Mongolia - Multiple Indicator Cluster Survey - 2012

Publication date: 2012

MICS “BCI” Õýâëýëèéí êîìïàíè Óòàñ: 319032 MICS KHUVSGUL KHUVSGUL AIMAG Child Development Survey-2012 Multiple Indicator Cluster Survey K H U V SG U L A IM A G 2 0 1 4 C hild D evelopm ent Survey-2 0 1 2 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” MonGoLIA August 2014 Prepared by: T. Altantsetseg, Senior Specialist, Statistics Department, Khuvsgul aimag R. Otgontsetseg, Specialist, Statistics Department, Khuvsgul aimag S. Sarmandakh, Specialist, Statistics Department, Khuvsgul aimag B. Chimed, Contracted Personnel, Statistics Department, Khuvsgul aimag Edited by: D.Khurelmaa, Evaluation officer, UNICEF Mongolia S.Todgerel, MICS5 National consultant, UNICEF Mongolia Cover photo: © UNICEF Mongolia/2010 STATISTICS DEPARTMENT OF GOVERNOR’S OFFICE OF KHUVSGUL AIMAG Khuvsgul aimag, Murun soum Bagh 8, Building A of Aimag Governor’s Office Web site: http://www.huvstat.mn E-mail: huv_stat@yahoo.com Telephone: 70382430, 70383212 The “Child Development Survey” (Multiple Indicator Cluster Survey) was carried out in 2012 by the Statistics Department of the Governor’s Office of Khuvsgul aimag with financial and technical support provided by the United Nations Children’s Fund (UNICEF). The Multiple Indicator Cluster Survey (MICS) is an international household survey programme developed by UNICEF. The Khuvsgul “Child Development Survey 2012” is the first one organized in a local area in Mongolia. For more information on the MICS, please visit: www.huv.mn, www.nso.mn, www.childinfo.org. Reference: Statistics Department of the Governor’s Office of Khuvsgul aimag, UNICEF, 2014. Khuvsgul Child Development Survey 2012 (MICS), Final Report. Khuvsgul aimag, Mongolia iii KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” CONTENT FOREWORD . vi ACKNOWLEDGEMENT . vii LIST OF TABLES .viii LIST OF FIGURES . xii LIST OF ABBREVIATIONS . xiii SUMMARY TABLE OF FINDINGS . xiv EXECUTIVE SUMMARY . xxi I. INTRODUCTION .27 Survey objectives .29 II. SAMPLE AND SURVEY METHODOLOGY . 31 Sample design .32 Questionnaires .32 Training and data collection .34 Data processing .35 III. SAMPLE COVERAGE AND THE CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS.37 Sample coverage .38 Characteristics of households .38 Characteristics of respondents .39 Data disaggregation . 41 IV. CHILD MORTALITY .49 V. NUTRITION .53 Nutritional status .54 Breastfeeding and infant and young child feeding .56 Salt iodization . 60 Vitamin A, D, iron and multi-nutrient supplementation . 61 Low birth weight . 64 VI. CHILD HEALTH.79 Immunization . 80 Oral rehydration treatment . 81 Knowledge on medical care seeking and antibiotic treatment of suspected pneumonia .83 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” iv Mothers’/caretakers’ knowledge of child nutrition and child illness .83 Solid fuel use . 84 Children at increased risk of disability and child injury . 84 VII. WATER AND SANITATION .99 Use of improved water sources . 100 Use of improved sanitation. 102 Hand washing . 103 VIII. REPRODUCTIVE HEALTH .117 Fertility . 118 Contraception . 119 Unmet needs for contraception . 119 Antenatal care. 121 Assistance at delivery .122 Place of delivery .123 IX. CHILD DEVELOPMENT . 137 Pre-school education . 138 Early childhood development . 140 X. LITERACY AND EDUCATION . 149 Literacy among young people . 150 School readiness . 150 Primary and lower secondary education enrolment . 150 XI. CHILD PROTECTION . 163 Birth registration . 164 Child labour . 164 Child discipline . 166 Early marriage .167 Attitudes toward domestic violence . 169 XII. HIV, AIDS AND SEXUAL BEHAVIOUR . 185 Knowledge about HIV transmission and misconceptions about HIV, AIDS . 186 Accepting attitudes toward people living with HIV, AIDS . 188 Knowledge of a place for HIV testing, counselling and testing during antenatal care . 188 Sexual behaviour related to HIV transmission . 189 v KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” XIII. ACCESS TO MASS MEDIA AND USE OF INFORMATION/ COMMUNICATION TECHNOLOGY . 215 Access to and use of the mass media . 216 Use of information/ communication technology . 216 XIV. TOBACCO AND ALCOHOL USE .223 Tobacco use .224 Alcohol use .225 XV. SUBJECTIVE WELL-BEING .233 APPENDIX A. SAMPLE DESIGN .243 APPENDIX B. LIST OF PERSONNEL INVOLVED IN THE SURVEY . 247 APPENDIX C. ESTIMATES OF SAMPLING ERRORS .249 APPENDIX D. DATA QUALITY TABLES . 261 APPENDIX E. KHUVSGUL CDS 2012 INDICATORS: NUMERATORS AND DENOMINATORS . 277 APPENDIX F. QUESTIONNAIRES .289 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” vi FOREWORD The Statistics Department of the Governor’s Office of the Khuvsgul aimag (province) has successfully conducted the “Child Development Survey-2012” (Multiple Indicator Cluster Survey) for the first time at the provincial level. Within the framework of the broader goal of developing Khuvsgul aimag as a “Child- Friendly Aimag”, and with the aim of ensuring successful completion of the survey, the technical and methodological recommendations and assistance, provided by NSO and UNICEF at each of the survey steps, have been noteworthy. The survey collected data to reveal the present state of children and women in Khuvsgul aimag, including health, education, development, protection, livelihood, as well as men’s and women’s knowledge and attitudes towards HIV, AIDS and sexual behaviours. The survey aimed to enrich and refresh the statistics, and to provide data to measure progress toward the goals of the World Fit for Children and the Millennium Development Goals. I believe that the results of the “Child Development Survey 2012” will be a source of valuable information for policy-makers and will make a contribution to provision of researchers and users with a wide range of information on children, women and men. One of the purposes of this survey is improving the capacity of statistical department. Leading role of the Khuvsgul Statistics department in all the stages of the survey, contributed extensively to build the capacity of the Statistics Department of the Khuvsgul aimag to manage the household surveys at the provincial level. Finally, I would like to express sincere gratitude to the Governor’s Office of the Khuvsgul aimag, UNICEF and all those who were involved in the survey for the provision of technical recommendations and collaboration for successful conduct of the survey. D. BAASANDORJ Director Statistics Department of the Governor’s Office of Khuvsgul aimag vii KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” ACKNOWLEDGEMENT The Khuvsgul aimag Statistics Department would like to express sincere gratitude to the NSO, UNICEF, and the Khuvsgul aimag Governor office as well as all the people involved in the survey and the development of the present report for the technical and methodological support to make the first ever survey in the Khuvsgul successful and up to the international standards. We would like also to appreciate 2000 households and people of the Khuvsgul aimag for their time to participate in the survey and share their information. This has been fundamental for the successful implementation of the survey. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” viii LIST OF TABLES Table HH.1: Results of household, women’s, men’s, under-5’s and children age 2-14’s interviews .42 Table HH.2: Household age distribution by sex .43 Table HH.3: Household composition . 44 Table HH.4: Women’s background characteristics .45 Table HH.4M: Men’s background characteristics . 46 Table HH.5: Under-5’s background characteristics .47 Table HH.5A: Children age 2-14’s background characteristics . 48 Table CM.1: Children ever born, children surviving and proportion dead . 51 Table CM.2: Child mortality .52 Table NU.1: Nutritional status of children .66 Table NU.2: Initial breastfeeding .67 Table NU.3: Breastfeeding . 68 Table NU.4: Duration of breastfeeding . 68 Table NU.5: Age-appropriate breastfeeding .69 Table NU.7: Minimum meal frequency .70 Table NU.8: Bottle feeding .71 Table NU.9: Iodized salt consumption . 72 Table NU.10: Children’s vitamin A supplementation . 73 Table NU.10A: Children’s vitamin A supplementation (according to mother’s report) .74 Table NU.10B: Children’s vitamin D supplementation . 75 Table NU.10C: Children’s multi-nutrient supplementation .76 Table NU.11: Low birth weight infants . 77 Table CH.1: Vaccinations in first year of life . 85 Table CH.2: Vaccinations by selected background characteristics . 86 Table CH.4: Oral rehydration solutions and recommended homemade fluids .87 Table CH.5: Feeding practices during diarrhoea . 88 Table CH.6: Oral rehydration therapy with continued feeding and other treatments . 89 Table CH.8: Knowledge of the two danger signs of pneumonia . 90 Table CH.8A: Knowledge about illnesses that can be caused due to nutrition deficiency or unhealthy eating among children . 91 Table CH.8B: Knowledge about anemia .92 Table CH.9: Solid fuel use .93 Table CH.10: Solid fuel use by place of cooking . 94 Table CH.17: Children at increased risk of disability .95 Table CH.17A: Types of child injury .96 Table CH.17B: Places of child injury .97 ix KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” Table WS.1: Use of improved water sources . 105 Table WS.2: Household water treatment . 106 Table WS.3: Time to source of drinking water .107 Table WS.3A: Time to source of drinking water based on country-specific definition . 108 Table WS.4: Person collecting water . 109 Table WS.5: Types of sanitation facilities . 110 Table WS.6: Use and sharing of sanitation facilities .111 Table WS.7: Disposal of child’s faeces . 112 Table WS.8: Drinking water and sanitation ladders . 113 Table WS.8A: Drinking water and sanitation ladders based on country-specific definition . 114 Table WS.9: Water and soap availability at specific place for hand washing . 115 Table WS.10: Availability of soap in household . 116 Table RH.1: Adolescent birth rate and total fertility rate for the one year preceding the survey . 124 Table RH.2: Early childbearing .125 Table RH.3: Trends in early childbearing . 126 Table RH.4: Use of contraception .127 Table RH.4A: Knowledge of contraception - Women . 128 Table RH.4AM: Knowledge of contraception - Men . 129 Table RH.5: Unmet need for contraception . 130 Table RH.6: Antenatal care coverage . 131 Table RH.7: Number of antenatal care visits .132 Table RH.7A: Timing of first antenatal care . 133 Table RH.8: Content of antenatal care . 134 Table RH.9: Assistance during delivery . 135 Table RH.10: Place of delivery . 136 Table CD.1: Early childhood education . 142 Table CD.2: Support for learning . 143 Table CD.3: Learning materials . 144 Table CD.4: Inadequate care . 145 Table CD.5: Early child development index . 146 Table CD.5A: Early child development index (based on country-specific definition) .147 Table ED.1: Literacy - Young women . 154 Table ED.1M: Literacy - Young men . 155 Table ED.2: School readiness . 156 Table ED.3: General educational school entry . 156 Table ED.4: Primary education attendance .157 Table ED.5: Lower secondary school attendance . 158 Table ED.5A: Basic education attendance . 159 Table ED.6: Children reaching last grade of primary education . 160 Table ED.7: Primary education completion and transition to secondary education . 161 Table ED.8: Education gender parity . 162 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” x Table CP.1: Birth registration .170 Table CP.2: Child labour . 171 Table CP.2A: Child labour based on country-specific definition .173 Table CP.3: Child labour and school attendance .175 Table CP.3À: Child labour and school attendance based on country-specific definition .176 Table CP.4: Child discipline . 177 Table CP.5: Early marriage - Women . 178 Table CP.5M: Early marriage - Men .179 Table CP.6: Trends in early marriage - Women . 180 Table CP.6M: Trends in early marriage - Men . 180 Table CP.7: Spousal age difference . 181 Table CP.11: Attitudes toward domestic violence - Women . 181 Table CP.11M: Attitudes toward domestic violence - Men . 182 Table CP.12: Children’s living arrangements and orphanhood . 183 Table HA.1: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission - Women . 191 Table HA.1M: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission - Men . 192 Table HA.2: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission - Young women . 193 Table HA.2M: Knowledge about HIV transmission, misconceptions about HIV/AIDS, and comprehensive knowledge about HIV transmission - Young men . 194 Table HA.3: Knowledge of mother-to-child HIV transmission - Women . 195 Table HA.3M: Knowledge of mother-to-child HIV transmission - Men . 196 Table HA.4: Accepting attitudes toward people living with HIV/AIDS - Women .197 Table HA.4M: Accepting attitudes toward people living with HIV/AIDS - Men . 198 Table HA.5: Knowledge of a place for HIV testing - Women . 199 Table HA.5M: Knowledge of a place for HIV testing - Men .200 Table HA.6: Knowledge of a place for HIV testing among sexually active young women . 201 Table HA.6M: Knowledge of a place for HIV testing among sexually active young men .202 Table HA.7: HIV counselling and testing during antenatal care .203 Table HA.8: Sexual behaviour that increases the risk of HIV infection - Young women.204 Table HA.8M: Sexual behaviour that increases the risk of HIV infection - Young men .205 Table HA.9: Sex with multiple partners - Women .206 Table HA.9M: Sex with multiple partners - Men . 207 Table HA.10: Sex with multiple partners - Young women . 208 Table HA.10M: Sex with multiple partners - Young men.209 Table HA.11: Sex with non-regular partners - Young women . 210 Table HA.11M: Sex with non-regular partners - Young men . 211 Table HA.12: Sex with non-regular partners - Women .212 Table HA.12M: Sex with non-regular partners - Men .213 xi KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” Table MT.1: Exposure to mass media - Women . 218 Table MT.1M: Exposure to mass media - Men . 219 Table MT.2: Use of computers and the internet - Young women .220 Table MT.2M: Use of computers and the internet - Young men .221 Table TA.1: Use of tobacco - Women .226 Table TA.1M: Use of tobacco - Men . 227 Table TA.2: Age at first use of cigarettes - Women .228 Table TA.2M: Age at first use of cigarettes and frequency of use - Men .229 Table TA.3: Use of alcohol - Women .230 Table TA.3M: Use of alcohol - Men .231 Table SW.1: Domains of life satisfaction - Young women .236 Table SW.1M: Domains of life satisfaction - Young men . 237 Table SW.2: Life satisfaction and happiness - Young women .238 Table SW.2M: Life satisfaction and happiness - Young men .239 Table SW.3: Perception of a better life - Young women .240 Table SW.3M: Perception of a better life - Young men . 241 Table SE.1: Indicators selected for sampling error calculations .251 Table SE.2: Sampling errors: Total aimag sample .256 Table DQ.1: Age distribution of household population .262 Table DQ.2: Age distribution of eligible and interviewed women .263 Table DQ.2M: Age distribution of eligible and interviewed men .263 Table DQ.3: Age distribution of eligible and interviewed under-5 children .264 Table DQ.3A: Age distribution of eligible and interviewed children age 2-14 years .264 Table DQ.4: Women’s completion rates by socio-economic characteristics of households .265 Table DQ.4M: Men’s completion rates by socio-economic characteristics of households .266 Table DQ.5: Completion rates for under-5 questionnaires by socio-economic characteristics of households . 267 Table DQ.5A: Completion rates for questionnaires for children age 2-14 years by socio-economic characteristics of households .268 Table DQ.6: Completeness of reporting.269 Table DQ.7: Completeness of information for anthropometric indicators . 270 Table DQ.8: Heaping in anthropometric measurements .271 Table DQ.9: Observation of places for hand washing .271 Table DQ.11: Observation of birth certificates of children age under 5 . 272 Table DQ.12: Observation of vaccination cards . 273 Table DQ.13: Presence of mother in the household and the person interviewed for the under-5 questionnaire . 274 Table DQ.14: Selection of children age 2-14 years for the child discipline module . 274 Table DQ.15: School attendance by single age . 275 Table DQ.16: Sex ratio at birth among children ever born and living . 276 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” xii LIST OF FIGURES Figure HH.1: Age and sex distribution of household population, Khuvsgul aimag, 2012 .39 Figure CM.1: Under-5 mortality rates by background characteristics, Khuvsgul aimag, 2012 . 51 Figure NU.1: Percentage of children under-five who are underweight, stunted and wasted, Khuvsgul aimag, 2012 .56 Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Khuvsgul aimag, 2012 .57 Figure NU.3: Percentage of households consuming adequately iodized salt, Khuvsgul aimag, 2012 . 61 Figure NU.4: Percentage of infants weighing less than 2,500 grams at birth, Khuvsgul aimag, 2012 .65 Figure CH.1: Percentage of children age 12-23 months who received the recommended vaccinations by 12 months, Khuvsgul aimag, 2012 . 81 Figure WS.1: Percent distribution of household members by source of drinking water, Khuvsgul aimag, 2012 . 101 Figure HA.1: Percentage of men and women who have comprehensive knowledge of HIV/AIDS transmission, Khuvsgul aimag, 2012 . 187 xiii KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” LIST OF ABBREVIATIONS AIDS Acquired Immune Deficiency Syndrome CSPro Census and Survey Processing System CDS Child Development Survey DPT Diphtheria, Pertussis and Tetanus ECDI Early Child Development Index ECD Early Childhood Education FMCS Full Management of Child’s Sickness GPI Gender Parity Index HIV Human Immunodeficiency Virus IDD Iodine Deficiency Disorder ILO International Labour Organization 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 Statistics Office ORS Oral Rehydration Salts ORT Oral Rehydration Treatment PPM Parts Per Million PSU Primary Sampling Unit 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 Fund UNICEF United Nations Children’s Fund WHO World Health Organization KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” xiv SUMMARY TABLE OF FINDINGS Multiple Indicator Cluster Survey (MICS) and Millennium Development Goals (MDG) Indicators, Khuvsgul aimag, 2012 Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD MORTALITY Child mortality 1.1 4.1 Under 5 mortality rate 47 per 1 000 live births 1.2 4.2 Infant mortality rate 38 per 1 000 live births CHILD NUTRITION Nutritional status 1.8 Underweight prevalence 2.1a Moderate and severe (Z<-2CX) 7.2 percent 2.1b Severe (Z<-3CХ) 1.7 percent Stunting prevalence 2.2a Moderate and severe (Z<-2CX) 21.6 percent 2.2b Severe(Z<-3CХ) 7.4 percent Wasting prevalence 2.3a Moderate and severe (Z<-2CX) 5.6 percent 2.3b Severe(Z<-3CХ) 2.6 percent Breastfeeding and infant feeding 2.4 Children ever breasfed 95.1 percent 2.5 Early initiation of breastfeeding 61.0 percent 2.6 Exclusive breastfeeding (0-5 months) 59.7 percent 2.7 Continued breastfeeding at 1 year (12-15 months) 75.4 percent 2.8 Continued breastfeeding at 2 years (20-23 months) 52.8 percent 2.9 Predominant breastfeeding (0-5 months) 61.1 percent 2.10 Median duration of breastfeeding (0-35 months) 23.0 month 2.11 Children who drank anything from a bottle with nipple (0-23 months) 17.9 percent 2.12 Introduction of solid or semi-solid foods (6-8 months) 73.0 percent 2.13 Minimum meal frequency (6-23 months) 29.6 percent 2.14 Age-appropriate breastfeeding (0-23 months) 63.6 percent 2.15 Milk feeding frequency for non-breastfed children 81.5 percent Salt iodization 2.16 Iodized salt consumption 63.3 percent Vitamin À 2.17 Vitamin A supplementation (6-59 months) 47.6 percent Low birth weight 2.18 Low birth weight infants 3.9 percent 2.19 Infants weighed at birth 99.0 percent xv KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” Topic MICS Indicator Number MDG Indicator Number Indicator Value CHILD HEALTH Immunization 3.1 Immunization coverage for Tuberculosis 96.3 percent 3.2 Immunization coverage for Polio 3 86.9 percent 3.3 Immunization coverage for DPT or Penta 3 80.5 percent 3.4 4.3 Immunization coverage for Measles, Mumps and Rubella 1 88.8 percent 3.5 Immunization coverage for Hepatitis B 91.2 percent Care of illness 3.8 Oral rehydration therapy with continued feeding 57.5 percent 3.9 Care seeking for suspected pneumonia 42.9 percent 3.10 Antibiotic treatment of suspected pneumonia 50.0 percent Solid fuel use 3.11 Use of solid fuels for cooking 97.1 percent Child disability 3.21 Children at increased risk of disability 23.3 percent Child injury CS.1 Children had injury in the last 12 months 9.9 percent WATER AND SANITATION Water and sanitation 4.1 7.8 Use of improved drinking water sources 40.0 percent CS.2 Use of improved drinking water sources (country specific) 48.3 percent 4.2 Water treatment 30.4 percent CS.3 Water treatment (country specific) 29.3 percent 4.3 7.9 Use of improved sanitation 46.4 percent CS.4 Use of improved sanitation (country specific) 60.6 percent 4.4 Safe disposal of child’s faeces 71.8 percent 4.5 Place for hand washing with water and soap available 90.2 percent 4.6 Availability of soap 98.7 percent REPRODUCTIVE HEALTH Contraception and unmet need 5.1 5.4 Adolescent birth rate 37 per 1 000 adolescents 5.2 Childbearing before age 18 among young women 5.5 percent CS.5 Knowledge of contraception (15-49 years) Women 95.9 percent Men 89.6 