Mongolia - Multiple Indicator Cluster Survey - 2010

Publication date: 2010

MONGOLIA "CHILD DEVELOPMENT-2010" survey Multiple Indicator Cluster Survey – 4 FINAL REPORT Ulaanbaatar 2013 ii Prepared by:: O. Baigalmaa, Statistician, PSSD, NSO S. Todgerel, Officer, PSSD, NSO N. Amarbayasgalan, Officer, PSSD, NSO Z. Munkhzul, MICS Consultant Cover picture: © UNICEF Mongolia/Sokol/2012 Note: This report is also available in Mongolian. The statements and opinions expressed here are only those of the authors and do not necessarily reflect those of the institutions involved. NATIONAL STATISTICS OFFICE OF MONGOLIA Government Building III Sukhbaatar District, Baga Toiruu Ulaanbaatar, Mongolia Website: http://www.nso.mn E-mail: nso@magicnet.mn Fax: 976-11-324518 Telephone: 976-11-264554, 265543 The Child Development Survey (Mongolia Multiple Indicator Cluster Survey) was carried out in 2010 by National Statistical Office. Financial and technical support was provided by the Government of Mongolia and the United Nations Children's Fund (UNICEF). Mongolia Multiple Indicator Cluster Survey (MICS) is an international household survey programme developed by UNICEF. The Mongolia Child Development 2010 survey was conducted as part of the fourth global round of MICS surveys (MICS4). Additional information on the global MICS project may be obtained from www.childinfo.org. Published by National Statistics Office. Ulaanbaatar, Mongolia, 2013 iii CONTENTS FOREWORD. .v ACKNOWLEDGEMENT . vi LIST OF TABLES. . vii LIST OF FIGURES. . xii LIST OF ABBREVIATIONS . xiii LIST OF REFERENCES . xiv SUMMARY TABLE OF FINDINGS . xv EXECUTIVE SUMMARY . xxii CHAPTER I. INTRODUCTION . 1 Background. . 2 A commitment to action: national and international reporting responsibilities . 2 Survey objectives . 3 CHAPTER II. SAMPLE AND SURVEY METHODOLOGY. 5 Sample design. . 6 Questionnaires. . 6 Training and fieldwork . 8 Data processing . 9 CHAPTER III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS .11 Sample coverage .12 Characteristics of households .12 Characteristics of respondents .13 Data disaggregation .15 CHAPTER IV. CHILD MORTALITY . 23 CHAPTER V. NUTRITION . 29 Nutritional status . 30 Breastfeeding and infant and young child feeding . 32 Salt iodization. . 35 Vitamin a supplementation . 37 Low birth weight . 38 CHAPTER VI. CHILD HEALTH .51 Immunizations. . 52 Oral rehydration treatment . 53 Care seeking and antibiotic treatment of suspected pneumonia . 55 Solid fuel use. . 56 Children increased at risk of disability and child injury . 56 CHAPTER VII. WATER AND SANITATION .71 Use of improved water sources . 72 Use of improved sanitation .74 Hand washing. . 75 iv CHAPTER VIII. REPRODUCTIVE HEALTH .91 Fertility. . 92 Contraception. . 93 Unmet need. . 94 Antenatal care. . 95 Assistance at delivery . 96 Place of delivery . 97 CHAPTER IX. CHILD DEVELOPMENT . 113 Early childhood education and learning .114 Early childhood development .116 CHAPTER X. LITERACY AND EDUCATION .125 Literacy among young women and men .126 School readiness .126 Primary and secondary education participation .127 CHAPTER XI. CHILD PROTECTION. .141 Birth registration .142 Child labour. .142 Child discipline . 144 Early marriage. .145 Attitudes toward domestic violence .147 CHAPTER XII. HIV, AIDS AND SEXUAL BEHAVIOUR .169 Knowledge about hiv transmission and misconceptions about hiv, aids. .170 Accepting attitudes toward people living with hiv, aids .172 Knowledge of a place for hiv testing, counseling and testing during antenatal care .172 Sexual behaviour related to hiv transmission .173 CHAPTER XIII.ACCESS TO MASS MEDIA AND USE OF INFORMATION/ COMMUNICATION TECHNOLOGY .199 Access to mass media . 200 Use of information/ communication technology . 200 CHAPTER XIV.TOBACCO AND ALCOHOL USE.207 Tobacco use. . 208 Alcohol use. 209 CHAPTER XV. SUBJECTIVE WELL-BEING .217 APPENDIX A. SAMPLE DESIGN . 227 Sample size and sample allocation . 228 Sampling frame and selection of clusters . 229 Household listing and selection . 230 Calculation of sample weights . 230 APPENDIX B.LIST OF PERSONNEL INVOLVED IN THE SURVEY . 233 APPENDIX C. ESTIMATES OF SAMPLING ERRORS . 237 APPENDIX D. DATA QUALITY TABLES . 283 APPENDIX E. MICS4 INDICATORS: NUMERATORS AND DENOMINATORS . 301 APPENDIX F. QUESTIONNAIRES .311 v FOREWORD The National Statistical Office of Mongolia and UNICEF Mongolia are pleased to introduce the results of the fourth round of the Multiple Indicator Cluster Survey (MICS). The survey aimed to provide data to measure Mongolia's progress towards achieving the goals of the National Programme of Action for the Development and Protection of Children, as well as the goals of the "World Fit for Children" and the Millennium Development Goals. The present MICS was conducted according to the national Law on statistics, with the financial support of the Government of Mongolia and UNICEF. The survey collected data to reveal the present situation of children and women in Mongolia, including information related to their rights, health, education, lifestyle and male and female awareness of, and attitudes towards, HIV/AIDS and sexual behavior. New indicators were introduced in this round of the MICS. These included indicators on child injuries, access to handwashing facilities, mass media, use of information and communication technologies, use of tobacco and alcohol, overall life satistaction, sexual behavior and knowledge of disease symptoms. In addition, the present MICS included a questionnaire for men aged 15 to 54, to enrich the availability of sex-disaggregated data. The MICS results will serve an integral role in Government policy-making and programming, with a view to improving the well-being, health and life conditions of children and women in Mongolia. It will serve as a key resource and reference for researchers and academics to conduct in-depth analysis and research in various areas. We wish to extend our heartfelt gratitude to the Intersectoral Steering Committee and Joint Task Force, comprising the Ministry of Education, Culture and Science, Ministry of Health, Social Welfare and Labour, Ministry of Justice and Home Affairs, Ministry of Environment and Tourism, as well as the National Authority for Children, the Nutrition Research Center at the Public Health Institute, the General Police Department and the End Child Prostitution, Child Pornography and Trafficking (ECPAT) network. Their valuable inputs and comments were an asset to the development and execution of the survey and its questionnaires, as well the writing of this report. MENDSAIKHAN Sonomtseren MOHAMED M. M FALL Chairman Representative National Statistical Office Mongolia UNICEF Mongolia vi ACKNOWLEDGEMENT The National Statistical Office of Mongolia (NSO) has successfully conducted the "Child Development Survey" (MICS) for the fourth time. The main objective of this survey was to make available statistical data on health, education, development, protection, well-being of children and women and the implementation of their rights in Mongolia and to review the "A World Fit for Children" Declaration, the National Programme of Action for the Development and Protection of Children, adopted by the Government of Mongolia, and the indicators of the Millennium Development Goals as well as to supplement the data of the previous surveys. I believe the results of the Child Development Survey 2010 will be an information source material to policymakers and will make a contribution to provision of researchers and users with a wide range of information about children, women and men. It is my pleasure to express my gratitude to the members of the Steering Committee and the Working Group of the survey and all contributors who participated in preparing the Survey Report for their professional advice and collaboration on successfully conducting the Child Development Survey, carried out in over 60 countries around the world, in Mongolia in line with the highest standards of professionalism and international standards. In meantime, I would like to stress that the provision technical and methodological recommendations from the UNICEF at every stage of the survey operations and the organization of three special training and workshops for our staff were of great importance for the successful conduct of the survey. Extended thanks go to the staff of the UNICEF Headquarters, EAPRO and UNICEF Representative Office of Mongolia for their financial, technical and methodological support and assistance in carrying out the Child Development Survey 2010. We would like to express our appreciation to the household, women and men who have involved in the survey. B. ERDENESUREN Vice-Chairman National Statistical Office Mongolia vii LIST OF TABLES Table HH.1: Results of household, women’s, men’s, under-5’s and children aged 2-14’s interviews .16 Table HH.2: Household age distribution by sex .17 Table HH.3: Household composition .18 Table HH.4: Women’s background characteristics .19 Table HH.4M: Men’s background characteristics . 20 Table HH.5: Under-5’s background characteristics .21 Table HH.5A: Children aged 2-14’s background characteristics. 22 Table CM.1: Children ever born, children surviving and proportion dead . 27 Table CM.2: Child mortality . 27 Table CM.3: Estimates of infant and under-5 mortality by selected life table models . 28 Table NU.1: Nutritional status of children . 40 Table NU.2: Initial breastfeeding .41 Table NU.3: Breastfeeding . 42 Table NU.4: Duration of breastfeeding . 43 Table NU.5: Age-appropriate breastfeeding . 44 Table NU.6: Introduction of solid or semi-solid foods . 45 Table NU.7: Minimum meal frequency . 46 Table NU.8: Bottle feeding . 47 Table NU.9: Iodized salt consumption . 48 Table NU.10: Children’s vitamin A supplementation . 49 Table NU.11: Low birth weight infants . 50 Table CH.1: Vaccinations in first year of life . 58 Table CH.2: Vaccinations by selected background characteristics . 59 Table CH.4: Oral rehydration solutions and recommended homemade fluids . 60 Table CH.5: Feeding practices during diarrhoea .61 Table CH.6: Oral rehydration therapy with continued feeding and other treatments . 62 Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia . 63 Table CH.8: Knowledge of the two danger signs of pneumonia . 64 Table CH.9: Solid fuel use . 65 Table CH.10: Solid fuel use by place of cooking . 66 Table CH.17: Children at increased risk of disability . 67 Table CH.17A: Types of child injury . 68 Table CH.17B: Places of child injury . 69 Table WS.1: Use of improved water sources . 77 Table WS.1A: Use of improved water sources based on country-specific definition . 78 viii Table WS.2: Household water treatment . 79 Table WS.2A: Household water treatment based on country-specific definition of improved and unimproved water source . 80 Table WS.3: Time to source of drinking water . 81 Table WS.3A: Time to source of drinking water based on country-specific definition of improved and unimproved water source . 82 Table WS.4: Person collecting water . 83 Table WS.5: Types of sanitation facilities . 84 Table WS.6: Use and sharing of sanitation facilities . 85 Table WS.7: Disposal of child’s faeces . 86 Table WS.8: Drinking water and sanitation ladders . 87 Table WS.8A: Drinking water and sanitation ladders based on country-specific definition . 88 Table WS.9: Water and soap at place for handwashing. 89 Table WS.10: Availability of soap . 90 Table RH.1: Adolescent birth rate and total fertility rate . 99 Table RH.2: Early childbearing . 100 Table RH.3: Trends in early childbearing .101 Table RH.4: Use of contraception.102 Table RH.4A: Women’s knowledge of contraception .103 Table RH.4AM: Men’s knowledge of contraception . 104 Table RH.5: Unmet need for contraception .105 Table RH.6: Antenatal care provider . 106 Table RH.7: Number of antenatal care visits .107 Table RH.7A: Timing of first antenatal care . 108 Table RH.8: Content of antenatal care . 109 Table RH.9: Assistance during delivery .110 Table RH.10: Place of delivery . 111 Table CD.1: Early childhood education .118 Table CD.2: Support for learning .119 Table CD.3: Learning materials .120 Table CD.4: Inadequate care .121 Table CD.5: Early child development index .122 Table CD.5A: Early child development index based on country-specific definition .123 Table ED.1: Literacy among young women .130 Table ED.1M: Literacy among young men .131 Table ED.2: School readiness .132 Table ED.3: General educational school entry .133 Table ED.4: Primary education attendance .134 Table ED.5: Secondary school attendance .135 ix Table ED.5A: Basic education attendance .136 Table ED.6: Children reaching last grade of primary education .137 Table ED.7: Primary education completion and transition to secondary education .138 Table ED.8: Education gender parity .139 Table CP.1: Birth registration . 148 Table CP.2: Child labour .149 Table CP.2A: Child labour based on country-specific definition .151 Table CP.3: Child labour and school attendance .153 Table CP.3A: Child labour and school attendance based on country-specific definition .155 Table CP.4: Child discipline .157 Table CP.5: Early marriage among women .158 Table CP.5M: Early marriage among men .159 Table CP.6: Trends in early marriage among women .160 Table CP.6M: Trends in early marriage among men .160 Table CP.7: Spousal age difference among women .161 Table CP.11: Women’s attitudes towards domestic violence .162 Table CP.11M: Men’s attitudes towards domestic violence . 164 Table CP.12: Children’s living arrangements and orphanhood .166 Table CP.13: School attendance of orphans and non-orphans .167 Table HA.1: Women’s knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission .175 Table HA.1M: Men’s knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission .176 Table HA.2: Young women’s knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission .177 Table HA.2M: Young men’s knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission .178 Table HA.3: Women’s knowledge of mother-to-child HIV transmission .179 Table HA.3M: Men’s knowledge of mother-to-child HIV transmission . 180 Table HA.4: Women’s accepting attitudes towards people living with HIV/AIDS .181 Table HA.4M: Men’s accepting attitudes towards people living with HIV/AIDS .182 Table HA.5: Women’s knowledge of a place for HIV testing .183 Table HA.5M: Men’s knowledge of a place for HIV testing . 184 Table HA.6: Knowledge of a place for HIV testing among sexually active young women .185 Table HA.6M: Knowledge of a place for HIV testing among sexually active young men .186 Table HA.7: HIV counseling and testing during antenatal care .187 Table HA.8: Sexual behaviour that increases the risk of HIV infection among young women . 188 Table HA.8M: Sexual behaviour that increases the risk of HIV infection among young men .189 Table HA.9: Sex with multiple partners among all women .190 Table HA.9M: Sex with multiple partners among all men.191 x Table HA.10: Sex with multiple partners among young women .192 Table HA.10M: Sex with multiple partners among young men .193 Table HA.11: Sex with non-regular partners among young women .194 Table HA.11M: Sex with non-regular partners among young men.195 Table HA.12: Sex with non-regular partners among all women .196 Table HA.12M: Sex with non-regular partners among all men .197 Table MT.1: Women’s exposure to mass media . 202 Table MT.1M: Men’s exposure to mass media . 202 Table MT.2: Use of computers and the internet among young women . 204 Table MT.2M: Use of computers and the internet among young men . 205 Table TA.1: Current and ever use of tobacco among women .210 Table TA.1M: Current and ever use of tobacco among men .211 Table TA.2: Women’s age at first use of cigarettes and frequency of use .212 Table TA.2M: Men’s age at first use of cigarettes and frequency of use .213 Table TA.3: Use of alcohol among women .214 Table TA.3M: Use of alcohol among men .215 Table SW.1: Domains of life satisfaction among young women . 220 Table SW.1M: Domains of life satisfaction among young men .221 Table SW.2: Life satisfaction and happiness among young women . 222 Table SW.2M: Life satisfaction and happiness among young men . 223 Table SW.3: Perception of a better life among young women .224 Table SW.3M: Perception of a better life among young men . 225 Table SE.1: Indicators selected for sampling error calculations . 239 Table SE.2: Sampling errors: Total sample .242 Table SE.3: Sampling errors: Urban .247 Table SE.4: Sampling errors: Rural .252 Table SE.5: Sampling errors: Western region .257 Table SE.6: Sampling errors: Khangai region . 262 Table SE.7: Sampling errors: Central region . 267 Table SE.8: Sampling errors: Eastern region .272 Table SE.9: Sampling errors: Ulaanbaatar . 277 Table DQ.1: Age distribution of household population . 284 Table DQ.2: Age distribution of eligible and interviewed women . 285 Table DQ.2M: Age distribution of eligible and interviewed men . 285 Table DQ.3: Age distribution of eligible and interviewed under-5 children . 286 Table DQ.3A: Age distribution of eligible and interviewed children aged 2-14 years . 286 Table DQ.4: Women’s completion rates by socio-economic characteristics of households . 287 Table DQ.4M: Men’s completion rates by socio-economic characteristics of households . 288 xi Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households . 289 Table DQ.5A: Completion rates for questionnaires for children aged 2-14 years by socio-economic characteristics of households . 290 Table DQ.6: Completeness of reporting .291 Table DQ.7: Completeness of information for anthropometric indicators .292 Table DQ.8: Heaping in anthropometric measurements .293 Table DQ.9: Observation of places for hand washing . 294 Table DQ.11: Observation of birth certificates of children age under 5 . 295 Table DQ.12: Observation of vaccination cards . 296 Table DQ.13: Presence of mother in the household and the person interviewed for the under-5 questionnaire . 297 Table DQ.14: Selection of children aged 2-14 years for the child discipline module . 298 Table DQ.15: School attendance by single age . 299 Table DQ.16: Sex ratio at birth among children ever born and living . 300 xii LIST OF FIGURES Figure HH.1: Age and sex distribution of household population, Mongolia, 2010 .13 Figure CM.1: Under-5 mortality rates by background characteristics, Mongolia, 2010 . 25 Figure CM.2: Trend in under-five mortality rates, from different sources, Mongolia, 2010 . 26 Figure NU.1: Percentage of children under-five who are underweight, stunted and wasted, Mongolia, 2010 . 32 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Mongolia, 2010 . 33 Figure NU.3: Percentage of households consuming adequately iodized salt, Mongolia, 2010 . 36 Figure NU.4: Percentage of infants weighing less than 2500 grams at birth, Mongolia, 2010 . 39 Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months, Mongolia, 2010 . 53 Figure CH.2: Percentage of children under age 5 with diarrhoea who received oral rehydration treatment, Mongolia, 2010 . 54 Figure CH.3: Percentage of children under age 5 with diarrhoea who received ORT or increased fluids, AND continued feeding, Mongolia, 2010 . 55 Figure WS.1: Percent distribution of household members by source of drinking water, Mongolia, 2010 . 73 Figure HA.1: Percentage of women who have comprehensive knowledge of HIV/AIDS transmission, Mongolia, 2010 .171 Figure HA.2: Sexual behaviour that increases risk of HIV infection, Mongolia, 2010 .174 xiii LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome CSPro Census and Survey Processing System DPT Diphtheria, pertussis and tetanus ECDI Early Childhood Development Index EPI Expanded Programme on Immunization FMCS Full Management of Child's Sickness GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorder IMR Infant mortality rate IUD Intra uterine device LAM Lactational amenorrheoa method MDG Millennium Development Goal MECS Ministry of Education, culture and science MICS Multiple Indicator Cluster Survey MMR Measles, Mumps and Rubella MoH Ministry of Health MSWL Ministry of Social Welfare and Labour NAC National Authority for Children NAR Net attendance ratio NDIC National Development and Innovation Committee NSO National Statistical Office ORS Oral rehydration salts ORT Oral rehydration therapy PPM Parts per million PSSD Population and Social Statistics Department PSU Primary Sampling Unit RHF Recommended Home Fluid SD Standard deviation SPSS Statistical Package for the Social Sciences STI Sexual transmitted infection TFR Total fertility rate U5MR Under 5 mortality rate UN United Nations UNFPA United Nations Population Funds UNGASS United Nations General Assembly Special Session UNICEF United Nations Children's Fund WHO World Health Organization xiv LIST OF REFERENCES Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. WHO and UNICEF, 2008. Joint Monitoring Programme: MDG assessment report. Avialable at: http://www.wssinfo.org/download?id_document=1279 United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). Government of Mongolia, 2002. National programme of action for the development and protection of children, 2002-2010, Ulaanbaatar, Mongolia National Statistical Office and UNICEF, 2007. Mongolia Multiple Indicator Cluster Survey 2005, Final Report. Ulaanbaatar, Mongolia National Statistical Office and UNICEF, 2001. Mongolia Multiple Indicator Cluster Survey 2000, Final Report. Ulaanbaatar, Mongolia National Statistical Office and UNFPA, 2004. Reproductive Health survey 2003, Ulaanbaatar, Mongolia National Statistical Office and UNFPA, 2009. Reproductive Health survey 2008, Ulaanbaatar, Mongolia http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf http://www.childinfo.org http://www.childmortality.org http://www.cdc.gov/ xv SUMMARY TABLE OF FINDINGS Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDG) Indicators, Mongolia, 20101 Topic MICS4 Indicator Number1 MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1.1 4.1 Under-five mortality rate 45 per 1 000 live births 1.2 4.2 Infant mortality rate 36 per 1 000 live births CHILD NUTRITION Nutritional status 1.8 Underweight prevalence 2.1a Moderate and severe (Z<-2SD) 3.3 percent 2.1b Severe (Z<-3SD) 0.9 percent Stunting prevalence 2.2a Moderate and severe (Z<-2SD) 15.3 percent 2.2b Severe (Z<-3SD) 4.7 percent Wasting prevalence 2.3a Moderate and severe (Z<-2SD) 1.6 percent 2.3b Severe (Z<-3SD) 0.7 percent Breastfeeding and infant feeding 2.4 Ever breastfeeding 97.5 percent 2.5 Early initiation of breastfeeding 71.4 percent 2.6 Exclusive breastfeeding (0-5 months) 65.7 percent 2.7 Continued breastfeeding at 1 year (12-15 months) 82.4 percent 2.8 Continued breastfeeding at 2 years (20-23 months) 64.7 percent 2.9 Predominant breastfeeding (0-5 months) 70.9 percent 2.10 Median duration of breastfeeding (0-35 months) 24.6 months 2.11 Children who drank anything from a bottle with nipple (0-23 months) 20.8 percent 2.12 Introduction of solid or semi-solid foods (6-8 months) 65.8 percent 2.13 Minimum meal frequency (6-23 months) 29.9 percent 2.14 Age-appropriate breastfeeding (0-23 months) 69.3 percent 2.15 Milk feeding frequency for non-breastfed children 71.4 percent Salt iodization 2.16 Iodized salt consumption 69.9 percent Vitamin A 2.17 Vitamin A supplementation (6-59 months) 61.0 percent Low birth weight 2.18 Low-birth weight infants 4.7 percent Infants weighed at birth 98.0 percent 1 Some indicators are calculated based on the country specific needs and these indicators are marked with CS. Male age group is 15-54 which is different from the age groups of standard indicators. xvi Topic