptom was the child becoming sick (36 percent). Twenty one percent of mothers identified fast breathing and 23 percent of mothers identified difficult breathing as symptoms for taking children immediately to a health care provider. Overall, 8 percent of women knew of the two danger signs of pneumonia – fast and difficult breathing. There was no correlation between the knowledge of recognizing the two danger signs of pneumonia and the level of education of the mother. Between 10 and 12 percent of the mothers/care takers in the Western and Central region were able to recognize the two danger signs of pneumonia while this proportion was 4 and 7 percent in the Khangai and Eastern region and 8 percent in Ulaanbaatar. These figures show there is a small difference in the mothers’ knowledge by regions. However, no differentiation was observed between rural and urban areas. 25 VI. CHILD HEALTH SOLID FUEL USE Cooking with solid fuels (biomass and coal) leads to high levels of indoor pollution and is a major cause of ill-health in the world, particularly among children under five, in the form of acute respiratory illness. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. More than three fourths of the total households in Mongolia (76.5 percent) use solid fuel for cooking. Table CH.7 presents the use of solid fuel by household location, wealth status and other background variables. Households in rural areas predominantly use solid fuel (98 percent) compared with 61 percent of households in urban areas. The use of solid fuel notably varies by regions. The highest use of solid fuel is in the Western and Khangai regions, where 8 out of 10 households cook their food using solid fuel. Since one third of households in Ulaanbaatar live in residential blocks and houses, the use of solid fuel is very low. When the use of solid fuel types is disaggregated according to different types, wood is the most commonly used and accounts for 33 percent of fuel, while in the Khangai region the figure for wood fuel is as high as 58 percent. The next most commonly used is animal dungs at 23 percent, while 42-43 percent of the total fuel sources is animal dung in the Western and Eastern regions. Coal accounts for 20 percent of the total sources of solid fuel, and is used predominantly in Ulaanbaatar,where 41 percent of households in the ger distri use coal for fuel. Figure VI.5: Type of fuel used for cooking, Mongolia, 2005 Figure VI.6. Percentage of households used solid fuels for cooking, by regions, Mongolia, 2005 26 VII. WATER AND SANITATION Water Safe drinking water is a basic necessity for good health. Unsafe drinking water can be a significant carrier of diseases such as trachoma, cholera, typhoid, and schistosomiasis. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, especially in rural areas, who bear the primary responsibility for carrying water, often for long distances. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one-third. The list of indicators used in MICS is as follows: Water Ù Use of improved drinking water sources Ù Use of adequate water treatment method Ù Time to source of drinking water Ù Person collecting drinking water Sanitation Ù Use of improved sanitation facilities Ù Sanitary disposal of child’s faeces The distribution of the population by source of drinking water is shown in Table EN.1 and Figure VII.1. The population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, yard or plot), public tap/standpipe, tubewell/, pumped well, protected well, protected spring, rain and snow water collection. Overall, 72 percent of the population is using an improved source of drinking water – 91 percent in urban areas and 46 percent in rural areas. Public tap, standpipe, protected or pumped well are the most Figure VII.1. Percentage distribution of household members by source of drinking water, Mongolia, 2005 VII 27 VII. WATER AND SANITATION popular sources of water and used by 50 percent of the total population. The source of drinking water for the population varies strongly by regions and location (Table EN.1). The situation in the West and Khangai regions are considerably worse than in other regions and only 50 percent of the population has access to improved drinking water sources. The proportion of the population using surface water (unimproved water source) is highest in the Western region (36 percent) followed by the Khangai region where the figure stands at 27 percent. In contrast, the proportion of the population in the East and Central regions using surface water is respectively 14 and 6 percent, which is the lowest in comparison to other regions. The use of in-house water treatment is presented in Table EN.2. Households were asked to describe ways they may be treating water at home to make it safer to drink – boiling, adding bleach or chlorine and using a water filter were considered as proper treatment of drinking water. The table shows the percentages of household members using appropriate water treatment methods, separately for all households, and for households using both improved and unimproved drinking water sources. It can be observed from the table that regardless of whether the water source is improved or not, almost all the households treat water to make it safer and the most popular method for this is boiling. In addition, variations in treating the water by background characteristics are negligible. The amount of time it takes to obtain water is presented in Table EN.3 and the person who usually collected the water in Table EN.4. It should be noted that these results refer to one roundtrip from home to the source of the drinking water . Information on the number of trips made in one day was not collected. Table EN.3 shows that for 22 percent of households, the drinking water source is on the premises. For 47 percent of all households, it takes less than 30 minutes to get to the water source and bring water, while 11 percent of households spend more than 1 hour for this purpose. Excluding those households with water on the premises, the average time to the source of drinking water is 31 minutes. The rural population spends, on average, 18 minutes more for the collection of water compared to the urban population. In remote areas households spend 44 minutes, on average, to collect water. Table EN.4 shows that for the majority of households (49 percent) an adult male collects the water. Adult women collect water in 32 percent of cases, while for the remainder of the households, female or male children under the age of 15 collect water (7 and 13 percent respectively). Sanitation Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases, including diarrhoeal diseases and polio. Improved sanitation facilities for excreta disposal include: flush or pour flush to a piped sewer system, septic tank, or latrine; ventilated improved pit latrine, pit latrine with slab, and composting toilet. Seventy seven percent of the population of Mongolia is living in households using improved sanitation facilities (Table EN.5). Pit latrine with slab is the most common improved sanitation facility used by nearly half of the population. Residents of West and Khangai regions are less likely than others to use improved facilities. The table indicates that use of improved sanitation facilities is strongly correlated with wealth and there are profound differences between urban and rural areas. The percentage of households using improved sanitation facilities is 95 in urban areas and 53 percent in rural areas. Moreover, in rural areas, a 28 VII. WATER AND SANITATION significant proportion (29 percent) of the population simply has no facility. In contrast, one third of the population in urban areas uses flush toilets with a connection to a sewage system or septic tank. Only 29 percent of the population of the poorest quintile has access to improved sanitation facilities, which is 3 times lower than the national average. Safe disposal of a child’s faeces indicates that the most recent stool by the child has been disposed of by using a toilet or is rinsed into a toilet or latrine. Disposal of faeces of children 0-2 years of age is presented in Table EN.6. The table reveals that in 60 percent of cases children’s stool was disposed of safely. An overview of the percentage of households with improved sources of drinking water and sanitary means of excreta disposal is presented in Table EN.7. Overall, 63 percent of the sampled households are using improved water source and sanitary means for excreta disposal. Notable variations are observed by wealth quintiles, urban, rural and regions. Therefore, while only 11 percent of the poorest households reported using improved water sources and sanitary means of excreta disposal, 99 percent of the households from the richest quintile reported using them. As expected, more households in urban areas (87 percent) practice both safe water and sanitary means for excreta disposal compared to rural households (30 percent). The situation is the worst in the countryside where only 21 percent of the households stated using improved water source and sanitary means for excreta disposal. Among the regions, the situation is the worst in the West and Khangai regions where this percent stands at 40 and 41 percent respectively. 29 VIII. REPRODUCTIVE HEALTH Contraception Appropriate family planning is important to the health of women and children by: 1) preventing pregnancies that are too early or too late; 2) extending the period between births; and 3) limiting the number of children. One of the goals of A World Fit for Children is access by all couples to information and services to prevent pregnancies that are too early, too closely spaced, too late or too many. As can be seen in the Table below, 66 percent of women currently married or in a union reported using contraception.(Table RH.1). The most popular method is the IUD which is used by 29 percent of women in Mongolia. The next most popular method is the pill, which accounts for 12 percent of women, followed by injections which are used by 11 percent. One out of twenty women reported using condoms as a method of contraception. Another five percent of women use traditional methods of contraception such as periodic abstinence, withdrawal, the lactational amenorrhea method (LAM) or other methods. Variations in prevalence of contraception usage by regions are slight with highest prevalence in the Central region (72 percent) and the lowest in the West (61 percent). Interestingly, contraceptive prevalence is slightly higher among rural women compared to women residing in urban areas. This difference is in a large part accounted for by the use of injections by rural women which is twice as high as compared to urban women. Older women aged between 40-49 years are less likely to use contraception than young women. Contraceptive prevalence is 38 percent for women aged 45-49 years old. A higher level of education is associated with higher contraceptive prevalence. The proportion of women with no education using contraception is 54 percent while for women with higher education this figure is 65 percent. However, it should be noted that the difference in contraceptive prevalence between educated and not educated women is not as large as it is in many other countries of within the region. The same can be said for the use of modern contraceptive methods. However, some differences can be observed in the case of specific methods of contraception. For instance, the proportion of women with higher education and wealthier women using the pill is higher compared to other education and wealth categories. In contrast, women who are poorer and have a lower level of education more commonly use injections compared to wealthier and educated women. Another interesting finding is that the largest proportion of women using traditional methods is women of the richest quintile. Unmet Need for Contraception Unmet need for contraception refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth or who wish to stop childbearing altogether. Unmet need is identified in MICS by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences. Women in unmet need for spacing includes women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and who want to space their births. Pregnant women are considered to want to space their births when they did not want the child at the time they got pregnant. Women who are not pregnant are classified in this category if they want to have another child, but want to have the child at least two years later, or after marriage. VIII 30 VIII. REPRODUCTIVE HEALTH Women in unmet need for limiting are those women who are currently married (or in union), fecund (are currently pregnant or think that they are physically able to become pregnant), currently not using contraception, and want to limit their births. The latter group includes women who are currently pregnant but had not