percent 5.3 5.3 Contraceptive prevalence rate 52.2 percent 5.4 5.6 Unmet need for contraception 26.2 percent KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” xvi Topic MICS Indicator Number MDG Indicator Number Indicator Value Maternal and newborn health 5.5 Antenatal care coverage 5.5a At least once by skilled personnel 98.7 percent 5.5b At least four times by any personnel 82.9 percent CS.6 First antenatal care visit during the first 3 months of pregnancy 66.2 percent 5.6 Content of antenatal care 91.8 percent 5.7 5.2 Skilled attendant at delivery 99.3 percent 5.8 Institutional deliveries 99.3 percent 5.9 Caesarean section 13.8 percent CHILD DEVELOPMENT Child Development 6.1 Support for learning 42.4 percent 6.2 Father’s support for learning 36.2 percent 6.3 Learning materials – Three or more children’s books 17.7 percent 6.4 Learning materials – Two or more types of playthings 75.0 percent 6.5 Inadequate care 11.4 percent 6.6 Early child development index 76.6 percent 6.7 Attendance to early childhood education 54.0 percent EDUCATION Literacy and education 7.1 2.3 Literacy rate among young people (15-24 years) Women 94.5 percent Men 92.8 percent 7.2 School readiness 73.6 percent 7.3 Net intake rate in primary education 86.7 percent 7.4 2.1 Primary education net attendance rate (adjusted) 96.9 percent 7.5 Lower secondary education net attendance rate (adjusted) 92.0 percent 7.6 2.2 Reaching last grade of primary education 97.4 percent 7.7 Primary education completion rate 100.0 percent 7.8 Transition rate to secondary education 97.7 percent 7.9 3.1 Gender parity index (primary education) 1.01 ratio 7.10 3.1 Gender parity index (lower secondary education) 1.09 ratio CHILD PROTECTION Birth registration 8.1 Birth registration 98.5 percent xvii KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” Topic MICS Indicator Number MDG Indicator Number Indicator Value Child labour 8.2 Child labour age 5-14 53.6 percent age 5-17 52.8 percent CS.7 Child labour (country specific) age 5-14 29.3 percent age 5-17 33.5 percent 8.3 School attendance among child labourers age 5-14 94.8 percent age 5-17 93.6 percent CS.8 School attendance among child labourers (country specific) age 5-14 95.8 percent age 5-17 93.8 percent 8.4 Child labour among students age 5-14 54.5 percent age 5-17 53.4 percent CS.9 Child labour among students (country specific) age 5-14 30.1 percent age 5-17 33.9 percent Child discipline 8.5 Violent discipline (children punished psychologically or corporally) 51.3 percent Early marriage 8.6 Marriage before age 15 (15-49 years) Women 0.5 percent Men 0.1 percent 8.7 Marriage before age 18 (20-49 years) Women 6.9 percent Men 1.0 percent 8.8 Young people age 15-19 currently married or in union (15-49 years) Women 4.0 percent Men 0.7 percent 8.10b Young women age 20-24 years and married/ in union with men older than 10 years 1.8 percent Domestic violence 8.14 Accepting attitudes toward domestic violence (15-49 years) Women 20.0 percent Men 11.6 percent KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” xviii Topic MICS Indicator Number MDG Indicator Number Indicator Value Orphaned children 9.17 Children living arrangements (children living with either of parents or none) 4.6 percent 9.18 Prevalence of children with one or both parents dead 7.7 percent HIV AND AIDS AND SEXUAL BEHAVIOUR HIV and AIDS knowledge and attitudes 9.1 Comprehensive knowledge about HIV prevention (15-49 years) Women 21.1 percent Men 15.9 percent CS.10 Ever heard of HIV (15-49 years) Women 85.0 percent Men 86.0 percent 9.2 6.3 Comprehensive knowledge about HIV prevention among young people (15-24 years) Women 25.9 percent Men 15.5 percent 9.3 Knowledge of mother-to-child transmission of HIV (15-49 years) Women 28.3 percent Men 26.0 percent 9.4 Accepting attitudes toward people living with HIV (15-49 years) Women 2.3 percent Men 3.6 percent 9.5 Know where to be tested for HIV (15-49 years) Women 49.6 percent Men 50.1 percent 9.6 Have been tested for HIV and told results (15-49 years) Women 13.0 percent Men 6.6 percent 9.7 Sexually active young people (15- 24 years) who have been tested for HIV and told results Women 20.3 percent Men 10.2 percent 9.8 HIV counselling during antenatal care 21.0 percent 9.9 HIV testing and told results during antenatal care 37.7 percent xix KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” Topic MICS Indicator Number MDG Indicator Number Indicator Value Sexual behaviour 9.10 Young people (15-24 years) never married/ in union who have never had sex Women 67.1 percent Men 47.8 percent 9.11 Sex before age 15 among young people (15-24 years) Women 0.0 percent Men 5.0 percent 9.12 Age-mixing among sexual partners (in the last 12 months and with partners older than 10 years) among women age 15-24 years 2.5 percent 9.13 Had sex with multiple partners in the last 12 months (15-49 years) Women 1.5 percent Men 8.1 percent 9.14 Condom use during sex with multiple partners in the last 12 months (15-49 years) Women (33.3) percent Men 56.4 percent 9.15 Young people (15-24 years) who had sex with non-regular partners in the last 12 months Women 49.0 percent Men 80.0 percent 9.16 6.2 Condom use with non-regular partners in the last 12 months among young people (15-24 years) Women 50.0 percent Men 66.2 percent MASS MEDIA AND INFORMATION/ COMMUNICATION TECHNOLOGY Mass media MT.1 Exposure to mass media (15-49 years) Women 15.6 percent Men 13.3 percent Information/ communication technology MT.2 Use of the computer in the last 12 months among young people (15- 24 years) Women 59.1 percent Men 57.1 percent MT.3 Use of the internet in the last 12 months among young people (15- 24 years) Women 42.6 percent Men 42.0 percent KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” xx Topic MICS Indicator Number MDG Indicator Number Indicator Value SUBJECTIVE WELL-BEING Subjective well- being SW.1 Life satisfaction among young people (15-24 years) Women 65.1 percent Men 75.3 percent SW.2 Happiness among young people (15-24 years) Women 86.5 percent Men 85.3 percent SW.3 Perception of a better life among young people (15-24 years) Women 50.4 percent Men 51.6 percent TOBACCO AND ALCOHOL Tobacco use TA.1 Use of tobacco in the last one month (15-49 years) Women 4.0 percent Men 52.8 percent TA.2 Smoking before age 15 (15-49 years) Women 0.6 percent Men 12.5 percent Alcohol use TA.3 Use of alcohol in the last one month (15-49 years) Women 20.0 percent Men 39.7 percent TA.4 Use of alcohol before age 15 (15-49 years) Women 0.2 percent Men 1.5 percent () Figures that based on 25-49 unweighted cases. xxi KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” EXECUTIVE SUMMARY The Child development survey 2012 carried out in Khuvsgul aimag is a sample survey that represents all households, women and men age 15-49 years, and children under age of 5 and age 2-14 years. The Child development survey 2012 was carried out with financial and technical support from the National Statistical Office of Mongolia (NSO) and United Nations Children’s Fund (UNICEF). The survey results refer to the period of survey conduct in August-September 2012, when the data collection fieldwork was implemented. The main results of the survey are summarized below. Child mortality w In Khuvsgul aimag, the infant mortality rate is 38 per 1,000 live births while the under-five mortality rate is 47 per 1,000 live births. In rural, the rates of child mortality are almost 3.5 times higher than in aimag center. While the infant mortality rate in aimag center is 17 per 1,000 live births, in soum center is 22, it is 53 in rural. Child nutrition w Among children under 5 in Khuvsgul aimag, the underweight prevalence is 7 percent, the stunting prevalence is 22 percent and the wasting prevalence is 6 percent. w The nutritional status of children varied in accordance with the mother’s education level. While the underweight prevalence is 5 percent, the stunting prevalence is 19 percent and the wasting prevalence is 3 percent for children whose mothers have attained higher education, the rates for children with uneducated mothers stand at 14, 37 and 10 percent respectively. Breastfeeding w Although it is recommended that all children under age of 6 months to be exclusively breastfed, only 60 percent of those children were exclusively breastfed during the day and night preceding the survey. w The survey results evidence that 6 of every 10 women with a live birth in the two years preceding the survey, put the newborn infant to the breast within 1 hour of birth. w 75 percent of children age 12-15 months and 53 percent of children age 20-23 months are still being breastfed. w 30 percent of children age 6-23 months were receiving solid or semi-solid foods at appropriate frequency during the day and night preceding the survey. Low birth weight w 99 percent of children age 0-23 months were weighed at birth and 4 percent of them are estimated to weigh less than 2,500 grams at birth. Child Development w For 42 percent of children age 3-4 years, an adult household member provided support and engaged in more than four activities that promote learning and cognitive development during the three days preceding the survey. The average number of activities that adults engaged with children is 3.1. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” xxii w Fathers’ participation in providing support to children’s development and learning is relatively low, with only 36 percent of fathers engaged in more than one activity with their children, and 19 percent of children age 3-4 were living in a household without their fathers. w Only 18 percent of children age 0-59 months are living in households where at least three children's books are present and the percentage of children with 10 or more children's books declines to 3 percent. The proportion of children with three or more children's books in aimag and soum centers is 21-26 percent, while this rate stands at 12 percent for rural, which evidences substantially lower opportunities for children in rural to have access to books as compared to their other peers. Early child development index w Early childhood development index is calculated for children age 3-4 years in Khuvsgul aimag as 77 percent. ECDI is equal by percentage points among girls (76 percent) and among boys (77 percent). w By ECDI domains, the percentages of children who are developmentally on track in the physical and learning domain is highest (95 percent and 94 percent, respectively), the percentages of children who are developmentally on track in the social-emotional domain is 78, and it is 9 percent for the literacy-numeracy domain. Immunization w 96 percent of children age 12-23 months received a Tuberculosis vaccination by the age of 12 months. Immunization coverage for Polio at birth is 96 percent and the percentage declines for subsequent doses of Polio to 93 percent for the first dose, 88 percent for the second dose and 87 percent for the third dose. Immunization coverage for the first dose of DPT or Penta is 89 percent for the first dose, while it drops to 83 percent for the second dose and 81 percent for the third dose. w 91 percent of children age 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 67 percent. Oral rehydration treatment w Approximately, 11 percent of children under age of 5 had diarrhoea during the 14 days preceding the survey. w 58 percent of children with diarrhoea either received oral rehydration treatment and, at the same time, feeding was continued. w During the diarrhoea episode, 36 percent of children drank more than usual while 61 percent drank the usual amount or lesser. 91 percent of children ate somewhat less, same or more, but 9 percent ate much less or almost none. Care seeking and antibiotic treatment of suspected pneumonia w 2 percent of children under 5 were reported to have had symptoms of pneumonia during the 14 days preceding the survey. Of these children, 43 xxiii KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” percent were taken to an appropriate provider. 50 percent of children with suspected symptoms of pneumonia had received an antibiotic treatment. w Only 2 percent of mothers know about the two danger signs of pneumonia – fast breathing and difficult breathing. The most commonly identified symptom for taking a child to a health facility is developing fever (74 percent). 8 percent of mothers identified fast breathing and 5 percent identified difficult breathing as symptoms for taking child immediately to a health care provider. Solid fuel use w 97 percent of all households in Khuvsgul aimag use solid fuels for cooking. Three out of every four households cook their meal indoors within a part of their dwelling. Children at increased risk of disability and child injury w 23 percent of all 2-9 year-old children were found to be at an increased risk of disability. 18 percent of aimag center children are at risk of a child disability, while this rate is comparatively increases to 24-25 percent for children living in rural areas (soum center and rural). w 10 percent of 2-14 year-old children have been affected by a type of child injury during the one year preceding the survey. Water and sanitation w 40 percent of the total population in Khuvsgul aimag has access to an improved source of drinking water. In rural (22 percent), the use of improved drinking water sources is less than in soum and aimag centers (54 percent). w 46 percent of the total population has access to an improved sanitation facility. There is a location disparity in the access to improved sanitation: the percentage stands at 69 percent in aimag center and 72 percent in soum center, while it is 15 percent for the rural population. Early childhood education attendance and school readiness w In Khuvsgul aimag, 54 percent of children age 36-59 months are attending early childhood education. The figure is 40 percent for rural children while it is 66-67 percent for aimag and soum centers children. w The attendance to early childhood education is 74 percent among children from the richest households while the rate is twice as less, or only 37 percent, among children from the poorest households. w 74 percent of children, who were attending the first grade of primary school during the timing of the survey, had attended kindergarten or its alternative programme in the preceding academic year. Primary and basic education attendance w The primary education attendance rate is 97 percent, with no considerable gender differential observed. w 92 percent of children of lower secondary education age, 12-15 years, are attending applicable level secondary education. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” xxiv w 97 percent of all children starting grade one, continue their education to eventually reach the fifth grade, and this indicator is estimated to be at 100 percent among children from the richest and well-off households and at 93 percent among children from the poorest households. Birth registration w In Khuvsgul aimag, the births of 99 percent of children under-5 have been registered. There is no considerable difference in the child registration by location or household wealth. Child labour w In accordance with the UNICEF definition, 54 percent of all children age 5- 14 are involved in child labour, and the majority of them (95 percent) attend schools. However, almost 55 percent of the 5-14 year-olds attending schools are involved in child labour. Child discipline w 51 percent of children age 2-14 were subjected to at least one form of psychological or physical punishment by their household members. w 17 percent of adults from the households with children age 2-14, responded to the household questionnaire indicating acceptance of using physical punishment in child discipline. Early marriage w Although percentage of marriage before age of 15 is relatively low (0.5 percent) among all women of reproductive age, a disparity could be observed in relevance to the level of education. For instance, early marriage before age of 15 is 4 times higher among women with no education or primary education in comparison with the aimag’s average rate. w In Khuvsgul aimag, 2 percent of the women married at the age of 20-24, have a husband who is 10 or more years older, 19 percent of the women have a husband who is 5-9 years older. Use of contraception w Knowledge of any contraception method is 96 percent among women currently married or in union. The current use of contraception was reported at 52 percent. The most commonly used method in Khuvsgul aimag is the IUD which is used by one in every three women (29 percent) currently married or in union. The next most common method is the injectable (8 percent) and the pill (7 percent). w Results of the survey indicate that 26 percent of the total women currently married or in union have unmet need for contraception. Antenatal care w The coverage of antenatal care by skilled personnel (a doctor, obstetrician, midwife, or feldsher) is relatively high with almost all (99 percent) of women receiving antenatal care at least once and 83 percent at least four times during the pregnancy. xxv KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” Assistance at delivery w 99 percent of births for women age 15-49 years, occurred in the two years preceding the survey, were assisted by skilled personnel. 53 percent of the total births were delivered with assistance by an obstetrician, 33 percent by a midwife, and 13 percent by a family or soum doctor. w The percentage of births delivered by an obstetrician is 68 in aimag center, 51 percent in soum center, while the percentage stands at 46 in rural. In Khuvsgul aimag, 99 percent of births in the two years preceding the survey to women age 15-49, were delivered in hospital and 14 percent by Caesarean section. Attitude toward domestic violence w For the age range of 15-49 in Khuvsgul aimag, 12 percent of men and 22 percent women feel that a husband/ partner has a right to hit or beat his wife/ partner for a particular reason. w Women who approve a husband's violence, in most cases agree and justify violence in instances when the woman neglects the children (18 percent), or if she spends significant amount of money without permission from him (8 percent). Among men, these two reasons are also the highest ones (9 percent and 4 percent, respectively). Knowledge, attitudes, and practice about HIV, AIDS w For the age-range of 15-24 in Khuvsgul aimag, 85 percent of men and 86 percent of women have heard of HIV and AIDS. However, the percentage of young people who know both ways of preventing HIV transmission drops to 61-62 percent. Only 16 percent of men and 26 percent of women age 15-24 were found to have comprehensive knowledge. For the age-range of 15-49, 16 percent of men and 21 percent of women have comprehensive knowledge about HIV transmission. w 72 percent of women know that HIV can be transmitted from mother to child, while the knowledge among men is relatively low, or 65 percent. The percentage of men who know all three ways of mother-to-child transmission is 26, for women the percentage is 28; while 21 percent of men and 13 percent of women did not know any specific way. w The survey findings show that stigma and discrimination towards people living with HIV is prevalent; with only 4 percent of men age 15-49 and 2 percent of women expressing accepting attitudes on all four questions. w The percentage of women and men age 15-49 who know of a facility for HIV testing is 50 percent. However, the percentage, who have been tested in the last 12 months preceding the survey and told the results, is 7 among men and 13 among women. Sexual behaviour w As for men and women age 15-24, 12 percent of men and 2 percent of women 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 73 percent. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” xxvi w 5 percent of men age 15-24 had sex before age 15. 3 percent of women of this age group had sex with 10 or more years older men in the 12 months preceding the survey. Access to the mass media and information/ communication technology w 13 percent (16 percent) of men (women) read newspaper, listen to FM, radio and watch television at least once on a weekly basis, whereas 2 percent (4 percent) do not have regular exposure to any of the three media. w 71 percent (70 percent) of men (women) age 15-24 ever used a computer, 57 percent (59 percent) used a computer during the last year, and 24 percent (20 percent) used at least once a week during the last month. 