MICS4 Indicator Number1 MDG Indicator Number Indicator Value CHILD HEALTH Immunization 3.1 Immunization coverage for Tuberculosis 97.9 percent 3.2 Immunization coverage for Polio 3 93.3 percent 3.3 Immunization coverage for DPT or Penta 3 92.1 percent 3.4 4.3 Immunization coverage for Measles, Mumps and Rubella 1 86.6 percent 3.5 Immunization coverage for Hepatitis B 96.7 percent Care of illness 3.8 Oral rehydration therapy with continued feeding 56.0 percent 3.9 Care seeking for suspected pneumonia 86.8 percent 3.10 Antibiotic treatment of suspected pneumonia 72.5 percent Solid fuel use 3.11 Use of solid fuels for cooking 68.2 percent Child disability 3.21 Children at increased risk of disability 13.5 percent Child injury CS.1 Children had injury in the last 12 months 4.3 percent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 65.2 percent CS.2 Use of improved drinking water sources (country specific) 77.9 percent 4.2 Water treatment 37.0 percent CS.3 Water treatment (country specific) 31.8 percent 4.3 7.9 Use of improved sanitation 54.3 percent CS.4 Use of improved sanitation (country specific) 83.1 percent 4.4 Safe disposal of child's faeces 60.0 percent 4.5 Place for handwashing with water and soap available 92.1 percent 4.6 Availability of soap 98.9 percent REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.4 Adolescent birth rate 38 per 1 000 adolescents 5.2 Childbearing before age 18 among young women 2.4 percent CS.5 Knowledge of contraception Women (age 15-49) 97.4 percent Men (age 15-54) 88.6 percent 5.3 5.3 Contraceptive prevalence rate 54.9 percent 5.4 5.6 Unmet need for contraception 22.3 percent xvii Topic MICS4 Indicator Number1 MDG Indicator Number Indicator Value Maternal and newborn health 5.5 Antenatal care coverage 5.5a At least once by skilled personnel 99.0 percent 5.5b At least four times by any personnel 81.4 percent CS.6 First antenatal care visit during the first 3 months of pregnancy 77.2 percent 5.6 Content of antenatal care 95.2 percent 5.7 5.2 Skilled attendant at delivery 98.8 percent 5.8 Institutional deliveries 98.5 percent 5.9 Caesarean section 20.9 percent CHILD DEVELOPMENT Child development 6.1 Support for learning 57.1 percent 6.2 Father›s support for learning 38.8 percent 6.3 Learning materials – Three or more children›s books 22.8 percent 6.4 Learning materials – Two or more types of playthings 68.4 percent 6.5 Inadequate care 8.5 percent 6.6 Early child development index 85.1 percent 6.7 Pre-school attendance 57.9 percent EDUCATION Literacy and education 7.1 2.3 Literacy rate among young people (15-24 years) Women 97.9 percent Men 95.8 percent 7.2 School readiness 90.5 percent 7.3 Net intake rate in primary education 81.0 percent 7.4 2.1 Primary education net attendance rate (adjusted) 98.5 percent 7.5 Secondary education net attendance rate (adjusted) 93.4 percent 7.6 2.2 Reaching last grade of primary education 98.6 percent 7.7 Primary education completion rate 98.7 percent 7.8 Transition rate to secondary education 99.0 percent 7.9 3.1 Gender parity index (primary education) 1.01 ratio 7.10 3.1 Gender parity index (secondary education) 1.05 ratio CHILD PROTECTION Birth registration 8.1 Birth registration 99.0 percent xviii Topic MICS4 Indicator Number1 MDG Indicator Number Indicator Value Child labour 8.2 Child labour Age 5-14 29.2 percent Age 5-17 28.4 percent CS.7 Child labour (country specific) Age 5-14 10.4 percent Age 5-17 12.9 percent 8.3 School attendance among child labourers Age 5-14 95.7 percent Age 5-17 91.9 percent CS.8 School attendance among child labourers (country specific) Age 5-14 94.8 percent Age 5-17 87.9 percent 8.4 Child labour among students Age 5-14 29.5 percent Age 5-17 27.9 percent CS.9 Child labour among students (country specific) Age 5-14 10.5 percent Age 5-17 12.1 percent Child discipline 8.5 Violent discipline 45.6 percent Early marriage 8.6 Marriage before age 15 Women (age 15-49) 0.4 percent Men (age 15-54) 0.3 percent 8.7 Marriage before age 18 Women (age 20-49) 6.8 percent Men (age 20-54) 2.0 percent 8.8 Young people aged 15-19 currently married or in union Women 4.8 percent Men 0.9 percent Young women married/ in union with men older than 10 years 8.10a Age 15-19 8.5 percent 8.10b Age 20-24 2.0 percent Domestic violence 8.14 Accepting attitudes towards domestic violence Women (age 15-49) 10.1 percent Men (age 15-54) 8.8 percent Orphaned children 9.17 Children living arrangements 6.0 percent 9.18 Prevalence of children with one or both parents dead 6.6 percent 9.19 6.4 School attendance of orphans 100.0 percent 9.20 6.4 School attendance of non-orphans 98.2 percent xix Topic MICS4 Indicator Number1 MDG Indicator Number Indicator Value HIV AND AIDS AND SEXUAL BEHAVIOUR HIV and AIDS knowledge and attitudes 9.1 Comprehensive knowledge about HIV prevention Women (age 15-49) 28.5 percent Men (age 15-54) 26.3 percent CS.10 Ever heard of HIV Women (age 15-49) 92.6 percent Men (age 15-54) 88.3 percent 9.2 6.3 Comprehensive knowledge about HIV prevention among young people (15-24 years) Women 31.6 percent Men 29.3 percent 9.3 Knowledge of mother-to-child transmission of HIV Women (age 15-49) 39.8 percent Men (age 15-54) 24.8 percent 9.4 Accepting attitudes towards people living with HIV Women (age 15-49) 3.6 percent Men (age 15-54) 5.2 percent 9.5 Know where to be tested for HIV Women (age 15-49) 69.6 percent Men (age 15-54) 62.0 percent 9.6 Have been tested for HIV and told results Women (age 15-49) 18.9 percent Men (age 15-54) 11.8 percent 9.7 Sexually active young people (15-24 years) who have been tested for HIV and told results Women 30.7 percent Men 20.7 percent 9.8 HIV counseling during antenatal care 39.9 percent 9.9 HIV testing and told results during antenatal care 60.7 percent xx Topic MICS4 Indicator Number1 MDG Indicator Number Indicator Value Sexual behaviour 9.10 Young people (15-24 years) never married/ in union who have never had sex Women 68.0 percent Men 46.8 percent 9.11 Sex before age 15 among young people (15-24 years) Women 0.2 percent Men 2.7 percent 9.12 Age-mixing among sexual partners among young people (15-24 years) Women 2.0 percent Men 0.0 percent 9.13 Had sex with multiple partners in the last 1 months Women (age 15-49) 1.0 percent Men (age 15-54) 8.0 percent 9.14 Condom use during sex with multiple partners in the last 12 months Women (age 15-49) 43.5 percent Men (age 15-54) 47.3 percent 9.15 Young people (15-24 years) who had sex with non-regular partners in the last 12 months Women 42.7 percent Men 73.5 percent 9.16 6.2 Condom use with non-regular partners in the last 12 months among young people (15-24 years) Women 53.8 percent Men 75.4 percent MASS MEDIA AND INFORMATION/ COMMUNICATION TECHNOLOGY Mass media MT.1 Exposure to mass media Women (age 15-49) 23.4 percent Men (age 15-54) 23.6 percent Information/ communication technology MT.2 Use of the computer in the last 12 months among young people (15-24 years) Women 72.0 percent Men 72.1 percent MT.3 Use of the internet in the last 12 months among young people (15-24 years) Women 59.2 percent Men 59.6 percent xxi Topic MICS4 Indicator Number1 MDG Indicator Number Indicator Value SUBJECTIVE WELL-BEING Subjective well-being SW.1 Life satisfaction among young people (15-24 years) Women 64.3 percent Men 65.3 percent SW.2 Happiness among young people (15-24 years) Women 85.9 percent Men 83.8 percent SW.3 Perception of a better life among young people (15-24 years) Women 52.8 percent Men 51.5 percent TOBACCO AND ALCOHOL Tobacco use TA.1 Use of tobacco in the last one month Women (age 15-49) 6.4 percent Men (age 15-54) 54.5 percent TA.2 Smoking before age 15 Women (age 15-49) 0.6 percent Men (age 15-54) 15.9 percent Alcohol use TA.3 Use of alcohol in the last one month Women (age 15-49) 22.2 percent Men (age 15-54) 49.4 percent TA.4 Use of alcohol before age 15 Women (age 15-49) 0.2 percent Men (age 15-54) 2.7 percent xxii EXECUTIVE SUMMARY The Mongolia Multiple Indicator Cluster Survey 2010 is a sample survey that nationally represents all households, women aged 15-49 years, men aged 15-54 years, and children under age of 5. The Multiple Indicator Cluster Survey 2010 was carried out by the National Statistical Office of Mongolia (NSO) with financial and technical support from the United Nations Children's Fund (UNICEF). The survey results refer to the period of September – December 2010, when the data collection fieldwork was carried out. Main results of the survey are summarized below. Child mortality • In Mongolia, the infant mortality rate is 36 per 1 000 live births while the under-five mortality rate is 45 per 1 000 live births. In rural areas, the rates of child mortality are almost two times higher than in urban areas. While the infant mortality rate in urban areas is 24 per 1,000 live births, it is 48 in rural areas. As for the under-five mortality rate, it is 29 in urban areas and 62 in rural areas. Child nutrition • Among children under 5, the underweight prevalence is 3 percent, the stunting prevalence is 15 percent and the wasting prevalence is 2 percent. • The stunting prevalence is the highest (18-25 percent) among children under 5 in Western and Khangai regions while it is the lowest (11-13 percent) in Ulaanbaatar city and Central region. • While 1 percent of children under 5 in richest quintile are underweight and 7 percent are stunted, these figures are respectively 5 and 25 percent among children in poorest quintile. Breastfeeding • Although it is recommended that all children under age of 6 months to be exclusively breastfed, only 66 percent of those children were exclusively breastfed during the day and night preceding the survey. • 7 of every 10 women with a live birth in the 2 years preceding the survey put the newborn infant to the breast within 1 hour of birth. • 82 percent of children aged 12-15 months and 65 percent of children aged 20-23 months are still being breastfed. • 30 percent of children aged 6-23 months were receiving solid or semi-solid foods the minimum number of times or more during the day and night preceding the survey. Low birth weight • 98 percent of children aged 0-23 months were weighed at birth and approximately 5 percent of them are estimated to weigh less than 2500 grams at birth. Immunization • 98 percent of children aged 12-23 months received a Tuberculosis vaccination by the age of 12 months. • Immunization coverage for Polio at birth is 98 percent and the percentage declines for subsequent doses of Polio to approximately 98 percent for the first dose, 96 percent for the second dose and 93 percent for the third dose. • Immunization coverage for the first dose of DPT or Penta is 96 percent while it is 94 xxiii percent for the second dose and 92 percent for the third dose. • 97 percent of children aged 12-23 months received the dose at birth of Hepatitis B vaccination by the age of 12 months. • Immunization coverage for the first dose of Measles, Mumps and Rubella by the age of 12 months is lower than for the other vaccinations. • The percentage of children who had all the recommended vaccinations by their first birthday is 76. Oral rehydration treatment • Approximately, 10 percent of children under age of 5 had diarrhoea during the 14 days preceding the survey. • 56 percent of children with diarrhoea either received oral rehydration treatment and, at the same time, feeding was continued. • During the diarrhoea episode, 43 percent of children drank more than usual while 56 percent drank the same or less and 90 percent of children ate somewhat less, same or more, but 4 percent ate much less or almost none. Care seeking and antibiotic treatment of suspected pneumonia • 2 percent of children under 5 were reported to have had symptoms of pneumonia during the 14 days preceding the survey. Of these children, 87 percent were taken to an appropriate provider and 73 percent had received an antibiotic. • Only one percent of mothers/ caretakers know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is developing fever (74 percent) while only 4 percent of mothers/ caretakers identified fast breathing and 3 percent identified difficult breathing as symptoms for taking children immediately to a health care provider. Solid fuel use • 68 percent of all households in Mongolia use solid fuels for cooking. The use of solid fuels is 54 percent in urban areas and this figure is the highest in rural areas (90 percent). Water and sanitation • 65 percent of total population has access to an improved source of drinking water. In rural areas (59 percent), the use of improved drinking water sources is less than in urban areas (69 percent). • Less than half of the population (48 percent) of Khangai region, which is the lowest compared to other regions, has access to improved drinking water source. • 54 percent of total population has access to an improved sanitation facility. While access to improved sanitation in urban areas is 66 percent, it is 36 percent in rural areas. Contraception • Knowledge of any contraception method is 97 percent among women currently married or in union. • Current use of contraception was reported by 55 percent of women currently married or in union. The most popular method in Mongolia is the IUD which is used by 23 percent of women currently married or in union. The next most popular method is the pill, which accounts for 12 percent of married or in union women. • The highest use of contraception is in Eastern region (64 percent). Compared to other regions, the lowest use of contraception is in Ulaanbaatar; 52 percent of married or in xxiv union women in Ulaanbaatar reported current use of any method. • 22 percent of the total women currently married or in union have unmet need for contraception. Antenatal care • The coverage of antenatal care by skilled personnel (a doctor, obstetrician, midwife, or feldsher) is relatively high in Mongolia with 99 percent of women receiving antenatal care at least once and 81 percent at least 4 times during the pregnancy. Assistance at delivery • 99 percent of births occurred in the two years preceding the MICS survey were delivered by skilled personnel. 69 percent of the births were delivered with assistance by an obstetrician, 26 percent by a midwife, and 3 percent by a family or soum doctor. • The percentage of births delivered by an obstetrician is 73 percent among urban women while 64 percent among rural women. • 21 percent of births in the two years preceding the survey to women aged 15-49 were delivered by Caesarean section. Delivering births by Caesarean section is more common among urban women than rural women (23 percent and 17 percent, respectively). • As a woman gets older the prevalence of deliveries by Caesarean section increases. For example, one out of every 10 mothers aged less than 20, one out every 5 women aged 20-34, and one out of every 3 women aged 35-49 had a caesarean delivery. Child development • For 57 percent of children aged 3-4, an adult household member engaged in more than four activities that promote learning and school readiness during the 3 days preceding the survey. The average number of activities that adults engaged with children is 3.7. • Only 39 percent of fathers engaged in more than one activity with their children and 18 percent of children aged 3-4 were living in a household without their fathers. • Only 23 percent of children aged 0-59 months are living in households where at least 3 children's books are present and the percentage of children with 10 or more children's books declines to 7 percent. The proportion of children under-5 with 3 or more children's books is highest in Ulaanbaatar (33 percent) and lowest in Khangai region (12 percent). Early childhood development index • Early childhood development index is calculated for children aged 3-4 in as 85 percent. ECDI is high by 9 percentage points among girls (90 percent) than among boys (81 percent). • By domains, the percentages of children who are developmentally on track in the physical and learning domain is highest (97 percent and 96 percent, respectively), 84 of children are developmentally on track in the social-emotional domain, and it is 15 percent for the literacy-numeracy domain. Early childhood education and learning • 58 percent of children aged 36-59 months are attending pre-school. The figure is 45 percent for rural children while it is 68 percent for urban children. • The attendance to pre-school is 80 percent among children from richest households while it is only 25 percent among children from poorest households. By regions, attendance to pre-school is less prevalent in Western and Khangai regions (50 percent) compared to children in other regions (61-65 percent). xxv • 91 percent of children who are currently attending the first grade of primary school were attending pre-school the previous year. • No significant gender and urban-rural differential, but some differences in the school readiness by regions and household wealth was observed. Primary and secondary education participation • 99 percent of children of primary education age, 6-11 years, are attending primary, secondary or high education and no gender differential is observed. • 93 percent of children of secondary education age, 12-15 years, are attending secondary education or higher. • Of all children starting grade one, the majority of them (99 percent) will eventually reach fifth grade and this indicator is estimated to be at 100 percent among urban children and at 97 percent among rural children. Birth registration • In our country, the births of 99 percent of children under-5 have been registered. • There is no significant difference in the child registration by urban, rural areas, regions, education of mothers / caretakers and household wealth. Child labour • In accordance with new definition by UNICEF, 34 percent of children aged 5-11 and 18 percent of children aged 12-14 are involved in child labour. As a result, the indicator – total child labour is calculated as 29 percent for children aged 5-14. However, in case of Mongolia, fetching water and collecting firewood and fuel for own household use is not likely to be regarded as an economic activity but a household chore. Thus, taking this country specific situation into consideration, the child labour among children aged 5-14 is calculated as 10 percent, 8 percent for children aged 5-11, and 16 percent for children aged 12-14. Child discipline • 46 percent of children aged 2-14 were subjected to at least one form of psychological or physical punishment by their mothers/ caretakers or other household members. • 16 percent of parents/ caretakers covered by survey believe that children should be physically punished. Attitudes towards Domestic Violence • Overall, 11 (10) percent of women (men) in Mongolia feel that a husband/ partner has a right to hit or beat his wife/ partner for at least one of a variety of reasons. • Women who approve a husband's violence, in most cases agree and justify violence in instances when the woman neglects the children (9 percent), or if she spends big amount of money without permission from him (3 percent). • Among men, these two reasons are also the highest ones (6 percent and 4 percent, respectively). Knowledge, attitudes, and practice about HIV, AIDS • Only 29 percent of women aged 15-49 and 26 percent of men aged 15-54 were found to have comprehensive knowledge. Comprehensive knowledge about HIV, AIDS is 32 percent among women aged 15-24 and 29 percent among men aged 15-24. xxvi • 93 percent of women and 88 percent of men have heard of AIDS. However, the percentage of women and men who know both ways of preventing HIV transmission drops respectively to 72 percent and 71 percent. • Similar to the level of knowledge on ways of HIV prevention, women have better knowledge (34 percent) than men in terms of rejecting the two most common misconceptions and knowing a healthy looking person can have the AIDS virus (79 percent). • 79 percent of women know that HIV can be transmitted from mother to child while 68 percent of men have this knowledge, which is lower than women. The percentage of women (men) who know all three ways of mother-to-child transmission is 40 (25), while 13 (21) percent of women (men) did not know any specific way. • The survey finding show stigma and discrimination toward people living with HIV is quite prevalent in Mongolia; only 4 percent of women aged 15-49 and 5 percent of men aged 15-54 express accepting attitudes on all four questions. • The percentage of women aged 15-49 who know of a facility for HIV testing is 70 percent while it is 62 percent for men aged 15-54. The percentage who have been tested in the last 12 months and told the results is 19 percent among women 12 percent among men. Sexual behaviour • As for women and men aged 15-24, 1 percent of women and 13 percent of men had sex with more than one partner in the 12 months preceding the survey. The condom use among men who had sex with more than one partner is at 69 percent. • 3 percent of men aged 15-24 and less than 1 percent of women aged 15-24 had sex before age 15 and in the 12 months preceding the survey 2 percent of women of this age group had sex with 10 or more years older men. Access to mass media and use of information/ communication technology • 3 (2) percent of women (men) do not have regular exposure to any of the three media, while 23 (24) percent are exposed to all the three types of media at least on a weekly basis. • 84 (79) percent of women (men) aged 15-24 ever used a computer, 72 (72) percent used a computer during the last year and 55 (59) percent used at least once a week during the last month. 68 (66) percent of women (men) aged 15-24 ever used the internet, while 59 (60) percent surfed the internet during the last year. The proportion of young women (men) who used the internet more frequently, at least once a week during the last month was smaller, at 43 (47) percent. Tobacco and alcohol use • 26 percent of women aged 15-49 and 81 percent of men aged 15-54 reported to have ever used a tobacco product. 6 percent of women and 54 percent of men smoked cigarettes, or used smoked or smokeless tobacco products on one or more days during the one month preceding the survey. • The current tobacco use among women is 2.4 times greater in urban areas (8 percent) than in rural areas (3 percent) there is no urban-rural differential in the use of tobacco among men (54-56 percent). • 22 percent of women aged 15-49 and 49 percent of men aged 15-54 had at least one drink of alcohol on one or more days during the one month preceding the survey. xxvii • Among women, 1 percent first drank alcohol before age 15 while 21 percent never had one drink of alcohol. These figures are 3 percent and 15 percent, respectively, among men. • The women and men in urban areas, from richest households, or with college or university education are more likely to use alcohol. Subjective well-being • Young women are the most satisfied with their marriage (93 percent), with their friendships (90 percent) and with their school (91 percent). The results for young men are similar; they are the most satisfied with their marriage (96 percent), with their friendships (93 percent), and how they look (91 percent). • 64 percent of women aged 15-24 and 65 percent of men aged 15-24 are satisfied with their life. • The proportion of men aged 15-24 who are very or somewhat happy (84 percent) is similar to that of young women (86 percent). • The percentage of women and men who think that their lives improved during the last one year is 54 percent, which is not a very promising figure. However, 92 percent of young women and 86 percent of young men think that their life will get better after one year, which suggest that Mongolian young people see their future brightly with positive believe. CHILD DEVELOPMENT 2010 SURVEY I. INTRODUCTION 1 CHAPTER I INTRODUCTION 2 I. INTRODUCTION CHILD DEVELOPMENT 2010 SURVEY _____________________________ I____________________________ Background This report is based on the Mongolia Multiple Indicator Cluster Survey, conducted in 2010 by the National Statistical Office (NSO) with collaboration of United Nations Children's Fund (UNICEF). The survey provides valuable information on the situation of children, women and men in Mongolia, and was based, in large part, on the needs to monitor progress towards goals and targets emanating from recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Chil- dren 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 improv- ing conditions for their children and to monitoring progress towards that end. UNICEF was as- signed a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring pro- gress towards the goals and objectives they contained: 'We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning." (A World Fit for Children, paragraph 60) "…We will conduct periodic reviews at the national and subnational levels of pro- gress in order to address obstacles more effectively and accelerate actions.