wanted the pregnancy at all, and women who are not currently pregnant but do not want to have another child. Total unmet need for contraception is simply the sum of unmet need for spacing and unmet need for limiting. Using information on contraception and unmet need, the percentage of demand for contraception satisfied is also estimated from the MICS data. The percentage of demand for contraception satisfied is defined as the proportion of women currently married or in union who are currently using contraception, of the total demand for contraception. The total demand for contraception includes women who currently have an unmet need (for spacing or limiting), plus those who are currently using contraception. Table RH.2 shows the results of the survey on contraception, unmet need, and the demand for contraception satisfied. Findings reveal that 14 percent of women are in unmet need for contraception and the majority of these wish to stop childbearing. Consequently, a much higher share of older women aged over 40 years are in need of contraception. For instance, the unmet need for contraception for women of age groups 40-44 and 45-49 are 17 and 22 percent respectively. As it has been mentioned earlier, the use of contraception is slightly higher among rural women. However, the proportion of urban and rural women does not vary in terms of unmet need for contraception. Unmet need for contraception is also more frequently found among women with a low level of education. With regard to the variation by region, the proportion of women in unmet need for contraception is highest in the West (16 percent) followed by the Eastern region where one out of seven women face an unsatisfied demand for contraception. Antenatal Care The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants. Better understanding of foetal growth and development and its relationship to the mother’s health has resulted in increased attention to the potential of antenatal care as an intervention to improve both maternal and newborn health. For example, if the antenatal period is used to inform women and families about the danger signs and symptoms and about the risks of labour and delivery, it may provide the route for ensuring that pregnant women do, in practice, deliver with the assistance of a skilled health care provider. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival. The management of anaemia during pregnancy and treatment of STIs can significantly improve foetal outcomes and improve maternal health. Adverse outcomes such as low birth weight can be reduced through a combination of interventions to improve women’s nutritional status and prevent infections (e.g., STIs and other) during pregnancy. More recently, the potential of the antenatal period as an entry point for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child, has led to renewed interest in access to and use of antenatal services. WHO recommends a minimum of four antenatal visits, based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content on antenatal care visits, which include: • Blood pressure measurement 31 VIII. REPRODUCTIVE HEALTH • Urine testing for bateriuria and proteinuria • Blood testing to detect syphilis and severe anaemia • Weight/height measurement (optional) Coverage of antenatal care (by a doctor, nurse, or midwife) is high in Mongolia with 99 percent of women who gave birth in the two years preceding the survey having received antenatal care at least once during the pregnancy. The lowest level of antenatal care is found in the Eastern Region, with a figure of 97 percent. Variations in antenatal care coverage are negligible by background characteristics. The only considerable difference can be seen by the age of mothers, the date revealing that the lowest proportion (96 percent) of mothers who attended antenatal care is among adolescent mothers aged 15-19 years. The type of personnel providing antenatal care to women aged 15-49 years who gave birth in the two years preceding the survey is presented in Table RH.3. Nearly all the women (99 percent) who gave birth in the two years preceding the survey received antenatal care from skilled personnel. Medical doctors provided antenatal care to most of mothers (83 percent) followed by feldshers (13 percent). Women who reside in Ulaanbaatar (95 percent), urban areas (92 percent), and who are educated (90 percent of women with college or university education) and wealthier (96 percent of women of richest quintile) are more likely to receive antenatal care services from medical doctors. The second popular antenatal care service provider is a feldsher/nurse and the proportion of women who received antenatal care from them is comparably higher among women residing in the Western and Eastern regions, living in the countryside and rural areas as well as those who have lower than complete secondary education and who belong to poorest 40 percent of the population. The types of services pregnant women received are shown in Table RH.4. Although, the findings of the survey demonstrate high antenatal care coverage in terms of the number of visits and small differences by background characteristics, the content of antenatal care varies significantly. Blood samples and urine specimens were taken from 89 percent of women during antenatal care visits. The lowest coverage of the above two components of antenatal care is to be found in the West region where correspondingly blood tests and urine specimens had been taken from 66 and 67 percent of women respectively. Fewer women representing the poorest quintiles as well as those who have a low level of education and those who reside in rural areas reported that they have had a blood sample and a urine test taken, when compared to the national average and to the other categories within each of the corresponding background characteristics. Some striking findings can also be seen from the table RH.4. Weight measurements were taken from only 88 percent of women, which represents the lowest figure out of the four components of antenatal care. The only component of antenatal care which was commonly received by more than 95 percent of women in each of the background category variables was the measurement of blood pressure. Assistance at Delivery Three quarters of all maternal deaths occur during delivery and the immediate post- partum period. The single most critical intervention for safe motherhood is to ensure that a competent health worker with midwifery skills is present at every birth, and that transport is available to a referral facility for obstetric care in case of emergency. One of the goals of A World Fit for Children is to ensure that women have ready and affordable access to skilled attendance at delivery. The indicators are the proportion of births with a skilled attendant and proportion of institutional deliveries. The skilled attendant at delivery indicator is also used to track progress toward the Millennium Development target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. 32 VIII. REPRODUCTIVE HEALTH The MICS included a number of questions to assess the proportion of births attended by a skilled attendant. A skilled attendant includes a doctor, nurse, or feldsher. About 99 percent of births occurring in the two years prior to the MICS survey were delivered by skilled personnel (Table RH.5). Seventy percent of births were attended by a medical doctor and 29 percent by a feldsher/nurse. Some differences can be observed by regions and residence. More than 80 percent of births in Ulaanbaatar were attended by a medical doctor, while this figure is lowest in the Western region at 58 percent. In urban areas, births are more likely to be attended by a medical doctor. In common with urban mothers, mothers with a higher level of education and those who belong to the wealthier quintiles are also more likely to receive the assistance of a medical doctor. 33 IX. CHILD DEVELOPMENT It is well recognized that a period of rapid brain development occurs in the first 3-4 years of life, and the quality of home care is the major determinant of the child’s development during this period. In this context, adult activities with children, the presence of books for the child in the home, and the conditions of care are important indicators of the quality of home care. One of the goals of A World Fit for Children is that “children should be physically healthy, mentally alert, emotionally secure, socially competent and ready to learn.” Information on a number of activities that support early learning was collected in the survey. These included the involvement of adults with children in the following activities: reading books or looking at picture books, telling stories, singing songs, taking children outside the home, compound or yard, playing with children, and spending time with children naming, counting, or drawing things. For 55 percent of under-five children, an adult was engaged in more than four activities that promote learning and school readiness during the 3 days preceding the survey (Table CD.1). The average number of activities that adults engaged in with their children was 4. The table indicates that the father’s involvement in such activities was somewhat limited. Fathers’ involvement with one or more activities was 44 percent. Every fifth child was living in a household without his or her father. There are no gender differentials in terms of adult activities with children; however, a slightly larger proportion of fathers engaged in activities with male children (45 percent) than with female children (42 percent). Slightly larger proportions of adults engaged in learning and school readiness activities with children in urban areas (58 percent) than in urban areas (52 percent). However, strong differentials by region and socio-economic status can be observed. Adult engagement in activities with children was greatest in the Central region (60 percent) and lowest in the Eastern region (49 percent), while the proportion was 60 percent for children living in the richest households, as opposed to 46 percent for those living in the poorest households. Fathers’ involvement showed a different pattern in terms of adults’ engagement in such activities. It is worthy of note more fathers of rural households and those residing in the Western region were involved in activities with their children, than in other regions. (Table CD.1) It was found that more educated mothers and fathers and those who are richer engaged more in such activities with children than those with less education and poorer. The presence of books is important for school performance later and for IQ scores. In Mongolia, 53 percent of children are living in households where at least 3 non-children’s books are present (Table CD.2). However, only 26 percent of children aged 0-59 months have children’s books. Both the median number of non-children’s books and children’s books are low (4 and 0 books). Urban children appear to have more access to both types of books than those living in rural households. Sixty-three percent of under-5 children living in urban areas live in households with more than 3 non-children’s books, while the figure is forty two percent in rural households. The proportion of under-5 children who have 3 or more children’s books is 36 percent in urban areas, compared to 16 percent in rural areas. The presence of both non-children’s and children’s books is positively correlated with the child’s IX 34 IX. CHILD DEVELOPMENT age; in the homes of 55 percent of children aged 24-59 months, there are 3 or more non- children’s books, while the figure is 50 percent for children aged 0-23 months. Even larger differentials exist in terms of children’s books. Table CD.2 also shows that only 4 percent of children aged 0-23 months had 3 or more playthings to play within their homes, while 8 percent had none of the playthings about which questions were asked of the mothers/caretakers. The playthings in the answers to the MICS questionnaire included household objects, homemade toys, toys that came from a store, and objects and materials found outside the home. It is interesting to note that 82 percent of children play with toys that come from a store, while the percentage for other types of toys is below 26 percent. The proportion of children who have 3 or more playthings to play with is 7 percent among male children and 5 percent among female children. Interestingly, more rural mothers (8 percent) reported that their children have 3 or more types of playthings compared to urban mothers of whom only 4 percent reported the same. This may be explained by the fact that urban children have more plaything substitutes than rural children. Unexpectedly, variations are notable by regions. In the West 12 percent of children have 3 or more types of playthings whereas this figure is the lowest in the East (only 1 percent) and stands at 3 