54 percent (50 percent) of men (women) age 15-24 ever used the internet, while 42 percent (43 percent) surfed the internet during the last year. The proportion of young men (women) who used the internet more frequently, at least once a week during the last month, was slighter, at 13 percent (14 percent). Use of tobacco and alcohol w Of the total respondents, age 15-49, 80 percent of men and 32 percent of women reported to have ever used a tobacco product. For the same age category, 53 percent of men and 4 percent of women smoked cigarettes, or used smoke or smokeless tobacco products during the one month preceding the survey. w In Khuvsgul aimag, 40 percent of men and 20 percent of women age 15-49 age had at least one drink of alcohol during the one month preceding the survey. w Among women, 22 percent have never tried alcohol, while 0.2 percent first drank alcohol before age 15. Among men, these figures stand at 19 percent and 2 percent, respectively. w The men with higher education, and women live in richest households, or with higher education are more likely to use alcohol. Subjective well-being w Young women age 15-24 are the most satisfied with their marriage (95 percent), with their school (92 percent) and with their friendships (89 percent). The results for young men are similar; they are the most satisfied with their marriage (96 percent), with their friendships (94 percent), and with their school (90 percent). w 75 percent of men age 15-24 and 65 percent of women age 15-24 responded that they were satisfied with their lives. w The proportion of men age 15-24 who are very or somewhat happy (85 percent) is similar to that of young women (87 percent). w 54 percent of men and 52 percent of women age 15-24 perceive that their lives improved during the one year preceding the survey. However, 87 percent of young men and 84 percent of young women think that their lives will get better after one year. IntrodUCtIon I KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 28 I. IntrodUCtIon This report presents the findings of the Child development survey (CDS), conducted by the Statistics Department of Khuvsgul aimag in 2012 with financial and technical support provided by the National Statistics Office (NSO) and United Nations Children’s Fund (UNICEF). The survey provides valuable information on the situation of children, women and men in Khuvsgul aimag, for measuring fulfilment of their rights of and was based largely on the needs to monitor progress towards goals and targets pertinent to recent international agreements: the Millennium Declaration, adopted by all 191 United Nations Member States in September 2000, and the Plan of Action of A World Fit For Children, adopted by 189 Member States at the United Nations Special Session on Children in May 2002. Both of these commitments build upon promises made by the international community at the 1990 World Summit for Children. In signing these international agreements, governments committed themselves to improving conditions for their children and to monitoring progress towards that end. UNICEF was assigned a supporting role in this task (see table below). A Commitment to Action: National and International Reporting Responsibilities The governments that signed the Millennium Declaration and the World Fit for Children Declaration and Plan of Action also committed themselves to monitoring progress towards the goals and objectives they contained: ‘We will monitor regularly at the national level and, where appropriate, at the regional level and assess progress towards the goals and targets of the present Plan of Action at the national, regional and global levels. Accordingly, we will strengthen our national statistical capacity to collect, analyse and disaggregate data, including by sex, age and other relevant factors that may lead to disparities, and support a wide range of child-focused research. We will enhance international cooperation to support statistical capacity-building efforts and build community capacity for monitoring, assessment and planning.” (A World Fit for Children, paragraph 60) “…We will conduct periodic reviews at the national and sub-national levels of progress in order to address obstacles more effectively and accelerate actions.…” (A World Fit for Children, paragraph 61) The Plan of Action (paragraph 61) also calls for the specific involvement of UNICEF in the preparation of periodic progress reports: “… As the world’s lead agency for children, the United Nations Children’s Fund is requested to continue to prepare and disseminate, in close collaboration with Governments, relevant funds, programmes and the specialized agencies of the United Nations system, and all other relevant actors, as appropriate, information on the progress made in the implementation of the Declaration and the Plan of Action.” Similarly, the Millennium Declaration (paragraph 31) calls for periodic reporting on 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.” This final report presents the results of the indicators and topics covered in the survey. 29 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” I. IntrodUCtIon Survey objectives Khuvsgul aimag “Child Development Survey 2012” (CDS) has the following primary objectives: • To provide up-to-date information for assessing at the aimag level the following national and international level policies and programmes - the World Fit for Children Declaration - Millennium Development Goals - Reproductive Health Programme • To serve the baseline for UNICEF’s Country Programme 2012-2016 • To build the capacity of the Statistics Department of the aimag II SAMpLe And SUrVey MetHodoLoGy © UnICeF Mongolia / odgerel.M / 2013 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 32 II. SAMpLe And SUrVey MetHodoLoGy Sample design The Child development survey is a household-based survey. Therefore households are defined as the sampling units. The sample for the survey was designed to provide estimates for a large number of indicators on the situation of children, women and men at the aimag (province) level. The total sample size was determined as 2,000 households and it was variably allocated for each of the soums depending on the respective number of households. The lowest administrative units (bagh of soum’s in the aimag) were defined as primary sampling units (PSUs). In total for the Khuvsgul aimag, 80 PSUs were selected systematically with probability proportional to size. After a household listing of the selected PSUs was carried out by the soum’s state treasury representative and the bagh governor, 25 households were selected using systematic random sampling in each PSU. During the data collection fieldwork in August-September 2012, we had encountered a problem due to nonappearance of families at the registered addresses, and absence of family members, because of seasonal movement for livestock hay and fodder preparation, as well as during the vacation period. In spite of this, we managed to collect survey data from the selected baghs. Data were collected from the households in the sample, and for reporting aimag level results, sample weights are used. A more detailed description of the sample design can be found in Appendix A. Questionnaires Based on the five core questionnaires contents of the Mongolia Child Development Survey, conducted nationwide in 2010, certain additional module and questions were added for the Khuvsgul “Child development survey 2012”. Based on the current priorities and needs, the questionnaire for men age 15-49 years was taken from all the households for this round of CDS. Altogether five types of questionnaires were used: 1. A Household Questionnaire 2. A Questionnaire for Woman age 15-49 3. A Questionnaire for Child under 5 4. A Questionnaire for Child age 2-14 5. A Questionnaire for Man age 15-49 In addition to the administration of the questionnaires, fieldwork teams tested the salt used for cooking in the households for iodine content, observed the place for hand washing and measured the weights and heights of children age under 5 years. Details and findings of these measurements and observations are provided in the respective sections of the report. 33 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” II. SAMpLe And SUrVey MetHodoLoGy The Household Questionnaire1 included the following modules: • Household Listing Form • Internal Migration • Education • Water and Sanitation • Household Characteristics • Child Labour • Child Discipline • Hand Washing • Salt Iodization In this round CDS 2012, internal migration questions (country specific module in household questionnaire) were asked for all household members listed in household listing module (HL). But result of internal migration is not presented in this report. The Questionnaire for Women age 15-49 was administered to all women age 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 Toward Domestic Violence • Sexual Behaviour • HIV/AIDS • Tobacco and Alcohol Use • Life Satisfaction The Questionnaire for Child under 5 was administered to mothers or caretakers of all children under 5 years of age2 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 1 This questionnaire was included Internal migration module as country specific 2 The terms “children under 5”, “children age 0-4 years”, and “children age 0-59 months” are used interchangeably in this report. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 34 II. SAMpLe And SUrVey MetHodoLoGy The Questionnaire for Child age 2-143 was administered to mothers or caretakers of children age 2-14 years living in the households. Normally, the questionnaire was administered to mothers of children age 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 age 15-49 was administered to all men age 15-49 years living in the 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 Use • Life Satisfaction Survey questionnaires can be found in Appendix F. Training and data collection Training for the fieldwork personnel was conducted for nine days on 20-28 July 2012 including lectures and practice sessions. The lectures held by the experts in the relevant field and practices were done for each group of questionnaires. In collaboration with the Nutrition Research Centre of the Public Health Institute, 40 trainees practiced child anthropometry measurements and test iodine content of salts. At the end of the lectures and practices on child anthropometry measurements, participants took the concluding joint practice of conducting the survey for two days in selected households from baghs 1, 7 and 11 of Murun soum. Finally, the participants were taken tests and the interviewers, editors and supervisors were selected based on their performance for the test. The data were collected by five teams; each team was comprised of a supervisor, an editor and 5 interviewers (2 men assigned as main measurers4). The data collection fieldwork for “Child development survey-2012” was carried out in August – September 2012 for the duration of two months. The process and quality had been monitored by the Statistics Department of Khuvsgul aimag and UNICEF staff. Fieldwork personnel’s achievements and disadvantages had been discussed during the monitoring visits and necessary actions had been taken accordingly. 3 This questionnaire is country specific and was designed to collect information on Child disability and Child injury based on the stan- dard module for child disability. 4 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. 35 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” II. SAMpLe And SUrVey MetHodoLoGy Data processing The data collected from the selected households were entered on computers using the CSPro 4.0 software program by five data entry operators and one data entry supervisor from 10 September to 10 October 20125. 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 the global MICS4 programme and adapted to the Khuvsgul CDS questionnaires with additional module and questions were used throughout. The data were analyzed using the standard 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 Khuvsgul CDS 2012 questionnaires. 5 This is deviation from MICS recommended a simultaneous data collection and entry. III SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS © UnICeF Mongolia/BrianSokol/2012 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 38 III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS Sample coverage In total, 2,000 households selected for the sample, and of these 1,996 were found to be available for the survey. Of these, 1,982 households were successfully interviewed and the household response rate is 99 percent. In the interviewed households, out of the total 1,909 women and 1,764 men age 15-49 years enlisted for the survey, 1,727 women and 1,417 men were successfully interviewed, yielding a response rate of 91 and 80 percent respectively. In addition, 837 children under age of 5 and 1,876 children age 2-14 years were listed in the household questionnaire. Questionnaires were completed with mothers/ caregivers for 817 of these under-5 children and for 1,850 of children age 2-14, which corresponds to a response rate of 98 and 99 percent respectively, within interviewed households. Overall response rates stand at 80 percent for men age 15-49 years, 90 percent for women, 97 percent and 98 percent are calculated for mothers/ caregivers of children under 5’s, children age 2-14’s respectively (please refer to Table HH.1). The above-mentioned response rates were varied across locations of residence. However, the response rate for men age 15-49 years’ interviews is relatively lower than the response rates for other interviews, because of the dynamic mobility nature of men, particularly 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 the survey, 6,985 persons form 1,996 households were successfully interviewed. Due to increased fertility rates since 2006, children age 0-4 years constitute 12 percent of the total population. 61 percent of the total population is the working-age population, which are men age 15-59 years and women age 15-54 years (Figure HH.1). Table HH.3 - HH.5A provide basic information on the households, male and female respondents age 15-49, mother/ caretaker respondents of children under 5, mother/ caretaker respondents of children age 2-14 by presenting the unweighted, as well as the weighted numbers. Information on the basic characteristics of households, women, men, children under 5 and children age 2-14 interviewed in the survey is essential for the interpretation of findings presented later in the report and can also 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. 39 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS Figure HH.1: Age and sex distribution of household population, Khuvsgul aimag, 2012 Table HH.3 provides basic background information on the households. Within households, the sex of the household head, location, number of household members and education, religion and ethnicity of the household head are shown in the table. These background characteristics are used in subsequent tables in this report. Of 1,996 households successfully interviewed in the survey, 443 households, or 22 percent, were from the aimag centre, 684 households, or 35 percent, were from soum centres, and 854 households, or 43 percent, were from rural. Of the total households interviewed, 48 percent have 3-4 members, households with size of 1-2 members account for 27 percent, and those with more than 5 members – 25 percent. The mean household size is 3.5 persons. 21 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 НН.3 also shows the proportions of households with at least one child age 0-17, at least one child age 0-4, at least one child age 2-14, at least one woman and at least one man age 15-49. Characteristics of respondents Tables HH.4, HH.4M, HH.5 and HH.5A provide information on the background characteristics of female respondents age 15-49, children under 5, male respondents age 15-49 and children age 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 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 40 III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS characteristics of men, women and children, the tables are also intended to show the numbers of observations in each background category. Table HH.4 presents background characteristics of women age 15-49 years. The data are disaggregated by location, age group, marital status, motherhood status, births in last two years, education6, household wealth index quintiles7, and ethnicity and religion of household head. By marital status, 64 percent of the total women are currently married or in union, 28 percent are never married or been in union, 3 percent are divorced, 3 percent widowed and 1 percent are separated. 17 percent of the total women had given a birth to a child in the two years preceding the survey. By education, 7 percent of the women have no education, 10 percent attained primary education, 23 percent have basic education, 31 percent have upper secondary education, 9 percent with vocational education, and 20 percent have college, university education. Table HH.4M presents background characteristics of men age 15-49 years. The data are disaggregated by location, age group, marital status, fatherhood status, education, household wealth index quintiles, and ethnicity and religion of household head. 62 percent of all men surveyed are married or in union, 35 percent are never married or been in union, and the remaining 3 percent are either divorced, separated or widowed. Males have lower level of education compared to females; 11 percent have no education, 16 percent have primary education, 28 percent with basic education, 23 percent have upper secondary education, 9 percent have vocational education, and 13 percent with college, university education. Table HH.5 shows background characteristics of children under 5. The data are disaggregated by sex, age, area, location, mother/ caretaker’s education, household wealth index quintiles, and ethnicity and religion of household head. From the total of 817 children under 5 covered by the survey, male proportion is 51 percent and female proportion is 49 percent. By education of their mothers/ caretakers, 10 percent have no education, 15 percent are primary educated, 20 percent are basic educated, 27 percent with upper secondary education, 6 percent have vocational education, and 23 percent have college, university education. The distribution of children under 5 by household wealth index quintiles shows that 20 percent live in the poorest 6 Unless otherwise stated, “education” refers to the highest educational level attended by the respondent throughout this report when it is used as a background variable. 7 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 five 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 shared, 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, refrigerator, wash- ing 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. 41 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS quintile, 21 percent in the second quintile, 23 percent in the middle quintile, 17 percent in the fourth quintile, and the remaining 19 percent in the richest quintile. Table HH.5A shows background characteristics of children age 2-14 years. The data are disaggregated by sex, age group, location, mother/ caretaker’s education, household wealth index quintiles, and ethnicity and religion of household head. The sex ratio of the total 1,850 children, age 2-14, covered by the survey is 96, in other words, there were 96 boys per 100 girls age 2-14. By education of their mothers/ caretakers, 9 percent have no education, 18 percent have primary education, 25 percent have basic education, 25 percent with upper secondary education, 7 percent have vocational education, and 16 percent have college, university education. Data disaggregation The survey results are disaggregated by location as well as education, household wealth index quintiles, and ethnicity and religion of household head. Location: Aimag center, soum center and rural Education: None, Primary, Basic, Upper secondary, Vocational and College, university Household wealth index quintiles: Poorest, Second, Middle, Fourth and Richest Ethnicity of household head: Khalkh, Other Religion of household head: No religion, Buddhist, Other KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 42 III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS Table HH.1: Results of household, women’s, men’s, under-5’s and children age 2-14’s interviews Number of households, women, men, children under 5 and children age 2-14 years by results of the household, women’s, men’s, under-5’s and children age 2-14’s interviews, and household, women’s, men’s under-5’s and children age 2-14’s response rates, Khuvsgul aimag, 2012 Location Total Aimag center Soum center Rural Households Sampled 450 676 874 2 000 Occupied 450 674 872 1 996 Interviewed 449 668 865 1 982 Household response rate 99.8 99.1 99.2 99.3 Women Eligible 434 658 817 1 909 Interviewed 400 565 762 1 727 Women’s response rate 92.2 85.9 93.3 90.5 Women’s overall response rate 92.0 85.1 92.5 89.8 Men Eligible 374 565 825 1 764 Interviewed 306 432 679 1 417 Men’s response rate 81.8 76.5 82.3 80.3 Men’s overall response rate 81.6 75.8 81.6 79.8 Children under 5 Eligible 186 266 385 837 Mothers/Caretakers interviewed 183 254 380 817 Under-5’s response rate 98.4 95.5 98.7 97.6 Under-5’s overall response rate 98.2 94.6 97.9 96.9 Children age 2-14 Eligible 400 597 879 1 876 Mothers/Caretakers interviewed 396 579 875 1 850 Children age 2-14’s response rate 99.0 97.0 99.5 98.6 Children age 2-14’s overall response rate 98.8 96.1 98.7 97.9 43 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS 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, Khuvsgul aimag, 2012 Males Females Total Number Percent Number Percent Number Percent Age 0-4 427 12.8 407 11.2 833 11.9 5-9 309 9.2 349 9.6 658 9.4 10-14 347 10.4 369 10.1 716 10.3 15-19 331 9.9 308 8.5 639 9.1 20-24 245 7.3 280 7.7 525 7.5 25-29 263 7.9 283 7.8 546 7.8 30-34 252 7.5 278 7.6 530 7.6 35-39 222 6.6 259 7.1 481 6.9 40-44 255 7.6 262 7.2 516 7.4 45-49 198 5.9 249 6.8 447 6.4 50-54 210 6.3 224 6.2 435 6.2 55-59 113 3.4 129 3.6 242 3.5 60-64 61 1.8 88 2.4 149 2.1 65-69 43 1.3 40 1.1 84 1.2 70-74 36 1.1 50 1.4 86 1.2 75-79 18 0.5 28 0.8 45 0.7 80-84 8 0.2 26 0.7 