…" (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: "… As the world's lead agency for children, the United Nations Children's Fund is requested to continue to prepare and disseminate, in close collaboration with Govern- ments, 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." CHILD DEVELOPMENT 2010 SURVEY I. INTRODUCTION 3 Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on pro- gress: "…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." In Mongolia, commitment to these internationally signed agreements has been demon- strated through development and implementation of national development strategies and pro- grams, namely National Strategy for Poverty Reduction, National Program of Action for the De- velopment and Protection of Children and National Millennium Development Goals. All these policy frameworks require monitoring and assessment progress. The fourth round of the MICS survey represents one of the largest sources of data for reporting on progress towards the above mentioned goals. This final report presents the results of the indicators and topics covered in the survey. Survey Objectives The Mongolia Multiple Indicator Cluster Survey 2010 has as its primary objectives: • To provide up-to-date information for assessing the situation of children, women and men in Mongolia; • To furnish data needed for monitoring progress toward goals established in the Millennium Declaration and other internationally agreed upon goals, as a basis for future action; • To contribute to the improvement of data and monitoring systems in Mongolia and to strengthen technical expertise in the design, implementation, and analysis of such systems; • To generate data on the situation of children, women and men, including the identification vulnerable groups and of disparities, to inform policies and interventions. II. SAMPLE AND SURVEY METHODOLOGY CHILD DEVELOPMENT 2010 SURVEY 5 CHILD DEVELOPMENT 2010 SURVEY II. SAMPLE AND SURVEY METHODOLOGY CHAPTER II SAMPLE AND SURVEY METHODOLOGY © NSO Mongolia/N.Amarbayasgalan/2010 6 II. SAMPLE AND SURVEY METHODOLOGY CHILD DEVELOPMENT 2010 SURVEY ____________________________ II____________________________ Sample Design The Multiple Indicator Cluster Survey is a household-based survey. Therefore, households are defined as sampling units. The sample for the Mongolia Multiple Indicator Cluster Survey (MICS) 2010 was designed to provide estimates for a large number of indicators on the situation of children, women and men at the national level, for urban and rural areas, and for five regions: Western, Khangai, Central, Eastern and Ulaanbaatar. The urban and rural areas within each region were identified as the main sampling strata and the sample was selected in two stages. The total sample size determined as 10,500 households and it was equally allocated into five regions. The lowest administrative units (kheseg of khoroo's for Ulaanbaatar, bagh of soum's for aimags) were defined as primary sampling units (PSUs). In total, 420 baghs and khesegs were selected systematically with probability proportional to size. After a household listing of the selected PSUs was carried out by the statistical departments or divisions, 25 households were selected using systematic sampling from each PSU. During the data collection fieldwork, we had encountered a problem due to National Emergency Commission's quarantine in eastern aimags: Dornod, Sukhbaatar and Khentii, because of highly infectious diseases of animal, murrain, spreading between September and November of 2010. In spite of this situation, we managed to collect data from those aimags and all 420 PSUs were visited. The sample was stratified by region, urban and rural areas, and is not self-weighting. For reporting national level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires In line with the survey objectives and coverage of the survey, three sets of standard UNICEF questionnaires12 were used and some country specific modifications were made. Questions and indicators for the questionnaires were developed by taking into consideration that they could be comparable with the previous surveys and the surveys done internationally. Based on the current priorities and needs, a questionnaire for men aged 15-54 years and a questionnaire for children aged 2-14 years were added for this round of MICS. It should be noted that age group for men covered in Mongolia MICS 2010 (15-54 years) is different than the one used in the MICS4 standard questionanaire, due to standard men's questionnaire was not developed yet when we develop MICS 2010's questionnaires. Altogether 5 types of questionnaires were used: 1. A Household Questionnaire 2. A Questionnaire for Woman aged 15-49 3. A Questionnaire for Child under 5 2 The model MICS questionnaires can be found at www.childinfo.org/mics4_questionnaire.html 7 CHILD DEVELOPMENT 2010 SURVEY II. SAMPLE AND SURVEY METHODOLOGY 4. A Questionnaire for Child aged 2-143 5. A Questionnaire for Man aged 15-54 In order to check the clarity and logical sequence of the questions, to determine the duration of data collection per household and to test the data entry program, a pre-testing was conducted in May 2010, covering selected households in Khan-Uul and Chingeltei districts of Ulaanbaatar, and Kherlen and Dadal soums of Khentii aimag. Based on the results of the pre-test, modifications were made to the wording and the logical sequence of the questions was improved. In addition to the administration of questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for handwashing and measured the weights and heights of children age under 5 years. Details and findings of these measurements are provided in the respective sections of the report. The Household Questionnaire included the following modules: • Household Listing Form • Education • Water and Sanitation • Household Characteristics • Child Labour • Child Discipline • Hand Washing • Salt Iodization The Questionnaire for Women aged 15-49 was administered to all women aged 15-49 years living in the households and included the following modules: • Woman's Background • Access to Mass Media and Use of Information Communication Technology • Child Mortality • Desire for Last Birth • Maternal and Newborn Health • Illness Symptoms • Contraception • Unmet Need • Marriage/ Union • Attitudes Towards Domestic Violence • Sexual Behaviour • HIV, AIDS • Tobacco and Alcohol Use4 • Subjective Well-Being4 3 This questionnaire is Country Specific and was designed to collect information on Child Disability and Child Injury based on the standard questions for child disability. 4 This module used in Mongolia 2010 survey is slightly different than the final version of the standard module of the global MICS4 programme. Therefore, the indicators produced may not fully correspond to the standard indicators of MICS4. 8 II. SAMPLE AND SURVEY METHODOLOGY CHILD DEVELOPMENT 2010 SURVEY The Questionnaire for Child under 5 was administered to mothers or caretakers of children under 5 years of age5 living in the households. Normally, the questionnaire was administered to mothers of under-5 children; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Age • Birth Registration • Early Childhood Development • Breastfeeding • Care of Illness • Immunization • Anthropometry The Questionnaire for Child aged 2-14 was administered to mothers or caretakers of children aged 2-14 years living in the households. Normally, the questionnaire was administered to mothers of children aged 2-14; in cases when the mother was not listed in the household roster, a primary caretaker for the child was identified and interviewed. The questionnaire included the following modules: • Child Injury • Child Disability The Questionnaire for Men aged 15-54 was administered to all men aged 15-54 years living in every two households and included the following modules: • Man's Background • Access to Mass Media and Use of Information Communication Technology • Reproduction • Contraception • Marriage/ Union • Fertility Preference • Gender Equity • Sexual Behaviour • HIV, AIDS • Tobacco and Alcohol Use6 • Subjective Well-Being Mongolia MICS 2010 questionnaires can be found in Appendix F. Training and Fieldwork Training for the fieldwork personnel was conducted for 15 days in 4-18 August 2010 including both lectures and practices. 5 The terms "children under 5", "children aged 0-4 years", and "children aged 0-59 months" are used interchangeably in this report. 6 This module used in Mongolia 2010 survey is slightly different than the final version of the standard module of the global MICS4 programme. Therefore, the indicators produced may not fully correspond to the standard indicators of MICS4. 9 CHILD DEVELOPMENT 2010 SURVEY II. SAMPLE AND SURVEY METHODOLOGY The lectures were held by the experts in the relevant field and practices were done for each questionnaire. In collaboration with Public Health Institute at the Child Department of Songinokhairkhan District Hospital, trainees practiced anthropometry measurement. Towards the end of the training period, trainees spent 2 days in practice interviewing and measuring in some households of Chingeltei and Bayanzurkh districts of Ulaanbaatar. At the end of the training, participants were taken tests and the interviewers, editors and supervisors were selected based on their performance for the test. The data were collected by 10 teams; each team was comprised of a supervisor, an editor and 5 interviewers (2 men assigned as main measurers7 ) and two drivers. The data collection fieldwork was carried out in August – December 2010 for the period of 4 months. NSO and UNICEF staff, an international consultant from the UNICEF Regional Office and the members of MICS Steering committee participated in field monitoring. Fieldwork personnel' achievements and disadvantages had been discussed during the monitoring visit and necessary actions had been taken accordingly. Data Processing Data collected from the selected households were entered on computers using the CSPro software program by 10 data entry operators and 1 data entry supervisor in October – December 2010. In order to ensure quality control, all questionnaires were double entered and internal consistency checks were performed before finalization of the database. Procedures and standard programs developed under the global MICS4 programme and adapted to the Mongolia questionnaires were used throughout. Data were analyzed using the SPSS 18.0 (Statistical Package for Social Sciences) software program and the model syntax and tabulation plans developed by UNICEF were customized for this purpose according to the Mongolia questionnaires. 7 This is a deviation from MICS recommended formation of a team composition where a separate dedicated measurer is supposed to be part of the data collection team. II. SAMPLE AND SURVEY METHODOLOGY CHILD DEVELOPMENT 2010 SURVEY 11 CHILD DEVELOPMENT 2010 SURVEY II. SAMPLE AND SURVEY METHODOLOGY CHAPTER III SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS © UNICEF Mongolia/Sokol/2012 12 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS CHILD DEVELOPMENT 2010 SURVEY ___________________________ III__________________________ Sample Coverage In total, 10,500 households selected for the sample, of these 10,300 were found to be occupied. Of these, 10,092 households were successfully interviewed for a household response rate of 98 percent. In the interviewed households, 9,599 women aged 15-49 years were identi- fied. Of these, 8,762 were successfully interviewed, yielding a response rate of 91 percent. In addition, 4,114 children under age of 5 and 9,440 children aged 2-14 years were listed in the household questionnaire. Questionnaires were completed for 3,956 of these under-5 children and for 9,131 of children aged 2-14, which corresponds to a response rate of 96 and 97 percent respectively, within interviewed households. Total of 5,185 men aged 15-54 years of households with odd household numbers (i.e., men of every two households) in the household listing were administered for individual interview. Of those, 4,025 were successfully interviewed with the response rate of 78 percent. Overall response rates of 89 percent, 94 percent, 95 percent and 76 percent are calculated for the women aged 15-49's, children under 5's, children aged 2-14's and men aged 15-54's interviews respectively (Table HH.1). The above mentioned response rates were similar across regions, areas, and locations of residence. However, as the response rate for men aged 15-54's interviews is relatively lower than the response rates for other interviews, the results for men should be interpreted with some caution. The main reason for the low response rate was the mobility nature of men, particulary of young men. Characteristics of Households The weighted age and sex distribution of survey population is provided in Table HH.2. The distribution is also used to produce the population pyramid in Figure HH.1. In 10,092 households successfully interviewed in the survey, 35,981 household members were listed. Of these, 17,590 were males and 18,391 were females, which yields sex ratio of 96. Due to increased fertility rates since 2006, children aged 0-4 years constitute 11 percent of the total population. 61 percent of the total population is the working-age population, which are men aged 15-59 years and women aged 15-54 years (Figure HH.1). Table HH.3 - HH.5A provide basic information on the households, female respondents aged 15-49, mother/ caretaker respondents of children under 5, male respondents aged 15-54, mother/ caretaker respondents of children aged 2-14 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women, children under 5, men and children aged 2-14 interviewed in the survey is essential for the interpretation of findings presented later in the report and also can provide an indication of the representativeness of the survey. The remaining tables in this report are presented only with weighted numbers. See Appendix A for more details about the weighting. 13 CHILD DEVELOPMENT 2010 SURVEY III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Figure HH.1: Age and sex distribution of household population, Mongolia, 2010 percent 8 6 4 2 0 2 4 6 8 85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Male Female Table HH.3 provides basic background information on the households. Within households, the sex of the household head, region, area, location, number of household members and edu- cation, religion and ethnicity of the household head are shown in the table. These background characteristics are used in subsequent tables in this report. Of 10,092 households interviewed, 6,086 or 60 percent are urban households and 4,006 or 40 percent are rural households. About half of these households have 3-4 members, households with size of 1-2 members account for 26 percent, and those with more than 5 members – 24 percent. The mean household size is 3.6 persons. 22 per cent of households are female headed. The weighted and unweighted numbers of households are equal, since sample weights were normalized (See Appendix A). The table also shows the proportions of households with at least one child aged 0-17, at least one child under 5, at least one child aged 2-14, at least one woman aged 15-49 and at least one man aged 15-54. Characteristics of Respondents Tables HH.4, HH.4M, HH.5 and HH.5A provide information on the background characteristics of female respondents aged 15-49, children under 5, male respondents aged 15-54 and children aged 2-14. In above tables, the total numbers of weighted and unweighted observations are equal, since sample weights have been normalized (standardized). In addition to providing useful information on the background characteristics of women, children and men, the tables are also intended to show the numbers of observations in each background category. 14 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS CHILD DEVELOPMENT 2010 SURVEY Table HH.4 presents background characteristics of women aged 15-49 years. The data are disaggregated by region, area, location, age group, marital status, motherhood status, births in last two years, education8, household wealth index quintiles9, and ethnicity and religion of household head. By marital status, 64 percent of the total women are currently married or in union, 26 percent are never married or been in union, 4 percent are divorced, 3 percent widowed and 3 percent are separated. 19 percent of the total women had given a birth to a child in the two years preceding the survey. By education, 3 percent of the women have no education, 5 percent with primary education, 19 percent have lower secondary education, 29 percent have upper secondary education, 10 percent with vocational education, and 34 percent have college, university education. Table HH.4M presents background characteristics of men aged 15-54 years. The data are disaggregated by region, area, location, age group, marital status, fatherhood status, education, household wealth index quintiles, and ethnicity and religion of household head. 65 percent of all surveyed men are married or in union, 30 percent are never married or been in union, and the remaining 5 percent are either divorced, separated or widowed. Males have lower level of education compared to females; 6 percent have no education, 9 percent have primary education, 26 percent with lower secondary education, 26 percent have upper secondary education, 10 percent have vocational education, and 23 percent with college, university education. Table HH.5 shows background characteristics of children under 5. The data are disaggregated by sex, age, region, area, location, mother/ caretaker's education, household wealth index quintiles, and ethnicity and religion of household head. From total of 3,956 children under 5 covered by the survey, male proportion is 50 percent and female proportion is 50 percent. By education of their mothers/ caretakers, 5 percent have no education, 8 percent are primary educated, 18 percent are lower secondary educated, 27 percent with upper secondary education, 7 percent have vocational education, and 35 percent have college, university education. The distribution of children under 5 by household wealth 8 Unless otherwise stated, "education" refers to educational level attended by the respondent throughout this report when it is used as a background variable. 9 Principal components analysis was performed by using information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household's wealth to assign weights (factor scores) to each of the household assets. Each household was then assigned a wealth score based on these weights and the assets owned by that household. The survey household population was then ranked according to the wealth score of the household they are living in, and was finally divided into 5 equal parts (quintiles) from lowest (poorest) to highest (richest). The assets and variables used in these calculations were as follows: source of drinking water, type of sanitation facilities, whether toilet is sharing, place for handwashing variables, type of dwelling, persons per sleeping room, type of floor, type of roof, type of wall, type of heating, type of heating fuel, type of cooking fuel, household assets: electricity, renewable-energy generator, computer, internet, TV, radio, non-mobile telephone, refrigetor, washing machine, vacuum cleaner, library; household member's assets: watch, mobile telephone, camera, bicycle, motorcycle, animal-drawn cart, car or truck, tractor; ownership of dwelling, ownership of agricultural land, ownership of livestock, ownership of bank account. 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 poorest to richest. The wealth index does not provide information on absolute poverty, current income or expenditure levels. The wealth scores calculated are applicable for only the particular data set they are based on. Further information on the construction of the wealth index can be found in Rutstein and Johnson, 2004, Filmer and Pritchett, 2001, and Gwatkin et. Al., 2000. 15 CHILD DEVELOPMENT 2010 SURVEY III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS index quintiles shows that 24 percent live in poorest quintile, 20 percent in second quintile, 19 percent in middle quintile, 19 percent in fourth quintile, and the remaining 18 percent in richest quintile. Table HH.5A shows background characteristics of children aged 2-14 years. The data are disaggregated by sex, age group, region, area, location, mother/ caretaker's education, household wealth index quintiles, and ethnicity and religion of household head. The sex ratio of total 9,131 children aged 2-14 covered by the survey is 105 boys per 100. By education of their mothers/ caretakers, 4 percent have no education, 8 percent have primary education, 21 percent have lower secondary education, 27 percent with upper secondary education, 11 percent have vocational education, and 29 percent have college, university education. Data Disaggregation As mentioned above, the survey results are disaggregated by regions as well as area, loca- tion, education, household wealth index quintiles, and ethnicity and religion of household head. Region: Western, Khangai, Central, Eastern and Ulaanbaatar Area: Urban (capital city, aimag center) and Rural (soum center, rural) Location: Capital city, Aimag center, Soum center and Rural Education: None, Primary, Lower secondary, Basic, Upper secondary, Vocational and College, university Household wealth index quintiles: Poorest, Second, Middle, Fourth and Richest (wealth index is estimated for each of surveyed household using the information such as source of drinking water, type of sanitary facility, housing type and materials, availability of electricity, household assets applying Principal Component Analysis technique. Households then are divided into 5 quintiles from poorest to richest) Ethnicity of household head: Khalkh, Khazakh, Other Religion of household head: No religion, Buddhist, Muslim, Other 16 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS CHILD DEVELOPMENT 2010 SURVEY Ta bl e H H .1 : R es ul ts o f h ou se ho ld , w om en 's , m en 's , u nd er -5 's a nd c hi ld re n ag ed 2 -1 4' s in te rv ie w s N um be r o f h ou se ho ld s, w om en , m en , c hi ld re n un de r 5 a nd c hi ld re n ag ed 2 -1 4 ye ar s by re su lts o f t he h ou se ho ld , w om en 's , m en 's , u nd er -5 's a nd c hi ld re n ag ed 2 -1 4' s in te rv ie w s, a nd h ou se ho ld , w om en 's , m en 's u nd er -5 's a nd c hi ld re n ag ed 2 -1 4' s re sp on se ra te s, M on go lia , 2 01 0 A re a R eg io n Lo ca tio n To ta l U rb an R ur al W es t K ha ng ai C en te r E as t U la an ba at ar C ap ita l ci ty A im ag ce nt er S ou m ce nt er R ur al H ou se ho ld s S am pl ed 5 0 00 5 5 00 2 10 0 2 1 00 2 1 00 2 1 00 2 10 0 2 1 00 2 90 0 2 48 5 3 0 15 1 0 50 0 O cc up ie d 4 8 76 5 4 24 2 07 9 2 0 90 2 0 36 2 0 66 2 02 9 2 0 29 2 8 47 2 44 3 2 9 81 1 0 30 0 In te rv ie w ed 4 7 60 5 3 32 2 03 8 2 0 64 1 9 79 2 0 47 1 96 4 1 9 64 2 7 96 2 40 9 2 9 23 1 0 09 2 H ou se ho ld re sp on se ra te 97 .6 98 .3 9 8. 