percent for Ulaanbaatar- capital city. Leaving children alone or in the presence of other young children is known to increase the risk of accidents. In MICS, two questions were asked to find out whether children aged 0-59 months were left alone during the week preceding the interview, and whether children were left in the care of other children under 10 years of age. Table CD.3 shows that 12 percent of children aged 0-59 months had been left in the care of other children, while 3 percent had been left alone, during the week preceding the interview. Combining the two care indicators, it is calculated that 13 percent of children had been left with inadequate care during the week preceding the survey. No differences were observed by the sex of the child or between urban and rural areas. Significant variations can be observed by regions and the wealth status of households. Nearly every fifth child under 5 years was left without adequate care in the Western region whereas this was the case for only 9 percent in Ulaanbaatar, a figure which is twice as low as the West. Lower wealth status is associated with a higher probability that the child will be left without adequate care. Thus, every sixth child in the poorest quintile versus only one out of twelve in the richest quintile had been left without adequate care in the previous week. 35 X. CHILD EDUCATION Pre-school attendance Attendance to pre-school education within an organized learning or child education programme is important for the readiness of children to attend school. One of the World Fit for Children goals is the promotion of early childhood education. MICS 2005 finds that 37 percent of all children aged 36-59 months attend a pre- school education programme (kindergarten) (Table ED.1). Preschool education attendance varies by rural and urban areas as well as by regions. The rate is 25 percent in rural areas compared to 50 percent in urban areas. According to the household’s location, in rural areas only 20 percent of children of 36- 59 months attend preschool education programme whilst the percentage in soum centers is 43 percent, in aimag centers 52 percent and in the capital city 48 percent. These figures show that urban children have more access and opportunities to pre-school education programme than rural children. No gender differential exists, but differentials by wealth quintiles are significant (Table ED.1). 73 percent of children aged 36-59 months living in rich households attend pre- school, while the figure drops to only 11 percent in poor households. Children of mothers with higher education are as much as four times more exposed to preschooling compared to children of mothers with primary education. This shows that preschool education attendance increases with the education of the mother. The mothers with higher education pay more attention to pre-school children’s educational attainment. 31 percent of children aged 36-47 months attend preschool education programme while it rises to 43 percent among children aged 48-59 months. Table ED.1 shows the proportion of children in the first grade of primary school who attended pre-school the previous year, an important indicator of school readiness. Overall, 81 percent of children who are currently attending the first grade of primary school had been attending pre-school the previous year. This indicator is 82 percent for boys and 79 percent for girls. ,80-92 percent of children in the first grade in aimag centers and the Capital city had attended pre-school the previous year compared to 73 percent among children living in rural areas. In terms of regional differentials, Ulaanbaatar demonstrates the highest X 36 X. CHILD EDUCATION proportion at 92 percent as opposed as the Khangai and the Central regions where these proportions are 70-73 percent. The difference in the proportion of preschool education attainment is 68-91 percent respectively among the poorest and richest households Primary and Secondary School Participation Universal access to basic education is one of the most important goals of Millennium Development Goals and A World Fit for Children. Education is a vital prerequisite for combating poverty, empowering women, protecting children from hazardous and exploitative labour and sexual exploitation, promoting human rights and democracy, protecting the environment and influencing population growth. The indicators for primary and secondary school attendance include: Ù Net intake rate in primary education Ù Net primary school attendance rate Ù Net secondary school attendance rate Ù Net primary school attendance rate of children of secondary school age Ù Female to male education ratio (GPI) The indicators of school progression include: Ù Survival rate to grade five Ù Transition rate to secondary school Ù Net primary completion rate The secondary school system in Mongolia introduced an 11 year schooling system in 2005. According to the 11 year schooling system, the age of school entry age is 7 years. The results of MICS 2005 (Table ED.2) indicate that the proportion of 7 year- olds who enter the first grade of primary school is 80 percent. Findings show that 82 percent of girls aged 7 years were attending primary school while the figure drops to 78 percent for boys. When aggregated by regions, data show that the participation of primary school is the highest in the Central Region, at 88 percent, while it is lowest at 73 percent in the Western region. The net primary school attendance rate is shown in Table ED.3. Overall, 95 percent of children of primary school age are attending school. The percentage of girls attending primary school is 96 percent and 94 percent for boys. Primary school attendance is lower (92 percent) in the Western region compared to other regions. The rate in rural areas (93 percent) is lower in rural areas than in Ulaanbaatar, aimag and soum centers. By household wealth, 98 percent of children from the richest households entered primary school as opposed to 93 percent of children living in the poorest households. These figures prove that the implementation of the goal that was adopted in the Mongolian government’s Master Plan of Education to protect the child’s right to education and improve access to primary and secondary education, is being realised. From the findings of the survey, it is clear that the school attendance rate varies condiderably among boys living in soum centers (98 percent) and rural areas (92 percent). 37 X. CHILD EDUCATION When disaggregated by household location, the overall attendance for girls is slightly higher than for boys, The secondary school net attendance ratio is presented in Table ED.4. According to the new education system, this applies to grades 6-9. The findings of the survey reveal that of children of secondary school age, 85 percent were attending secondary school. This figure is lower by 10 percentage points than that of primary school attendance. Secondary school attendance is 91 percent in the Capital city and drops to 74 percent in rural areas. Non attendance at secondary school (26 percent) among children of rural herder households can be assumed to be driven by the need of labour in herding. Herder households make their children leave school after they have learnt reading, writing and simple mathematics. This fact is supported by the findings that the lowest percentage of school attendance among 12 year olds ( the primary school completion age) is 77 percent. The Mongolian Human Development Report identifies the key factors in the school drop out rate amongst boys, as herder households forcing their children to leave school and the absence of vocational schools5. The net school attendance rate is higher for girls (88 percent) than for boys (83 percent). Moreover, the secondary school net attendance ratio is 91 percent in Ulaanbaatar whereas it is 80-84 percent in other regions. When disaggregated by household wealth, the percentage is 96 percent for children from the richest households while the rate drops to 67 percent among children living in the poor households. Table ED.5 illustrates the percentage of children entering first grade who eventually reach grade 5. Those who conducted the survey collected these data by asking if children of the surveyed housholds attend school during the survey period and what grade they had finished in the preceding year. The findings of the survey reveal that of all children starting grade one, 96 percent of them eventually reach grade five. When disaggregated according to location, this indicator is 99 percent in urban versus 94 percent in rural areas. Gender differentials are not very marked; the rate for children of the richest households that reach fifth grade is 100 percent and that of the poor households is 91 percent. The net primary school completion rate and transition rate to secondary education is presented in Table ED.6. Of children of primary school completion age (11 years), 94 percent graduated from primary school. In terms of gender, the figures are 95 percent for girls and 92 percent for boys. Of the children who attended the last grade of primary education, 98.4 percent advanced to secondary school. There is no significant difference by gender, regions and location in this indicator. The ratio of girls to boys attending primary and secondary education is presented in Table ED.7. These ratios are better known as the Gender Parity Index (GPI). For attendance at primary school, the percentage of boys and girls is 94 percent and 96 percent respectively. The higher the grades, the smaller the percentage of boys attendance. The secondary school attendance rate is 83 percent for boys and 88 percent for girls. The gender parity index of school children estimates the ratio of net attendance of girls to the net 5 UNDP, Government of Mongolia, 2003. Human Development Report. 38 X. CHILD EDUCATION attendance ratio of boys. In other words, the ratio is close to 1.00, indicating no difference in the attendance of girls and boys to primary school. Gender parity index is 1.02 at primary school and 1.07 at secondary school. This means there are 102 or 107 girls to 100 boys at primary and secondary school respectively. Literacy One of the goals of A World Fit for Children and the MDGs is to assure literacy. MICS 2005 only provided data on the literacy of the women of 15-24 years. Their literacy was assessed by school attendance or by the ability of women to read a short simple statement in the case of non-school attendance. The literacy rate of women of 15- 24 years is 95 percent (Table ED.8). 39 XI. CHILD PROTECTION Birth Registration The Convention on the Rights of the Child states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Birth registration is a fundamental means of securing these rights for children. One of the goals of A World Fit for Children is to develop systems to ensure the registration of every child at or shortly after birth, and to fulfil his or her right to acquire a name and a nationality, in accordance with the national laws and relevant international instruments. The indicator is the percentage of children under 5 years of age whose birth is registered. Table CP.1 shows the proportion of registered children under 5, by sex, age, mother’s education and location. The births of 98 percent of children under-five years have been registered. Nearly 86 percent of mothers/care takers were able to demonstrate the birth certificate while 13 percent of them, although they were not able to present the birth certificate, reported that they had it. There were no significant variations in birth registration across sex, regions, education or other categories. According to the Law of Mongolia on Civil Registration, a child has to be registered within 15 days after birth in urban areas and in 30 days in remote rural areas. As can be seen from the table, there are no variations (98 percent) in registration by urban or rural residence. Child Labour Article 32 of the Convention on the Rights of the Child states: “States Parties recognize the right of the child to be protected from economic exploitation and from performing any work that is likely to be hazardous or to interfere with the child’s education, or to be harmful to the child’s health or physical, mental, spiritual, moral or social development.” The World Fit for Children mentions nine strategies to combat child labour and the MDGs call for the protection of children against exploitation. Mongolia ratified the UN Convention 182 on the Worst Forms of Child Labour in 1999, which has created opportunities for the implementation of various projects and which attracts international funds. In the MICS questionnaire, a number of questions addressed the issue of child labour; namely, children between 5-17 years of age (as well as the age group of 5-14 years) involved in labour activities. A child is considered to be involved in child labour activities