34 0.5 85+ 2 0.1 10 0.3 12 0.2 Missing/DK 5 0.1 1 0.0 6 0.1 Dependency age groups 0-14 1 082 32.4 1 125 30.9 2 207 31.6 15-64 2 150 64.3 2 361 64.8 4 511 64.6 65+ 107 3.2 154 4.2 261 3.7 Missing/DK 5 0.1 1 0.0 6 0.1 Child and adult populations Children (age 0-17 years) 1 311 39.2 1 334 36.6 2 646 37.9 Adults (age 18 or more years) 2 027 60.6 2 306 63.3 4 333 62.0 Missing/DK 5 0.1 1 0.0 6 0.1 Total 3 344 100.0 3 641 100.0 6 985 100.0 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 44 III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS Table HH.3: Household composition Percent and frequency distribution of households by selected characteristics, Khuvsgul aimag, 2012 Weighted percent Number of households Weighted Unweighted Sex of household head Male 78.7 1 560 1 564 Female 21.3 422 418 Location Aimag center 22.4 443 449 Soum center 34.5 684 668 Rural 43.1 854 865 Number of household members 1 10.8 213 214 2 16.3 323 321 3 21.6 429 431 4 26.3 521 519 5 15.5 308 312 6 6.8 134 135 7 1.4 29 29 8+ 1.2 25 21 Education of household head None 12.1 239 241 Primary 24.5 486 487 Basic 24.3 481 481 Upper secondary 14.6 290 285 Vocational 12.1 239 242 College, university 12.4 246 245 Missing/DK 0.0 1 1 Ethnicity of household head Khalkh 70.2 1 390 1 407 Other 29.5 586 569 Missing/DK 0.3 6 6 Religion of household head No religion 55.7 1 103 1 102 Buddhist 40.5 803 807 Other 3.5 70 67 Missing/DK 0.3 6 6 Total 100.0 1 982 1 982 Households with at least One child age 0-4 years 34.2 1 982 1 982 One child age 0-17 years 69.0 1 982 1 982 One child age 2-14 years 56.8 1 982 1 982 One woman age 15-49 years 74.6 1 982 1 982 One man age 15-49 years 71.3 1 982 1 982 Mean household size 3.5 1 982 1 982 45 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS Table HH.4: Women’s background characteristics Percent and frequency distribution of women age 15-49 years by selected background characteristics, Khuvsgul aimag, 2012 Weighted percent Number of women Weighted Unweighted Location Aimag center 22.7 393 400 Soum center 33.9 586 565 Rural 43.3 748 762 Age 15-19 15.5 268 268 20-24 14.4 248 245 25-29 14.6 252 254 30-34 15.2 263 264 35-39 13.9 241 243 40-44 13.6 235 236 45-49 12.7 220 217 Marital/Union status Currently married/in union 64.4 1 111 1 120 Widowed 3.4 59 58 Divorced 3.4 59 60 Separated 1.1 20 19 Never married/in union 27.7 478 470 Motherhood status Ever gave birth 75.6 1 305 1 311 Never gave birth 24.4 422 416 Births in last two years Had a birth in last two years 17.3 299 302 Had no birth in last two years 82.7 1 428 1 425 Education None 7.0 121 122 Primary 10.0 173 173 Basic 22.9 395 398 Upper secondary 31.4 542 538 Vocational 8.5 146 148 College, university 20.3 351 348 Wealth index quintile Poorest 19.6 339 339 Second 19.4 336 339 Middle 20.1 348 344 Fourth 19.4 335 331 Richest 21.4 370 374 Ethnicity of household head Khalkh 69.5 1 200 1 221 Other 30.3 523 502 Missing/DK 0.2 4 4 Religion of household head No religion 55.6 960 958 Buddhist 40.5 699 705 Other 3.7 64 60 Missing/DK 0.2 4 4 Total 100.0 1 727 1 727 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 46 III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS Table HH.4M: Men’s background characteristics Percent and frequency distribution of men age 15-49 years by selected background characteristics, Khuvsgul aimag, 2012 Weighted percent Number of men Weighted Unweighted Location Aimag center 21.3 302 306 Soum center 31.5 446 432 Rural 47.3 670 679 Age 15-19 19.1 270 269 20-24 12.7 180 180 25-29 14.7 208 210 30-34 14.7 208 207 35-39 12.7 180 182 40-44 14.6 207 208 45-49 11.5 163 161 Marital/Union status Currently married/in union 62.0 879 881 Widowed 0.6 8 8 Divorced 1.7 25 25 Separated 0.7 10 10 Never married/in union 35.0 496 493 Fatherhood status Ever have a biological child 62.8 889 893 Never have a biological child 37.0 525 521 Missing/DK 0.2 3 3 Education None 11.0 156 156 Primary 15.7 222 224 Basic 28.2 399 399 Upper secondary 23.1 327 324 Vocational 9.2 130 132 College, university 12.9 182 182 Wealth index quintile Poorest 23.2 328 331 Second 20.9 296 297 Middle 16.6 235 232 Fourth 19.2 272 269 Richest 20.2 286 288 Ethnicity of household head Khalkh 71.8 1 018 1 031 Other 28.0 396 383 Missing/DK 0.2 3 3 Religion of household head No religion 57.2 811 806 Buddhist 39.3 557 563 Other 3.1 43 42 Missing/DK 0.4 6 6 Total 100.0 1 417 1 417 47 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 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, Khuvsgul aimag, 2012 Weighted percent Number of under-5 children Weighted Unweighted Sex Male 51.3 419 422 Female 48.7 398 395 Location Aimag center 22.2 181 183 Soum center 31.7 259 254 Rural 46.1 377 380 Age 0-5 months 8.7 71 70 6-11 months 9.8 80 81 12-23 months 20.1 165 165 24-35 months 20.4 167 168 36-47 months 21.4 174 174 48-59 months 19.5 160 159 Mother’s education* None 10.0 81 81 Primary 14.7 120 120 Basic 19.8 162 162 Upper secondary 26.5 216 215 Vocational 6.1 50 50 College, university 23.1 188 189 Wealth index quintile Poorest 20.3 166 166 Second 21.0 172 173 Middle 22.9 187 185 Fourth 17.2 141 140 Richest 18.6 152 153 Ethnicity of household head Khalkh 71.1 581 586 Other 28.8 235 230 Missing/DK 0.1 1 1 Religion of household head No religion 59.6 487 486 Buddhist 35.6 291 293 Other 4.2 35 33 Missing/DK 0.6 5 5 Total 100.0 817 817 * Mother’s education refers to educational attainment of mothers and caretakers of children under 5. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 48 III. SAMpLe CoVerAGe And tHe CHArACterIStICS oF HoUSeHoLdS And reSpondentS Table HH.5A: Children age 2-14’s background characteristics Percent and frequency distribution of children age 2-14 years by selected background characteristics, Khuvsgul aimag, 2012 Weighted percent Number of children age 2-14 Weighted Unweighted Sex Male 48.9 905 908 Female 51.1 945 942 Location Aimag center 21.1 391 396 Soum center 32.2 596 579 Rural 46.7 863 875 Age 2-4 26.6 491 494 5-6 15.0 278 278 7-9 20.2 373 372 10-12 21.9 405 404 13-14 16.4 303 302 Mother’s education* None 8.9 164 165 Primary 17.8 329 328 Basic 25.2 466 470 Upper secondary 25.3 469 462 Vocational 6.6 122 123 College, university 16.3 301 302 Wealth index quintile Poorest 21.1 391 393 Second 21.2 393 397 Middle 20.5 379 376 Fourth 19.0 351 344 Richest 18.2 336 340 Ethnicity of household head Khalkh 68.3 1 263 1 278 Other 31.5 582 567 Missing/DK 0.3 5 5 Religion of household head No religion 57.2 1 059 1 058 Buddhist 38.3 708 712 Other 4.1 75 72 Missing/DK 0.4 8 8 Total 100.0 1 850 1 850 * Mother’s education refers to educational attainment of mothers and caretakers of children age 2-14 years. IV CHILd MortALIty KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 50 IV. CHILd MortALIty 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. Specifically, the MDGs call for the reduction in under-five mortality by two- thirds between 1990 and 2015. Monitoring progress towards this goal is an important, but difficult objective. Using direct measures of child mortality from birth histories is time consuming, more costly, and requires greater attention to training and supervision, and professional capacity. Alternatively, indirect methods developed to measure child mortality produce robust estimates that are comparable with the ones obtained from other sources. Indirect methods minimize the pitfalls of memory lapses, inexact or misinterpreted definitions, and poor interviewing technique. The infant mortality rate (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. Like in the previous MICS surveys, in MICS 2012, infant and under-five mortality rates are calculated based on an indirect estimation technique known as the Brass method8 (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 age 15-49 and the proportion of these children who are dead, also for the 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. Sex ratio at birth among children ever born, living and deceased shown in Table DQ.16. As shown in this table, sex ratio among deceased children is 1.93, it shows that missed a girls deceased. Table CM.2 provides estimates of child mortality. The infant mortality rate is estimated at 38 per 1,000 live births, while the probability of dying under age 5 is 47 per 1,000 live births. There is some difference between the probabilities of dying among males and females. For example, the mortality rate among male infants is 49 per thousand, while among female infants it is 27 per thousand, which is 22 percentage points lower than among male infants. Under-five mortality rates among males are estimated at 61 per thousand, which is 29 percentage points higher than among females (32 per 1,000 live births). 8 United Nations, 1983. Manual X: Indirect Techniques for Demographic Estimation (United Nations publication, Sales No. E.83.XIII.2). United Nations, 1990a. QFIVE, United Nations Program for Child Mortality Estimation. New York, UN Pop Division. United Nations, 1990b. Step-by-step Guide to the Estimation of Child Mortality. New York, UN. 51 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” IV. CHILd MortALIty Figure CM.1: Under-5 mortality rates by background characteristics, Khuvsgul aimag, 2012 The child mortality rates get higher for households in rural. For example, the infant mortality rate in rural is 53 per 1,000 live births, which is 3.1 times higher than in aimag center. Similarly, under-five mortality rate in aimag center is 20 per 1,000 live births, 26 in soum center, and in rural areas, it is 70. 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. 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, Khuvsgul aimag, 2012 Children ever born Children surviving Proportion dead Number of women Mean Total Mean Total Age 15-19 0.040 11 0.040 11 0.000 268 20-24 0.747 186 0.704 175 0.058 248 25-29 1.712 432 1.646 415 0.039 252 30-34 2.470 650 2.340 616 0.053 263 35-39 2.857 687 2.625 631 0.081 241 40-44 3.025 710 2.690 631 0.111 235 45-49 3.594 790 3.080 677 0.143 220 Total 2.007 3 466 1.828 3 157 0.089 1 727 Khuvsgul KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 52 IV. CHILd MortALIty Table CM.2: Child mortality Infant and under-five mortality rates, Coale-Demeny West Model, Khuvsgul aimag, 2012 Infant mortality rate1 Under-five mortality rate2 Sex Male 49 61 Female 27 32 Location Aimag center 17 20 Soum center 22 26 Rural 53 70 Mother’s education Less than upper secondary 42 53 Upper secondary or higher 29 36 Wealth index quintiles Poorest 60 percent 46 59 Richest 40 percent 18 21 Ethnicity of household head Khalkh 31 38 Other 51 67 Religion of household head No religion 41 52 Buddhist 33 40 Total 38 47 1 MICS indicator 1.2; MDG indicator 4.2 2 MICS indicator 1.1; MDG indicator 4.1 Rates refer to 2007.09 and Coale-Demeny West Model V nUtrItIon © UnICeF Mongolia/Brian Sokol/2012 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 54 V. nUtrItIon Nutritional status Children’s nutritional status is a reflection of their overall health. When children have access to an adequate food supply, they are not exposed to repeated illness, and are well cared for, they reach their growth potential and are considered well nourished. Malnutrition is associated with more than half of 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, in part assessed by the proportion of underweight children. 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 standards9. 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 more than 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. 9 http://www.who.int/childgrowth/standards/second_set/technical_report_2.pdf 55 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon In the Child development survey (CDS), 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 above two standard deviations from the median of the reference 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 91 percent of under-5 children had both their weights and heights measured (Table DQ.6). Table DQ.7 shows 11 percent of children have been excluded from calculation of the weight-for-height indicator, while the figures are 9 percent for the height-for-age indicator, and 9 percent for the weight-for-age indicator due to implausible measurements, and missing weight and/ or height. Of the total children under-5 in Khuvsgul aimag, 7 percent are underweight, 2 percent severely underweight. Moreover, 22 percent of the children under-5 are stunted, or short for their ages, 7 percent are severely stunted and 6 percent are wasted, or thin for their height (See Table NU.1). In addition, the stunting prevalence is higher in rural and soum center (24 percent and 23 percent respectively) than in aimag center (15 percent) by 8-9 percentage points. Nutritional status of children under-5 differs due to education of their mothers/ caretakers. The children whose non-educated mothers/ caretakers have more risks of being underweight or stunted or wasted compared to the children of educated mothers/ caretakers, especially with higher education. For example, the stunted rate among children who have non-educated mothers/ caretakers is 37 percent as compared to the rate of 19 percent for children whose mothers/ caretakers obtained college, university education. The percentage of underweight children who have non-educated mothers/ caretakers is 14 percent compared to the figure of 5 percent among children whose mothers/ caretakers obtained college, university education. Furthermore, 24 percent, or one in every 4 children under-5 in poorest quintile household is stunted, while 13 percent of children under-5 in the richest quintile household is stunted (See Table NU.1). KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 56 V. nUtrItIon The underweight and stunted rates differ by ethnicity of household head. For instance, the percentage of stunted children who live in household headed by khalkh is 19 percent as compared to the figure of 27 percent for children who live in household headed by other ethnicity. As Figure NU.1 shows, the stunting prevalence is the highest among children age 12-35 months (29 percent) in comparison to children who are younger and older. Please note that there is some data quality issue related anthropometry measurement. Regarding data quality, completeness of information for anthropometric indicators shown in Table DQ.7 and heaping in anthropometric measurements shown in Table DQ.8. As shown in Table DQ.7, missing data among older kids is higher than for younger kids. Heaping at 0 is 40 percent for all height measurements which is quite large (Table DQ.8). Figure NU.1: Percentage of children under age 5 who are underweight, stunted and wasted, Khuvsgul aimag, 2012 Wasting and underweight prevalence are relatively low among the total children under-5, and there are no considerable differences in its distribution by background characteristics such as household locations and household wealth index quintiles (See Table NU.1). The overweight prevalence is 13 percent among the total children under-5, which is almost at similar rate to the national average (11 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, too many mothers introduce liquids and foods other than breastmilk in first 6 months of their child’s life, 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. 57 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon WHO/ UNICEF have the following feeding recommendations: • Exclusive breastfeeding for the first six months; • Continued breastfeeding for two years or more; • Safe, and age-appropriate 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 which were collected through this survey include: • 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); • 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); • Percentage of bottle-fed (with nipple) children (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, 61 percent are breastfed for the first time within one hour of birth while 90 percent start breastfeeding within one day of birth. Figure NU.2: Percentage of mothers who started breastfeeding within one hour and within one day of birth, Khuvsgul aimag, 2012 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 58 V. nUtrItIon Table NU.2 shows that the percentages of children age 0-23 months that are breastfed for the first time within one hour of birth and within one day of birth does not differ by location, education of mothers/ caretakers. Interestingly, the percentage of children that are breastfed for the first time within one hour is 63 percent among households with khalkh heads, while it is 56 percent among other households (Table NU.2). Furthermore, Table NU.2 shows that the percentage of children who received prelacteal feed is comparatively high among children whose mothers/ caretakers obtained college, university education. When the practice of feeding the children age 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 (Figure NU.2). 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. 60 percent of children age less than six months are exclusively breastfed. In addition, by age of 12-15 months, 75 percent of children are still being breastfed and by age 20-23 months, 53 percent are still breastfed. Please note that the results on breastfed indicators should not be interpreted as the number of children age 0-5 months, 12-15 months and 20-23 months (denominator of indicators) are quite low. Table NU.4 shows the median duration of breastfeeding by selected background characteristics. For instance, among children under age 3, the median duration is 26 months for breastfeeding, 3 months is same for exclusive breastfeeding and predominant breastfeeding. The median duration for exclusive breastfeeding among children under age 3, covered by the survey, slightly differ by gender and location. For instance, the median duration for exclusive breastfeeding for girls (2.8-2.9 months) is one month less than for boys (3.9 months) (See Table NU.4). The adequacy of infant feeding of children under age of 24 months is shown in Table NU.5. Different criteria of appropriate feeding are used depending on the age of the child. For infants age 0-5 months, exclusive breastfeeding is considered as approprate feeding, while infants age 6-23 months are considered to be appropriately fed if they are receiving breast milk and solid or semi-solid foods. As the findings for adequate feeding among young children, 65 percent of children age 6-23 months are currently breastfeeding and received solid or semi-solid foods. Of the total children age 0-23 months, 64 percent are appropriately breastfed. The percentage of children under age 2 who are appropriately breastfed does not differ by gender. Please note that appropriately breastfed indicator among children under 2 years is almost same with appropriately breastfed among children age 6-23 months due to very small number of children age 0-5 months. 59 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon Appropriate complementary feeding of children from 6 months to 23 months of age is particularly important for growth and development and prevention of under-nutrition. Continued breastfeeding beyond 6 months should be accompanied by consumption of nutritionally 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 age 6-23 months and older who are not breastfed, four or more meals of solid or semi- solid or milk feeds are needed. Of the total children age 6-8 months covered by the survey, 73 percent received solid or semi-solid foods (MICS Indicator 2.12). Among currently breastfeeding infants, this percentage is 71 percent. Please note that the results on complementary feeding indicators should not be interpreted as the number of children age 6-8 months (denominator of indicators) are quite low. Table NU.7 presents the proportion of children age 6-23 months, who received solid or semi-solid foods the minimum appropriate number of times or more during the day preceding the survey according to breastfeeding status. Among currently breastfeeding children age 6-23 months, 14 percent of children received solid or semi-solid foods the minimum appropriate number of times. The percentage of girls received the minimum appropriate number of meals (19 percent) is almost two times higher compared to boys (10 percent) (See Table NU.7). For non-breastfeeding children age 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. 82 percent of the total non-breastfed children age 6-23 months, covered by the survey, receive solid or semi-solid foods or milk feeds at least 2 times or more a day (See Table NU.7). In Khuvsgul aimag, only one in every three children (30 percent) received solid or semi- solid foods the minimum appropriate number of times a day, which shows there is a common practice of inadequate feeding frequency. The percentage of children age 6- 23 months received minimum meal frequency slightly differs by by location (31 percent in aimag center, 34 percent in soum center, 26 percent in rural), by gender (26 percent for boys, 33 percent for girls) and ethnicity of household head (25 percent for children who live in household headed by Khalkh, 44 percent for children who live in household headed by other ethnicity). The continued practice of bottle-feeding is a concern because of the possible contamination due to unsafe water and lack of hygiene in preparation. Bottle-feeding among children age 0-23 months is still prevalent. 