0 9 8. 8 97 .2 99 .1 9 6. 8 9 6. 8 98 .2 98 .6 98 .1 9 8. 0 W om en E lig ib le 4 8 01 4 7 98 2 00 8 1 8 16 1 8 90 1 7 55 2 13 0 2 1 30 2 6 71 2 30 2 2 4 96 9 59 9 In te rv ie w ed 4 3 79 4 3 83 1 85 8 1 6 70 1 7 16 1 6 03 1 9 15 1 9 15 2 4 64 2 10 8 2 2 75 8 76 2 W om en 's re sp on se ra te 91 .2 91 .4 9 2. 5 9 2. 0 90 .8 91 .3 8 9. 9 8 9. 9 9 2. 3 91 .6 91 .1 9 1. 3 W om en 's o ve ra ll re sp on se ra te 89 .0 89 .8 9 0. 7 9 0. 8 88 .3 90 .5 8 7. 0 8 7. 0 9 0. 6 90 .3 89 .4 8 9. 4 M en E lig ib le 2 3 92 2 7 93 1 08 6 9 93 1 0 26 9 93 1 08 7 1 0 87 1 30 5 1 19 9 1 5 94 5 18 5 In te rv ie w ed 1 8 79 2 1 46 86 3 7 77 7 60 7 58 8 67 8 67 1 01 2 91 9 1 2 27 4 02 5 M en 's re sp on se ra te 78 .6 76 .8 7 9. 5 7 8. 2 74 .1 76 .3 7 9. 8 7 9. 8 7 7. 5 76 .6 77 .0 7 7. 6 M en 's o ve ra ll re sp on se ra te 76 .7 75 .5 7 7. 9 7 7. 3 72 .0 75 .6 7 7. 2 7 7. 2 76 .2 75 .6 75 .5 7 6. 1 C hi ld re n un de r 5 E lig ib le 1 8 39 2 2 75 96 8 8 20 8 38 7 43 7 45 7 45 1 0 94 98 6 1 2 89 4 11 4 M ot he rs /C ar et ak er s in te rv ie w ed 1 7 47 2 2 09 95 6 7 87 8 10 7 09 69 4 6 94 1 0 53 96 1 1 2 48 3 95 6 U nd er -5 's re sp on se ra te 95 .0 97 .1 9 8. 8 9 6. 0 96 .7 95 .4 9 3. 2 9 3. 2 9 6. 3 97 .5 96 .8 9 6. 2 U nd er -5 's o ve ra ll re sp on se ra te 92 .7 95 .5 9 6. 8 9 4. 8 94 .0 94 .5 9 0. 2 9 0. 2 9 4. 5 96 .1 94 .9 9 4. 2 C hi ld re n ag ed 2 -1 4 E lig ib le 4 0 36 5 4 04 2 42 1 1 8 09 1 8 95 1 8 37 1 47 8 1 4 78 2 55 8 2 64 8 2 7 56 9 44 0 17 CHILD DEVELOPMENT 2010 SURVEY III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Mothers/Caretakers interviewed 3 854 5 277 2 385 1 773 1 826 1 772 1 375 1 375 2 479 2 582 2 695 9 131 Children aged 2-14's response rate 95.5 97.6 98.5 98.0 96.4 96.5 93.0 93.0 96.9 97.5 97.8 96.7 Children aged 2-14's overall response rate 93.2 96.0 96.6 96.8 93.7 95.6 90.1 90.1 95.2 96.2 95.9 94.8 Table HH.2: Household age distribution by sex Percent and frequency distribution of the household population by five-year age groups, dependency age groups, and by child (age 0-17 years) and adult populations (age 18 or more years), by sex, Mongolia, 2010 Males Females Total Number Percent Number Percent Number Percent Age 0-4 2 034 11.6 2 036 11.1 4 070 11.3 5-9 1 663 9.5 1 571 8.5 3 234 9.0 10-14 1 827 10.4 1 704 9.3 3 531 9.8 15-19 1 531 8.7 1 347 7.3 2 878 8.0 20-24 1 590 9.0 1 589 8.6 3 179 8.8 25-29 1 418 8.1 1 523 8.3 2 940 8.2 30-34 1 429 8.1 1 495 8.1 2 924 8.1 35-39 1 280 7.3 1 465 8.0 2 745 7.6 40-44 1 225 7.0 1 354 7.4 2 579 7.2 45-49 1 129 6.4 1 178 6.4 2 307 6.4 50-54 804 4.6 1 032 5.6 1 836 5.1 55-59 570 3.2 670 3.6 1 240 3.4 60-64 405 2.3 443 2.4 848 2.4 65-69 255 1.5 320 1.7 575 1.6 70-74 209 1.2 309 1.7 518 1.4 75-79 117 0.7 173 0.9 290 0.8 80-84 64 0.4 105 0.6 169 0.5 85+ 37 0.2 72 0.4 109 0.3 Missing/DK 5 0.0 5 0.0 9 0.0 Dependency age groups 0-14 5 523 31.4 5 312 28.9 10 835 30.1 15-64 11 381 64.7 12 095 65.8 23 476 65.2 65+ 682 3.9 980 5.3 1 661 4.6 Missing/DK 5 0.0 5 0.0 9 0.0 Child and adult populations Children (age 0-17 years) 6 507 37.0 6 150 33.4 12 657 35.2 Adults (age 18 or more years) 11 078 63.0 12 237 66.5 23 315 64.8 Missing/DK 5 0.0 5 0.0 9 0.0 Total 17 590 100.0 18 391 100.0 35 981 100.0 18 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS CHILD DEVELOPMENT 2010 SURVEY Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Mongolia, 2010 Weighted percent Number of households Weighted Unweighted Sex of household head Male 78.4 7 909 8 051 Female 21.6 2 183 2 041 Region Western 13.3 1 338 2 038 Khangai 22.6 2 279 2 064 Central 17.8 1 793 1 979 Eastern 8.2 831 2 047 Ulaanbaatar 38.2 3 850 1 964 Area Urban 60.3 6 086 4 760 Rural 39.7 4 006 5 332 Location Capital city 38.2 3 850 1 964 Aimag center 22.2 2 235 2 796 Soum center 17.5 1 769 2 409 Rural 22.2 2 237 2 923 Number of household members 1 9.0 904 970 2 16.7 1 690 1 698 3 24.3 2 455 2 435 4 25.7 2 598 2 554 5 14.2 1 438 1 424 6 5.9 593 602 7 2.5 256 258 8+ 1.6 157 151 Education of household head None 7.8 786 947 Primary 15.6 1 577 1 822 Basic (lower secondary) 20.1 2 026 2 282 Upper secondary 19.5 1 966 1 773 Vocational 11.3 1 144 1 098 College, university 25.4 2 563 2 137 Missing/DK 0.3 31 33 Ethnicity of household head Khalkh 81.7 8 244 7 715 Khazakh 2.8 279 437 Other 15.4 1 549 1 917 Missing/DK 0.2 19 23 Religion of household head No religion 41.3 4 168 4 446 Buddhist 52.6 5 304 4 976 Muslim 2.1 212 334 Other 3.8 379 306 Missing/DK 0.3 29 30 Total 100.0 10 092 10 092 Households with at least One child aged 0-4 years 33.3 10 092 10 092 One child aged 0-17 years 67.7 10 092 10 092 One child aged 2-14 years 55.1 10 092 10 092 One woman aged 15-49 years 76.9 10 092 10 092 One man aged 15-54 years 77.4 5 234 5 231 Mean household size 3.6 10 092 10 092 19 CHILD DEVELOPMENT 2010 SURVEY III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table HH.4: Women's background characteristics Percent and frequency distribution of women aged 15-49 years by selected background characteristics, Mongolia, 2010 Weighted percent Number of women Weighted Unweighted Region Western 13.2 1 158 1 858 Khangai 20.2 1 766 1 670 Central 17.2 1 510 1 716 Eastern 7.2 629 1 603 Ulaanbaatar 42.2 3 699 1 915 Area Urban 63.8 5 587 4 379 Rural 36.2 3 175 4 383 Location Capital city 42.2 3 699 1 915 Aimag center 21.6 1 888 2 464 Soum center 16.9 1 484 2 108 Rural 19.3 1 691 2 275 Age 15-19 13.5 1 186 1 151 20-24 15.8 1 385 1 225 25-29 15.2 1 336 1 364 30-34 15.2 1 333 1 369 35-39 14.7 1 291 1 344 40-44 13.6 1 192 1 252 45-49 11.9 1 039 1 057 Marital/Union status Currently married/in union 64.0 5 603 5 872 Widowed 3.0 265 285 Divorced 4.3 376 327 Separated 2.8 247 208 Never married/in union 25.9 2 270 2 070 Motherhood status Ever gave birth 74.3 6 510 6 742 Never gave birth 25.7 2 252 2 020 Births in last two years Had a birth in last two years 18.9 1 654 1 690 Had no birth in last two years 81.1 7 108 7 072 Education None 3.3 293 392 Primary 5.0 437 536 Basic (lower secondary) 18.9 1 655 1 958 Upper secondary 28.7 2 514 2 426 Vocational 10.0 878 891 College, university 34.1 2 986 2 559 Wealth index quintile Poorest 17.7 1 554 2 117 Second 19.2 1 681 1 906 Middle 20.4 1 790 1 771 Fourth 20.9 1 831 1 519 Richest 21.8 1 906 1 449 Ethnicity of household head Khalkh 81.2 7 118 6 600 Khazakh 3.3 288 481 Other 15.3 1 342 1 663 Missing/DK 0.2 13 18 Religion of household head No religion 41.7 3 656 3 945 Buddhist 51.0 4 470 4 122 Muslim 2.5 218 363 Other 4.4 387 299 Missing/DK 0.4 31 33 Total 100.0 8 762 8 762 20 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS CHILD DEVELOPMENT 2010 SURVEY Table HH.4M: Men's background characteristics Percent and frequency distribution of men aged 15-54 years by selected background characteristics, Mongolia, 2010 Weighted percent Number of men Weighted Unweighted Region Western 13.5 542 863 Khangai 20.8 839 777 Central 17.6 710 760 Eastern 7.6 307 758 Ulaanbaatar 40.5 1 628 867 Area Urban 60.7 2 443 1 879 Rural 39.3 1 582 2 146 Location Capital city 40.5 1 628 867 Aimag center 20.2 815 1 012 Soum center 16.4 660 919 Rural 22.9 922 1 227 Age 15-19 15.4 620 586 20-24 14.5 585 524 25-29 12.6 507 531 30-34 14.5 585 591 35-39 12.5 502 531 40-44 11.4 460 479 45-49 11.2 451 461 50-54 7.8 314 322 Marital/Union status Currently married/in union 65.0 2 616 2 718 Widowed 0.7 29 30 Divorced 1.9 76 73 Separated 2.0 81 69 Never married/in union 30.4 1 223 1 135 Fatherhood status Ever have a biological child 65.1 2 622 2 723 Never have a biological child 34.9 1 403 1 301 Missing/DK 0.0 1 1 Education None 5.8 234 296 Primary 9.4 380 475 Basic (lower secondary) 26.2 1 055 1 162 Upper secondary 25.7 1 034 932 Vocational 10.4 417 417 College, university 22.5 906 743 Wealth index quintile Poorest 20.5 827 1 112 Second 18.4 742 820 Middle 19.5 785 764 Fourth 21.0 846 703 Richest 20.5 825 626 Ethnicity of household head Khalkh 80.4 3 238 2 984 Khazakh 3.8 154 255 Other 15.6 626 778 Missing/DK 0.2 7 8 Religion of household head No religion 44.0 1 773 1 884 Buddhist 48.7 1 961 1 810 Muslim 3.0 119 190 Other 3.8 154 121 Missing/DK 0.5 19 20 Total 100.0 4 025 4 025 21 CHILD DEVELOPMENT 2010 SURVEY III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table HH.5: Under-5's background characteristics Percent and frequency distribution of children under five years of age by selected background characteristics, Mongolia, 2010 Weighted percent Number of under-5 children Weighted Unweighted Sex Male 50.1 1 981 1 990 Female 49.9 1 975 1 966 Region Western 15.5 613 956 Khangai 22.2 877 787 Central 18.7 739 810 Eastern 7.4 292 709 Ulaanbaatar 36.3 1 435 694 Area Urban 58.1 2 298 1 747 Rural 41.9 1 658 2 209 Location Capital city 36.3 1 435 694 Aimag center 21.8 863 1 053 Soum center 17.6 698 961 Rural 24.3 960 1 248 Age 0-5 months 10.1 400 410 6-11 months 10.8 426 409 12-23 months 24.2 958 914 24-35 months 21.0 832 859 36-47 months 18.1 714 713 48-59 months 15.8 626 651 Mother’s education* None 4.6 181 235 Primary 7.9 312 366 Basic (lower secondary) 18.5 730 823 Upper secondary 27.0 1 069 1 034 Vocational 6.6 261 258 College, university 35.5 1 403 1 240 Wealth index quintile Poorest 23.5 930 1 213 Second 20.2 797 874 Middle 19.3 764 706 Fourth 18.7 738 608 Richest 18.4 727 555 Ethnicity of household head Khalkh 80.0 3 166 2 908 Khazakh 3.7 148 249 Other 16.0 635 787 Missing/DK 0.2 8 12 Religion of household head No religion 46.3 1 831 1 905 Buddhist 46.6 1 843 1 712 Muslim 2.9 117 196 Other 3.9 154 129 Missing/DK 0.3 12 14 Total 100.0 3 956 3 956 * Mother's education refers to educational attainment of mothers and caretakers of children under 5. 22 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS CHILD DEVELOPMENT 2010 SURVEY Table HH.5A: Children aged 2-14's background characteristics Percent and frequency distribution of children aged 2-14 years by selected background characteristics, Mongolia, 2010 Weighted percent Number of children aged 2-14 Weighted Unweighted Sex Male 51.2 4 678 4 682 Female 48.8 4 453 4 449 Region Western 17.6 1 608 2 385 Khangai 22.3 2 034 1 773 Central 19.2 1 749 1 826 Eastern 8.3 758 1 772 Ulaanbaatar 32.7 2 982 1 375 Area Urban 55.2 5 041 3 854 Rural 44.8 4 090 5 277 Location Capital city 32.7 2 982 1 375 Aimag center 22.6 2 059 2 479 Soum center 21.3 1 941 2 582 Rural 23.5 2 149 2 695 Age 2-4 24.4 2 232 2 194 5-6 14.6 1 336 1 326 7-9 21.5 1 965 1 966 10-12 23.3 2 131 2 151 13-14 16.1 1 466 1 494 Mother’s education* None 4.3 395 483 Primary 8.0 731 846 Basic (lower secondary) 21.4 1 952 2 201 Upper secondary 26.7 2 442 2 393 Vocational 10.7 974 949 College, university 28.9 2 636 2 258 Missing/DK 0.0 1 1 Wealth index quintile Poorest 22.3 2 033 2 592 Second 22.7 2 074 2 245 Middle 19.3 1 764 1 700 Fourth 19.2 1 755 1 452 Richest 16.5 1 505 1 142 Ethnicity of household head Khalkh 78.9 7 206 6 602 Khazakh 4.4 403 628 Other 16.5 1 510 1 885 Missing/DK 0.1 12 16 Religion of household head No religion 43.2 3 948 4 204 Buddhist 49.4 4 515 4 141 Muslim 3.4 310 484 Other 3.6 326 273 Missing/DK 0.3 31 29 Total 100.0 9 131 9 131 * Mother's education refers to educational attainment of mothers and caretakers of children aged 2-14 years. 23 CHILD DEVELOPMENT 2010 SURVEY IV. CHILD MORTALITY CHAPTER IV CHILD MORTALITY © UNICEF Mongolia/Sokol/2012 24 IV. CHILD MORTALITY CHILD DEVELOPMENT 2010 SURVEY __________________________ IV_________________________ One of the overarching goals of the Millennium Development Goals (MDGs) and the Plan of Action of A World Fit For Children is the reduction of infant and under-five mortality. Specifi- cally, 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. Using direct measures of child mortality from birth histories is time consuming, more ex- pensive, and requires greater attention to training and supervision. Alternatively, indirect meth- ods 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 (IMR) is the probability of dying before their first birthday. The under-five mortality rate (U5MR) is the probability of dying before reaching the fifth birthday. Likewise the previous MICS surveys, in MICS 2010, 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 aged 15-49 and the proportion of these children who are dead, also for five-year age groups of women (Table CM.1). The technique converts the proportions dead among children of women in each age group into probabilities of dying by taking into account the approximate length of exposure of children to the risk of dying, assuming a particular model age pattern of mortality. Based on previous information on mortality in Mongolia, the Coale-Demeny's West model life table was selected as most appropriate (Table CM.3). Table CM.3 shows IMR and U5MR by different lite table models. Table CM.2 provides estimates of child mortality. The infant mortality rate is estimated at 36 per 1,000 live births while the probability of dying under age 5 is 45 per 1,000 live births. These estimates have been calculated by averaging mortality estimates obtained from women aged 20-29 and 30-34, and refer to first quarter 2006. There is some difference between the probabilities of dying among males and females. For example, the mortality rate among male infants is 41 per thousand, while among female infants it is 31 per thousand, which is 10 points lower than among male infants. Under-five mortality rates among males are estimated at 51 per thousand, which is 12 percentage points higher than among females (39 per thousand). By regions, the infant and under-five mortality rates are the lowest in Ulaanbaatar (IMR is 18, U5MR is 21 per 1,000 live births), while the figures for Khangai region are the highest (55 and 72, respectively) compared to other regions. By areas, the child mortality rates are still high in rural areas. For example, the infant mortality rate in rural areas is 48 per thousand, which is twice higher than in urban areas, and the under-five mortality rate in rural areas is 62 per thousand, which is 2.1 times higher than in urban areas. 25 CHILD DEVELOPMENT 2010 SURVEY IV. CHILD MORTALITY Figure CM.1: Under-5 mortality rates by background characteristics, Mongolia, 2010 Regions Western Khangai Central Eastern Ulaanbaatar Area Urban Rural Mother’s Education No education Primary Secondary Basic Vocational College, university Wealth Quintiles Poorest 60% Richest 40% National 0 20 40 60 80 100 per 1000 56 72 32 49 21 29 62 95 77 41 38 54 26 49 27 45 By household locations, as the household gets far from the capital city, the differences of the child mortality rates get higher. For example, the infant mortality rate in the capital city is 18 per thousand, in aimag center 31, in soum center 37 and in rural areas 54. Similarly, under-five mortality rate in the capital city is 21 per thousand, in aimag center 38, in soum center 46, and in rural areas it is 72. As disaggregating the child mortality rates by the mother/ caretaker's education, the children of mothers/ caretakers with low education are more likely to die compared to the children of high educated mothers/ caretakers. For example, U5MR for the children of mothers/ caretakers with no education is 95, primary – 77, lower secondary – 41, upper secondary – 38, vocational – 54, and college, university – 26. By household wealth index quintiles, the child mortality rates strongly differ and as the household gets wealthier the child mortality rates decrease as shown in Figure CM.1. Figure CM.2 shows the series of U5MR estimates of MICS surveys as well as of other sources, based on responses of women in different age groups, and referring to various points in time, thus showing the estimated trend in U5MR based on different sources. The Mongolia MICS 2010 estimates indicate a decline in child mortality during the last 5 years. It can be seen from that the IMR and U5MR estimates (36 per thousand and 45 per thousand, respectively) from MICS 2010 is lower than the estimates from MICS 2005, which was 40 and 51 per thousand, respectively (NSO Mongolia, UNICEF, 2007). 26 IV. CHILD MORTALITY CHILD DEVELOPMENT 2010 SURVEY The child mortality trend depicted by the vital statistics from the Ministry of Health is also a declining one; IMR declined to 20.2 per thousand in 2010 from 20.7 in 2005 while U5MR de- clined to 23.6 per thousand in 2010 from 26.0 in 2005 (Statistical Yearbook, NSO, 2005, 2010). However, the MICS results are considerably higher than those indicated by the above mentioned source. Further qualification of these apparent declines and differences as well as its determi- nants should be taken up in a more detailed and separate analysis. Figure CM.2: Trend in Under-five mortality rates, from different sources, Mongolia, 2010 Source: www.childmortality.org, retreived in January 2012. 27 CHILD DEVELOPMENT 2010 SURVEY IV. CHILD MORTALITY Table CM.1: Children ever born, children surviving and proportion dead Mean and total numbers of children ever born, children surviving and proportion dead by age of women, Mongolia, 2010 Children ever born Children surviving Proportion dead Number of women Mean Total Mean Total Age 15-19 0.052 61 0.050 59 0.034 1 186 20-24 0.584 809 0.561 777 0.039 1 385 25-29 1.486 1 986 1.430 1 910 0.038 1 336 30-34 2.109 2 811 2.009 2 678 0.048 1 333 35-39 2.628 3 392 2.464 3 181 0.062 1 291 40-44 3.099 3 694 2.801 3 339 0.096 1 192 45-49 3.640 3 782 3.257 3 385 0.105 1 039 Total 1.887 16 536 1.749 15 329 0.073 8 762 Table CM.2: Child mortality Infant and under-five mortality rates, Coale-Demeny West Model, Mongolia, 2010 Infant mortality rate1 Under-five mortality rate2 Sex Male 41 51 Female 31 39 Region Western 44 56 Khangai 55 72 Central 27 32 Eastern 39 49 Ulaanbaatar 18 21 Area Urban 24 29 Rural 48 62 Location Capital city 18 21 Aimag center 31 38 Soum center 37 46 Rural 54 72 Mother's education* None 69 95 Primary 57 77 Basic (lower secondary) 33 41 Upper secondary 31 38 Vocational 41 54 College, university 22 26 Wealth index quintiles Poorest 51 67 Second 38 48 Middle 27 32 Fourth 25 30 Richest 21 25 Ethnicity of household head Khalkh 35 42 Other 44 56 Religion of household head No religion 31 38 Buddhist 38 48 Other 60 80 Total 36 45 * Mother's education refers to educational attainment of mothers and caretakers of children under 5. 1 MICS indicator 1.2; MDG indicator 4.2 2 MICS indicator 1.1; MDG indicator 4.1 Rates refer to 2006.2 and Coale-Demeny West Model. 28 IV. CHILD MORTALITY CHILD DEVELOPMENT 2010 SURVEY Ta bl e C M .3 : E st im at es o f i nf an t a nd u nd er -5 m or ta lit y by s el ec te d lif e ta bl e m od el s E st im at es o f i nf an t m or ta lit y ra te s (IM R ) a nd u nd er -5 m or ta lit y ra te s (U 5M R ) b y se le ct ed li fe ta bl e m od el s, a nd e st im at ed re fe re nc e da te s (t) , b y ag e of w om en , M on go lia , 2 01 0 C oa le -D em en y M od el L ife T ab le s W es t N or th Ea st So ut h IM R U 5M R t IM R U 5M R t IM R U 5M R t IM R U 5M R t A ge 15 -1 9 0. 04 0 0. 05 1 20 10 .0 0. 04 0 0. 05 7 20 10 .0 0. 04 0 0. 04 6 20 10 .0 0. 03 9 0. 04 5 20 10 .0 20 -2 4 0. 03 9 0. 04 9 20 08 .9 0. 03 7 0. 05 2 20 08 .9 0. 04 0 0. 04 7 20 08 .9 0. 04 1 0. 04 7 20 08 .9 25 -2 9 0. 03 4 0. 04 2 20 07 .1 0. 03 1 0. 04 2 20 07 .2 0. 03 6 0. 04 1 20 07 .1 0. 03 6 0. 04 1 20 07 .2 30 -3 4 0. 03 9 0. 04 9 20 04 .9 0. 03 5 0. 04 8 20 05 .2 0. 04 2 0. 04 9 20 04 .8 0. 04 2 0. 04 9 20 05 .0 35 -3 9 0. 04 6 0. 05 9 20 02 .4 0. 04 1 0. 05 8 20 02 .8 0. 05 2 0. 06 1 20 02 .2 0. 05 2 0. 06 3 20 02 .4 40 -4 4 0. 06 3 0. 08 5 19 99 .7 0. 05 4 0. 08 1 20 00 .2 0. 07 1 0. 08 8 19 99 .4 0. 07 1 0. 09 2 19 99 .6 45 -4 9 0. 06 2 0. 08 4 19 96 .7 0. 05 3 0. 07 9 19 97 .2 0. 07 2 0. 08 9 19 96 .1 0. 07 2 0. 09 4 19 96 .4 U ni te d N at io ns M od el L ife T ab le s fo r D ev el op in g C ou nt rie s La tin A m er ic an C hi le an So ut h A si an Fa r E as t A si an G en er al IM R U 5M R t IM R U 5M R t IM R U 5M R t IM R U 5M R t IM R U 5M R t A ge 15 -1 9 0. 03 6 0. 04 8 20 09 .7 0. 04 0 0. 04 5 20 09 .6 0. 03 6 0. 04 7 20 09 .7 0. 03 6 0. 04 5 20 09 .6 0. 03 6 0. 04 6 20 09 .7 20 -2 4 0. 03 8 0. 05 0 20 08 .8 0. 04 1 0. 04 7 20 08 .7 0. 03 8 0. 04 9 20 08 .8 0. 03 8 0. 04 8 20 08 .7 0. 03 8 0. 04 9 20 08 .8 25 -2 9 0. 03 2 0. 04 2 20 07 .3 0. 03 6 0. 04 1 20 07 .1 0. 03 3 0. 04 2 20 07 .3 0. 03 3 0. 04 1 20 07 .2 0. 03 3 0. 04 2 20 07 .3 30 -3 4 0. 03 7 0. 04 9 20 05 .3 0. 04 3 0. 04 8 20 05 .0 0. 03 8 0. 04 9 20 05 .2 0. 03 8 0. 04 8 20 05 .2 0. 03 8 0. 04 8 20 05 .2 35 -3 9 0. 04 4 0. 06 0 20 02 .8 0. 05 3 0. 06 1 20 02 .4 0. 04 6 0. 06 1 20 02 .6 0. 04 5 0. 05 9 20 02 .7 0. 04 5 0. 06 0 20 02 .7 40 -4 4 0. 05 9 0. 08 5 19 99 .8 0. 07 5 0. 08 9 19 99 .4 0. 06 4 0. 08 9 19 99 .6 0. 06 0 0. 08 2 19 99 .9 0. 06 1 0. 08 4 19 99 .8 45 -4 9 0. 06 1 0. 08 8 19 96 .4 0. 07 7 0. 09 1 19 96 .0 0. 06 6 0. 09 3 19 95 .9 0. 06 0 0. 08 1 19 96 .8 0. 06 3 0. 08 6 19 96 .5 29 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION CHAPTER V NUTRITION © UNICEF Mongolia/Sokol/2012 30 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY ____________________________ V___________________________ 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, their growth and development is at an appropriate level and their nutrition status is normal. Malnutrition is associated with more than half of total child deaths worldwide. Undernourished children are more likely to die from common childhood ailments, and those who survive have recurring illnesses and are at risk of becoming underdeveloped. Three of four children, who died from malnutrition, were only mildly or moderately malnourished, which shows that the risk of death or vulnerability does not depend on the form of malnutrition. The Millennium Development target is to reduce hunger by half between 1990 and 2015. A reduction in the prevalence of malnutrition will also assist in the goal to reduce child mortality. A reference distribution of height and weight for children under age of five is based on data of population with good nutritional status. Under-nourishment in a population can be gauged by comparing children to a reference population. The reference population used in this report is based on new WHO growth standards10. Each of the three nutritional status indicators can be expressed in standard deviation units (z-scores) from the median of the reference population. Weight-for-age is a measure of both acute and chronic malnutrition. Children whose weight-for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight. Height-for-age is a measure for linear growth. Children whose height-for-age is two standard deviations below the median of the reference population are considered as moderately or severely stunted while those whose height-for-age is more than three standard deviations below the median of the reference population are classified as severely stunted. Stunting is a failure to reach an appropriate height and is a reflection of chronic malnutrition as a result of not receiving adequate nutrition over a long period and recurrent or chronic illness. 