at the time of the survey if, during the week preceding the survey, they have been engaged in: Ù Ages 5-11: at least one hour of economic work or 28 hours of domestic work per week. Ù Ages 12-17 (and ages 12-14): at least 14 hours of economic work or 28 hours of domestic work per week. This definition allows us to differentiate child labour from child work, and to identify the type of work that should be eliminated. As such, the estimate provided here is a minimum measurement of the prevalence of child labour, since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria explained above. XI 40 XI. CHILD PROTECTION Among the total number of children between 5-17 years old, 84 percent were engaged in domestic work or non-economic activities. This data is close to the results of MICS 2000 and Child Labour Survey of Mongolia, 2002-2003 (Figure XI.1). More girls are engaged in domestic work or non economic activities than the boys are. Table CP.2.2 shows the result of MICS 2005, the number of children who had worked outside the household, helped with domestic work and helped their household business in the seven days prior to the survey. Overall, 24 percent of the surveyed children between 5-17 years old, were exposed to labour or engaged in economic activities. The estimate, by age and hours worked per week, shows that 22 percent of children are exposed to child labour6. This is relatively higher than presented by the Child Labour Survey (MICS 2005 estimated 10.1 percent engaged in economic activities, among which 5.7 percent were exposed to child labour according to definition of ILO Convention 138 and 182). The difference is a result of the methodology used to estimate child labour. For instance, MICS 2005 includes children engaged in domestic works for more than 28 hours, as children exposed to Child Labour. However, the percentage of 5-14 year old children engaged in paid and unpaid work outside the household is 1.3 percent, which is a figure similar to the findings of MICS 2000 (1.4 percent). When Child labour is estimated by age, data show that the rate is lower than the national average within the 5-11 age group, by 7.5 percentage points, while the rate is 3-13 percentage points higher than the national average within the 12-14 and 15-17 age groups. There is almost no gender disparity in child labour with the figures for girls participating in child labour being close to the figures for boys. The survey finds that 0.6 percent of 15-17 year old children are engaged in paid work outside the household, 1.0 percent in unpaid work, 9 percent in own household business and 14 percent in domestic work for more than 28 hours. The percentage of children engaged in paid work outside the household is similar for urban and rural areas (0.6 percent) while that of children engaged in unpaid work outside the household is higher by 1.2 percentage point in rural areas than in urban areas (Figure XI.2). Child labour in the form of unpaid family work and business varies significantly by urban and rural areas (2 percent in urban areas and 17 percent in rural areas). The number of children engaged in domestic work for 28 and more hours per week is less by 6 percentage points in urban areas compared with rural areas. Figure XI.1. Proportion of 5-17 children engaged in domestic work, by sex, Mongolia , 2005 6 Comparison should be done carefully because definitions used for child labour in MICS 2005 are different from MICS 2000 and Child labour survey conducted in 2002-2003. 41 XI. CHILD PROTECTION The percentage of 5-17 year old children in labour varies significantly by region. Among the regions, the Khangai region shows the highest incidence of child labour at 23 percent while Ulaanbaatar shows the lowest at 11 percent. There is not much relation between child labour and mother’s education. In contrast, household wealth is quite often associated with child labour. In one in three poor households and one in ten of the richest households, one child is involved in child labour. Table CP.3 presents the percentage of children classified as student labourers or as labourer students. Student labourers are those children attending school, who were involved in child labour activities at the time of the surveys. The percentage of student labourers are 21 percent7 and this percentage is relatively high in rural areas, exceeding national average by 9 percentage points and the percentage of student labourers is lower by 6 percentage points in urban areas. Child Discipline As stated in A World Fit for Children, “children must be protected against any acts of violence…” and the Millennium Declaration calls for the protection of children against abuse, exploitation and violence. In MICS, the mothers/caretakers of children age 2-14 years were asked a series of questions on the methods parents tend to use to discipline their children when they misbehave. Note that for the child discipline module, one child aged 2-14 years old per household was selected randomly during fieldwork. Out of the questions which were asked, two indicators used to describe aspects of child discipline were: 1) the number of children between the ages of 2-14 years, who have experienced psychological aggression as a punishment or any physical punishment; and 2) the number of parents/caretakers of children of 2-14 years of age, who believe that in order to raise their children properly, they need to physically punish them. Overall, 17 percent of children had experienced non violent aggression (explained why something was wrong, gave him/her something else to do) in being disciplined by their parents or other family members in the month prior to the survey. In Mongolia, 79 percent of children aged 2-14 years had been subjected to at least one form of psychological or physical punishment by their mothers/caretakers or other household members. More importantly, 38 percent of children had been subjected to some form of physical punishment. More male children had been subjected to both psychological and physical Figure XI.2. Child labour within 5-17 years age group, by urban and rural areas, Mongolia, 2005 7 By definition of MICS 2005. 42 XI. CHILD PROTECTION discipline (80 and 42 percent respectively) than female children (76 and 34 percent respectively). There is almost no disparity with respect to many of the background variables such as region, location, wealth status and mother’s education. On the other hand, 15 percent of mothers/caretakers believed that children should be physically punished, which implies an interesting contrast with the actual prevalence of physical discipline. While only 15 percent of mothers/caretakers responded they believe that in order to raise their children properly, they need to physically punish them, it is interesting to note that 38 percent of the mothers/caretakers responded they had physically punished their children. Responses significantly vary by mother’s education and wealth of the household. Nearly 25 percent of mothers who were uneducated or had only primary education and from poorest families, believe that children should be physically punished whereas only 10 percent of the higher educated and wealthiest mothers believed they should be physically punished. Early Marriage Child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation, with little education and poor vocational training reinforcing the gendered nature of poverty. Women married at younger ages are more likely to dropout of school, experience higher levels of fertility, domestic violence, and maternal mortality. The indicator is to estimate the percentage of women married before 18 years of age. The percentage of women married before the age of 18 is indicated in Table CP.5. Overall, 8 percent of women aged 20-49 married or started live in union before their 18th birthday. The higher proportions of women who had married and started live in union before age 18 are among rural women (particularly those from the countryside), women who are less educated and who are from poorer households. Approximately 18 percent of the women aged 20-49 years, who had married before Figure XI.4. Percentage of women aged 20-49 in marriage or union before their 18th birthday, by background variables, Mongolia, 2005 43 XI. CHILD PROTECTION age 18, were uneducated or have primary education, while the figure is only 3 percent for women with college and university education (Figure XI.3). Early marriage (in union) is likely to increase. By age group, the percentage of women aged 45-49 who were married (in union) before the age of 18 stood at 11 percent. This percentage decreased to 4 percent among the women aged 35-39 and rose to 9 percent for the women aged between 20-24 years. Another component is the spousal age difference with an indicator being the percentage of married/in union women with a difference of 10 or more years of age compared to their current spouse. Table CP.6 presents the results of the age difference between husbands and wives. For most of currently married/in union women aged 15-19 as well as those aged 20- 24, the age difference between their husband or partner is 0-4 years (correspondingly 58 and 67 percent). One third of women aged 15-19 and 21 percent of women aged 20-24 have between 5-9 years age difference with their husbands/partners. For women aged 20-24, the age difference tends to be relatively higher in the Khangai region, among remote rural women, the less educated and those who are poorer. Domestic Violence A number of questions were asked of women age 15-49 years to assess their attitudes as to whether husbands are justified in hitting or beating their wives/partners, within a variety of scenarios. These questions were asked in order to have an indication of cultural beliefs that tend to be associated with the prevalence of violence against women by their husbands/partners. The main assumption here is that women, who agree with the statements indicating that husbands/partners are justified in beating their wives/partners within the situations described, tend to be abused, in reality, by their own husbands/partners. The responses to these questions can be found in Table CP.7. Every fifth woman aged 15-49 considers that a husband is justified in beating his wife/ partner. The most common reason for beating reported by respondent women was “when she neglects the children” (12 percent) followed by “when she argues with him” (11 percent). There were considerable variations by background characteristics. The highest proportion of women who believed that a husband is justified in beating his wife/partner was in the Western region (33 percent) compared to only 12 percent in Ulaanbaatar. Rural women, particularly those who live in remote rural areas, as well as older women, tend to report the same attitudes. The proportion of less educated and poorer women who believed that a husband is justified in beating his wife/partner was more than twice as high, when compared to educated and wealthier women. Child Disability One of the goals of A World Fit for Children is to protect children against abuse, exploitation, and violence, including the elimination of discrimination against children with disabilities. 44 XI. CHILD PROTECTION For children age 2 through 9 years, a series of questions were asked to assess a number of disabilities/impairments, such as sight impairment, deafness, and difficulties with speech. This approach is rooted in the concept of functional disability developed by WHO and aims to identify the implications of any impairment or disability for the development of the child. Table CP.10 presents the results of these questions. Thus, 17 percent of children between 2-9 years old were reported as having at least one disability8. Children who appear to be mentally backward, dull, or slow account for 5 percent. The proportion of children with this type of disability is significantly higher in the Eastern region at 13 percent. However, there is almost no difference for other background variables. The second common disability, reported by 4 percent of mothers/caretakers, was “not speaking at all/cannot say any recognisable words”. The pattern, when disaggregated by background characteristics is somewhat the same with the mentally backward, dull, or slow. In addition, difficulty in walking and moving was observed in 4 percent of children. Difficulty in seeing is the next most common problem, reported by 3 percent of mothers/ caretakers. However, difficulty in seeing was reported more often in urban areas by mothers with a higher level of education. With regard to the variations by background characteristics, nearly all the types of disability are prevalent in the Eastern region, rural areas, and among children of less educated and poorer mothers. 