18 percent of children under 2 years old were fed from a bottle with nipple during the day preceding the survey. As shown in Table NU.8, practice of drinking liquids from a bottle with nipple among children age 0-5 months (21 percent) is high compared to that among children of other ages. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 60 V. nUtrItIon 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). 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 this research report, goitre was found in 29 percent of children age 7-12 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. Within the framework 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 63 percent of households, covered by the survey, salt was found to contain 15 parts per million or more of iodine, which is considered to be at the appropriate level content of iodized salt. The use of iodized salt slightly differs by location (Figure NU.3). 61 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 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 55-58 percent while this figure is 71-74 percent for the households in fourth and richest quintiles (Table NU.9). Vitamin A, D, iron and multi-nutrient 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 of Vitamin A 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. Figure NU.3: Percentage of households consuming adequately iodized salt, Khuvsgul aimag, 2012 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 62 V. nUtrItIon 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 age 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 (MOH) recommends that children age 6-11 months be given one high dose Vitamin A capsule and children age 12-59 months given a vitamin A capsule every 4 to 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. As the requirements for vitamin A increase during pregnancy and lactation, guidelines on providing new mothers in maternity hospitals a Vitamin A supplement within 8 weeks of delivery are being implemented. Within the six months prior to the current round of CDS, 48 percent of children age 6-59 months received a high dose Vitamin A supplement. By age groups, the vitamin A supplementation in the 6 months prior to the survey is 44 percent among children age 6-11 months, and 57 percent among children age 12-23 months, which is higher compared to the previous age group. However, for further ages, the consumption decreases as follows: 52 percent for children age 24-35 months, 38 percent for children age 36-47 months, and 46 percent for children age 48-59 months. There is no considerable difference in the rate of vitamin A supplementation by children’s gender or household location, but slight variances are observed by household wealth index quintiles. In this round of CDS, additional questions10 on Vitamin A, D, iron and micronutrient supplementation have been included in Immunization module of the Children under-5 Questionnaire for mothers/caretakers of children under 5. According to the reports of mothers/caretakers, 47 percent of all children age 6-59 months were provided with vitamin A supplementation in the six months preceding the survey. Majority of those children, or 72 percent received the red-coloured vitamin A supplementation (See Table NU.10A). Rickets is mainly caused by vitamin D deficiency and is wide spread among young children11. The methods used by developed countries to become rickets-free were vitamin D fortification of food, as well as vitamin D supplementation. Rickets not only affect children’s growth, but also make their immune vulnerable, thus indirectly impacting increase of child mortality. In order to prevent a child from vitamin D deficiency, it 10 As requested by UNICEF Mongolia, this questions have been included immunization module of children under 5 questionnaire. 11 Annex 1: Preventive and treatment utilization of vitamin A and D, Directive #74 of 2000 by the Minister of Health and Social Wel- fare. http://www.legalinfo.mn/annex/details/4476?lawid=7481 63 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon is recommended to administer vitamin D supplementation in the cooler season from October to May. Table NU.10B shows the percentage of children who had taken vitamin D supplementation in the six months preceding the survey. One out of every three (30 percent) children age 6-59 months in Khuvsgul aimag had taken vitamin D supplementation in the six months preceding the survey. Discrepancies were observed in the rates of children, who had taken vitamin D supplementation by age group, mother’s education and wealth quintiles. For instance, one out of every two (46 percent) children age 6-23 months had taken vitamin D supplementation in the six months preceding the survey, while one out of every three children age 24-35 months and one out of every six children age 36- 47 months and one out of every five children 48-59 months had taken vitamin D, as shown in the Table. According to the responses of mothers/caretakers, of the children who had taken vitamin D supplementation in the six months preceding the survey, 53 percent had taken in the form of a tablet, 35 percent in liquid form and 10 percent in the form of a capsule (Table NU.10B). Anemia is among the wide-spread illnesses among young children, and consumption of iron can help prevention and treatment of iron deficiency anaemia. In this round of survey, mothers/ caretakers of children age 6-59 months were asked whether their children had taken iron supplementation in the six months preceding the survey, and if so, the type of iron taken. Only 4 percent of children age 6-59 months had taken iron supplementation in the six months preceding the survey. Because the number of children age 6-59 months, who had taken iron supplementation in the six months preceding the survey, is quite low (denominator of indicator), disaggregation estimates are not presented. Breast milk provides children under 6 months with sufficient amount of nutrients, minerals and vitamins needed. However, intensive growth and development from 6 months require additional nutrients, and breast milk becomes insufficient to provide the minerals and vitamins needed. Therefore, many countries in the world introduced supplementation of multi-nutrient supplementation in order to support growth and development of young children and sustaining the appropriate level. In Mongolia, as a part of implementation of the Government Action Plan 2008-2012, “The Guidelines for introduction of supplementation of multi-nutrient supplementation” was approved in 2009 and implemented by the Directive of the Minister of Health. The approved guidelines indicate that multi-nutrient supplementation should be provided through soum and family doctors to mothers from the first antenatal care visit until the delivery, as well as to breastfeeding mothers from one month after the delivery for the duration of six months; and 60 supplementation packs to young children at the ages of 6, 12, 18 and 23 months. For children, the multi-nutrient supplementation is recommended to be taken one pack in one appropriate portion meal, mixing into meal while warm12. Table NU.10C provides information on the percentage of children age 6-59 months, who had taken multi-nutrient supplementation in the six months preceding the survey, the 12 Annex : “Recommended multi-nutrient intake and guidelines” to Directive #190 of 2008 by the Minister of Health KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 64 V. nUtrItIon way the supplementation is prepared, as well the source of information on provision of multi-nutrient supplementation. 17 percent of all children age 6-59 months had taken multi-nutrient supplementation in the six months preceding the survey. Consumption of multi-nutrient supplementation does not considerably differ by gender, mother’s education and household wealth, but varies by child’s age group and ethnicity of household head (Table NU.10С). For instance, 30 percent of children age 6-23 months had taken multi-nutrient supplementation, while this rate stands at only 10 percent for children age 24-59 months. When asked about mixing the supplementation with meal, the majority of mothers/ caretakers, or 88 percent, responded that they mixed into the cup with meal while warm. The remaining 12 percent does not follow the instructions recommended, as shown in the Table. 96 percent of mothers/caretakers of children, who had taken multi-nutrient supplementation in the six months preceding the survey, responded that they obtained the information on the multi-nutrient supplementation from soum, or family clinic (Table NU.10C). 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 diseases; 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 developed and industrialized countries, 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 65 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon developing countries, because the majority of newborns are not delivered in facilities, and those who were represented only a selected sample of all births. In addition, 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 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 birth13. In Khuvsgul aimag, 99 percent of the total children age 0-23 months were successfully weighed at birth and 4 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 household wealth index quintiles. For example, the percentage of low birth weight among children from poorest households stands at 6.6 percent, while it is 6 times less, or 1.1 percent, among children from wealthier households. The low birth weight percentage for children under-2 years stands at 5 percent in rural, while the rate is 2 percent in aimag center (Figure NU.4). 13 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. Figure NU.4: Percentage of infants weighing less than 2500 grams at birth, Khuvsgul aimag, 2012 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 66 V. nUtrItIon Ta bl e N U .1 : N u tr it io n al s ta tu s of c h ild re n Pe rc en ta ge o f ch ild re n un de r ag e 5 by n ut rit io na l s ta tu s ac co rd in g to t hr ee a nt hr op om et ric in di ce s: w ei gh t fo r ag e, h ei gh t fo r ag e, a nd w ei gh t fo r he ig ht , K hu vs gu l a im ag , 20 12 W ei g h t fo r ag e N um be r of c hi ld re n H ei g h t fo r ag e N um be r of c hi ld re n W ei g h t fo r h ei g h t N um be r of ch ild re n U n de rw ei g h t M ea n Z- Sc or e (S D ) St u n te d M ea n Z- Sc or e (S D ) W as te d O ve rw ei g h t M ea n Z- Sc or e (S D ) pe rc en t be lo w pe rc en t be lo w pe rc en t be lo w pe rc en t ab ov e - 2 SD 1 - 3 SD 2 - 2 SD 3 - 3 SD 4 - 2 S D 5 - 3 SD 6 + 2 S D Se x M al e 6. 8 1. 6 0. 0 37 7 24 .9 7. 9 -0 .9 37 5 5. 1 1. 9 14 .3 0. 7 36 8 Fe m al e 7. 5 1. 9 0. 0 36 8 18 .2 6. 8 -0 .8 36 6 6. 0 3. 3 12 .6 0. 5 36 3 Lo ca ti on A im ag c en te r 5. 7 1. 1 0. 3 17 5 14 .8 4. 5 -0 .5 17 5 7. 1 2. 4 16 .5 0. 7 16 9 So um c en te r 9. 2 1. 7 -0 .1 22 7 23 .2 7. 5 -0 .9 22 6 6. 6 3. 5 14 .1 0. 6 22 5 Ru ra l 6. 6 2. 0 -0 .2 34 3 23 .9 8 .7 -1 .1 34 0 4. 1 2. 1 11 .5 0. 5 33 7 A g e 0- 5 m on th s 13 .0 2. 9 0. 1 68 7. 2 2. 9 0. 2 68 20 .9 13 .4 19 .4 0. 0 66 6- 11 m on th s 4. 1 1. 4 0. 3 73 12 .3 5. 5 -0 .4 72 5. 4 0. 0 16 .2 0. 8 73 12 -2 3 m on th s 6. 4 1. 3 0. 1 15 5 28 .8 9. 6 -1 .1 15 5 2. 6 1. 3 16 .0 0. 8 15 5 24 -3 5 m on th s 5. 2 1. 3 -0 .2 15 3 28 .6 8 .4 -1 .2 15 3 2. 0 0. 7 9. 8 0. 6 15 2 36 -4 7 m on th s 7. 8 1. 3 -0 .2 15 3 21 .7 8 .6 -1 .1 15 1 5. 3 1. 3 14 .6 0. 7 15 0 48 -5 9 m on th s 8 .3 2. 8 -0 .1 14 3 17 .5 5. 6 -0 .9 14 2 5. 9 3. 7 8 .8 0. 5 13 5 M ot h er ’s e du ca ti on N on e 14 .1 7. 0 -0 .5 70 37 .1 12 .9 -1 .5 69 10 .1 7. 2 13 .0 0. 3 68 Pr im ar y 6. 5 2. 8 -0 .2 10 6 20 .0 8 .6 -0 .9 10 4 6. 6 1. 9 9. 4 0. 4 10 5 Ba si c 5. 8 1. 3 -0 .1 15 3 18 .2 5. 8 -0 .9 15 3 4. 6 1. 3 10 .6 0. 6 15 0 U pp er s ec on da ry 7. 6 1. 0 0. 0 19 5 23 .0 7. 7 -0 .8 19 4 6. 2 3. 1 14 .0 0. 6 19 1 V oc at io na l (8 .7 ) (0 .0 ) (0 .0 ) 46 (1 5. 2) (8 .7 ) -( 0. 8 ) 46 (6 .7 ) (6 .7 ) (1 1. 1) (0 .7 ) 45 C ol le ge , un iv er si ty 5. 1 0. 6 0. 2 17 5 19 .3 5. 1 -0 .7 17 5 2. 9 0. 6 18 .5 0. 8 17 2 W ea lt h i n de x qu in ti le s Po or es t 9. 1 3. 9 -0 .3 15 3 24 .3 7. 9 -1 .2 15 1 4. 7 2. 7 9. 4 0. 5 14 8 Se co nd 6. 4 1. 3 -0 .1 15 5 20 .6 6. 5 -1 .0 15 4 4. 5 2. 6 11 .0 0. 5 15 4 M id dl e 7. 6 1. 7 -0 .1 17 1 27 .9 9. 9 -1 .0 17 1 6. 5 2. 4 14 .2 0. 6 16 8 Fo ur th 5. 6 0. 0 0. 3 12 3 20 .3 7. 3 -0 .6 12 2 4. 9 2. 5 19 .7 0. 9 12 1 Ri ch es t 6. 9 1. 4 0. 2 14 4 13 .1 4. 8 -0 .6 14 4 7. 0 2. 8 14 .1 0. 7 14 1 Et h n ic it y of h ou se h ol d h ea d* K ha lk h 6. 3 1. 5 0. 0 53 3 19 .3 6. 2 -0 .8 52 9 5. 9 2. 5 12 .5 0. 6 52 2 O th er 9. 4 2. 4 -0 .1 21 0 27 .4 10 .4 -1 .1 21 0 4. 8 2. 9 15 .2 0. 6 20 8 R el ig io n o f h ou se h ol d h ea d* * N o re lig io n 7. 0 1. 6 0. 0 44 0 20 .5 6. 1 -0 .8 43 9 6. 2 3. 4 13 .3 0. 6 43 2 Bu dd hi st 6. 7 1. 5 -0 .1 26 7 22 .6 9. 4 -1 .0 26 4 4. 5 1. 5 14 .4 0. 7 26 2 O th er (9 .1 ) (3 .0 ) -( 0. 3) 33 (3 0. 3) (9 .1 ) -( 1. 3) 33 (3 .0 ) (0 .0 ) (9 .1 ) (0 .5 ) 33 To ta l 7. 2 1. 7 0. 0 74 5 21 .6 7. 4 -0 .9 74 1 5. 6 2. 6 13 .4 0. 6 73 1 * O ne , on e an d on e un w ei gh te d ca se s w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n re sp ec tiv el y. ** F iv e, f iv e an d fo ur u nw ei gh te d ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n re sp ec tiv el y. ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 1 M IC S in di ca to r 2. 1a a n d M D G i n di ca to r 1. 8 2 M IC S in di ca to r 2. 1b 3 M IC S in di ca to r 2. 2a , 4 M IC S in di ca to r 2. 2b 5 M IC S in di ca to r 2. 3a , 6 M IC S in di ca to r 2. 3b 67 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 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, Khuvsgul aimag, 2012 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 Location Aimag center 95.4 61.5 92.3 10.8 64 Soum center 96.2 62.5 88.5 17.3 102 Rural 94.1 59.6 89.0 12.5 134 Months since last birth 0-11 months 92.5 50.9 86.8 13.2 52 12-23 months (95.9) (55.1) (85.7) (20.4) 48 Assistance at delivery Skilled attendant 95.4 61.1 89.8 13.9 298 Relative, friend, other, missing (*) (*) (*) (*) 2 Place of delivery Public sector health facility 95.4 61.4 89.8 13.9 298 Home, other, missing (*) (*) (*) (*) 2 Mother’s education None or primary 94.9 52.5 86.4 8.5 58 Basic 93.8 59.4 84.4 10.9 63 Upper secondary 94.2 66.3 90.7 11.6 84 Vocational (*) (*) (*) (*) 17 College, university 97.5 63.3 93.7 19.0 78 Wealth index quintiles Poorest 90.2 56.9 84.3 7.8 50 Second 97.0 62.7 89.6 11.9 66 Middle 93.0 59.2 87.3 12.7 70 Fourth 94.8 60.4 91.4 19.0 57 Richest 100.0 65.5 94.8 17.2 57 Ethnicity of household head Khalkh 96.1 62.7 90.6 12.9 229 Other 91.7 55.6 86.1 16.7 71 Religion of household head* No religion 93.4 63.7 89.0 14.3 179 Buddhist 98.1 60.4 89.6 14.2 104 Other (*) (*) (*) (*) 14 Total 95.1 61.0 89.5 13.8 299 * Three unweighted cases with missing “Religion of household head” not shown. ( ) Figures that are based on 25-49 unweighted cases. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 2.4 2 MICS indicator 2.5 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 68 V. nUtrItIon Table NU.3: Breastfeeding Percentage of living children according to breastfeeding status at selected age groups, Khuvsgul aimag, 2012 Children age 0-5 months Children age 12-15 months Children age 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 (65.6) (65.6) 32 (79.4) 34 (44.4) 27 Female (55.0) (57.5) 40 69.6 23 (61.5) 26 Total 59.7 61.1 71 75.4 57 52.8 53 ( ) Figures that are based on 25-49 unweighted cases. 1 MICS indicator 2.6 2 MICS indicator 2.9 3 MICS indicator 2.7 4 MICS indicator 2.8 Table NU.4: Duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children age 0-35 months, Khuvsgul aimag, 2012 Median duration (in months) of Number of children age 0-35 months Any breastfeeding1 Exclusive breastfeeding Predominant breastfeeding Sex Male 24.0 3.9 3.9 244 Female 25.4 2.8 2.9 239 Location Aimag center 23.3 4.3 4.3 97 Soum center 25.0 2.5 2.7 165 Rural 25.8 3.2 3.2 221 Mother’s education None (24.9) (4.9) (4.9) 48 Primary 26.2 1.7 2.5 61 Basic 27.1 4.7 4.7 94 Upper secondary 26.9 1.9 1.9 126 Vocational (13.8) (4.9) (4.9) 32 College, university 19.9 3.4 3.4 122 Wealth index quintiles Poorest 28.9 2.4 2.4 90 Second 25.4 4.1 4.1 104 Middle 24.3 2.7 3.0 112 Fourth 23.3 3.1 3.1 86 Richest 19.4 2.9 2.9 90 Ethnicity of household head Khalkh 25.9 3.5 3.6 355 Other 22.1 2.2 2.2 128 Religion of household head* No religion 26.5 3.7 3.8 291 Buddhist 26.2 2.0 2.0 167 Other (*) (*) (*) 23 Median 25.8 3.2 3.2 483 Mean for all children (0-35 months) 23.0 3.6 3.7 483 * Three unweighted cases with missing “Religion of household head” not shown. ( ) Figures that are based on 25-49 unweighted cases. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 2.10 69 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon Table NU.5: Age-appropriate breastfeeding Percentage of children age 0-23 months who were appropriately breastfed during the last day and night preceding the survey, Khuvsgul aimag, 2012 Children age 0-5 months Children age 6-23 months Children age 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 (65.6) 32 63.6 128 64.0 160 Female (55.0) 40 66.1 117 63.3 157 Location Aimag center (*) 12 76.4 55 77.6 66 Soum center (50.0) 30 58.5 81 56.3 111 Rural (60.0) 30 63.6 109 62.9 139 Mother’s education None or primary (*) 12 58.0 50 58.1 61 Basic (*) 15 (70.2) 47 71.0 61 Upper secondary (*) 22 71.0 68 63.7 90 Vocational (*) 7 (*) 13 (*) 20 College, university (*) 16 61.8 67 61.9 83 Wealth index quintiles Poorest (*) 11 (61.9) 42 58.5 53 Second (*) 16 64.7 51 68.7 66 Middle (*) 23 61.5 52 58.7 74 Fourth (*) 15 (64.6) 48 63.5 62 Richest (*) 7 70.4 54 68.9 60 Ethnicity of household head Khalkh 65.5 55 66.8 188 66.5 243 Other (*) 17 57.9 57 54.1 73 Religion of household head* No religion 68.6 51 64.0 138 65.3 188 Buddhist (*) 14 64.7 98 62.0 112 Other (*) 5 (*) 8 (*) 13 Total 59.7 71 64.8 245 63.6 316 * Two, one 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. 1 MICS indicator 2.6 2 MICS indicator 2.14 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 70 V. nUtrItIon Ta bl e N U .7 : M in im u m m ea l fr eq u en cy Pe rc en ta ge o f ch ild re n ag e 6- 23 m on th s w ho r ec ei ve d so lid o r se m i- so lid f oo ds ( an d m ilk f ee ds f or n on -b re as tf ee di ng c hi ld re n) t he m in im um n um be r of t im es o r m or e du rin g th e pr ev io us d ay p re ce di ng t he s ur ve y, a cc or di ng t o br ea st fe ed in g st at us , K hu vs gu l a im ag , 20 12 C u rr en tl y br ea st fe ed in g C u rr en tl y n ot b re as tf ee di n g To ta l Pe rc en t re ce iv in g so lid or s em i- so lid f oo ds th e m in im um n um be r of t im es N um be r of ch ild re n ag e 6- 23 m on th s Pe rc en t re ce iv in g m ilk f ee ds a t le as t 2 tim es 1 Pe rc en t re ce iv in g so lid o r se m i- so lid fo od s or m ilk f ee ds 4 tim es o r m or e N um be r of ch ild re n ag e 6- 23 m on th s Pe rc en t w ith m in im um m ea l fr eq ue nc y2 N um be r of ch ild re n ag e 6- 23 m on th s Se x M al e 9. 8 91 (7 8 .4 ) (6 7. 6) 37 26 .4 12 8 Fe m al e 18 .9 8 9 (8 5. 7) (7 8 .6 ) 28 33 .1 11 7 A g e 6- 8 m on th s (3 2. 3) 34 (* ) (* ) 3 (3 7. 8 ) 37 9- 11 m on th s (7 .7 ) 39 (* ) (* ) 5 (1 8 .2 ) 44 12 -1 7 m on th s 12 .1 65 (8 1. 8 ) (7 7. 3) 22 28 .4 8 7 18 -2 3 m on th s (9 .3 ) 43 (7 7. 1) (6 2. 9) 35 33 .3 77 Lo ca ti on A im ag c en te r (2 5. 6) 43 (* ) (* ) 12 30 .9 55 So um c en te r 17 .9 56 (7 3. 1) (6 9. 2) 26 34 .1 8 1 Ru ra l 6. 0 8 2 (9 6. 3) (8 5. 2) 27 25 .5 10 9 M ot h er ’s e du ca ti on N on e or p rim ar y (* ) 37 (* ) (* ) 13 28 .0 ) 50 Ba si c (1 3. 5) 37 (* ) (* ) 10 (2 9. 8 ) 47 U pp er s ec on da ry (1 3. 0) 54 (* ) (* ) 15 27 .5 68 V oc at io na l (* ) 8 (* ) (* ) 5 (* ) 13 C ol le ge , un iv er si ty (2 3. 9) 46 (* ) (* ) 22 32 .4 67 W ea lt h i n de x qu in ti le s Po or es t (6 .3 ) 32 (* ) (* ) 10 (2 6. 2) 42 Se co nd (7 .7 ) 39 (* ) (* ) 12 21 .6 51 M id dl e (1 0. 8 ) 37 (* ) (* ) 15 32 .7 52 Fo ur th (2 0. 6) 34 (* ) (* ) 14 (3 1. 2) 48 Ri ch es t (2 5. 0) 40 (* ) (* ) 14 35 .2 54 Et h n ic it y of h ou se h ol d h ea d K ha lk h 13 .0 14 5 (7 5. 0) (6 5. 9) 44 25 .3 18 8 O th er (1 9. 4) 36 (* ) (* ) 21 43 .9 57 R el ig io n o f h ou se h ol d h ea d* N o re lig io n 7. 8 10 2 (8 3. 3) (7 7. 8 ) 36 25 .9 13 8 Bu dd hi st 22 .5 70 (7 8 .6 ) (6 4. 3) 28 34 .3 98 O th er (* ) 7 (* ) (* ) 1 (* ) 8 To ta l 14 .3 18 0 8 1. 5 72 .3 64 29 .6 24 5 * O ne , ze ro a nd o ne u nw ei gh te d ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n re sp ec tiv el y. ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) Fi gu re s th at a re b as ed o n le ss t ha n 25 u nw ei gh te d ca se s. 1 M IC S in di ca to r 2. 15 2 M IC S in di ca to r 2. 13 A m on g cu rr en tly b re as tf ee di ng c hi ld re n ag e 6- 8 m on th s, m in im um m ea l f re qu en cy is d ef in ed a s ch ild re n w ho a ls o re ce iv ed s ol id , se m i- so lid o r so ft f oo ds 2 t im es o r m or e. A m on g cu rr en tly b re as tf ee di ng c hi ld re n ag e 9- 23 m on th s, r ec ei pt o f so lid , se m i- so lid o r so ft f oo ds a t le as t 3 tim es c on st itu te s m in im um m ea l f re qu en cy . Fo r no n- br ea st fe ed in g ch ild re n ag e 6- 23 m on th s, m in im um m ea l f re qu en cy is d ef in ed a s ch ild re n re ce iv in g so lid , se m i- so lid o r so ft f oo ds , an d m ilk f ee ds , at le as t 4 tim es d ur in g th e pr ev io us d ay . 