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 classified as severely wasted. Wasting is usually a result of a recent nutritional deficiency. The indicator may exhibit significant seasonal shifts, associated with changes in the availability of food or disease prevalence. In Multiple Indicator Cluster Survey (MICS), weight and height of all children under 5 years of age were measured using anthropometric equipment recommended by UNICEF (www. childinfo.org). 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 two standard deviations above the median of the reference 10 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf 31 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION population, and mean Z-scores for all three anthropometric indicators. There were no children whose full birth date (day, month and year) was not obtained and children whose measurements are outside a plausible range are excluded from Table NU.1. Children are excluded from one or more of the anthropometric indicators when their weights and heights have not been measured, whichever applicable. For example, if a child has been weighed but his/ her height has not been measured, the child is included in underweight calculations, but not in the calculations for stunting and wasting. The percentages of children by age and reasons for exclusion are shown in the data quality tables DQ.6 and DQ.7. Overall 94 percent of under-5 children had both their weights and heights measured (Table DQ.6). Table DQ.7 shows that due to incomplete dates of birth, implausible measurements, and missing weight and/ or height, 6 percent of children have been excluded from calculations of the weight-for-age indicator, while the figures are 7 percent for the height-for-age indicator, and 7 percent for the weight-for- height indicator. Of the total children under-5 in Mongolia, 3 percent are moderately or severely underweight, of them 1 percent are severely underweight. Moreover, 15 percent of the children are moderately or severely stunted or short for their ages, 5 percent are severely stunted and 2 percent are moderately or severely wasted or thin for their height (See Table NU.1). Children in Western and Khangai regions are more likely to be stunted. For example, 25 percent of children under-5 in Western and 18 percent of children under-5 in Khangai region are stunted while stunting is less common among the children of Ulaanbaatar and Central region. Moreover, the stunting prevalence is lower in urban areas (12 percent) than in rural areas (20 percent). Nutritional status of children under-5 differs due to education of their mothers/ caretakers. The children whose mothers/ caretakers have vocational or higher education have less risks of being underweight or stunted compared to the children of mothers/ caretakers with no education or primary education. For example, the percentage of stunted children who have non-educated mothers/ caretakers is 28 percent compared to the figure of 9 percent among children whose mothers/ caretakers obtained college, university education. Furthermore, 25 percent or one in every 4 children under-5 in poorest quintile is stunted while only 7 percent of children under-5 in richest quintile is stunted (See Table NU.1). As Figure NU.1 shows, the stunting prevalence is the highest among children aged 12-23 months (21 percent) while it is less among children aged 0-11 months. The high prevalence for stunting among the children aged 12-35 months is primarily related to that this is the age at which many children cease to be breastfed and are exposed to contamination in water, food, and environment. 32 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY Figure NU.1: Percentage of children under 5 who are underweight, stunted and wasted, Mongolia, 2010 Pe rc en t Stunted Age (in Months) Underweight Wasted 0.0 5.0 10.0 15.0 20.0 25.0 06 06 12 18 24 30 36 42 48 54 60 Wasting and underweight prevalence are relatively low among the total children under-5 and there are no significant differences in its distribution by background characteristics such as regions, areas, locations, education of mothers/ caretakers, and household wealth index quintiles (See Table NU.1). The overweight prevalence is 11 percent among the total children under-5, which is almost at similar rate in 2005 when it was 10 percent. Breastfeeding and Infant and Young Child Feeding Breastfeeding in the first few years of child life protects children from infection, provides an ideal source of nutrients, and is economical and safe. Unfortunately, the majority of mothers stop breastfeeding too soon and switch to infant formula, which can lead to slowdown of the child growth and development, shortage of micronutrients and risk of diseases if clean water is not readily available. WHO/ UNICEF have the following feeding recommendations: • Exclusive breastfeeding for the first six months; • Continued breastfeeding for two years or more; • Safe, appropriate and adequate complementary foods beginning at 6 months; • 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 related to recommended child feeding practices are as follows: • Early initiation of breastfeeding (within 1 hour of birth); • Exclusive breastfeeding rate (0-5 months); • Predominant breastfeeding (0-5 months); • Continued breastfeeding at 1 year and 2 years (12-15 months and 20-23 months); • Median duration of breastfeeding (0-35 months); 33 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION • Age-appropriate breastfeeding (0-23 months); • Introduction of solid or semi-solid foods (6-8 months); • Minimum meal frequency (6-23 months); • Milk feeding frequency for non-breastfed children (6-23 months); • Children who drank anything from a bottle with nipple (0-23 months). Table NU.2 shows the proportion of children born in the last two years who were ever breastfed, those who were first breastfed within one hour and one day of birth, and those who received a prelacteal feed. A very important step in management of lactation and establishment of a physical and emotional relationship between the baby and the mother is an early initiation of breastfeeding. Of the total children born in the two years preceding the survey, 71 percent are breastfed for the first time within one hour of birth while 92 percent start breastfeeding within one day of birth. By regions, the percentage of newborns breastfed for the first time within one hour of birth is relatively lower in Western and Central regions (64 percent) compared to other regions (72-80 percent). Starting breastfeeding within one day of birth is at 90-96 percent in the regions (Figure NU.2). Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Mongolia, 2010 92 93 90 96 92 92 93 92 64 80 64 79 72 72 71 71 0 20 40 60 80 100 120 Western Khangai Central Eastern Ulaanbaatar Urban Rural National Pe rc en t Within one day Within one hour Table NU.2 shows that the percentages of children aged 0-23 months that are breastfed for the first time within one hour of birth and within one day of birth do not differ significantly by areas, locations, education of mothers/ caretakers, and household wealth index quintiles. Interestingly, the percentage of children that are breastfed for the first time within one hour is 20 percent among households with Khazakh heads while it is 73 percent among households with Khalkh heads (Table NU.2). Furthermore, Table NU.2 shows that the percentage of children who received prelacteal feed is quite high among mothers/ caretakers with college, university education (13 percent). When the practice of feeding the children aged 0-23 months with liquids or foods other than breast milk before initial breastfeeding is compared by household wealth index quintiles, it is more common among households in richest quintile. 34 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY In Table NU.3, breastfeeding status is based on the reports of mothers/ caretakers of children's consumption of 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, as well as continued breastfeeding of children at 12-15 and 20-23 months of age. 66 percent of children aged less than six months are exclusively breastfed. Also, as in Table NU.3, the highest percentage of exclusive breastfeeding among children aged 0-5 months is in Western region (74 percent) and the lowest is in Khangai region and Ulaanbaatar city (61 and 62 percent). Furthermore, by age of 12-15 months, 82 percent of children are still being breastfed and by age 20-23 months, 65 percent are still breastfed. Boys are more likely to be continuously breastfed at 1 year and 2 years (85 and 67 percents, respectively) than girls (79 and 63 percents, respectively). By regions, continued breastfeeding at 1 year and 2 years are the lowest in Eastern region (71 and 45 percents, respectively) while continued breastfeeding at 1 year is the highest in Khangai region (95 percent) and continued breastfeeding at 2 years is the highest in Western region (76 percent). Table NU.4 shows the median duration of breastfeeding by selected background characteristics. For instance, among children under age 3, the median duration is 25 months for any breastfeeding, 4 months is same for exclusive breastfeeding and predominant breastfeeding. The median duration for exclusive breastfeeding among children under age 3 covered by the survey do not differ much by gender while there are some variations by regions. For instance, the median duration for exclusive breastfeeding is 5 months in Western region and it is 3 months in Khangai region and Ulaanbaatar (Table NU.4). The adequacy of infant feeding of children under age of 24 months is shown in Table NU.5. Different criteria of adequate feeding are used depending on the age of the child. For infants aged 0-5 months, exclusive breastfeeding is considered as adequate feeding, while infants aged 6-23 months are considered to be adequately fed if they are receiving breast milk and solid or semi-solid foods. As the findings for adequate feeding among young children, 70 percent of children aged 6-23 months are currently breastfeeding and received solid or semi-solid foods. The Table NU.5 shows that the percentage of children who are currently breastfeeding and received solid or semi-solid foods does not differ by gender, regions, areas and locations. Of the total children aged 0-23 months, 69 percent are appropriately breastfed. The percentage of children under age 2 who are appropriately breastfed differs slightly by regions; the figure is the lowest in Eastern region (65 percent) while it is the highest in Khangai regions (72 percent). Adequate complementary feeding of children from 6 months to two years of age is particularly important for growth and development and prevention of undernutrition. Continued breastfeeding beyond 6 months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breast milk is no longer sufficient. This requires that for breastfed children, two or more meals of solid or semi-solid foods are needed if they are 6-8 months old, and three or more meals if they are 9-23 months of age. For children aged 6-23 months and older who are not breastfed, four or more meals of solid or semi-solid or milk feeds are needed. 35 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION Of the total children aged 6-8 months covered by the survey, 66 percent received solid or semi-solid foods. Among currently breastfeeding infants this percentage is 64 percent (Table NU.6). As shown in the table, the introduction of solid or semi-solid foods differs in urban and rural areas. For instance, 71 percent of children aged 6-8 months in urban areas received solid or semi-solid foods while 58 percent of children in rural areas introduced to complementary foods on time. Table NU.7 presents the proportion of children aged 6-23 months who received solid or semi-solid foods the minimum number of times or more during the previous day preceding the survey according to breastfeeding status. Among currently breastfeeding children aged 6-23 months, one in every 5 (21 percent) children received solid or semi-solid foods the minimum number of times. The percentage of girls received the minimum number of meals (23 percent) is slightly higher compared to boys (18 percent). Among non-breastfeeding children aged 6-23 months, it is necessary to feed them with milk feeds at least twice and with solid or semi-solid foods or milk feeds 4 times or more a day. This percentage is 71 percent for this survey and does not differ by gender. Also, 67 percent of the non-breastfeeding children aged 6-23 months received solid or semi-solid foods or milk feeds 4 times or more a day and again this figure does not differ by gender. In Mongolia, only one in every 3 children (30 percent) received solid or semi-solid foods the minimum number of times a day, which shows there is a common practice of inaqequate feeding in the country. The percentage of children aged 6-23 months received minimum meal frequency is 32 percent in urban areas and 27 percent in rural areas. Also, Table NU.7 shows that the figure on minimum meal frequency is the lowest in Western region (15 percent). The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. As shown in Table NU.8, bottle-feeding among children aged 0-23 months is still prevalent in the country. One in every 5 children under 2 years old (21 percent) drank anything from a bottle with nipple. Practice of drinking liquids from a bottle with nipple among children aged 6-11 months (34 percent) is nearly twice higher than that among children of other ages. Moreover, the practice of bottle-feeding among children aged 0-23 months in urban areas (26 percent) is twice higher than that of children in rural areas (13 percent). Salt Iodization Iodine Deficiency Disorders (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). 36 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY Since about 80 percent of Mongolia's territory is located in a region with the iodine scarcity, in 1992-1995 IDD Salt Iodization Research has been launched with the assistance of UNICEF in order to determine the level of national IDD distribution. According to the research report, goitre has been detected in 29 percent among children aged 7-23 in Mongolia. Since the IDD distribution has been alarmingly high in some regions of Mongolia according to the research findings, the Government of Mongolia developed and implemented the first National Program on "Combating IDD", starting from 1996 to 2001. Since then, the Government approved and implemented the second and the third stages of this program in 2002-2006 and 2007-2010. In the frame of the National program, the Government of Mongolia implemented numerous activities such as improving the legal environment for the iodized salt production and support of its consumption; raising public awareness of the iodized salt and its benefits and other actions, directed towards establishing the attitudes and practices of iodized salt consumption. The National Standards of Iodized Salt (2001), the Law of Mongolia on "Prevention of IDD by Salt Iodization" (2003), and the Regulations on "Control of Enriched Products" (2006) were adopted under which mandatory use of iodized salt was legalized. Starting with the launch of the "Combating IDD program" in 1996, iodized salt was first introduced into food consumption of the population. Since then, the household consumption of this product has been increasing constantly and IDD distribution has reduced every year. According to the National Standards of Mongolia, only potassium iodide is allowed to iodize the salt for cooking. Therefore, in order to determine the presence of iodine in the salt used by the surveyed households, an accelerated method of detecting potassium iodide (KiO3) in salt was used. In about 95 percent of households, salt used for cooking was tested for iodine content by using salt test kits and testing for the presence of potassium iodide. Table NU.9 shows that in a very small proportion of households (1 percent), there was no salt available. In 70 percent of households, salt was found to contain 15 parts per million or more of iodine. The use of iodized salt differs significantly by regions and areas. For instance, 3 in every 4 households (77 percent) in urban areas use adequately iodized salt for cooking while this figure is 59 percent in rural areas. The use of iodized salt was found to be the highest in Ulaanbaatar (81 percent) as compared to only 48 percent in Western region, which is the lowest (Figure NU.3). Figure NU.3: Percentage of households consuming adequately iodized salt, Mongolia, 2010 48 64 68 76 81 77 59 70 0 10 20 30 40 50 60 70 80 90 Western Khangai Central Eastern Ulaanbaatar Urban Rural National Regions Pe rc en t 37 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION The use of adequately iodized salt has strong association with the household wealth index quintiles and as household gets wealthier the use of iodized salt increases. For instance, the households in poorest and second quintiles were found to be using adequately iodized salt at 53-68 percent while this figure is 76-79 percent for the households in fourth and richest quintiles (Table NU.9). Vitamin A Supplementation Vitamin A is essential for eye health and 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, daily per capita intake is often insufficient to meet dietary requirements. Inadequate intakes are further compromised by increased requirements 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 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 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 high-dose vitamin A supplementation every 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 six 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 aged 6-59 months who received at least one high dose of vitamin A supplement in the last six months. Based on UNICEF/ WHO guidelines, the Ministry of Health of Mongolia recommends that children aged 6-11 months be given one high dose Vitamin A capsule and children aged 12-59 months given a vitamin A capsule every 6 months. Our country organizes the programs for supplying high dosage of Vitamin A to young children every May and October of each year along with immunization activities. Since during the pregnancy or lactation the body needs in Vitamin A increases, guidelines on providing new mothers in maternity hospitals with a Vitamin A supplement are being implemented. Within the six months prior to the MICS 2010, 61 percent of children aged 6-59 months received a high dose Vitamin A supplement and the survey findings shows no significant 38 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY difference in consumption of high dose Vitamin A supplements among urban and rural children (Table NU.10). By age groups, the vitamin A supplementation in the 6 months prior to the survey is 52 percent among children aged 6-11 months, and 66 percent among children aged 12-23 months, which shows increase against the previous age group. However, for further ages, the consumption decreases as follows: 64 percent for children aged 24-35 months, 59 percent for children aged 36-47 months, and 58 percent for children aged 48-59 months. In addition, while only half of children in Western region (49 percent) consume high dose of vitamin A, in other regions this indicator is 58-74 percent. Specially, in Eastern and Khangai regions, the use of high dose vitamin A was the highest. There is no any significant difference in the vitamin A supplementations by children's age, areas, locations and wealth index quintiles of their households. Low Birth Weight Weight at birth is a good indicator not only of the 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 mother's womb, face a greatly increased risk of death during their early months and the first year of life. Those who survive have impaired immune function and an 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 lower 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 the most impact: the mother's poor nutritional status before conception or in her childhood, infectious diseases, 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 and malaria, which are common in many developing countries, can significantly impair foetal growth if the mother becomes infected while pregnant. In the industrialized world, smoking during pregnancy is the leading cause of low birth weight. In developed and developing countries alike, teenagers who give birth when their own bodies have yet to finish growing run the risk of bearing underweight babies. One of the major challenges in measuring the incidence of low birth weight is the fact that more than half of infants in the developing world are not weighed at birth. In the past, most estimates of low birth weight for developing countries were based on data compiled from health facilities. However, these estimates were biased for most developing countries, because the majority of newborns are not delivered in facilities, and those who were represented only a selected sample of all births. Also, because many infants are not weighed at birth and those who are weighed may be a biased sample of all births the reported birth weights usually cannot be used to estimate the prevalence of low birth weight among all children. Therefore, the percentage of births weighing 39 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION below 2,500 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 birth11. Figure NU.4: Percentage of infants weighing less than 2500 grams at birth, Mongolia, 2010 6.6 4.4 5.4 4.9 3.8 4.7 0.0 5.0 10.0 15.0 20.0 Western Khangai Central Eastern Ulaanbaatar National Regions Pe rc en t In Mongolia, almost 98 percent of the total children aged 0-23 months were successfully weighed at birth and only 5 percent of them are estimated to weigh less than 2,500 grams at birth (See Table NU.11). The percentage of children with low birth weight varies by regions. For example, the highest percentage is observed in Western region at 7 percent while the lowest percentage in Ulaanbaatar city at 4 percent (Figure NU.4). The low birth weight percentage for children under-2 does not differ by areas and household wealth index quintiles (Table NU.11). 11 For a detailed description of the methodology, see Boerma, J. T., Weinstein, K. I., Rutstein, S.O., and Sommerfelt, A. E. , 1996. Data on Birth Weight in Developing Countries: Can Surveys Help? Bulletin of the World Health Organization, 74(2), 209-16. 40 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY Ta bl e N U .1 : N ut rit io na l s ta tu s of c hi ld re n P er ce nt ag e of c hi ld re n un de r a ge 5 b y nu tri tio na l s ta tu s ac co rd in g to th re e an th ro po m et ric in di ce s: w ei gh t f or a ge , h ei gh t f or a ge , a nd w ei gh t f or h ei gh t, M on go lia , 2 01 0 W ei gh t f or a ge N um be r o f ch ild re n H ei gh t f or a ge N um be r o f ch ild re n W ei gh t f or h ei gh t N um be r o f ch ild re n U nd er w ei gh t M ea n Z- S co re (S D ) St un te d M ea n Z- S co re (S D ) W as te d O ve rw ei gh t M ea n Z- S co re (S D ) pe rc en t b el ow pe rc en t b el ow pe rc en t b el ow pe rc en t ab ov e - 2 S D 1 - 3 S D 2 - 2 S D 3 - 3 S D 4 - 2 S D 5 - 3 S D 6 + 2 S D Se x M al e 3. 