8 The concept of disability is used in broad terms 45 XII. HIV/AIDS HIV/AIDS knowledge A very important prerequisite to protection from HIV infection is an accurate knowledge of how HIV is transmitted and strategies for preventing transmission. Correct information is the first step toward raising awareness and teaching the tools to protect from HIV infection. Misconceptions about HIV confuse the youth and hinder prevention efforts . Although, the knowledge of HIV infection varies by region, there are some common beliefs which regularly occur, for example that sharing food can transmit HIV or mosquito bites can transmit HIV. The UN General Assembly Special Session on HIV/AIDS (UNGASS) called on govermnents to improve the knowledge of HIV prevention. The indicators to measure this goal as well as the Millennium Development Goal of reducing HIV infections by 50 percent include improving the level of knowledge of HIV and its prevention and changing behaviours in order to prevent further spread of the disease. One indicator, which is both an MDG and UNGASS indicator, is the HIV prevention and transmission knowledge among young women. Women were asked in the survey whether they knew of the three main ways of HIV transmission – having only one faithful uninfected partner, using a condom at every intercourse and abstaining from sex. The results are presented in Table HA.1 Overall, 88 percent of interviewed women had heard of AIDS and 56 percent of these women knew of all three of the main ways of preventing HIV transmission. In terms of each of the three main ways of preventing HIV transmission, 74 percent of women reported they knew about having one faithful uninfected sex partner, 75 percent of women knew of using a condom every time, and 66 percent knew of abstaining from sex. While 84 percent of women knew at least one way of HIV transmission, 16 percent of women do not know any of the three ways. By location, the knowledge of HIV infection is higher in urban areas, especially in Ulaanbaatar. The percentage of women who have heard of AIDS is the highest in Ulaanbaatar (93 percent) and the lowest in the Western region (73 percent). The percentage of women who know of all three main ways of preventing HIV transmission is also the highest in Ulaanbaatar . The knowledge of HIV infection is the highest among women aged 25-39 years old, with higher education and richer families. It is important to note that 61 percent of uneducated women responded that they knew none of the three ways to prevent HIV infection. Table HA.2 presents the misconceptions concerning HIV. The indicator is based on the two most common misconceptions in Mongolia, that HIV can be transmitted by sharing food and cannot be transmitted by mosquito bites and the percentage of women who know that a healthy-looking person can be infected. The Table also shows the percentage of women who know that HIV cannot be transmitted by supernatural means but can be transmitted by sharing needles. The percentage of women who reject the two most common misconceptions and know that a healthy-looking person can be infected is 38 percent. XII 46 XII. HIV/AIDS Among the surveyed women, 57 percent know that HIV cannot be transmitted by sharing the food and 54 percent know that HIV cannot be transmitted by mosquito bites while 75 percent know that a healthy-looking person can be infected. Table HA.3 summarizes information from Tables HA.1 and HA.2 and presents the percentage of women who know 2 ways of preventing HIV transmission and reject the three common misconceptions. The percentage of women who know about two ways of HIV prevention is 66 percent and the percentage of women who reject the three common misconceptions is 38 percent. Overall, the percentage of women who have a comprehensive knowledge of HIV/AIDS transmission is 31 percent (Figure XII.1). The knowledge of HIV transmission and ways of preventing HIV varies according to whether they are rural or urban women. The percentage of women who know 2 ways of preventing HIV transmission is 71 percent in urban areas versus 59 percent in rural areas. The knowledge of ways of preventing HIV increases with the woman’s education level and household wealth. Only 30 percent of uneducated women know about 2 ways of HIV prevention as opposed to 78 percent of higher educated women. Generally, knowledge of HIV tramsmission is lower among rural, low educated and poor women. For example, the percentage of women who know about 2 ways of HIV prevention and reject the three common misconceptions is 18 percent in the Western region, 21 percent in rural areas, 16 percent for the women with a lower level of education and 14 percent among the poor women. The level of knowledge of mother-to-child transmission of HIV is an important factor in encouraging women to seek HIV testing when they are pregnant, to avoid infection in the baby. Women should know that HIV can be transmitted during pregnancy, delivery and through breasfeeding. The level of knowledge of mother-to-child transmission of HIV is presented in Table HA.4. Figure XII.1. Percentage of women with a comprehensive knowledge of HIV/AIDS transmission, by education level, Mongolia, 2005 47 XII. HIV/AIDS Overall, 79 percent of interviewed women know about mother to child transmission of HIV. Out of these, 72 percent of women know about transmission during pregnancy, 64 percent during the delivery and 60 percent through breastfeeding. The percentage of women who know all three ways of mother-to-child transmission is 49 percent, while only 8 percent of women did not know of any specific way of transmission. The knowledge of mother-to-child transmission of HIV increases with a woman’s age, education level and household wealth. On the other hand, the percentage of women who do not know about mother-to-child transmission of HIV is higher in Western and Eastern regions (10-12 percent), among young women (12 percent), among uneducated and low educated women (10-13 percent) and among poor women (11.2 percent) compared to other groups. The survey assessed the attitudes of women towards people with HIV infection. The indicators on attitudes toward people living with HIV, measure stigma and discrimination in the community. Stigma and discrimination are low if respondents report an accepting attitude in answer to the following four questions: 1) would care for a family member who is sick with AIDS; 2) would buy fresh vegetables from a vendor who was HIV positive; 3) thinks that a female teacher who is HIV positive should be allowed to teach in school; and 4) would not want to keep HIV status of a family member a secret. Table HA.5 presents the attitudes of women towards people living with HIV/AIDS. Out of the interviewed women, 68 percent of women responded that they would buy fresh vegetables from a vendor who was HIV positive, 43 percent would keep the HIV status of a family member a secret, 43 percent thinks that a female teacher who is HIV positive should not be allowed to teach in school and 14 percent would not care for a family member sick with AIDS. Overall, 87 percent of women agreed with at least one of the stigma or discriminations towards people with HIV infection, while 13 percent did not agree with any of these stigma or discriminations. HIV tesing Voluntary HIV testing and consulting are very important in order to know about HIV infection, to reduce the risk of HIV transmission, to prevent HIV transmission and to receive necessary aid services and treatment at an earlier stage. Questions related to knowledge among women of a facility for HIV testing and whether they have ever been tested is presented in Table HA.6. Out of the women interviewed, 57 percent of women know where to be tested, while 15 percent have actually been tested. Of these, a large proportion or 94 percent has been told the result. Knowledge of where to be tested is higher among urban women (70 percent) than rural women (38 percent), higher among educated women (82 percent of higher educated women) than low educated women (16 percent for uneducated women and 27 percent for less educated women) and higher among wealthy women (77 percent) than poor women (28 percent). Among women under 20 years old, 42 percent are aware of where they can be HIV tested, as opposed to 60 percent of older women who are aware of where to go. Most of the women who had been tested were from urban areas (23 percent), with complete secondary or higher education (17-26 percent) and wealthy women (22 percent). Among women who had given birth within the two years preceding the survey, the percent who had received counselling and HIV testing during antenatal care is presented in Table HA.7. Overall, 62 percent of women provided information on HIV/AIDS prevention during their 48 XII. HIV/AIDS antenatal care and 37 percent of them had been tested and 35 percent of these had been told the result. The percentage of women who were provided with information on HIV/AIDS prevention during their antenatal care is higher for urban women (71 percent) than rural women (52 percent), higher for educated women (72 percent for higher educated women) than less educated (31 percent for uneducated women) and higher for wealthy women (72 percent) than poor women (43 percent). Less than 50 percent of women aged under 20 years old received information on HIV while 67-70 percent of older women did so. The proportion of women who had HIV testing during antenatal care is high among urban areas (55 percent), among complete secondary and higher educated women (40-55 percent) and among wealthy women (57 percent). 49 Tables TABLES Note: na not available (*) Figures that are based on less than 25 unweighted cases ( ) Figures that are based on 25–49 unweighted cases 50 Tables U rb a n R u ra l C a p ita l c ity A im a g c e n te r S o u m c e n te r C o u n tr ys id e W e st K h a n g a i C e n tr a l E a st U la a n b a a ta r N um be r o f h ou se ho ld s S a m p le d 3 6 0 0 2 7 2 5 2 1 5 0 1 4 5 0 6 6 6 2 0 5 9 1 0 2 5 1 5 0 0 1 1 2 5 5 2 5 2 1 5 0 6 3 2 5 O cc u p ie d 3 6 0 0 2 7 2 5 2 1 5 0 1 4 5 0 6 6 6 2 0 5 9 1 0 2 5 1 5 0 0 1 1 2 5 5 2 5 2 1 5 0 6 3 2 5 In te rv ie w e d 3 5 4 7 2 6 7 3 2 1 3 3 1 4 1 4 6 5 2 2 0 2 1 1 0 0 8 1 4 6 0 1 1 0 5 5 1 4 2 1 3 3 6 2 2 0 R e sp o n se r a te 9 8 .5 9 8 .1 9 9 .2 9 7 .5 9 7 .9 9 8 .2 9 8 .3 9 7 .3 9 8 .2 9 7 .9 9 9 .2 9 8 .3 N um be r o f w om en E lig ib le 4 7 9 5 3 2 6 2 2 9 2 3 1 8 7 2 8 4 4 2 4 1 8 1 2 1 7 1 8 5 2 1 3 4 5 7 2 0 2 9 2 3 8 0 5 7 In te rv ie w e d 4 4 1 1 3 0 4 8 2 6 5 4 1 7 5 7 7 8 6 2 2 6 2 1 1 3 7 1 6 9 9 1 2 9 7 6 7 2 2 6 5 4 7 4 5 9 R e sp o n se r a te 9 2 .0 9 3 .4 9 0 .8 9 3 .9 9 3 .1 9 3 .5 9 3 .4 9 1 .7 9 6 .4 9 3 .3 9 0 .8 9 2 .6 O ve ra ll re sp o n se r a te 9 0 .6 9 1 .7 9 0 .1 9 1 .5 9 1 .2 9 1 .8 9 1 .9 8 9 .3 9 4 .7 9 1 .4 9 0 .1 9 1 .0 N um be r o f c hi ld re n un de r 5 E lig ib le 1 8 5 3 1 7 1 5 1 0 4 9 8 0 4 3 9 4 1 3 2 1 6 8 2 8 4 4 6 1 0 3 8 3 1 0 4 9 3 5 6 8 M o th e r/ C a re ta ke r In te rv ie w e d 1 8 4 0 1 7 0 7 1 0 4 1 7 9 9 3 9 0 1 3 1 7 6 7 6 8 4 3 6 0 9 3 7 8 1 0 4 1 3 5 4 7 R e sp o n se r a te 9 9 .3 9 9 .5 9 9 .2 9 9 .4 9 9 .0 9 9 .7 9 9 .1 9 9 .9 9 9 .8 9 8 .7 9 9 .2 9 9 .4 O ve ra ll re sp o n se r a te 9 7 .8 9 7 .6 9 8 .5 9 6 .9 9 6 .9 9 7 .9 9 7 .5 9 7 .2 9 8 .1 9 6 .6 9 8 .5 9 7 .8 Ta bl e H H .1 : R es ul ts o f h ou se ho ld a nd in di vi du al in te rv ie w s N u m b e rs o f h o u se h o ld s, w o m e n a n d c h ild re n u n d e r 5 b y re su lts o f th e h o u se h o ld , w o m e n 's a n d u n d e r- fiv e 's in te rv ie w s, a n d h o u se h o ld , w o m e n 's a n d u n d e r- fiv e 's r e sp o n se r a te s, M o n g o lia , 2 0 0 5 R es id en ce Lo ca tio n R eg io n T o ta l 51 Tables Number Percent Number Percent Number Percent Age 0-4 1 848 14.4 1 715 12.3 3 563 13.3 5-9 1 498 11.7 1 378 9.9 2 877 10.8 10-14 1 514 11.8 1 590 11.4 3 104 11.6 15-19 1 437 11.2 1 488 10.7 2 925 10.9 20-24 1 030 8.1 1 295 9.3 2 325 8.7 25-29 1 133 8.9 1 386 10.0 2 519 9.4 30-34 1 006 7.9 1 175 8.4 2 181 8.2 35-39 893 7.0 1 074 7.7 1 966 7.4 40-44 809 6.3 947 6.8 1 756 6.6 45-49 639 5.0 696 5.0 1 335 5.0 50-54 358 2.8 363 2.6 721 2.7 55-59 208 1.6 244 1.8 452 1.7 60-64 155 1.2 187 1.3 342 1.3 65-69 126 1.0 153 1.1 279 1.0 70+ 136 1.1 231 1.7 367 1.4 Missing/DK 0 (*) 2 (*) 2 (*) Dependency age groups <15 4 860 38.0 4 683 33.6 9 543 35.7 15-64 7 667 59.9 8 855 63.6 16 522 61.8 65+ 263 2.1 383 2.8 646 2.4 Missing/DK 0 (*) 2 (*) 2 (*) Children aged 0-17 5 862 45.8 5 698 40.9 11 560 43.3 Adults 18+/Missing/DK 6 928 54.2 8 225 59.1 15 153 56.7 Total 12 789 100.0 13 923 100.0 26 713 100.0 TotalMale Female Table HH.2: Household age distribution by sex Percent distribution of the household population by five-year age groups and dependency age groups, and number of children aged 0-17 years, by sex, Mongolia, 2005 52 Tables Weighted Unweighted Sex of household head Male 82.4 5 125 5 128 Female 17.6 1 095 1 092 Region West 16.1 1 001 1 008 Khangai 23.2 1 446 1 460 Central 17.7 1 104 1 105 East 8.1 506 514 Ulaanbaatar 