71 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon Table NU.8: Bottle feeding Percentage of children age 0-23 months who were fed with a bottle with a nipple during the previous day, Khuvsgul aimag, 2012 Percentage of children age 0- 23 months fed with a bottle with a nipple1 Number of children age 0-23 months Sex Male 13.7 160 Female 22.2 157 Age 0-5 months 20.8 71 6-11 months 16.0 80 12-23 months 17.5 165 Location Aimag center 16.4 66 Soum center 22.3 111 Rural 15.0 139 Mother’s education None or primary 19.4 61 Basic 12.9 61 Upper secondary 17.6 90 Vocational (*) 20 College, university 20.2 83 Wealth index quintiles Poorest 13.2 53 Second 13.4 66 Middle 21.3 74 Fourth 17.5 62 Richest 23.0 60 Ethnicity of household head Khalkh 16.7 243 Other 21.6 73 Religion of household head* No religion 18.9 188 Buddhist 15.0 112 Other (*) 13 Total 17.9 316 * Three unweighted cases with missing “Religion of household head” not shown. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 2.11 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 72 V. nUtrItIon Ta bl e N U .9 : Io di ze d sa lt c on su m pt io n Pe rc en t di st rib ut io n of h ou se ho ld s by c on su m pt io n of io di ze d sa lt, K hu vs gu l a im ag , 20 12 Pe rc en t of ho us eh ol ds in w hi ch s al t w as te st ed N um be r of ho us eh ol ds Pe rc en t of h ou se h ol ds w it h To ta l N um be r of ho us eh ol ds in w hi ch sa lt w as t es te d or w ith n o sa lt Pe rc en t of ho us eh ol ds w ith n o sa lt Sa lt t es t re su lt N ot io di ze d (0 PP M ) Io di ze d (l es s th an 1 5 PP M ) Io di ze d (1 5+ PP M )1 Lo ca ti on A im ag c en te r 98 .7 44 3 0. 9 25 .7 9. 0 64 .4 10 0. 0 44 1 So um c en te r 95 .7 68 4 1. 2 20 .1 10 .4 68 .3 10 0. 0 66 3 Ru ra l 95 .6 8 54 1. 5 29 .5 10 .2 58 .7 10 0. 0 8 30 Ed u ca ti on o f h ou se h ol d h ea d* N on e 95 .5 23 9 2. 5 36 .3 6. 3 54 .9 10 0. 0 23 4 Pr im ar y 94 .9 48 6 2. 3 31 .2 11 .3 55 .2 10 0. 0 47 2 Ba si c 96 .5 48 1 1. 5 28 .1 11 .1 59 .3 10 0. 0 47 1 U pp er s ec on da ry 98 .0 29 0 0. 0 16 .3 8 .0 75 .7 10 0. 0 28 4 V oc at io na l 97 .1 23 9 0. 4 19 .9 13 .1 66 .5 10 0. 0 23 3 C ol le ge , un iv er si ty 96 .8 24 6 0. 0 14 .5 8 .3 77 .2 10 0. 0 23 8 W ea lt h i n de x qu in ti le s Po or es t 96 .0 36 7 2. 2 31 .8 11 .5 54 .5 10 0. 0 36 0 Se co nd 93 .8 39 8 2. 3 29 .5 10 .3 57 .9 10 0. 0 38 2 M id dl e 97 .8 40 6 1. 2 32 .9 7. 9 58 .0 10 0. 0 40 2 Fo ur th 96 .6 40 6 0. 5 17 .8 10 .3 71 .4 10 0. 0 39 4 Ri ch es t 97 .3 40 5 0. 2 15 .7 10 .3 73 .8 10 0. 0 39 5 Et h n ic it y of h ou se h ol d h ea d* * K ha lk h 96 .3 1 39 0 1. 4 26 .4 9. 0 63 .2 10 0. 0 1 35 8 O th er 96 .6 58 6 0. 9 23 .2 12 .5 63 .5 10 0. 0 57 1 R el ig io n o f h ou se h ol d h ea d* ** N o re lig io n 95 .4 1 10 3 1. 5 24 .1 10 .8 63 .6 10 0. 0 1 06 9 Bu dd hi st 97 .4 8 03 1. 0 27 .7 8 .0 63 .2 10 0. 0 79 0 O th er 97 .2 70 1. 4 20 .0 20 .0 58 .6 10 0. 0 69 To ta l 96 .3 1 98 2 1. 3 25 .4 10 .0 63 .3 10 0. 0 1 93 4 * O ne a nd o ne u nw ei gh te d ca se s w ith m is si ng “ Ed uc at io n of h ou se ho ld h ea d” n ot s ho w n re sp ec tiv el y. ** S ix a nd f iv e un w ei gh te d ca se s w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n re sp ec tiv el y. ** * Si x an d si x un w ei gh te d ca se s w ith m is si ng “ Re lig 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. 16 73 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon Table NU.10: Children’s vitamin A supplementation Percent distribution of children age 6-59 months by receipt of a high dose vitamin A supplement in the last 6 months, Khuvsgul aimag, 2012 Percentage who received Vitamin A in the last 6 months according to: Percentage of children who received Vitamin A during the last 6 months1 Number of children age 6-59 months Mother and child health booklet/ vaccination card Mother’s report Sex Male 1.0 47.1 47.6 388 Female 1.1 47.4 47.6 358 Location Aimag center 1.8 48.5 49.1 170 Soum center 1.7 43.3 43.7 229 Rural 0.3 49.1 49.4 347 Age 6-11 months 4.9 43.2 44.4 80 12-23 months 0.6 56.6 56.6 165 24-35 months 0.0 52.4 52.4 167 36-47 months 0.0 37.5 37.5 174 48-59 months 1.9 44.7 46.0 160 Mother’s education None 0.0 30.8 30.8 77 Primary 0.0 42.5 42.5 112 Basic 0.0 50.0 50.0 147 Upper secondary 2.0 48.5 50.0 194 Vocational (0.0) (39.5) (39.5) 43 College, university 2.3 55.8 55.8 173 Wealth index quintiles Poorest 0.6 42.9 43.6 155 Second 0.0 49.7 49.7 156 Middle 1.2 43.4 44.6 165 Fourth 0.8 48.8 48.8 126 Richest 2.7 52.1 52.1 145 Ethnicity of household head* Khalkh 1.1 49.9 50.3 526 Other 0.9 40.5 40.9 218 Religion of household head** No religion 0.9 47.0 47.5 436 Buddhist 1.4 47.7 48.0 277 Other (0.0) (50.0) (50.0) 30 Total 1.1 47.2 47.6 746 * One unweighted cases with missing “Ethnicity of household head” not shown. ** Three unweighted cases with missing “Religion of household head” not shown. ( ) Figures that are based on 25-49 unweighted cases. 1 MICS indicator 2.17 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 74 V. nUtrItIon Table NU.10A: Children’s vitamin A supplementation (according to mother’s report) Percent distribution of children age 6-59 months by receipt of different types of vitamin A supplement in the last 6 months according to mother’s report, Khuvsgul aimag, 2012 Received Vitamin A during the last 6 months Number of children age 6-59 months Types of Vitamin A: Number of children age 6-59 months received Vitamin A during the last 6 months Red Blue White DK Sex Male 47.1 388 71.2 16.3 8.2 6.5 182 Female 47.4 358 72.5 15.2 5.8 9.4 170 Location Aimag center 48.5 170 75.9 13.3 4.8 6.0 82 Soum center 43.3 229 64.0 9.0 11.0 16.0 99 Rural 49.1 347 74.4 20.9 5.8 4.1 171 Age 6-11 months 43.2 80 (62.9) (14.3) (17.1) (5.7) 35 12-23 months 56.6 165 69.2 12.8 10.6 7.4 93 24-35 months 52.4 167 73.9 13.6 6.8 8.0 87 36-47 months 37.5 174 75.8 19.7 0.0 7.6 65 48-59 months 44.7 160 73.6 19.4 4.2 9.7 71 Mother’s education None or primary 37.7 189 63.9 23.6 6.9 6.9 71 Basic 50.0 147 73.0 18.9 5.4 5.4 73 Upper secondary 48.5 194 81.1 10.5 5.3 5.3 94 Vocational (39.5) 43 (*) (*) (*) (*) 17 College, university 55.8 173 66.0 15.5 8.2 13.4 96 Wealth index quintiles Poorest 42.9 155 77.6 22.4 3.0 1.5 66 Second 49.7 156 75.6 21.8 5.1 3.8 77 Middle 43.4 165 73.6 9.7 8.3 9.7 71 Fourth 48.8 126 64.5 9.7 14.5 11.3 61 Richest 52.1 145 67.1 14.5 5.3 13.2 75 Ethnicity of household head* Khalkh 49.9 526 74.3 13.2 7.9 7.2 263 Other 40.5 218 64.0 23.6 4.5 10.1 88 Religion of household head** No religion 47.0 436 71.5 18.8 7.2 6.3 205 Buddhist 47.7 277 72.9 11.3 7.5 9.0 132 Other (50.0) 30 (*) (*) (*) (*) 15 Total 47.2 746 71.8 15.8 7.0 7.9 352 * One and one unweighted cases with missing “Ethnicity of household head” not shown respectively. ** Three and zero 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. 75 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon Table NU.10B: Children’s vitamin D supplementation Percent distribution of children age 6-59 months by receipt of different types of vitamin D supplement in the last 6 months according to mother’s report, Khuvsgul aimag, 2012 Received Vitamin D during the last 6 months Number of children age 6-59 months Types of Vitamin D: Number of children age 6-59 months received Vitamin D during the last 6 months Tablets (50,000) Capsule (50,000) Liquor (droppings) Other DK Sex Male 29.9 388 52.1 11.1 34.2 0.9 3.4 116 Female 30.5 358 53.6 9.1 36.4 0.0 2.7 109 Location Aimag center 25.7 170 (50.0) (9.1) (36.4) (0.0) (4.5) 44 Soum center 32.9 229 57.9 13.2 30.3 1.3 0.0 75 Rural 30.6 347 50.5 8.4 38.3 0.0 4.7 106 Age 6-11 months 45.7 80 (48.7) (8.1) (45.9) (2.7) (0.0) 37 12-23 months 45.8 165 51.3 10.5 39.5 0.0 0.0 75 24-35 months 31.0 167 67.3 11.5 21.2 0.0 1.9 52 36-47 months 16.5 174 (48.3) (13.8) (31.0) (0.0) (6.9) 29 48-59 months 20.5 160 (42.4) (6.1) (39.4) (0.0) (12.1) 33 Mother’s education None or primary 21.5 189 (46.3) (17.1) (36.6) (0.0) (2.4) 41 Basic 36.5 147 59.3 7.4 29.6 1.9 3.7 54 Upper secondary 29.6 194 56.9 5.2 37.9 0.0 1.7 58 Vocational (25.6) 43 (*) (*) (*) (*) (*) 11 College, university 36.2 173 47.6 9.5 39.7 0.0 4.8 62 Wealth index quintiles Poorest 26.9 155 (52.4) (9.5) (40.5) (0.0) (2.4) 42 Second 35.7 156 55.4 7.1 35.7 0.0 1.8 56 Middle 19.3 165 (68.8) (12.5) (15.6) (0.0) (3.1) 32 Fourth 33.9 126 (51.2) (7.0) (41.9) (2.3) (0.0) 43 Richest 37.0 145 42.6 14.8 37.0 0.0 7.4 54 Ethnicity of household head* Khalkh 32.8 526 52.9 12.1 35.1 0.0 1.7 173 Other 24.1 218 52.8 3.8 35.9 1.9 7.5 53 Religion of household head** No religion 30.2 436 54.9 9.8 33.8 0.0 3.8 132 Buddhist 29.4 277 46.3 12.2 40.2 1.2 1.2 81 Other (36.7) 30 (*) (*) (*) (*) (*) 11 Total 30.2 746 52.9 10.1 35.2 0.4 3.1 225 * One and zero unweighted cases with missing “Ethnicity of household head” not shown respectively. ** Three 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. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 76 V. nUtrItIon Ta bl e N U .1 0C : C h ild re n ’s m u lt i- n u tr ie n t su pp le m en ta ti on Pe rc en t di st rib ut io n of c hi ld re n ag e 6- 59 m on th s by r ec ei pt o f m ul ti- nu tr ie nt s up pl em en t in t he la st 6 m on th s ac co rd in g to m ot he r’s r ep or t an d pe rc en ta ge o f m ai n so ur ce o f in fo rm at io n ab ou t m ul ti- nu tr ie nt s up pl em en t, K hu vs gu l a im ag , 20 12 Re ce iv ed m ul ti- nu tr ie nt su pp le m en t du rin g th e la st 6 m on th s N um be r of ch ild re n ag e 6- 59 m on th s A ve ra ge nu m be r of m ul ti- nu tr ie nt pa ck et s re ce iv ed in th e la st 6 m on th s Th e w ay o f m ix in g th e m ul ti- nu tr ie nt in t he c hi ld re n’ s m ea ls : To ta l So ur ce o f in fo rm at io n ab ou t m ul ti- nu tr ie nt su pp le m en t: N um be r of ch ild re n ag e 6- 59 m on th s re ce iv ed m ul ti- nu tr ie nt su pp le m en t du rin g th e la st 6 m on th s W he n co ok fo od A ft er co ok ed , in w ho le fo od H ot fo od in cu p W ar m fo od in cu p C ol d fo od in cu p O th er D K So um / fa m ily ho sp ita l O th er ho sp ita l, cl in ic TV Ra di o, FM Re la tiv e, fr ie nd O th er D K Se x M al e 16 .1 38 8 25 .0 1. 6 1. 6 7. 9 8 5. 7 0. 0 1. 6 1. 6 10 0. 0 15 .9 0. 0 1. 3 0. 3 0. 3 0. 3 0. 3 62 Fe m al e 17 .5 35 8 26 .6 0. 0 1. 6 3. 2 90 .5 1. 6 0. 0 3. 2 10 0. 0 16 .6 0. 3 0. 6 0. 0 0. 0 0. 0 0. 3 62 A re a U rb an 15 .2 17 0 (1 8 .7 ) (3 .8 ) (0 .0 ) (1 1. 5) (8 0. 8 ) (0 .0 ) (0 .0 ) (3 .8 ) 10 0. 0 (1 4. 6) (0 .0 ) (1 .8 ) (0 .0 ) (0 .6 ) (0 .6 ) (0 .6 ) 26 Ru ra l 17 .2 57 6 27 .6 0. 0 2. 0 4. 0 90 .0 1. 0 1. 0 2. 0 10 0. 0 16 .7 0. 2 0. 7 0. 2 0. 0 0. 0 0. 2 99 Lo ca ti on A im ag c en te r 15 .2 17 0 (1 8 .7 ) (3 .8 ) (0 .0 ) (1 1. 5) (8 0. 8 ) (0 .0 ) (0 .0 ) (3 .8 ) 10 0. 0 (1 4. 6) (0 .0 ) (1 .8 ) (0 .0 ) (0 .6 ) (0 .6 ) (0 .6 ) 26 So um c en te r 15 .6 22 9 (2 4. 0) (0 .0 ) (2 .8 ) (0 .0 ) (9 1. 7) (2 .8 ) (2 .8 ) (0 .0 ) 10 0. 0 (1 5. 2) (0 .0 ) (1 .7 ) (0 .4 ) (0 .0 ) (0 .0 ) (0 .0 ) 36 Ru ra l 18 .3 34 7 29 .6 0. 0 1. 6 6. 3 8 9. 1 0. 0 0. 0 3. 1 10 0. 0 17 .7 0. 3 0. 0 0. 0 0. 0 0. 0 0. 3 63 A g e 6- 23 m on th s 29 .1 24 5 25 .4 1. 4 1. 4 5. 6 90 .3 0. 0 0. 0 1. 4 10 0. 0 97 .2 0. 0 4. 2 1. 4 0. 0 0. 0 1. 4 71 24 -5 9 m on th s 10 .7 50 1 26 .3 0. 0 1. 9 5. 6 8 5. 2 1. 9 1. 9 3. 7 10 0. 0 96 .3 1. 9 7. 4 0. 0 1. 9 1. 9 1. 9 54 M ot h er ’s e du ca ti on Le ss t ha n up pe r se co nd ar y 17 .4 33 6 24 .8 1. 7 0. 0 5. 1 8 9. 8 1. 7 0. 0 1. 7 10 0. 0 98 .3 0. 0 0. 0 0. 0 0. 0 0. 0 1. 7 58 U pp er s ec on da ry o r hi gh er 16 .2 40 9 26 .7 0. 0 3. 0 6. 0 8 6. 6 0. 0 1. 5 3. 0 10 0. 0 95 .5 1. 5 10 .5 1. 5 1. 5 1. 5 1. 5 66 W ea lt h i n de x qu in ti le s Po or es t 60 % 15 .9 47 5 27 .7 1. 3 1. 3 5. 3 8 9. 5 0. 0 0. 0 2. 6 10 0. 0 97 .4 1. 3 0. 0 0. 0 1. 3 1. 3 1. 3 75 Ri ch es t 40 % 18 .3 27 1 22 .8 0. 0 2. 0 6. 0 8 6. 0 2. 0 2. 0 2. 0 10 0. 0 96 .0 0. 0 14 .0 2. 0 0. 0 0. 0 2. 0 50 Et h n ic it y of h ou se h ol d h ea d* K ha lk h 19 .2 52 6 27 .3 1. 0 2. 0 3. 9 90 .2 0. 0 1. 0 2. 0 10 0. 0 18 .6 0. 2 1. 3 0. 2 0. 0 0. 0 0. 2 10 1 O th er 10 .9 21 8 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 24 R el ig io n o f h ou se h ol d h ea d* * N o re lig io n 15 .2 43 6 27 .9 1. 5 3. 0 1. 5 94 .0 0. 0 0. 0 0. 0 10 0. 0 15 .0 0. 2 0. 5 0. 0 0. 0 0. 0 0. 0 66 Bu dd hi st 19 .4 27 7 24 .5 0. 0 0. 0 9. 3 8 3. 3 1. 9 1. 9 3. 7 10 0. 0 18 .6 0. 0 1. 8 0. 4 0. 4 0. 4 0. 4 54 O th er (1 6. 7) 30 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 To ta l 16 .8 74 6 25 .8 0. 8 1. 6 5. 6 8 8 .1 0. 8 0. 8 2. 4 10 0. 0 16 .2 0. 1 0. 9 0. 1 0. 1 0. 1 0. 3 12 5 * O ne a nd z er o un w ei gh te d ca se s w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n re sp ec tiv el y. ** T hr ee a nd z er o un w ei gh te d ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n re sp ec tiv el y. ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) Fi gu re s th at a re b as ed o n le ss t ha n 25 u nw ei gh te d ca se s. 77 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” V. nUtrItIon 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, Khuvsgul aimag, 2012 Percent of live births: Number of last-born children in the two years preceding the survey Below 2500 grams1 Weighed at birth2 Location Aimag center 2.2 100.0 64 Soum center 3.9 99.0 102 Rural 4.7 98.5 134 Mother’s education None or primary 6.4 98.3 58 Basic 3.5 100.0 63 Upper secondary 3.3 98.8 84 Vocational (*) (*) 17 College, university 2.7 98.7 78 Wealth index quintiles Poorest 6.6 98.0 50 Second 4.6 98.5 66 Middle 4.3 100.0 70 Fourth 3.1 100.0 57 Richest 1.1 98.3 57 Ethnicity of household head Khalkh 4.1 99.1 229 Other 3.5 98.6 71 Religion of household head* No religion 3.7 99.5 179 Buddhist 4.7 98.1 104 Other (*) (*) 14 Total 3.9 99.0 299 * Three unweighted cases with missing “Religion of household head” not shown. (*) Figures that are based on less than 25 unweighted cases. 1 MICS indicator 2.18 2 MICS indicator 2.19 VI CHILd HeALtH © UnICeF Mongolia/Amin solution/2010 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 80 VI. CHILd HeALtH Immunization The Millennium Development Goal (MDG) 4 is to reduce child mortality by two thirds between 1990 and 2015. Immunization plays a key part in 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 aimag and the capital city. 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/caretakers 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 immunized by receiving the Tuberculosis vaccine, three doses to DTP (diphtheria, pertussis and tetanus) vaccine, Hepatitis B vaccine and Measles vaccine. Starting from 2005, new combined vaccines such as vaccines against diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus Influenza B and since 2009, a vaccine against Measles, Mumps and Rubella have been included into the “National Plan for Mandatory Vaccination”. Overall, 66 percent of children age 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 age 12-23 months who received each of the vaccinations is shown in Table CH.1. The table provides the immunization coverage 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 96 percent of children age 12-23 months received a Tuberculosis vaccination by the age of 12 months and the first dose of DPT was given to 89 percent of them. The percentage declines for subsequent doses of DPT to 83 percent for the second dose, and 81 percent for the third dose (Figure CH.1). Similarly, 96 percent of children received the first dose of Polio (at birth) by age of 12 months and this figure declines to 87 percent by the third dose. As for the dose at birth of Hepatitis B vaccination, the coverage is 91 percent among children age 12-23 by the age of 12 months. The coverage for the first dose of Measles 81 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH vaccine by 12 months is relatively lower (89 percent) than for the other vaccinations. As a result, the percentage of children who had all the recommended vaccinations by their first birthday is 67 at the aimag level. Figure CH.1: Percentage of children aged 12-23 months who received the recommended vaccinations by 12 months, Khuvsgul aimag, 2012 Table CH.2 shows vaccination coverage rates among children age 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 rate differs slightly by sex, and locations. The table shows that coverage rate for any type of vaccination is lower among girls compared with boys. 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. 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. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 82 VI. CHILd HeALtH Main indicators: • Prevalence of diarrhoea • Oral rehydration therapy (ORT) • Home management of diarrhoea • Oral rehydration therapy with continued feeding In the Khuvsgul aimag “Child development survey - 2012” 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. It should be noted that as a result of successful implementation of programs on Diarrhoea Monitoring, “Full Management of Child’s Sickness Programme” the mortality rate of children due to diarrhoea reduced significantly in Mongolia. Overall, 11 percent of under-five children had diarrhoea in the 14 days preceding the survey. Table CH.4 shows that the peak of diarrhoea prevalence occurs during the weaning and introduction of complementary feeding period, meaning more among children age 0-23 months. The percentage of under-five children, who had diarrhea in the 14 days preceding the survey does not differ considerably by sex, and locations. 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. 25 percent of children with diarrhoea received ORS packets and 30 percent received recommended homemade ORS fluids. 47 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). 36 percent of children under five with diarrhoea drank more than usual, while 64 percent drank the same amount or less. As for the feeding practice, 91 percent ate somewhat less, same or more (continued feeding), but 9 percent ate much less or almost none. Table CH.6 provides data on the proportion of children age 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, 52 percent of children with diarrhoea received ORS fluids from packet or increased fluids, 63 percent received ORT (ORS fluids from packet or homemade ORS fluids, recommended by FMCS). Combining the information in Table CH.4 with those in Table CH.5 on oral rehydration therapy, it is observed that 58 percent of children either received ORT and, at the same time, feeding was continued, as it is recommended by IMCI. There are differences in administration of this diarrhoea intervention by gender (64 percent for boys, 50 percent for girls). Because the number of children with diarrhea is small, the diarrhea management indicators should be interpreted with caution. 83 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH Knowledge on medical care seeking and antibiotic treatment of suspected pneumonia Pneumonia is the leading cause of death in children and the use of antibiotics for children under age 5 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. Typical symptoms of pneumonia include coughing, rapid or difficult breathing rather than blocked nose or chest congestion. The main suspected pneumonia indicators are: • Percentage of children with suspected pneumonia • Care seeking for suspected pneumonia • Antibiotic treatment for suspected pneumonia • Knowledge of the two main signs of pneumonia 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. Please note that the results on care seeking and antibiotic treatment during suspected pneumonia indicators should not be interpreted as the number of children suspected pneumonia (denominator of indicators) are quite low. 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 2 percent of mothers/ caretakers’ covered by the survey knew of the two danger signs of pneumonia – rapid and difficult breathing. The most commonly identified symptom for taking a child to a health facility is developing fever (74 per cent). 8 percent of mothers/ caretakers identified rapid breathing and 5 percent of mothers/ caretakers identified difficult breathing as symptoms for taking children immediately to a health care provider. Mothers’/caretakers’ knowledge of child nutrition and child illness14 Mothers/ caretakers’ knowledge of the child nutrition and child illness is an important to prevent illnesses related with nutrition/ malnutrition. When asked to identify illnesses related with nutrition/ malnutrition in children age 0-59 months, 44 percent of mothers/caretakers named diarrhoea, 35 percent named wasting, 25 percent named fatigue (Table CH.8A). Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. Anemia leads to lack of oxygen in organs. There are several types of anemia but almost 80 percent of anemia cases among children age 0-59 months is iron deficiency anemia. Table CH.8B demonstrate the level of mothers’/caretakers’ knowledge of anemia. It is critical that more than half (55 percent) of the mothers/caretakers, covered by the survey, do not know about anemia. 14 As requested by UNICEF Mongolia, this questions have been included symptoms of illness module of women’s questionnaire. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 84 VI. CHILd HeALtH 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, 97 percent of all households in Khuvsgul aimag use solid fuels for cooking. 