6 1. 1 0. 1 1 85 7 17 .1 5. 5 -0 .8 1 84 6 1. 9 0. 9 11 .9 0. 8 1 83 9 Fe m al e 3. 0 0. 8 0. 1 1 85 1 13 .5 3. 8 -0 .7 1 83 9 1. 3 0. 5 9. 8 0. 7 1 83 4 R eg io n W es te rn 4. 1 1. 6 -0 .2 57 5 24 .5 6. 7 -1 .3 57 4 1. 4 0. 9 8. 3 0. 7 57 1 K ha ng ai 4. 2 0. 9 0. 0 84 3 18 .0 4. 9 -0 .9 83 0 1. 7 0. 4 10 .0 0. 7 83 2 C en tra l 2. 5 0. 8 0. 1 68 4 12 .9 4. 0 -0 .7 68 2 0. 8 0. 1 8. 3 0. 6 68 0 E as te rn 2. 6 0. 3 0. 1 27 6 15 .5 2. 9 -0 .8 27 4 1. 0 0. 4 7. 8 0. 8 27 3 U la an ba at ar 3. 0 0. 9 0. 3 1 33 0 10 .8 4. 4 -0 .5 1 32 3 2. 2 1. 1 14 .4 0. 8 1 31 7 A re a U rb an 2. 8 0. 7 0. 2 2 13 9 11 .9 4. 1 -0 .6 2 13 0 1. 9 0. 9 12 .8 0. 7 2 12 1 R ur al 4. 0 1. 3 -0 .1 1 57 0 19 .9 5. 5 -1 .0 1 55 5 1. 3 0. 4 8. 2 0. 7 1 55 2 Lo ca tio n C ap ita l c ity 3. 0 0. 9 0. 3 1 33 0 10 .8 4. 4 -0 .5 1 32 3 2. 2 1. 1 14 .4 0. 8 1 31 7 A im ag c en te r 2. 5 0. 3 0. 1 80 8 13 .8 3. 6 -0 .7 80 7 1. 4 0. 5 10 .2 0. 7 80 4 S ou m c en te r 3. 9 1. 3 0. 0 65 8 15 .0 4. 2 -0 .9 65 2 0. 8 0. 3 7. 4 0. 6 65 0 R ur al 4. 1 1. 3 -0 .1 91 2 23 .5 6. 4 -1 .2 90 3 1. 6 0. 5 8. 8 0. 7 90 2 A ge 0- 5 m on th s 8. 4 2. 5 0. 2 38 1 8. 0 3. 8 -0 .1 37 5 6. 4 3. 6 13 .1 0. 4 37 2 6- 11 m on th s 0. 8 0. 2 0. 7 40 7 7. 0 1. 4 -0 .1 40 4 0. 4 0. 3 12 .3 1. 0 40 6 12 -2 3 m on th s 2. 6 1. 2 0. 3 89 7 20 .5 6. 6 -0 .9 89 3 1. 1 0. 2 16 .2 0. 9 89 0 24 -3 5 m on th s 3. 6 0. 9 0. 0 77 4 19 .6 6. 1 -1 .1 77 0 1. 6 0. 2 9. 2 0. 8 76 6 36 -4 7 m on th s 3. 0 0. 4 -0 .1 66 8 15 .5 4. 8 -1 .0 66 5 0. 2 0. 2 7. 1 0. 7 66 2 48 -5 9 m on th s 2. 8 0. 8 -0 .2 58 2 11 .7 2. 6 -0 .9 57 8 1. 7 0. 9 6. 7 0. 5 57 7 M ot he r's e du ca tio n* N on e 8. 0 2. 9 -0 .4 17 5 28 .2 11 .8 -1 .4 17 3 1. 0 1. 0 7. 5 0. 6 17 3 P rim ar y 5. 1 1. 2 -0 .2 28 3 21 .1 7. 1 -1 .2 28 0 2. 0 0. 3 10 .0 0. 7 27 9 B as ic (l ow er s ec on da ry ) 3. 6 1. 1 0. 0 69 2 20 .6 6. 7 -1 .0 68 7 1. 1 0. 0 7. 7 0. 7 68 4 U pp er s ec on da ry 3. 1 0. 6 0. 1 1 01 5 15 .9 4. 0 -0 .8 1 01 1 1. 8 0. 9 10 .1 0. 7 1 00 3 Vo ca tio na l 3. 3 0. 4 0. 1 25 0 15 .1 2. 9 -0 .8 24 8 1. 2 0. 2 9. 8 0. 7 25 0 C ol le ge , u ni ve rs ity 2. 3 0. 9 0. 3 1 29 3 9. 1 3. 0 -0 .4 1 28 6 1. 8 1. 0 13 .9 0. 7 1 28 4 W ea lth in de x qu in til es P oo re st 5. 0 1. 3 -0 .2 88 4 25 .2 7. 6 -1 .2 87 6 1. 2 0. 3 7. 5 0. 7 87 2 S ec on d 4. 0 0. 8 -0 .1 74 3 18 .4 5. 6 -1 .0 73 7 1. 5 0. 6 8. 6 0. 7 73 7 M id dl e 2. 9 1. 0 0. 2 72 9 11 .4 4. 1 -0 .7 72 6 2. 3 1. 2 11 .3 0. 7 72 1 Fo ur th 3. 2 0. 9 0. 2 68 4 11 .9 3. 5 -0 .6 68 0 2. 3 1. 3 13 .8 0. 8 67 8 R ic he st 0. 9 0. 7 0. 5 66 9 6. 5 1. 7 -0 .2 66 5 0. 8 0. 2 14 .3 0. 7 66 5 Et hn ic ity o f h ou se ho ld h ea d* * K ha lk h 3. 2 0. 9 0. 1 2 98 2 14 .1 4. 5 -0 .7 2 96 3 1. 7 0. 8 11 .2 0. 7 2 95 2 K ha za kh 8. 9 5. 1 -0 .5 12 9 30 .4 10 .0 -1 .5 12 8 1. 1 0. 6 8. 1 0. 4 12 7 O th er 2. 5 0. 5 0. 1 59 0 18 .4 4. 6 -0 .9 58 5 1. 0 0. 4 9. 9 0. 7 58 6 R el ig io n of h ou se ho ld h ea d* ** N o re lig io n 3. 0 0. 9 0. 1 1 70 3 14 .9 4. 9 -0 .8 1 69 7 1. 7 0. 7 10 .1 0. 7 1 68 7 B ud dh is t 3. 6 0. 8 0. 1 1 74 9 14 .3 4. 2 -0 .7 1 73 2 1. 7 0. 8 11 .7 0. 7 1 73 1 M us lim 9. 1 5. 2 -0 .5 98 32 .7 8. 8 -1 .5 98 0. 9 0. 8 9. 8 0. 5 98 O th er 0. 6 0. 6 0. 2 14 8 19 .9 4. 2 -0 .7 14 8 0. 0 0. 0 10 .0 0. 7 14 5 To ta l 3. 3 0. 9 0. 1 3 70 8 15 .3 4. 7 -0 .8 3 68 4 1. 6 0. 7 10 .9 0. 7 3 67 2 * M ot he r's e du ca tio n re fe rs to e du ca tio na l a tta in m en t o f m ot he rs a nd c ar et ak er s of c hi ld re n un de r 5 . ** T w el ve , t w el ve a nd tw el ve u nw ei gh te d ca se s w ith m is si ng "E th ni ci ty o f h ou se ho ld h ea d" n ot s ho w n re sp ec tiv el y. ** * T hi rte en , t hi rte en a nd fo ur te en u nw ei gh te d ca se s w ith m is si ng "R el ig io n of h ou se ho ld h ea d" n ot s ho w n re sp ec tiv el y. 1 M IC S in di ca to r 2 .1 a an d M D G in di ca to r 1 .8 2 M IC S in di ca to r 2 .1 b 3 M IC S in di ca to r 2 .2 a, 4 M IC S in di ca to r 2 .2 b 5 M IC S in di ca to r 2 .3 a, 6 M IC S in di ca to r 2 .3 b 41 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION Table NU.2: Initial breastfeeding Percentage of last-born children in the two years preceding the survey who were ever breastfed, percentage who were breastfed within one hour of birth and within one day of birth, and percentage who received a prelacteal feed, Mongolia, 2010 Percentage who were ever breastfed1 Percentage who were first breastfed: Percentage who received a prelacteal feed Number of last-born children in the two years preceding the survey Within one hour of birth2 Within one day of birth Region Western 97.6 63.8 92.4 4.3 241 Khangai 96.5 79.7 93.0 7.3 374 Central 96.2 64.0 90.4 12.6 308 Eastern 98.6 78.6 95.7 3.7 107 Ulaanbaatar 98.4 71.8 91.5 11.7 624 Area Urban 98.1 71.8 91.6 11.3 992 Rural 96.6 70.9 92.8 6.2 662 Location Capital city 98.4 71.8 91.5 11.7 624 Aimag center 97.5 71.7 91.6 10.8 368 Soum center 98.9 71.6 95.5 8.3 281 Rural 94.8 70.4 90.8 4.6 381 Months since last birth 0-11 months 97.9 71.2 92.6 8.8 781 12-23 months 97.2 71.6 91.5 9.9 847 Assistance at delivery Skilled attendant 97.9 71.8 92.5 9.4 1 635 Relative, friend (*) (*) (*) (*) 5 Other/Missing (*) (*) (*) (*) 15 Place of delivery Public sector health facility 98.1 71.9 92.7 9.2 1 617 Private sector health facility (*) (*) (*) (*) 13 Home (*) (*) (*) (*) 17 Other/Missing (*) (*) (*) (*) 8 Mother's education* None 97.2 73.3 92.6 3.4 61 Primary 94.6 72.4 90.5 0.3 116 Basic (lower secondary) 98.5 73.3 94.8 6.3 282 Upper secondary 96.5 74.7 91.1 9.5 477 Vocational 96.6 72.9 93.5 5.0 103 College, university 98.5 67.3 91.6 13.4 615 Wealth index quintiles Poorest 95.4 72.1 92.2 4.2 368 Second 97.6 72.8 91.9 6.2 343 Middle 98.7 72.1 91.6 7.7 340 Fourth 99.0 76.3 93.8 12.5 298 Richest 97.0 63.4 91.0 17.5 305 Ethnicity of household head** Khalkh 97.8 73.1 92.1 9.9 1 334 Khazakh 96.4 19.7 86.9 1.1 60 Other 96.0 74.3 92.7 7.9 257 Religion of household head*** No religion 97.3 71.5 91.7 8.7 742 Buddhist 98.2 75.1 93.2 9.6 782 Muslim 95.6 17.2 84.3 1.4 48 Other 95.3 69.3 91.3 17.2 71 Total 97.5 71.4 92.1 9.3 1 654 * Mother's education refers to educational attainment of mothers and caretakers of last-born children in the two years preceding the survey. ** Six unweighted cases with missing "Ethnicity of household head" not shown. *** Twelve unweighted cases with missing "Religion of household head" not shown. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 2.4 2 MICS indicator 2.5 42 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Mongolia, 2010 Children aged 0-5 months Children aged 12-15 months Children aged 20-23 months Percent exclusively breastfed1 Percent predominantly breastfed2 Number of children Percent breastfed (continued breastfeeding at 1 year)3 Number of children Percent breastfed (continued breastfeeding at 2 years)4 Number of children Sex Male 65.8 70.6 201 85.1 179 66.5 122 Female 65.5 71.3 199 79.3 153 63.1 135 Region Western 74.4 74.9 69 86.8 37 76.2 41 Khangai 61.4 64.1 84 95.2 68 59.8 61 Central 69.1 73.1 80 81.1 67 (69.2) 40 Eastern 66.6 66.6 31 70.7 23 (44.5) 15 Ulaanbaatar 61.7 72.8 137 77.5 138 (64.2) 99 Area Urban 62.5 70.4 228 81.6 207 67.0 149 Rural 69.9 71.7 172 83.8 126 61.6 107 Location Capital city 61.7 72.8 137 77.5 138 (64.2) 99 Aimag center 63.5 66.6 91 89.8 68 72.4 50 Soum center 71.8 73.0 73 77.0 53 60.8 50 Rural 68.6 70.7 99 88.6 74 62.3 57 Mother's education* None (*) (*) 15 (*) 13 (*) 10 Primary (68.7) (70.3) 25 (89.3) 23 (*) 16 Basic (lower secondary) 70.9 70.9 71 76.1 53 73.5 53 Upper secondary 60.9 67.3 111 92.1 94 67.4 65 Vocational (*) (*) 24 (*) 24 (*) 17 College, university 63.3 70.9 153 75.3 125 64.2 96 Wealth index quintiles Poorest 68.4 68.9 98 89.1 70 65.8 55 Second 68.9 71.1 97 87.5 51 62.7 53 Middle 67.8 70.5 97 83.4 61 (58.4) 53 Fourth (56.2) (73.3) 40 84.3 77 (74.5) 58 Richest 59.7 72.8 68 (69.8) 74 (59.7) 37 Ethnicity of household head** Khalkh 63.7 69.6 318 82.4 280 65.7 211 Other 73.1 75.8 81 82.8 53 60.2 46 Religion of household head*** No religion 67.3 72.4 167 78.0 157 65.6 121 Buddhist 66.5 70.0 205 86.6 147 63.7 114 Other (53.3) (74.3) 24 (86.4) 28 (63.2) 20 Total 65.7 70.9 400 82.4 333 64.7 256 * Mother's education refers to educational attainment of mothers and caretakers of living children. ** Unweighted cases with missing “Ethnicity of household head “, one for children aged 0-5 months, no for children aged 12-15 and 20-23 months, not shown. *** Four, two and one unweighted cases with missing "Religion of household head" not shown respectively. ( ) Figures that are based on 25-49 unweighted cases. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 43 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION Table NU.4: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children aged 0-35 months, Mongolia, 2010 Median duration (in months) of Number of children aged 0-35 monthsAny breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Sex Male 25.7 3.9 4.2 1 327 Female 26.0 3.7 4.0 1 288 Region Western 26.3 4.9 5.0 389 Khangai 27.3 3.4 3.6 587 Central 25.3 4.2 4.5 487 Eastern 20.9 3.8 3.8 190 Ulaanbaatar 25.8 3.4 4.0 963 Area Urban 26.1 3.5 4.0 1 528 Rural 25.5 4.1 4.3 1 088 Location Capital city 25.8 3.4 4.0 963 Aimag center 27.1 3.7 3.9 565 Soum center 26.9 4.1 4.2 462 Rural 24.8 4.2 4.3 625 Mother's education* None 24.4 4.7 4.7 108 Primary 28.4 4.2 4.3 201 Basic (lower secondary) 26.2 4.2 4.2 458 Upper secondary 25.7 3.3 3.7 714 Vocational 24.4 4.2 4.6 179 College, university 25.4 3.7 4.2 955 Wealth index quintiles Poorest 24.6 4.2 4.2 602 Second 27.9 4.1 4.2 533 Middle 24.8 4.0 4.2 504 Fourth 28.6 2.9 3.7 489 Richest 24.9 3.3 4.0 488 Ethnicity of household head** Khalkh 26.2 3.7 4.1 2 105 Khazakh 26.0 3.8 3.8 97 Other 24.7 4.0 4.1 409 Religion of household head*** No religion 26.7 3.9 4.2 1 169 Buddhist 25.6 3.8 4.0 1 255 Muslim 27.0 2.9 2.9 75 Other 26.0 2.7 4.6 107 Median 25.8 3.8 4.1 2 615 Mean for all children (0-35 months) 24.6 4.0 4.3 2 615 * Mother's education refers to educational attainment of mothers and caretakers of children aged 0-35 months. ** Six unweighted cases with missing "Ethnicity of household head" not shown. *** Twelve unweighted cases with missing "Religion of household head" not shown. 1 MICS indicator 2.10 44 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY Table NU.5: Age-appropriate breastfeeding Percentage of children aged 0-23 months who were appropriately breastfed during the last day and night preceding the survey, Mongolia, 2010 Children aged 0-5 months Children aged 6-23 months Children aged 0-23 months Percent exclusively breastfed1 Number of children Percent currently breastfeeding and receiving solid or semi-solid foods Number of children Percent appropriately breastfed2 Number of children Sex Male 65.8 201 73.3 701 71.6 902 Female 65.5 199 67.4 682 67.0 881 Region Western 74.4 69 68.6 183 70.2 251 Khangai 61.4 84 74.7 324 72.0 408 Central 69.1 80 68.8 242 68.9 322 Eastern 66.6 31 63.8 88 64.6 119 Ulaanbaatar 61.7 137 70.1 546 68.4 683 Area Urban 62.5 228 72.3 846 70.2 1 074 Rural 69.9 172 67.3 537 68.0 709 Location Capital city 61.7 137 70.1 546 68.4 683 Aimag center 63.5 91 76.2 300 73.3 391 Soum center 71.8 73 66.4 230 67.7 303 Rural 68.6 99 68.0 307 68.2 407 Mother's education* None (*) 15 77.6 48 77.3 63 Primary (68.7) 25 61.3 103 62.7 128 Basic (lower secondary) 70.9 71 74.0 232 73.3 303 Upper secondary 60.9 111 74.5 400 71.6 511 Vocational (*) 24 56.4 94 60.7 118 College, university 63.3 153 69.2 507 67.8 660 Wealth index quintiles Poorest 68.4 98 68.5 299 68.5 397 Second 68.9 97 68.6 263 68.7 360 Middle 67.8 97 71.0 275 70.2 371 Fourth (56.2) 40 77.9 282 75.2 323 Richest 59.7 68 65.4 264 64.2 332 Ethnicity of household head** Khalkh 63.7 318 71.5 1 130 69.8 1 448 Khazakh (*) 14 54.6 47 56.8 62 Other 75.0 66 67.2 203 69.1 270 Religion of household head*** No religion 67.3 167 69.6 639 69.1 806 Buddhist 66.5 205 74.2 637 72.3 842 Muslim (*) 10 55.2 39 55.1 49 Other (*) 14 (53.4) 63 53.2 77 Total 65.7 400 70.4 1 383 69.3 1 784 * Mother's education refers to educational attainment of mothers and caretakers of children aged 0-23 months. ** One, five and six unweighted cases with missing "Ethnicity of household head" not shown respectively. *** Four, six and ten unweighted cases with missing "Religion of household head" not shown respectively. ( ) Figures that are based on 25-49 unweighted cases. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 2.6 2 MICS indicator 2.14 45 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION Table NU.6: Introduction of solid or semi-solid foods Percentage of infants aged 6-8 months who received solid or semi-solid foods during the previous day, Mongolia, 2010 Currently breastfeeding Total Percent receiving solid or semi-solid foods Number of children aged 6-8 months Percent receiving solid or semi-solid foods Number of children aged 6-8 months Sex Male 69.9 113 70.1 121 Female 55.9 92 60.8 104 Region Western (50.0) 29 (50.0) 29 Khangai (72.7) 50 (73.9) 53 Central (58.3) 31 (57.9) 36 Eastern (61.3) 13 (61.8) 15 Ulaanbaatar (65.2) 82 (69.6) 94 Area Urban 68.1 124 70.9 135 Rural 56.8 82 58.0 90 Location Capital city (65.2) 82 (69.6) 94 Aimag center 73.9 42 73.9 42 Soum center (59.8) 31 (59.9) 36 Rural 55.0 51 56.7 53 Mother's education* None (*) 6 (*) 6 Primary (*) 16 (*) 17 Basic (lower secondary) (61.0) 30 (61.6) 31 Upper secondary 59.0 79 60.8 84 Vocational (*) 11 (*) 13 College, university 75.4 62 76.6 73 Wealth index quintiles Poorest 57.6 47 59.8 49 Second (61.1) 38 (61.6) 40 Middle (64.8) 47 (66.0) 52 Fourth (70.8) 35 (72.3) 40 Richest (65.5) 38 (70.0) 44 Ethnicity of household head Khalkh 65.0 162 67.6 180 Other 58.4 44 58.3 45 Religion of household head No religion 57.2 88 59.7 94 Buddhist 73.7 107 74.5 118 Other (*) 10 (*) 13 Total 63.6 206 65.8 225 * Mother's education refers to educational attainment of mothers and caretakers of infants aged 6-8 months. ( ) Figures that are based on 25-49 unweighted cases. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 2.12 46 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY Ta bl e N U .7 : M in im um m ea l f re qu en cy P er ce nt ag e of c hi ld re n ag ed 6 -2 3 m on th s w ho re ce iv ed s ol id o r s em i-s ol id fo od s (a nd m ilk fe ed s fo r n on -b re as tfe ed in g ch ild re n) th e m in im um n um be r o f t im es o r m or e du rin g th e pr ev io us d ay pr ec ed in g th e su rv ey , a cc or di ng to b re as tfe ed in g st at us , M on go lia , 2 01 0 C ur re nt ly b re as tfe ed in g C ur re nt ly n ot b re as tfe ed in g To ta l P er ce nt re ce iv in g so lid or s em i-s ol id fo od s th e m in im um n um be r o f t im es N um be r o f ch ild re n ag ed 6- 23 m on th s P er ce nt re ce iv in g m ilk fe ed s at le as t 2 ti m es 1 P er ce nt re ce iv in g so lid o r s em i-s ol id fo od s or m ilk fe ed s 4 tim es o r m or e N um be r o f ch ild re n ag ed 6- 23 m on th s P er ce nt w ith m in im um m ea l fre qu en cy 2 N um be r o f ch ild re n ag ed 6- 23 m on th s Se x M al e 18 .1 57 6 71 .4 65 .4 12 5 26 .6 70 1 Fe m al e 23 .1 52 6 71 .3 67 .4 15 6 33 .2 68 2 A ge 6- 8 m on th s 24 .5 20 6 (* ) (* ) 19 30 .6 22 5 9- 11 m on th s 13 .1 17 4 (8 3. 8) (7 6. 4) 27 21 .6 20 1 12 -1 7 m on th s 22 .3 42 2 76 .6 67 .0 95 30 .5 51 7 18 -2 3 m on th s 19 .5 30 1 61 .5 60 .4 14 0 32 .5 44 1 R eg io n W es te rn 8. 9 15 8 (6 2. 4) (5 4. 8) 25 15 .1 18 3 K ha ng ai 22 .6 26 2 68 .1 55 .7 63 29 .0 32 4 C en tra l 20 .1 18 8 70 .4 66 .0 53 30 .2 24 2 E as te rn 20 .2 65 47 .3 51 .0 23 28 .3 88 U la an ba at ar 23 .8 42 9 80 .2 78 .2 11 7 35 .4 54 6 A re a U rb an 22 .8 67 9 69 .8 69 .0 16 8 32 .0 84 6 R ur al 16 .8 42 3 73 .7 62 .9 11 4 26 .6 53 7 Lo ca tio n C ap ita l c ity 23 .8 42 9 80 .2 78 .2 11 7 35 .4 54 6 A im ag c en te r 21 .2 25 0 45 .7 47 .8 51 25 .7 30 0 S ou m c en te r 16 .2 17 5 68 .0 57 .8 55 26 .2 23 0 R ur al 17 .2 24 9 79 .0 67 .7 59 26 .9 30 7 M ot he r's e du ca tio n* N on e 10 .2 42 (* ) (* ) 6 14 .0 48 P rim ar y 12 .3 79 (* ) (* ) 24 23 .9 10 3 B as ic (l ow er s ec on da ry ) 21 .9 19 0 (7 3. 2) (6 7. 6) 42 30 .2 23 2 U pp er s ec on da ry 18 .3 34 3 57 .1 62 .0 56 24 .4 40 0 Vo ca tio na l 62 (7 2. 4) (5 9. 7) 32 33 .4 94 C ol le ge , u ni ve rs ity 24 .7 38 6 79 .1 72 .4 12 1 36 .1 50 7 W ea lth in de x qu in til es P oo re st 15 .4 24 3 75 .1 60 .1 56 23 .7 29 9 S ec on d 22 .2 21 2 60 .5 60 .0 51 29 .5 26 3 M id dl e 19 .0 21 8 66 .6 57 .4 57 26 .9 27 5 Fo ur th 21 .9 23 3 (7 4. 8) (8 5. 7) 49 33 .0 28 2 R ic he st 25 .2 19 6 (7 7. 8) (7 0. 5) 68 36 .9 26 4 Et hn ic ity o f h ou se ho ld h ea d* * K ha lk h 21 .7 90 0 69 .3 66 .7 23 0 30 .9 1 13 0 O th er 15 .4 19 9 80 .5 66 .0 51 25 .7 25 1 R el ig io n of h ou se ho ld h ea d* ** N o re lig io n 24 .6 50 1 66 .0 64 .9 13 8 33 .3 63 9 B ud dh is t 18 .6 51 6 76 .5 67 .4 12 1 27 .8 63 7 O th er 8. 8 82 (* ) (* ) 20 20 .8 10 2 To ta l 20 .5 1 10 2 71 .4 66 .5 28 1 29 .9 1 38 3 * M ot he r's e du ca tio n re fe rs to e du ca tio na l a tta in m en t o f m ot he rs a nd c ar et ak er s of in fa nt s ag ed 6 -2 3 m on th s. ** U nw ei gh te d ca se s w ith m is si ng “E th ni ci ty o f h ou se ho ld h ea d” , fi ve fo r c hi ld re n cu rr en tly b re as tfe ed in g, n o fo r c hi ld re n cu rr en tly n ot b re as tfe ed in g, n ot s ho w n. ** * T hr ee , t hr ee a nd s ix u nw ei gh te d ca se s w ith m is si ng "R el ig io n of h ou se ho ld h ea d" n ot s ho w n re sp ec tiv el y. ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s. 1 M IC S in di ca to r 2 .1 5 2 M IC S in di ca to r 2 .1 3 47 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION Table NU.8: Bottle feeding Percentage of children aged 0-23 months who were fed with a bottle with a nipple during the previous day, Mongolia, 2010 Percentage of children aged 0-23 months fed with a bottle with a nipple1 Number of children aged 0-23 months Sex Male 20.1 902 Female 21.5 881 Age 0-5 months 17.3 400 6-11 months 33.6 426 12-23 months 16.5 958 Region Western 9.2 251 Khangai 16.9 408 Central 20.8 322 Eastern 17.0 119 Ulaanbaatar 28.0 683 Area Urban 25.7 1 074 Rural 13.3 709 Location Capital city 28.0 683 Aimag center 21.7 391 Soum center 14.7 303 Rural 12.2 407 Mother's education* None 6.6 63 Primary 11.1 128 Basic (lower secondary) 16.6 303 Upper secondary 20.3 511 Vocational 15.9 118 College, university 27.2 660 Wealth index quintiles Poorest 11.9 397 Second 15.9 360 Middle 17.3 371 Fourth 24.0 323 Richest 37.5 332 Ethnicity of household head Khalkh 22.2 1 448 Khazakh 12.4 62 Other 15.0 270 Religion of household head No religion 21.7 806 Buddhist 19.7 842 Muslim 14.4 49 Other 26.3 77 Total 20.8 1 784 * Mother's education refers to educational attainment of mothers and caretakers of infants aged 0-23 months. ** Six unweighted cases with missing "Ethnicity of household head" not shown. *** Ten unweighted cases with missing "Religion of household head" not shown. 1 MICS indicator 2.11 48 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY Table NU.9: Iodized salt consumption Percent distribution of households by consumption of iodized salt, Mongolia, 2010 Percent of households in which salt was tested Number of households Percent of households with Total Number of households in which salt was tested or with no salt Percent of households with no salt Salt test result Not iodized (0 PPM) Iodized (less than 15 PPM) Iodized (15+ PPM)1 Region Western 96.7 1 338 0.8 40.9 10.2 48.1 100.0 1 304 Khangai 94.6 2 279 1.4 27.4 7.4 63.8 100.0 2 187 Central 91.8 1 793 1.1 13.0 17.5 68.3 100.0 1 665 Eastern 91.3 831 1.4 6.3 15.8 76.5 100.0 769 Ulaanbaatar 96.5 3 850 0.9 9.0 9.6 80.5 100.0 3 748 Area Urban 95.7 6 086 1.0 11.9 10.4 76.7 100.0 5 882 Rural 93.4 4 006 1.2 27.3 12.1 59.4 100.0 3 791 Location Capital city 96.5 3 850 0.9 9.0 9.6 80.5 100.0 3 748 Aimag center 94.4 2 235 1.2 17.1 11.6 70.1 100.0 2 135 Soum center 93.9 1 769 1.1 22.1 12.7 64.1 100.0 1 680 Rural 93.1 2 237 1.4 31.3 11.7 55.6 100.0 2 110 Education of household head* None 94.5 786 1.0 32.8 10.4 55.9 100.0 750 Primary 94.5 1 577 1.5 25.4 10.3 62.9 100.0 1 513 Basic (lower secondary) 94.6 2 026 1.1 18.9 12.4 67.6 100.0 1 937 Upper secondary 96.0 1 966 0.8 14.2 10.8 74.3 100.0 1 902 Vocational 95.2 1 144 0.5 15.0 11.8 72.7 100.0 1 094 College, university 94.3 2 563 1.3 12.3 10.4 76.0 100.0 2 448 Wealth index quintiles Poorest 92.7 2 082 1.4 35.0 11.0 52.7 100.0 1 957 Second 95.4 2 011 1.2 19.5 11.6 67.8 100.0 1 941 Middle 95.3 1 989 1.0 11.7 12.7 74.7 100.0 1 913 Fourth 95.9 1 926 0.8 10.7 9.6 78.9 100.0 1 862 Richest 95.0 2 084 1.0 12.5 10.5 76.0 100.0 2 000 Ethnicity of household head** Khalkh 94.7 8 244 1.1 16.2 11.4 71.4 100.0 7 892 Khazakh 98.2 279 0.4 12.1 14.3 73.2 100.0 275 Other 95.0 1 549 1.1 28.5 8.6 61.7 100.0 1 489 Religion of household head*** No religion 93.9 4 168 1.4 16.1 12.1 70.3 100.0 3 968 Buddhist 95.5 5 304 0.7 19.9 9.9 69.5 100.0 5 104 Muslim 98.8 212 0.2 14.0 14.2 71.6 100.0 210 Other 93.5 379 3.0 12.7 13.9 70.4 100.0 365 Total 94.8 10 092 1.1 17.9 11.0 69.9 100.0 9 673 * Thirty three and thirty one unweighted cases with missing "Education of household head" not shown respectively. ** Twenty three and eighteen unweighted cases with missing "Ethnicity of household head" not shown respectively. *** Thirty and twenty six unweighted cases with missing "Religion of household head" not shown respectively. 1 MICS indicator 2.16 49 CHILD DEVELOPMENT 2010 SURVEY V. NUTRITION Table NU.10: Children's vitamin A supplementation Percent distribution of children aged 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, Mongolia, 2010 Percentage who received Vitamin A according to: Percentage of children who received Vitamin A during the last 6 months1 Number of children age 6-59 monthsChild health book/card/ vaccination card Mother's report Sex Male 9.7 58.6 61.0 1 781 Female 9.3 59.0 61.0 1 775 Region Western 0.4 48.8 49.0 544 Khangai 10.8 64.4 67.1 793 Central 11.0 55.8 58.1 660 Eastern 27.9 63.9 74.1 261 Ulaanbaatar 8.1 60.2 61.2 1 298 Area Urban 9.4 60.2 61.6 2 071 Rural 9.7 57.0 60.2 1 485 Location Capital city 8.1 60.2 61.2 1 298 Aimag center 11.5 60.1 62.2 773 Soum center 9.7 60.7 63.1 625 Rural 9.8 54.3 58.1 861 Age 6-11 months 8.6 50.7 52.3 426 12-23 months 11.7 64.4 66.4 958 24-35 months 10.8 61.4 64.0 832 36-47 months 7.0 56.4 58.5 714 48-59 months 8.1 55.2 57.5 626 Mother's education* None 9.5 50.5 56.3 165 Primary 8.4 55.5 58.3 287 Basic (lower secondary) 10.8 61.8 64.5 659 Upper secondary 8.5 60.0 61.5 957 Vocational 12.9 58.5 62.0 236 College, university 9.3 58.3 59.8 1 251 Wealth index quintiles Poorest 10.4 54.5 58.3 832 Second 9.8 58.6 61.7 700 Middle 10.0 63.8 65.5 667 Fourth 7.7 62.9 63.7 697 Richest 9.5 55.2 56.3 659 Ethnicity of household head** Khalkh 10.3 60.7 63.0 2 848 Khazakh 1.5 37.2 38.3 133 Other 7.6 54.6 56.3 568 Religion of household head*** No religion 10.6 58.7 61.0 1 664 Buddhist 9.4 60.1 62.4 1 637 Muslim 1.4 38.2 39.6 106 Other 5.8 62.1 63.0 140 Total 9.5 58.8 61.0 3 556 * Mother's education refers to educational attainment of mothers and caretakers of infants aged 6-59 months. ** Eleven unweighted cases with missing "Ethnicity of household head" not shown. *** Ten unweighted cases with missing "Religion of household head" not shown. 