34.8 2 163 2 133 Residence Urban 57.4 3 570 3 547 Rural 42.6 2 650 2 673 Location Capital city 34.8 2 163 2 133 Aimag center 22.6 1 406 1 414 Soum center 10.4 647 652 Countryside 32.2 2 003 2 021 Number of household members 1 1.2 77 77 2-3 30.0 1 868 1 866 4-5 50.2 3 124 3 125 6-7 15.0 932 933 8-9 2.8 174 174 10+ (0.7) 45 45 Total 100.0 6 220 6 220 At least one child aged < 18 years 87.7 6 220 6 220 At least one child aged < 5 years 48.3 6 220 6 220 At least one woman aged 15-49 years 95.0 6 220 6 220 Table HH.3: Household composition Percent distribution of households by selected characteristics, Mongolia, 2005 Number of households Weighted percent 53 Tables Weighted Unweighted Region West 15.0 1 118 1 137 Khangai 22.8 1 698 1 699 Central 16.7 1 243 1 297 East 8.8 657 672 Ulaanbaatar 36.8 2 744 2 654 Residence Urban 59.9 4 468 4 411 Rural 40.1 2 991 3 048 Location Capital city 36.8 2 744 2 654 Aimag center 23.1 1 724 1 757 Soum center 10.3 771 786 Countryside 29.8 2 220 2 262 Age 15-19 17.1 1 274 1 272 20-24 15.5 1 154 1 151 25-29 17.7 1 318 1 321 30-34 15.0 1 121 1 122 35-39 14.0 1 041 1 043 40-44 12.0 897 897 45-49 8.8 653 653 Marital/Union status Currently married/in union 60.6 4 523 4 535 Formerly married/in union 10.7 801 797 Never married/in union 28.6 2 135 2 127 Motherhood status Ever gave birth 74.6 5 568 5 576 Never gave birth 25.4 1 891 1 883 Education None 3.9 292 296 Primary 10.0 749 754 Secondary (8th grade) 25.6 1 911 1 923 Secondary (10th grade) 25.4 1 895 1 890 Vocational 9.2 684 684 College, university 25.8 1 928 1 912 Wealth index quintiles Poorest 18.0 1 342 1 363 Second 19.2 1 435 1 452 Middle 20.1 1 502 1 500 Fourth 20.8 1 549 1 531 Richest 21.9 1 632 1 613 Total 100.0 7 459 7 459 Table HH.4: Women's background characteristics Percent distribution of women aged 15-49 years by background characteristics, Mongolia, 2005 Number of women Weighted percent 54 Tables Weighted Unweighted Sex Male 51.9 1 842 1 841 Female 48.1 1 705 1 706 Region West 19.0 674 676 Khangai 23.5 832 843 Central 17.1 607 609 East 10.6 375 378 Ulaanbaatar 29.9 1 059 1 041 Residence Urban 52.3 1 856 1 840 Rural 47.7 1 691 1 707 Location Capital city 29.9 1 059 1 041 Aimag center 22.5 797 799 Soum center 10.9 386 390 Countryside 36.8 1 305 1 317 Age < 6 months 11.3 400 399 6-11 months 10.6 375 375 12-23 months 20.4 724 723 24-35 months 20.1 714 714 36-47 months 18.9 672 672 48-59 months 18.7 663 664 Mother's education None 4.5 161 162 Primary 8.4 297 299 Secondary (8th grade) 25.2 895 898 Secondary (10th grade) 28.8 1 023 1 022 Vocational 7.1 252 252 College, university 25.9 919 914 Wealth index quintiles Poorest 22.7 805 813 Second 23.6 838 842 Middle 19.4 688 686 Fourth 16.5 584 579 Richest 17.8 632 627 Total 100.0 3 547 3 547 Table HH.5: Children's background characteristics Percent distribution of children under five years of age by background characteristics, Mongolia, 2005 Weighted percent Number of children under 5 55 Tables Infant mortality rate* Under-five mortality rate** Sex Male 45 55 Female 36 46 Residence Urban 25 31 Rural 52 69 Mother's education None, primary 66 90 Secondary, vocational 35 44 College, university 18 22 Wealth Index quintiles Poorest, 60% 46 60 Richest, 40% 25 30 Total 40 51 Table CM.1: Child mortality Infant and under-five mortality rates by background and demographic characteristics, Mongolia, 2005 * MICS indicator 2; MDG indicator 14 ** MICS indicator 1; MDG indicator 13 56 Tables M e a n n u m b e r o f ch ild re n e ve r b o rn M e a n n u m b e r o f ch ild re n s u rv iv in g P ro p o rt io n d e a d N u m b e r o f w o m e n A ge 1 5 -1 9 0 .0 6 1 0 .0 6 0 0 .0 1 3 1 2 7 4 2 0 -2 4 0 .8 0 4 0 .7 7 5 0 .0 3 6 1 1 5 4 2 5 -2 9 1 .5 9 0 1 .5 0 2 0 .0 5 5 1 3 1 8 3 0 -3 4 2 .4 1 9 2 .2 2 7 0 .0 7 9 1 1 2 1 3 5 -3 9 3 .0 9 1 2 .8 5 5 0 .0 7 6 1 0 4 1 4 0 -4 4 3 .7 1 4 3 .3 4 4 0 .1 0 0 8 9 7 4 5 -4 9 4 .5 2 8 3 .9 0 4 0 .1 3 8 6 5 3 T o ta l 2 .0 5 4 1 .8 7 3 0 .0 8 8 7 4 5 9 Ta bl e C M .2 : C hi ld re n ev er b or n, c hi ld re n su rv iv in g, p ro po rt io n de ad M e a n n u m b e r o f ch ild re n e ve r b o rn , ch ild re n s u rv iv in g a n d p ro p o rt io n d e a d b y a g e o f w o m e n , M o n g o lia , 2 0 0 5 57 Tables % b e lo w - 2 S D * % b e lo w - 3 S D * % b e lo w - 2 S D ** % b e lo w - 3 S D ** % b e lo w - 2 S D ** * % b e lo w - 3 S D ** * % a b o ve + 2 S D S ex M a le 5 .9 1 .2 2 1 .5 5 .9 1 .9 0 .6 9 .6 1 7 0 0 F e m a le 6 .6 1 .0 2 0 .3 5 .9 2 .4 0 .5 9 .6 1 5 5 2 R eg io n W e st 8 .0 0 .8 2 8 .0 8 .2 2 .1 0 .5 6 .1 6 2 3 K h a n g a i 6 .8 1 .9 1 9 .8 4 .8 2 .2 0 .7 5 .8 7 9 6 C e n tr a l 4 .9 0 .7 1 5 .9 3 .6 2 .0 0 .5 8 .5 5 8 5 E a st 6 .5 1 .2 2 6 .9 9 .8 1 .5 0 .0 1 3 .7 3 3 5 U la a n b a a ta r 5 .4 0 .9 1 8 .2 5 .2 2 .5 0 .7 1 4 .5 9 1 3 R es id en ce U rb a n 5 .6 0 .9 1 8 .4 5 .0 2 .2 0 .5 1 1 .1 1 6 7 4 R u ra l 7 .0 1 .3 2 3 .6 6 .8 2 .1 0 .6 8 .0 1 5 7 9 Lo ca tio n C a p ita l c ity 5 .4 0 .9 1 8 .2 5 .2 2 .5 0 .7 1 4 .5 9 1 3 A im a g c e n te r 5 .9 0 .9 1 8 .8 4 .8 1 .8 0 .4 7 .0 7 6 1 S o u m c e n te r 5 .9 0 .6 2 4 .1 5 .8 0 .6 0 .3 7 .5 3 5 7 C o u n tr ys id e 7 .3 1 .5 2 3 .4 7 .1 2 .6 0 .6 8 .2 1 2 2 2 A ge < 6 m o n th s 1 .2 0 .3 1 0 .8 1 .5 2 .0 0 .3 2 5 .4 3 4 4 6 -1 1 m o n th s 2 .6 0 .6 7 .2 0 .9 2 .9 0 .3 1 8 .8 3 4 8 1 2 -2 3 m o n th s 6 .6 1 .3 2 6 .4 6 .6 2 .1 0 .3 1 0 .3 6 7 1 2 4 -3 5 m o n th s 9 .6 1 .3 2 0 .7 5 .7 2 .3 0 .5 5 .6 6 6 7 3 6 -4 7 m o n th s 6 .7 0 .8 2 5 .6 8 .5 1 .4 0 .6 3 .5 6 2 0 4 8 -5 9 m o n th s 6 .8 1 .7 2 4 .2 8 .0 2 .5 1 .2 5 .2 6 0 2 M ot he r's e du ca tio n N o n e 1 3 .5 4 .1 3 1 .5 8 .8 4 .7 0 .7 7 .3 1 4 8 P ri m a ry 8 .2 1 .4 2 6 .0 7 .1 2 .9 1 .4 7 .1 2 7 9 S e co n d a ry ( 8 th g ra d e ) 8 .5 1 .7 2 6 .7 9 .0 2 .3 0 .5 8 .1 8 2 9 S e co n d a ry ( 1 0 th g ra d e ) 5 .7 0 .7 1 9 .8 5 .2 1 .9 0 .3 8 .8 9 3 4 V o ca tio n a l 3 .4 1 .3 1 5 .9 3 .9 1 .7 0 .9 1 0 .8 2 3 3 C o lle g e , u n iv e rs ity 3 .5 0 .2 1 4 .3 3 .2 1 .7 0 .5 1 2 .9 8 2 8 W ea lth in de x qu in til es P o o re st 7 .8 1 .8 2 6 .1 7 .5 2 .8 0 .9 7 .7 7 4 9 S e co n d 8 .6 1 .3 2 6 .1 8 .2 2 .0 0 .3 8 .3 7 8 1 M id d le 5 .5 1 .0 2 0 .5 5 .3 1 .6 0 .8 7 .7 6 2 6 F o u rt h 4 .6 1 .1 1 5 .0 3 .8 2 .1 0 .4 1 1 .8 5 2 9 R ic h e st 3 .5 0 .0 1 3 .1 3 .0 2 .1 0 .4 1 3 .9 5 6 8 T o ta l 6 .3 1 .1 2 0 .9 5 .9 2 .2 0 .6 9 .6 3 2 5 2 * M IC S in di ca to r 6; M D G in di ca to r 4 ** M IC S in di ca to r 7 ** * M IC S in di ca to r 8 W ei gh t f or a ge H ei gh t f or a ge W ei gh t f or h ei gh t N u m b e r o f ch ild re n a g e d 0 -5 9 m o n th s Ta bl e N U .1 : C hi ld m al no ur is hm en t P e rc e n ta g e o f u n d e r- fiv e c h ild re n w h o a re s e ve re ly o r m o d e ra te ly u n d e rn o u ri sh e d , M o n g o lia , 2 0 0 5 58 Tables P e rc e n ta g e w h o s ta rt e d b re a st fe e d in g w ith in o n e h o u r o f b ir th * P e rc e n ta g e w h o s ta rt e d b re a st fe e d in g w ith in o n e d a y o f b ir th N u m b e r o f w o m e n w ith li ve b ir th in t h e t w o ye a rs p re ce d in g t h e s u rv e y R eg io n W e st 7 3 .8 9 4 .2 2 5 2 K h a n g a i 8 4 .5 9 2 .6 3 2 2 C e n tr a l 8 3 .1 9 1 .6 2 3 9 E a st 7 7 .7 9 0 .4 1 6 3 U la a n b a a ta r 7 1 .8 8 8 .6 4 8 1 R es id en ce U rb a n 7 4 .5 8 9 .1 8 0 1 R u ra l 8 1 .1 9 3 .6 6 5 6 Lo ca tio n C a p ita l c ity 7 1 .8 8 8 .6 4 8 1 A im a g c e n te r 7 8 .6 8 9 .9 3 2 1 S o u m c e n te r 8 2 .4 9 1 .2 1 5 7 C o u n tr ys id e 8 0 .7 9 4 .3 4 9 9 M on th s si nc e la st b irt h < 6 m o n th s 7 6 .7 9 0 .4 3 9 7 6 -1 1 m o n th s 7 7 .9 9 3 .0 3 5 8 1 2 -2 3 m o n th s 7 7 .8 9 0 .6 7 0 2 Ed uc at io n N o n e 7 7 .3 9 5 .8 7 0 P ri m a ry 7 7 .3 9 0 .8 1 1 7 S e co n d a ry ( 8 th g ra d e ) 8 0 .4 9 3 .3 3 4 5 S e co n d a ry ( 1 0 th g ra d e ) 7 6 .5 9 1 .3 4 1 3 V o ca tio n a l 7 0 .4 8 5 .3 9 5 C o lle g e , u n iv e rs ity 7 7 .8 8 9 .8 4 1 7 W ea lth in de x qu in til es P o o re st 8 1 .7 9 5 .0 3 1 3 S e co n d 8 1 .8 9 1 .1 3 2 2 M id d le 7 1 .5 9 0 .4 2 7 2 F o u rt h 7 8 .8 9 2 .7 2 6 2 R ic h e st 7 2 .5 8 6 .3 2 8 8 T o ta l 7 7 .5 9 1 .1 1 4 5 7 Ta bl e N U .2 : I nt iti al b re as tfe ed in g P e rc e n ta g e o f w o m e n a g e d 1 5 -4 9 y e a rs w ith a b ir th in t h e 2 y e a rs p re ce d in g t h e s u rv e y w h o b re a st fe d t h e ir b a b y w ith in o n e h o u r o f b ir th a n d w ith in o n e d a y o f b ir th , M o n g o lia , 2 0 0 5 * M IC S in di ca to r 4 5 59 Tables P e rc e n t e xc lu si ve ly b re a st fe d N u m b e r o f ch ild re n P e rc e n t e xc lu si ve ly b re a st fe d * N u m b e r o f ch ild re n P e rc e n t re ce iv in g b re a st m ilk a n d so lid /m u sh y fo o d ** N u m b e r o f ch ild re n P e rc e n t b re a st fe d ** * N u m b e r o f ch ild re n P e rc e n t b re a st fe d ** * N u m b e r o f ch ild re n S ex M a le 7 1 .7 1 1 3 5 8 .4 2 0 9 5 7 .0 1 2 6 7 8 .5 1 1 2 6 5 .8 1 1 1 F e m a le 6 5 .9 1 2 1 5 5 .9 1 9 1 5 7 .8 1 4 0 8 6 .6 9 8 6 3 .9 9 7 R eg io n W e st (5 8 .1 ) 4 3 5 4 .7 7 5 (5 0 .0 ) 3 6 (9 0 .0 ) 4 0 (5 5 .9 ) 3 4 K h a n g a i 6 9 .7 5 2 5 9 .0 8 2 6 9 .0 7 0 (9 0 .5 ) 4 1 (6 4 .4 ) 4 4 C e n tr a l (7 2 .4 ) 3 6 5 2 .2 6 9 (5 6 .4 ) 4 6 (7 5 .8 ) 3 3 (6 1 .2 ) 3 6 E a st (* ) 1 9 (5 5 .6 ) 3 6 (* ) 2 1 (* ) 2 2 (7 1 .7 ) 2 5 U la a n b a a ta r 7 3 .2 8 3 6 0 .3 1 3 8 5 2 .2 9 4 7 6 .7 7 4 6 9 .1 6 9 R es id en ce U rb a n 6 6 .3 1 3 1 5 5 .1 2 2 2 5 6 .3 1 5 7 7 7 .3 1 2 0 6 5 .1 1 2 7 R u ra l 7 1 .8 1 0 2 5 9 .8 1 7 8 5 9 .0 1 0 9 8 9 .0 9 0 6 4 .6 8 1 Lo ca tio n C a p ita l c ity 7 3 .2 8 3 6 0 .3 1 3 8 5 2 .2 9 4 7 6 .7 7 4 6 9 .1 6 9 A im a g c e n te r (5 4 .3 ) 4 8 4 6 .5 8 4 6 2 .4 6 4 (7 8 .2 ) 4 6 6 0 .4 5 8 S o u m c e n te r (* ) 2 3 (5 4 .6 ) 4 2 (* ) 1 9 (* ) 2 1 (7 0 .3 ) 2 7 C o u n tr ys id e 7 2 .5 7 9 6 1 .3 1 3 6 5 4 .8 9 0 9 0 .0 6 9 6 1 .7 5 5 M ot he r's e du ca tio n N o n e (* ) 1 4 (* ) 2 2 (* ) 1 3 (* ) 9 (* ) 8 P ri m a ry (* ) 2 1 (7 2 .7 ) 3 3 (* ) 1 8 (* ) 2 3 (* ) 1 2 S e co n d a ry ( 8 th g ra d e ) 7 0 .5 5 4 6 1 .8 9 4 5 7 .8 5 7 (8 6 .6 ) 4 5 7 6 .9 5 2 S e co n d a ry ( 1 0 th g ra d e ) 6 4 .1 6 4 5 5 .0 1 0 2 5 7 .3 7 3 8 0 .5 6 7 6 1 .9 6 3 V o ca tio n a l (* ) 1 3 (5 3 .4 ) 3 0 (* ) 1 6 (* ) 1 0 (* ) 1 9 C o lle g e , u n iv e rs ity 6 8 .7 6 8 5 0 .9 1 1 9 5 7 .2 9 0 7 8 .5 5 6 5 5 .6 5 4 W ea lth in de x qu in til es P o o re st 7 8 .2 5 4 6 9 .4 8 7 5 6 .3 5 4 (9 0 .5 ) 4 2 (5 7 .4 ) 4 0 S e co n d (6 3 .2 ) 4 6 5 6 .7 8 3 4 9 .8 5 2 (9 1 .8 ) 4 9 (6 1 .4 ) 3 9 M id d le (5 7 .6 ) 4 0 4 2 .7 7 5 (6 1 .2 ) 4 4 (7 5 .6 ) 4 1 (7 2 .7 ) 4 4 F o u rt h (7 0 .5 ) 4 4 6 1 .8 6 9 (6 3 .1 ) 4 9 (7 9 .9 ) 3 5 (7 9 .6 ) 3 9 R ic h e st (7 0 .8 ) 4 9 5 4 .2 8 6 5 7 .4 6 7 (7 2 .1 ) 4 4 (5 4 .4 ) 4 6 T o ta l 6 8 .7 2 3 4 5 7 .2 4 0 0 5 7 .4 2 6 6 8 2 .3 2 1 0 6 4 .9 2 0 8 Ta bl e N U .3 : B re as tf ee di ng P e rc e n t o f liv in g c h ild re n a cc o rd in g t o b re a st fe e d in g s ta tu s a t e a ch a g e g ro u p , M o n g o lia , 2 0 0 5 * M IC S in di ca to r 15 ** M IC S in di ca to r 17 ** * M IC S in di ca to r 16 C hi ld re n 0- 3 m on th s C hi ld re n 0- 5 m on th s C hi ld re n 6- 9 m on th s C hi ld re n 1 2- 15 m on th s C hi ld re n 20 -2 3 m on th s 60 Tables 0 -5 m o n th s e xc lu si ve ly b re a st fe d 6 -8 m o n th s w h o r e ce iv e d b re a st m ilk a n d c o m p le m e n ta ry fo o d a t le a st 2 t im e s in p ri o r 2 4 h o u rs 9 -1 1 m o n th s w h o re ce iv e d b re a st m ilk a n d c o m p le m e n ta ry fo o d a t le a st 3 t im e s in p ri o r 2 4 h o u rs 6 -1 1 m o n th s w h o r e ce iv e d b re a st m ilk a n d co m p le m e n ta ry f o o d a t le a st th e m in im u m r e co m m e n d e d n u m b e r o f tim e s p e r d a y* 0 -1 1 m o n th s w h o w e re a p p ro p ri a te ly f e d ** Se x M a le 5 8 .4 3 1 .8 1 2 .2 2 2 .4 4 1 .4 3 9 6 F e m a le 5 5 .9 2 9 .5 1 2 .2 2 1 .2 3 8 .7 3 7 9 R eg io n W e st 5 4 .7 1 9 .3 4 .0 1 2 .5 3 6 .6 1 3 1 K h a n g a i 5 9 .0 4 3 .4 1 4 .3 3 0 .5 4 3 .8 1 7 6 C e n tr a l 5 2 .2 1 8 .7 2 3 .3 2 0 .9 3 7 .4 1 3 1 E a st 5 5 .6 4 0 .6 1 3 .6 2 5 .4 3 9 .9 7 5 U la a n b a a ta r 6 0 .3 2 9 .0 8 .2 1 8 .7 4 0 .5 2 6 4 R es id en ce U rb a n 5 5 .1 3 0 .0 1 1 .9 2 1 .4 3 8 .6 4 3 4 R u ra l 5 9 .8 3 1 .6 1 2 .5 2 2 .3 4 1 .8 3 4 1 Lo ca tio n C a p ita l c ity 6 0 .3 2 9 .0 8 .2 1 8 .7 4 0 .5 2 6 4 A im a g c e n te r 4 6 .5 3 1 .2 1 7 .9 2 5 .2 3 5 .7 1 7 1 S o u m c e n te r 5 4 .6 4 6 .6 1 3 .5 3 0 .0 4 4 .4 7 1 C o u n tr ys id e 6 1 .3 2 8 .4 1 2 .3 2 0 .6 4 1 .2 2 7 0 M ot he r's e du ca tio n N o n e 6 3 .5 3 7 .2 3 7 .7 3 7 .5 (5 2 .6 ) 3 8 P ri m a ry 7 2 .7 2 6 .7 1 7 .9 2 3 .0 5 0 .8 5 9 S e co n d a ry ( 8 th g ra d e ) 6 1 .8 3 1 .1 8 .5 1 9 .6 4 0 .9 1 8 6 S e co n d a ry ( 1 0 th g ra d e ) 5 5 .0 3 1 .9 1 2 .7 2 2 .8 3 9 .1 2 0 2 V o ca tio n a l 5 3 .4 3 6 .2 1 1 .3 2 5 .0 (4 2 .0 ) 5 0 C o lle g e , u n iv e rs ity 5 0 .9 2 8 .5 1 0 .3 1 9 .8 3 5 .2 2 4 1 W ea lth in de x qu in til es P o o re st 6 9 .4 2 4 .3 1 7 .5 2 0 .9 4 6 .2 1 6 7 S e co n d 5 6 .7 3 0 .5 1 7 .2 2 4 .2 4 1 .4 1 5 6 M id d le 4 2 .7 4 0 .5 3 .1 2 1 .5 3 2 .8 1 4 1 F o u rt h 6 1 .8 3 2 .4 9 .0 2 1 .3 4 1 .3 1 3 9 R ic h e st 5 4 .2 2 8 .2 1 2 .8 2 1 .1 3 7 .7 1 7 2 T o ta l 5 7 .2 3 0 .7 1 2 .2 2 1 .8 4 0 .0 7 7 5 * M IC S in di ca to r 1 8 ** M IC S in di ca to r 1 9 Ta bl e N U .4 : A de qu at el y fe d in fa nt s P e rc e n ta g e o f in fa n ts u n d e r 6 m o n th s o f a g e e xc lu si ve ly b re a st fe d , p e rc e n ta g e o f in fa n ts 6 -1 1 m o n th s w h o a re b re a st fe d a n d w h o a te s o lid /s e m i- so lid f o o d a t le a st t h e m in im u m r e co m m e n d e d n u m b e r o f tim e s ye st e rd a y a n d p e rc e n ta g e o f in fa n ts a d e q u a te ly f e d , M o n g o lia , 2 0 0 5 Pe rc en t o f i nf an ts N u m b e r o f in fa n ts a g e d 0 -1 1 m o n th s 61 Tables Io di ze d* N ot Io di ze d Re gi on W es t 97 .5 1 00 1 0. 