92 percent of households in aimag center use solid food- this percentage is higher than the national average due to number of factors, including poor infrastructure, remote location and scarce number of building blocks in Khuvsgul aimag. The use of solid fuels differs by household wealth and education of household head. 91 percent of richest households use solid fuels for cooking, while all (100 percent) of poorest households use solid fuels for cooking. The table also clearly shows that the overall percentage is high due to high level of use wood 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 24 percent of households who use solid fuels for cooking have separate kitchen rooms, 76 percent do not have a separate kitchen. It shows that there is a high risk for indoor air pollution in Khuvsgul aimag. The table also shows that this indicator differs considerably by household wealth quintiles. Children at increased risk of disability and child injury In this survey, a separate questionnaire was used for children age 2-14 regarding the incidence of accidents and injuries and the presence of any disability. 23 percent of surveyed children age 2-915 are at increased risk of disability (Table CH.17). While 18 percent of children, living in aimag center have an increased risk of disability, the percentage is higher in rural at 25 percent. As shown in Table CH.17, percentage of children at increased risk of disability differs by mother’s education and household wealth. Children, whose mothers are less educated and who are from poorest households, are more likely to screen positive for a disability compared with other children. Table CH.17A shows that 10 percent of surveyed children, age 2-14 years, had an accident or injury in the preceding year. Boys are more likely to suffer from accidents and injuries. There is no considerable difference in prevalence of accidents and injuries by location and household wealth. 15 According to the MICS standard, child disability indicators were calculated among children age 2-9 years. 85 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH As shown in Table CH.17A, the most common injury among children is falls (53 percent). The number of child accidents and injuries prevail at home (37 percent), while 29 percent happened in the countryside and field, and 18 percent on the road and street (Table CH.17B). Table CH.1: Vaccinations in first year of life Percentage of children age 12-23 months immunized against childhood diseases at any time before the survey and before the first birthday, Khuvsgul aimag, 2012 Vaccinated at any time before the survey according to Vaccinated by 12 months of age Mother and child health booklet/ Vaccination card Mother’s report Either BCG1 65.0 31.3 96.3 96.3 Polio At birth 64.0 31.7 95.7 95.7 1 65.2 28.0 93.3 93.3 2 62.2 26.2 88.4 87.5 32 62.8 25.0 87.8 86.9 DPT 1 61.5 28.6 90.1 89.1 2 59.0 24.8 83.8 83.0 33 58.4 23.0 81.4 80.5 HepB At birth 63.1 28.1 91.2 91.2 MMR 14 62.1 26.7 88.8 88.8 All vaccinations 51.2 17.5 68.7 67.1 No vaccinations 0.0 1.2 1.2 1.2 Number of children age 12-23 months 165 165 165 165 1 MICS indicator 3.1; 2 MICS indicator 3.2; 3 MICS indicator 3.3 4 MICS indicator 3.4; MDG indicator 4.3 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 86 VI. CHILd HeALtH Ta bl e C H .2 : V ac ci n at io n s by s el ec te d ba ck g ro u n d ch ar ac te ri st ic s Pe rc en ta ge o f ch ild re n ag e 12 -2 3 m on th s cu rr en tly v ac ci na te d ag ai ns t ch ild ho od d is ea se s, K hu vs gu l a im ag , 20 12 Pe rc en ta g e of c h ild re n w h o re ce iv ed : Pe rc en ta ge w ith va cc in at io n ca rd s ee n N um be r of c hi ld re n ag e 12 -2 3 m on th s BC G Po lio D PT H ep B M M R 1 N on e A ll A t bi rt h 1 2 3 1 2 3 A t bi rt h Se x M al e 96 .8 96 .8 94 .6 8 9. 2 8 9. 2 90 .2 8 5. 9 8 7. 0 93 .4 94 .4 1. 1 74 .7 66 .3 94 Fe m al e 95 .7 94 .4 91 .5 8 7. 3 8 5. 9 8 9. 9 8 1. 2 73 .9 8 8 .4 8 1. 7 1. 4 60 .9 66 .2 70 Lo ca ti on A im ag c en te r (1 00 .0 ) (9 7. 3) (8 6. 5) (8 3. 8 ) (8 1. 1) (7 7. 8 ) (7 2. 2) (6 9. 4) (9 4. 4) (8 1. 1) (0 .0 ) (5 6. 8 ) (4 2. 1) 38 So um c en te r 92 .9 92 .9 96 .4 8 7. 5 8 9. 3 94 .5 8 1. 8 8 0. 0 8 7. 3 8 8 .9 1. 8 66 .7 68 .4 57 Ru ra l 97 .1 97 .2 94 .4 91 .5 90 .1 92 .9 91 .4 8 8 .6 92 .8 92 .9 1. 4 76 .8 77 .5 70 M ot h er ’s e du ca ti on N on e (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 17 Pr im ar y (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 16 Ba si c (9 6. 6) (9 3. 1) (1 00 .0 ) (9 6. 6) (9 6. 6) (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (9 2. 9) (9 6. 6) (0 .0 ) (8 5. 7) (7 3. 3) 30 U pp er s ec on da ry (1 00 .0 ) (1 00 .0 ) (9 7. 7) (8 8 .6 ) (8 6. 4) (9 0. 7) (8 6. 0) (8 3. 7) (9 5. 3) (9 5. 3) (0 .0 ) (7 2. 1) (7 5. 0) 44 V oc at io na l (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 8 C ol le ge , un iv er si ty 93 .9 94 .0 98 .0 90 .0 90 .0 93 .8 77 .1 77 .1 8 7. 8 8 3. 7 0. 0 64 .6 58 .8 51 W ea lt h i n de x qu in ti le s Po or es t (1 00 .0 ) (1 00 .0 ) (8 8 .9 ) (8 5. 2) (8 1. 5) (9 2. 3) (8 8 .5 ) (8 8 .5 ) (9 2. 0) (9 2. 3) (0 .0 ) (6 8 .0 ) (7 4. 1) 27 Se co nd (9 4. 1) (9 4. 1) (9 4. 1) (9 1. 2) (9 1. 2) (9 1. 2) (8 8 .2 ) (8 2. 4) (9 1. 2) (8 8 .2 ) (2 .9 ) (7 3. 5) (7 3. 5) 34 M id dl e (9 4. 3) (9 1. 4) (8 8 .6 ) (8 5. 7) (8 5. 7) (8 2. 9) (8 2. 9) (7 7. 1) (9 1. 4) (8 8 .2 ) (2 .9 ) (6 4. 7) (6 3. 9) 36 Fo ur th (1 00 .0 ) (1 00 .0 ) (1 00 .0 ) (8 7. 9) (9 3. 9) (1 00 .0 ) (8 3. 9) (9 0. 3) (9 3. 6) (9 3. 8 ) (0 .0 ) (7 8 .1 ) (6 3. 6) 33 Ri ch es t (9 4. 3) (9 4. 3) (9 4. 3) (9 1. 4) (8 5. 7) (8 5. 7) (7 7. 1) (7 1. 4) (8 8 .6 ) (8 2. 9) (0 .0 ) (6 0. 0) (5 8 .3 ) 36 Et h n ic it y of h ou se h ol d h ea d K ha lk h 95 .3 94 .5 92 .2 8 6. 7 8 6. 7 91 .2 8 3. 2 8 2. 4 90 .4 8 8 .8 1. 6 67 .2 59 .2 12 9 O th er (1 00 .0 ) (1 00 .0 ) (9 7. 2) (9 4. 4) (9 1. 7) (8 6. 1) (8 6. 1) (7 7. 8 ) (9 4. 3) (8 8 .9 ) (0 .0 ) (7 4. 3) (9 1. 7) 36 R el ig io n o f h ou se h ol d h ea d N o re lig io n 98 .9 98 .9 94 .6 93 .5 90 .2 91 .2 90 .1 8 5. 7 97 .8 94 .4 0. 0 75 .3 69 .1 93 Bu dd hi st 92 .5 91 .0 91 .0 8 0. 6 8 3. 6 8 7. 7 73 .8 73 .8 8 1. 5 8 0. 3 3. 0 57 .6 59 .7 66 O th er (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 5 To ta l 96 .3 95 .7 93 .3 8 8 .4 8 7. 8 90 .1 8 3. 8 8 1. 4 91 .2 8 8 .8 1. 2 68 .7 66 .3 16 5 ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) Fi gu re s th at a re b as ed o n le ss t ha n 25 u nw ei gh te d ca se s. 87 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH Table CH.4: Oral rehydration solutions and recommended homemade fluids Percentage of children age 0-59 months with diarrhoea in the last two weeks, and treatment with oral rehydration solutions and recommended homemade fluids, Khuvsgul aimag, 2012 Had diarrhoea in the last two weeks Number of children age 0-59 months Children with diarrhoea who received: Number of children age 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 10.6 419 (24.4) (31.1) (46.7) 45 Female 10.5 398 (26.2) (28.6) (47.6) 42 Total 10.6 817 25.3 29.9 47.1 86 ( ) Figures that are based on 25-49 unweighted cases. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 88 VI. CHILd HeALtH Ta bl e C H .5 : Fe ed in g p ra ct ic es d u ri n g d ia rr h oe a Pe rc en t di st rib ut io n of c hi ld re n ag e 0- 59 m on th s w ith d ia rr ho ea in t he la st t w o w ee ks b y am ou nt o f liq ui ds a nd f oo d gi ve n du rin g ep is od e of d ia rr ho ea , K hu vs gu l a im ag , 20 12 H ad di ar rh oe a in t he la st tw o w ee ks N um be r of c hi ld re n ag e 0- 59 m on th s D ri n ki n g p ra ct ic es d u ri n g d ia rr h oe a: To ta l Ea ti n g p ra ct ic es d u ri n g d ia rr h oe a: To ta l N um be r of ch ild re n ag e 0- 59 m on th s w ith d ia rr ho ea in t he la st t w o w ee ks G iv en m uc h le ss to dr in k G iv en so m ew ha t le ss t o dr in k G iv en ab ou t th e sa m e to dr in k G iv en m or e to dr in k G iv en m uc h le ss t o ea t G iv en so m ew ha t le ss t o ea t G iv en ab ou t th e sa m e to ea t G iv en m or e to e at St op pe d fo od Se x M al e 10 .6 41 9 (4 .4 ) (2 .2 ) (4 6. 7) (4 6. 7) 10 0. 0 (6 .7 ) (2 6. 7) (5 7. 8 ) (6 .7 ) (2 .2 ) 10 0. 0 45 Fe m al e 10 .5 39 8 (2 .4 ) (1 4. 3) (5 9. 5) (2 3. 8 ) 10 0. 0 (7 .1 ) (1 9. 0) (7 1. 4) (0 .0 ) (2 .4 ) 10 0. 0 42 To ta l 10 .6 8 17 3. 4 8 .0 52 .9 35 .6 10 0. 0 6. 9 23 .0 64 .4 3. 4 2. 3 10 0. 0 8 6 ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 89 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH Ta bl e C H .6 : O ra l re h yd ra ti on t h er ap y w it h c on ti n u ed f ee di n g a n d ot h er t re at m en ts Pe rc en ta ge o f ch ild re n ag ed 0 -5 9 m on th s w ith d ia rr ho ea in t he la st t w o w ee ks w ho r ec ei ve d or al 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 ch ild re n w ith d ia rr ho ea w ho r ec ei ve d ot he r tr ea tm en ts , K hu vs gu l a im ag , 20 12 C h ild re n w it h d ia rr h oe a w h o re ce iv ed : O th er t re at m en ts : N ot gi ve n an y tr ea tm en t or d ru g N um be r of c hi ld re n ag ed 0 -5 9 m on th s w ith di ar rh oe a in th e la st t w o w ee ks O RS f lu id fr om pa ck et o r in cr ea se d fl ui ds O RT ( O RS f lu id fr om p ac ke t or re co m m en de d ho m em ad e fl ui ds o r in cr ea se d fl ui ds ) O RT w ith co nt in ue d fe ed in g1 Pi ll or s yr u p In je ct io n In tr a- ve no us H om e re m ed y, he rb al m ed ic in e O th er A nt i- bi ot ic A nt i- m ot ili ty Zi nc O th er U n- kn ow n A nt i- bi ot ic N on - an tib io tic U n- kn ow n Se x M al e (5 7. 8 ) (6 8 .9 ) (6 4. 4) (1 7. 8 ) (2 .2 ) (0 .0 ) (6 .7 ) (2 .2 ) (2 .2 ) (0 .0 ) (0 .0 ) (2 .2 ) (2 .2 ) (6 .7 ) (2 4. 4) 45 Fe m al e (4 5. 2) (5 7. 1) (5 0. 0) (2 3. 8 ) (9 .5 ) (0 .0 ) (1 1. 9) (0 .0 ) (4 .8 ) (4 .8 ) (0 .0 ) (0 .0 ) (4 .8 ) (7 .1 ) (2 1. 4) 42 To ta l 51 .7 63 .2 57 .5 20 .7 5. 7 0. 0 9. 2 1. 1 3. 4 2. 3 0. 0 1. 1 3. 4 6. 9 23 .0 8 6 ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 1 M IC S in di ca to r 3. 8 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 90 VI. CHILd HeALtH Ta bl e C H .8 : K n ow le dg e of t h e tw o da n g er s ig n s of p n eu m on ia Pe rc en ta ge o f m ot he rs a nd c ar et ak er s of c hi ld re n ag e 0- 59 m on th s by s ym pt om s th at w ou ld c au se t o ta ke t he c hi ld im m ed ia te ly t o a he al th f ac ili ty , an d pe rc en ta ge o f m ot he rs a nd c ar et ak er s w ho re co gn iz e fa st a nd d if fi cu lt br ea th in g as s ig ns f or s ee ki ng c ar e im m ed ia te ly , K hu vs gu l a im ag , 20 12 Pe rc en ta g e of m ot h er s/ ca re ta ke rs w h o th in k th at a c h ild s h ou ld b e ta ke n i m m ed ia te ly t o a h ea lt h f ac ili ty i f th e ch ild : M ot he rs / ca re ta ke rs w ho re co gn iz e th e tw o da ng er s ig ns o f pn eu m on ia N um be r of m ot he rs / ca re ta ke rs o f ch ild re n ag e 0- 59 m on th s Is n ot a bl e to d rin k or br ea st fe ed Be co m es si ck er D ev el op s a fe ve r H as f as t br ea th in g H as di ff ic ul t br ea th in g H as bl oo d in s to ol V om its Re fu se s to d rin k H as di ar rh oe a H as ill ne ss w ith a co ug h H as se iz ur e, fi ts o r fa in t C rie s w ith a n un kn ow n re as on H as o th er sy m pt om s Lo ca ti on A im ag c en te r 5. 4 6. 1 73 .5 9. 5 5. 4 3. 4 8 .8 2. 7 33 .3 44 .9 6. 8 13 .6 12 .2 1. 4 14 4 So um c en te r 2. 6 4. 6 75 .0 7. 7 3. 1 2. 0 6. 6 1. 0 27 .0 46 .9 4. 6 18 .4 9. 7 1. 0 19 2 Ru ra l 4. 0 3. 0 73 .0 8 .0 5. 7 2. 7 9. 7 2. 7 23 .3 46 .3 6. 7 11 .3 11 .7 2. 7 29 5 Ed u ca ti on N on e 1. 5 4. 6 70 .8 6. 2 4. 6 1. 5 10 .8 1. 5 15 .4 56 .9 9. 2 15 .4 15 .4 3. 1 64 Pr im ar y 3. 4 2. 3 63 .6 10 .2 3. 4 4. 5 9. 1 3. 4 25 .0 47 .7 4. 5 12 .5 9. 1 1. 1 8 6 Ba si c 2. 2 4. 5 71 .6 6. 0 3. 0 0. 0 5. 2 0. 7 22 .4 47 .0 3. 0 10 .5 13 .4 0. 7 13 2 U pp er s ec on da ry 4. 0 4. 0 76 .6 5. 7 5. 7 2. 3 9. 1 2. 3 30 .9 42 .9 5. 1 16 .0 11 .4 1. 7 17 2 V oc at io na l (6 .1 ) (0 .0 ) (8 7. 9) (1 5. 1) (6 .1 ) (6 .1 ) (1 2. 1) (6 .1 ) (3 3. 3) (2 4. 2) (6 .1 ) (1 5. 2) (2 4. 2) (6 .1 ) 32 C ol le ge , un iv er si ty 6. 1 6. 1 76 .3 11 .5 6. 1 4. 1 8 .8 2. 0 30 .4 48 .6 9. 5 14 .9 5. 4 2. 0 14 5 W ea lt h i n de x qu in ti le s Po or es t 4. 5 2. 3 67 .7 9. 0 5. 3 2. 3 9. 0 3. 8 23 .3 48 .1 8 .3 12 .8 11 .3 3. 0 13 1 Se co nd 2. 9 2. 9 68 .6 7. 3 4. 4 3. 6 11 .7 1. 5 24 .1 46 .0 4. 4 10 .9 9. 5 1. 5 13 5 M id dl e 2. 8 4. 2 76 .1 6. 3 4. 9 2. 1 3. 5 1. 4 21 .8 48 .6 5. 6 16 .2 12 .0 2. 1 13 9 Fo ur th 5. 4 6. 3 76 .6 10 .8 5. 4 0. 9 11 .7 2. 7 26 .1 43 .2 5. 4 15 .3 9. 9 1. 8 10 9 Ri ch es t 4. 2 5. 8 8 0. 8 8 .3 4. 2 4. 2 7. 5 1. 7 40 .0 44 .2 6. 7 15 .0 13 .3 0. 8 11 8 Et h n ic it y of h ou se h ol d h ea d* K ha lk h 4. 8 3. 5 73 .1 7. 7 5. 0 2. 0 8 .3 2. 6 27 .1 46 .0 6. 8 15 .3 10 .7 1. 5 44 9 O th er 1. 6 5. 9 75 .1 9. 7 4. 3 4. 3 9. 2 1. 1 25 .9 46 .5 4. 3 10 .8 12 .4 2. 7 18 2 R el ig io n o f h ou se h ol d h ea d* * N o re lig io n 4. 1 3. 9 74 .0 7. 5 4. 9 2. 1 8 .8 2. 6 26 .8 46 .9 6. 4 12 .1 11 .1 1. 5 38 1 Bu dd hi st 3. 6 5. 4 74 .4 9. 4 4. 9 3. 6 7. 6 1. 8 26 .5 45 .3 4. 9 16 .6 11 .2 2. 7 21 9 O th er (3 .4 ) (0 .0 ) (6 5. 5) (6 .9 ) (3 .4 ) (3 .4 ) (1 3. 8 ) (0 .0 ) (3 1. 0) (4 4. 8 ) (1 0. 3) (1 7. 2) (1 3. 8 ) (0 .0 ) 28 To ta l 3. 9 4. 2 73 .7 8 .2 4. 8 2. 6 8 .6 2. 2 26 .7 46 .2 6. 1 14 .0 11 .2 1. 9 63 1 * O ne u nw ei gh te d ca se s w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n. ** T hr ee u nw ei gh te d ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n. ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 91 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH Ta bl e C H .8 A : K n ow le dg e ab ou t ill n es se s th at c an b e ca u se d du e to n u tr it io n d ef ic ie n cy o r u n h ea lt h y ea ti n g a m on g c h ild re n Pe rc en ta ge o f m ot he rs / ca re ta ke rs o f ch ild re n ag e 0- 59 m on th s, b y th ei r kn ow le dg e ab ou t ill ne ss es t ha t ca n be c au se d du e to n ut rit io n de fi ci en cy o r un he al th y ea tin g am on g ch ild re n, K hu vs gu l a im ag , 20 12 Ra ch iti s Fa tiq ue W as tin g A ne m ia Ir on de fi ci en cy St un tin g Io di ne de fi ci en cy D ia rr ho ea O th er D K N um be r of m ot he rs / ca re ta ke rs o f ch ild re n ag e 0- 59 m on th s Lo ca ti on A im ag c en te r 6. 1 34 .0 44 .9 6. 8 1. 4 12 .9 2. 0 43 .5 6. 8 17 .7 14 4 So um c en te r 5. 6 23 .5 33 .2 5. 1 0. 5 10 .2 1. 0 44 .4 4. 6 19 .9 19 2 Ru ra l 3. 0 22 .0 30 .3 2. 3 1. 3 6. 0 2. 3 43 .0 6. 0 27 .7 29 5 Ed u ca ti on N on e 1. 5 16 .9 24 .6 0. 0 0. 0 7. 7 4. 6 40 .0 0. 0 43 .1 64 Pr im ar y 1. 1 17 .0 19 .3 1. 1 1. 1 6. 8 0. 0 46 .6 9. 1 31 .8 8 6 Ba si c 2. 2 20 .9 26 .9 0. 7 0. 7 5. 2 1. 5 40 .3 6. 0 29 .9 13 2 U pp er s ec on da ry 6. 9 25 .1 41 .7 4. 0 0. 6 8 .0 2. 3 46 .9 4. 0 17 .7 17 2 V oc at io na l (0 .0 ) (3 0. 3) (3 0. 3) (3 .0 ) (0 .0 ) (3 .0 ) (0 .0 ) (4 5. 5) (6 .1 ) (2 1. 2) 32 C ol le ge , un iv er si ty 8 .1 36 .5 47 .3 11 .5 2. 7 16 .2 2. 0 41 .9 8 .1 9. 5 14 5 W ea lt h i n de x qu in ti le s Po or es t 3. 8 24 .1 31 .6 3. 8 0. 0 6. 8 3. 0 42 .1 3. 0 30 .1 13 1 Se co nd 1. 5 19 .7 24 .1 0. 7 2. 2 4. 4 1. 5 46 .0 8 .0 27 .7 13 5 M id dl e 4. 2 18 .3 29 .6 1. 4 0. 7 8 .4 1. 4 44 .4 3. 5 23 .2 13 9 Fo ur th 6. 3 23 .4 38 .7 5. 4 1. 8 11 .7 1. 8 39 .6 6. 3 20 .7 10 9 Ri ch es t 7. 5 42 .5 51 .7 10 .8 0. 8 14 .2 1. 7 45 .0 8 .3 11 .7 11 8 Et h n ic it y of h ou se h ol d h ea d* K ha lk h 3. 9 26 .5 35 .0 4. 6 1. 1 10 .3 2. 0 43 .1 4. 6 22 .8 44 9 O th er 5. 9 22 .2 33 .5 3. 2 1. 1 5. 4 1. 6 44 .3 8 .6 23 .8 18 2 R el ig io n o f h ou se h ol d h ea d* * N o re lig io n 3. 6 25 .3 32 .0 2. 3 0. 8 7. 7 1. 5 41 .8 5. 4 25 .5 38 1 Bu dd hi st 6. 3 23 .3 38 .1 7. 2 1. 8 9. 9 2. 7 47 .5 5. 8 18 .4 21 9 O th er (3 .4 ) (3 1. 0) (3 7. 9) (6 .9 ) (0 .0 ) (1 7. 2) (0 .0 ) (3 7. 9) (1 0. 3) (2 7. 6) 28 To ta l 4. 5 25 .2 34 .5 4. 2 1. 1 8 .9 1. 9 43 .5 5. 8 23 .0 63 1 * O ne u nw ei gh te d ca se s w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n. ** T hr ee u nw ei gh te d ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n. ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 92 VI. CHILd HeALtH Ta bl e C H .8 B : K n ow le dg e ab ou t an em ia Pe rc en ta ge o f m ot he rs / ca re ta ke rs o f ch ild re n ag e 0- 59 , by t he ir kn ow le dg e ab ou t an em ia , K hu vs gu l a im ag , 20 12 Q ua lit y of bl oo d is n ot go od H em og lo bi n of b lo od is de cr ea se d B lo od is lo w P re ss ur e is lo w R ic ke ts O th er D K N um be r of m ot he rs / ca re ta ke rs o f ch ild re n ag e 0- 59 m on th s Lo ca ti on A im ag c en te r 0. 0 3. 4 19 .0 7. 5 10 .2 8 .8 51 .0 14 4 So um c en te r 1. 5 2. 6 21 .4 5. 1 11 .7 5. 6 52 .0 19 2 Ru ra l 1. 7 2. 3 16 .0 4. 3 11 .0 6. 0 58 .7 29 5 Ed u ca ti on N on e 0. 0 0. 0 9. 2 3. 1 9. 2 6. 2 72 .3 64 Pr im ar y 1. 1 2. 3 11 .4 5. 7 10 .2 3. 4 65 .9 8 6 Ba si c 0. 0 2. 2 23 .9 4. 5 11 .2 2. 2 56 .0 13 2 U pp er s ec on da ry 0. 0 2. 3 17 .1 6. 9 9. 7 9. 1 54 .9 17 2 V oc at io na l (0 .0 ) (0 .0 ) (1 8 .2 ) (9 .1 ) (1 2. 1) (1 2. 1) (4 8 .5 ) 32 C ol le ge , un iv er si ty 4. 7 5. 4 23 .0 4. 1 13 .5 8 .1 41 .2 14 5 W ea lt h i n de x qu in ti le s Po or es t 1. 5 1. 5 19 .5 5. 3 11 .3 6. 0 54 .9 13 1 Se co nd 0. 7 2. 2 14 .6 3. 6 8 .0 5. 8 65 .0 13 5 M id dl e 1. 4 2. 1 16 .9 7. 0 10 .6 2. 1 59 .9 13 9 Fo ur th 1. 8 2. 7 19 .8 2. 7 13 .5 6. 3 53 .2 10 9 Ri ch es t 0. 8 5. 0 21 .7 7. 5 12 .5 13 .3 39 .2 11 8 Et h n ic it y of h ou se h ol d h ea d* K ha lk h 1. 1 3. 3 17 .1 5. 7 11 .8 5. 5 55 .6 44 9 O th er 1. 6 1. 1 21 .1 4. 3 9. 2 9. 2 53 .5 18 2 R el ig io n o f h ou se h ol d h ea d* * N o re lig io n 1. 0 1. 8 18 .8 6. 2 10 .6 6. 4 55 .2 38 1 Bu dd hi st 0. 9 4. 5 17 .9 2. 2 12 .6 6. 3 55 .6 21 9 O th er (6 .9 ) (0 .0 ) (1 3. 8 ) (1 3. 8 ) (6 .9 ) (1 0. 3) (4 8 .3 ) 28 To ta l 1. 2 2. 6 18 .4 5. 3 11 .0 6. 5 54 .9 63 1 * O ne u nw ei gh te d ca se s w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n. ** T hr ee u nw ei gh te d ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n. ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. 93 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH Ta bl e C H .9 : So lid f u el u se Pe rc en t di st rib ut io n of h ou se ho ld m em be rs a cc or di ng t o ty pe o f co ok in g fu el u se d by t he h ou se ho ld , an d pe rc en ta ge o f ho us eh ol d m em be rs li vi ng in h ou se ho ld s us in g so lid fu el s fo r co ok in g, K hu vs gu l a im ag , 20 12 Pe rc en ta g e of h ou se h ol d m em be rs i n h ou se h ol ds u si n g : N um be r of ho us eh ol d m em be rs El ec tr ic ity So lid f u el s To ta l So lid fu el s fo r co ok in g1 C oa l ( st on e co al , lig ni te , w oo d co al ) C ha rc oa l W oo d St ra w , sh ru bs , gr as s D un g Sa w du st Lo ca ti on A im ag c en te r 8 .5 0. 3 0. 1 8 9. 4 0. 3 0. 8 0. 5 10 0. 0 91 .5 1 51 6 So um c en te r 2. 8 0. 0 0. 4 96 .1 0. 0 0. 6 0. 0 10 0. 0 97 .2 2 38 0 Ru ra l 0. 3 0. 2 0. 7 94 .3 0. 2 4. 3 0. 0 10 0. 0 99 .7 3 08 9 Ed u ca ti on o f h ou se h ol d h ea d* N on e 1. 4 0. 0 0. 5 92 .8 0. 3 5. 0 0. 0 10 0. 0 98 .6 76 8 Pr im ar y 0. 6 0. 0 1. 1 94 .2 0. 0 4. 1 0. 0 10 0. 0 99 .4 1 66 0 Ba si c 1. 7 0. 0 0. 3 96 .7 0. 5 0. 5 0. 3 10 0. 0 98 .3 1 8 39 U pp er s ec on da ry 3. 8 0. 3 0. 0 95 .3 0. 0 0. 6 0. 0 10 0. 0 96 .2 1 09 8 V oc at io na l 4. 3 0. 5 0. 4 91 .8 0. 0 2. 6 0. 4 10 0. 0 95 .7 8 21 C ol le ge , un iv er si ty 9. 6 0. 6 0. 4 8 7. 6 0. 0 1. 9 0. 0 10 0. 0 90 .4 79 5 W ea lt h i n de x qu in ti le s Po or es t 0. 0 0. 0 1. 1 90 .3 0. 1 8 .4 0. 0 10 0. 0 10 0. 0 1 39 6 Se co nd 0. 0 0. 0 0. 3 96 .7 0. 4 2. 6 0. 0 10 0. 0 10 0. 0 1 39 6 M id dl e 1. 2 0. 5 0. 6 97 .3 0. 3 0. 1 0. 0 10 0. 0 98 .8 1 39 9 Fo ur th 4. 0 0. 0 0. 1 94 .9 0. 1 0. 3 0. 6 10 0. 0 96 .0 1 39 4 Ri ch es t 9. 5 0. 4 0. 1 90 .0 0. 0 0. 0 0. 0 10 0. 0 90 .5 1 39 8 Et h n ic it y of h ou se h ol d h ea d* * K ha lk h 3. 6 0. 2 0. 6 93 .2 0. 2 2. 1 0. 2 10 0. 0 96 .4 4 8 52 O th er 1. 5 0. 2 0. 2 95 .3 0. 1 2. 6 0. 0 10 0. 0 98 .5 2 11 2 R el ig io n o f h ou se h ol d h ea d* ** N o re lig io n 2. 6 0. 1 0. 4 94 .4 0. 1 2. 4 0. 1 10 0. 0 97 .4 3 8 98 Bu dd hi st 3. 4 0. 3 0. 7 92 .8 0. 3 2. 4 0. 2 10 0. 0 96 .6 2 8 10 O th er 3. 5 0. 0 0. 0 96 .5 0. 0 0. 0 0. 0 10 0. 0 96 .5 25 3 To ta l 2. 9 0. 2 0. 5 93 .9 0. 2 2. 3 0. 1 10 0. 0 97 .1 6 98 5 * O ne u nw ei gh te d ca se s w ith m is si ng “ Ed uc at io n of h ou se ho ld h ea d” n ot s ho w n. ** S ix u nw ei gh te d ca se s w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n. ** * Si x un w ei gh te d ca se s w ith m is si ng “ Re lig 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. 11 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 94 VI. CHILd HeALtH Table CH.10: Solid fuel use by place of cooking Percent distribution of household members in households using solid fuels by place of cooking, Khuvsgul aimag, 2012 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 Total Location Aimag center 45.2 54.4 0.0 0.4 100.0 1 387 Soum center 35.3 64.4 0.3 0.0 100.0 2 313 Rural 6.4 92.4 1.0 0.2 100.0 3 079 Education of household head* None 8.2 90.9 0.9 0.0 100.0 757 Primary 13.2 86.3 0.5 0.0 100.0 1 650 Basic 19.0 80.3 0.5 0.3 100.0 1 807 Upper secondary 36.3 63.7 0.0 0.0 100.0 1 057 Vocational 32.5 65.3 1.6 0.6 100.0 785 College, university 53.0 47.0 0.0 0.0 100.0 719 Wealth index quintiles Poorest 0.0 99.1 0.6 0.4 100.0 1 396 Second 3.4 95.7 0.9 0.0 100.0 1 396 Middle 9.3 89.5 0.9 0.4 100.0 1 383 Fourth 45.2 54.5 0.4 0.0 100.0 1 338 Richest 68.0 32.0 0.0 0.0 100.0 1 266 Ethnicity of household head** Khalkh 25.7 73.4 0.7 0.1 100.0 4 679 Other 21.1 78.5 0.1 0.2 100.0 2 080 Religion of household head*** No religion 21.4 77.5 1.0 0.1 100.0 3 796 Buddhist 27.8 72.1 0.0 0.2 100.0 2 715 Other 26.3 73.7 0.0 0.0 100.0 244 Total 24.2 75.1 0.6 0.1 100.0 6 779 * One four unweighted cases with missing “Education of household head” not shown. ** Six unweighted cases with missing “Ethnicity of household head” not shown. *** Six unweighted cases with missing “Religion of household head” not shown. 