1 MICS indicator 2.17 50 V. NUTRITION CHILD DEVELOPMENT 2010 SURVEY Table NU.11: Low birth weight infants Percentage of last-born children in the two years preceding the survey that are estimated to have weighed below 2500 grams at birth and percentage of live births weighed at birth, Mongolia, 2010 Percent of live births: Number of last-born children in the two years preceding the surveyBelow 2500 grams1 Weighed at birth2 Region Western 6.6 96.6 241 Khangai 4.4 98.3 374 Central 5.4 97.2 308 Eastern 4.9 98.6 107 Ulaanbaatar 3.8 98.8 624 Area Urban 4.2 98.7 992 Rural 5.6 97.1 662 Location Capital city 3.8 98.8 624 Aimag center 4.7 98.6 368 Soum center 5.9 97.3 281 Rural 5.3 96.9 381 Mother's education* None 7.3 94.4 61 Primary 5.7 96.1 116 Basic (lower secondary) 5.8 97.6 282 Upper secondary 4.2 97.6 477 Vocational 3.1 99.3 103 College, university 4.5 99.1 615 Wealth index quintiles Poorest 5.9 96.8 368 Second 5.0 96.7 343 Middle 4.7 98.5 340 Fourth 4.0 99.4 298 Richest 3.8 99.3 305 Ethnicity of household head** Khalkh 4.7 98.5 1 334 Khazakh 8.9 89.1 60 Other 3.8 97.6 257 Religion of household head*** No religion 4.8 98.6 742 Buddhist 4.1 98.4 782 Muslim 10.1 90.0 48 Other 6.1 94.1 71 Total 4.7 98.0 1 654 * Mother's education refers to educational attainment of mothers and caretakers of last-born children in the two years preceding the survey. ** Six unweighted cases with missing "Ethnicity of household head" not shown. *** Twelve unweighted cases with missing "Religion of household head" not shown. 1 MICS indicator 2.18 2 MICS indicator 2.19 51 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH CHAPTER VI CHILD HEALTH © UNICEF Mongolia/Sokol/2012 52 VI. CHILD HEALTH CHILD DEVELOPMENT 2010 SURVEY __________________________ VI _________________________ Immunizations The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in achieving 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. A World Fit for Children goal is to ensure full immunization of children less than one year of age at 90 percent nationally, with at least 80 percent coverage in every district or equivalent administrative unit. According to UNICEF and WHO guidelines, in Mongolia, a child should receive a BCG vaccination to protect against tuberculosis, three doses of DPT or Penta to protect against diphtheria, pertussis, tetanus, Hepatitis B, and Haemophilus Influenza B, four doses of Polio vaccine, the dose of at birth of Hepatitis B vaccine, and one dose of Measles, Mumps and Rubella vaccination by the age of 12 months. Mothers were asked to provide vaccination cards for children under the age of five and interviewers copied vaccination information from the cards onto the survey questionnaire. Before 2005, children were being immunized by receiving the Tuberculosis vaccine, three doses to DTP (diphtheria, pertussis and tetanus) vaccine, Hepatitis B vaccine, Measles vaccine. But, new combined vaccines such as vaccines against diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus Influenza B starting from 2005 and three doses of vaccines against Measles, Mumps and Rubella since 2009 have been included into the "National Plan for Mandatory Vaccination". Overall, 85 percent of children aged 12-23 months covered by the survey had immunization cards (Table CH.2). If the child did not have a card, the mother/ caretaker was asked to recall whether or not the child had received each of the vaccinations and, for DPT and Polio, how many times. The percentage of children aged 12-23 months who received each of the vaccinations is shown in Table CH.1. The table provides the immunization coverages for all children who were vaccinated at any time before the survey according to the vaccination card or the mother's recall, as well as only for those who were vaccinated before their first birthday. Approximately 98 percent of children aged 12-23 months received a Tuberculosis vaccination by the age of 12 months and the first dose of DPT or Penta was given to 96 percent of them. The percentage declines for subsequent doses of DPT to 94 percent for the second dose, and 92 percent for the third dose (Figure CH.1). Similarly, 98 percent of children received Polio 1 by age of 12 months and this figure declines to 93 percent by the third dose. As for the dose at birth of Hepatitis B vaccination, the coverage is 97 percent among children aged 12-23 by the age of 12 months. The coverage for the first dose of Measles, Mumps and Rubella vaccine by 12 months is relatively lower (87 percent) than for the other vaccinations. As a result, the percentage of children who had all the recommended vaccinations by their first birthday is 76. 53 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months, Mongolia, 2010 98 96 94 92 98 96 93 87 76 0 20 40 60 80 100 120 Pe rc en t BCG DPT1 DPT2 DPT3 Polio1 Polio2 Polio3 Measles All Table CH.2 shows vaccination coverage rates among children aged 12-23 months by basic characteristics. The figures indicate children receiving the vaccinations at any time preceding the survey and are based on information from both the vaccination cards and mothers/ caretakers' reports. Immunization coverage does not differ significantly by sex, areas, and locations, education of mothers / caretakers, and household wealth index quintiles. However, it differs by regions; the children in Western and Central regions are less likely to be immunized for any of the vaccinations compared to the children in other regions. As a result, the percentage of fully immunized children aged 12-23 months in those regions is the lowest (67-68 percent). Oral Rehydration Treatment Diarrhoea is the second leading cause of death among children under five years old 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: to reduce by one half death due to diarrhoea among children under five by 2010 compared to 2000 (A World Fit for Children); and to reduce by two thirds the mortality rate among children under five by 2015 compared to 1990 (Millennium Development Goals). In addition, the World Fit for Children calls for a reduction in the incidence of diarrhoea by 25 percent. The main diarrhoea treatment indicators are: • Oral rehydration therapy (ORT) • Home management of diarrhoea • ORT with continued feeding 54 VI. CHILD HEALTH CHILD DEVELOPMENT 2010 SURVEY In the MICS questionnaire, mothers (or caretakers) were asked to report whether their child had diarrhoea in the 14 days preceding the survey. If so, the mother was asked a series of questions about whether the child was given liquids and food during the episode and whether its quantity was greater or smaller than the child usually ate and drank. We need to note that as a result of successful implementation of programs on Diarrhoea Monitoring, Full Management of Child's Sickness (FMCS) the mortality rate of children due to diarrhoea reduced significantly in Mongolia. Overall, 10 percent of under-five children had diarrhoea in the 14 days preceding the survey (Results of the diarrhoea prevalence indicator is subject to seasonality and caretaker's recognition considerably, therefore, it should be interpreted with caution). Diarrhoea prevalence is the lowest in Ulaanbaatar and the highest in Central region. The peak of diarrhoea prevalence occurs more in the weaning and introduction of complementary feeding period, which means more among children aged 0-23 months. Table CH.4 also shows the percentage of children receiving various types of recommended liquids during the episode of diarrhoea. Since mothers were able to name more than one type of liquid, the percentages do not necessarily add to 100. 31 percent of children with diarrhoea received ORS fluids from packet and 14 percent received recommended homemade ORS fluids. 42 percent of children with diarrhoea received one or more of the recommended home treatments (i.e., were treated with ORS or any recommended homemade fluid. Pe rc en t 10 20 30 40 50 60 70 80 90 S e x M al e Fe m al e A re a U rb an R u ra l N at io n al Figure CH.2: Percentage of children under age 5 with diarrhoea who received oral rehydration treatment, Mongolia, 2010 10 63 60 62 61 62 43 percent of children under five with diarrhoea drank more than usual while 56 percent drank the same or less. As for the feeding practice, 90 percent ate somewhat less, same or more (continued feeding), but 4 percent ate much less or almost none (Table CH.5). Table CH.6 provides data on the proportion of children aged 0-59 months with diarrhoea in the 14 days preceding the survey who received oral rehydration therapy with continued feeding, and the percentage of children with diarrhoea who received other treatments. Overall, 56 percent of children with diarrhoea received ORS fluids from packet or increased fluids, 62 percent received ORT (ORS fluids from packet or recommended homemade ORS fluids or increased fluids). 55 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH 0 10 20 30 40 50 60 70 58 54 57 55 56 Percent 48 63 Sex Male Female Area Urban Rural National Figure CH.3: Percentage of children under age 5 with diarrhoea who received ORT or increased fluids, AND continued feeding, Mongolia, 2010 Combining the information in Table CH.5 with those in Table CH.4 on oral rehydration therapy, it is observed that 56 percent of children either received ORT and, at the same time, feeding was continued, as is the recommendation. There are no significant differences in administration of this diarrhoea intervention by gender (58 percent for boys, 54 percent for girls) and areas (55 percent for rural and 57 percent for urban area). As shown in Table CH.6, in Western region and Ulaanbaatar, only half of children (48-50 percent) with diarrhoea received ORT and continued feeding. Also, there is a significant differene in the administration of ORT and continued feeding by household wealth index quintiles; only the mothers/ caretakers of the households in richest quintile takes more appropriate steps to manage the sickness of their children (66 percent). Care Seeking and Antibiotic Treatment of Suspected 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. A World Fit for Children goal is to reduce by one-third the deaths due to acute respiratory infections. Children with suspected pneumonia are those who had an illness with a cough accompanied by rapid or difficult breathing and whose symptoms were NOT due to a problem in the chest. The main suspected pneumonia indicators are: • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the danger signs of pneumonia Table CH.7 presents the prevalence of suspected pneumonia and, if care was sought outside the home, the site of care (Results of the prevalence of suspected pneumonia indicator is subject to seasonality and caretakere's recognition considerably, therefore, it should be interpreted with caution). 2 percent of children under five covered by the survey were reported to have had symptoms of pneumonia in the 14 days preceding the survey. Of these children, 87 percent were taken to an appropriate provide. Moreover, Table CH.7 presents use of antibiotics for the treatment of suspected pneumonia in under-5s by sex, age, regions, areas, and locations, education of mothers / caretakes and household wealth index quintiles. 73 percent of under-5 children with suspected pneumonia had received an antibiotic treatment. Please note that the results on care seeking and antibiotic treatment of suspected pneumonia should not be interpreted as the denominator for these indicators (number of children under-5 with suspected pneumonia) is quite low. 56 VI. CHILD HEALTH CHILD DEVELOPMENT 2010 SURVEY Issues related to knowledge of danger signs of pneumonia are presented in Table CH.8. Obviously, mothers/ caretakers' knowledge of the danger signs is an important determinant of care-seeking behaviour. Only one percent of mothers/ caretakers' covered by the survey know of the two danger signs of pneumonia – fast and difficult breathing. The most commonly identified symptom for taking a child to a health facility is developing fever. 4 percent of mothers/ caretakers identified fast breathing and 3 percent of mothers/ caretakers identified difficult breathing as symptoms for taking children immediately to a health care provider. Solid Fuel Use More than 3 billion people around the world rely on solid fuels for their basic energy needs, including cooking and heating. Cooking and heating with solid fuels leads to high levels of indoor smoke, a complex mix of health-damaging pollutants. The main problem with the use of solid fuels is products of incomplete combustion, including carbon, hydrocarbons and other toxic elements. Use of solid fuels increases the risks of acute respiratory illness, pneumonia, chronic obstructive lung disease, cancer, possibly tuberculosis, low birth weight, cataracts, and asthma. The primary indicator is the proportion of the population using solid fuels as the primary source of domestic energy for cooking. Overall, 68 percent of all households in Mongolia use solid fuels for cooking (See Table CH.9). While 54 percent or half of urban households use solid fuels, the percentage is very high in rural areas at 90 percent. The use of solid fuels differs by household wealth index quintiles and education of household head. The findings show that use of solid fuels for cooking is very uncommon among households in richest quintile (2 percent), but almost all of households in poorest quintile use solid fuels for cooking (99 percent). The table also clearly shows that the overall percentage is high due to high level of use wood and coal for cooking purposes. Solid fuel use alone is a poor proxy for indoor air pollution, since the concentration of the pollutants is different when the same fuel is burnt in different stoves. Use of closed stoves with chimneys minimizes indoor pollution, while open stove or fire with no chimney or hood means that there is no protection from the harmful effects of solid fuels. Solid fuel use by place of cooking is depicted in Table CH.10. While 31 percent of households who use solid fuels for cooking have separate kitchen rooms, 69 percent do not have a separate kitchen. It shows that there is a high risk for indoor air pollution in the country. The table also shows that this indicator differs significantly by household wealth index quintiles. Children increased at risk of disability and child injury In this survey, a separate questionnaire12 were used for children aged 2-14 regarding the incidence of accidents and injuries and the presence of any disability. 14 percent of surveyed children aged 12-14 could possibly have one kind of developmental disability13 (Table CH.17). While 12 percent of children who lives in urban have an increased at risk of disability, the percentage is higher in rural areas at 15 percent. By regions, percentage 12 As requested by the Ministry of Health, this question looks into child Injury. 13 It should be noted that the methodology for collecting information regarding the child disability is based on the mother/caretaker's report and not supported by a medical evaluation. 57 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH of children increased at risk of disability are the lowest in Ulaanbaatar (11 percent), while the figures for Central region are the highest (19 percent) compared to other regions. As a shown Table CH.17, percentage of children increased at risk of disability differs by age group, mother's education and household wealth index quintiles. Children from younger age, less educated ,mothers and poorest households are more likely to have any kind of disabilities compared to other children. Table CH.17A shows 4 percent of all children aged 12-14 years had an accident or injury in the previous year. Male children are more likely to suffer from accidents and injuries. There is no difference in prevalence of accidents and injuries by area and household wealth quantiles. The percentage of accidents and injuries among children aged 2-14 years is lowest in Ulaanbaatar city at 3 percent compared with other regions As a shown Table CH.17A, most common injury among children is falls (53 percent). The number of child accidents and injuries prevail at home (29 percent), in the road and street (24 percent) and in the countryside field (22 percent) (Table CH.17B). 58 VI. CHILD HEALTH CHILD DEVELOPMENT 2010 SURVEY Table CH.1: Vaccinations in first year of life Percentage of children aged 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Mongolia, 2010 Vaccinated at any time before the survey according to Vaccinated by 12 months of ageVaccination card Mother's report Either BCG1 83.1 14.9 97.9 97.9 Polio At birth 83.1 14.8 97.9 97.9 1 84.0 13.7 97.7 97.6 2 83.8 12.8 96.6 96.4 32 81.8 12.0 93.8 93.3 DPT 1 81.4 14.2 95.6 95.5 2 80.8 13.7 94.5 94.3 33 79.1 13.3 92.4 92.1 HepB At birth 82.9 13.7 96.7 96.7 MMR 14 74.6 13.2 87.8 86.6 All vaccinations 67.5 9.8 77.4 75.7 No vaccinations 0.0 0.2 0.2 0.2 Number of children age 12-23 months 944 944 944 944 1 MICS indicator 3.1; 2 MICS indicator 3.2; 3 MICS indicator 3.3 4 MICS indicator 3.4; MDG indicator 4.3 59 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH Ta bl e C H .2 : V ac ci na tio ns b y se le ct ed b ac kg ro un d ch ar ac te ris 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 01 0 Pe rc en ta ge o f c hi ld re n w ho re ce iv ed : P er ce nt ag e w ith va cc in at io n ca rd s ee n N um be r of c hi ld re n ag ed 1 2- 23 m on th s B C G Po lio D PT H ep B M M R 1 N on e A ll A t b irt h 1 2 3 1 2 3 A t b irt h Se x M al e 98 .4 98 .2 97 .7 96 .1 94 .0 95 .6 94 .3 92 .7 97 .6 86 .2 0. 5 77 .7 86 .5 45 0 Fe m al e 97 .5 97 .6 97 .8 97 .1 93 .6 95 .7 94 .6 92 .2 95 .8 89 .3 0. 0 77 .1 82 .9 49 3 R eg io n W es te rn 96 .4 97 .5 97 .6 94 .6 91 .2 93 .2 91 .4 88 .7 93 .3 79 .8 0. 9 67 .7 79 .8 12 7 K ha ng ai 98 .9 98 .8 10 0. 0 98 .6 98 .1 94 .2 93 .6 92 .6 97 .3 94 .1 0. 0 84 .5 87 .5 22 8 C en tra l 95 .9 96 .0 94 .2 89 .6 87 .1 96 .5 90 .0 88 .5 93 .3 84 .5 0. 5 67 .1 83 .2 16 3 E as te rn 98 .1 98 .1 98 .8 98 .1 93 .1 98 .1 96 .7 95 .3 97 .3 88 .7 0. 0 81 .0 87 .4 55 U la an ba at ar 98 .8 98 .2 97 .8 98 .9 95 .1 96 .6 97 .7 94 .9 98 .8 87 .9 0. 0 80 .2 84 .8 37 1 A re a U rb an 98 .9 98 .4 97 .8 97 .7 94 .5 96 .7 96 .2 93 .7 98 .6 89 .4 0. 1 79 .9 83 .2 57 1 R ur al 96 .4 97 .1 97 .7 95 .0 92 .7 94 .1 91 .9 90 .5 93 .8 85 .3 0. 4 73 .5 86 .8 37 3 Lo ca tio n C ap ita l c ity 98 .8 98 .2 97 .8 98 .9 95 .1 96 .6 97 .7 94 .9 98 .8 87 .9 0. 0 80 .2 84 .8 37 1 A im ag c en te r 99 .1 98 .7 97 .6 95 .3 93 .4 96 .7 93 .3 91 .4 98 .1 92 .1 0. 3 79 .4 80 .3 20 1 S ou m c en te r 96 .6 96 .1 98 .4 96 .4 93 .3 96 .4 93 .5 91 .8 93 .6 84 .7 0. 5 73 .3 89 .3 16 2 R ur al 96 .3 97 .9 97 .2 94 .0 92 .3 92 .3 90 .7 89 .5 93 .9 85 .8 0. 3 73 .6 84 .9 21 0 M ot he r's e du ca tio n* N on e (9 5. 6) (9 6. 6) (9 7. 0) (9 7. 0) (9 4. 7) (9 5. 3) (9 5. 3) (9 1. 2) (9 4. 8) (8 1. 5) (0 .0 ) (7 8. 7) (8 7. 0) 39 P rim ar y 98 .3 98 .1 98 .1 96 .9 94 .8 94 .9 94 .5 94 .4 94 .5 90 .2 0. 9 82 .8 83 .3 71 B as ic (l ow er s ec on da ry ) 98 .7 98 .3 99 .2 98 .0 96 .4 97 .9 96 .8 96 .1 96 .8 89 .8 0. 0 81 .2 84 .9 17 4 U pp er s ec on da ry 97 .2 98 .0 98 .3 96 .2 91 .3 94 .5 93 .8 90 .0 96 .6 87 .9 0. 2 75 .5 86 .0 25 5 Vo ca tio na l 98 .6 98 .6 10 0. 0 97 .1 99 .1 10 0. 0 97 .9 96 .4 95 .5 83 .8 0. 0 74 .4 92 .2 60 C ol le ge , u ni ve rs ity 98 .2 97 .6 96 .2 96 .0 93 .1 94 .7 93 .2 91 .4 97 .5 87 .6 0. 2 76 .1 82 .2 34 5 W ea lth in de x qu in til es P oo re st 96 .0 97 .5 97 .1 95 .2 93 .4 92 .9 91 .9 90 .5 94 .0 88 .1 0. 3 76 .5 85 .4 20 2 S ec on d 98 .9 98 .6 98 .2 95 .5 95 .1 97 .1 94 .1 93 .2 96 .7 80 .4 0. 3 72 .1 85 .7 19 0 M id dl e 98 .2 98 .7 96 .4 96 .5 93 .9 96 .4 94 .8 92 .8 96 .4 88 .2 0. 4 78 .7 83 .3 19 1 Fo ur th 99 .3 97 .7 10 0. 0 98 .5 91 .5 96 .0 94 .9 90 .6 99 .3 90 .5 0. 0 79 .3 88 .8 20 4 R ic he st 97 .2 96 .7 96 .8 97 .4 95 .7 96 .0 97 .4 96 .0 96 .9 92 .2 0. 0 80 .8 78 .8 15 7 Et hn ic ity o f h ou se ho ld h ea d* * K ha lk h 98 .2 97 .9 97 .8 96 .9 94 .1 95 .6 94 .9 92 .4 96 .7 88 .0 0. 1 77 .6 85 .8 77 8 O th er 96 .9 98 .0 98 .2 95 .7 93 .1 95 .7 93 .0 93 .0 96 .4 86 .5 0. 7 76 .8 79 .6 16 4 R el ig io n of h ou se ho ld h ea d* ** N o re lig io n 98 .1 98 .4 97 .1 95 .8 92 .7 94 .8 93 .4 91 .5 96 .9 88 .6 0. 3 78 .3 85 .8 45 5 B ud dh is t 98 .0 97 .3 98 .3 97 .7 94 .8 96 .6 96 .0 93 .4 96 .3 88 .4 0. 0 77 .4 86 .2 42 0 O th er 96 .4 98 .2 98 .3 95 .4 94 .7 95 .0 92 .6 92 .6 97 .4 78 .3 0. 8 70 .0 67 .6 66 To ta l 97 .9 97 .9 97 .7 96 .6 93 .8 95 .6 94 .5 92 .4 96 .7 87 .8 0. 2 77 .4 84 .7 94 4 * M ot he r's e du ca tio n re fe rs to e du ca tio na l a tta in m en t o f m ot he rs a nd c ar et ak er s of c hi ld re n ag ed 1 2- 23 m on th s. ** O ne u nw ei gh te d ca se s w ith m is si ng "E th ni ci ty o f h ou se ho ld h ea d" n ot s ho w n. ** *F ou r u nw ei gh te d ca se s w ith m is si ng "R el ig io n of h ou se ho ld h ea d" n ot s ho w n. ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 60 VI. CHILD HEALTH CHILD DEVELOPMENT 2010 SURVEY Table CH.4: Oral rehydration solutions and recommended homemade fluids Percentage of children aged 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, Mongolia, 2010 Had diarrhoea in the last two weeks Number of children aged 0-59 months Children with diarrhoea who received: Number of children aged 0-59 months with diarrhoea in the last two weeks ORS fluid from packet Recommendad homemade fluids ORS fluid from packet or recommended homemade fluids Sex Male 11.1 1 981 31.6 13.9 43.0 221 Female 9.7 1 975 29.3 13.3 40.9 192 Region Western 13.0 613 25.5 12.9 37.7 80 Khangai 12.2 877 33.2 18.9 47.1 107 Central 14.8 739 27.3 13.4 38.4 109 Eastern 10.0 292 41.4 22.9 62.9 29 Ulaanbaatar 6.1 1 435 (32.4) (4.9) (37.4) 87 Area Urban 9.2 2 298 35.1 9.2 42.7 211 Rural 12.1 1 658 25.8 18.2 41.3 201 Location Capital city 6.1 1 435 (32.4) (4.9) (37.4) 87 Aimag center 14.4 863 37.0 12.3 46.4 124 Soum center 12.2 698 25.2 12.0 36.1 85 Rural 12.1 960 26.2 22.8 45.1 116 Age 0-11 months 14.7 826 41.5 8.1 48.8 122 12-23 months 15.7 958 34.3 16.9 47.8 150 24-35 months 8.8 832 20.1 13.0 30.2 73 36-47 months 6.1 714 (18.0) (14.4) (30.8) 44 48-59 months 3.8 626 (6.0) (21.3) (27.3) 24 Mother's education* None 10.7 181 (22.1) (28.5) (50.6) 19 Primary 11.6 312 (22.3) (13.0) (32.0) 36 Basic (lower secondary) 8.3 730 20.5 13.7 31.4 60 Upper secondary 12.0 1 069 32.6 13.3 44.7 128 Vocational 12.2 261 (29.5) (11.5) (41.0) 32 College, university 9.7 1 403 36.7 12.5 45.9 136 Wealth index quintiles Poorest 11.2 930 24.0 20.9 40.6 104 Second 11.1 797 24.6 14.0 36.3 88 Middle 11.8 764 34.9 10.2 44.5 90 Fourth 8.5 738 22.2 9.0 30.3 62 Richest 9.3 727 50.4 10.9 59.4 67 Ethnicity of household head** Khalkh 10.1 3 166 29.7 12.9 40.6 321 Other 11.6 782 33.4 16.2 46.7 91 Religion of household head*** No religion 10.5 1 831 29.3 15.3 42.2 193 Buddhist 10.4 1 843 31.8 9.7 40.1 192 Other 9.1 271 (34.5) (27.9) (56.1) 25 Total 10.4 3 956 30.6 13.6 42.0 412 * Mother's education refers to educational attainment of mothers and caretakers of children aged 0-59 months. **Twelve and one unweighted cases with missing "Ethnicity of household head" not shown respectively. ***Fourteen and three unweighted cases with missing "Religion of household head" not shown respectively. ( ) Figures that are based on 25-49 unweighted cases. (*) Figures that are based on less than 25 unweighted cases. 61 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH Ta bl e C H .5 : F ee di ng p ra ct ic es d ur in g di ar rh oe a P er ce nt d is tri bu tio n 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 b y am ou nt o f l iq ui ds a nd fo od g iv en d ur in g ep is od e of d ia rr ho ea , M on go lia , 2 01 0 Had diarrhoea in the last two weeks Number of children aged 0-59 months D rin ki ng p ra ct ic es d ur in g di ar rh oe a: To ta l Ea tin g pr ac tic es d ur in g di ar rh oe a: To ta l Number of children aged 0-59 months with diarrhoea in the last two weeks Given much less to drink Given somewhat less to drink Given about the same to drink Given more to drink Given nothing to drink Missing/ DK Given much less to eat Given somewhat less to eat Given about the same to eat Given more to eat Stopped food Had never been given food Missing/ DK Se x M al e 11 .1 1 98 1 1. 