1 57 .7 42 .2 10 0. 0 9 77 K ha ng ai 97 .3 1 44 6 0. 3 73 .8 25 .9 10 0. 0 1 41 1 C en tr al 99 .8 1 10 4 0. 0 87 .9 12 .1 10 0. 0 1 10 2 E as t 98 .6 5 06 0. 0 90 .5 9. 5 10 0. 0 4 99 U la an ba at ar 98 .1 2 16 3 0. 1 96 .8 3. 1 10 0. 0 2 12 4 Re si de nc e U rb an 98 .4 3 57 0 0. 1 91 .3 8. 7 10 0. 0 3 51 5 R ur al 97 .8 2 65 0 0. 2 72 .1 27 .7 10 0. 0 2 59 8 Lo ca tio n C ap ita l c ity 98 .1 2 16 3 0. 1 96 .8 3. 1 10 0. 0 2 12 4 A im ag c en te r 98 .9 1 40 6 0. 0 82 .7 17 .3 10 0. 0 1 39 1 S ou m c en te r 98 .3 6 47 0. 0 79 .4 20 .6 10 0. 0 6 36 C ou nt ry si de 97 .7 2 00 3 0. 3 69 .8 30 .0 10 0. 0 1 96 2 Ed uc at io n of h ou se ho ld h ea d N on e 97 .9 3 78 0. 3 68 .2 31 .5 10 0. 0 3 71 P rim ar y 98 .2 8 59 0. 1 68 .5 31 .4 10 0. 0 8 44 S ec on da ry ( 8t h gr ad e) 98 .0 1 63 3 0. 1 80 .8 19 .0 10 0. 0 1 60 2 S ec on da ry ( 10 th g ra de ) 98 .1 1 28 6 0. 2 89 .1 10 .8 10 0. 0 1 26 3 V oc at io na l 98 .7 6 36 0. 0 86 .1 13 .9 10 0. 0 6 28 C ol le ge , u ni ve rs ity 98 .3 1 42 9 0. 1 91 .8 8. 1 10 0. 0 1 40 5 W ea lth in de x qu in til es P oo re st 97 .0 1 18 5 0. 2 61 .9 37 .9 10 0. 0 1 15 1 S ec on d 97 .8 1 18 6 0. 3 76 .5 23 .2 10 0. 0 1 16 3 M id dl e 99 .3 1 22 6 0. 0 87 .7 12 .3 10 0. 0 1 21 7 F ou rt h 99 .3 1 25 7 0. 1 92 .6 7. 4 10 0. 0 1 24 9 R ic he st 97 .5 1 36 7 0. 1 94 .2 5. 7 10 0. 0 1 33 4 T ot al 98 .2 6 22 0 0. 1 83 .1 16 .8 10 0. 0 6 11 3 *M IC S in di ca to r 4 1 N um be r of h ou se ho ld s in w hi ch s al t w as te st ed o r w ith n o sa lt Ta bl e NU .5 : I od iz ed s al t c on su m pt io n P er ce nt ag e of h ou se ho ld s co ns um in g ad eu qa te ly io di ze d sa lt, M on go lia , 2 00 5 Sa lt te st re su lt N o sa lt T ot al P er ce nt o f h ou se ho ld s in w hi ch s al t w as te st ed N um be r of h ou se ho ld s in te rv ie w ed Pe rc en t o f h ou se ho ld s 62 Tables Y es , a lw ay s Y es , o cc as io na lly N o D K Re si de nc e U rb an 59 .2 3 57 0 41 .8 29 .9 28 .2 0. 0 10 0. 0 2 11 5 R ur al 48 .1 2 65 0 26 .3 32 .0 41 .5 0. 2 10 0. 0 1 27 4 Re gi on s W es t 31 .3 1 00 1 7. 3 19 .6 72 .8 0. 3 10 0. 0 3 13 K ha ng ai 54 .5 1 44 6 30 .6 34 .8 34 .5 0. 1 10 0. 0 7 88 C en tr al 64 .7 1 10 4 30 .6 33 .2 36 .2 0. 0 10 0. 0 7 14 E as t 54 .1 5 06 40 .9 28 .8 29 .9 0. 4 10 0. 0 2 73 U la an ba at ar 60 .1 2 16 3 48 .1 29 .9 22 .0 0. 0 10 0. 0 1 30 0 Lo ca tio n C ap ita l c ity 60 .1 2 16 3 48 .1 29 .9 22 .0 0. 0 10 0. 0 1 30 0 A im ag c en te r 57 .9 1 40 6 31 .8 29 .9 38 .1 0. 1 10 0. 0 8 15 S ou m c en te r 53 .2 6 47 27 .1 26 .8 46 .1 0. 0 10 0. 0 3 44 C ou nt ry si de 46 .4 2 00 3 26 .0 33 .9 39 .8 0. 2 10 0. 0 9 29 Ed uc at io n of h ou se ho ld h ea d N on e 35 .5 3 78 25 .3 31 .1 43 .7 0. 0 10 0. 0 1 34 P rim ar y 42 .9 8 59 30 .6 32 .7 36 .7 0. 0 10 0. 0 3 69 S ec on da ry ( 8t h gr ad e) 48 .1 1 63 3 32 .4 30 .1 37 .4 0. 1 10 0. 0 7 85 S ec on da ry ( 10 th g ra de ) 59 .1 1 28 6 34 .9 34 .2 30 .9 0. 0 10 0. 0 7 60 V oc at io na l 58 .3 6 36 33 .3 29 .3 36 .8 0. 5 10 0. 0 3 71 C ol le ge , u ni ve rs ity 67 .9 1 42 9 44 .4 28 .1 27 .5 0. 0 10 0. 0 9 70 W ea lth in de x qu in til es P oo re st 40 .0 1 18 5 24 .8 32 .3 42 .5 0. 4 10 0. 0 4 74 S ec on d 48 .9 1 18 6 26 .2 32 .1 41 .7 0. 0 10 0. 0 5 80 M id dl e 53 .4 1 22 6 31 .8 30 .8 37 .4 0. 0 10 0. 0 6 54 F ou rt h 62 .3 1 25 7 39 .9 30 .3 29 .8 0. 0 10 0. 0 7 82 R ic he st 65 .7 1 36 7 47 .9 29 .2 22 .8 0. 1 10 0. 0 8 98 T ot al 54 .5 6 22 0 36 .0 30 .7 33 .2 0. 1 10 0. 0 3 38 9 H ea rd o f f or tif ie d flo ur N um be r of ho us eh ol ds U se o f f or tif ie d flo ur T ot al N um be r of h ou se ho ld s th at h av e he ar d of fo rt ifi ed fl ou r Ta bl e NU .5 A: K no w le dg e an d us e of fl ou r f or tif ie d by m in er al s an d vi ta m in s P er ce nt ag e of h ou se ho ld s th at h av e ev er h ea rd a bo ut fl ou r th at is fo rt ifi ed b y m in er al s an d vi ta m in s, a nd p er ce nt di st rib ut io n of h ou se ho ld s by u se o f e nr ic he d flo ur , M on go lia 2 00 5 63 Tables W it h in l a s t 6 m o n th s * P ri o r to l a s t 6 m o n th s N o t s u re w h e n S ex M a le 6 5 .8 1 5 .9 3 .6 0 .7 1 3 .9 1 0 0 .0 1 6 3 2 F e m a le 6 3 .5 1 7 .3 4 .4 0 .4 1 4 .4 1 0 0 .0 1 5 1 5 R eg io n W e s t 5 4 .9 1 7 .1 7 .1 1 .3 1 9 .5 1 0 0 .0 5 9 9 K h a n g a i 6 1 .3 1 9 .9 4 .5 0 .3 1 4 .1 1 0 0 .0 7 5 0 C e n tr a l 7 0 .9 1 6 .1 1 .7 0 .0 1 1 .3 1 0 0 .0 5 3 8 E a s t 5 6 .7 2 1 .1 6 .1 0 .9 1 5 .2 1 0 0 .0 3 3 9 U la a n b a a ta r 7 3 .1 1 2 .2 2 .1 0 .6 1 2 .0 1 0 0 .0 9 2 1 R es id en ce U rb a n 6 9 .5 1 4 .1 3 .3 0 .6 1 2 .6 1 0 0 .0 1 6 3 4 R u ra l 5 9 .6 1 9 .3 4 .7 0 .6 1 5 .9 1 0 0 .0 1 5 1 3 Lo ca tio n C a p it a l c it y 7 3 .1 1 2 .2 2 .1 0 .6 1 2 .0 1 0 0 .0 9 2 1 A im a g c e n te r 6 4 .7 1 6 .5 4 .9 0 .6 1 3 .3 1 0 0 .0 7 1 3 S o u m c e n te r 6 6 .6 1 9 .9 5 .2 0 .6 7 .8 1 0 0 .0 3 4 5 C o u n tr y s id e 5 7 .5 1 9 .1 4 .6 0 .6 1 8 .2 1 0 0 .0 1 1 6 9 A ge 6 -1 1 m o n th s 6 5 .4 3 .4 0 .5 0 .3 3 0 .3 1 0 0 .0 3 7 5 1 2 -2 3 m o n th s 7 4 .1 1 2 .8 1 .9 0 .3 1 0 .9 1 0 0 .0 7 2 4 2 4 -3 5 m o n th s 6 3 .9 1 9 .1 4 .6 0 .7 1 1 .6 1 0 0 .0 7 1 4 3 6 -4 7 m o n th s 6 2 .4 2 0 .5 5 .3 0 .9 1 0 .9 1 0 0 .0 6 7 2 4 8 -5 9 m o n th s 5 7 .3 2 1 .4 6 .2 0 .6 1 4 .6 1 0 0 .0 6 6 3 M ot he r' s ed uc at io n N o n e 5 2 .9 1 9 .9 4 .3 1 .4 2 1 .4 1 0 0 .0 1 3 9 P ri m a ry 5 8 .4 1 7 .6 5 .6 0 .4 1 8 .0 1 0 0 .0 2 6 4 S e c o n d a ry ( 8 th g ra d e ) 6 0 .6 1 6 .9 5 .0 1 .0 1 6 .6 1 0 0 .0 8 0 1 S e c o n d a ry ( 1 0 th g ra d e ) 6 6 .8 1 6 .7 3 .1 0 .5 1 2 .8 1 0 0 .0 9 2 1 V o c a ti o n a l 6 9 .4 1 5 .7 3 .6 0 .0 1 1 .3 1 0 0 .0 2 2 2 C o lle g e , u n iv e rs it y 6 9 .3 1 5 .4 3 .5 0 .3 1 1 .6 1 0 0 .0 8 0 0 W ea lth in de x qu in til es P o o re s t 5 6 .0 2 0 .3 5 .2 0 .6 1 8 .0 1 0 0 .0 7 1 8 S e c o n d 6 1 .6 1 8 .4 4 .6 0 .5 1 4 .9 1 0 0 .0 7 5 5 M id d le 6 6 .9 1 6 .5 3 .4 1 .0 1 2 .1 1 0 0 .0 6 1 3 F o u rt h 7 1 .9 1 2 .9 3 .5 0 .4 1 1 .4 1 0 0 .0 5 1 5 R ic h e s t 7 1 .2 1 2 .7 2 .6 0 .4 1 3 .1 1 0 0 .0 5 4 6 T o ta l 6 4 .7 1 6 .6 4 .0 0 .6 1 4 .2 1 0 0 .0 3 1 4 7 * M IC S in di ca to r 42 Ta bl e N U .6 : C hi ld re n' s vi ta m in A s up pl em en ta tio n P e rc e n t d is tr ib u ti o n o f c h ild re n a g e d 6 -5 9 m o n th s b y w h e th e r th e y r e c e iv e d a h ig h d o s e V it a m in A s u p p le m e n t in t h e l a s t 6 m o n th s , M o n g o lia , 2 0 0 5 N o t s u re i f re c e iv e d V it a m in A N e v e r re c e iv e d V it a m in A P er ce nt o f c hi ld re n w ho r ec ei ve d V ita m in A : T o ta l N u m b e r o f c h ild re n a g e d 6 -5 9 m o n th s 64 Tables R e ce iv e d V ita m in A s u p p le m e n t* N o t su re if r e ce iv e d V ita m in A N u m b e r o f w o m e n a g e d 1 5 -4 9 y e a rs R eg io n W e st 5 0 .7 0 .4 2 5 2 K h a n g a i 5 7 .3 0 .6 3 2 2 C e n tr a l 5 5 .0 0 .8 2 3 9 E a st 5 3 .3 1 .2 1 6 3 U la a n b a a ta r 5 9 .8 1 .5 4 8 1 R es id en ce U rb a n 5 8 .0 1 .1 8 0 1 R u ra l 5 3 .9 0 .7 6 5 6 Lo ca tio n C a p ita l c ity 5 9 .8 1 .5 4 8 1 A im a g c e n te r 5 5 .4 0 .6 3 2 1 S o u m c e n te r 6 5 .6 1 .9 1 5 7 C o u n tr ys id e 5 0 .2 0 .4 4 9 9 Ed uc at io n N o n e 4 5 .1 4 .2 7 0 P ri m a ry 5 2 .1 0 .0 1 1 7 S e co n d a ry ( 8 th g ra d e ) 5 4 .6 0 .3 3 4 5 S e co n d a ry ( 1 0 th g ra d e ) 5 7 .1 0 .8 4 1 3 V o ca tio n a l 4 6 .5 3 .2 9 5 C o lle g e , U n iv e rs ity 6 1 .7 0 .9 4 1 7 W ea lth in de x qu in til es P o o re st 5 1 .0 0 .3 3 1 3 S e co n d 5 4 .0 0 .6 3 2 2 M id d le 5 6 .6 1 .5 2 7 2 F o u rt h 6 2 .9 0 .4 2 6 2 R ic h e st 5 7 .6 2 .1 2 8 8 T o ta l 5 6 .2 1 .0 1 4 5 7 Ta bl e N U .7 : P os t-p ar tu m m ot he r's V ita m in A s up pl em en ta tio n P e rc e n ta g e o f w o m e n a g e d 1 5 -4 9 y e a rs w ith a b ir th in t h e 2 la st y e a rs p re ce d in g t h e s u rv e y w h e th e r th e y re ce iv e d a h ig h d o se V ita m in A s u p p le m e n b e fo re t h e in fa n t w a s 8 w e e ks o ld , M o n g o lia , 2 0 0 5 * M IC S in di ca to r 4 3 65 Tables Below 2500 grams* Weighed at birth** Region West 7.3 92.9 252 Khangai 4.6 99.1 322 Central 5.9 100.0 239 East 4.8 98.2 163 Ulaanbaatar 5.1 99.8 481 Residence Urban 4.9 99.4 801 Rural 6.1 97.0 656 Location Capital city 5.1 99.8 481 Aimag center 4.7 98.8 321 Soum center 6.1 94.3 157 Countryside 6.1 97.8 499 Mother's education None 10.1 95.8 70 Primary 6.4 93.3 117 Secondary (8th grade) 5.8 98.6 345 Secondary (10th grade) 4.8 99.0 413 Vocational 5.5 97.9 95 College, university 4.9 99.3 417 Wealth index quintiles Poorest 6.2 96.5 313 Second 5.0 99.1 322 Middle 6.1 96.7 272 Fourth 5.8 99.2 262 Richest 4.4 100.0 288 Total 5.5 98.3 1 457 * MICS Indicator 9 ** MICS Indicator 10 Table NU.8 : Low birth weight infants Percentage of live births in the 2 years preceding the survey that weighed below 2500 grams at birth, Mongolia, 2005 Percent of live births Number of live births 66 Tables B C G * D P T 1 D P T 2 D P T 3 ** P o lio 1 P o lio 2 P o lio 3 ** * M e a sl e s* ** * A ll* ** ** N o n e Va cc in at ed b ef or e at a ny ti m e be fo re th e su rv ey A cc or di ng to : V a cc in a tio n c a rd 7 9 .7 7 6 .7 7 7 .6 7 6 .3 7 9 .8 7 8 .8 7 6 .3 7 3 .7 6 7 .4 0 .0 7 2 4 M o th e r's r e p o rt 1 7 .9 1 6 .9 1 6 .9 1 6 .9 1 7 .9 1 7 .9 1 7 .9 1 4 .5 1 4 .3 1 .5 7 2 4 E ith e r 9 7 .6 9 3 .6 9 4 .4 9 3 .2 9 7 .6 9 6 .7 9 4 .2 8 8 .2 8 1 .7 1 .5 7 2 4 V a cc in a te d b y 1 2 m o n th s o f a g e 9 7 .6 9 2 .6 9 3 .6 9 2 .0 9 7 .1 9 5 .7 9 3 .0 7 6 .1 6 7 .5 1 .5 7 2 4 Ta bl e C H .1 : V ac ci na tio ns in fi rs t y ea r o f l ife P e rc e n ta g e o f ch ild re n a g e d 1 2 -2 3 m o n th s im m u n iz e d a g a in st c h ild h o o d d is e a se s a t a n y tim e b e fo re t h e s u rv e y a n d b e fo re t h e f ir st b ir th d a y, M o n g o lia , 2 0 0 5 * M IC S In di ca to r 2 5 ** M IC S In di ca to r 2 7 ** * M IC S In di ca to r 2 6 ** ** M IC S In di ca to r 2 8 ; M D G In di ca to r 1 5 ** ** * M IC S In di ca to r 3 1 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : N u m b e r o f ch ild re n a g e d 1 2 -2 3 m o n th s 67 Tables B C G D P T 1 D P T 2 D P T 3 P ol io 1 P ol io 2 P ol io 3 M ea sl es A ll N on e Se x M al e 97 .1 93 .9 93 .6 92 .1 97 .4 95 .5 92 .9 87 .1 80 .8 1. 8 81 .1 3 81 F em al e 98 .2 93 .3 95 .3 94 .4 97 .9 97 .9 95 .6 89 .4 82 .7 1. 2 79 .8 3 42 Re gi on W es t 97 .7 91 .3 90 .5 86 .5 95 .3 93 .0 88 .3 77 .9 72 .4 2. 3 72 .6 1 28 K ha ng ai 97 .4 93 .0 96 .8 94 .9 98 .7 98 .7 94 .9 90 .9 80 .0 1. 3 79 .5 1 54 C en tr al 10 0. 0 96 .8 97 .6 96 .8 10 0. 0 99 .2 98 .4 95 .2 90 .4 0. 0 92 .0 1 25 E as t 94 .3 90 .9 92 .0 92 .0 96 .6 95 .5 92 .2 77 .7 69 .9 2. 3 88 .9 8 9 U la an ba at ar 97 .8 94 .6 94 .2 94 .2 97 .3 96 .4 95 .5 92 .4 87 .9 1. 8 75 .9 2 28 Re si de nc e U rb an 97 .9 95 .1 94 .8 94 .3 97 .9 96 .6 94 .9 89 .9 84 .5 1. 3 79 .4 3 93 R ur al 97 .3 91 .9 94 .0 91 .8 97 .3 96 .7 93 .4 86 .1 78 .3 1. 8 81 .7 3 31 Lo ca tio n C ap ita l c ity 97 .8 94 .6 94 .2 94 .2 97 .3 96 .4 95 .5 92 .4 87 .9 1. 8 75 .9 2 28 A im ag c en te r 98 .1 95 .7 95 .7 94 .5 98 .8 96 .9 93 .9 86 .6 79 .9 0. 6 84 .3 1 65 S ou m c en te r 96 .6 93 .1 93 .1 89 .6 96 .6 95 .4 89 .8 84 .1 73 .8 2. 3 87 .5 8 7 C ou nt ry si de 97 .6 91 .4 94 .3 92 .6 97 .6 97 .2 94 .7 86 .9 80 .0 1. 6 79 .6 2 44 M ot he r's e du ca tio n N on e (9 6. 9) (8 7. 5) (9 3. 7) (9 3. 7) (9 6. 9) (9 6. 9) (9 6. 9) (8 7. 5) (8 1. 3) (3 .1 ) (8 1. 1) 3 2 P rim ar y 96 .7 90 .1 93 .4 91 .7 96 .7 95 .0 91 .7 89 .9 79 .9 3. 3 85 .2 6 1 S ec on da ry ( 8t h gr ad e) 98 .3 94 .3 94 .9 92 .0 97 .7 96 .0 93 .3 87 .7 81 .0 0. 6 81 .4 1 77 S ec on da ry ( 10 th g ra de ) 98 .6 94 .5 95 .0 93 .6 98 .2 97 .3 94 .1 86 .6 80 .2 0. 4 82 .2 2 20 V oc at io na l (9 2. 5) (9 2. 3) (9 2. 3) (9 2. 3) (9 2. 5) (9 2. 5) (9 0. 0) (8 5. 0) (8 2. 5) (7 .5 ) (6 0. 1) 4 0 C ol le ge , u ni ve rs ity 97 .4 94 .3 94 .3 94 .3 98 .4 97 .9 96 .4 90 .6 84 .4 1. 6 80 .2 1 94 W ea lth in de x qu in til es P oo re st 98 .7 92 .8 94 .1 92 .1 98 .7 98 .1 96 .1 88 .1 81 .0 1. 3 75 .9 1 52 S ec on d 97 .2 92 .6 93 .7 92 .5 97 .1 94 .8 92 .6 84 .7 79 .6 1. 