95 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH Ta bl e C H .1 7: C h ild re n a t in cr ea se d ri sk o f di sa bi lit y Pe rc en ta ge o f ch ild re n ag e 2- 9 ye ar s re po rt ed b y m ot he rs /c ar et ak er s to h av e im pa irm en ts o r ac tiv ity li m ita tio ns , K hu vs gu l a im ag , 20 12 Pe rc en ta g e of c h ild re n a g e 2- 9 re po rt ed t o h av e sp ec if ie d im pa ir m en ts o r ac ti vi ty l im it at io n s N um be r of ch ild re n ag e 2- 9 ye ar s 2 ye ar s N um be r of ch ild re n ag e 2 ye ar s 3- 9 ye ar s N um be r of ch ild re n ag e 3- 9 ye ar s Pe rc en ta ge of c hi ld re n ag e 2- 9 w ith at le as t on e re po rt ed im pa irm en t1 N um be r of ch ild re n ag e 2- 9 ye ar s D el ay in si tt in g, st an di ng or w al ki ng D if fi cu lty se ei ng , ei th er in t he da yt im e or at n ig ht A pp ea rs to h av e di ff ic ul ty he ar in g N o un de rs - ta nd in g of in st ru c- tio ns D if fi cu lty in w al ki ng , m ov in g ar m s or h av e w ea kn es s or st if fn es s H av e fi ts , be co m e rig id , lo se co nc io us - ne ss N ot le ar ni ng t o do t hi ng s lik e ot he r ch ild re n hi s/ he r ag e N o sp ea ki ng / ca nn ot b e un de rs to od in w or ds A pp ea rs m en ta lly ba ck w ar d, du ll or sl ow C an no t na m e at le as t on e ob je ct Sp ee ch is no t no rm al Se x M al e 2. 5 1. 9 3. 2 4. 8 3. 5 1. 9 4. 2 8 .5 3. 7 55 9 17 .6 8 4 15 .1 47 6 21 .7 55 9 Fe m al e 2. 5 4. 9 3. 4 4. 6 3. 7 2. 2 6. 3 8 .5 4. 1 58 3 23 .3 8 5 16 .0 49 8 24 .9 58 3 Lo ca ti on A im ag c en te r 2. 1 2. 6 1. 3 4. 7 1. 7 2. 1 2. 6 8 .1 2. 6 23 1 (1 8 .8 ) 32 10 .9 19 9 17 .5 23 1 So um c en te r 1. 4 3. 5 4. 1 3. 8 3. 5 1. 9 4. 6 7. 1 4. 4 36 2 25 .5 54 18 .6 30 8 24 .0 36 2 Ru ra l 3. 4 3. 8 3. 6 5. 2 4. 5 2. 2 6. 8 9. 5 4. 1 55 0 17 .9 8 3 15 .6 46 7 25 .3 55 0 A g e 2- 4 2. 8 3. 0 1. 2 4. 8 4. 2 2. 4 4. 4 12 .0 3. 8 49 1 20 .5 * 16 9 19 .3 ** 32 3 22 .9 49 1 5- 6 2. 5 1. 1 3. 9 4. 6 3. 5 1. 4 7. 1 5. 7 3. 9 27 8 na na 16 .3 27 8 20 .6 27 8 7- 9 2. 1 5. 8 5. 6 4. 5 2. 9 2. 1 5. 0 5. 8 4. 0 37 3 na na 11 .9 37 3 25 .9 37 3 M ot h er ’s e du ca ti on N on e 6. 5 4. 9 4. 9 7. 3 7. 3 2. 4 14 .6 13 .0 7. 3 12 1 (* ) 20 26 .2 10 2 35 .0 12 1 Pr im ar y 4. 0 4. 9 4. 0 4. 4 7. 6 2. 2 6. 2 10 .7 5. 8 22 2 (1 6. 7) 30 18 .5 19 2 26 .7 22 2 Ba si c 1. 1 1. 9 3. 7 4. 4 1. 9 1. 9 3. 7 7. 8 2. 6 26 6 (2 5. 0) 32 11 .3 23 5 20 .0 26 6 U pp er s ec on da ry 1. 5 3. 3 3. 0 1. 9 2. 2 1. 5 3. 7 6. 7 2. 2 26 6 (1 6. 2) 37 16 .3 23 0 19 .6 26 6 V oc at io na l 1. 5 3. 1 1. 5 6. 2 3. 1 1. 5 1. 5 6. 2 3. 1 64 (* ) 12 13 .2 52 21 .5 64 C ol le ge , un iv er si ty 2. 0 3. 4 2. 0 6. 8 1. 5 2. 9 3. 9 7. 3 3. 9 20 2 (3 0. 0) 39 11 .5 16 3 22 .4 20 2 W ea lt h i n de x qu in ti le s Po or es t 3. 6 3. 6 4. 8 7. 5 4. 8 3. 2 7. 1 10 .3 5. 6 24 9 (1 7. 5) 39 17 .0 20 9 27 .4 24 9 Se co nd 2. 8 3. 6 2. 0 5. 2 4. 8 2. 0 5. 6 8 .4 4. 0 24 8 (2 1. 1) 37 14 .1 21 0 24 .7 24 8 M id dl e 3. 7 4. 5 3. 3 2. 0 3. 7 1. 2 4. 9 9. 0 3. 7 24 1 (2 5. 7) 35 18 .7 20 6 22 .1 24 1 Fo ur th 1. 9 1. 9 5. 2 4. 3 2. 8 2. 8 6. 6 9. 5 2. 8 20 8 (2 3. 1) 26 16 .2 18 3 24 .2 20 8 Ri ch es t 0. 0 3. 5 1. 0 4. 0 1. 5 1. 0 1. 5 4. 5 3. 0 19 7 (1 5. 6) 32 11 .3 16 6 17 .0 19 7 Et h n ic it y of h ou se h ol d h ea d* ** K ha lk h 2. 1 2. 9 3. 1 4. 5 3. 1 1. 8 4. 2 7. 8 3. 4 78 3 16 .5 11 3 15 .0 67 0 22 .2 78 3 O th er 3. 3 4. 7 3. 6 5. 0 4. 7 2. 8 7. 8 10 .0 5. 0 35 6 28 .6 55 17 .0 30 1 26 .0 35 6 R el ig io n o f h ou se h ol d h ea d* ** * N o re lig io n 2. 8 2. 7 2. 5 4. 6 4. 3 1. 8 5. 8 9. 2 3. 8 66 7 19 .8 10 5 13 .3 56 2 24 .1 66 7 Bu dd hi st 2. 1 4. 6 4. 4 4. 6 2. 3 2. 5 4. 4 7. 6 3. 9 42 6 21 .8 54 18 .3 37 2 22 .2 42 6 O th er (2 .2 ) (4 .4 ) (4 .4 ) (6 .7 ) (6 .7 ) (2 .2 ) (6 .7 ) (6 .7 ) (4 .4 ) 44 (* ) 10 (2 5. 7) 35 (2 4. 4) 44 To ta l 2. 5 3. 5 3. 3 4. 7 3. 6 2. 1 5. 3 8 .5 3. 9 1 14 3 20 .5 16 9 15 .6 97 4 23 .3 1 14 3 * Pe rc en t ba se d on c hi ld re n ag e 2 ye ar s on ly . ** P er ce nt b as ed o n ch ild re n ag e 3- 4 ye ar s on ly . ** * Th re e, z er o, t hr ee a nd t hr ee u nw ei gh te d ca se s w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n re sp ec tiv el y. ** ** F iv e, z er o, f iv e an d fi ve u nw ei gh te d ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n re sp ec tiv el y. na : no t ap pl ic ab le ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) Fi gu re s th at a re b as ed o n le ss t ha n 25 u nw ei gh te d ca se s. 1 M IC S in di ca to r 3. 21 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 96 VI. CHILd HeALtH Ta bl e C H .1 7A : Ty pe s of c h ild i n ju ry Pe rc en ta ge o f ch ild re n ag e 2- 14 y ea rs w ho h ad in ju ry in t he la st 1 2 m on th s pr ec ed in g th e su rv ey a nd p er ce nt d is tr ib ut io n of c hi ld re n w ho h ad a n in ju ry b y ty pe o f m os t re ce nt in ju ry , K hu vs gu l a im ag , 20 12 H ad in ju ry in t he la st 12 m on th s N um be r of ch ild re n ag e 2- 14 y ea rs Pe rc en ta g e of c h ild re n w h o h ad b el ow t yp e of i n ju ry a t m os t re ce n t ti m e in t h e la st 1 2 m on th s To ta l N um be r of c hi ld re n ag e 2- 14 y ea rs w ho h ad in ju ry in t he la st 1 2 m on th s Fa lls Bu rn s D ro w ni ng Se ve re ly fr ee zi ng W ou nd by cu tt in g St ru ck b y an o bj ec t Bi tt en b y an im al s Ro ad tr af fi c in ju rie s O th er D K Se x M al e 13 .0 90 5 59 .7 6. 7 0. 0 0. 8 6. 7 4. 2 14 .3 4. 2 3. 4 0. 0 10 0. 0 11 7 Fe m al e 6. 9 94 5 40 .9 16 .7 1. 5 0. 0 22 .7 1. 5 10 .6 1. 5 3. 0 1. 5 10 0. 0 65 Lo ca ti on A im ag c en te r 10 .9 39 1 (4 6. 5) (1 6. 3) (2 .3 ) (0 .0 ) (1 6. 3) (4 .6 ) (9 .3 ) (0 .0 ) (4 .7 ) (0 .0 ) 10 0. 0 42 So um c en te r 9. 4 59 6 49 .1 14 .0 0. 0 0. 0 14 .0 1. 8 12 .3 8 .8 0. 0 0. 0 10 0. 0 56 Ru ra l 9. 7 8 63 58 .8 4. 7 0. 0 1. 2 9. 4 3. 5 15 .3 1. 2 4. 7 1. 2 10 0. 0 8 4 A g e 2- 4 9. 6 49 1 (4 7. 9) (2 2. 9) (2 .1 ) (2 .1 ) (1 6. 7) (0 .0 ) (4 .2 ) (0 .0 ) (4 .2 ) (0 .0 ) 10 0. 0 47 5- 6 11 .3 27 8 (4 6. 9) (9 .4 ) (0 .0 ) (0 .0 ) (1 2. 5) (9 .4 ) (1 8 .8 ) (0 .0 ) (0 .0 ) (3 .1 ) 10 0. 0 32 7- 9 9. 5 37 3 (4 1. 7) (5 .6 ) (0 .0 ) (0 .0 ) (1 1. 1) (2 .8 ) (2 2. 2) (8 .3 ) (8 .3 ) (0 .0 ) 10 0. 0 36 10 -1 2 9. 8 40 5 (6 0. 0) (0 .0 ) (0 .0 ) (0 .0 ) (1 2. 5) (2 .5 ) (1 5. 0) (7 .5 ) (2 .5 ) (0 .0 ) 10 0. 0 39 13 -1 4 9. 4 30 3 (7 2. 4) (1 0. 4) (0 .0 ) (0 .0 ) (6 .9 ) (3 .4 ) (6 .9 ) (0 .0 ) (0 .0 ) (0 .0 ) 10 0. 0 29 M ot h er ’s e du ca ti on N on e 12 .7 16 4 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 21 Pr im ar y 8 .1 32 9 (4 0. 7) (3 .7 ) (0 .0 ) (3 .7 ) (1 8 .5 ) (3 .7 ) (1 8 .5 ) (0 .0 ) (7 .4 ) (3 .7 ) 10 0. 0 27 Ba si c 8 .9 46 6 (5 7. 1) (4 .8 ) (0 .0 ) (0 .0 ) (1 6. 7) (0 .0 ) (1 4. 3) (4 .8 ) (2 .4 ) (0 .0 ) 10 0. 0 41 U pp er s ec on da ry 7. 2 46 9 (5 5. 9) (1 1. 8 ) (2 .9 ) (0 .0 ) (5 .9 ) (2 .9 ) (1 1. 8 ) (5 .9 ) (2 .9 ) (0 .0 ) 10 0. 0 34 V oc at io na l 11 .3 12 2 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 14 C ol le ge , un iv er si ty 15 .4 30 1 (5 3. 2) (1 9. 2) (0 .0 ) (0 .0 ) (1 2. 8 ) (4 .3 ) (4 .3 ) (4 .3 ) (2 .1 ) (0 .0 ) 10 0. 0 46 W ea lt h i n de x qu in ti le Po or es t 11 .1 39 1 (5 9. 1) (6 .8 ) (0 .0 ) (2 .3 ) (1 1. 4) (2 .3 ) (1 1. 4) (0 .0 ) (6 .8 ) (0 .0 ) 10 0. 0 43 Se co nd 8 .0 39 3 (5 9. 4) (3 .1 ) (0 .0 ) (0 .0 ) (6 .3 ) (6 .3 ) (1 8 .8 ) (3 .1 ) (3 .1 ) (0 .0 ) 10 0. 0 32 M id dl e 7. 6 37 9 (4 8 .3 ) (3 .4 ) (0 .0 ) (0 .0 ) (1 7. 2) (3 .4 ) (2 0. 7) (0 .0 ) (3 .4 ) (3 .4 ) 10 0. 0 29 Fo ur th 9. 3 35 1 (5 7. 6) (1 2. 1) (3 .0 ) (0 .0 ) (9 .1 ) (6 .1 ) (6 .1 ) (6 .1 ) (0 .0 ) (0 .0 ) 10 0. 0 33 Ri ch es t 13 .8 33 6 (4 2. 6) (2 1. 3) (0 .0 ) (0 .0 ) (1 7. 0) (0 .0 ) (1 0. 6) (6 .4 ) (2 .1 ) (0 .0 ) 10 0. 0 46 Et h n ic it y of h ou se h ol d h ea d* K ha lk h 9. 7 1 26 3 52 .4 8 .1 0. 8 0. 8 12 .1 3. 2 15 .3 3. 2 4. 0 0. 0 10 0. 0 12 2 O th er 10 .2 58 2 55 .0 15 .0 0. 0 0. 0 11 .7 3. 3 8 .3 3. 3 1. 7 1. 7 10 0. 0 59 R el ig io n o f h ou se h ol d h ea d* * N o re lig io n 8 .7 1 05 9 59 .1 11 .8 0. 0 0. 0 10 .8 2. 2 9. 7 4. 3 2. 2 0. 0 10 0. 0 92 Bu dd hi st 11 .1 70 8 47 .5 10 .0 1. 2 1. 2 10 .0 3. 7 17 .5 2. 5 5. 0 1. 2 10 0. 0 79 O th er 13 .2 75 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 10 To ta l 9. 9 1 8 50 53 .0 10 .3 0. 5 0. 5 12 .4 3. 2 13 .0 3. 2 3. 2 0. 5 10 0. 0 18 3 * Fi ve a nd o ne c as es w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n re sp ec tiv el y. ** E ig ht a nd t w o ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n re sp ec tiv el y. ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) Fi gu re s th at a re b as ed o n le ss t ha n 25 u nw ei gh te d ca se s. 97 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VI. CHILd HeALtH Ta bl e C H .1 7B : Pl ac es o f ch ild i n ju ry Pe rc en ta ge o f ch ild re n ag e 2- 14 y ea rs w ho h ad in ju ry in t he la st 1 2 m on th s pr ec ed in g th e su rv ey a nd p er ce nt d is tr ib ut io n of c hi ld re n w ho h ad a n in ju ry b y pl ac e of t he m os t re ce nt in ju ry , K hu vs gu l a im ag , 20 12 H ad in ju ry in t he la st 12 m on th s N um be r of ch ild re n ag e 2- 14 y ea rs Pe rc en ta g e of c h ild re n w h o h ad i n ju ry i n t h e la st 1 2 m on th s, b y pl ac e of t h e m os t re ce n t in ju ry To ta l N um be r of c hi ld re n ag e 2- 14 y ea rs w ho ha d in ju ry in t he la st 1 2 m on th s H om e Sc ho ol / K in de rg ar te n Sp or t ar ea Bu ild in gs ar ea Pl ay ar ea Ro ad , st re et Ri ve r, la ke C ou nt ry si de fi el d O th er Se x M al e 13 .0 90 5 31 .1 6. 7 1. 7 0. 0 0. 8 18 .5 1. 7 35 .3 4. 2 10 0. 0 11 7 Fe m al e 6. 9 94 5 47 .0 4. 5 0. 0 1. 5 0. 0 16 .7 3. 0 18 .2 9. 1 10 0. 0 65 Lo ca ti on A im ag c en te r 10 .9 39 1 (4 8 .8 ) (9 .3 ) (0 .0 ) (0 .0 ) (2 .3 ) (1 6. 3) (2 .3 ) (1 8 .6 ) (2 .3 ) 10 0. 0 42 So um c en te r 9. 4 59 6 31 .6 5. 3 1. 8 1. 8 0. 0 31 .6 0. 0 22 .8 5. 3 10 0. 0 56 Ru ra l 9. 7 8 63 34 .1 4. 7 1. 2 0. 0 0. 0 9. 4 3. 5 38 .8 8 .2 10 0. 0 8 4 A g e 2- 4 9. 6 49 1 (6 8 .8 ) (0 .0 ) (2 .1 ) (0 .0 ) (2 .1 ) (1 4. 6) (2 .1 ) (6 .2 ) (4 .2 ) 10 0. 0 47 5- 6 11 .3 27 8 (5 0. 0) (9 .4 ) (0 .0 ) (0 .0 ) (0 .0 ) (9 .4 ) (0 .0 ) (1 5. 6) (1 5. 6) 10 0. 0 32 7- 9 9. 5 37 3 (1 3. 9) (5 .6 ) (0 .0 ) (0 .0 ) (0 .0 ) (3 0. 6) (2 .8 ) (4 1. 7) (5 .6 ) 10 0. 0 36 10 -1 2 9. 8 40 5 (2 0. 0) (5 .0 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 5. 0) (2 .5 ) (5 2. 5) (5 .0 ) 10 0. 0 39 13 -1 4 9. 4 30 3 (2 0. 7) (1 3. 8 ) (3 .4 ) (3 .4 ) (0 .0 ) (2 0. 7) (3 .4 ) (3 4. 5) (0 .0 ) 10 0. 0 29 M ot h er ’s e du ca ti on N on e 12 .7 16 4 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 21 Pr im ar y 8 .1 32 9 (2 9. 6) (7 .4 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 8 .5 ) (0 .0 ) (3 3. 3) (1 1. 1) 10 0. 0 27 Ba si c 8 .9 46 6 (2 8 .6 ) (4 .8 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 9. 0) (0 .0 ) (4 2. 9) (4 .8 ) 10 0. 0 41 U pp er s ec on da ry 7. 2 46 9 (4 1. 2) (0 .0 ) (2 .9 ) (0 .0 ) (0 .0 ) (1 1. 8 ) (5 .9 ) (3 5. 3) (2 .9 ) 10 0. 0 34 V oc at io na l 11 .3 12 2 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 14 C ol le ge , un iv er si ty 15 .4 30 1 (4 0. 4) (8 .5 ) (0 .0 ) (2 .1 ) (2 .1 ) (2 1. 3) (0 .0 ) (1 9. 2) (6 .4 ) 10 0. 0 46 W ea lt h i n de x qu in ti le Po or es t 11 .1 39 1 (3 1. 8 ) (2 .3 ) (2 .3 ) (0 .0 ) (0 .0 ) (4 .5 ) (2 .3 ) (5 2. 3) (4 .5 ) 10 0. 0 43 Se co nd 8 .0 39 3 (3 1. 3) (3 .1 ) (0 .0 ) (0 .0 ) (0 .0 ) (1 5. 6) (6 .3 ) (3 1. 3) (1 2. 5) 10 0. 0 32 M id dl e 7. 6 37 9 (4 1. 4) (6 .9 ) (0 .0 ) (0 .0 ) (0 .0 ) (2 4. 1) (0 .0 ) (2 4. 1) (3 .5 ) 10 0. 0 29 Fo ur th 9. 3 35 1 (3 3. 3) (6 .1 ) (3 .0 ) (0 .0 ) (3 .0 ) (3 0. 3) (3 .0 ) (2 1. 2) (0 .0 ) 10 0. 0 33 Ri ch es t 13 .8 33 6 (4 4. 7) (1 0. 6) (0 .0 ) (2 .1 ) (0 .0 ) (1 9. 1) (0 .0 ) (1 4. 9) (8 .5 ) 10 0. 0 46 Et h n ic it y of h ou se h ol d h ea d* K ha lk h 9. 7 1 26 3 33 .9 4. 0 1. 6 0. 8 0. 8 20 .2 2. 4 32 .3 4. 0 10 0. 0 12 2 O th er 10 .2 58 2 41 .7 10 .0 0. 0 0. 0 0. 0 13 .3 1. 7 23 .3 10 .0 10 0. 0 59 R el ig io n o f h ou se h ol d h ea d* * N o re lig io n 8 .7 1 05 9 33 .3 7. 5 1. 1 1. 1 1. 1 18 .3 1. 1 28 .0 8 .6 10 0. 0 92 Bu dd hi st 11 .1 70 8 40 .0 2. 5 1. 2 0. 0 0. 0 20 .0 3. 7 30 .0 2. 5 10 0. 0 79 O th er 13 .2 75 (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) (* ) 10 0. 0 10 To ta l 9. 9 1 8 50 36 .8 5. 9 1. 1 0. 5 0. 5 17 .8 2. 2 29 .2 5. 9 10 0. 0 18 3 * Fi ve a nd o ne c as es w ith m is si ng “ Et hn ic ity o f ho us eh ol d he ad ” no t sh ow n re sp ec tiv el y. ** E ig ht a nd t w o ca se s w ith m is si ng “ Re lig io n of h ou se ho ld h ea d” n ot s ho w n re sp ec tiv el y. ( ) Fi gu re s th at a re b as ed o n 25 -4 9 un w ei gh te d ca se s. (* ) Fi gu re s th at a re b as ed o n le ss t ha n 25 u nw ei gh te d ca se s. VII WAter And SAnItAtIon © UnICeF Mongolia/Jim Holmes/2007 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 100 VII. WAter And SAnItAtIon Safe drinking water is a basic necessity for good public health. Unsafe drinking water can be a significant carrier of pathogens of diseases such as trachoma, cholera and typhoid. Drinking water can also be tainted with chemical, physical and radiological contaminants with harmful effects on human health. In addition to its association with disease, access to drinking water may be particularly important for women and children, who bear the primary responsibility for carrying water, often from long distances, especially in rural areas. The MDG goal is to reduce by half, between 1990 and 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The World Fit for Children goal calls for a reduction in the proportion of households without access to hygienic sanitation facilities and affordable and safe drinking water by at least one- third. The list of indicators used in the “Child Development Survey - 2012” is as follows: Water: • Use of improved drinking water sources • Use of adequate water treatment method • Time to the source of drinking water • Person collecting drinking water Sanitation: • Use of improved sanitation facilities • Sanitary disposal of child’s faeces Use of improved water sources The distribution of the survey population by source of drinking water is shown in Table WS.1 and Figure WS.1. According to UNICEF and WHO definition, the population using improved sources of drinking water are those using any of the following types of supply: piped water (into dwelling, compound, yard or plot, public tap/ standpipe), tube well/ borehole, protected well, protected spring, and rain and snow water collection. Bottled water is considered as an improved water source only if the household is using an improved water source for other purposes, such as hand washing and cooking. In accordance with UNICEF and WHO definition, 40 percent of the population, covered by the survey, are using an improved source of drinking water and the use of an improved source of drinking water is lower in rural (22 percent) than in aimag and soum center (54 percent). The source of drinking water for the population varies strongly by locations (Table WS.1). In aimag center, 4 percent of the population uses drinking water that is piped into their dwelling or public water kiosks. The main source of drinking water for the population in aimag and soum centers is tube well or borehole (45 percent for aimag center and 47 percent for soum center), while the most important source of drinking water for population in rural is surface water (52 percent). 101 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VII. WAter And SAnItAtIon Note 1: Use of improved source of drinking water is estimated by taking the country’s specific characteristics into consideration in addition to the international standards. In Mongolia, the public water kiosks located in urban areas, water for which is transported by designated tanker-trucks, are regarded as an improved source of drinking water since hygienic procedures in the tanker-trucks and tanks in the kiosks are conducted on a regular basis. As a result, the use of improved sources of drinking water is estimated to be at 48 percent in the above-mentioned case. Table WS.1, Table WS.2 and Table WS.3A show the results based on country specific definition of improved water source. Figure WS.1: Percent distribution of household members by source of drinking water, Khuvsgul aimag, 2012 Use of in-house water treatment is presented in Table WS.2. Households who treat water at home to make it safer to drink by boiling, adding bleach or chlorine, using a water filter, and using solar disinfection are considered as the ones who use proper treatment of drinking water. The table shows water treatment by all households and the percentage of household members living in households using unimproved water sources but using appropriate water treatment methods. Of the population in households covered by the survey, 30 percent live in households using unimproved water sources but using appropriate water treatment methods. The amount of time it takes to obtain water is presented in Table WS.3 and the person who usually collects the water is shown in Table WS.4. Note that these results refer to one roundtrip from home to drinking water source and that information on the number of trips made in one day was not collected. KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” 102 VII. WAter And SAnItAtIon Table WS.3 shows that for 98 percent of the population, the drinking water source is located anywhere else than premises. For a majority of households (75 percent), it takes less than 30 minutes to get to the water source and bring water while 22 percent of the households spend 30 minutes or more for this purpose. As shown in the table, the households in rural spend more time in collecting water compared to those in aimag center and soum center. Table WS.4 shows that for the majority of households, an adult male (53 percent) is usually the person collecting the water, when the source of drinking water is not on the premises. 36 percent of female adults and 11 percent of female or male children under age 15 collect water. Use of improved sanitation Inadequate disposal of human excreta and personal hygiene is associated with a range of diseases including diarrhoeal diseases and polio. Improved sanitation can reduce diarrheal disease by more than third, and can significantly lessen the adverse health impacts of other disorders responsible for death and disease among millions of children in developing countries. An improved sanitation facility is defined as one that hygienically separates human excreta from human contact. According to the new definition by UNICEF and WHO, improved sanitation for excreta disposal include flush/ pour flush toilet to piped sewer system, septic tank, or pit latrine, ventilated improved pit latrine, pit latrine with slab, and use of a composting toilet. The data on the use of improved sanitation facilities in Khuvsgul aimag are provided in this report in Table WS.5. The MDG sanitation indicator excludes users of improved sanitation facilities which are shared between two or more households from having access to sanitation. Therefore, ‘use of improved sanitation’ is used both in the context of this report and as an MDG indicator to refer to improved sanitation facilities, which are not shared. Data on the use of improved sanitation are presented in Tables WS.6 and WS.8. In Table WS.5, the distribution of total population covered by the survey is shown by the sanitation facilities they use while Table WS.6 shows the use of shared sanitation (improved and non-improved). In Khuvsgul aimag, the pit latrine with slab is commonly used by the population (59 percent). While one in every five rural residents does not have any sanitation facility (21 percent), 3 percent of aimag center residents have flush toilets connected to piped sewer system, which clearly shows the existence of loacation disparities. The table illustrates a strong correlation between the use of sanitation and the household wealth, as well as the education of household head. In line with the international definition, 46 percent of total population in our aimag use improved sanitation facilities (Table WS.6). By location, 69 percent of aimag center population use improved sanitation, 72 percent of soum center population, while only 103 KHUVSGUL AIMAG “CHILd deVeLopMent SUrVey 2012” VII. WAter And SAnItAtIon 15 percent of rural population does the same. As the table shows, use of improved sanitation facilities has a strong association with the household wealth, as well as with the household location. Note 2: In order to compare the present findings with the previous surveys and to take the country specific characteristics into account, we estimated the use of improved sanitation regardless of sharing with other households. As a result, it is estimated that 83 percent of total population use improved sanitation. Although a pit latrine with slab is regarded as an improved sanitation, the pit latrines with slab in our country do not always meet the international standards. Therefore, we should not conclude that issues related to improved sanitation are resolved in our country and the majority of our people use improved sanitation (Table WS.8A). Majority of households, which use unimproved sanitation facilities do not share it with other households. 13 percent of households use improved sanitation and share the sanitation facilities with other households while the use of public sanitation is at 1 percent

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