4 10 .4 44 .5 43 .2 0. 0 0. 5 10 0. 0 3. 5 28 .0 57 .0 5. 7 1. 3 3. 1 1. 4 10 0. 0 22 1 Fe m al e 9. 7 1 97 5 1. 1 11 .9 42 .6 42 .0 0. 9 1. 6 10 0. 0 4. 7 28 .7 55 .6 4. 6 2. 3 2. 8 1. 2 10 0. 0 19 2 R eg io n W es te rn 13 .0 61 3 2. 1 19 .5 42 .2 34 .6 0. 9 0. 8 10 0. 0 4. 1 35 .2 49 .5 3. 8 2. 3 5. 1 0. 0 10 0. 0 80 K ha ng ai 12 .2 87 7 2. 1 10 .6 41 .9 43 .1 0. 0 2. 2 10 0. 0 4. 0 23 .8 58 .7 7. 0 1. 0 3. 2 2. 2 10 0. 0 10 7 C en tra l 14 .8 73 9 0. 0 7. 3 39 .8 51 .0 0. 9 0. 9 10 0. 0 2. 5 29 .9 54 .1 6. 0 3. 3 3. 2 0. 9 10 0. 0 10 9 E as te rn 10 .0 29 2 4. 3 6. 9 41 .6 47 .1 0. 0 0. 0 10 0. 0 1. 5 24 .4 59 .5 7. 3 2. 8 4. 5 0. 0 10 0. 0 29 U la an ba at ar 6. 1 1 43 5 (0 .0 ) (1 0. 1) (5 2. 6) (3 7. 3) (0 .0 ) (0 .0 ) 10 0. 0 (6 .9 ) (2 6. 8) (6 1. 4) (2 .4 ) (0 .0 ) (0 .0 ) (2 .4 ) 10 0. 0 87 A re a U rb an 9. 2 2 29 8 0. 8 8. 0 47 .6 41 .7 0. 5 1. 4 10 0. 0 4. 0 29 .4 57 .4 3. 4 1. 2 2. 4 2. 1 10 0. 0 21 1 R ur al 12 .1 1 65 8 1. 8 14 .3 39 .5 43 .5 0. 3 0. 5 10 0. 0 4. 1 27 .1 55 .2 7. 1 2. 4 3. 6 0. 5 10 0. 0 20 1 Lo ca tio n C ap ita l c ity 6. 1 1 43 5 (0 .0 ) (1 0. 1) (5 2. 6) (3 7. 3) (0 .0 ) (0 .0 ) 10 0. 0 (6 .9 ) (2 6. 8) (6 1. 4) (2 .4 ) (0 .0 ) (0 .0 ) (2 .4 ) 10 0. 0 87 A im ag c en te r 14 .4 86 3 1. 3 6. 6 44 .1 44 .8 0. 8 2. 4 10 0. 0 2. 0 31 .3 54 .7 4. 0 2. 0 4. 1 1. 9 10 0. 0 12 4 S ou m c en te r 12 .2 69 8 1. 0 13 .3 34 .5 51 .2 0. 0 0. 0 10 0. 0 2. 1 29 .2 54 .7 6. 5 3. 3 4. 2 0. 0 10 0. 0 85 R ur al 12 .1 96 0 2. 4 15 .1 43 .1 37 .9 0. 6 0. 9 10 0. 0 5. 6 25 .6 55 .5 7. 5 1. 7 3. 1 0. 9 10 0. 0 11 6 A ge 0- 11 m on th s 14 .7 82 6 0. 7 17 .7 45 .4 34 .8 1. 4 0. 0 10 0. 0 4. 6 19 .6 52 .0 10 .5 3. 2 10 .1 0. 0 10 0. 0 12 2 12 -2 3 m on th s 15 .7 95 8 1. 2 8. 8 39 .4 49 .1 0. 0 1. 6 10 0. 0 5. 2 34 .7 53 .8 2. 2 1. 0 0. 0 3. 0 10 0. 0 15 0 24 -3 5 m on th s 8. 8 83 2 2. 7 4. 9 50 .0 42 .4 0. 0 0. 0 10 0. 0 3. 0 29 .6 62 .7 2. 0 2. 7 0. 0 0. 0 10 0. 0 73 36 -4 7 m on th s 6. 1 71 4 (1 .3 ) (9 .3 ) (5 0. 7) (3 8. 8) (0 .0 ) (0 .0 ) 10 0. 0 (2 .6 ) (2 7. 4) (6 2. 2) (7 .8 ) (0 .0 ) (0 .0 ) (0 .0 ) 10 0. 0 44 48 -5 9 m on th s 3. 8 62 6 (0 .0 ) (1 4. 8) (2 8. 4) (5 0. 0) (0 .0 ) (6 .9 ) 10 0. 0 (0 .0 ) (3 0. 4) (6 3. 5) (1 .8 ) (0 .0 ) (0 .0 ) (4 .2 ) 10 0. 0 24 M ot he r's e du ca tio n* N on e 10 .7 18 1 (2 .4 ) (1 7. 2) (5 5. 0) (2 5. 4) (0 .0 ) (0 .0 ) 10 0. 0 (0 .0 ) (2 9. 2) (6 8. 6) (0 .0 ) (0 .0 ) (2 .3 ) (0 .0 ) 10 0. 0 19 P rim ar y 11 .6 31 2 (1 .8 ) (1 6. 6) (5 5. 8) (2 5. 8) (0 .0 ) (0 .0 ) 10 0. 0 (6 .9 ) (2 0. 7) (6 0. 7) (5 .0 ) (3 .7 ) (3 .0 ) (0 .0 ) 10 0. 0 36 B as ic (l ow er s ec on da ry ) 8. 3 73 0 2. 8 9. 8 46 .8 38 .9 0. 0 1. 7 10 0. 0 0. 9 30 .4 61 .1 3. 0 1. 1 1. 7 1. 7 10 0. 0 60 U pp er s ec on da ry 12 .0 1 06 9 0. 3 12 .1 33 .4 52 .8 1. 3 0. 0 10 0. 0 2. 9 30 .6 52 .2 8. 0 3. 2 1. 5 1. 6 10 0. 0 12 8 Vo ca tio na l 12 .2 26 1 (0 .0 ) (1 1. 4) (5 1. 4) (3 7. 2) (0 .0 ) (0 .0 ) 10 0. 0 (2 .2 ) (3 5. 4) (4 9. 4) (4 .9 ) (0 .0 ) (8 .1 ) (0 .0 ) 10 0. 0 32 C ol le ge , u ni ve rs ity 9. 7 1 40 3 1. 5 8. 4 45 .1 42 .8 0. 0 2. 2 10 0. 0 6. 8 25 .5 56 .9 4. 4 0. 9 3. 9 1. 7 10 0. 0 13 6 W ea lth in de x qu in til es P oo re st 11 .2 93 0 1. 1 17 .4 44 .6 35 .3 0. 7 1. 0 10 0. 0 4. 6 27 .6 53 .2 7. 9 1. 9 3. 7 1. 0 10 0. 0 10 4 S ec on d 11 .1 79 7 2. 4 7. 4 49 .0 40 .1 1. 1 0. 0 10 0. 0 2. 0 19 .8 60 .7 7. 7 3. 1 6. 8 0. 0 10 0. 0 88 M id dl e 11 .8 76 4 1. 7 16 .1 35 .0 45 .7 0. 0 1. 5 10 0. 0 3. 0 31 .2 60 .2 1. 4 1. 7 0. 9 1. 5 10 0. 0 90 Fo ur th 8. 5 73 8 0. 7 9. 4 38 .2 49 .2 0. 0 2. 6 10 0. 0 2. 3 35 .8 51 .7 5. 8 1. 8 1. 0 1. 6 10 0. 0 62 R ic he st 9. 3 72 7 0. 0 1. 3 51 .7 47 .1 0. 0 0. 0 10 0. 0 8. 9 29 .8 54 .5 2. 1 0. 0 1. 5 3. 1 10 0. 0 67 Et hn ic ity o f h ou se ho ld h ea d* * K ha lk h 10 .1 3 16 6 0. 8 11 .1 42 .9 43 .7 0. 3 1. 1 10 0. 0 4. 3 27 .3 57 .8 4. 5 2. 3 2. 2 1. 7 10 0. 0 32 1 O th er 11 .6 78 2 2. 8 11 .0 46 .3 38 .5 0. 8 0. 7 10 0. 0 3. 4 32 .0 51 .1 7. 6 0. 0 5. 9 0. 0 10 0. 0 91 R el ig io n of h ou se ho ld h ea d* ** N o re lig io n 10 .5 1 83 1 1. 3 9. 1 44 .2 44 .1 0. 0 1. 2 10 0. 0 3. 9 30 .8 52 .7 5. 5 1. 6 3. 1 2. 3 10 0. 0 19 3 B ud dh is t 10 .4 1 84 3 1. 1 13 .1 42 .2 42 .4 0. 4 0. 8 10 0. 0 4. 8 25 .6 60 .1 4. 5 1. 7 2. 9 0. 5 10 0. 0 19 2 O th er 9. 1 27 1 (2 .3 ) (1 2. 6) (4 7. 4) (3 7. 7) (0 .0 ) (0 .0 ) 10 0. 0 (0 .0 ) (3 3. 1) (5 4. 3) (8 .9 ) (0 .0 ) (3 .8 ) (0 .0 ) 10 0. 0 25 To ta l 10 .4 3 95 6 1. 3 11 .1 43 .6 42 .6 0. 4 1. 0 10 0. 0 4. 1 28 .3 56 .3 5. 2 1. 8 3. 0 1. 3 10 0. 0 41 2 * M ot he r's e du ca tio n re fe rs to e du ca tio na l a tta in m en t o f m ot he rs a nd c ar et ak er s of c hi ld re n ag ed 0 -5 9 m on th s. ** Tw el ve a nd o ne u nw ei gh te d ca se s w ith m is si ng "E th ni ci ty o f h ou se ho ld h ea d" n ot s ho w n re sp ec tiv el y. ** *F ou rte en a nd th re e un w ei gh te d ca se s w ith m is si ng "R el ig io n of h ou se ho ld h ea d" n ot s ho w n re sp ec tiv el y. ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s. 62 VI. CHILD HEALTH CHILD DEVELOPMENT 2010 SURVEY Ta bl e C H .6 : O ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g an d ot he r t re at m en ts 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 re ce iv ed o ra l r eh yd ra tio n th er ap y w ith c on tin ue d fe ed in g, a nd p er ce nt ag e of c hi ld re n w ith d ia rr ho ea w ho re ce iv ed o th er tr ea tm en ts , M on go lia , 2 01 0 C hi ld re n w ith d ia rr ho ea w ho re ce iv ed : O th er tr ea tm en ts : Not given any treatment or drug Number of children aged 0-59 months with diarrhoea in the last two weeks ORS fluid from packet or increased fluids ORT (ORS fluid from packet or recommended homemade fluids or increased fluids) ORT with continued feeding 1 Pi ll or s yr up In je ct io n Intravenous Home remedy, herbal medicine Other Antibiotic Antimotility Zinc Other Unknown Antibiotic Non-antibiotic Un-known Se x M al e 56 .0 63 .1 58 .0 22 .4 11 .2 0. 3 17 .2 2. 2 3. 6 1. 7 0. 3 4. 5 3. 9 5. 9 19 .3 22 1 Fe m al e 54 .9 59 .8 53 .7 17 .4 13 .5 0. 0 16 .2 0. 5 1. 1 4. 2 1. 3 3. 4 4. 4 2. 5 25 .2 19 2 R eg io n W es te rn 45 .0 52 .9 48 .0 15 .7 7. 2 0. 8 15 .4 0. 9 1. 7 0. 6 0. 8 3. 3 2. 2 2. 2 31 .9 80 K ha ng ai 62 .2 70 .4 63 .2 23 .6 18 .8 0. 0 11 .4 0. 9 2. 3 4. 2 0. 0 5. 4 2. 2 5. 4 18 .2 10 7 C en tra l 56 .2 60 .4 57 .1 19 .1 7. 1 0. 0 20 .3 1. 7 3. 5 2. 4 0. 0 3. 6 2. 8 5. 9 24 .9 10 9 E as te rn 60 .1 71 .5 65 .7 9. 3 14 .6 0. 0 11 .0 0. 0 0. 0 0. 0 0. 0 5. 5 3. 0 8. 2 19 .1 29 U la an ba at ar (5 4. 5) (5 6. 9) (4 9. 9) (2 4. 8) (1 4. 7) (0 .0 ) (2 2. 0) (2 .6 ) (2 .8 ) (4 .9 ) (2 .8 ) (2 .8 ) (1 0. 4) (1 .8 ) (1 4. 9) 87 A re a U rb an 57 .8 62 .3 56 .7 21 .9 15 .8 0. 0 18 .1 1. 8 3. 5 3. 3 1. 4 3. 4 5. 6 4. 2 18 .2 21 1 R ur al 53 .0 60 .9 55 .3 18 .2 8. 6 0. 3 15 .4 0. 9 1. 3 2. 4 0. 0 4. 6 2. 6 4. 5 26 .0 20 1 Lo ca tio n C ap ita l c ity (5 4. 5) (5 6. 9) (4 9. 9) (2 4. 8) (1 4. 7) (0 .0 ) (2 2. 0) (2 .6 ) (2 .8 ) (4 .9 ) (2 .8 ) (2 .8 ) (1 0. 4) (1 .8 ) (1 4. 9) 87 A im ag c en te r 60 .2 66 .0 61 .4 19 .8 16 .5 0. 0 15 .3 1. 3 4. 0 2. 2 0. 5 3. 8 2. 2 5. 8 20 .5 12 4 S ou m c en te r 57 .4 62 .5 57 .4 15 .9 9. 2 0. 8 16 .5 0. 0 1. 3 3. 7 0. 0 6. 5 4. 3 4. 6 23 .6 85 R ur al 49 .8 59 .7 53 .8 19 .9 8. 3 0. 0 14 .5 1. 6 1. 3 1. 5 0. 0 3. 2 1. 3 4. 5 27 .7 11 6 A ge 0 -1 1 m on th s 56 .0 59 .8 50 .4 21 .2 13 .8 0. 0 18 .5 0. 8 5. 2 2. 2 0. 0 7. 6 5. 7 3. 9 25 .4 12 2 12 -2 3 m on th s 63 .2 71 .2 66 .1 25 .6 11 .5 0. 4 16 .5 3. 2 2. 0 3. 3 0. 4 3. 9 2. 0 5. 3 15 .4 15 0 24 -3 5 m on th s 47 .2 52 .3 48 .6 12 .2 17 .3 0. 0 19 .0 0. 0 0. 8 2. 9 3. 3 0. 5 5. 2 4. 9 25 .6 73 36 -4 7 m on th s (4 3. 4) (5 1. 3) (4 8. 7) (1 3. 0) (9 .2 ) (0 .0 ) (1 7. 8) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (7 .3 ) (3 .5 ) (2 6. 7) 44 48 -5 9 m on th s (5 1. 8) (5 7. 3) (5 7. 3) (1 7. 3) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (9 .2 ) (0 .0 ) (4 .2 ) (0 .0 ) (0 .0 ) (2 7. 2) 24 M ot he r's e du ca tio n* N on e (3 8. 9) (6 3. 0) (6 3. 0) (1 4. 3) (5 .0 ) (0 .0 ) (1 8. 6) (0 .0 ) (0 .0 ) (2 .4 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (3 1. 3) 19 P rim ar y (3 3. 9) (4 0. 4) (3 5. 3) (2 7. 5) (2 .0 ) (0 .0 ) (1 .9 ) (2 .6 ) (5 .1 ) (3 .4 ) (0 .0 ) (7 .9 ) (0 .0 ) (1 .8 ) (4 0. 9) 36 B as ic (l ow er s ec on da ry ) 47 .4 53 .0 51 .1 17 .6 2. 7 0. 0 9. 8 1. 6 0. 0 0. 0 0. 0 1. 7 0. 0 6. 2 30 .3 60 U pp er s ec on da ry 66 .4 72 .3 65 .0 22 .5 12 .4 0. 0 18 .1 0. 5 0. 6 2. 5 0. 5 1. 9 5. 8 6. 2 15 .4 12 8 Vo ca tio na l (4 9. 4) (5 3. 1) (4 9. 4) (2 8. 7) (9 .8 ) (0 .0 ) (2 5. 8) (7 .0 ) (3 .2 ) (1 .8 ) (0 .0 ) (3 .7 ) (0 .0 ) (1 0. 8) (1 7. 7) 32 C ol le ge , u ni ve rs ity 58 .3 62 .8 55 .8 15 .8 20 .8 0. 5 20 .1 0. 7 4. 7 4. 7 1. 8 6. 5 7. 0 1. 6 19 .3 13 6 W ea lth in de x qu in til es P oo re st 44 .9 55 .6 51 .0 18 .3 4. 7 0. 0 15 .6 1. 8 0. 7 1. 6 0. 0 2. 0 1. 1 3. 5 31 .2 10 4 S ec on d 51 .1 56 .8 51 .5 17 .5 11 .1 0. 0 11 .8 3. 6 3. 2 0. 0 0. 0 3. 8 4. 1 8. 5 25 .6 88 M id dl e 59 .1 63 .1 58 .3 28 .2 15 .1 0. 0 13 .2 0. 8 0. 0 1. 8 0. 7 3. 3 6. 4 4. 7 17 .0 90 Fo ur th 55 .8 60 .0 56 .5 22 .4 19 .8 1. 0 18 .5 0. 0 1. 0 3. 3 0. 0 2. 8 5. 7 2. 3 16 .5 62 R ic he st 72 .4 76 .8 66 .2 13 .2 14 .8 0. 0 28 .2 0. 0 8. 6 9. 6 3. 6 9. 2 4. 2 1. 5 15 .1 67 Et hn ic ity o f h ou se ho ld h ea d* * K ha lk h 56 .5 61 .8 56 .3 21 .2 13 .2 0. 0 18 .1 1. 2 2. 2 3. 5 0. 8 3. 4 5. 0 4. 6 21 .5 32 1 O th er 51 .8 60 .6 55 .0 16 .5 9. 3 0. 7 12 .0 2. 1 3. 4 0. 5 0. 7 6. 1 0. 9 3. 3 23 .8 91 R el ig io n of h ou se ho ld h ea d* ** N o re lig io n 55 .1 62 .8 56 .7 16 .4 11 .2 0. 0 19 .6 0. 9 2. 0 1. 4 0. 0 3. 0 4. 5 3. 5 22 .7 19 3 B ud dh is t 57 .2 60 .5 54 .6 24 .8 14 .7 0. 3 14 .6 1. 7 2. 8 4. 8 1. 3 5. 5 4. 3 5. 8 20 .4 19 2 O th er (5 1. 1) (6 2. 9) (6 2. 9) (1 0. 1) (3 .6 ) (0 .0 ) (1 3. 3) (3 .8 ) (3 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (2 8. 2) 25 To ta l 55 .5 61 .6 56 .0 20 .1 12 .3 0. 2 16 .8 1. 4 2. 4 2. 9 0. 7 4. 0 4. 1 4. 3 22 .0 41 2 * M ot he r's e du ca tio n re fe rs to e du ca tio na l a tta in m en t o f m ot he rs a nd c ar et ak er s of c hi ld re n ag ed 0 -5 9 m on th s. ** O ne u nw ei gh te d ca se s w ith m is si ng "E th ni ci ty o f h ou se ho ld h ea d" n ot s ho w n. ** *T hr ee u nw ei gh te d ca se s w ith m is si ng "R el ig io n of h ou se ho ld h ea d" n ot s ho w n. ( ) F ig ur es th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) F ig ur es th at a re b as ed o n le ss th an 2 5 un w ei gh te d ca se s. 1 M IC S in di ca to r 3 .8 63 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH Table CH.7: Care seeking for suspected pneumonia and antibiotic use during suspected pneumonia Percentage of children aged 0-59 months with suspected pneumonia in the last two weeks who were taken to a health provider and percentage of children who were given antibiotics, Mongolia, 2010 Had suspected pneumonia in the last two weeks Number of children aged 0-59 months Any appropriate provider1 Percentage of children with suspected pneumonia who received antibiotics in the last two weeks2 Number of children aged 0-59 months with suspected pneumonia in the last two weeks Sex Male 2.1 1 981 (82.9) (68.6) 42 Female 2.0 1 975 (90.9) (76.4) 40 Area Urban 2.8 2 298 (89.9) (74.3) 65 Rural 1.0 1 658 (*) (*) 17 Total 2.1 3 956 86.8 72.5 82 ( ) Figures that are based on 25-49 unweighted cases. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 3.9 2 MICS indicator 3.10 64 VI. CHILD HEALTH CHILD DEVELOPMENT 2010 SURVEY Ta bl e C H .8 : K no w le dg e of th e tw o da ng er s ig ns o f p ne um on ia P er ce nt ag e of m ot he rs a nd c ar et ak er s of c hi ld re n ag ed 0 -5 9 m on th s by s ym pt om s th at w ou ld c au se to ta ke th e ch ild im m ed ia te ly to a h ea lth fa ci lit y, a nd p er ce nt ag e of m ot he rs a nd c ar et ak er s w ho re co gn iz e fa st a nd d iffi cu lt br ea th in g as s ig ns fo r s ee ki ng c ar e im m ed ia te ly , M on go lia , 2 01 0 Pe rc en ta ge o f m ot he rs /c ar et ak er s w ho th in k th at a c hi ld s ho ul d be ta ke n im m ed ia te ly to a h ea lth fa ci lit y if th e ch ild : Mothers/ caretakers who recognize the two danger signs of pneumonia Number of mothers/ caretakers of children aged 0-59 months Is not able to drink or breastfeed Becomes sicker Develops a fever Has fast breathing Has difficulty breathing Has blood in stool Vomits Refuses to drink Has diarrhoea Has illness with a cough Has seizure, fits or faint Cries with an unknown reason Has other symptoms R eg io n W es te rn 2. 7 5. 3 81 .4 3. 5 2. 5 3. 6 6. 0 1. 2 16 .7 58 .9 3. 4 13 .3 13 .9 1. 2 44 1 K ha ng ai 5. 9 12 .9 78 .7 6. 1 3. 7 2. 5 9. 0 1. 0 27 .4 55 .6 4. 7 15 .6 8. 4 1. 6 66 4 C en tra l 3. 2 7. 4 70 .9 3. 3 3. 7 1. 1 9. 1 0. 3 27 .7 45 .6 5. 5 17 .5 9. 0 1. 0 57 3 E as te rn 1. 1 4. 4 73 .2 1. 3 1. 2 0. 5 4. 5 1. 4 16 .0 49 .4 1. 8 15 .8 12 .0 0. 2 22 7 U la an ba at ar 6. 3 7. 7 70 .3 4. 4 3. 3 2. 4 7. 8 1. 3 20 .4 56 .5 4. 0 19 .2 17 .5 1. 5 1 12 3 A re a U rb an 5. 1 8. 5 72 .2 4. 1 3. 5 1. 8 7. 5 1. 1 21 .3 54 .1 3. 8 18 .4 15 .9 1. 3 1 78 7 R ur al 4. 2 7. 8 76 .8 4. 3 2. 8 2. 8 8. 2 1. 0 24 .2 53 .9 4. 8 14 .9 8. 7 1. 3 1 24 1 Lo ca tio n C ap ita l c ity 6. 3 7. 7 70 .3 4. 4 3. 3 2. 4 7. 8 1. 3 20 .4 56 .5 4. 0 19 .2 17 .5 1. 5 1 12 3 A im ag c en te r 3. 1 9. 8 75 .4 3. 6 3. 7 0. 7 7. 1 0. 7 22 .7 50 .1 3. 4 17 .0 13 .3 0. 9 66 4 S ou m c en te r 4. 2 8. 7 76 .5 3. 6 2. 0 2. 5 7. 9 0. 6 26 .6 49 .2 5. 2 15 .7 9. 9 0. 8 54 4 R ur al 4. 1 7. 1 77 .1 4. 8 3. 4 3. 0 8. 4 1. 3 22 .2 57 .6 4. 4 14 .4 7. 7 1. 6 69 7 Ed uc at io n N on e 2. 2 6. 6 71 .4 5. 7 0. 8 1. 4 3. 1 0. 8 20 .6 68 .7 5. 6 11 .1 8. 2 0. 3 12 9 P rim ar y 6. 3 9. 6 79 .9 5. 4 4. 4 3. 6 7. 8 3. 3 28 .2 55 .3 6. 1 16 .9 7. 8 2. 2 21 5 B as ic (l ow er s ec on da ry ) 3. 7 8. 0 72 .2 4. 0 2. 4 2. 0 9. 0 0. 9 20 .2 57 .4 4. 7 13 .4 13 .7 1. 3 53 2 U pp er s ec on da ry 4. 1 7. 3 76 .9 3. 9 4. 3 2. 6 8. 3 1. 2 22 .6 54 .1 3. 1 18 .8 10 .0 1. 8 83 5 Vo ca tio na l 2. 5 10 .5 70 .7 7. 5 3. 4 2. 1 6. 0 0. 5 22 .0 50 .2 6. 6 16 .3 13 .4 1. 2 20 9 C ol le ge , u ni ve rs ity 6. 0 8. 5 72 .7 3. 4 2. 8 1. 9 7. 7 0. 7 22 .6 51 .3 3. 8 18 .2 16 .3 0. 8 1 10 7 W ea lth in de x qu in til es P oo re st 4. 1 6. 6 76 .4 4. 2 2. 9 3. 3 7. 9 1. 6 23 .7 58 .3 5. 3 13 .6 8. 7 1. 5 67 4 S ec on d 4. 8 8. 8 71 .6 3. 2 2. 5 0. 8 7. 5 0. 6 20 .7 55 .1 3. 3 15 .3 13 .5 0. 9 60 9 M id dl e 5. 0 10 .4 75 .8 5. 0 5. 2 2. 2 7. 4 0. 8 22 .2 52 .2 3. 9 20 .4 10 .8 1. 5 59 1 Fo ur th 3. 8 6. 6 77 .2 4. 1 3. 5 1. 8 10 .0 0. 8 27 .7 55 .0 4. 6 19 .6 12 .9 1. 4 58 0 R ic he st 5. 9 8. 8 69 .0 4. 3 2. 0 2. 8 6. 2 1. 3 17 .9 48 .9 3. 7 16 .6 19 .6 1. 1 57 3 Et hn ic ity o f h ou se ho ld h ea d* K ha lk h 4. 9 8. 5 73 .4 4. 5 3. 4 2. 4 8. 1 1. 1 24 .1 54 .6 4. 5 17 .3 13 .3 1. 4 2 44 4 K ha za kh 0. 9 2. 8 86 .3 5. 3 5. 0 2. 6 3. 5 1. 7 3. 9 49 .3 4. 0 10 .9 7. 4 2. 4 10 2 O th er 4. 4 7. 5 75 .0 2. 3 1. 8 1. 2 7. 3 0. 8 17 .8 52 .3 2. 8 17 .1 12 .4 0. 2 47 6 R el ig io n of h ou se ho ld h ea d* * N o re lig io n 3. 6 8. 0 72 .9 4. 5 3. 5 1. 8 8. 3 0. 9 20 .9 51 .7 5. 0 16 .0 12 .9 1. 1 1 40 0 B ud dh is t 5. 2 8. 8 75 .2 3. 9 3. 0 2. 6 7. 3 0. 8 25 .3 56 .4 3. 5 17 .7 12 .8 1. 4 1 43 3 M us lim 1. 2 2. 7 87 .3 4. 4 2. 2 2. 6 4. 5 1. 3 3. 0 54 .1 3. 2 11 .4 7. 4 0. 7 79 O th er 14 .4 8. 5 65 .0 3. 0 4. 1 2. 2 10 .7 4. 9 20 .9 52 .4 3. 5 23 .2 20 .6 2. 2 10 6 To ta l 4. 7 8. 2 74 .1 4. 2 3. 2 2. 2 7. 8 1. 0 22 .5 54 .1 4. 2 17 .0 12 .9 1. 3 3 02 8 *T en u nw ei gh te d ca se s w ith m is si ng "E th ni ci ty o f h ou se ho ld h ea d" n ot s ho w n. ** Th irt ee n un w ei gh te d ca se s w ith m is si ng "R el ig io n of h ou se ho ld h ea d" n ot s ho w n. 65 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH Ta bl e C H .9 : S ol id fu el u se P er ce nt d is tri bu tio n of h ou se ho ld m em be rs a cc or di ng to ty pe o f c oo ki ng fu el u se d by th e ho us eh ol d, a nd p er ce nt ag e of h ou se ho ld m em be rs li vi ng in h ou se ho ld s us in g so lid fu el s fo r c oo ki ng , M on go lia , 2 01 0 Pe rc en ta ge o f h ou se ho ld m em be rs in h ou se ho ld s us in g: N um be r o f ho us eh ol d m em be rs E le ct ric ity Li qu efi ed P et ro le um G as (L P G ) So lid fu el s O th er fu el s/ M is si ng / D K To ta l S ol id fu el s fo r c oo ki ng 1 C oa l ( st on e co al , l ig ni te , w oo d co al ) C ha rc oa l W oo d S tra w , sh ru bs , gr as s D un g S aw du st Ti re , ru bb er R eg io n W es te rn 14 .7 1. 0 11 .4 0. 0 25 .3 3. 8 42 .7 0. 0 0. 0 1. 0 10 0. 0 83 .3 5 15 1 K ha ng ai 12 .5 0. 2 2. 8 0. 1 61 .4 0. 5 22 .3 0. 2 0. 0 0. 0 10 0. 0 87 .3 7 61 3 C en tra l 33 .9 2. 2 5. 5 0. 0 33 .3 1. 6 23 .2 0. 3 0. 0 0. 1 10 0. 0 63 .8 6 44 4 E as te rn 21 .5 0. 4 10 .8 0. 0 17 .3 0. 7 49 .2 0. 0 0. 0 0. 0 10 0. 0 78 .1 2 74 7 U la an ba at ar 45 .1 2. 5 43 .7 0. 4 6. 5 0. 0 0. 6 0. 9 0. 1 0. 1 10 0. 0 52 .3 14 0 26 A re a U rb an 43 .8 2. 2 32 .7 0. 3 16 .5 0. 1 3. 6 0. 7 0. 1 0. 0 10 0. 0 54 .0 21 8 42 R ur al 8. 8 0. 7 3. 2 0. 0 41 .8 2. 4 42 .7 0. 0 0. 0 0. 4 10 0. 0 90 .1 14 1 39 Lo ca tio n C ap ita l c ity 45 .1 2. 5 43 .7 0. 4 6. 5 0. 0 0. 6 0. 9 0. 1 0. 1 10 0. 0 52 .3 14 0 26 A im ag c en te r 41 .4 1. 6 12 .8 0. 1 34 .4 0. 3 9. 0 0. 4 0. 0 0. 0 10 0. 0 57 .0 7 81 6 S ou m c en te r 15 .3 1. 5 5. 2 0. 0 48 .2 3. 0 26 .5 0. 1 0. 0 0. 2 10 0. 0 83 .0 6 41 2 R ur al 3. 5 0. 0 1. 5 0. 0 36 .5 1. 8 56 .2 0. 0 0. 0 0. 5 10 0. 0 96 .0 7 72 7 Ed uc at io n of h ou se ho ld h ea d* N on e 7. 4 0. 2 11 .4 0. 0 35 .4 2. 1 41 .8 1. 4 0. 0 0. 4 10 0. 0 92 .0 2 46 1 P rim ar y 10 .5 0. 5 13 .5 0. 0 35 .8 2. 0 37 .0 0. 4 0. 0 0. 3 10 0. 0 88 .7 5 07 7 B as ic (l ow er s ec on da ry ) 16 .4 0. 5 19 .1 0. 1 33 .5 1. 4 28 .2 0. 3 0. 0 0. 4 10 0. 0 82 .7 7 87 8 U pp er s ec on da ry 32 .8 1. 9 28 .3 0. 5 24 .7 0. 7 10 .3 0. 5 0. 3 0. 0 10 0. 0 65 .3 7 41 4 Vo ca tio na l 27 .6 2. 1 28 .0 0. 0 29 .0 0. 6 12 .1 0. 4 0. 0 0. 2 10 0. 0 70 .1 4 24 6 C ol le ge , u ni ve rs ity 58 .9 3. 1 20 .5 0. 2 12 .4 0. 1 4. 5 0. 3 0. 0 0. 0 10 0. 0 38 .0 8 78 3 W ea lth in de x qu in til es P oo re st 0. 2 0. 0 0. 3 0. 0 31 .9 2. 4 64 .5 0. 1 0. 0 0. 7 10 0. 0 99 .1 7 19 6 S ec on d 8. 2 0. 2 24 .0 0. 0 43 .2 1. 9 20 .8 1. 1 0. 3 0. 2 10 0. 0 91 .4 7 19 3 M id dl e 14 .4 0. 8 40 .5 0. 6 34 .6 0. 6 7. 7 0. 8 0. 0 0. 0 10 0. 0 84 .8 7 20 0 Fo ur th 33 .7 2. 6 39 .4 0. 2 22 .1 0. 0 1. 8 0. 1 0. 0 0. 0 10 0. 0 63 .6 7 19 5 R ic he st 93 .8 4. 4 1. 3 0. 0 0. 5 0. 0 0. 0 0. 0 0. 0 0. 0 10 0. 0 1. 8 7 19 7 Et hn ic ity o f h ou se ho ld h ea d* * K ha lk h 32 .0 1. 7 21 .8 0. 2 26 .7 0. 6 16 .4 0. 4 0. 1 0. 1 10 0. 0 66 .2 28 9 53 K ha za kh 14 .9 0. 5 30 .2 0. 0 12 .9 1. 4 40 .1 0. 0 0. 0 0. 0 10 0. 0 84 .5 1 26 5 O th er 23 .9 1. 1 15 .5 0. 3 28 .1 2. 9 27 .0 0. 7 0. 0 0. 4 10 0. 0 74 .5 5 69 7 R el ig io n of h ou se ho ld h ea d* ** N o re lig io n 28 .9 1. 8 20 .3 0. 2 27 .1 1. 3 19 .7 0. 5 0. 0 0. 2 10 0. 0 69 .1 15 1 34 B ud dh is t 31 .3 1. 6 20 .5 0. 2 26 .8 0. 8 18 .1 0. 4 0. 0 0. 2 10 0. 0 66 .9 18 3 60 M us lim 13 .6 0. 7 32 .6 0. 0 11 .2 1. 8 39 .8 0. 0 0. 0 0. 3 10 0. 0 85 .3 96 8 O th er 37 .7 0. 4 28 .9 0. 4 22 .6 0. 1 8. 3 0. 2 1. 4 0. 0 10 0. 0 62 .0 1 39 4 To ta l 30 .1 1. 6 21 .1 0. 2 26 .4 1. 0 19 .0 0. 4 0. 1 0. 2 10 0. 0 68 .2 35 9 81 *T hi rty th re e un w ei gh te d ca se s w ith m is si ng "E du ca tio n of h ou se ho ld h ea d" n ot s ho w n. ** Tw en ty th re e un w ei gh te d ca se s w ith m is si ng "E th ni ci ty o f h ou se ho ld h ea d" n ot s ho w n. ** *T hi rty u nw ei gh te d ca se s w ith m is si ng "R el ig io n of h ou se ho ld h ea d" n ot s ho w n. 1 M IC S in di ca to r 3 .1 1 66 VI. CHILD HEALTH CHILD DEVELOPMENT 2010 SURVEY Table CH.10: Solid fuel use by place of cooking Percent distribution of household members in households using solid fuels by place of cooking, Mongolia, 2010 Place of cooking: Number of household members in households using solid fuels for cooking In a separate room used as kitchen Elsewhere in the dwelling In a separate building At another place Missing/DK Total Region Western 26.3 73.2 0.4 0.1 0.1 100.0 4 290 Khangai 19.2 80.1 0.7 0.0 0.0 100.0 6 646 Central 37.6 60.7 0.9 0.5 0.2 100.0 4 112 Eastern 16.9 82.3 0.7 0.0 0.1 100.0 2 144 Ulaanbaatar 43.5 56.3 0.2 0.0 0.0 100.0 7 330 Area Urban 41.3 58.3 0.3 0.0 0.1 100.0 11 784 Rural 20.7 78.4 0.7 0.2 0.0 100.0 12 738 Location Capital city 43.5 56.3 0.2 0.0 0.0 100.0 7 330 Aimag center 37.7 61.5 0.5 0.1 0.2 100.0 4 454 Soum center 39.1 60.2 0.6 0.1 0.0 100.0 5 322 Rural 7.5 91.4 0.8 0.2 0.0 100.0 7 415 Education of household head* None 11.4 87.7 0.7 0.2 0.0 100.0 2 264 Primary 17.3 81.6 0.8 0.2 0.1 100.0 4 503 Basic (lower secondary) 24.2 75.1 0.6 0.0 0.1 100.0 6 513 Upper secondary 37.6 61.9 0.5 0.1 0.0 100.0 4 840 Vocational 43.3 56.4 0.3 0.0 0.1 100.0 2 974 College, university 52.1 47.6 0.2 0.1 0.1 100.0 3 341 Wealth index quintiles Poorest 1.3 97.5 0.9 0.2 0.0 100.0 7 134 Second 10.7 88.6 0.5 0.1 0.1 100.0 6 576 Middle 46.6 52.8 0.5 0.0 0.0 100.0 6 107 Fourth 81.6 18.3 0.1 0.0 0.1 100.0 4 578 Richest (*) (*) (*) (*) (*) 100.0 127 Ethnicity of household head** Khalkh 30.1 69.3 0.5 0.1 0.1 100.0 19 157 Khazakh 67.2 31.6 1.2 0.0 0.0 100.0 1 069 Other 23.4 75.7 0.7 0.3 0.0 100.0 4 246 Religion of household head*** No religion 28.9 70.2 0.8 0.1 0.0 100.0 10 460 Buddhist 29.3 70.2 0.3 0.1 0.1 100.0 12 281 Muslim 66.7 32.3 1.0 0.0 0.0 100.0 826 Other 35.1 64.9 0.0 0.0 0.0 100.0 864 Total 30.6 68.7 0.5 0.1 0.1 100.0 24 521 *Twenty four unweighted cases with missing "Education of household head" not shown. **Nineteen unweighted cases with missing "Ethnicity of household head" not shown. ***Twenty three unweighted cases with missing "Religion of household head" not shown. (*) Figures that are based on less than 25 unweighted cases. 67 CHILD DEVELOPMENT 2010 SURVEY VI. CHILD HEALTH Ta bl e C H .1 7: C hi ld re n at in cr ea se d ris k of d is ab ili ty P er ce nt ag e of c hi ld re n ag ed 2 -1 4 ye ar s re po rte d by m ot he rs /c ar et ak er s to h av e im pa irm en ts o r a ct iv ity li m ita tio ns , b y se le ct ed b ac kg ro un d ch ar ac te ris tic s, M on go lia , 2 01 0 P er ce nt ag e of c hi ld re n ag ed 2 -1 4 re po rt ed to h av e sp ec ifi ed im pa ir m en ts o r ac tiv ity li m ita tio ns Number of children aged 2-14 years 2 ye ar s Number of children aged 2 years 3- 14 ye ar s Number of children aged 3-14 years Percentage of children aged 2-14 with at least one reported impairment 1 Number of children aged 2-14 years Delay in sitting, standing or walking Difficulty seeing, either in the daytime or at night Appears to have difficulty hearing No under-standing of instructions Difficulty in walking, moving arms or have weakness or stiffness Have fits, become rigid, lose conscious- ness Not learning to do things like other children his/ her age No speaking/ cannot be understood in words Appears mentally backward, dull or slow Cannot name at least one object Speech is not normal Se x M al e 2. 2 3. 4 2. 6 2. 9 2. 6 1. 4 2. 8 3. 9 1. 3 4 67 8 13 .5 45 2 7. 0 4 22 6 14 .3 4 67 8 Fe m al e 1. 7 3. 9 2. 0 2. 3 2. 1 1. 0 2. 3 2. 9 0. 9 4 45 3 14 .0 41 7 5. 5 4 03 6 12 .8 4 45 3 R eg io n W es te rn 2. 0 2. 4 1. 9 3. 2 2. 0 0. 7 2. 3 4. 5 1. 2 1 60 8 14 .3 14 8 7. 9 1 46 0 12 .8 1 60 8 K ha ng ai 2. 0 3. 7 2.

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