7 80 .0 1 75 M id dl e 97 .9 94 .2 94 .2 90 .6 96 .4 95 .7 89 .3 89 .2 79 .2 1. 4 88 .5 1 40 F ou rt h 97 .5 95 .8 95 .8 95 .0 99 .2 98 .3 96 .7 89 .2 82 .5 0. 8 80 .9 1 22 R ic he st 97 .0 93 .2 94 .7 96 .2 97 .0 97 .0 97 .0 90 .9 87 .1 2. 3 77 .4 1 34 T ot al 97 .6 93 .6 94 .4 93 .2 97 .6 96 .7 94 .2 88 .2 81 .7 1. 5 80 .5 7 24 Ta bl e CH .2 : V ac ci na tio ns b y ba ck gr ou nd c ha ra ct er is tic s P er ce nt ag e of c hi ld re n ag ed 1 2- 23 m on th s cu rr en tly v ac ci na te d ag ai ns t c hi ld ho od d is ea se s, M on go lia , 2 00 5 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : P er ce nt w ith h ea lth c ar d N um be r of c hi ld re n ag ed 1 2- 23 m on th s 68 Tables F lu id f ro m O R S p a ck e t R e co m m e n d e d h o m e m a d e f lu id N o t re a tm e n t S ex M a le 7 .3 1 8 4 2 3 8 .9 2 5 .3 4 1 .8 5 8 .2 1 3 4 F e m a le 5 .8 1 7 0 5 3 6 .9 3 5 .9 3 1 .1 6 8 .9 1 0 0 R eg io n W e st 7 .4 6 7 4 (2 4 .0 ) (3 2 .0 ) (4 8 .0 ) (5 2 .0 ) 5 0 K h a n g a i 8 .7 8 3 2 4 3 .8 3 4 .2 3 0 .1 6 9 .9 7 2 C e n tr a l 6 .6 6 0 7 (3 5 .0 ) (2 7 .6 ) (3 9 .9 ) (6 0 .1 ) 4 0 E a st 7 .2 3 7 5 (4 0 .8 ) (4 0 .8 ) (2 2 .3 ) (7 7 .7 ) 2 7 U la a n b a a ta r 4 .2 1 0 5 9 (4 5 .5 ) (1 5 .9 ) (4 3 .2 ) (5 6 .8 ) 4 5 R es id en ce U rb a n 4 .9 1 8 5 6 4 1 .2 2 2 .3 4 2 .1 5 7 .9 9 1 R u ra l 8 .4 1 6 9 1 3 6 .1 3 4 .7 3 4 .1 6 5 .9 1 4 3 Lo ca tio n C a p ita l c ity 4 .2 1 0 5 9 (4 5 .5 ) (1 5 .9 ) (4 3 .2 ) (5 6 .8 ) 4 5 A im a g c e n te r 5 .8 7 9 7 (3 7 .0 ) (2 8 .4 ) (4 1 .1 ) (5 8 .9 ) 4 6 S o u m c e n te r 8 .2 3 8 6 (3 7 .5 ) (3 4 .4 ) (3 7 .5 ) (6 2 .5 ) 3 2 C o u n tr ys id e 8 .5 1 3 0 5 3 5 .7 3 4 .8 3 3 .1 6 6 .9 1 1 1 A ge < 6 m o n th s 7 .8 4 0 0 (3 2 .5 ) (2 5 .8 ) (4 8 .2 ) (5 1 .8 ) 3 1 6 -1 1 m o n th s 1 0 .9 3 7 5 (5 3 .7 ) (2 2 .0 ) (2 6 .7 ) (7 3 .3 ) 4 1 1 2 -2 3 m o n th s 9 .7 7 2 4 3 4 .2 3 7 .1 3 7 .2 6 2 .8 7 0 2 4 -3 5 m o n th s 4 .7 7 1 4 (4 4 .1 ) (1 4 .6 ) (4 1 .3 ) (5 8 .7 ) 3 4 3 6 -4 7 m o n th s 4 .2 6 7 2 (3 2 .0 ) (4 6 .3 ) (2 8 .8 ) (7 1 .2 ) 2 8 4 8 -5 9 m o n th s 4 .5 6 6 3 (3 0 .2 ) (2 9 .8 ) (4 3 .3 ) (5 6 .7 ) 3 0 M ot he r's e du ca tio n N o n e 1 2 .3 1 6 1 (* ) (* ) (* ) (* ) 2 0 P ri m a ry 8 .0 2 9 7 (* ) (* ) (* ) (* ) 2 4 S e co n d a ry ( 8 th g ra d e ) 6 .6 8 9 5 3 2 .1 2 7 .1 4 2 .5 5 7 .5 5 9 S e co n d a ry ( 1 0 th g ra d e ) 5 .7 1 0 2 3 3 8 .9 3 0 .5 3 5 .7 6 4 .3 5 9 V o ca tio n a l 6 .7 2 5 2 (* ) (* ) (* ) (* ) 1 7 C o lle g e , u n iv e rs ity 6 .0 9 1 9 4 7 .4 2 9 .0 3 0 .9 6 9 .1 5 5 W ea lth in de x qu in til es P o o re st 8 .4 8 0 5 3 3 .8 3 2 .3 3 8 .2 6 1 .8 6 7 S e co n d 7 .1 8 3 8 3 1 .5 3 4 .9 3 6 .9 6 3 .1 6 0 M id d le 6 .5 6 8 8 (4 4 .4 ) (2 8 .8 ) (3 5 .7 ) (6 4 .3 ) 4 5 F o u rt h 5 .2 5 8 4 (3 6 .8 ) (2 6 .7 ) (3 6 .5 ) (6 3 .5 ) 3 0 R ic h e st 5 .0 6 3 2 (5 1 .7 ) (1 9 .5 ) (3 8 .6 ) (6 1 .4 ) 3 1 T o ta l 6 .6 3 5 4 7 3 8 .0 2 9 .9 3 7 .2 6 2 .8 2 3 4 Ta bl e C H .3 : O ra l r eh yd ra tio n tr ea tm en t P e rc e n ta g e o f a g e d 0 -5 9 m o n th s w ith d ia rr h o e a in t h e la st t w o w e e ks a n d t re a tm e n t w ith o ra l r e h yd ra tio n s o lu tio n ( O R S ) o r o th e r o ra l r e h yd ra tio n t re a tm e n t (O R T ), M o n g o lia , 2 0 0 5 * M IC S In di ca to r 33 C hi dr en w ith d ia rr ho ea w ho r ec ei ve d: N u m b e r o f ch ild re n a g e d 0 -5 9 m o n th s H a d d ia rr h o e a in la st t w o w e e ks N u m b e r o f ch ild re n a g e d 0 -5 9 m o n th s w ith d ia rr h o e a O R T u se r a te * 69 Tables D ra nk m or e D ra nk th e sa m e or le ss A te s om ew ha t l es s, sa m e or m or e A te m uc h le ss or n on e Se x M al e 7. 3 1 84 2 33 .6 64 .9 71 .0 29 .0 23 .9 45 .5 1 34 F em al e 5. 8 1 70 5 32 .0 66 .1 73 .1 26 .9 17 .0 47 .9 1 00 R eg io n W es t 7. 4 6 74 (3 4. 0) (6 2. 0) (6 6. 0) (3 4. 0) (2 0. 0) (3 8. 0) 5 0 K ha ng ai 8. 7 8 32 34 .2 63 .0 61 .6 38 .4 17 .8 46 .6 7 2 C en tr al 6. 6 6 07 (3 5. 1) (6 4. 9) (8 5. 0) (1 5. 0) (3 0. 1) (5 2. 6) 4 0 E as t 7. 2 3 75 (2 5. 7) (7 4. 3) (7 0. 5) (2 9. 5) (1 4. 6) (5 5. 4) 2 7 U la an ba at ar 4. 2 1 05 9 (3 1. 8) (6 8. 2) (8 4. 1) (1 5. 9) (2 2. 7) (4 5. 5) 4 5 R es id en ce U rb an 4. 9 1 85 6 27 .8 70 .0 78 .9 21 .1 17 .8 42 .3 9 1 R ur al 8. 4 1 69 1 36 .1 62 .5 67 .4 32 .6 23 .0 49 .3 1 43 Lo ca tio n C ap ita l c ity 4. 2 1 05 9 (3 1. 8) (6 8. 2) (8 4. 1) (1 5. 9) (2 2. 7) (4 5. 5) 4 5 A im ag c en te r 5. 8 7 97 (2 3. 9) (7 1. 8) (7 3. 9) (2 6. 1) (1 3. 0) (3 9. 2) 4 6 S ou m c en te r 8. 2 3 86 (5 0. 2) (4 6. 7) (5 3. 3) (4 6. 7) (3 1. 4) (4 0. 8) 3 2 C ou nt ry si de 8. 5 1 30 5 32 .1 67 .0 71 .4 28 .6 20 .5 51 .7 1 11 A ge 0 -1 1 m on th s 9. 3 7 75 36 .2 59 .6 79 .2 20 .8 23 .7 51 .5 7 2 12 -2 3 m on th s 9. 7 7 24 25 .6 74 .4 70 .2 29 .8 15 .7 44 .3 7 0 24 -3 5 m on th s 4. 7 7 14 (3 5. 1) (6 4. 9) (7 0. 7) (2 9. 3) (2 0. 6) (4 1. 1) 3 4 36 -4 7 m on th s 4. 2 6 72 (4 6. 3) (5 0. 2) (7 1. 5) (2 8. 5) (3 9. 2) (6 0. 5) 2 8 48 -5 9 m on th s 4. 5 6 63 (2 6. 8) (7 3. 2) (6 0. 1) (3 9. 9) (1 0. 1) (3 3. 3) 3 0 M ot he r's e du ca tio n N on e 12 .3 1 61 (* ) (* ) (* ) (* ) (* ) (* ) 2 0 P rim ar y 8. 0 2 97 (* ) (* ) (* ) (* ) (* ) (* ) 2 4 S ec on da ry ( 8t h gr ad e) 6. 6 8 95 23 .7 76 .3 66 .1 33 .9 13 .4 38 .7 5 9 S ec on da ry ( 10 th g ra de ) 5. 7 1 02 3 40 .6 57 .7 76 .4 23 .6 28 .9 50 .9 5 9 V oc at io na l 6. 7 2 52 (* ) (* ) (* ) (* ) (* ) (* ) 1 7 C ol le ge , u ni ve rs ity 6. 0 9 19 36 .4 61 .8 74 .7 25 .3 25 .5 52 .8 5 5 W ea lth in de x qu in til es P oo re st 8. 4 8 05 29 .4 69 .1 70 .6 29 .4 19 .2 47 .1 6 7 S ec on d 7. 1 8 38 35 .0 63 .4 63 .4 36 .6 16 .6 39 .8 6 0 M id dl e 6. 5 6 88 (3 3. 3) (6 2. 3) (7 5. 6) (2 4. 4) (2 4. 4) (5 0. 9) 4 5 F ou rt h 5. 2 5 84 (4 3. 4) (5 6. 6) (6 7. 0) (3 3. 0) (2 3. 4) (4 3. 6) 3 0 R ic he st 5. 0 6 32 (2 5. 8) (7 4. 2) (9 0. 3) (9 .7 ) (2 5. 8) (5 5. 0) 3 1 T ot al 6. 6 3 54 7 32 .9 65 .4 71 .9 28 .1 20 .9 46 .6 2 34 Ta bl e C H .4 : H om e m an ag em en t o f d ia rr ho ea P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s w ith d ia rr ho ea in th e la st tw o w ee ks w ho to ok in cr ea se d flu id s an d co nt in ue d to fe ed d u rin g th e ep is od e, M on go lia , 2 00 5 H ad d ia rr ho ea in la st tw o w ee ks N um be r of c hi ld re n ag ed 0 -5 9 m on th s w ith d ia rr ho ea * M IC S in di ca to r 3 4 ** M IC S in di ca to r 3 5 C hi ld re n w ith d ia rr ho ea w ho : R ec ei ve d O R T o r in cr ea se d flu id s A N D co nt in ue d fe ed in g* * H om e m an ag em en t o f di ar rh oe a* N um be r of c hi ld re n ag ed 0 -5 9 m on th s 70 Tables G ov t. ho sp ita l G ov t. he al th ce nt re F am ily do ct or B ag h do ct or M ob ile /o ut re ac h cl in ic O th er p ub lic P riv at e ho sp ita l cl in ic P riv at e ph ys ic ia n R el at iv e or fr ie nd T ra di tio na l pr ac tit io ne r Se x M al e 9. 7 1 84 2 4. 5 2. 8 30 .7 22 .8 0. 6 1. 7 0. 6 0. 6 5. 1 0. 0 62 .6 1 78 F em al e 8. 0 1 70 5 5. 2 1. 5 24 .5 31 .4 0. 0 1. 5 1. 5 0. 0 8. 8 1. 5 62 .5 1 36 Re gi on W es t 8. 4 6 74 8. 7 3. 5 12 .2 36 .9 0. 0 1. 7 0. 0 0. 0 3. 5 0. 0 61 .4 5 7 K ha ng ai 12 .3 8 32 5. 8 2. 9 12 .6 41 .3 0. 0 0. 0 1. 0 0. 0 5. 8 1. 0 59 .6 1 03 C en tr al 6. 6 6 07 (5 .0 ) (0 .0 ) (1 7. 3) (3 5. 1) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 2. 4) (0 .0 ) (5 7. 5) 4 0 E as t 6. 6 3 75 (0 .0 ) (0 .0 ) (2 9. 0) (1 9. 7) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (4 .2 ) (0 .0 ) (4 8. 6) 2 5 U la an ba at ar 8. 5 1 05 9 2. 3 2. 3 60 .2 1. 1 1. 1 4. 5 2. 3 1. 1 8. 0 1. 1 72 .7 9 0 Re si de nc e U rb an 8. 2 1 85 6 6. 6 3. 9 53 .8 3. 3 0. 7 3. 3 2. 0 0. 7 7. 9 1. 3 70 .3 1 52 R ur al 9. 5 1 69 1 3. 1 0. 6 3. 7 48 .5 0. 0 0. 0 0. 0 0. 0 5. 5 0. 0 55 .3 1 61 Lo ca tio n C ap ita l c ity 8. 5 1 05 9 2. 3 2. 3 60 .2 1. 1 1. 1 4. 5 2. 3 1. 1 8. 0 1. 1 72 .7 9 0 A im ag c en te r 7. 9 7 97 12 .7 6. 3 44 .6 6. 3 0. 0 1. 6 1. 6 0. 0 7. 9 1. 6 66 .8 6 3 S ou m c en te r 7. 2 3 86 (0 .0 ) (0 .0 ) (7 .1 ) (7 1. 5) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (7 5. 0) 2 8 C ou nt ry si de 10 .2 1 30 5 3. 7 0. 7 3. 0 43 .7 0. 0 0. 0 0. 0 0. 0 6. 7 0. 0 51 .2 1 33 Ag e 0- 11 m on th s 8. 6 7 75 1. 5 4. 5 28 .7 32 .6 0. 0 3. 0 1. 5 1. 5 2. 9 0. 0 68 .8 6 7 12 -2 3 m on th s 10 .0 7 24 7. 0 0. 0 36 .6 22 .0 1. 4 1. 4 1. 4 0. 0 4. 1 1. 4 68 .3 7 2 24 -3 5 m on th s 10 .4 7 14 8. 0 4. 1 28 .6 25 .5 0. 0 1. 4 1. 4 0. 0 8. 2 1. 3 66 .2 7 4 36 -4 7 m on th s 8. 1 6 72 3. 6 0. 0 11 .0 37 .9 0. 0 1. 9 0. 0 0. 0 9. 2 0. 0 52 .6 5 5 48 -5 9 m on th s 6. 9 6 63 (2 .2 ) (2 .2 ) (3 2. 9) (1 3. 0) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 0. 9) (0 .0 ) (5 0. 2) 4 6 M ot he r's e du ca tio n N on e 11 .7 1 61 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 1 9 P rim ar y 9. 7 2 97 (0 .0 ) (0 .0 ) (1 0. 5) (1 7. 1) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (2 0. 7) (0 .0 ) (2 7. 6) 2 9 S ec on da ry ( 8t h gr ad e) 9. 2 8 95 4. 9 2. 4 23 .2 30 .0 0. 0 2. 4 1. 2 0. 0 4. 8 0. 0 59 .3 8 3 S ec on da ry ( 10 th g ra de ) 8. 7 1 02 3 4. 5 1. 1 32 .9 27 .8 1. 1 2. 3 0. 0 0. 0 4. 5 0. 0 69 .8 8 9 V oc at io na l 8. 7 2 52 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 2 2 C ol le ge , u ni ve rs ity 7. 9 9 19 4. 1 4. 2 40 .5 17 .8 0. 0 1. 4 2. 8 0. 0 9. 7 1. 4 66 .6 7 2 W ea lth in de x qu in til es P oo re st 10 .2 8 05 6. 0 1. 2 1. 2 38 .5 0. 0 0. 0 0. 0 0. 0 8. 4 0. 0 47 .0 8 2 S ec on d 8. 3 8 38 0. 0 2. 9 24 .6 37 .0 0. 0 0. 0 1. 4 1. 5 4. 3 1. 4 63 .0 7 0 M id dl e 10 .3 6 88 5. 6 1. 4 32 .6 26 .6 0. 0 5. 7 0. 0 0. 0 7. 1 0. 0 70 .5 7 1 F ou rt h 7. 4 5 84 (4 .7 ) (2 .3 ) (5 3. 7) (1 6. 1) (2 .3 ) (0 .0 ) (0 .0 ) (0 .0 ) (7 .0 ) (0 .0 ) (7 6. 8) 4 3 R ic he st 7. 5 6 32 (8 .4 ) (4 .2 ) (4 9. 1) (0 .0 ) (0 .0 ) (2 .1 ) (4 .3 ) (0 .0 ) (6 .4 ) (2 .1 ) (6 3. 9) 4 7 T ot al 8. 8 3 54 7 4. 8 2. 2 28 .0 26 .5 0. 3 1. 6 1. 0 0. 3 6. 7 0. 6 62 .6 3 13 Ta bl e CH .5 : C ar e se ek in g fo r s us pe ct ed p ne um on ia P er ce nt ag e of c hi ld re n ag ed 0 -5 9 m on th s in th e la st tw o w ee ks ta ke n to a h ea lth p ro vi de r, M on go lia , 2 00 5 N um be r of ch ild re n ag ed 0- 59 m on th s H ad a cu te re sp ito ry in fe ct io n * M IC S in di ca to r 2 3 Ch ild re n w ith s us pe ct ed p ne um on ia w ho w er e ta ke n to : Pu bl ic s ou rc es Pr iv at e so ur ce s O th er s ou rc e N um be r of c hi ld re n ag ed 0 -5 9 m on th s w ith s us pe ct ed pn eu m on ia A ny ap pr op ria te pr ov id er * 71 Tables P e rc e n ta g e o f c h ild re n a g e d 0 -5 9 m o n th s w it h s u s p e c te d p n e u m o n ia w h o r e c e iv e d a n ti b io ti c s i n t h e l a s t tw o w e e k s * N u m b e r o f c h ild re n a g e d 0 -5 9 m o n th s w it h s u s p e c te d p n e u m o n ia i n t h e t w o w e e k s p ri o r to t h e s u rv e y S ex M a le 7 2 .5 1 7 8 F e m a le 6 9 .1 1 3 6 R eg io n W e s t 8 2 .5 5 7 K h a n g a i 6 3 .4 1 0 3 C e n tr a l (7 5 .0 ) 4 0 E a s t (6 8 .3 ) 2 5 U la a n b a a ta r 7 1 .6 9 0 R es id en ce U rb a n 7 1 .5 1 5 2 R u ra l 7 0 .6 1 6 1 Lo ca tio n C a p it a l c it y 7 1 .6 9 0 A im a g c e n te r 7 1 .5 6 3 S o u m c e n te r (7 8 .7 ) 2 8 C o u n tr y s id e 6 8 .9 1 3 3 A ge 0 -1 1 m o n th s 7 3 .0 6 7 1 2 -2 3 m o n th s 7 3 .7 7 2 2 4 -3 5 m o n th s 6 7 .7 7 4 3 6 -4 7 m o n th s 7 6 .4 5 5 4 8 -5 9 m o n th s (6 3 .2 ) 4 6 M ot he r' s ed uc at io n N o n e (6 3 .1 ) 1 9 P ri m a ry (5 5 .2 ) 2 9 S e c o n d a ry ( 8 th g ra d e ) 7 2 .3 8 3 S e c o n d a ry ( 1 0 th g ra d e ) 7 6 .5 8 9 V o c a ti o n a l (7 2 .5 ) 2 2 C o lle g e , u n iv e rs it y 7 0 .9 7 2 W ea lth in de x qu in til es P o o re s t 6 2 .7 8 2 S e c o n d 7 1 .4 7 0 M id d le 6 9 .0 7 1 F o u rt h (8 1 .3 ) 4 3 R ic h e s t (7 8 .7 ) 4 7 T o ta l 7 1 .1 3 1 3 * M IC S in di ca to r 22 Ta bl e C H .6 : A nt ib io tic tr ea tm en t o f p ne um on ia P e rc e n ta g e o f c h ild re n a g e d 0 -5 9 m o n th s w it h s u s p e c te d p n e u m o n ia w h o r e c e iv e d a n ti b io ti c t re a tm e n t, M o n g o lia , 2 0 0 5 72 Tables Is n o t a b le t o d ri n k o r b re a st fe e d B e co m e s si ck e r D e ve lo p s a fe ve r H a s fa st b re a th in g H a s d iff ic u lty b re a th in g H a s b lo o d in st o o l Is d ri n ki n g p o o rl y H a s o th e r sy m p to m s R eg io n W e st 1 4 .6 3 7 .1 8 6 .4 2 2 .8 2 7 .5 2 0 .4 4 .1 1 7 .0 1 0 .2 6 7 4 K h a n g a i 1 7 .0 2 4 .6 8 5 .5 1 5 .3 2 5 .8 1 3 .6 5 .3 2 7 .4 4 .1 8 3 2 C e n tr a l 1 5 .3 3 5 .8 8 5 .1 2 6 .6 2 5 .0 1 8 .4 5 .4 2 8 .1 1 2 .3 6 0 7 E a st 9 .5 3 7 .1 9 1 .2 2 1 .0 1 4 .0 9 .9 1 .3 1 9 .2 7 .4 3 7 5 U la a n b a a ta r 1 2 .1 4 5 .3 8 3 .5 2 1 .3 2 1 .3 1 2 .0 2 .1 1 9 .4 8 .1 1 0 5 9 R es id en ce U rb a n 1 2 .9 4 3 .2 8 3 .8 2 1 .5 2 1 .0 1 4 .2 2 .9 2 1 .0 7 .9 1 8 5 6 R u ra l 1 5 .2 2 8 .9 8 7 .6 2 0 .5 2 6 .0 1 5 .6 4 .6 2 3 .7 8 .5 1 6 9 1 Lo ca tio n C a p ita l c ity 1 2 .1 4 5 .3 8 3 .5 2 1 .3 2 1 .3 1 2 .0 2 .1 1 9 .4 8 .1 1 0 5 9 A im a g c e n te r 1 4 .0 4 0 .4 8 4 .3

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